The first-generation contrast agents were all ionic monomers, consisting of a tri-iodinated benzene ring with 2 organic side chains and a carboxyl group. Diatrizoate or iothalamate are common iodinated anions, conjugated with a cation, sodium or meglumine. The ionization at the carboxyl-cation bond makes the agent water soluble.
Ionic monomers have the highest osmolality (high-osmolar contrast media (HOCM) possess an osmolality seven to eight times higher than plasma) of the different groups of contrast agents (CM ratio=1.5) and the lowest viscosity. The osmolality in solutions of ionic monomers ranges from 600 to 2100 mOsm/kg (human plasma = 290 mOsm/kg). These high osmolality is related to some of the adverse reactions. HOCM's have been widely replaced by newer contrast agents with improved tolerability and safety profiles.
Examples of HOCM's are Renografin®-60, Hypaque 76, Hypaque Meglumine, Hypaque Sodium and Conray®.

See also Ionic Contrast Agents.

(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.

A myelography is a radiographic imaging procedure to visualize the spinal canal, the spinal cord, cerebrospinal fluid (CSF), intervertebral disks and nerve roots. A special contrast agent (dye) is injected through a needle into the subarachnoid space of the spinal canal. A myelogram provides a very detailed picture of the spinal cord and spinal column. A fluoroscopy displays the bones and the fluid-filled space of the spine also in motion. An additional computerized tomography (CT or CAT) scan helps to differentiate the spinal conditions better. The indications include disc herniation, spinal stenosis, tumor, and vertebral fracture.

See also Myeloscintigraphy, Fluoroscopic System, Hounsfield Unit, Bone Densitometry, Nonionic Contrast Agents.

Omnipaque is a low-osmolar, nonionic, contrast medium with a broad range of indications, for example intravascular diagnostic procedures such as coronary angiography, spinal cord imaging, and body cavity procedures including shoulder and knee joints. Omnipaque is approved for use in adults and children, and is available in a wide variety of packagings.

See also Nonionic Contrast Agents.

A nonionic dimer consists of 2 joined nonionic monomers. Nonionic dimers are used as x-ray and CT contrast media.
Nonionic dimers have the lowest osmolarity. These contrast materials contain 6 iodine atoms for every 1 particle in solution (CM ratio=6). Modern CT techniques require fast bolus injections and thus low-viscosity, high-concentration, well-tolerated contrast agents. Nonionic dimers have the highest viscosity, which limits the clinical usefulness. Examples of nonionic dimers are iotrolan (Isovist®) and iodixanol (Visipaque).

See also Contrast Agents.