CONTRAST MEDIA

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

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

17. LOCA

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----- 20% - LOCM ----- 5 % • 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 ---- 40% BaSO4 solution. • Thick barium : for double contrast studies ---- 85% BaSO4 solution

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