1. CONTRAST MEDIA
Dr. Ahmed Refaey
FRCR

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

14. IODINATED CONTRAST AGENTS

15. Classification High osmolar contrast agents ( HOCA )
Low osmolar contrast agents ( LOCA )
* Ionic
* Non-ionic

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

17. LOCA
Non-ionic
Ionic
Ultravist
Omnipaque
Visipaue
Oxilan
Hexabrix

18. 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.

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

20. 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

21. 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 )

22. 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

23. *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

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

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

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

27. Urography

28. IVU

29. Cystogram

32. Urethrogram

33. Angiography

35. Sialogram

36. Sialogram

37. Fistulogram

38. PTC

39. PTC

40. ERCP

41. T-tube cholangiogram

42. HSG

43. HSG

44. GIT contrast agents

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

47. BARIUM SULPHATE

48. Barium sulphate
Thin barium : for upper GI studies, small bowel follow through, barium enema % BaSO4 solution.
Thick barium : for double contrast studies % BaSO4 solution

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

51. Complications:
Exacerbation of GI obstruction above a preexisting bowel obstruction
Intraperitoneal extravasation through gut perforation results in extensive fibrosis

52. Contraindication :
Bowel obstruction
Bowel perforation

53. Water soluble contrast medium (gastrografin )

54. Water soluble contrast medium (Gastrografin )
Oral contrast medium for opacification of GIT
Hygroscopic agent
Undiluted or diluted
Can be used as a substitute for barium if GI perforation is suspected.
In CT , diluted by 1:40

55. Complications Aspiration can cause chemical pneumonitis Diarrhea
Hypovolemic shock if used undiluted

66. CT contrast agents IV contrast medium
Oral water soluble contrast medium (gastrografin)

72. MRI contrast agent

73. MRI contrast agent
Gadolinium
Gd-DTPA IV

76. ULTRASOUND CONTRAST AGENT
Levovist / echovist IV

79. Thank you

80. All agents consist of radiodense iodinated Benzene ring.
Ionic agent typically formulated as Sodium and or meglumine salts.