Iodide mumps following intravenous urography with iopamidol

We report a case of bilateral submandibular and parotid sialadenitis subsequent to the injection of 100 ml of iopamidol (Niopam 370, Bracco) for an intravenous urogram. Iodide 'mumps' has previously been reported as a rare sequela of ionic contrast media injection. It is a mild and short lived condition, usually requiring no treatment.     

A double-blind comparison of iopromide and iopamidol in intravenous urography

A randomised double-blind comparative study was performed to assess the imaging properties and side-effects of two non-ionic contrast media, iopromide and iopamidol, in intravenous urography in high risk patients. The results showed the two contrast media to be similar in their imaging efficacy and incidence of side-effects. Using 50 or 100 ml of iopromide or iopamidol (370 mgI/ml), the quality of nephrograms was found to be dose dependent but the quality of pyelograms was not dose dependent.     

A comparative study of the nephrotoxicity of iohexol, iopamidol and ioxaglate in peripheral angiography

Iohexol (Omnipaque 350) and iopamidol (Isovue 370) are nonionic monomers; ioxaglate (Hexabrix 320) is an ionic dimer. We compared the nephrotoxicity of these three media by a prospective double-blind evaluation in 500 patients who underwent peripheral angiography during a 6-month period. Serum creatinine levels were determined before injection of the contrast medium and 72 hours after in 478 patients. In 308 (64%) patients there was an average increase in the serum creatinine level of 18.1 mumol/L after injection of an average volume of 123 ml of contrast medium. A subset of 80 patients who had an elevated baseline creatinine level (more than 110 mumol/L) had an average increase in the serum creatinine level of 40.45 mumol/L. Of patients who had arterial injections, 182 (72%) had an increase in serum creatinine level (20.7 mumol/L), but of those who had peripheral venous injections, only 43 (45%) had an elevated creatinine level (9.2 mumol/L), and of those who had central venous injections, 83 (63.8%) had an elevated level (17.0 mumol/L). In most patients elevation of the serum creatinine level was not of clinical importance. High-risk patients with an elevated serum creatinine level were found to be most vulnerable to contrast nephrotoxicity. Although mean differences were not statistically significant, there were consistent trends which suggested that ioxaglate was the least nephrotoxic of the three agents studied.     

A comparison of iopamidol and ioxaglate in CT enhancement

We evaluated the adverse reactions (AR) rate produced in patients to see if any difference related to the diferent chemotoxicities of two low-osmolality contrast media (CM), could be detected. We compared the AR rate intravenous administration for brain or body computed tomography (CT) enhancement of either the ionic CM ioxaglate 320 mgI/ml or the non-ionic iopamidol 300 mgI/ml at a dose of 0.8 gI/kg. Three hundred and thirty patients (164 ioxaglate, 166 iopamidol) were studied according to a randomized double-blind design. AR reported by the patients (subjective) and/or observed by the radiologist (objective) were recorded by the radiologist on the patients record card. Laboratory test were performed prior to and 24 h after contrast administration.Fifty-nine mild to moderate AR occurred in 30 patients (18.3%) receiving ioxaglate, 4 mild to moderate AR occurred in 2 patients (1.2%) receiving iopamidol (P < 0.05). No severe AR occurred in either group.The results of our study are comparative to the available evidence from 16 comparative randomized trials of iopamidol versus ioxaglate both after intraarterial and intravenous administration that gave an overall odds ratio of 3.9 [confidence interval (CI) 95% = 3.1–4.9].The diagnostic efficacy of the two CM was comparable. This study showed that the non-ionic CM iopamidol was better tolerated than the ionic ioxaglate after intravenous administration. We conclude that the chemotoxicity of the molecule influences the AR when CM with comparable osmolality are administered. Correspondence to: Carlo Del Favero     

Iohexol, ioxaglate and iopamidol in coronary angiography. A double-blind comparative study of 300 patients

A randomized, double-blind study was carried out in 300 consecutive coronary angiography examinations to investigate the clinical safety of three low osmolar contrast media, iohexol 300, ioxaglate 320 and iopamidol 300, and the electrocardiographic changes that occurred with them. The ECG from electrode V5/V6 or AVF and intra-arterial pressure were monitored continuously, and recorded before and after the first contrast injections into the left and right coronary arteries. Of the variables tested, no statistically significant changes occurred in systolic arterial pressure, PR interval or ventricular extrasystole. The QT interval increased in the ioxaglate group (p = 0.001). Heart rate decreased in all groups, but slightly less in the ioxaglate group than in the iopamidol group (p = 0.02). The ST segment depression (mean 0.67m) was more marked in the ioxaglate group than in the other treatment groups (p = 0.0001) during right coronary angiography. The same characteristics, but less marked, were observed during left coronary angiography, the ioxaglate group (mean 0.251mm) differing from the iopamidol group (mean 0.050mm) (p = 0.04). No significant difference in severe adverse reactions were detected between these groups (ioxaglate 1, iopamidol 1). Ioxaglate produced mild side effects (nausea, vomitus, urticaria) in 16% of the patients, the other two contrast agents producing side effects in 1%.     

A Japanese multicenter comparison of iotrolan 280 with iopamidol 300 in intravenous urography

A multicenter study was carried out to compare iotrolan 280, a non-ionic, dimeric water-soluble contrast agent, with iopamidol 300 a non-ionic, monomeric agent, to assess visualization, safety and clinical benefit in intravenous urography. Both iotrolan and iopamidol showed a high rate of effective visualization. Iotrolan was significantly better than iopamidol in visualizing the renal pelvis. Adverse reactions did not differ significantly between the two contrast agents, and no severe reactions developed. Both contrast agents were clinically valuable in over 95% of patients. There was no significant difference between the two patient groups in clinical benefit. Iotrolan has been demonstrated to be clinically comparable to iopamidol and is thus very suitable for use in intravenous urography.     

Iodixanol vs iopamidol in intravenous DSA of the abdominal aorta and lower extremity arteries: a comparative phase-III trial

Iodixanol (visipaque, 320 mgI/ml) was compared with iopamidol (Solutrast, 370 mfI/ml) in a double-blind, randomized, parallel group, intravenous DSA phase-III trial for evaluation of safety and efficacy. A total of 117 patients received iodixanol (n = 60) or iopamidol (n = 57). Diagnostic efficacy was evaluated using categoric and visual analogue scales. Discomfort and adverse evenets were recorded. A total of 39 patients collected urine up to 72 h after the examination for analysis. Diagnostic efficacy and radiographic density were similar in both groups. Discomfort was milder with iodixanol. The difference between the frequency of adverse events between both groups (iodixanol = 7, iopamidol = 2) was without statistical significance. Creatinine clearance was slightly more affected by iodixanol, whereas the increase in renal excretion ofN-acetyl-beta-glucosaminidase (NAG) in the first 24 h collection period after the examination was significantly higher (p < 0.01) with iopamidol. Iodixanol was of equal diagnostic efficacy compared with iopamidol despite its reduced iodine content. Both contrast media are well suited for IV DSA.     

Evaluation of the myocardial ischemic and arrhythmogenic risk of digitalized angiography by venous route. Apropos of a comparative trial of ioxaglate and iopamidol

Cardiac tolerance to digital subtraction angiography by venous route (DSAV) was evaluated during a prospective study of a continuous series of 100 patients of both sexes investigated for various arterial diseases, and classified previously as "cardiac" and "non-cardiac". A permanent 12 lead ECE recording by sequences of 3 allowed study of ischemic and rhythmic changes provoked by randomly allocated injections of contrast media, Ioxaglate or Iopamidol. Major cardiac complications were not observed in the 98 patients studied (2 excluded), but in 32.6% auricular extrasystoles (AES) and/or ventricular extrasystoles (VES) were noted and in 19.4% a painless widening of the ST segment of 0.5 mm or more. The and ST widening were more frequent in the VES 40 patients classed as "cardiac" than in the 58 "non cardiac" (35% against 8.6%, p less than 0.01 and 37.5% against 6.9%, p less than 0.001 respectively). The two products did not differ with respect to their effect on frequency of repolarization anomalies, whereas Ioxaglate provoked more VES than Iopamidol (30% against 8%, p less than 0.02). It is concluded that cardiac tolerance to DSAV is good, but that the frequency of VES and painless repolarization ischemic disorders observed, even with only weakly hypertonic contrast media of non ionic type, suggests that their indications be limited and that certain precautions are necessary in cardiac patients.     

Clinical trial of iopamidol for lumbosacral myelography

The results of the initial North American trial of the nonionic, water-soluble contrast medium iopamidol for lumbosacral myelography are reported. The iopamidol was easily visualized by fluoroscopy during introduction, and the radiographic quality of all 12 conventional myelographic examinations was excellent. The diagnoses were herniated nucleus pulposus (seven), traumatic dislocation (one), metastasis (one), and normal (three). One patient had a repeat myelogram with a different hydrosoluble contrast medium 2 months after his iopamidol examination and surgery and showed no radiographic evidence of arachnoiditis. The adverse reactions were all mild and transient: headache (four cases), nausea (two), and leg pain (one). There were no diaphoresis, fever, seizures, hallucinations, agitation, or vital sign changes. Electrocardiography, hematology, and blood chemistries were all normal. In two patients, electroencephalogram changes, three to four bursts of diffuse intermittent rhythmic delta activity with no spiking, were present at 6 hr with return to normal at 24 hr.     

64层螺旋CT尿路成像与静脉尿路造影对照分析

目的探讨64层螺旋CT尿路成像(CTU)与静脉尿路造影(IVU)对泌尿系病变的应用价值。方法 130例临床疑诊泌尿系病变的患者,先进行IVU,再行64层螺旋CT尿路成像检查,通过工作站进行多种后处理,比较两者结果。结果 IVU诊断正常3例,诊断泌尿系结石95例,其中肾结石50例,输尿管结石44例,膀胱结石1例,输尿管外压病变2例,泌尿系畸形6例,肿瘤7例,感染性病变1例。CTU诊断正常2例,诊断泌尿系结石106例,其中肾结石60例,输尿管结石45例,膀胱结石1例,外压病变4例,泌尿系畸形9例,肿瘤20例,感染性病变17例。对于泌尿系结石、畸形的诊断两种方法无统计学差异(P>0.05),对于泌尿系肿瘤、感染的诊断两者有统计学差异(P<0.05)。结论 64层螺旋CT通过多种后处理方法,既可全景显示泌尿系的形态结构,也可观察局部病变细节,对泌尿系各种疾病的诊断有重要的临床价值;而对于泌尿系单纯结石性梗阻亦可采用IVU。     

Ventilatory function during urography: a comparison of iopamidol and sodium iothalamate

The effects on respiratory function during intravenous urography of the ionic contrast medium sodium iothalamate and the non-ionic contrast medium iopamidol were compared. Forced expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were recorded in 37 non-atopic patients referred for intravenous urography. Nineteen patients received iopamidol and 18 patients received sodium iothalamate. Both the sodium iothalamate and the iopamidol groups showed a significant fall in FEV1 and FVC (P less than 0.001). The reductions in FEV1 and FVC were comparable and were not symptomatic. The differences in the percentage changes of the FEV1 and FVC in the iopamidol and the sodium iothalamate groups were not statistically significant (P greater than 0.5 and P greater than 0.1 respectively). No significant change in the ratio of the FEV1 and the FVC was demonstrated in either the iopamidol or the sodium iothalamate groups. Both the ionic and the non-ionic contrast media produced a measurable but asymptomatic and biologically insignificant fall in static ventilatory function. Bronchospasm does not appear to be an important contrast-induced effect in non-atopic individuals. Iopamidol offers no advantage over sodium iothalamate with respect to ventilatory effects in non-atopic patients undergoing intravenous urography.     

The quality of urography with iopamidol and various diuretic agents

The results obtained in four successive trials based on the analysis of urography performed on patients with normal kidney function are reported. The scores obtained with a non-ionic contrast (iopamidol) were compared with those produced after injecting the same contrast medium with the addition of various diuretics (furosemide, various quantities of 5% glucose solution, 20% mannitol). The results obtained by injecting the diuretic together with the iopamidol were usually unsatisfactory. Injection of diuretic 15 ms after the iopamidol gave better results in the lower urinary tract, particularly the bladder. The best results were obtained by injecting 250 ml, 20% mannitol, after 15 ms. However this technique is not applicable to patients requiring a voiding cystourethrogram due to the inadequate opacification of the urethra it provides.     

Iohexol and ioxithalamate for intravenous urography. A comparative parallel study

Omnipaque (iohexol) 350 mg I/ml has been compared with Telebrix (ioxithalamate) 380 mg I/ml in 48 patients undergoing intravenous urography. The contrast medium dose corresponded to 400 mg I/kg body weight. No cardiovascular reactions (BP and pulse rate) were observed. Subjective reactions occurred somewhat more frequently after Telebrix than after Omnipaque. Sensation of warmth was significantly less with Omnipaque (p less than or equal to 0.05). The overall radiological quality was equally good for the two contrast media.     

Cytogenic effects of diatrizoate and ioxaglate on patients undergoing excretory urography

Possible cytogenic alterations due to radiologic contrast medium in patients undergoing a common radiologic examination is studied. Two groups of 20 patients each were used. Group I consisted of patients undergoing excretory urography, using sodium and meglumine diatrizoate as contrast. A different agent, sodium and meglumine ioxaglate, was used with group II. Three blood samples were taken from each patient before urography, immediately after urography, and 1 week later. The frequency of sister chromatid exchanges (SCE) and chromosomal aberrations (CA) were found to increase significantly in the B samples from both groups, that of group I being higher (P less than .01 compared with P less than .05). Furthermore, these alterations were found to persist in the C samples from group I. No modification of the Proliferating Rate Index (PRI) was found. The osmolarity or other components of the contrast media studied could be involved in the process. The results indicate that ioxaglate produces less cytogenic damage than diatrizoate.     

Iotrolan in urography: efficacy and tolerance in comparison with iohexol and iopamidol

Iotrolan was compared with iohexol and iopamidol for efficacy and general tolerance in excretory urography in three controlled, randomized, inte-individual, double-blind studies. Two hundred and eighty-four patients received fixed doses of 100 ml, 120 ml or 150 ml iotrolan 280 or iohexol 300/iopamidol 300 by rapid or bolus injection. Contrast quality in films taken 3–40 min after injection was rated by experienced radiologists both on an overall basis and with regard to distinct anatomical regions (parenchyma, pelvicalyceal system, ureter, bladder). In all studies, contrast quality was assessed as better in the iotrolan group. In two studies (dosages 100 and 120 ml), significant differences in contrast quality were found in lavour of iotrolan (P < 0.05), and in the third study (dosage 150 ml) there was a trend towards better contrast quality in the iotrolan group (P = 0.06). General tolerance of iotrolan was good with only minor side effects (iotrolan 6.3%, iohexol/iopamidol 9.9%), but the difference was not significant. No severe adverse reactions were observed with iotrolan. In comparison with non-ionic monomers, iotrolan shows very good efficacy and general tolerance for excretory urography.     

Iotrolan in urography: efficacy and tolerance in comparison with iohexol and iopamidol

Iotrolan was compared with iohexol and iopamidol for efficacy and general tolerance in excretory urography in three controlled, randomized, inte-individual, double-blind studies. Two hundred and eighty-four patients received fixed doses of 100 ml, 120 ml or 150 ml iotrolan 280 or iohexol 300/iopamidol 300 by rapid or bolus injection. Contrast quality in films taken 3–40 min after injection was rated by experienced radiologists both on an overall basis and with regard to distinct anatomical regions (parenchyma, pelvicalyceal system, ureter, bladder). In all studies, contrast quality was assessed as better in the iotrolan group. In two studies (dosages 100 and 120 ml), significant differences in contrast quality were found in lavour of iotrolan (P < 0.05), and in the third study (dosage 150 ml) there was a trend towards better contrast quality in the iotrolan group (P = 0.06). General tolerance of iotrolan was good with only minor side effects (iotrolan 6.3%, iohexol/iopamidol 9.9%), but the difference was not significant. No severe adverse reactions were observed with iotrolan. In comparison with non-ionic monomers, iotrolan shows very good efficacy and general tolerance for excretory urography.