非离子型与离子型碘对比剂的临床安全性对比研究

本文综述了近年国外对非离子型对比剂与离子型对比剂不同程度副反应发生情况的对比研究,指出非离子低渗性对比剂的安全性受益是有限的。在临床选择使用对比剂类型时,对于有诱导对比剂副反应发生的危险因素存在的患者,选用非离子型低渗性对比剂是受益最大的,而对于无危险因素存在的患者,价格－效益比是选用对比剂类型的重要参考因素。     

非离子碘对比剂对相关风险人群甲状腺功能影响研究进展

碘对比剂(ICM)是CT检查和介入治疗首选显影剂,对甲状腺功能有一定影响,甚至是重要危险因素之一。ICM影响甲状腺功能的机制复杂,其中离子碘对比剂(IICM)对甲状腺功能的影响研究得到认可,而非离子碘对比剂(NICM)虽明显减少了对甲状腺功能的影响,但在临床应用范围日益增大情况下,相关研究显得难以深入,未达成共识,尚无可遵循的明确依据。该文就NICM对甲状腺疾病及其相关风险人群甲状腺功能影响的研究作一综述,旨在为该类患者早期评估和可能的干预提供参考,为下一步深入研究提出建议。     

不同浓度非离子型碘对比剂对 HSG 的比较研究

目的：比较不同浓度非离子型碘对比剂在子宫输卵管造影术(HSG)中的图像质量及不良反应。方法将本研究中接受 HSG 的99例女性不孕患者平均分为 A、B、C 组。对比剂用法如下：A 组使用碘美普尔注射液(400 mg I/mL),B 组使用碘帕醇注射液(370 mg I/mL),C 组使用碘海醇注射液(300 mg I/mL)。2名医师采用3分制(1~3分),独立评价图像质量,并记录不良反应。结果(1)图像质量评分：所有图像都满足诊断要求,A 组(2.55±0.51)分,B 组(2.42±0.50)分,C 组(2.21±0.42)分,组间差异有统计学意义(H=7.790,P=0.022)。图像评分的 Kappa 值：A 组0.693,B 组0.687,C 组0.672。(2)不良反应：A 组4例(12.12%),B组3例(9.09%),C 组2例(6.06%),差异无统计学意义(χ2=0.733,P =0.693)。结论3种浓度的非离子型碘对比剂均可应用于HSG。碘浓度越高,图像对比度越好。     

碘克沙醇——一种新型的更安全的对比剂

非离子型对比剂具有与离子型对比剂相等的碘成分，但渗透压明显低于离子型，且不带电荷现象，不干扰体内的电离环境及电解质平衡，具有较少的毒性。临床上需要对比剂能快速、大量团注，并具有低粘度、高浓度，对患耐受性好。基于对对比剂越来越高的要求，目前已经研制出了大量的新型对比剂，其中碘克沙醇是一种新型的等渗二聚体对比剂，由挪威奈科明公司研制成功。目前碘克沙醇在国外得到越来越多的应用与研究，为提高对该种对比剂的认识，笔就碘克沙醇做一介绍。     

过量碘摄入对甲状腺功能影响的探讨

过量碘摄入可以引起甲状腺细胞形态的改变,继而引起甲状腺功能紊乱,从而导致各种甲状腺疾病。将与碘属同族元素的核素引入体内进行甲状腺显像对于诊断甲状腺疾病有重要意义,而阐述过量碘对甲状腺功能的影响,对于指导甲状腺核素显像前的准备有重要的临床价值。     

碘普胺致窦性心动过缓一例

患儿女，13岁。主诉“头晕、恶心、乏力3h”，于2002年8月26日入院。入院前3h患儿体检时做腹部B超检查，发现肝内占位，怀疑肝血管瘤，拟行CT肝脏增强扫描。在做碘普胺(0．1m1)皮肤试验后2～3min突然出现头晕、恶心、乏力、脉搏缓慢。追问病史，患儿既往身体健康，从未有类似发作。发病前无上呼吸道感染及腹泻史，亦无特殊用药史。     

国产非离子型对比剂碘佛醇安全性的临床研究

目的 研究国产非离子型对比剂碘佛醇的安全性. 资料与方法 对随机抽取的159例腹部增强CT检查资料进行分析,对比剂注射流率3～6 ml/s,剂量为80～100 ml.全部病例增强前2 h内、增强后即时、1 h、48 h分别进行生命体征、12导联心电图及注射部位观察,于增强前2 h内与增强后48 h分别抽血检测肾功能与血液生化指标,并于增强时、增强后即时、5～15 min、1 h与48 h分别观察与记录不良反应. 结果 159例患者注射对比剂后出现热感和潮红者占8.8%(14/159);轻度不良反应发生率为1.26%(2/159).未见中、重度不良反应出现. 结论 国产非离子型对比剂碘佛醇临床应用的安全性较高.     

高碘影响大鼠甲状腺功能及甲状腺细胞Trail表达

目的:观察高碘对大鼠甲状腺功能及病理生理改变的影响。方法:以高碘喂养雌性SD大鼠,检测游离三碘甲状腺原氨酸(FT3)、游离甲状腺素(FT4)水平,用半定量RT-PCR、Western印迹及免疫组织化学方法检测大鼠甲状腺细胞Trail的表达。结果:高碘组较对照组甲状腺功能增高(P<0.05)。半定量RT-PCR、Western印迹及免疫组织化学方法结果显示Trail在正常大鼠甲状腺细胞中有表达,在高碘组表达增高(P<0.01)。结论:高碘使大鼠甲状腺细胞Trail表达增高,可能通过引起Trail表达的增强诱导甲状腺细胞过度凋亡,进而影响其功能及病理生理改变。     

The toxicity of non-ionic water-soluble contrast media in selective vertebral angiography

Summary Selective vertebral angiography was performed in 28 rabbits in order to compare the adverse effects of two monomeric (metrizamide, iohexol) and two dimeric (iodecol, 2-5410-3) non-ionic water-soluble contrast media. The dose was 2,5 ml and the iodine concentrations 300 mg per ml. Marked, but transitory changes were seen in the electrocardiographic and blood pressure recording with all the contrast media and with no difference between them in this respect. The two monomers had a higher tendency than the dimers to cause spasm in the intracranial arteries. No serious complications were seen in the series.     

CT angiography with gadolinium-based contrast media

RATIONALE AND OBJECTIVES: To evaluate the potential use of gadolinium (Gd)-based contrast media, especially that of Gadovist, a 1-molar Gd medium, in computed tomography (CT) and compare our findings with standard iodinated contrast media. MATERIAL AND METHODS: Using a live rabbit and an acrylic CT body phantom for comparative CT imaging of Gd- and I-based media. The images were acquired at 80, 100, and 120 kVp, using fixed standard beam filtration. The phantom study used serial dilutions of the Magnevist and Ultravist 300 (2.4-molar I), whereas the animal study used different volumes of Gadovist, Magnevist (0.5 molar Gd), and Ultravist administered intravenously. RESULTS: At 80 kVp for the same injection volumes of Gadovist and Ultravist, the image contrast enhancement of the aorta with Gadovist was 40% lower than that of Ultravist. In the phantom studies, however, for the same kVp settings the CT image contrast was up to fourfold higher for Gd compared with iodine when comparing the same molar concentrations of the two elements in the solutions. CONCLUSION: These results indicate a potential of Gd-based media for clinical CT angiography and provide incentive for further investigation of this subject.     

离子型与非离子型造影剂支气管造影的临床对比研究

目的评价离子型、非离子型造影剂在支气管造影检查中的诊断效果。材料与方法对长期慢性咳嗽、咳痰、咯血,疑诊为支气管扩张的150例患者,用离子型或非离子型造影剂行支气管造影检查。结果支气管扩张98例,支气管炎12例,支气管狭窄7例,支气管扭曲移位6例,正常27例。非离子型与离子型造影剂的支气管显影结果相当,两者比较无明显差异。支气管影像清晰,细小的支气管乃至肺泡都显影良好。结论非离子型造影剂可用做支气管造影检查,支气管影像清晰,能够满足支气管病变的诊断要求。     

Results of a double blind study of three contrast media and technic for lumbosacral radiculography

Summary The rate of side effects, the results of EMG, EEG and CSF changes after radiculography, the rates of late leptomeningeal changes and the details of the hyperosmolality following the ionic contrast media are recorded and discussed. In conclusion rules are presented for the choice of contrast medium and the examination technic for radiculography.     

Optimum utilisation of intravascular radiological contrast media

The major current problem related to radiological contrast media is how best to achieve the optimum cost benefit efficiency in the deployment of contrast agents. Low osmolar contrast media (LOCM) are more comfortable for the patient and cause less adverse reactions than high osmolar contrast media (HOCM), but there is no statistically proven reduction in mortality. There is no improvement in diagnostic intravascular imaging when LOCM replaces HOCM. LOCM are 4–5 times more expensive than HOCM.It is therefore proposed that, until adequate finances become available, HOCM might well continue to be utilised for routine injections for intravenous urography (IVU), computed tomography (CT) and for visceral angiography, reserving LOCM for high-risk patients, high-risk procedures and for painful procedures. Offprint requests to: R. G. Grainger     

Effect of iodinated contrast media on thyroid function in adults

Excess free iodide in the blood (ingested or injected) may cause thyrotoxicosis in patients at risk. Iodinated contrast medium solutions contain small amounts of free iodide and may be of significance for patients at risk. The free iodide may also interfere with nuclear medicine diagnostic studies and treatment. Therefore the Contrast Media Safety Committee of the European Society of Urogenital Radiology reviewed the literature on this subject in order to prepare guidelines. A report and guidelines were prepared based on an extensive Medline search. The report was discussed with the participants attending the Tenth European Symposium on Urogenital Radiology, Uppsala, Sweden, September 2003. Contrast medium induced thyrotoxicosis is rare. Contrast medium injection does not affect thyroid function tests (e.g., T3, T4, TSH) in patients with a normal thyroid. Routine monitoring of thyroid function tests before contrast medium injection in patients with a normal thyroid is not indicated even in areas where there is dietary iodine deficiency. Patients at risk of developing thyrotoxicosis after contrast medium injection are patients with Graves disease and patients with multinodular goiter with thyroid autonomy, especially elderly patients and patients living in areas of iodine deficiency. Patients at high-risk should be carefully monitored by endocrinologists after contrast medium examinations. Prophylaxis in these groups is not generally recommended, although it may offer some protection in selected high-risk individuals. The free iodide load of contrast media injections interferes with iodide uptake in the thyroid and therefore compromises diagnostic thyroid scintigraphy and radio-iodine treatment of thyroid malignancies for 2 months after administration of contrast media. Simple guidelines on the subject are proposed.The members of the Contrast Media Safety Committee of ESUR are H.S. Thomsen (Chairman, Denmark), S.K. Morcos (Secretary, UK), T. Almén (Sweden), P. Aspelin (Sweden), M.F. Bellin (France), H. Flaten (Amersham Health, Norway), J.. Jakobsen (Norway), G.P. Krestin (The Netherlands), A. Löwe (Schering, Germany), R. Oyen (Belgium), F. Stacul (Italy), and J.A.W. Webb (UK).