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PubMed1984

Iopamidol: new, nonionic contrast agent for excretory urography.

Iopamidol, a new, nonionic contrast agent, was evaluated in 18 patients undergoing excretory urography. None of the 18 patients experienced any side effects or adverse reactions. No abnormalities were noted in serum chemistries, complete blood cell counts, urinalyses, or electrocardiograms. The half-life of iopamidol in 17 patients with normal renal function was 2.5 hr. The urograms were judged to be of good or excellent quality in 15 of 16 patients using doses of 200 and 250 mg l/kg of iopamidol. Two patients who were studied using a dose of only 120 mg l/kg had urograms rated poor. Fifteen iopamidol urograms (mean iodine dose, 17.4 g) were compared in a blind fashion with 15 meglumine diatrizoate studies (iodine dose, 29 g). No qualitative difference could be detected between the two groups of urograms. Iopamidol may provide equal-quality diagnostic studies with a lower iodine dose and perhaps greater safety than the currently used ionic agents.

Adult↗
PubMed1984

Renal toxicity of contrast agents: iopamidol, iothalamate, and diatrizoate.

As part of a general safety study of iopamidol, a nonionic iodinated contrast agent, urine N-acetyl-beta-glucosaminidase enzyme assays were done to compare the renal toxicity of iopamidol with that of iothalamate and diatrizoate. In a randomized study of 30 patients for computed body tomography and another 30 patients for angiography, 10 in each group were injected with iopamidol, 10 with iothalamate, and 10 with diatrizoate. After computed tomography or angiography with the three agents, there was no significant difference in urinary enzyme levels among the groups. The nephrotoxicity of iopamidol appears equivalent to that of diatrizoate and iothalamate.

Acetylglucosaminidase↗
PubMed1984

Iopamidol and metrizamide for myelography: prospective double-blind clinical trial.

In a comparative randomized double-blind study, 73 patients underwent myelography using iopamidol (36 patients) or metrizamide (37 patients) as contrast medium. The overall diagnostic adequacy of iopamidol myelography was found to be comparable to that of metrizamide myelography. The incidence of examinations graded as superior (64%) or adequate (36%) with iopamidol was equivalent to that with metrizamide (57% superior, 43% adequate). Adverse reactions after iopamidol myelography were fewer, less severe, and generally of shorter duration than those associated with metrizamide. In the iopamidol group, adverse reactions occurred in nine (25%) patients, all of whom experienced mild or moderate headache, one with nausea, vomiting, and fatigue. In the metrizamide group, adverse reactions occurred in 17 (46%) patients, all of whom experienced mild or moderate headache, six with nausea and vomiting and four with back and leg pain. Of nine individuals who underwent myelography using 300 mg 1/ml metrizamide injected via lateral C1-C2 puncture, three experienced a toxic encephalopathy with confusion, dysphasia, headache, nausea, and vomiting, and a fourth individual suffered severe nausea, vomiting, fever, and irregular pulse. Encephalopathy was not observed in any of the 11 patients in whom myelography was performed via lateral C1-C2 puncture with a similar concentration of iopamidol. No seizures were encountered, and no clinically significant changes in laboratory studies were observed with either contrast medium.

Clinical Trials as Topic↗
PubMed1985

Experimental evaluation of iosefamate meglumine and its derivatives as hepatobiliary CT contrast agents.

Iosefamate meglumine has attracted attention as a possible hepatobiliary contrast agent for CT scanning. However, its limited hepatic opacification has prevented clinical acceptance. To find a more efficient agent, the efficacy and toxicity of six derivatives of iosefamate were compared with those of the parent compound in dogs. Twenty dogs received intravenous doses ranging from 150 to 600 mg I/kg of one of these seven water-soluble, ionic, dimeric agents. Three control animals received equivalent amounts of physiologic saline. The CT densities of liver, biliary tract, kidneys, and blood were then measured for up to 3 hr. Toxicity tests of liver and kidney function were performed for up to 3 days. Among the new agents, only MI-294, a previously unreported compound, proved to be a slightly more efficient hepatic opacifier than iosefamate (0.40 vs. 0.34 H per mg I/kg, respectively). MI-294 was also the least toxic. However, transient abnormalities in at least one liver function test were observed with every agent at some dose level. One animal died with hepatic necrosis after receiving iosefamate. No renal impairment was noted in any case. MI-294 has advantages over iosefamate as a CT liver and biliary opacifier in dogs. Potential hepatotoxicity of this class of agents needs to be more fully evaluated.

Animals↗
PubMed1986

Comparison of patient responses to high- and low-osmolality contrast agents injected intravenously.

Low-osmolar intravascular radiographic contrast media have recently been introduced for clinical use in an attempt to reduce the frequency and severity of side effects. This study was undertaken to test patients' subjective reactions to IV injection of three different types of contrast media--iopamidol, meglumine/sodium ioxaglate, and sodium iothalamate. The low-osmolar contrast media (ioxaglate, iopamidol) were found to have a significantly lower frequency of nonidiosyncratic reactions than the high-osmolar contrast media (iothalamate). However, in view of the present cost of low-osmolar contrast media and the relatively minor nature of nonidiosyncratic reactions, it is concluded that high-osmolar contrast media should remain the contrast media of choice for routine IV use.

Contrast Media↗
PubMed1986

Cystic necrosis of the spinal cord in compressive cervical myelopathy: demonstration by iopamidol CT-myelography.

Seven consecutive patients with compressive cervical myelopathy were studied with standard water-soluble contrast myelography and immediate CT followed by delayed CT of the spinal canal at 10 to 12 hr. Every case demonstrated findings suggestive of necrosis and/or cavitation of the central portions of the spinal cord on the delayed CT study. Two types of abnormalities were visualized in the form of delayed collections of contrast media inside the cord: bilateral enhancement, a double-barreled "snake-eyes" appearance at or near the level of compression (consistent with central gray matter necrosis and/or cavitation--local syringomyelia ex-vacuo); and longitudinally oriented, "pencil-shaped" central enhancement of variable length distant from the level of compression (consistent either with an enlarged central canal--hydromyelia ex-vacuo--or with necrosis and/or cavitation extending craniad and caudad from the area of maximal compression and located in or near the anterior portion of the dorsal columns--distant syringomyelia ex-vacuo). These findings, supported by previous reports of autopsy specimens, may explain in part: the frequent discrepancy between the levels of maximal cervical compression and the variable neurologic signs; and the frequent lack of improvement in clinical signs after surgical decompression of the spinal cord at this late stage of the illness. We believe similar intramedullary lesions may be present in other cases of chronic compression of varying etiology at any location within the spinal cord.

Adult↗
PubMed1989

Contrast-enhanced CT of the liver and spleen: comparison of ionic and nonionic contrast agents.

We conducted a randomized, blinded, prospective study evaluating hepatic parenchymal density changes during dynamic bolus CT (180 ml of contrast material given IV) and delayed CT (5 hr after 60 g of iodine) in order to compare the enhancement characteristics of an ionic contrast agent (iothalamate-60) and two nonionic agents (iohexol-300 and iopamidol-300). A total of 75 patients with known or suspected cancer were studied (25 patients per contrast agent). After a baseline unenhanced CT scan was obtained, dynamic bolus and delayed CT scans were obtained for all patients with one of the three contrast agents. The density of the liver and spleen was measured in Hounsfield units (H) for unenhanced CT, dynamic bolus CT, and delayed CT. The average percentage of enhancement was calculated as follows: postcontrast density minus precontrast density was divided by precontrast density and then multiplied by 100. For dynamic bolus CT, the average percentage of enhancement of the liver was 105% when iohexol-300 was used, 98% when iopamidol-300 was used, and 83% when iothalamate-60 was used. No significant difference was seen between the postcontrast enhancement of the three contrast agents on dynamic bolus CT scans (p greater than .05). For delayed CT, the average percentage of enhancement of the liver was 34% when iothalamate-60 was used, 28% when iopamidol-300 was used, and 16% when iohexol-300 was used. Both iothalamate-60 and iopamidol-300 showed superior enhancement on delayed CT, compared with iohexol-300 (p = .0001). We conclude that for dynamic bolus CT, all three contrast agents are similar, with no statistically significant differences in postcontrast enhancement of the liver. For delayed CT, however, hepatic enhancement with iothalamate-60 and iopamidol-300 is statistically superior to that with iohexol-300.

Adult↗
PubMed1992

Focal hyperdense areas in endometriomas: a characteristic finding on CT.

OBJECTIVE: To assess the value of a hyperdense focus seen on CT scans of endometrial cysts in the differential diagnosis of a lesion. MATERIALS AND METHODS: The preoperative CT scans of 328 patients with 410 ovarian masses (54 patients with 62 pathologically proved endometriomas and 274 patients with 348 pathologically proved other ovarian masses) were retrospectively reviewed in a random fashion without knowledge of the pathologic findings to determine whether a hyperdense focus was visible inside a cyst. RESULTS: In nine of 62 endometrial cysts (sensitivity, 15%), CT scans showed a hyperdense round or crescent-shaped focus, measuring 2 to 15 mm. This focus was located close to the inner border of the cyst in eight cases and in the central part of the cyst in one case. A hyperdense focus was not seen on CT scans of 348 other ovarian masses (specificity, 100%). An in vitro CT study of two specimens showed that this hyperdense area corresponded to a blood clot next to the inner wall of the cyst. This hyperdense area appeared as a nonspecific hyperechogenic focus on sonograms in five of nine cases and as a hypointense signal on T1- and/or T2-weighted MR images in four of five cases. CONCLUSION: The finding on CT scans of a hyperdense focus inside an ovarian cyst is suggestive of endometrioma and should help distinguish endometrioma from other pelvic masses.

Carcinoma↗
PubMed1995

Helical CT for the preoperative localization of islet cell tumors of the pancreas: value of arterial and parenchymal phase images.

OBJECTIVE: In two-phase helical CT, organs are scanned in both the arterial and the parenchymal phase after IV injection of contrast material. The purpose of our study was to evaluate the usefulness of two-phase helical CT for the preoperative localization of pancreatic islet cell tumors. MATERIALS AND METHODS: Ten patients with 11 surgically proven islet cell tumors were included in the study. Helical CT scans of the pancreas were obtained with 5-mm collimation and overlapping image reconstruction. Images were obtained in the arterial and parenchymal phases after contrast material injection. A test bolus was used for tailored bolus timing. Images were analyzed by two observers. If a tumor was detected, its density relative to the surrounding parenchyma was scored by consensus, using a five-point scale. RESULTS: Nine of 11 tumors could be located using two-phase helical CT (sensitivity, 82%), including one 4-mm gastrinoma. Two lesions smaller than 5 mm could not be visualized. Two tumors were easier to detect (n = 1) or could only be detected on parenchymal-phase images (n = 1). Tumor conspicuity was better on arterial-phase images in two patients. CONCLUSION: Our results show that obtaining CT scans in both the arterial and the parenchymal phase leads to improved detection of pancreatic islet cell tumors.

Adenoma, Islet Cell↗
PubMed1997

Detection of hypervascular nodular hepatocellular carcinomas: value of triphasic helical CT compared with iodized-oil CT.

OBJECTIVE: The objective of this study was to compare the capability of arterial, portal venous, and delayed phases of helical CT with that of iodized-oil CT for revealing nodular hepatocellular carcinomas. MATERIALS AND METHODS: Forty-eight patients with nodular hepatocellular carcinomas underwent triphasic helical CT examination with 10-mm collimation at 10-mm/sec table speed. We injected 120 ml of contrast material (36 g of iodine) at the rate of 3 ml/sec. Arterial-phase, portal venous-phase, and delayed-phase images were obtained with 30-sec, 65-sec, and 360-sec delays, respectively. All 48 patients also underwent angiography and intraarterial infusion of iodized oil after helical CT; iodized-oil CT was performed about 2 weeks after infusion of iodized oil. Helical CT images were compared with iodized-oil CT images for revealing hepatic nodules. RESULTS: In 48 patients, 79 hepatocellular carcinomas were seen with iodized-oil CT. Using helical CT, the arterial phase revealed 68 lesions (86%), the portal venous phase revealed 53 lesions (67%), and the delayed phase revealed 57 lesions (72%). The arterial phase proved superior to the portal venous and delayed phases for revealing lesions (p = .0025). The portal venous phase showed no significant difference for revealing lesions compared with the delayed phase. When combined, helical CT of the arterial and portal venous phases revealed 73 lesions (92%); a combination of the arterial and delayed phases revealed 72 lesions (91%); and a combination of the portal venous and delayed phases revealed 63 lesions (80%). Any combination of two phases that included the arterial phase proved superior to the combination of the portal venous and delayed phases (p = .0033). Overall, the combination of the arterial and portal venous phases (92%) or the combination of all three phases (92%) proved best at revealing lesions. CONCLUSION: The arterial phase of helical CT is better for revealing nodular hypervascular hepatocellular carcinoma than are the portal venous and delayed phases. The combination of the arterial and portal venous phases is superior to the arterial phase alone. Also, the combination of the arterial and portal venous phases is equal to the combination of the three phases for revealing hypervascular hepatocellular carcinomas.

Carcinoma, Hepatocellular↗
PubMed1999

Proximal arterioportal shunting associated with hepatocellular carcinoma: features revealed by dynamic helical CT.

OBJECTIVE: This study investigated the findings revealed by dynamic helical CT of proximal arterioportal shunting associated with hepatocellular carcinoma. We also evaluated the diagnostic capability of this imaging technique to reveal the mass in patients with hepatocellular carcinoma. CONCLUSION: On dynamic helical CT, proximal arterioportal shunting altered liver perfusion and tumor enhancement. Heterogeneous enhancement of liver parenchyma and decreased enhancement of hepatomas diminished diagnostic capability on the arterial dominant phase image. However, with the addition of imaging in the arterial portal phase, lesion conspicuity improved.

Carcinoma, Hepatocellular↗
PubMed2000

Detection of pharyngeal perforation: comparison of aqueous and barium-containing contrast agents.

OBJECTIVE: We sought to assess the value of aqueous and barium-containing contrast agents in the detection of pharyngeal perforation. SUBJECTS AND METHODS: Visual and objective in vitro comparisons of an iodinated aqueous contrast agent, a 50% weight/volume barium suspension, and a 100% weight/volume barium suspension were performed. Moreover, to exclude pharyngeal perforation after surgery, we prospectively examined 109 patients by pharyngography, using the aqueous contrast agent and the 100% weight/volume barium suspension. All patients with a pharyngeal perforation were followed up clinically to exclude complications due to barium application. RESULTS: As opposed to the 100% weight/volume barium suspension, in vitro comparison between the aqueous contrast agent and the 50% weight/volume barium suspension yielded no substantial differences. Seventeen perforations could be detected with the aqueous contrast agent. Although 10 of 17 perforations could be slightly better visualized with the 100% weight/volume barium suspension, two perforations were missed with this agent. Five perforations were equally well detected with both. CONCLUSION: Because of a higher radiopacity, 100% weight/volume barium suspensions may more sharply delineate perforations. However, in contrast to aqueous contrast media, narrow pharyngeal perforations can be missed. Thus, the use of a 100% weight/volume barium suspension does not improve the detection of pharyngeal perforation.

Adult↗
PubMed2004

CT features of the accessory spleen.

OBJECTIVE: The purpose of this study was to describe the prevalence and CT features of the accessory spleen. CONCLUSION: Accessory spleens are present in 16% of patients undergoing contrast-enhanced abdominal CT. Typically, accessory spleens appear on CT scans as well-marginated, round masses that are smaller than 2 cm and enhance homogeneously on contrast-enhanced images. When accessory spleens are smaller than 1 cm, their attenuation may be lower than that of the spleen because of partial volume effects. Their most frequent location (22%) is posteromedial to the spleen; anterolateral to the upper pole of the left kidney; and lateral, posterior, and superior to the tail of the pancreas. Familiarity with these characteristic features may differentiate them from other pathologic findings in the upper abdomen.

Adult↗