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CONTRAST MEDIA

CONTRAST MEDIA. Dr. Ahmed Refaey FRCR. Types of contrast media. * Iodinated : * HOCM * LOCM * GIT contrast agents * Barium sulphate * water soluble contrast media ( Gastrographin) * MRI contrast agent * Ultrasound contrast agent. IODINATED CONTRAST AGENTS.

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CONTRAST MEDIA

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  1. CONTRAST MEDIA Dr. Ahmed Refaey FRCR

  2. Types of contrast media * Iodinated : * HOCM * LOCM * GIT contrast agents * Barium sulphate * water soluble contrast media ( Gastrographin) * MRI contrast agent * Ultrasound contrast agent

  3. IODINATED CONTRAST AGENTS

  4. Classification

  5. HOCM • HOCA are in use since the 1950. * Urovist. * Urogarfin * Angiovist. * Conray. * Renografin. * Renovist. * Hypaque.

  6. LOCA

  7. LOCA have a lower incidence of adverse reactions by a factor of 6 for all reactions , and by a factor of 9 for the severe reactions.

  8. Toxic effects • Vascular toxicity • Soft tissue toxicity • Cardiovascular toxicity • Haematological changes • Thyroid function • Nephrotoxicity

  9. Nephrotoxicity • Incidence of contrast induced nephrotoxicity 5% • In the majority, renal impairment is temporary • Predisposing factors : * impairment of renal function * DM * dehydration * old age * large doses of CM * multiple myeloma

  10. Reactions of CM • Fatal reactions ( death ) -1/140,000 for HOCM 1/300,000 for LOCM -occur in minutes -old age -causes ( cardiac arrest – pulmonary edema – respiratory arrest – coagulopathy – laryngeal edema- bronchospasm )

  11. Non- fatal reactions 1-flushing, metallic taste in the mouth, nausea, sneezing, cough—common & related to dose and speed of injection. 2- urticaria 3- angioneurotic edema 4- bronchospasm 5- pulmonary edema 6- arrythmia 7- hypotension 8- delayed reactions: rashes , headaches, itching

  12. *Excluding death, adverse reactions can be classified in terms of severity as: • 1- major reactions : those that interfere with the examination and require treatment. • 2- intermediate reactions : those that interfere with the examination but do not require treatment. • 3- minor reactions : those that do not interfere with the examination and require only assurance

  13. Risk factors • allergy , asthma • Cardiac disease • Hepatic failure • Poor hydration • Co-administration of: glucophage • Previous reaction to contrast media - HOCM----- 20% - LOCM ----- 5 % • Other factors: * pheochromocytoma * sickle cell disease * hyperprotinemia ( multiple myeloma )

  14. High risk patients should either: 1 – be premeicated with steroids 2- to be evaluated with other modality ( U/S – MRI )

  15. Route of administration : intravenous • Uses : * CT study * urography ( IVP- urethrography_ cystography ) * angiography ( arteriography – venography ) * PTC, ERCP, T-tube cholangiography * hystrosalpingography * sialography * fistulography

  16. Urography

  17. IVU

  18. Cystogram

  19. Urethrogram

  20. Angiography

  21. Sialogram

  22. Sialogram

  23. Fistulogram

  24. PTC

  25. PTC

  26. ERCP

  27. T-tube cholangiogram

  28. HSG

  29. HSG

  30. GIT contrast agents

  31. Gastrointestinal contrast agents • BARIUM SULPHATE • WATER SOLUBLE CONTRAST MEDIUM (GASTROGRAFIN )

  32. BARIUM SULPHATE

  33. Barium sulphate • Thin barium : for upper GI studies, small bowel follow through, barium enema ---- 40% BaSO4 solution. • Thick barium : for double contrast studies ---- 85% BaSO4 solution

  34. Advantages : * excellent coating, allowing the demonstration of normal and abnormal mucosal patterns. * cost

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