Positive contrast ventriculography with Dimer X in hydrocephalus.
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Adipates↗
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Computerised axial tomography and the diagnosis of glioma: a study of 100 consecutive histologically proven cases.
The reliability of computerised axial tomography (CAT) in the recognition of intracranial lesions is now accepted. Apart from ventricular displacement, compression or distension, abnormal patterns in the area of a lesion may be shown on the oscilloscope display and the corresponding polaroid film, and these may show additional enhancement patterns after the intravenous injection of a contrast medium. In an attempt to assess the changes shown with gliomas, both before and after contrast enhancement, and the possible relationship to the type of glioma present, and analysis has been made of 100 consecutive histologically proven cases. Other lesions occurring during the same period as the study, and giving a similar display, are illustrated and the differential diagnosis discussed.
Arteriovenous Malformations↗
Double contrast knee arthrography. Some new points of technique including the use of Dimer X.
A short review of the development of techniques in knee arthrography is given, together with a full account of the author's technique, including the use of a specially designed pad and a frame to facilitate radiography and a new method to demonstrate the cruciate ligaments. Side effects in a group of patients examined using Dimer X as the positive contrast medium are compared with those in a group of patients who were examined using Urografin 60%. Comparason of the radiological advantages of Dimer X examinations with Urografin 60% examinations has been made. A possible method to distinguish normal from damaged or degenerate tissues is suggested. The author concludes that Dimer X is the positive contrast medium of choice at the present time.
Humans↗
Clinical cardiovascular experiences with iopamidol: a new non-ionic contrast medium.
Iopamidol, a new non-ionic water-soluble contrast medium, has been compared with standard ionic media in a number of cardiovascular applications. It is stable in aqueous solution, is much less viscous and only slightly more osmolar than metrizamide. Compared to sodium meglumine diatrizoate in a series of 40 coronary arteriograms, it produced a consistent and highly significant decrease in the incidence and severity of hypotension and bradycardia following intracoronary injection. In the same group and in 62 children undergoing ventricular or great vessel angiocardiography, a subjective assessment of patient reaction showed that iopamidol was better tolerated than the ionic medium. There was a very strong patient preference for iopamidol in a group of 20 of the adult patients who had also consented to femoral artery injections of both media. Throughout these series there was no detectable difference in arterial image quality between the media. Venous phase opacification during arterioportography was assessed in 11 cases comparing iopamidol with sodium meglumine iothalamate. No significant difference was found. We conclude that iopamidol is clearly preferable to ionic media for routine cardiovascular applications.
Angiocardiography↗
Comparison between iodamide and iothalamate in intravenous urography.
A number of iodinated contrast media such as Iothalamate, whose excretion depends on glomerular filtration are well established for use in intravenous urography. Iodamide, a relatively new iodinated contrast medium, is thought to be actively secreted by the tubules in addition to glomerular filtration. We set out to compare the nephrogram and pyelogram using these two types of contrast medium, injecting each either slowly or rapidly. Only patients with normal plasma urea and creatinine concentrations were included in the assessment. The results, although inconclusive, suggest that the quality of the nephrogram and pyelogram is better with Iodamide than with Iothalamate.
Humans↗
An assessment of iopamidol, a non-ionic contrast medium, in aorto-femoral angiography.
Iopamidol, a recently developed non-ionic contrast medium, was used for aorta-femoral angiography in a concentration of 370 mg of iodine/ml. The injection of 35-40 ml was painless in most cases and was never severe. A sensation of heat in the legs accompanied all injections. A fall in systolic and diastolic blood pressure and an increase in heart rate occurred, these effects being greater than with metrizamide. The image quality was satisfactory. Iopamidol is well tolerated and preferable to conventional hyperosmolar contrast media in aorto-femoral angiography.
Aorta↗
The new low-osmolar contrast media: a simple guide.
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Chemical Phenomena↗
Contrast media and bronchospasm: a study with iopamidol.
Conventional radiological contrast media given intravenously are known to produce bronchospasm in the majority of patients, even though this is rarely clinically apparent. We have found that this phenomenon is much less pronounced with the new, low-osmolality contrast medium iopamidol. If the mechanism underlying the clinically silent bronchospasm observed with the conventional media is the same as that underlying the occasional life-threatening or fatal bronchospasm, then this observation is of considerable importance.
Bronchial Spasm↗
Comparative study of the sodium salts of iodamide and iothalamate in clinical urography.
In a comparative urographic study of the sodium salts of iodamide (Uromiro 300 Sodium) and iothalamate (Conray 420) the following conclusions have been made. (i) In subjects with radiologically normal kidneys and a creatinine clearance greater than 70 ml/min, nephrogram scores were significantly higher with iodamide (P less than 0.02). There were differences between the media in respect of total urogram scores and pyelogram scores but they were not statistically significant. (ii) In patients with radiologically normal kidneys and a spectrum of normal and abnormal renal function, performance scores for iothalamate showed no significant relationship with creatinine clearance. Results for iodamide, however, showed some relationship with creatinine clearance (nephrogram score r = 0.46, pyelogram score r = 0.38, total urogram score r = 0.49). A possible mechanism for this is proposed. (iii) Side-effects encountered in the study were mild and there were no significant differences between the contrast media in either the incidence or severity of the side-effects. (iv) Blood-pressure and pulse-rate profiles following iodamide were not significantly different from those following iothalamate. (v) Cardiac arrhythmias were mild and uncommon.
Adult↗
Femoral artery flow and pain during lumbar aortography: comparison of ionic and non-ionic contrast media.
A method is described for non-invasively measuring the increase in lower limb blood flow during transfemoral lumbar aortography. Flow measurements were made using a continuous wave Doppler-shift ultrasound transducer placed over the contralateral femoral artery. The effect of the non-ionic contrast medium B15000 (Iopamidol), conventional contrast medium (Urografin 370) and Urografin 370 plus Lignocaine were compared in a double-blind trial. All three produced an increase in flow which reached a peak between 12 and 45 s after injection. The peak flow following Iopamidol was significantly lower than that from both Urografin 370 alone and with addition of Lignocaine. There was a difference of lesser degree between Urografin 370 plus Lignocaine and Urografin 370 alone; however, this was not statistically significant. The subjective assessments of pain and patient 'discomfort' paralleled these objective flow measurements.
Aged↗
A comparative study of two non-ionic contrast media, iopamidol and metrizamide, in translumbar aortography.
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Aortography↗
Water-soluble contrast medium in the localisation of cord and dural stab wounds.
Two cases are reported of dorsal stab wounds involving the spinal cord. In both cases the site of the dural tear and cord damage were accurately localised by supine screening with water-soluble contrast medium.
Adult↗
Radiculography with non-ionic contrast medium: routine bed rest is unnecessary.
In a prospective study into the occurrence of side-effects, 200 patients who had undergone iopamidol radiculography were randomly allocated into two groups, one being confined to bed for 24 h and the other allowed to be fully ambulant. We found that the incidence of side-effects was not increased by allowing the patients to remain ambulant and that headache and dizziness were significantly less frequent than in a comparable study in which we had used metrizamide.
Bed Rest↗
Digital subtraction imaging in cardiac investigations.
The role of digital subtraction imaging (DSI) in the investigation of heart disease in patients of all ages, including neonates, was evaluated by the addition of a continuous fluoroscopy system to an existing, single-plane catheterisation laboratory. In some situations, DSI provided diagnostic images where conventional radiography could not and, in general, provided images of comparable quality to cineangiography. The total dose of contrast medium was usually less than that which would have been required for biplane cineangiography and the dose of radiation was always less. Digital subtraction imaging can make a significant contribution to the investigation of congenital heart disease and has some useful features in the study of acquired heart disease.
Adult↗
Intravenous urography with low-osmolality contrast agents: theoretical considerations and clinical findings.
There are theoretical reasons for expecting some aspects of image quality in intravenous urography to be modified when low-osmolality, rather than conventional, contrast agents are used. The clinical findings in urography using two of these, the non-ionic agents iohexol (Omnipaque 350, Nyegaard) and iopamidol (Niopam 370, Bracco/Merck), are compared with those using sodium iothalamate (Conray 420, May & Baker Ltd), and are discussed against this theoretical background. The best nephrogram obtained with the new agents often occurred later than with the conventional agent, but quantitative differences in its density were explicable on a total iodine dose basis. The pyelographic density obtained with the new agents was significantly greater than with the conventional agent without any evidence, when abdominal compression was used, of the predicted associated poor distension of the collecting system.
Contrast Media↗
Visual evoked response changes following intrathecal injection of water-soluble contrast media: a possible method of assessing neurotoxicity and a comparison of metrizamide and iopamidol.
An investigation was carried out to ascertain if there was a change in visual evoked responses following the intrathecal injection of water-soluble contrast media for myeloradiculography and if this change provided an indication of neurotoxicity as assessed by the onset of headache during a period of 20 h following the radiological examination. The patients were unselected and examined, when facilities for measuring the visual evoked response were available, immediately before and at 1 and 20 h after the examination. Control readings were carried out before, 1 h and 20 h after lumbar puncture in patients who did not have an injection of contrast medium. The first 25 patients in the series received metrizamide; when iopamidol became available a change to the newer medium was made and iopamidol was used on all subsequent patients. All the injections were carried out by the same radiologist and the patients were kept in hospital overnight and interviewed the next morning, avoiding a specific reference to headache unless the patient denied all symptoms. It was found that the latency of the visual evoked response was affected in some cases by the presence of contrast medium in the cerebrospinal fluid and that there was a correlation between the severity of headaches and the delay in the visual evoked response at the 20 h post-myelogram measurement, but not at 1 h after the examination. It would appear, therefore, that the visual evoked response measurement is a valid method of assessing, in the short term, the neurotoxicity of intrathecal water-soluble contrast media and that, on this evidence, iopamidol is less neurotoxic than metrizamide. We are not aware of any long-term complications resulting from the use of either contrast medium.
Contrast Media↗
Bronchospasm following intravenous injection of ionic and non-ionic low-osmolality contrast media.
Eighty patients were given either intravenous Hexabrix 320 or Niopam 300 for urography, and any bronchospastic effect was assessed by measurement of forced expiratory volume in 1 s (FEV1). No significant difference between pre- and post-injection FEV1 was shown with either contrast medium. Minor side-effects were comparable, the only significant difference between the two being the higher incidence of nausea and vomiting with Hexabrix 320.
Adult↗
Comparison of the side-effects of low-osmolar contrast media in intravenous urography.
The subjective side-effects of almost equivalent intravenous iodine doses of the three new low-osmolar contrast media, ioxaglate (Hexabrix), iopamidol (Niopam) and iohexol (Omnipaque) have been recorded and are found to be generally comparable. Urticaria occurred more frequently with ioxaglate than with the other contrast media and there was a tendency for ioxaglate to cause more nausea. Pain at the injection site occurred less often with ioxaglate than with iohexol. If low-osmolar contrast media are to be used in intravenous urography the relative cost of each is important, there being as yet insufficient data concerning the relative incidences of major reactions.
Contrast Media↗