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Nonionic Contrast Agents
 
Nonionic contrast agents are a group of contrast media that do not dissociate into charged particles. Many of the side effects of contrast agents are due to the injection of a solution with high osmolality compared to blood. Nonionic contrast agents have a low osmolality and tend to have less toxicity. However, as with all iodinated contrast agents, serious or fatal reactions have been associated with their use.
Due to their lower neurotoxicity, nonionic contrast agents can also be used for myelography. The only FDA approved agent, iodixanol, is iso-osmolar to blood, which makes it preferable for examinations of the central nervous system and cardiovascular studies. Because of its higher costs relative to other nonionic agents, the use is sometimes reserved for patients with high risk of nephrotoxicity.
See also Nonionic Dimer, Nonionic Monomer and CM Ratio.
  Further Reading:
  Basics:
Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media.Open this link in a new window
by www.ncbi.nlm.nih.gov    
Imaging-related medications: a class overview(.pdf)Open this link in a new window
'Imaging-related medications (contrast agents) are commonly utilized to improve visualization of radiographic, computed tomography ...'
October 2007 by www.baylorhealth.edu    
  News & More:
Non-Ionic ReactionsOpen this link in a new window
by www.cem.msu.edu    
Contrast Agents
 
(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:
point ionic contrast agents:
ionic dimer;
ionic monomer (high-osmolar contrast media).
point nonionic contrast agents:
nonionic dimer (low- or iso-osmolar contrast media);
nonionic monomer (low-osmolar contrast media).
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 and Abdomen CT.
  Further Reading:
  Basics:
POSITIVE CONTRAST MATERIAL: IODINATEDOpen this link in a new window
by www.e-radiography.net    
COURSE OF STUDY FOR THE CERTIFICATE OF COMPETENCE IN ADMINISTERING INTRAVENOUS INJECTIONS(.pdf)Open this link in a new window
'Contrast media (CM) are diagnostic agents used in radiology to enhance or create the necessary visual contrast in an image ...'
September 2006 by www.e-radiography.org    
Contrast Media: New Agents, New ConceptsOpen this link in a new window
'Contrast is a key factor in perceiving a difference in the density between areas of a radiographic image. Therefore, radiographic ...'
July 2006 by www.imagingeconomics.com    
Imaging-related medications: a class overview(.pdf)Open this link in a new window
'Imaging-related medications (contrast agents) are commonly utilized to improve visualization of radiographic, computed tomography ...'
October 2007 by www.baylorhealth.edu    
  News & More:
Contrast Medium Reactions, Recognition and TreatmentOpen this link in a new window
by www.emedicine.com    
Comparative cytotoxicity of high-osmolar and low-osmolar contrast media on HKCs in vitroOpen this link in a new window
'ABSTRACT: Background: Radiocontrast-induced nephropathy is a clinically important complication of intravascularly applied ...'
2006 by www.sin-italy.org    
NEUROTOXICITY(.doc)Open this link in a new window
'Neurotoxicity is the degree of toxicity produced by molecules of contrast media in contact with the central nervous system ...'
by www.centauro-online.it    
CT Clinical Practice: IV Contrast AdministrationOpen this link in a new window
'Administering IV contrast in the setting of renal insufficiency 1. At what level of serum creatinine do you become anxious ...'
by www.ctisus.org    
Guidelines for Contrast Media from the European Society of Urogenital RadiologyOpen this link in a new window
'This perspective will present all guidelines produced to date by the Contrast Media Safety Committee of the European Society of ...'
Wednesday, 2 July 2003 by www.ajronline.org    
Canadian Association of Radiologists: Consensus Guidelines for the Prevention of Contrast Induced Nephropathy(.pdf)Open this link in a new window
'The development of acute renal failure is a significant complication of intravascular contrast medium (CM) use and is linked ...'
by www.carj.ca    
 •• There are 4 news about 'Contrast Agents'.
Ionic Contrast Agents
 
Iodinated contrast agents (typically iodine-substituted benzene derivatives) are bound either in nonionic or ionic compounds. Ionic contrast agents consist of the negatively charged anion and the positively charged cation. Used components of the anion are for example diatrizoate, iodamide, iothalamate or metrizoate and of the cation the sodium or meglumine ion. The osmotic pressure depends on the number of particles in solution. Ionic contrast agents have a greater osmolarity; double that of nonionic contrast agents due to delivering more iodine atoms per molecule.
Ionic contrast agents were developed first and are still in use depending on the examination. Iodine based contrast media are water soluble and as harmless as possible to the body. However, ionic agents have more side effects compared to nonionic contrast agents due to their high osmolarity.
See also Ionic Dimer.
  Further Reading:
  Basics:
Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media.Open this link in a new window
by www.ncbi.nlm.nih.gov    
  News & More:
COURSE OF STUDY FOR THE CERTIFICATE OF COMPETENCE IN ADMINISTERING INTRAVENOUS INJECTIONS(.pdf)Open this link in a new window
'Contrast media (CM) are diagnostic agents used in radiology to enhance or create the necessary visual contrast in an image ...'
September 2006 by www.e-radiography.org    
Contrast-Induced Nephropathy
 
Contrast-induced nephropathy is a serious complication of intravascular x-ray contrast agents. The osmolality of the contrast medium is an important fact in contrast-induced nephropathy and should ideally be iso-osmolar to blood. Today, nonionic contrast agents are state of the art for vascular use, the ionic contrast agents caused more adverse reactions.
Signs of contrast-induced nephropathy after the application of vascular contrast agents are a serum creatinine increase of 0.5 mg/dL (In the United States, creatinine is typically reported in mg/dL, while in Canada and Europe µmol/L may be used. 1 mg/dL of creatinine is 88.4 µmol/L) or an increase of serum creatinine greater than 25%.

A higher risk of contrast-induced nephropathy is associated with:
point renal insufficiency;
point diabetes;
point reduced intravascular volume.
The use of a nonionic contrast agent, iso-osmolar to blood and a low dose reduces the risk for contrast-induced nephropathy.
  Further Reading:
  Basics:
Comparative cytotoxicity of high-osmolar and low-osmolar contrast media on HKCs in vitroOpen this link in a new window
'ABSTRACT: Background: Radiocontrast-induced nephropathy is a clinically important complication of intravascularly applied ...'
2006 by www.sin-italy.org    
Canadian Association of Radiologists: Consensus Guidelines for the Prevention of Contrast Induced Nephropathy(.pdf)Open this link in a new window
'The development of acute renal failure is a significant complication of intravascular contrast medium (CM) use and is linked ...'
by www.carj.ca    
Guidelines for Contrast Media from the European Society of Urogenital RadiologyOpen this link in a new window
'This perspective will present all guidelines produced to date by the Contrast Media Safety Committee of the European Society of ...'
Wednesday, 2 July 2003 by www.ajronline.org    
  News & More:
RadiocontrastOpen this link in a new window
'Radiocontrast agents (also simply contrast agents or contrast materials) are compounds used to improve the visibility of internal ...'
May 2007 by en.wikipedia.org    
CT Clinical Practice: IV Contrast AdministrationOpen this link in a new window
'Administering IV contrast in the setting of renal insufficiency 1. At what level of serum creatinine do you become anxious ...'
by www.ctisus.org    
 •• There are 2 news about 'Contrast-Induced Nephropathy'.
Omnipaque™
 
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.

Drug Information and Specification
NAME OF COMPOUND Iohexol
DEVELOPER GE Healthcare
INDICATION Brain and body computed tomography, urography, angiography
APPLICATION Intravascular
PHARMACOKINETIC Renal excretion
CHEMICAL BOND Nonionic monomer
OSMOLALITY 520, 672, 844 mosm/kgH2O
IODINE CONCENTRATION 240, 300 or 350 mg iodine
DOSAGE 50 to 250 mL depending on concentration and examination
PREPARATION Ready-to-use product
STORAGE Store below 30°Celsius (86°Fahrenheit)
PRESENTATION 50, 75, 100, 125, 150, 200 or 250mL bottle or +PLUSPAK (polymer bottle)
DO NOT RELY ON THE INFORMATION PROVIDED HERE, THEY ARE NOT A SUBSTITUTE FOR THE ACCOMPANYING PACKAGE INSERT!
  Further Reading:
  Basics:
Omnipaque? Package Insert(.pdf)Open this link in a new window
by www.amershamhealth-us.com    
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