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PubMed1980

Reduction of venous thrombosis complicating phlebography.

Patients who underwent radiographic phlebography were studied to determine the frequency of postphlebographic venous thrombosis. In a group of 23 patients who had negative phlebograms performed with standard contrast agent (60% sodium methylglucamine diatrizoate), nine had positive 125I-fibrinogen leg scans. On repeat phlebography, three had confirmed deep vein thrombosis, six overall developed deep or superficial thrombosis, and three had positive scans without demonstrable thrombi. In a second group of 34 patients studied with the contrast material diluted to 45%, only three developed positive scans, one due to deep venous thrombosis and two to superficial thrombosis. There was also a reduction in the incidence of postphlebographic symptoms of pain, tenderness, and erythema, but no apparent sacrifice in diagnostic accuracy.

Diatrizoate↗
PubMed1983

Intravenous vs. left ventricular injection of ionic contrast material: hemodynamic implications for digital subtraction angiography.

Because of the increased use of intravenous injection of contrast material for the evaluation of cardiac structure and function by digital subtraction techniques, a study was done to assess the hemodynamic effects of contrast material when used in this fashion in man. In 10 patients, with each serving as his own control, the effects of intravenous and intraventricular injections of sodium meglumine diatrizoate (Renografin 76) in the same dose were compared. There was no difference between these two methods with respect to changes in pulmonary wedge pressures, systemic pressures, and pulmonary vascular resistance. The elevation of mean pulmonary artery and right atrial pressure was greater after the intraventricular injection (p less than 0.05). The elevated cardiac output and systemic vascular resistance returned to control values somewhat more quickly after the intravenous injection (p less than 0.001 and p less than 0.05, respectively); and the increase in cardiac output was greater after the intravenous injection at 1 min (p less than 0.05), but less than after the intraventricular injection at 2 min (p less than 0.05). Despite the detection of these statistically significant differences, the magnitude and timing of these differences are too small to justify the notion that imaging by intravenous injections of standard ionic contrast media provides any substantial hemodynamic benefits or decreased risk to the patient.

Aged↗
PubMed1986

Renografin-60 for urography: effect on serum electrolytes and proteins in adults.

A prospective study was done on 27 adults to assess the changes in serum electrolytes and proteins induced by bolus administration of 100 ml of the ionic contrast medium diatrizoate meglumine and sodium (Renografin-60) for IV urography. Statistically significant changes in serum sodium, chloride, potassium, calcium, bicarbonate, phosphate, total proteins, and albumin were shown at 5 min postinjection. The mean percentage decreases were sodium 2%, chloride 2%, potassium 9%, calcium 13%, bicarbonate 9%, phosphate 10%, and proteins 15%. A mean 3% increase in serum osmolality was observed. By 30 min, sodium and chloride levels had returned to baseline; potassium, calcium, and albumin values were incompletely recovered; bicarbonate was not significantly changed from 5 min; and phosphate values continued to decrease. An in vitro dialysis experiment in which different volumes of Renografin-60 were dialysed against an electrolyte solution (pseudoserum) produced a dilutional factor of 5 to render a given volume of the contrast isoosmotic with plasma. The observed changes from the baseline values of the electrolytes and proteins up to 10% are therefore assumed to be due to hemodilution resulting from movement of fluid from the extravascular to the intravascular compartment. This study confirms alterations in serum levels of several electrolytes after the use of ionic contrast media beyond simple hemodilution. Although these changes appear not to be clinically significant in this investigation, the alterations in potassium and calcium may contribute to arrhythmias, particularly when hypokalemia or hypocalcemia preexists.

Adolescent↗
PubMed1997

The SHR as a small animal model for radiocontrast renal failure. Relation of nephrotoxicity to animal's age, gender, strain, and dose of radiocontrast.

The male spontaneously hypertensive rat (SHR), as it ages, suffers many of the renal and cardiovascular complications that are recognized in humans as risk factors for radiocontrast (RC) agent induced renal failure (RF). Knowledge of this led us to test this strain of rats as a small animal model for RC-induced renal failure (RC-RF). Functional studies demonstrated a significant fall in GFR in the recovery period after RC administration. In addition, histopathologic evaluation of the kidneys was done in this study. Our results are based on assigning separate scale values to the histopathological evaluation of the (a) glomeruli, (b) tubules, (c) interstitium, and (d) arteries and arterioles of the kidneys. Saline (S) was administered to one group and the RC agent Hypaque-76 (diatrizoate meglumine sodium) to paired groups of 5-, 8-, 10-, 12-, and 14-month-old male SHR. The results indicated that younger animals (5 and 8 months old) were resistant to the nephrotoxic effects of the RC, but developed susceptibility at 10 months of age, when spontaneous renal pathology became manifest. Both spontaneous renal pathology and RC-induced renal damage (RC-RD) increased as the animals aged. In addition, when the administered dose of RC was repeated after a short interval of only 6 h, the degree of RC-RD increased greatly. In parallel control studies of the influence of gender and strain on the response to RC in 12-month-old rats, neither hypertensive female SHR nor male normotensive Wistar-Kyoto (WKY) rats demonstrated significant spontaneous renal pathology or the marked susceptibility to RC nephrotoxicity shown by their male SHR counterparts. This small animal model for RC-RD, the mature male SHR, has the distinct advantage that risk factors for RC-RD, similar to those characterized in humans for RC-RF, develop spontaneously without requiring any special treatment or surgical intervention.

Age Factors↗
PubMedDate not supplied

[Cardiac complications of intravenous digital angiography. Comparison of ionic and nonionic contrast media].

The review of 1405 digital intravenous subtraction angiographies carried out in the period may 1982-february 1985 showed in about 2% of the cases cardiac symptoms, which arose during or after the examination. In the great majority of the cases the symptomatology was characterized by angina pectoris. In order to better understand these data and analysing the results of the literature, a trial has been performed in 100 patients who underwent DSA. They have been divided into two groups in which two different contrast media, ionic (sodium meglumine diatrizoate) and non ionic (iopamidol) have been randomly injected. A detailed cardiologic anamnesis has been collected and EKG has been performed before and after each injection with pre-established gaps. The results showed that the incidence of cardiac symptoms and EKG variations is lesser with the non ionic contrast medium: therefore this agent is to be preferred at least in patients at risk from cardiologic point of view.

Acute Disease↗
PubMedDate not supplied

Sequential changes in the CT numbers of the normal canine kidney following intravenous contrast administration. II: The renal medulla.

Following the intravenous administration of sodium and meglumine salts of both diatrizoate and iothalamate (at doses of 310-880 mg I/kg body weight) sequential changes in computed tomographic (CT) numbers of the inner medulla were determined in three dogs, using a 30-second CT scanner. Peak medullary enhancement was greater than, and usually occurred 1-2 minutes after, peak cortical enhancement. The CT number of the medulla increased linearly with increasingly large doses of the contrast agent. At peak enhancement, the meglumine salts produced a significantly lower (p less than 0.025) mean CT attenuation value of the medulla than did the sodium salts. The difference in mean attenuation values between the sodium salts and meglumine salts was maximum (50-60 HU)at peak enhancement. Our data indicate the known difference in renal handling of the meglumine and sodium salts is readily detectable by CT.

Animals↗
PubMed1979

Use of metrizamide in coronary arteriography.

In the investigation of the arteriae coronariae by means of angiography, a comparative study has been done of two contrast media in the same patients, by injecting these media in a randomized order. The contrast media are sodium methylglucamine diatrizoate (10:66) and metrizamide, both used in a concentration of 370 mg I/ml. The reaction of the heart was registered in different ways with which also the influence on the blood pressure was measured. The quality of the films was judged by persons who were not acquainted with the sequence of the injections.

Adult↗
PubMedDate not supplied

Effects of low osmolality contrast materials on coronary hemodynamics, myocardial function, and coronary sinus osmolality in normal and ischemic states.

The effects of intracoronary administration of contrast materials on regional and global left ventricular (LV) function and coronary sinus osmolality were assessed in six anesthetized dogs with segmental myocardial ischemia produced by critical stenosis of the circumflex coronary artery. Effects caused by Renografin (sodium meglumine diatrizoate), two new low osmolality contrast agents (Hexabrix and Hexabrix with added calcium ions), and metrizamide were evaluated. In a nonischemic state, Renografin produced an early (0-10 seconds) decrease in LV contractility followed by a late (10-20 seconds) rebound augmentation in contractility. In the presence of regional ischemia, there are prolongation of the depression of the myocardial contractile state. The monoacid dimer, Hexabrix, demonstrated a similar biphasic response, although the initial depression of myocardial contractility was significantly less than that observed with Renografin. Hexabrix with added calcium ions and metrizamide produced only augmentation in global and regional parameters of LV contractile function. This lack of depressant effects was also observed in the ischemic state. Renografin caused a significantly greater increase in coronary sinus osmolality (Tp) as compared with Hexabrix, Hexabrix-Ca++, and metrizamide. The increases in osmolality in response to the latter three contrast agents were statistically indistinguishable.

Animals↗
PubMed1981

[Renal tubular damage after rapid intravenous contrast study with iopamidol].

Reference is made to results obtained in 53 nephropathics in the study of urinary elimination of alphaglycosidase and lysozyme before and after rapid contrastography with sodium and meglumine diatrizoate and with iopamidol. A statistically significant difference in alphaglycosidase was evident with both media, whereas no change was noted for lysozyme. As far as the evaluation of alphaglycosidase was concerned, the tubular alteration induced by each medium was the same in terms of statistical comparison of the mean differences before and after urography.

Contrast Media↗
PubMedDate not supplied

[Comparison between ionic and non ionic contrast media in fast injection nephro-urography (author's transl)].

The authors judged the quality of the films in two groups of patients who underwent fast injection nephro-urography with iopamidol and meglumine sodium diatrizoate. The scores ascribed to the urograms obtained with the two contrast media have been compared. The ionic contrast medium got a higher score, at it allowed a better evaluation of ureters and bladder. Tolerability of the two contrast media has been evaluated.

Adult↗
PubMed1980

Pharmacokinetics of contrast media: experimental results in dog and man with CT implications.

The pharmacokinetics of contrast media such as sodium iocarmate, sodium ioxithalamate, metrizamide, sodium/meglumine diatrizoate, and sodium ioxaglate (a recently introduced medium: a hexaiodinated monoacid dimer) was compared in 25 dogs. A biphasic phenomenon was observed due to the rapid diffusion of contrast media from plasma into tissue (interstitium) followed by slow urinary excretion. A bicompartmental analysis was performed in dogs for each agent, showing that the tissue distribution of ioxithalamate is higher than that of other media. Sodium/meglumine ioxithalamate, sodium iocarmate, and sodium/meglumine ioxaglate were also compared in 20 human subjects. The diffusion and excretion phases observed in man appear to be slower than in the dog. Significant variations of iodine plasma concentration from one patient to another were recorded for the same medium and at the same interval after injection. Significant differences were observed between ioxithalamate and iocarmate or ioxaglate plasma concentrations due to the greater tissue diffusibility of ioxithalamate. The mechanisms affecting contrast media diffusibility are discussed: osmolarity, liposolubility, protein binding, and molecular size. Variations in contrast medium concentration in plasma noted in different patients with the same medium are explained by variations in tissue distribution, contrast medium volume, patient age, and patient hydration. Some computed tomographic (CT) implications of these pharmacokinetic studies are discussed. The need for highly diffusible media in routine CT and for less diffusible media in CT angiography is emphasized.

Adult↗
PubMed1996

Contrast-induced encephalopathy and seizures in a patient with chronic renal insufficiency.

Radiographic contrast agents are associated with a number of adverse effects, including central nervous system effects and seizures. Almost all contrast agents are primarily filtered and excreted by the kidneys, and they accumulate in patients with end-stage renal disease. Brain retention of contrast associated with high doses is a rare event, having been reported only twice in the literature. We report a case of a 49-year-old male on chronic hemodialysis who developed brain retention of contrast resulting in seizures and encephalopathy after receiving large doses of meglumine/sodium diatrizoate during coronary angiography. He was treated successfully with hemodialysis and suffered no permanent neurologic sequelae. Patients with end-stage renal disease may be at increased risk of adverse effects from contrast when administered in high doses.

Brain Diseases↗
PubMed1984

Obliteration of the gallbladder without formal cholecystectomy. A feasibility study.

Obliteration of the gallbladder without formal cholecystectomy was attempted in 36 rabbits, using an open technique for cannulation of the gallbladder during laparotomy. The gallbladder was cannulated, the proximal cystic duct was occluded with cyanoacrylate-nitrocellulose 2% wt/wt, and the gallbladder mucosa was exposed to various sclerosing agents to induce fibrosis. Heated 60% diatrizoate meglumine and absolute alcohol induced a controllable chronic cholecystitis with transmural fibrosis within two weeks, a result not seen with morrhuate sodium or in the control groups. All animals survived without complications, and no instances of common bile duct damage or occlusion was noted. The results reported are promising and indicate the need for further studies of this technique for its efficacy and safety.

Animals↗
PubMedDate not supplied

Influence of the viscosity of iodixanol on medullary and cortical blood flow in the rat kidney: a potential cause of Nephrotoxicity.

The aim of the present study was to investigate the effects of four iodinated contrast media on cortical, inner medullary and outer medullary blood flow in the rat kidney by using laser-Doppler flowmetry. The high-osmolar contrast medium diatrizoate did not significantly modify medullary perfusion but moderately decreased the cortical blood flow when injected at a dose of 1600 mg iodine kg(-1). Similar effects were obtained with the low-osmolar contrast media ioxaglate and iobitridol. In contrast, the new iso-osmolar contrast medium iodixanol induced a dose-dependent reduction of perfusion in all regions tested. This effect was accompanied by concomitant hypotension. The reduction of inner medullary and cortical blood flow induced by iodixanol was partially alleviated by heating the solution prior to injection and subsequently reducing its viscosity. In the outer medulla, however, this procedure did not improve blood flow. These results suggest that lowering the viscosity may palliate the harmful effects of iodixanol on the inner medulla and cortex, but may not protect the outer medulla from hypoxic injury.

Animals↗
PubMed2000

Reversibility of experimental acute renal failure in rats: assessment with USPIO-enhanced MR imaging.

The purpose of this study was to evaluate the potential reversibility of kidney lesions in an experimental model of acute renal failure using ultra-small particles of iron oxide (USPIO)-enhanced magnetic resonance (MR) imaging. This study was conducted in 21 uninephrectomized rats using a model of iodinated contrast media-induced renal failure. Thirteen rats received selective intraarterial renal administration of diatrizoate (370 mg/ml) and were compared with two control groups, including six animals injected with saline and two noninjected animals. MR imaging was performed 28 hours, 8 days, and 22 days after the procedure. Each MR session included axial and coronal T1- and coronal T2-weighted images before and after intravenous administration of 60 micromol Fe/kg of USPIO. The rats were sacrificed immediately after the last MR session for pathologic evaluation. MR images were qualitatively and quantitatively interpreted with respect to pathologic data, and differences were statistically studied. At day 22, histology showed 4 severely diseased kidneys with focal areas of necrosis, 5 mildly diseased kidneys with tubular vacuolization, and 12 normal kidneys. On quantitative data, a high correlation between the percentage of negative enhancement and histologic data was observed (P < 0.05). Qualitative interpretation showed a sensitivity and specificity of USPIO-enhanced T2-weighted MR images of 88% and 91%, respectively. Follow-up enhancement curves showed a constant increase of intrarenal USPIO negative enhancement in normal kidneys between day 1 and day 22, whereas all severely involved kidneys displayed higher USPIO negative enhancement at day 1 without significant changes over time until day 22. USPIO may be useful for in vivo follow-up of the reversibility of experimentally induced iodinated contrast media renal impairment in animals.

Acute Kidney Injury↗
PubMed1994

Comparison of a low osmolarity nonionic radiographic contrast agent with a standard medium on renal function in cyanotic and normal dogs.

Renal dysfunction may follow administration of iodinated radiographic contrast agents. This complication may be less common when low osmolarity nonionic agents are used. Although potential benefits from the use of low osmolarity nonionic contrast may be minimal in individuals with normal physiology, a greater benefit has been postulated in the presence of chronic cyanosis. To test this hypothesis, six adult mongrel dogs underwent anastomosis of the inferior vena cava to the left atrium. This produced chronic cyanosis with a mean pO2 of 48 +/- 4 mm Hg and polycythemia with a mean hematocrit of 56 +/- 2 gm%. Three to 5 months after preparation, these cyanotic dogs and five control dogs each received diatrizoate (a high osmolarity ionic agent) or ioversol (a low osmolarity nonionic agent), 465 mg iodine/kg body weight, by intravenous bolus injection. One month later, each animal received the other agent. The order of administration was randomized. Renal function studies, including serum creatinine and creatinine clearance, were performed precontrast, after 60 min, and 24 hr postcontrast. Neither agent adversely affected renal function in either the cyanotic or the normal group. We conclude that at the doses that are commonly used in clinical practice, high osmolarity ionic contrast agents do not create a greater risk of renal injury than do low osmolarity nonionic agents in this model of cyanosis.

Angiocardiography↗
PubMed1994

Comparison of hemodynamic and Doppler echocardiographic effects of a new low osmolar nonionic and a standard ionic contrast agent after left ventriculography.

The hemodynamic effects of a new nonionic low osmolar contrast agent (iomeprol) during left ventriculography (LC) was compared with a standard ionic contrast agent (meglumine diatrizoate) in a randomized double blind study in 30 patients with suspected coronary artery disease and normal systolic ventricular function. LV diastolic function was assessed by Doppler echocardiographic recording of the transmittal filling curve and by intraventricular tip-manometry before and within 30 sec of the LC. In the group receiving the ionic contrast agent the systolic pressure fell from 126 +/- 23 to 111 +/- 18 mmHg (P < 0.05), and heart rate increased from 64 +/- 9 to 71 +/- 11 min-1 (P < 0.05), while no such effects were observed with the nonionic contrast agent, indicating differences in the vasodilator properties. The latter caused an increase of the peak early Doppler velocity (52 +/- 11 to 62 +/- 14 cm/sec; P < 0.05). After the ionic contrast agent, the effect on the peak early Doppler velocity was less pronounced, probably due to an interaction with the known depressant effect of the increase in heart rate on the early Doppler velocity. In both groups the left ventricular end diastolic pressure was increased from 7 +/- 3 to 10 +/- 4 mmHg. No significant effects on peak-dp/dt and dp/dt were observed in either group. The nonionic contrast agent iomeprol had no significant effect on systolic arterial pressure and heart rate in contrast to the ionic contrast agent, probably due to a less pronounced vasodilator effect. Despite these differences of the global hemodynamic response, there were similar effects of both contrast agents on LV diastolic filling.

Adolescent↗
PubMed1980

Deiodination kinetics of water-soluble radiopaques.

Deiodination of diatrizoic acid, an anionic radiopaque, was found to be catalyzed by Cu(II). Through a detailed study of o-iodobenzoic acid, a model compound, the copper-catalyzed SN1 mechanism was established based on observations of common ion, salt, and pH effects. Meta- and para-iodobenzoic acids were unreactive. Deiodination thus was facilitated by a neighboring carboxylate that attracted copper. Iopamidol, a nonionic radiopaque, also underwent deiodination. At pH 7 or above, the hydroxide-ion substitution predominated. At pH below 7, the reaction is in favor of the copper-catalyzed SN1 mechanism.

Contrast Media↗