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PubMed1977

Effect of radiation and contrast media on chromosomes. Preliminary report.

Measurements of chromosome aberrations or micronuclei in lymphocytes obtained from 7 patients indicate that angiocardiography produced chromosome damage corresponding to an average absorbed dose of about 50 rads. This is an order of magnitude larger than was estimated from the exposure rate. Experiments on lymphocytes suspended in solutions of methylglucamine and sodium diatrizoate (Renografin) or sodium diatrizoate alone (Hypaque) indicate that the chromosome damage observed in the patients is due in larger part to two effects: (a) an increased absorption of x rays as compared to blood and (b) a breakage of chromosomes even in the absence of x rays.

Adolescent↗
PubMed2001

Diagnostic accuracy of focused appendiceal CT in clinically equivocal cases of acute appendicitis.

PURPOSE: To determine the diagnostic accuracy of modified focused appendiceal computed tomography (CT) to exclude or confirm appendicitis in patients who presented with equivocal symptoms and signs of appendicitis. MATERIALS AND METHODS: One hundred patients (age range, 14-81 years; mean age, 30.6 years) with equivocal symptoms and signs of acute appendicitis were included in this prospective study. Patients were given 30 mL of diatrizoate meglumine and diatrizoate sodium and 60 mL of sorbitol mixed in 1 L of water orally over 1 hour. CT was performed 1.5 hours after the commencement of oral contrast material administration. The criteria used for the diagnosis of appendicitis were (a) appendix greater than 6 mm in maximum diameter, (b) no contrast material in the appendiceal lumen, and (c) inflammatory changes in the periappendiceal fat. CT results were compared with histopathologic findings at appendectomy. Patients with negative CT findings were followed up by telephone or clinically. RESULTS: Of 100 cases, 30 were positive at CT and 70 were negative. There were 28 true-positive cases; two false-positive cases, one cecal diverticulitis and one pelvic peritonitis with periappendicitis; and two false-negative cases, one perforated appendix and one mucosal and submucosal inflammation of the appendix but no transmural inflammation. Sensitivity was 93%, specificity was 97%, and accuracy was 96%. CONCLUSION: Focused appendiceal CT in which oral contrast material is used alone yields high levels of accuracy in clinically equivocal cases of acute appendicitis.

Acute Disease↗
PubMed1982

Neurotoxicity of iohexol: a new nonionic contrast medium.

The neurotoxicity of iohexol was evaluated and compared with the neurotoxicity of sodium diatrizoate, meglumine iothalamate, and metrizamide. Direct neurotoxicity was evaluated with in vitro rat hippocampal slices, and angiographic neurotoxicity was studied in a cat's spinal cord following thoracic aortography. In the experiments with the hippocampal slices, the ionic agents, sodium diatrizoate and meglumine iothalamate, and metrizamide caused early excitatory changes in electrical activity and later inhibition, but iohexol caused only inhibition. In the experiments with the cat's spinal cord, the ionic contrast materials produced an increase in the ventral root reflexes, and iohexol and metrizamide produced no significant effect. These results indicate that iohexol is less neurotoxic than metrizamide and the ionic contrast materials and may be a very useful angiographic and/or myelographic contrast agent.

Animals↗
PubMed1983

The effect of contrast media on immature renal function. Comparison of agents with high and low osmolality.

Contrast media having high osmolality (methylglucamine diatrizoate; 1,510 mOsm/kg) and low osmolality (triiodoisophthaldiamide, 616 mOsm/kg) were compared in 15 functionally immature rabbits 2-3 weeks of age. Renal function was assessed with a gamma camera and whole-body counter, using excretion of technetium-99m-tin-DTPA as an index of glomerular filtration rate. Both DTPA and the contrast agent (2 ml/kg) were injected as a single intravenous bolus in 15 seconds. After 40 minutes, per cent DTPA excreted was 33.0 +/- 2.3 for triiodoisophthaldiamide and 28.2 +/- 1.5 (p less than 0.01) for methylglucamine diatrizoate. Excretion of DTPA was reduced with the latter (p less than 0.005) but not the former agent (p greater than 0.6). Thus contrast materials with high osmolality depress renal function in immature rabbits, suggesting that agents with low osmolality are preferable for use in newborns.

Animals↗
PubMed1985

Shoulder arthrography: comparison of morbidity after use of various contrast media.

This prospective study compares immediate and delayed patient discomfort in 177 patients following shoulder arthrography using intraarticular combinations of metrizamide, meglumine/sodium diatrizoate, meglumine diatrizoate, lidocaine, epinephrine, and air. Patients receiving conventional ionic monomeric positive contrast media had a 60% (90/150) incidence of moderate or severe delayed exacerbation of their baseline symptoms; only 14% (3/21) of patients receiving metrizamide, a nonionic contrast medium, had similar levels of postprocedural discomfort. Morbidity was somewhat diminished with the use of double-contrast (45%, 34/75) rather than single-contrast (75%, 56/75) examinations, and with avoidance of sodium-containing contrast agents or epinephrine. Nonionic or monovalent polymeric contrast media, despite their present high cost, may be the agents of choice if single-contrast arthrography is performed in joints (such as the shoulder, hip, and temporomandibular) associated with a high incidence of post-procedural pain.

Air↗
PubMed1985

Iopamidol arteriography: discomfort and pain.

A double-blind, randomized study was performed to compare discomfort and pain associated with the use of iopamidol and Hypaque (diatrizoate sodium and diatrizoate meglumine) during iliofemoral runoff arteriography in 33 patients. Iopamidol caused substantially less discomfort and pain. The evaluation was helped by audiotaping the study and comparing patients' vocal responses to injections of these materials.

Aged↗
PubMed1986

Contrast medium precipitation during abdominal CT.

Abdominal computed tomography (CT) scans of 55 patients who had ingested Gastrografin (meglumine diatrizoate and diatrizoate sodium) diluted to 2% with tap water and flavored with a commercial fruit juice base were reviewed. Twenty patients (36%) demonstrated intraluminal precipitation of Gastrografin shown by focal areas of markedly increased attenuation within the gastric lumen or trapped within gastric folds. Beam-hardening artifact produced by precipitation was observed, which limited the diagnostic value of some examinations. In vitro CT scans of the same Gastrografin solution titrated with hydrochloric acid or sodium hydroxide showed that by raising the pH of the solution, precipitation was virtually eliminated. Fifty-one CT scans of the abdomen using a buffered Gastrografin solution demonstrated precipitation in only five patients. Properly buffered dilute oral Gastrografin solutions should significantly decrease the prevalence of precipitation during abdominal CT examinations.

Beverages↗
PubMed1987

High-dose clinical urography with the low-osmolality contrast agent Hexabrix: comparison with a conventional contrast agent.

A double-blind clinical trial was performed in 60 patients to compare Hexabrix (ioxaglate meglumine and ioxaglate sodium) and Renografin-60 (diatrizoate meglumine and diatrizoate sodium). Use of Hexabrix produced higher urinary iodine concentrations, lower urine volumes at 30 minutes, and excretory urograms significantly better in diagnostic quality, as rated by four independent observers. There was no difference in nephrogram quality between contrast agents. Patients receiving Hexabrix had less of an increase in heart rate and demonstrated a slight rise in mean arterial blood pressure, rather than the biphasic rise then fall seen with Renografin-60. There was no significant change for up to 96 hours after urography in results of hematology, clinical chemistry, or urinalysis, except for an increase of 0.005 in urine specific gravity with Renografin-60. Patients reported significantly less body heat, heat in the injection arm, and overall discomfort with Hexabrix. There was a similar amount of nausea and vomiting in the two groups. Hexabrix also caused histaminic-type reactions in three patients.

Adult↗
PubMed1981

Retrograde urography with a new antiseptic contrast contrast material. An experimental study.

A new antiseptic contrast material, composed of sodium diatrizoate-meglumine diatrizoate and PVP-iodine solution, was prepared and tested for retrograde cystography. It was tested in vitro and in dogs, showed satisfactory radiological features and rapid wide bactericidal action without detectable side effects. Septic complications following radiological demonstration of the urinary tract may be reduced.

Animals↗
PubMed1983

Pulmonary angiography with iopamidol and Renografin 76 in normal and pulmonary hypertensive dogs.

The cardiovascular response produced during pulmonary angiography performed with the standard ionic agent diatrizoate (Renografin 76) and a new non-ionic agent iopamidol was compared. Nine dogs were evaluated while ventilated on room air and on 10% O2 which significantly elevated pulmonary arterial pressure. Iopamidol produced similar changes in mean aortic and pulmonary arterial pressures compared with normal saline (less than 20% change). Renografin 76, however, produced a significantly greater elevation in mean pulmonary arterial pressure (a 41% increase) and depression in mean aortic pressure (a 40% reduction) than either saline or iopamidol (p less than 0.01). These results were similar for dogs being ventilated with room air and oxygen. The results indicate that iopamidol should be better tolerated and therefore a safer contrast agent for pulmonary angiography than diatrizoate.

Animals↗
PubMed1985

Comparative study of two iodinated contrast media containing 20% iodine in lower-limb phlebography: ioxaglate versus a conventional product.

Forty-eight patients were examined by bilateral ascending phlebography in a crossover, prospective, randomised, double-blind study. A low-osmolar agent (Hexabrix) (ioxaglate, 200 mg iodine/ml) and a dilute conventional contrast medium (Angiografin) (meglumine diatrizoate) with the same iodine concentration were used for each limb alternately. The adverse reactions and the quality of diagnostic data were recorded: the Student paired-t-test showed statistically that ioxaglate containing 200 mg iodine per ml was better tolerated and that diagnostic information was equally good for the deep and ilio-caval systems, but seemed better with diatrizoate for superficial veins with extensive varicosity. The authors conclude that ioxaglate 200 is advantageous overall in lower-limb phlebography from the standpoints of tolerance, diagnostic data and cost.

Adult↗
PubMed1985

Plasma histamine levels following administration of radiographic contrast media.

The effect of two conventional high-osmolality and two new low-osmolality contrast media on plasma histamine levels has been examined. The study population included 25 patients undergoing intravenous urography with Urovison 58% (sodium and meglumine diatrizoate), 24 patients receiving intravenous Hexabrix 320 (sodium and meglumine ioxaglate) for urography, 16 patients receiving intravenous Iopamiro 370 (iopamidol) for urography and 12 patients receiving Urografin 76% (sodium and meglumine diatrizoate) for coronary angiography. Seventy-four percent of the 77 patients studied suffered adverse reactions ranging from a feeling of warmth and nausea to laryngeal oedema and bronchospasm. Hexabrix 320 and Iopamiro 370 were associated with the least patient discomfort. All contrast agents usually produced a rise in plasma histamine following injection (Iopamiro 370 causing the least change) and the histamine levels then fell towards preinjection values over a space of about 10 minutes. No relationship was observed between the magnitude of the increase in histamine and the severity of the reaction that occurred. However, a relationship was suggested between the mean peak plasma histamine level achieved and the occurrence of a Grade II reaction (i.e., dry retching/vomiting, mild urticaria or rash). These findings raise the probability that histamine contributes to the more severe grades of reaction to radiographic contrast media.

Contrast Media↗
PubMed1990

Effects of ionic and nonionic contrast media on bradyarrhythmia during coronary angiography: a comparison of Renografin-76, Hypaque-76, and Isovue-370.

Contrast media occasionally produce bradyarrhythmias defined as a 25% decrease in heart rate and/or developing atrioventricular block during coronary angiography. Twelve left coronary angiographies and seven right coronary angiographies were performed with 10 ml of diatrizoate meglumine and diatrizoate sodium (Renografin-76 [R76] or Hypaque [H76]) or iopamidol (Isovue 370 [ISO]) in a blinded randomized fashion. Heart rate decreased significantly from 135 +/- 5 to 120 +/- 5 beats/min (p less than 0.001) with R76, to 127 +/- 7 beats/min (p less than 0.01) with H76, and to 130 +/- 6 beats/min (p less than 0.05) with ISO in left coronary angiographies; more profound decrease was observed in right coronary angiographies from 134 +/- 4 to 87 +/- 18 beats/min (p less than 0.001) with R76, to 99 +/- 14 beats/min (p less than 0.001) with H76, and to 125 +/- 7 beats/min (p less than 0.01) with ISO. In 12 left coronary angiographies bradyarrhythmia was observed in five cases with R76, two with H76, and none with ISO. In seven right coronary angiographies it occurred in six with R76, three with H76, and none with ISO. The differences in the incidence of bradyarrhythmia between R76 and ISO were significant during left and right coronary angiographies (p less than 0.05 and p less than 0.01, respectively). Thus ionic contrast media produced more marked bradyarrhythmias than nonionic contrast media in coronary angiography, especially R76. Right coronary angiography resulted in more profound bradyarrhythmias than left coronary angiographies. This study suggested that nonionic contrast media (ISO) might be preferable to ionic contrast media (R76 or H76) for coronary arteriography.

Angiography↗
PubMed1990

Intraoperative perfusion contrast echocardiography. Initial experience during coronary artery bypass grafting.

Intraoperative evaluation of the effectiveness of myocardial revascularization has been limited by an inability to assess regional myocardial perfusion. Microbubbles of sonicated diatrizoate sodium and diatrizoate meglumine (Renografin) have been an effective echocardiographic contrast agent and have been employed clinically during cardiac catheterization. This recent development in contrast-enhanced two-dimensional echocardiography permits real-time imaging of transmural myocardial blood flow but has not been evaluated in the operating room. This study represents the initial surgical application of this directed technique and was designed to evaluate the safety and efficacy of intraoperative perfusion contrast echocardiography in assessing the results of coronary artery bypass grafting. Twenty men with significant coronary artery disease ranging in age from 49 to 73 years were studied. Direct contrast agent injection into completed saphenous vein bypass grafts caused the myocardium supplied by each graft to be well delineated and provided a tomographic view of contrast distribution. The enhanced region was well correlated with the size and distribution of the native vessel. Rapid contrast washout (less than 20 seconds) indicated satisfactory regional perfusion. Contrast echocardiography prolonged the operation less than 10 minutes and did not result in any perioperative complications.

Aged↗
PubMed1985

Prostacyclin (PGI2) and thromboxane (TXA2) levels during intravenous contrast medium administration in CT.

Meglumine/sodium diatrizoate was administered as a one minute bolus of 60 ml. (60%) and subsequent 5 minute infusion of 250 ml. (24%) into antecubital veins during pelvic CT Scanning of 15 patients. Blood samples were taken from the opposite arm before and at 1 and 5 minutes after starting the contrast medium injection. The average plasma concentrations of diatrizoate were 2.2 +/- 0.5 and 3.8 +/- 0.8 mg./ml. in the 1 and 5 minute blood samples, respectively. The systemic levels of thromboxane A2 (TXA2) increased in 10 patient's plasma during contrast medium infusion while the level of prostacyclin (PGI2) remained unchanged. One patient had immediate adverse reaction due to contrast without any changes in PGI2 of TXA2 levels. Contrast medium infusion increased the systemic ratio of TXA2/PGI2 which may predispose to hemostatic disorders.

6-Ketoprostaglandin F1 alpha↗
PubMedDate not supplied

Intravenous digital subtraction angiography with iohexol.

Iohexol is a nonionic water-soluble iodinated contrast medium with chemical and physical properties similar to those of metrizamide. A randomized double-blind study was performed in 40 patients undergoing intravenous digital subtraction angiography for suspected carotid and vertebral disease to compare the radiographic imaging quality and side effects of iohexol with those of Renografin-76 (diatrizoate meglumine and diatrizoate sodium). The use of iohexol yielded a higher percentage of "excellent" images with a lesser incidence of image degradation due to swallowing and motion. Iohexol was also associated with milder and less frequent patient discomfort. No clinically significant changes in laboratory data parameters were observed with either contrast medium.

Adult↗
PubMedDate not supplied

Antiplatelet action of intravascular contrast media. Implications in diagnostic procedures.

The antiplatelet action of intravascular contrast media (CM) Renografin-76 (diatrizoate meglumine and diatrizoate sodium) was studied in vitro and in 21 patients undergoing radiodiagnostic procedures. In vitro studies suggested that in Renografin-76, meglumine was the chief constituent responsible for its antiplatelet action. In post-CM plasma from patients, clotting times were prolonged and platelet aggregation greatly impaired, albeit normal aggregation restored within 3 hours. Although changes in global clotting times and platelet aggregation were mostly transient, it is possible that CM usage in patients with thrombocytopenia, sickle cell phenomenon, and on anticoagulant-antiplatelet drugs may present a serious risk to their hemostatic integrity.

Adult↗
PubMedDate not supplied

Investigation of a new arthrographic contrast agent: Iotrol.

A new nonionic dimer (Iotrol; Schering AG) and diatrizoate meglumine-diatrizoate sodium (Renografin-60; Squibb) were compared as arthrographic agents by injecting these substances into the knees of rabbits. Three experienced arthrographers judged the image quality produced by Iotrol to be superior to that of Renografin-60. Following animal sacrifice, histologic examination of the synovium revealed a significant difference in the inflammatory response evoked by the contrast agents: Iotrol caused less inflammation. In a second group of rabbits, methylprednisolone was subcutaneously injected 24 hours before the arthrographic studies. The methylprednisolone significantly reduced the inflammation in the Renografin-60 subgroup when compared with the nonmedicated counterparts. No significant effect was noted in a like comparison with Iotrol. In addition, the administration of methylprednisolone led to a deterioration of the radiographic images. Based upon our data, we believe Iotrol is superior to Renografin-60 as an arthrographic agent.

Animals↗