Contrast Media

in Diagnostic
Radiology
DR JAYA SELVI
NAGENDRAN

IMAGING
MODALITIES
- use different kinds of energy to
produce
images
- use different kinds of contrast
media which
interact with the energy

IMAGING

Structural imaging
Biochemical imaging
Functional imaging

CONTRAST MEDIA

Enhances inherent contrast between

tissues
POSITIVE agents (bright)
- iodinated agents
- gadolinium
- GIT contrast
NEGATIVE agents (dark)
- air, CO2
-Resovist

DIAGNOSTIC RADIOLOGY
-

Fluoroscopy GIT, Hepatobiliary, Genitourinary,

Cardiopulmonary, MSK, spine
- Computed Tomography
- Ultrasound
- Magnetic Resonance Imaging

INTERVENTIONAL RADIOLOGY
- GIT intussuception, neonatal intestinal obstruction

- Lymphovascular angiogram, venogram,

lymphogram
- dilatation, embolization, stenting,
ablation
- Hepatobiliary extraction of biliary calculi (PTC,
ERCP),
biliary drainage
- Urology nephrostomy
- Cardiac coronary angiogram

ORAL CONTRAST
MEDIA
BARIUM SULPHATE
inert substance, not absorbed by GIT
Used in GIT series : esophagus-stomachbowel.
CI/Cx perforation -> peritonitis, shock,
granuloma, adhesions - 50%
mortality
complete obstruction
intravasation 80% mortality
aspiration - physiotherapy

GASTROGRAFFIN

Iodinated ionic high osmolar CM

Used in 1.GIT series suspected
perforation, leak
2.meconium ileus
3.CT oral & rectal contrast (3%)
CI/Cx pulmonary edema if aspiration
hypovolemia in children
allergic rxn if intravasated
ileus in post-op patients

TELEPAQUE, BILOPTIN
oral cholecystogram
largely obsolete

INTRAVASCULAR
Intravenous CONTRAST
/intra-arterial
Water soluble
Ionic/ non-ionic
Osmolarity - plasma osmolarity 270320mlosm/kg
- hypo/iso/hyperosmolar
Basic chemical structure is tri-iodinated
benzene
Attenuates x-ray very much because of its high
atomic number
Its K-edge is 34KeV which is around commonly
used in diagnostic radiology

 HOCM osmolality up to 5X serum

dissociate

- iodine based
- composed of salts which

into cations and anions in water

- toxic - no longer for IV use
Uses: Gastrograffin (GIT)
Urograffin (uro)
Isteropac (HSG)

 LOCM

only

2x serum osmolality
- non dissociating
- less nephrotoxic
- more expensive
Uses : Uro-imaging IVU, APG, RPU, MCU..
GIT risk of aspiration or leak
children
HBS ERCP, PTC,T tube .
CT enhancement pattern tumours,
infection
vessels -CTA, CTV, Coros, CTPA
Vascular imaging diagnostic /
intervention

Others
Myelogram
Arthrogram
Sialogram, dacryocystogram,
Fistulogram, sinogram
Bronchogram
Lymphangiogram

COMPLICATIONS- types
ANAPHYLACTOID
Etiology unknown ?serotonin,histamine
Urticaria, facial and laryngeal edema,
bronchospasm
Hypotension life threatening
NON-IDIOSYNCRATIC
Direct effect on organs nephrotoxicity,
arrhythmias, MI, vasovagal attack
LOCAL
Extravasation, phlebitis

COMPLICATIONSseverity
MILD hives, flushed feeling, metallic taste

MILD hives, flushed feeling, metallic taste

Rx reassurance, no treatment
MODERATE bronchospasm
facial, laryngeal edema
hypotension
Rx requires therapy, usually not
life threatening
SEVERE hypotensive shock, circulatory
collapse
Mortality - 1: 40 000

COMPLICATIONSmechanism
-

Chemotoxicity - hyperosmolarity
/enzyme inhibition/ release of
vasoactive amine

Anxiety/ fear - activates

hypothalamic and limbic system

leading to CVS/Respiratory symptom.
-

Contrast-induced nephropathy

COMPLICATIONS- high
risk
HIGH RISK PATIENTS
- asthmatic, allergy (drug/ seafood), previous
adverse reaction
- renal impairment
(dehydrated,DM, sepsis,infancy-elderly)
- heart disease
- hematological, metabolic disorder
(multiple myeloma, sickle cell)

COMPLICATIONS
PREPARATION OF HIGH RISK
PATIENTS
- mental preparation and counselling
- steroid prophylaxis
- Contrast-induced Nephropathy
(CIN) guideline

Contrast-induced
nephropathy (CIN)
guideline
Def : acute decline in renal function within 2448 hrs
increased serum creatinine >25% from
baseline.
Peak in D2-D3, may normalize within 14days,
may progress to ARF requiring dialysis
Major risk factor is pre-existing renal disease

Contrast-induced
nephropathy guideline
Preventive measures
-alternative imaging not requiring CM
-nephrotoxic medication discontinued
48hr prior
to study
-avoid fluid volume loading
-minimize volume and frequency of CM
-iso/hypo-osmolar CM in pt with
GFR<60mL/min

Contrast-induced
nephropathy guideline
Serum creatinine not reliable
Glomerular filtration rate
- GFR< 30 mL/min : greatest risk
- GFR <60 mL/min
- GFR >60 mL/min : minimal risk
Acetylcystine (AC) reduces the incidence of
CIN

MRI CONTRAST MEDIA

Exerts a large magnetic field density to
interact with the magnetic moments of
protons in the tissues
Alters the rate of protons relaxation in
tissues to produce differential
enhancement of signal
POSITIVE -acts by T1 shortening
-appears white on T1
NEGATIVE - acts by T2 shortening
- appears black on T2

MRI CONTRAST MEDIA

INTRAVASCULAR
enhancement patterns tumours, infection
demarcate vessels aneurysm, stenoses .
- Positive agents gadolinium (paramagnetic)
- Negative agents SPIO2 (superparamagnectic)
ORAL
delineate bowel
distinguish bowel from adjacent structures
- Positive agents gadolinium (paramagnetic)
fatty oils
- Negative agents - SPIO2
Barium sulphate (60-70%)

AIR/CO2

Negative agent
For distension &
double contrast to see mucosal detail

CO2 - Barium meal

Air Barium enema, CT colonoscopy

Tampon in CT localization
Arthrogram knee, shoulder

..THANK
YOU..

Barium
swallow

DCBM

BMFT

DCBE

DCBE

ORAL
CHOLANGIOGR
AM

ERCP

PTC

IVU

MCU

CECT

Solitary HCC

(a)

Nonenhanced CT scan shows a large

mass that is hypoattenuating to the liver.
(b) CT scan obtained during the hepatic
arterial phase after bolus injection of
contrast material demonstrates
heterogeneous enhancement of the tumor
(c) CT scan obtained during the portal
venous phase demonstrates the
heterogeneous tumor and thrombosis of
the left portal vein (arrow).

(b)

(c)

CTA COW

MIP
SSD

VRT

2 aneurysms at the
MCA

DSA

CT
ARHROGRA

T
1

Gd

T
2

G
d

MR-SPIO

IV Contrast Media in
Special x-ray examination,
CT, DSA
Monomer ionic
Dimer ionic
Monomer non-ionic
- iopamidol, iohexol
Dimer non-ionic
- iotrolan
Iso-osmolar iotrolan, ioxaglate