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.     

Amipaque as contrast medium for intraosseous phlebography.

The degree of pain produced by Amipaque 260 and Isopaque 260 at intraosseous phlebography in patients with varicose ulcerations in the ankle region was compared. Amipaque produced less pain than Isopaque. No complications or side-effects occurred during the observation period of about one year.     

不同温度对比剂在冠状动脉造影术中不良反应的对比观察

目的 探讨进行冠状动脉造影检查时不同温度对比剂与受检者不适反应及心率、ST段、T波变化、手术时间、对比剂用量之间的关系.方法 将患者随机分为常温组(521例)与温浴组(522例),常温组对比剂在室温情况下进行冠状动脉造影,温浴组将瓶装的对比剂放入恒定温度37℃水浴箱,60 min后按冠状动脉造影常规进行操作.观察两组患...     

256层 CT 冠状动脉成像对比剂用量应用研究

目的：研究对比剂剂量对256层 CT 冠状动脉成像质量的影响。方法选择366例256层冠状动脉前瞻性心电门控扫描成像患者[体质量指数(BMI)<30,心率50~80次/min],将其按注射碘海醇350剂量分为3组,<1.0 mL/kg(105例)、1.0~1.1 mL/kg (111例)及>1.1~<1.2 mL/kg(150例)。由3位评估者以优、良、可、差4个等级分别观察不同对比剂剂量组及组内3种不同心率(≤60次/min、61~70次/min、71~80次/min)图像质量。结果3组不同注射对比剂剂量组间优秀图像、优秀良好图像差异无显著性(P >0.05)。3组不同注射对比剂剂量组内的心率改变对图像质量影响有显著性差异(P <0.05),低心率者(≤60次/min)图像质量优于心率较快者(71~80次/min)。结论正常 BMI,正常心率者进行256层前瞻性心电门控扫描冠状动脉 CT 成像对比剂剂量(0.9~1.2 mL/kg)不影响成像质量,心率是影响图像质量的重要因素。     

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.     

Iopamidol,a new nonionic contrast medium in peripheral angiography

Iopamidol (B 15,000), a new nonionic contrast medium, was compared to diatrizoate (Urografin 60%) in a controlled clinical trial using aortofemoral runoff angiography in a consecutive series of 50 severely arteriosclerotic patients. Iopamidol was found to be superior to the conventionally used contrast medium, as it significantly reduced the pain and discomfort following injection. Only slight to moderate alterations of aortic blood pressure and pulse rate were observed following the injection of both media. The hemodynamic influence of iopamidol, however, was significantly less pronounced than that of diatrizoate.     

Ioxaglate, a new low osmolar contrast medium used in femoral angiography.

Ioxaglate, a new monoacid, dimeric contrast medium was compared with diatrizoate (Urografin 60%) in a series of 61 femoral angiographies. In a double blind group of 34 examinations all patients preferred ioxaglate which caused slight pain in only five cases, whereas after diatrizoate 14 patients felt severe pain (six were unable to keep their legs still) and 12 felt slight pain. Increase in heart rate and decrease in systolic and diastolic arterial blood pressure was seen after both contrast medium injections, but significantly less after ioxaglate than after diatrizoate.     

Safety of the nonionic contrast medium omnipaque in coronary angiography

The low osmolar nonionic contrast medium Omnipaque was used in 5,339 consecutive coronary angiographies and serious complications were registered. Myocardial infarction occurred in 4 patients, of whom 2 died, and ventricular fibrillation in 1. Cerebral embolism occurred in 11 patients, all of whom survived. The results are compared with those of previous series of coronary angiography with high osmolar ionic media. It is concluded that use of the nonionic medium Omnipaque resulted in a significant reduction of the frequency of serious complications.     

Three-dimensional coronary magnetic resonance angiography with injection of extracellular contrast medium.

RATIONALE AND OBJECTIVES: To evaluate serial changes of the signal intensity and the contrast-to-noise ratios of the coronary arteries on three-dimensional (3D) coronary magnetic resonance angiography (MRA) after an injection of extracellular contrast medium, and to demonstrate the feasibility of this method for the diagnosis of coronary artery abnormalities. METHODS: Five healthy volunteers and two patients with Kawasaki disease and an anomalous coronary artery were studied. Coronary MRAs of the left anterior descending artery and the right coronary artery were obtained using a fat-suppressed 3D MRA sequence before and 0 to 5, 10 to 15, 20 to 25, and 30 to 35 minutes after administration of Gd-DTPA-BMA. RESULTS: Administration of the contrast agent provided a significant increase in the signal intensity and contrast-to-noise ratio. Aneurysm of the left anterior descending artery in Kawasaki disease and the proximal course of the anomalous right coronary artery, which were not well depicted on precontrast 3D MRA, were clearly demonstrated after contrast injection. CONCLUSIONS: The current study demonstrated that the use of an extracellular gadolinium contrast agent can significantly improve the clinical usefulness of 3D coronary MRA.     

Addition of sodium to the nonionic contrast medium iohexol during coronary angiography in man. Lack of electrocardiographic or hemodynamic effects.

It has recently been claimed that lack of sodium in nonionic contrast media may increase the risk of ventricular arrhythmias during coronary angiography. Thus, the influence of sodium addition to the nonionic contrast medium iohexol was studied in 75 patients with severe coronary heart disease. The study design was randomized, parallel and double-blind, and iohexol was given either with or without addition of NaCl (28 mmol/l). Both formulations induced a transient drop in arterial blood pressure, and prolongation of the QT interval and QRS duration at 10 s only (p less than 0.01). The electrical QRS axis was significantly changed by the coronary artery injections after 10 s, but not later. No differences between iohexol with and without NaCl were observed for any of the variables studied. No serious arrhythmias were observed. Thus, the addition of NaCl (28 mmol/l) to iohexol did not influence the electrocardiographic or hemodynamic changes induced by iohexol during coronary angiography.     

Experience with mechanical contrast medium injection at selective coronary angiography

This is a report of our experiences with the automatic contrast medium injector at selective coronary angiography during 836 examinations, and the quantitative evaluation of 193 single injections. Using average injection volumes per single injection of 5.0 ml for the left and 2.5 ml for the right coronary artery, a clear reduction of the quantity of contrast medium at constant definition can be registered. The variability in increase in the injection flow from 0 up to the peakflow appears to be important according to the anatomic and pathologic facts. Frequently a contrast medium reflux occurs out of the coronary ostium into the aorta. On the whole, automatic injection at selective coronary angiography is a reproductible and extensible method with few risks.     

Multiphase contrast medium injection for optimization of computed tomographic coronary angiography

RATIONALE AND OBJECTIVES: Electron beam angiography is a minimally invasive imaging technique. Adequate vascular opacification throughout the study remains a critical issue for image quality. We hypothesized that vascular image opacification and uniformity of vascular enhancement between slices can be improved using multiphase contrast medium injection protocols. MATERIALS AND METHODS: We enrolled 244 consecutive patients who were randomized to three different injection protocols: single-phase contrast medium injection (Group 1), dual-phase contrast medium injection with each phase at a different injection rate (Group 2), and a three-phase injection with two phases of contrast medium injection followed by a saline injection phase (Group 3). Parameters measured were aortic opacification based on Hounsfield units and uniformity of aortic enhancement at predetermined slices (locations from top [level 1] to base [level 60]). RESULTS: In Group 1, contrast opacification differed across seven predetermined locations (scan levels: 1st versus 60th, P < .05), demonstrating significant nonuniformity. In Group 2, there was more uniform vascular enhancement, with no significant differences between the first 50 slices (P > .05). In Group 3, there was greater uniformity of vascular enhancement and higher mean Hounsfield units value across all 60 images, from the aortic root to the base of the heart (P < .05). CONCLUSIONS: The three-phase injection protocol improved vascular opacification at the base of the heart, as well as uniformity of arterial enhancement throughout the study.     

High-pitch dual-source CT coronary angiography with low volumes of contrast medium

Objectives

To assess the effect of lower volumes of contrast medium (CM) on image quality in high-pitch dual-source computed tomography coronary angiography (CTCA).

Methods

One-hundred consecutive patients (body weight 65–85 kg, stable heart rate ≤65 bpm, cardiac index ≥2.5 L/min/m²) referred for CTCA were prospectively enrolled. Patients were randomly assigned to one of five groups of different CM volumes (G₃₀, 30 mL; G₄₀, 40 mL; G₅₀, 50 mL; G₆₀, 60 mL; G₇₀, 70 mL; flow rate 5 mL/s each, iodine content 370 mg/mL). Attenuation within the proximal and distal coronary artery segments was analysed.

Results

Mean attenuation for men and women ranged from 345.0 and 399.1 HU in G₃₀ to 478.2 and 571.8 HU in G₇₀. Mean attenuation values were higher in groups with higher CM volumes (P?<?0.0001) and higher in women than in men (P?<?0.0001). The proportions of segments with attenuation of at least 300 HU in G₃₀, G₄₀, G₅₀, G₆₀ and G₇₀ were 89 %, 95 %, 98 %, 98 % and 99 %. CM volume of 30 mL in women and 40 mL in men proved to be sufficient to guarantee attenuation of at least 300 HU.

Conclusions

In selected patients high-pitch dual-source CTCA can be performed with CM volumes of 40 mL in men or 30 mL in women.

Key Points

? High-pitch dual-source coronary angiography is feasible with low contrast media volumes. ? Traditional injection rules still apply: higher volumes result in higher enhancement. ? The patient’s gender is a co-factor determining the level of contrast enhancement. ? Volumes can be reduced down to 30–40 mL in selected patients.     

CT pulmonary angiography with a macromolecular contrast medium: a comparative study versus iobitridol in rabbits

RATIONALE AND OBJECTIVES: To compare the pharmacokinetics of a new macromolecular iodinated contrast medium, prototype P743, with a standard contrast agent (iobitridol) for spiral computed tomography pulmonary angiography in rabbits. METHODS: Manual injection was first used to test the performance of P743 even in cases of nonoptimal bolus timing. Then a protocol was designed to compare vessel enhancement in both first-pass and delayed scans for the two contrast agents with the help of a power injector. RESULTS: With manual fast injection, the first pass of iobitridol was observed only on proximal scans. Conversely, opacification of vessels was maintained during three spiral scans with P743 under the same injection conditions. When optimal bolus timing was performed, higher vessel enhancement was observed during bolus first pass with iobitridol (iodine dosage 250 mg I/kg) compared with P743 (150 mg I/kg). However, during the postbolus phase, the decrease in attenuation values was markedly faster with iobitridol than with P743. CONCLUSIONS: This study confirmed that P743 remains more intravascular than iobitridol, which may have clinical implications for the diagnosis of pulmonary embolism, for example.