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14-September-2008 18:02:39 - Contrast medium See also: Radiocontrast In a medical setting, a contrast medium is any substance that is used to enhance the visibility of structures or fluids within the body. An example of this is the use of a radiopaque substance during an x-ray exam to highlight features that would otherwise be less distinguishable from nearby tissue. Another example is the use of air bubbles during an echocardiogram to search for a shunt in the heart. Contents 1 Summary 2 Types of Positive Contrast Medium 2.1 Iodine Based Contrast Media 2.2 Non Iodine Based Contrast Media 2.3 Other 3 Types of Negative Contrast 4 Clinical Applications 4.1 Iodine Base Contrast Media 4.2 Non Iodine Based Contrast Madia Barium Studies 4.3 Other 4.4 Negative Contrast Media 5 Allergy Reactions 6 Drug Interactions 7 Toxicity 8 See also 9 References Summary The contrast can either be positive or negative. Positive contrast media has a higher attenuation density than the surrounding tissue. This means that the contrast looks more opaque than the surrounding tissue when seen on an x-ray. Negative contrast media has a lower attenuation density than the surrounding tissue. This means that the contrast looks less opaque than the body. Negative contrast is only found as a gas. Positive contrast is a substance with a high atomic number, but is also non-toxic. Contrast can be used to produce images of almost any hollow structure in the body. Types of Positive Contrast Medium Iodine Based Non Iodine Based Other Iodine Based Contrast Media Iodine based contrast media such as urografin or Omnipaque is used most commonly in radiology, due to its relatively harmless interaction with the body. It is primarily used to visualise vessels, but can also be used for tests of the urinary tract, uterus and fallopian tubes. Commonly used iodinated contrast agents Compound Name Type Iodine Content Osmolality Level Ionic Diatrizoate Hypaque 50 Ionic Monomer 300 1550 High Osmolar Ionic Metrizoate Isopaque Coronar 370 Ionic 370 2100 High Osmolar Ionic Ioxaglate Hexabrix Ionic dimer 320 580 Low Osmolar Non-Ionic Iopamidol Isovue 370 Non-ionic monomer 370 796 Low Osmolar Non-Ionic Iohexol Omnipaque 350 Non-ionic 350 884 Low Osmolar Non-Ionic Ioxilan Oxilan Non-ionic Low Osmolar Non-Ionic Iopromide Non-ionic Low Osmolar Non-Ionic Iodixanol Visipaque 320 Non-ionic dimer 320 290 Iso Osmolar Non Iodine Based Contrast Media These often appear in the form of barium sulfate. Barium is mainly used in the imaging of the digestion system. Other This would include gadolinium for use in magnetic resonance imaging as a contrast agent. Types of Negative Contrast Negative contrast always occurs in a gas, usually as one of the following: Air Carbon dioxide Oxygen Clinical Applications Examples of the use of positive contrast medium are as follows: Iodine Base Contrast Media Example of Iodine based contrast in Cerebral Angiography Example of Iodine based contrast in Cerebral Angiography Example of a DCBE Example of a DCBE Angiography Arterial Investigations Venography Venous Investigations VCUG Voiding Cystourethrography HSG Hysterosalpinogram IVU Intravenous Urography Non Iodine Based Contrast Madia Barium Studies Barium Enema Large Bowel Investigation Barium Swallow Oesophagael Investigation Barium Meal Stomach Investigation Barium Follow Through Stomach and Small Bowel Investigation Other Gadolinium, or Gad for short, is used as a component of MRI contrast agents, in the 3+ oxidation state the metal and has 7 unpaired f electrons. This causes water around the contrast agent to relax quickly, enhancing the quality of the MRI scan. Negative Contrast Media Examples of the use of negative contrast medium are as follows: DCBE Double Contrast Barium Enema Double Contrast Barium Meal CT Pneumocolon / Virtual Colonoscopy the use of air bubbles to aid the sonographic detection of a cardiac shunt Allergy Reactions Although rare, it is possible to be allergic to contrast media. Reactions can range from minor to severe, in the worst case scenario, resulting in death. Mild no treatment necessary Hot flush Vomiting Moderate treatment necessary, but no intensive care Urticaria hives Slight wheezing bronchospasm Severe life-threatening, intensive care necessary Respiratory arrest Cardiac arrest Contrast media is never given to a patient unless a doctor is present to assist should an allergic reaction occur. Patients are usually screened before being given contrast, by means of a series of questions. These typically include an allergy history and a history of any asthma and diabetes. Drug Interactions It has been recommended1 that metformin, an oral antidiabetic agent, be stopped for 48 hours following the intravascular administration of contrast media and that the use of metformin not be resumed until renal function has been shown to be normal. The reasoning is that if the contrast medium causes kidney failure as happens rarely and the person continues to take metformin which is normally excreted by the kidneys, there may be a toxic accumulation of metformin, increasing the risk of lactic acidosis, a dangerous complication. However, guidelines published by the Royal College of Radiologists suggest this is not as important for patients who receive 100mls of contrast media and have normal renal function. If renal impairment is found before administration of the contrast, metformin should be stopped 48 hours before and after the procedure.1. Toxicity See Contrast-induced nephropathy Nephrotoxicity toxicity to the kidneys is a major consideration for clinicians when requesting tests which use an iodine-based contrast media. Patients whose renal function is impaired usually with a creatinine 120 micromol/litre should only have contrast media if absolutely necessary. In these circumstances, a special form of contrast media, which is 'kinder' to the kidneys, can be given. See also Medical imaging Radiology Radiocontrast References ^ Thomsen HS, Morcos SK, and members of the Contrast Media Safety Committee of the European Society of Urogenital Radiology. Contrast media and Metformin. Guidelines to distinguish the risk of lactic acidosis in non-insulin dependent diabetics after administration of contrast media.European Radiology, 1999; 9: 738-740. Dorland's Illustrated Medical Dictionary Twenty-sixth ion ISBN 0-7216-1645-3 v d e Major drug groups Gastrointestinal tract/metabolism A stomach acid Antacids, H2 antagonists, Proton pump inhibitors Antiemetics Laxatives Antidiarrhoeals/Antipropulsives Anti-obesity drugs Anti-diabetics Vitamins Dietary minerals Blood and blood forming organs B Antithrombotics Anticoagulants, Antiplatelets, Thrombolytics Antihemorrhagics Cardiovascular system C cardiac therapy/antianginals Cardiac glycosides, Antiarrhythmics, Cardiac stimulant Antihypertensives Diuretics Vasodilators Beta blockers renin-angiotensin system ACE inhibitors, Angiotensin II receptor antagonists, Renin inhibitors Antihyperlipidemics Skin D Emollients Cicatrizant Antipruritics Reproductive system G Hormonal contraception Fertility agents SERMs Sex hormones Endocrine system H Corticosteroids Sex hormones Thyroid hormones Antithyroid agent Infections and infestations J, P Antibiotics Antivirals Vaccines Antifungals Antiparasitic Antiprotozoals, Anthelmintics Malignant and immune disease L Anticancer agents Immunostimulators Immunosuppressants Muscles, bones, and joints M Anabolic steroids Anti-inflammatories NSAID Antirheumatics Corticosteroids Muscle relaxants Brain and nervous system N Anesthetics General, Local Analgesics Anticonvulsants Mood stabilizers Psycholeptic Anxiolytics, Antipsychotics, Hypnotics/Sedatives Psychoanaleptic Antidepressants, Stimulants/Psychostimulants Respiratory system R Bronchodilators Decongestants H1 antagonists Other ATC V Antidotes Contrast media Radiopharmaceuticals Dressing v d e Contrast media V08 X-ray, iodinated Water-soluble Nephrotropic, high osmolar: Diatrizoic acid · Metrizoic acid · Iodamide · Iotalamic acid · Ioxitalamic acid · Ioglicic acid · Acetrizoic acid · Iocarmic acid · Methiodal · Diodone Nephrotropic, low osmolar: Metrizamide · Iohexol · Ioxaglic acid · Iopamidol · Iopromide · Iotrolan · Ioversol · Iopentol · Iodixanol · Iomeprol · Iobitridol · Ioxilan Hepatotropic: Iodoxamic acid · Iotroxic acid · Ioglycamic acid · Adipiodone · Iobenzamic acid · Iopanoic acid · Iocetamic acid · Sodium iopodate · Tyropanoic acid · Calcium iopodate Non-watersoluble Ethyl esters of iodised fatty acids · Iopydol · Propyliodone · Iofendylate X-ray, non-iodinated Barium sulfate MRI Paramagnetic Gadopentetic acid · Gadoteric acid · Gadodiamide · Gadoteridol · Mangafodipir · Gadoversetamide · Ferric ammonium citrate · Gadobenic acid · Gadobutrol · Gadoxetic acid Superparamagnetic Ferumoxsil · Ferristene · Iron oxide, nanoparticles Other Perflubron Ultrasound Microspheres of human albumin · Microparticles of galactose · Perflenapent · Microspheres of phospholipids · Sulfur hexafluoride Retrieved from http://en..org/wiki/Contrast_medium Categories: Medical imaging | Radiography Views Article Discussion this page History Personal tools Log in / create account Navigation Main page Contents Featured content Current events Random article Search Go Search Interaction Community portal Recent changes Contact Donate to Help Toolbox What links here Related changes Upload file Special pages Printable version Permanent link Cite this page Languages Türkçe 中文 日本語 Deutsch Norsk nynorsk Português This page was last modified on 12 September 2008, at 04:06
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