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No iodinated compound other than Iopamidol was found in the urine of subjects who received intrathecal injection of 10 ml of Iopamiro "300". The compound was neither metabolized nor altered in its optical configuration and urinary iodide content was always in the normal range. Between 72 and 85% of injected Iopamidol was excreted within 72 h of injection.
With high resolution computed tomography (CT) of the skull, performing rapid series of 1.5 mm slices during an intravenous bolus injection of contrast medium, an angiography-like image (angio-CT) of the basal cerebral arteries can be obtained. From 76 consecutive angiographically or autopsy-verified cerebral aneurysms of various size down to 3 mm in diameter, 74 (97.4%) were shown up by the angio-CT. One ruptured and one incidental aneurysm escaped CT visualization. Besides the correct localization of the aneurysms, angio-CT provides information concerning the size and main direction of the aneurysms and yields, in addition, a coronal view of the aneurysms and their surrounding structures. Pitfalls for mis-diagnosis can be the following: Aneurysms of below 5 mm in diameter, located at the supraclinoid part of the carotid artery, multiple or non-ruptured aneurysms, bony or movement artefacts, poorly contrasted vessels due to wrong injection technique of contrast medium or vasospasm, and incorrect interpretation.
Intrathecal injection of a non-ionic contrast agent in the lumbar area of rabbits resulted in: (1) a rapid rise in blood iodine level with a maximum after 23-46 min; (2) low concentrations in cisterna magna during the observation period (24 h); and (3) complete or almost complete disappearance of visible contrast medium on the radiographs within 30 min. This indicates that after injection in the lumbar area of the rabbit most of the contrast medium absorption takes place from the lumbar area. Similar injections in cisterna magna showed the following: (1) a slow rise in blood level with a maximum after 150-275 min; (2) little or no disappeared of visible contrast medium on the radiographs within the first hour. This indicates that in the rabbit the absorption from the subarachnoid space of the spine takes place at different rates dependent on the level at which the injection has been made and the area of deposition of contrast medium.
Dependent layering of contrast enhanced fluid in cystic astrocytomas has not been described on computed tomograms. Two children in which this phenomenon occurred are described and its significance is discussed. In a third cystic lesion contrast layering was confirmed by head tilting.
An experimental method for testing contrast media for myelography was developed and used to compare three watersoluble contrast media, iocarmate meglumine, iothalamate meglumine and metrizamide after suboccipital myelography in 120 rabbits. A further 71 rabbits served as controls. Iocarmate and iothalamate caused vigorous convulsions; metrizamide did not. Examination of the CSF revealed an acute pleocytosis after installation of the contrast media and after cisternal puncture with injection of hypertonic saline. Histological examination of the spinal cord, nerve roots and meninges revealed pathological changes in 1 or 32 unoperatec controls (3%). Leucocyte infiltrations were found in the meninges, nerve roots and spinal cord of about 20% of the animals after myelography, after cisternal puncture without injection or with injection of hypertonic saline. There were no significant quantitative differences between the experimental groups. Degenerative changes were seen only after myelography. No meningeal fibrosis was demonstrated. An abnormal leucocyte count in the primary CSF influenced the incidence of histological changes, indicating that only rabbits with CSF cell counts within normal limits should be used in future experiments.
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A double-blind study was performed on 20 patients comparing the safety and efficacy of Iopamidol and Metrizamide in cervical myelography. The radiographic qualities of the Iopamidol and Metrizamide examinations were equivalent when using the same volume (12 to 13 ml), concentration (200 mg I/ml), and a C1-2 route of administration. The performance of a CT scan on selected patients in specified areas of interest provided additional diagnostic information in some patients (e.g syringomyelia, degenerative spondylosis). The adverse reactions were mild in the Iopamidol group with 4 of the 10 patients experiencing no adverse reactions. The more severe reactions, including disorientation, agitation, dysarthria, asterixis, hyperreflexia and EEG abnormalities were limited to the Metrizamide group with one or more occurring in 2 of the 10 patients studied. Only one Metrizamide patient experienced no adverse reactions. In this study containing a limited number of patients, Iopamidol was shown to be a diagnostically effective and safer contrast medium for performing cervical myelography.
A review of immediate and delayed side effects noted in a consecutive series of 1,138 myelograms made with Iopamidol in the Services of Neuroradiology of various hospitals and university clinics at Pavia, Perugia, Vicenza, and Parma (all in Italy). The contrast was administered by lumbar spinal route at iodine concentrations of 200, 300 and 370 mg/ml, in amounts varying from 5 to 20 ml depending on segments being examined and extant clinical indications. The incidence and characteristics of complications (headache, nausea, vomiting, evidence of radicular irritation, etc.) were assessed in relation to examination technics, segments of spine being explored, iodine concentrations, and amounts of contrast injected.
The side effects associated with the use of Iotrol were determined in 100 patients and compared with metrizamide and iopamidol in two double-blind studies. The relevance of the distribution of the contrast medium in the CSF space to the occurrence of headache is discussed. The low persistence of iotrol in the brain parenchyma is demonstrated on CT density profiles, compared with metrizamide and iopamidol. Iotrol seems to be the safest contrast substance for intrathecal use.
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The nonionic contrast agent iohexol was compared with the ionic agent iothalamate for contrast enhancement of brain tumors and radiation brain damage in dogs. Tissue enhancement during infusion of contrast and 5, 10, 15 and 30 min later was measured using quantitative computed tomography. Blood iodine was measured using x-ray fluorescence. Peak contrast enhancement occurred during infusion in tumors and after 5 min in irradiated normal brain for both contrast agents. Absolute uptake of contrast in each lesion was the same for both agents when normalized to total grams of iodine administered. Blood iodine levels were slightly but not significantly higher using iohexol. The reduced osmotic load and similar contrast enhancement of lesions suggest that the nonionic contrast medium iohexol may be a useful agent for routine CT of the brain.
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