Clinical testing of conray meglumine and Amipaque in cerebral angiography

Summary Amipaque 280 mg I/ml and Conray meglumine 282 mg I/ml have been compared in a double-blind trial in cerebral angiography. Altogether 55 cerebral artery branches have been examined in 21 patients, who served as their own controls. The effect of the contrast injections on the intra-arterial blood pressure, pulse rate, ECG, circulatory rate and the patients' reactions were recorded under standardized conditions. The quality of the films was also evaluated. No signficant difference in the cardiovascular effects of the two contrast media was found. There was a significant difference in favour of Amipaque in the discomfort of the patients—less pain and sensation of warmth. No serious side effects were observed.Read at the Annual Meeting of the Scandinavian Society of Neuroradiology, September 1978     

Arthrography with Amipaque (metrizamide) and other contrast media. A roentgenographic and histologic evaluation in rabbits.

Arthrography of the knee joint was performed in 30 rabbits for comparison of Amipaque (metrizamide) with Urografin 60% (meglumine-sodium diatrizoate), Isopaque Amin (meglumine-calcium metrizoate), Conray Meglumin 282 (meglumine iothalamate) and Dimer-X (meglumine iocarmate). Films taken at regular intervals show longer contrast duration, and less hydrarthrosis after injection of Amipaque. Minimal focal inflammatory reaction in the synovial membrane is found in many cases when the animals are sacrificed 1 day or 7 days after the injections. No significant difference can be found between the contrast media, and similar changes are also seen after injection of physiologic saline.     

The toxicity of the non-ionic watersoluble contrast medium metrizamide (Amipaque) in selective vertebral angiography

Summary Selective left vertebral angiography was carried out in 21 rabbits comparing the toxic effects of meglumine iothalamate (Conray meglumine), meglumine metrizoate (Isopaque Cerebral) and metrizamide (Amipaque). The iodine concentration for all 3 media was 280 mg/ml. General convulsions were seen in many of the animals with all 3 media. The convulsions occurred at higher doses and were milder with metrizamide than with the 2 other contrast agents. Bradycardia was also seen with all 3 media and there was no statistical significant difference between them in this respect. The mortality was approximately 50% with both meglumine iothalamate and meglumine metrizoate, while no animals died following angiography with metrizamide.     

Clinical testing of omnipaque and amipaque in external carotid and vertebral angiography: randomized double-blind crossover study

Omnipaque, 300 mg l/ml, was compared with Amipaque, 300 mg l/ml, for cerebral angiography. Twelve patients were included in a randomized, double-blind, crossover study. Twenty comparisons were made in the external carotid and 21 in the vertebral artery, Both contrast media caused no or minor changes in blood pressure and heart rate. Good to excellent radiographic visualization of the cerebral arteries was obtained with both agents. The frequency of subjective reactions was almost equal, but the intensity of the reactions was less with Amipaque. No severe reactions were observed. Omnipaque is a more practical nonionic contrast medium than Amipaque because it is delivered in ready-to-use solutions.     

Clinical testing of amipaque for cerebral angiography

Summary Amipaque 280 mg I/ml was compared to Isopaque Cerebral 280 mg I/ml for common carotid injection in twenty patients in a double blind trial. Simple comparison was also performed in examinations with selective external carotid injections. The reaction of the patients to the common carotid injection was mild on the whole but Amipaque caused significantly less discomfort than Isopaque. Selective external carotid injection of Amipaque caused very little discomfort while most patients complained of severe pain when Isopaque was used. No serious side-effect was observed.Read at the Annual Meeting of the Scandinavian Society of Neuroradiology August 31 1977, and at the 7th Congress of the European Society of Neuroradiology September 10 1977     

Comparative double-blind investigation of meglumine metrizoate, metrizamide, and iohexol in carotid angiography

The new nonionic contrast medium iohexol (Omnipaque) was compared with its predecessor metrizamide (Amipaque) and with the conventional ionic medium meglumine metrizoate (Isopaque Cerebral) in carotid angiography using a double-blind crossover technique. The results indicated that iohexol and metrizamide caused less discomfort than the ionic medium. The circulatory effects of the three media were generally mild, and the diagnostic effectiveness was comparable when the iodine concentration was kept in the range of 280-300 mg I/ml.     

Hexabrix (ioxaglate), a new low osmolality contrast agent for lumbar epidural double-catheter venography

Summary Hexabrix (ioxaglate), a new low osmolality contrast agent, has been compared with Télébrix (ioxitalamate) in a series of 50 lumbar epidural venograms. The intensity of the pain and heat sensation experienced by the patient was significantly lower following the injection of Hexabrix. For this reason Hexabrix may be considered the contrast medium of choice for epidural venography. In 15 additional cases Hexabrix was compared with Amipaque (metrizamide) in the same iodine concentration (320 mg/ml). In these patients hardly any difference in pain and heat sensation was observed after the injection of both contrast agents. Frequently only a slight feeling of warmth was noticed. A minimal sensation of pain was occasionally observed to the same degree with both contrast agents.     

Randomized double-blind cross-over study of iohexol and Amipaque in cerebral angiography

Iohexol was compared with Amipaque (metrizamide) in a double-blind study in one pair of injections in each of 20 patients referred for routine cerebral angiography. Catheter position, patient position, injection pressure, contrast medium volume, and concentration (300 mg l/ml) were the same in the two injections, with iohexol and Amipaque being used alternately. Except for these two injections iohexol was used throughout. The parameters studied included diagnostic information obtained (quality of the examination), circulation time, and comparison of patient reactions to the pair of injections (e.g., electrocardiogram, heart rate, and subjective reactions). The patients' reactions to the noncomparative part of the examination were evaluated also, and the patients were observed for possible adverse reactions after the examination. No difference could be detected between the two contrast media in this series. No serious adverse reactions occurred.     

Iopamidol and Conray 60: comparison in superselective angiography

Iopamidol (280 mgI/ml) was compared with Conray 60 (iothalmate meglumine, 282 mgI/ml) during selective and superselective cerebral arteriography. Twelve patients were examined, and a total of 51 selective injections were compared. Iopamidol produced significantly less pain and burning than Conray 60 and caused no patient motion.     

Intravenous urography with a new non-ionic contrast media in a clinical phase III study: iopentol vs iohexol

The safety and diagnostic efficacy of iopentol 300 mg I/ml were compared with iohexol 300 mg I/ml in 300 patients submitted for urography. The study was carried out as a double-blind, randomised parallel study where 149 patients received iopentol and 150 patients iohexol. There were no significant differences between the patients receiving the two contrast media with regard to demographic parameters, rate of injection or total dose of injected contrast media. No changes in blood pressure and no clinically important changes in heart rate were detected in the two groups. No serious adverse effects occurred. Seven patients (5%) in the iohexol and 12 patients (8%) in the iopentol group experienced adverse effects other than a sensation of warmth. Fourteen iohexol patients (9%) and 18 iopentol patients (12%) experienced warmth related to the contrast injection. Excellent films were obtained in most patients and no difference in diagnostic quality between iopentol and iohexol was observed.     

Bolus geometry in various central and peripheral contrast medium applications: study with serial CT using non-ionic contrast media

Measurements of concentration in 27 patients with a calibrated Serio-CT yielded for the intravasal contrast medium bolus maximum a value of approx. 23 mg I/ml for the a. carotis with central injection and approx. 14 mg I/ml for the a. iliaca with peripheral injection. 7 invasive measurements were performed at the bifurcation of the aorta, yielding a value of 12.5 mg I/ml with peripheral injection. In all these cases, 40 ml nonionic contrast medium (Iohexol) with an iodine content of 350 mg I/ml were applied. The average bolus half-life was 9.5 sec. measured at the carotid artery, 11.5 sec. at the a. iliaca, and 7 sec. at the bifurcation of the aorta. Differences in bolus geometry were not seen on comparing arterial injection with cava superior injection; likewise, there were no differences between peripheral injections at various speeds. Animal experiments reported in literature show that these observations can be mainly ascribed to vascular dilatation in the minor circulation produced by the contrast medium.     

Comparison of iodixanol 270 with iohexol 300 in infrapopliteal arteriography. Digital densitometric analysis of angiographic opacification.

PURPOSE: To compare iodixanol 270 mg I/ml with iohexol 300 mg I/ml in infrapopliteal arteriography by measuring digital densitometric vessel opacification and by visually assessing angiographic enhancement. MATERIAL AND METHODS: In a double-blind, dual-balanced, 4-sequence cross-over design, 50 claudicant patients received two contrast media injections (10 min interval) in the superficial femoral artery. Digital angiography was performed at 8 frames/s and time-density curves with a circular region of interest over a distal calf artery were generated. A mixed, linear model was used to identify effects influencing the density measurements. Subjective evaluation of the image quality was made independently by two observers. RESULTS: No statistically significant difference between the contrast media was revealed in the analysis of the densitometric measurements (p=0.14) nor in the subjective visual evaluation (p=0.74). However, the mean density at the time of maximum opacification was higher after the first injection than that after the second injection (p=0.02). There was a tendency towards lower intensity of warmth during injection of iodixanol 270 than during injection of iohexol 300. CONCLUSION: In patients with severe occlusive atherosclerotic disease, iodixanol yielded the same image quality as iohexol in infrapopliteal arteriography, in spite of the 30 mg I/ml lower iodine concentration.     

A clinical trial of a new low osmolality contrast medium. Sodium and meglumine ioxaglate (Hexabrix) compared with meglumine iothalamate (Conray) for carotid arteriography.

The discomfort of cerebral arteriography is due mainly to the osmolality of the contrast medium injection. A new low osmolality contrast medium--Hexabrix (32% iodine)--sodium and meglumine salts of ioxaglic acid was compared with Conray 280 (28% iodine)--meglumine iothalamate for carotid arteriography in 33 conscious patients. 30 patients preferred the ioxaglate solution which caused significantly less sensation of heat. Three patients could not distinguish between the two media. No patient preferred iothalamate. Ioxaglic acid is a newly synthesized mono-acid dimer. Its salts produce the same osmolality as non-ionics (e.g. metrizamide), and one third of the osmolality of currently used mono-valent salts (e.g. meglumine iothalamate) in solutions of the same iodine content. Low osmolality contrast media have significant clinical advantages and will probably become the media of choice for arteriography and venography.     

Amipaque in coeliac angiography

Coeliac angiography was performed in 12 patients using Amipaque 370 mg I/ml or Isopaque 370 mg I/ml. No significant biochemical alterations were found in serum. Amipaque improved the demonstration of small vessels in the liver and in the head of the pancreas. Amipaque caused no discomfort contrary to Isopaque, which gave moderate to severe heat during injection.     

Iohexol in coronary angiography. A double blind investigation

Iohexol 350 mg I/ml (Omnipaque) was compared with the routine contrast medium meglumine, Na-Ca-metrizoate 370 mg I/ml (Isopaque Coronar) in coronary angiography in 30 patients. A randomized, double blind, crossover design was employed. Angiographic image quality, ECG, heart rate, aortic blood pressure and adverse reactions were recorded. Excellent image quality was obtained with both media. Except for one single event of hypotension, only few and minor changes in the parameters measured were recorded. No distinct difference between the two media was found. Iohexol seems to be suitable for selective coronary angiography.     

A comparison between iohexol and metrizamide, two nonionic contrast media, in aorto-femoral angiography

Iohexol, a recently developed non-ionic contrast medium, is shown to be well tolerated on aorto-femoral angiography. The aortic injection of 40 ml of iohexol (350 mg I/ml) was usually associated with a moderate sensation of heat and an absence of pain. A transient fall in blood pressure, no different from that resulting from metrizamide, was associated with some increase in heart rate.     

Comparative evaluation of metrizamide and meglumine ioxithalamate in angiography of the vessels of the head and neck

Summary Metrizamide, a non-ionic contrast medium of low osmolality was compared with meglumine ioxithalamate, the ionic angiographic contrast medium currently in use in our department in a double-blind study. Criteria upon which the comparison was based were: 1) the pain reaction of the patient upon intra-arterial contrast injection, 2) bradycardial reactions upon common carotid injection and 3) the quality of the contrast image. Metrizamide induced significantly less painful sensations than meglumine ioxithalamate in those vessels in which injections of contrast medium are frequently painful (external carotid artery, vertebral artery). No significant difference in the degree of bradycardia was caused by the two contrast media. The degree of bradycardia was also found to be poorly reproducible upon successive injections of the same contrast medium in the same patient, thus raising questions as to the suitability of this method for determining the toxicity of the contrast medium. The quality of the angiograms obtained did not differ significantly with the two media. Spasm, when it occurred during selective external carotid injections, was found to be independent of the contrast agent used, being correlated instead with the depth of distal advance of the catheter tip into the external carotid. Of the 51 patients included in the study, two patients suffered transient neurological deficit after angiography with metrizamide, and one patient suffered a permanent hemiplegia after angiography with meglumine ioxithalamate.     

Arthrography of the knee joint with amipaque.

In a double-blind investigation, 30 knee arthrographies were performed by injection of either Amipaque 290 mg I/ml or Urografin 60% (292 mg I/ml). Both contrast media are well tolerated, and give excellent initial contrast quality, which deteriorates rapidly. This occurs more slowly with Amipaque, which has lower osmolality and causes less joint effusion.     

Cardiovascular responses to the intracarotid injections of ionic contrast media and iohexol in the dog

Hypotension and bradycardia are the most significant cardiovascular responses resulting from intracarotid injections of hypertonic contrast media (CM). We have assessed both local and systemic vascular responses to the selective intracarotid injections of ionic and non-ionic CM in twelve pentobarbital anesthetized dogs. Alterations in blood pressure, heart rate, and femoral, renal and carotid blood flows were monitored following right common carotid artery injections of ionic contrast media (282-288 mg I/ml), isotonic saline, and iohexol (300 mg I/ml). Ionic CM led to early (0 to 10 s) decreases in blood pressure, heart rate and femoral vascular resistance. Isotonic saline induced no significant early changes in these same parameters while iohexol caused a decrease in heart rate. Our observations suggest that the early (0 to 10 s) decreases in femoral vascular resistance, heart rate and pressure that occur with the intracarotid injection of hypertonic CM are mediated via the autonomic nervous system and initiated from a site in the carotid circulation. During the 15 to 40 s period when the CM has reached the systemic circulation, iohexol produced smaller effects on systemic blood pressure and peripheral vascular resistances than did the ionic CM. During this 15 to 40 s period there were decreased vascular resistances in the carotid and renal vascular beds that probably result from local effects of the CM, however, the femoral resistance was actually increased. This later increase in femoral resistance probably represents the results of increased sympathetic nervous system activity working to offset the decrease in renal and carotid resistances and thus maintain pressure at baseline values.(ABSTRACT TRUNCATED AT 250 WORDS)     

Three-dimensional image of Adamkiewicz artery detected by using multidetector CT: preoperative assessment of thoraco-abdominal aortic aneurysm

Images were obtained with the following parameter 0.5 sec/r, 1 mm collimation, pitch 3.5, 120 kV, 300 mA. One hundred ml of contrast material containing 350 mg I/ml was injected with a power injector (dual shot type) into an antecubital vein at a rate of 3.5 ml/sec (70 ml). Then remaining 30 ml and same volume of saline were infused at a rate of 1.5 ml/sec simultaneously. Twenty-five seconds after the injection, scan was performed from the level of L2 to T5 vertebrae. Transverse sections were reconstructed with a 1 mm thickness at 0.7 mm intervals. Imaging was done with multiplanar and curved planar reformations. In case of vertebral deformity, however, 3D images were made to depict the Adamkiewicz artery. In 141 patients, 107 (76%) Adamkiewicz arteries from the interverbral foramen to the hairpin-shaped union with the anterior spinal artery were visualized. Seventy-nine arteries of Adamkiewicz (73%) originated from the left side. Our method is useful for depicting Adamkiewicz artery.