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PubMed2002

Cardiopulmonary arrest induced by anaphylactoid reaction with contrast media.

Anaphylactoid reactions to iodinated contrast media can cause life-threatening events and even death. A 44-year-old woman presented with cardiopulmonary arrest (CPA) immediately following the administration of nonionic iodinated contrast media for an intravenous pyelography. Her cardiac rhythm during CPA was asystole. She was successfully resuscitated by the radiologists supported by paged emergency physicians using the prompt intravenous administration of 1 mg of epinephrine. Neither laryngeal edema nor bronchial spasm was observed during the course of treatment, and she was discharged on the 4th day without any complications. The patient did not have a history of allergy, but had experienced a myocardial infarction and aortitis. She had undergone 11 angiographies and had been taking a beta-adrenergic receptor antagonist. Planned emergency medical backup is advisable to ensure resuscitation in the event of an anaphylactoid reaction to the use of contrast media in-hospital settings.

Adrenergic Agonists↗

PubMed1996

[Current problems with delayed reactions to intravascular administration of nonionic contrast media].

Administration of X-ray contrast media is essential in many radiologic procedures such as angiography, computed, tomography, and many other diagnostic methods. These substances have become made more tolerable since the introduction of the first water-soluble X-ray media. Adverse drug reactions decreased by the factor 4 with the development of nonionic contrast media compared to the elder ionic substances. At the same time, a shift to more frequent delayed reactions occurred. Currently the dimeric contrast media for intravascular use are suspected of causing frequent delayed side effects, especially with rashes and other cutaneous symptoms. In this paper, the reasons for adverse reactions independent of drug administration, are discussed. Causes related to patients and geographic differences are reviewed. Summing up, it may be said that the new dimeric contrast media are well tolerated drugs. A higher incidence of adverse drug reactions is not evident from scientific studies. A shift to more delayed side effects, especially, reactions is possible. The mechanism is still unclear. Additionally a classification of the time of incidence of side effects is proposed.

Contrast Media↗

PubMed1988

Red blood cell aggregation versus blood clot formation in ionic and nonionic contrast media.

The effects of ionic and nonionic radiographic contrast media on human blood in plastic syringes were investigated in an in vitro double-blind study. Venous blood, which was drawn into plastic syringes containing one of four (iohexol, iopamidol, diatrizoate sodium meglumine, and ioxaglate sodium meglumine) contrast media, was visually inspected at predetermined time intervals before and after mixing. Aliquots of the mixtures of blood and contrast media also were evaluated microscopically. Irregular red blood cell (RBC) aggregates were observed with the nonionic contrast media. Pronounced RBC morphologic alterations occurred with diatrizoate (ionic), and marked crenation was observed with ioxaglate (ionic). Observed aggregates were freely disaggregated in isotonic saline. Recovered supernatant blood from centrifuged aliquots of the mixtures was evaluated for clot formation. There was no evidence of blood clot formation within 1 hour after blood was introduced into syringes containing either ionic or nonionic contrast media. This time period exceeded the normal clotting time, since blood in syringes without contrast media formed clots within 30 to 45 minutes. Both the nonionic and ionic contrast media prolonged coagulation.

Blood Coagulation↗

PubMed1986

[Pharmacology of nonionic roentgen contrast media].

The non-ionic X-ray contrast media metrizamide, iopamidol, iohexol, and iopromide do not bind calcium and are less hyperosmolar than the conventional ionic contrast media, for instance amidotrizoate (diatrizoate), iothalamate, or ioglicate. Hence the use of non-ionic contrast media is associated with less undesirable side-effects that are attributable to hypertonicity such as an increase in circulating plasma volume, decreased deformability of red blood cells, damage of vascular endothelium with consequent activation of blood coagulation, the complement system and fibrinolysis, increased release of bradykinin and histamine, cardiac arrhythmias, diuresis, vasodilation and decreased blood pressure, pain and heat sensation. Because of less dilution the quality of imaging is also better. According to the intravenous LD50 in experimental animals the acute toxicity of non-ionic contrast media is lower than that of ionic media. With respect to contrast quality and the rate of side-effects the various non-ionic contrast media appear to be equivalent. Despite their higher price and higher viscosity it is probable that the non-ionic contrast media will replace the classical ionic media, especially in angio- and myelography.

Animals↗

PubMed1984

[Central venous injection of large amounts of contrast media--advantages of a low osmolar contrast medium in experimentally-induced pulmonary hypertension].

Intravenous administration of contrast material is a prerequisite for the imaging of the cardiovascular system with computed tomography and digital subtraction techniques. Fatal side effects after intravenous contrast injection, particularly in patients with pulmonary hypertension, have been reported repeatedly. The object of this study was to compare hemodynamic side effects of a conventional, ionic contrast medium (amidotrizoate; 2.1 osmol/kg) and a modern, non-ionic compound (iopamidol; 0.8 osmol/kg) after intravenous bolus injection (1.5 ml/kg). Experiments were carried out in 10 open-chest dogs with pulmonary normotension and hypertension induced by embolisation. Under control conditions (PPA = 19.9 mm Hg) both contrast media produced marked pulmonary and peripheral vasodilation. Major effects were seen after amidotrizoate (RPULM 60.3%, RPERI 32.1% vs 72.5% and 70.4% of controls). In pulmonary hypertension (PPA = 44.2 mmHg), iopamidol had similar hemodynamic effects compared to control conditions. In contrast, amidotrizoate initially led to a significant increase in pulmonary pressure and resistance (PPA = 118.6%; RPULM = 141.7%) followed by a delayed depression of right ventricular function (dP/dt = 65.3%; PRVED = 180.9%). Resuscitation was required in 3 dogs with pulmonary hypertension after amidotrizoate injection. Because of these unfavorable hemodynamic side effects of the conventional high osmolality contrast medium in animal experiments, it can be expected that modern compounds with low osmolality pruduce smaller side effects during diognostic interventions in patients with pulmonary hypertension.

Animals↗

PubMedDate not supplied

Death following intravascular administration of contrast media.

Adverse reactions to intravascularly administered contrast media preceding death and the autopsy findings in 44 patients are presented. There is a wide scatter of the age distribution of fatal reactions. The highest incidence is in the 50-70 year age group. Similar observations were obtained from the 405 deaths due to contrast media reported to the Food and Drug Administration of the United States. In the same age group the number of reactions is highest, likewise the autopsy findings. The predominant autopsy findings are pulmonary edema, congestion and hemorrhage; arteriosclerosis, both general and coronary. In the younger age group the autopsy findings are limited mostly to the respiratory tract. Fatal reactions to contrast media occur often without warning and most deaths occur within 15 min to 6 hours. Reactions to contrast media occur without relation to sex or age.

Adult↗

PubMed1986

Reactions to radiographic contrast media: an attempt to detect specific anti-contrast medium antibodies in the sera of reactor patients.

A radioimmunoassay was used in an attempt to detect specific anti-contrast medium antibodies in the sera of a group of 68 patients who reacted to radiographic contrast media and a group of 30 age-, sex- and disease-matched control patients who did not react. No evidence of specific antibodies of the IgG or IgE classes was demonstrated in these two groups. The results suggest the lack of an antibody-mediated aetiology for reactions to radiographic contrast media.

Antibodies↗

PubMed1980

Electrophysiological and mechanical effects of contrast media on isolated rat atria.

Cardiac complications caused by contrast media may occur during angiocardiography. The present study on spontaneously beating and electrically stimulated isolated rat atrial preparations investigated the direct effects on the myocardium of four different contrast media. A low-osmolar non-ionic compound, metrizamide, was compared with three ionic contrast media having different cation compositions: meglumine-Na-Ca metrizoate, meglumine-Na diatrizoate and meglumine iothalamate. The ionic contrast media at an organ bath concentration of 30 mg I.cm-3 produced a striking shortening of the effective refractory period. In addition, they reduced the spontaneous rate of contractions, prolonged sinus node recovery time and decreased excitability. Meglumine-Na diatrizoate and meglumine iothalamate induced great reductions in contractile force and "force-rate" product. Metrizamide influenced both the electrical and mechanical activities of the isolated rat atrial preparations to a smaller extent than the three ionic contrast media. The present study demonstrated direct arrhythmogenic and cardiodepressive effects of commonly used ionic contrast media. The low-osmolar non-ionic medium, metrizamide, appears to have lower cardiotoxicity than the ionic contrast media.

Animals↗

PubMed1993

[Experimental histopathological studies of renal lesions induced by high- or low-osmolality contrast media].

To elucidate the morphological basis of renal lesions due to intravenous administration of radiocontrast media, a comparative study was performed by injecting contrast media with different properties, such as high-osmolar ionic diatrizoate (60% Urografin), low-osmolar ionic ioxaglate (Hexabix 320) and low-osmolar non-ionic iopamidol (lopamiron 300), via the tail vein of male Wistar rats. Physiologic saline was injected in controls. Each contrast media was administered singly as a low dose (1 g I/kg), a moderate dose (3 g I/kg) or a high dose (9 g I/kg) to three separate groups of rats. In additional groups of rats, a high dose of each contrast media (9 mg I/kg) was administered repeatedly two or four times. The animals were sacrificed chronologically from 5 minutes to 30 days after the last administration and their renal tissues were examined by light and electron microscopy. The results indicated that the low osmolar contrast media is beneficial in decreasing general symptoms, but there are no definite differences between high and low osmolar contrast media in the data of blood and urine examination after administration. The iodinated contrast media with a low or moderate dose does not induce definite histopathological changes of the renal tissue, however, with a high dose it causes vacuolization of proximal tubular epithelia, although this change recovers within three days. The repeated administration of contrast media with a high dose induces severe damage of proximal tubular epithelia with prominent vacuolization, appearance of intracytoplasmic granular structure and occasional cell necroses. The vacuolization appears even in distal and collective tubules and glomerular epithelia. Recovery is retarded under this condition. There are no qualitative histological differences of renal lesions induced by the three different contrast media. In conclusion, either high or low osmolar contrast media induces almost the same histological alteration in renal tissues under the same experimental conditions. The more the quantitative increase in administered iodinated contrast media, the more prominent is the histological impairment of the kidney. The degree of renal lesion and its recovery might depend on the dose of iodine rather than the osmolality of the contrast media.

Animals↗

PubMed1989

Low-osmolality contrast media: a current perspective.

Intravascular radiographic contrast media play a major role in diagnostic imaging. Recently, low-osmolality contrast media (LOCM) have become available in the United States. Because of their lower osmolality, these new agents cause fewer undesirable physiologic effects and fewer adverse reactions than do conventional agents after intravascular administration. Unfortunately, the cost of LOCM is substantially higher than the cost of conventional contrast media. Appropriate use of these newer, more expensive contrast agents must be based on a thorough knowledge and understanding of their chemistry, physiologic features, and relative safety. Some questions remain about these new agents. Further studies are needed to determine the nephrotoxicity of LOCM relative to that of conventional agents. In addition, LOCM have less anticoagulant capacity than do the conventional media; therefore, clotting may occur when the LOCM and blood mix in syringes and small catheters. This potential decrease in anticoagulation and its clinical implications should be further investigated. Finally, the mortality rate associated with use of LOCM needs to be determined in future studies in large numbers of patients.

Contrast Media↗

PubMed1996

Thrombogenic potential of non-ionic contrast media--fact or fiction?

The role of contrast media in determining the occurrence of thromboembolic complications is not easy to define. Contrast media have a series of effects on blood constituents and on the hemostatic system. As for in vitro studies, it is generally agreed that ionic contrast media are stronger anticoagulants than nonionic, this being due to the fact that nonionic media are more inert on biological systems. This has been confirmed also in a recent paper comparing a nonionic monomer (iopamidol) with an ionic monomer (diatrizoate) and an ionic dimer (ioxaglate). Clinical data failed to demonstrate a greater thrombogenicity of one class of contrast media with respect to the other. The occurrence of thromboembolic complications in coronary angiography and PTCA is mostly related to operator experience and type of angiographic procedure.

Angioplasty, Balloon, Coronary↗

PubMed1998

Frequency of late allergy-like adverse reactions following injection of intravascular non-ionic contrast media. A retrospective study comparing a non-ionic monomeric contrast medium with a non-ionic dimeric contrast medium.

PURPOSE: A retrospective study was undertaken of the late adverse reactions following the injection of contrast media. The purpose was to determine whether there was a difference between non-ionic monomeric (iohexol) and non-ionic dimeric (iodixanol) contrast media in the reactions produced. MATERIAL AND METHODS: A total of 3,408 patients were sent a written questionnaire in which they were asked to confirm or deny any subjective discomfort or adverse event during a period of one hour to one week after a previous radiological examination with contrast medium. Patients who had undergone angiography (i.v. or i.a. injection) and CT (i.v. injection) were included. Objective signs of an allergy-like reaction were listed and the patients were asked to subjectively quantify any consequent discomfort. RESULTS: The compliance rate was 84%. Of the 3075 injections finally included in the study, 133 (4.3%) had resulted in contrast-medium-related adverse reactions of which 72 (2.3%) were immediate and 61 (2%) were late. Iohexol induced late reactions in 14/851 (1.7%) cases, and iodixanol in 24/1218 (2.0%) cases following i.v. injection and in 23/1006 (2.3%) cases following i.a. injection. The differences were not significant. There were no differences between the two contrast media in the subjective rating of discomfort except that the patients who had received iodixanol also had the highest individual-intensity score. No patient had been hospitalized owing to an adverse reaction and all reactions had been regarded as mild or moderate. CONCLUSION: The number of late adverse reactions was low. There was no difference in the frequency of the late adverse reactions following i.v. injection between iodixanol and iohexol. There was also no difference in the reactions between the i.a. and i.v. injections of iodixanol.

Contrast Media↗

PubMed2000

Delayed allergy-like reactions to X-ray contrast media: mechanistic considerations.

Iodinated X-ray contrast media are among the most frequently used pharmaceuticals for intravascular administration. Although the newer low osmolality, nonionic contrast media, are generally well tolerated, it is well known that they, like the ionic contrast media, give rise to immediate or delayed adverse reactions in susceptible individuals. In the present review, the delayed allergy-like reactions, which by definition occur more than 1 h after contrast medium administration, are described, and the possible pathophysiological mechanisms discussed. Delayed allergy-like reactions to contrast media, which have been reported to occur in 0.5-2% of recipients, are mainly mild to moderate skin reactions of the maculopapular exanthematous and urticarial/angioedematous types. Most of the reactions become apparent after a latency of 3 h to 2 days and disappear within 1 week. The incidence of more severe reactions is extremely low. Main risk factors for delayed allergy-like reactions appear to be a previous contrast medium reaction, a history of allergy, IL-2 treatment and being of Japanese descent. At present, the exact pathogenesis of these delayed reactions is still unclear. There is, however, increasing evidence that a significant proportion of the reactions are T-cell mediated.

Contrast Media↗

PubMed1997

Anaphylactoid reactions with gastrointestinal contrast media.

Significant anaphylactoid reactions to gastrointestinal contrast media are rare. Whether a patient who is atopic or has asthma is predisposed to these reactions is speculative. The rare patient who previously had a severe allergic reaction to such a product probably should not undergo a subsequent examination with a similar agent. The American College of Radiology classification of contrast media side effects can also be applied to the gastrointestinal contrast media.

Anaphylaxis↗

PubMed1996

Angiography with nonionic X-ray contrast media in severe chronic renal failure: renal function and contrast retention.

The effects of contrast media on renal function and the cortical retention of contrast media after abdominal angiography were investigated. Sixteen nondiabetic patients with predialytic chronic renal failure received either the nonionic dimeric contrast medium iodixanol or the monomeric contrast medium iohexol in a double-blind randomized study. All patients were well hydrated before, during and after angiography. Mean 99mTc-DTPA clearance was 14.0 ml/min/1.73 m2 in the iodixanol group, and 9.3 ml/min/1.73 m2 in the iohexol group at baseline. No statistically significant changes were seen after angiography. Serum creatinine increased significantly 48 and 72 h after angiography in both groups, and then normalized. Creatinine clearance was reduced only in the iohexol group, at 72-96 h. The urinary excretion of renal enzymes and of total protein did not change significantly. No patients developed oliguria or required dialysis during the 7-day observation period. Increased attenuation in the renal cortex, measured by computed tomography and probably reflecting intracellular retention of contrast medium, peaked at 24 h, and was observed in both groups during the follow-up period. Thus, although transient and minor changes in glomerular filtration rate were noted, both iodixanol and iohexol were safe for use in angiography in nondiabetic patients with severe chronic failure when the patients were well hydrated.

Adult↗

PubMed2003

Contrast media and the kidney: European Society of Urogenital Radiology (ESUR) guidelines.

The Contrast Media Safety Committee of the European Society of Urogenital Radiology (ESUR) has looked at the effects of contrast media on the kidney including prevention of contrast medium induced nephropathy. This has resulted in four reports dealing with 1) contrast medium induced nephrotoxicity, 2) haemodialysis and contrast media, 3) use of gadolinium contrast media instead of iodinated contrast media and 4) contrast media injection in diabetic patients receiving metformin. The review presents an overview of these four reports and offers the current understanding of the interaction between contrast agents and the kidney.

Biomarkers↗

PubMed1980

[Quality of roentgenological visualization and tolerance of various intravenous cholegraphic contrast media (author's transl)].

The recently introduced intravenous cholegraphic contrast media produce a greater diagnostic yield in radiological routine thanks to improved roentgenological contrasting. Whereas the percentage share of roentgenologically clearly assessable cases is about 75 % when using Biligrafin, this percentage is much higher with the more recent contrast media, especially Biliscopin, namely, up to 88 %. These new contrast media are also superior in respect of tolerance, since they produce fewer side effects. While side effects must be expected in about 28 % of the cases when injecting Biligrafin, the side effect quota is about 10 % only with Biliscopin or Endomirabil. If the contrast medium is infused instead of injected, the quota of side effect drops to 2.3 % with Biliscopin or 3.9 % with Endomirabil. Slight and medium side effects have definitely decreased with the more recent contrast media. The slower and more continually the contrast medium is administered, the fewer are the side effects observed; this becomes particularly noticeable in the case of long-term infusions. However, the likelihood of severe incidents caused by the contrast medium, remains unchanged at about 1 % of the examined patients, even with the more recently introduced contrast media.

Cholangiography↗

PubMed1993

Readability of informed consent forms for use with iodinated contrast media.

Informed consent forms used before intravenous administration of contrast media by both private practice (Pennsylvania Blue Shield) and academic (Association of University Radiologists) physician groups were analyzed to evaluate for readability and content. Most of the 160 consent forms required at least a high school education to be understood; 10 (6%) required a college education. Consent forms from academic institutions tended to be longer and contain more problems with sentence structure than those from private practice. Consent forms from both groups tended to have a weak, wordy writing style. Although most of the consent forms discussed at least some of the potential adverse reactions from intravenous contrast media, 37 (23%) made no mention of any potential adverse reaction. Indeed, 25 (16%) made no mention of contrast media at all. Only 12 (8%) consent forms included a discussion of nonionic contrast media. The authors provide sample consent forms that cover the common risks of ionic and nonionic contrast media and describe the availability of nonionic contrast media; these forms are understandable by an individual reading at only an eighth-grade level.

Comprehension↗