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PubMed1992

Multiple myeloma and contrast media.

Contrast media administered intravenously are still thought by many to be a major cause of acute renal failure (ARF) in myeloma patients. Recently, several authors found that the predominant risk factors of ARF in myeloma patients are hypercalcemia, dehydration, infection, and Bence Jones proteinuria rather than contrast media. In a review of seven retrospective studies of myeloma patients receiving contrast media, 476 patients were noted to have undergone 568 contrast media studies, with an ARF prevalence of 0.6%-1.25%. One large series showed the incidence of ARF after administration of contrast media to be 0.15% in the general population. Although the administration of contrast media to myeloma patients is not totally risk free, it may be performed if the clinical need arises and the patient is well hydrated.

Acute Kidney Injury↗
PubMed1993

[Reactions to iodine contrast media].

Contrast media are used in many radiological examinations, but they are responsible for 4.6 to 8.5 percent of the toxic or anaphylactoid adverse reactions observed. The early contrast media were hyperosmolar, whereas those in current use are isosmolar and either ionic or non-ionic. The patient's age, the presence of a pre-existing disease and a history of adverse reactions to contrast media are the most important risk factors. Seventeen to 35 percent of these reactions recur. Several physiopathological mechanisms have been blamed for adverse reactions to contrast media, including complement activation, histamine release, recruitment of inflammation mediators, and antigen-antibody reaction. There is no paraclinical examination that can diagnose or predict such reactions. Various preventive tests have been studied and applied to individuals with or without history of reaction. In a population of patients with previous reaction, the administration of corticosteroids 12 h and 2 h before the radiological examination resulted in a significant reduction of the number of reactions. In patients at risk (i.e. those with previous reactions of this kind) the results varied, but in these 2 groups of subjects non-ionic products given either alone or with corticosteroids or H1-antihistaminics reduced to 1 percent the incidence of reactions. So far, tachyphylaxis has virtually played no role compared with these preventive treatments. It is concluded that patients with a history of anaphylactoid reactions who must receive another injection of contrast medium, a non-ionic product and/or the H1-antihistaminic-corticosteroid combination should be used.

Contrast Media↗
PubMed1990

[Asymptomatic blood pressure and pulse rate changes during intravenous urography. Ionic contrast media vs. nonionic contrast media].

In 8,232 examinations of intravenous urography (4,832 examinations with ionic contrast media and 3,400 examinations with nonionic contrast media), systemic blood pressure and pulse rate were continuously monitored by an automatic blood pressure and pulse rate monitoring device before and after injection of contrast media. The intravenous injection of ionic contrast media caused mild to moderate hypotensive reactions (20%-39% decrease of systemic blood pressure) in 7 examinations (0.14%) and severe hypotensive reactions (greater than 40% decrease of systemic blood pressure) in 12 examinations (0.25%). There were no clinical symptoms other than hypotensive reactions in 8 of the 19 examinations (42.1%). On the other hand, the intravenous injection of nonionic contrast media did not cause severe hypotensive reactions but mild hypotensive reactions (20%-29% decrease of systemic blood pressure) in 3 examinations (0.09%). These 3 examinations did not have clinical symptoms other than hypotensive reactions. Of the 19 examinations using ionic contrast media, the hypotensive reactions with significant change of pulse rate (greater than 20%) was associated with increase of pulse rate in 17 examinations and decrease of pulse rate in 2 examinations. On the other hand, the hypotensive reactions had an association with a significant increase (greater than 20%) of the pulse rate in only one of the 3 examinations using nonionic contrast media. The pulse rate was unchanged after injection of contrast media in the remaining 2 examinations although there was mild hypotension. In conclusion, nonionic contrast media caused fewer and less severe changes in blood pressure and pulse rate without obvious clinical symptoms compared with ionic contrast media.

Adolescent↗
PubMed1995

Cardiac electrophysiology, arrhythmogenic mechanisms and roentgen contrast media.

Contrast media (CM) affect normal cardiac electrophysiology when injected into the coronary arteries. High-osmolality CM cause more pronounced electrophysiological effects than do low-osmolality CM. Further, both high- and low-osmolality ionic CM have more pronounced effects than the nonionic CM. The CM-induced electrophysiological effects involve regional disturbances of depolarization and repolarization, thereby causing disturbances of impulse conduction as well as dispersion of refractoriness. Recent experimental studies have demonstrated that the addition of sodium or a balanced electrolyte supplement to nonionic CM reduces the risk of ventricular fibrillation (VF), particularly when the CM is injected in a wedged catheter situation. The reduced risk of VF may be due to the small and transient lengthening of repolarization seen in the CM-perfused area of the myocardium. Iodixanol, which is an isotonic nonionic dimer supplemented with NaCl and CaCl(2), is as well tolerated as iohexol during free coronary flow. However, when flow is restricted, such as when CM is injected through a wedged catheter, the risk of VF is less with iodixanol than with iopamidol, iohexol and ioxaglate.

Animals↗
PubMed2002

Allergies correlated to adverse reactions induced by non-ionic monomeric and ionic dimeric contrast media for contrast enhanced CT examination.

Although contrast media are indispensable for x-ray diagnosis, they are xenobiotics and may cause undesirable adverse reactions. We have correlated several allergies to the adverse reactions caused by three representative contrast media in order to predict and prevent possible problems. The adverse reactions were observed at probabilities of up to 100%(odds ratio 8.0) in drug allergy and contact dermatitis patients. These allergies were proven in this study to be type IV reactions, and all the observed adverse reactions were classified as allergies of either type I or IV. Thus, one can predict to some extent even the time when the adverse reaction will appear after the injection of contrast medium. Finally, a questionnaire to be administered prior to contrast enhanced CT examinations has been proposed. The questionnaire is designed to predict adverse reactions on the basis of statistical analysis. Since the physicochemical properties of contrast media are different, this questionnaire is also useful for selecting the most suitable contrast medium for the patient.

Contrast Media↗
PubMed1988

Does dilution of contrast media affect contrast enhancement? An experimental study in rats.

The effect of contrast media (CM) dilution on contrast enhancement was studied using CM representing four structurally different molecular types at osmolalities ranging from 135 to 1340 mosm/kg. Diatrizoate (ionic monomer), iopamidol (nonionic monomer), ioxaglate (ionic dimer), and iodecol (nonionic dimer) were each given at a dose of 500 mgI/kg and at concentrations of both 300 and 150 mgI/mL. Contrast media concentrations were measured using iodine 125I. Tissue blood volumes were determined using human serum albumin labeled with 131I. For each of the four CM at each of the two concentrations and after each of five time intervals following injection (0, 15, 40, 120, and 300 seconds), five rats were killed (total = 200 rats). Blood and 14 other tissues were studied. Dilution of the CM did not lead to any lower iodine tissue concentrations, iodine distribution volumes, plasma volumes, or hematocrit. The authors conclude that lowering CM osmolality by dilution with water should improve tolerance without affecting CT contrast enhancement.

Animals↗
PubMedDate not supplied

New media. Particulate contrast media.

Particulate contrast agents, when compared to water-soluble media, offer the advantage of allowing the administration of high doses without creating hypertonicity gradients and ionic imbalances. Since these radiopaque particles are accumulated in the reticuloendothelial system, they could be ideal hepatic CT contrast agents. We have developed a method for making particles of 2 +/- 1 microns by precipitating from an organic solvent. Preincubation of these particles in human serum albumin overcomes the very serious problem of in vivo particle aggregation and embolization. The ethyl esters of iothalamic and iodipamic acid have been injected intravenously into mice, rats, and rabbits. Radiopacification of the liver is maximal within 2-3 hours postinfusion, with radiopaque material subsequently clearing through the biliary system. Elimination from the organism seems to be complete within a few days postinfusion. Efforts to decrease the subacute toxicity of these agents are underway.

Animals↗
PubMed1999

Contrast media and metformin: guidelines to diminish the risk of lactic acidosis in non-insulin-dependent diabetics after administration of contrast media. ESUR Contrast Media Safety Committee.

The purpose of this study was to establish guidelines on how to avoid metformin-induced lactic acidosis following intravascular use of contrast media. We reviewed articles published in international journals. No conclusive evidence was found to indicate that the intravascular use of contrast media precipitated the development of metformin-induced lactic acidosis in patients with normal S-creatinine (< 130 mumol/l). The complication was almost always observed in non-insulin-dependent diabetic patients with decreased renal function before injection of contrast media. Guidelines for the use of contrast media in this group of patients are proposed.

Acidosis, Lactic↗
PubMed1989

[Measuring periodontal pockets with contrast media. 1. Preparation of contrast media].

Periodontal pocket is main clinical symptom of periodontitis. Measurement of periodontal pocket depth is the most important examination. The purpose of this study was to get contrast medium radiography of periodontal pocket. The present study was compared with contrast media of varying concentration. Contrast medium-sample containing 40% Sodium Iothalamate and 30% Meglumine Adipiodone had slight higher radiopacity than the others. These contrast media-sample were adequate to clinical practice over 40% concentration. Using Sodium Iothalamate and Meglumine Adipiodone, radiopacity was able to differ from radiopacity of teeth at 60%-100%.

Contrast Media↗
PubMed1996

Risk of clot formation with ionic and nonionic contrast media in cerebral angiography. Tama Contrast Media Study Group.

RATIONALE AND OBJECTIVES: The introduction of low-osmolality contrast media has improved patient tolerance to angiographic procedures. However, nonionic contrast media may be associated with an increase in the risk of clot formation. The objective of this study was to test whether there is more clotting with nonionic agents than with ionic agents. METHODS: Ninety-eight patients undergoing transfemoral cerebral angiography were randomly assigned to receive ionic (ioxaglate) (n = 62) or nonionic (iopamidol or iohexol) (n = 36) contrast material. Incidence of clot formation was examined by observation of catheters. RESULTS: Clot formation was found in 4.8% of patients in the ionic contrast material group and 22.2% of patients in the nonionic contrast material group (P < .05). CONCLUSION: Nonionic contrast media resulted in a statistically significantly higher incidence of clot formation than ionic media during cerebral catheter angiography. These results suggest that ionic contrast media are preferable in patients with risk of thrombosis.

Blood Coagulation↗
PubMed1990

[Comparative studies on the radioactivity of bone cements containing x-ray contrast media and of the contrast media].

Various PMMA bone cements containing zirconium oxide (ZrO2) as an X-ray contrast medium and zirconium oxides of several manufacturers were tested for their radioactivity by means of a gamma spectrometer. All the bone cements tested (Implast, Palacos R, and Sulfix-6) showed a certain degree of radioactivity. The radiation source in the bone cement is the added zirconium oxide, which is polluted by radioactive elements. The examination of various zirconium oxides showed some high radioactive emissions. The risk of radiation-induced cancer seems to be small, because the cements are normally implanted in humans older than 60 years. In view of the fact that these X-ray contrast media remain in the body for decades as components of the bone cement, the radioactive zirconium oxides should be replaced by high-purity radiation-free zirconium oxide or barium sulphate as soon as possible.

Bone Cements↗
PubMed1991

Low osmolar (non-ionic) contrast media versus high osmolar (ionic) contrast media in intravenous urography and enhanced computerized tomography: a cost-effectiveness analysis.

The cost-effectiveness of three alternative policies for the use of intravenous contrast media for urography and enhanced computerized tomography (CT) are analyzed. Alternative #1 is to use high osmolar contrast media (HOCM) in all patients, the historical policy. Alternative #2 is to replace it with low osmolar contrast media (LOCM) in all patients. Alternative #3 is to use LOCM only in the high risk patients. Data on the 6,242 patients who underwent intravenous urography and enhanced CT at the Department of Radiology, Chulalongkorn Hospital in 1989 were used. Both societal and hospital viewpoints were analyzed. The incremental cost-effectiveness (ICE) between #2 and #1 was 26,739 Baht (US$1,070) per healthy day saved (HDS), while the ICE between #3 and #1 was 12,057 Baht (US$482) per HDS. For fatal cases only, ICE between #2 and #1 was 35,111 Baht (US$1,404) per HDS, while the ICE between #3 and #1 was 18,266 Baht (US$731) per HDS. The incremental cost (IC) per patient was 2,341 Baht (US$94) and 681 Baht (US$27) respectively. For the hospital viewpoint the ICE between #2 and #1 was 13,744 (US$550) and between #3 and #1 was 6,127 Baht (US$245) per HDS. The IC per patient was 1,203 Baht (US$48) and 346 Baht (US$14), respectively. From the sensitivity analysis, #3 should be used if the LOCM price is reduced more than 75% (equal to 626 Baht or less) and more than 80% of the patients are able to pay for the contrast media.

Adult↗
PubMed1999

Contrast-media-induced nephrotoxicity: a consensus report. Contrast Media Safety Committee, European Society of Urogenital Radiology (ESUR).

The purpose of this study was, using consensus methodology, to document current understanding of contrast media nephrotoxicity (CMN) and to identify areas where there is disagreement or confusion. To draw up guidelines for avoiding CMN based on the current understanding of the condition established by the survey. One hundred sixty-four statements were mailed to 148 members of the European Society of Urogenital Radiology (ESUR) and to 48 experts in the field of CMN. They were asked about the definition, clinical features, predisposing factors and pathophysiology of CMN and about prophylactic measures. The importance of the statements was rated on a scale from 1 to 10 (1 least important, 10 most important). Fifty-three members (38%) and 23 experts (48%) responded. Both groups considered that an increase in serum creatinine that peaks within 3-4 days and a decrease in creatinine clearance are the most important (rating > 7) features of CMN. Enzymuria was not considered important (rating < 6). Pre-existing renal insufficiency, diabetic nephropathy, dehydration, congestive heart failure, concurrent administration of nephrotoxic drugs and the dose and type of contrast media were considered to be risk factors. Reduction in renal perfusion and damage to tubular cells were considered the main factors in the pathophysiology of CMN (rating > 6). Hydration and the use of low osmolar contrast media were thought to minimize the incidence of CMN (rating > 6). The majority of the responders (84.6% of members and 95.5% of experts) believe that the incidence of CMN in patients with normal renal function is less than 5%. Of the members, 62.5%, and 35.3% of experts, believe that the incidence of CMN is 20-30% in the presence of risk factors. There was disagreement about the definition of CMN, the threshold dose of contrast media above which renal complications may develop, the safe period between repeat injections, the relevance of contrast media renal retention shown on CT and whether contrast media have long-term effects on renal function. The survey showed good understanding of CMN among those who answered the questionnaires, although areas of disagreement remain which require further research. Simple guidelines are proposed.

Contrast Media↗