The molecular structure of some iodinated contrast agents makes them suitable for the computer-tomographic examination of the biliary tract. Organic iodine compounds increase the attenuation of x-rays and the contrast between body tissues containing iodine and those tissues that do not contain iodine. The degree of opacification is directly proportional to the concentration and volume of the iodinated contrast agent (the total amount of iodine).
Biliary contrast agents can be taken orally, for example calcium iopodate, or intravenous meglumine iotroxate. The contrast media are excreted by the liver and concentrate in the gallbladder after passing the intrahepatic biliary tree and cystic duct.
Oral biliary contrast agents usually opacify the gallbladder after a few hours. If the gallbladder is removed, an intravenous cholegraphic agent is required and gallbladder CT can start 60 minutes after the beginning of contrast medium infusion.
The main limitation of the use of biliary contrast agents is the high rate of allergic reactions and of renal or hepatic toxicity. Caused by the potential for systemic toxicity with intravenous cholangiography, ultrasonography should be the preferred method for evaluation of the gallbladder and the bile ducts.

Biliscopin® Infusion, an iodinated contrast medium for intravenous cholecystography is secreted actively by the hepatocytes. The biliary excretion rate of a biliary contrast medium is determined by the binding to plasma proteins and liver receptor proteins, and by its transport maximum for the liver. Because of its high hepatocellular transport rate, Biliscopin® Infusion leads rapidly to high grade contrast density in the intra-hepatic and extra-hepatic biliary ducts as well as in the gallbladder.
Computed tomography with biliary contrast agents provides maximum quality preoperative imaging of the biliary tract.

(CA) Contrast agents are used to change the imaging characteristics, resulting in additional information about anatomy, morphology or physiology of the human body. Radiocontrast agents (also called photon-based imaging agents) are used to improve the visibility of internal body structures in x-ray and CT procedures. Contrast agents are also used to increase the contrast between different tissues in MRI (magnetic resonance imaging) and ultrasound imaging. The ideal imaging agent provides enhanced contrast with little biological interaction.
First investigations with radiopaque materials are done shortly after the discovery of x-rays. These positive contrast agents attenuate x-rays more than body soft tissues due to their high atomic weight. Iodine and barium have been identified as suitable materials with high radiodensity and are used until today in x-ray and CT contrast agents. Iodine-based contrast agents are water-soluble and the solutions are used nearly anywhere in the body. Iodinated contrast materials are most administered intravenous, but can also be introduced intraarterial, intrathecal, oral, rectal, intravesical, or installed in body cavities. Barium sulfate is only used for opacification of the gastrointestinal tract. Negative contrast agents attenuate x-rays less than body soft tissues, for example gas.

Iodinated contrast media are differentiated in;

Intravascular iodinated contrast agents are required for a large number of x-ray and CT studies to enhance vessels and organs dependent on the blood supply. Injectable contrast agents are diluted in the bloodstream and rapidly distributed throughout the extracellular fluid. The main route of excretion is through the kidneys, related to the poor binding of the agent to serum albumin. The liver (gall bladder) and small intestine provide alternate routes of elimination particularly in patients with severe renal impairment. The use of special biliary contrast agents is suitable for gallbladder CT and cholecystograms because they are concentrated by the liver to be detectable in the hepatic bile.
The introduction of fast multi-detector row CT technology, has led to the development of optimized contrast injection techniques. The amount of contrast enhancement depends on the contrast agent characteristics, such as iodine concentration, osmolality, viscosity, and the injection protocol, such as iodine flux and iodine dose. Adverse reactions are rare and have decreased with the introduction of nonionic contrast agents.
See also Contrast Enhanced Computed Tomography, Abdomen CT, Contrast Media Injector, Single-Head CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector, CT Power Injector.

(LOCM) Low-osmolar contrast media have a wide range of indications due to their lower side effects. The type of contrast media is an important risk factor for an adverse reaction.
LOCM have not completely replaced contrast media with higher osmolality due to their higher cost. Guidelines of professional organizations give recommendations for the selective use of low-osmolar contrast media for certain high-risk patients.
There are ionic and nonionic iodinated contrast materials with low osmolality available:
An adverse reaction occurs in low-risk patients who receive conventional ionic contrast agents more often than in high-risk patients who receive nonionic LOCM.

See also Contrast Enhancement, Biliary Contrast Agents, Safety of Contrast Agents and Contrast-Induced Nephropathy.