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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;

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.
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Contrast Enhanced Computed Tomography
(CECT) Contrast agents are used during contrast enhanced computed (or computerized) tomography examinations to highlight specific tissues and parts of the body. Bones can be clearly seen on x-ray images, the visualization of some other organs and soft tissues is more difficult. Sufficient contrast is important in perceiving a difference in the density between areas of a CT image. The identification of a disease may be challenging due to very low contrast between pathological tissues (for example tumors, metastases and abscesses), normal organ structures and surrounding tissues.
Contrast agents are used in CT angiography (CTA) to delineate vessels, in multiphasic CT studies to provide dynamic information of blood supply (e.g., liver CT) and in CECT studies of various body parts to achieve opacification of tissue of interest (e.g., kidney CT) in relation to the background tissue. Contrast enhanced multi-detector row CT (MDCT) replaces several conventional diagnostic imaging methods such as intravenous urography, cholangiography, or catheter angiography, due to advanced CT studies with fast examination times, high contrast enhancement, perfusion measurement and multiplanar reformatting capabilities.
See also Contrast Media Injector, Single-Head CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector, CT Power Injector.
Abdomen CT
A computed tomography (CT) of the abdomen images the region from the thoracic diaphragm to the pelvic groin. The computed tomography technique uses x-rays to differentiate tissues by their different radiation absorption rates.
Oral contrast material can be given to opacify the bowel before scanning. An i.v. injection of a contrast agent (x-ray dye) improves the visualization of organs like liver, spleen, pancreas and kidneys and provides additional information about the blood supply.
Spiral- or helical CT, including improvements in detector technology support faster image acquisition with higher quality. Advanced CT systems can usually obtain a CT scan of the whole abdomen during a single breath hold. This speed increases the detection of small lesions (caused by differences in breathing on consecutive scans) and is beneficial especially in pediatric, elderly or critically-ill patients.
Changes in patient weight require variations in x-ray tube potential to maintain constant detector energy fluence. An increased x-ray tube potential improves the contrast to noise resolution (CNR).

An abdominal CT is typically used to help diagnose the cause of abdominal pain and diseases such as:
appendicitis, diverticulitis;
kidney and gallbladder calcifications;
abscesses and inflammations;
cancer, metastases and other tumors;
pancreatitis;
vascular disorders.

Other indications for CT scanning of the abdomen/pelvis include planning radiation treatments, guide biopsies and other minimally invasive procedures. Advanced techniques include for example 3D CT angiography, multiphasic contrast-enhanced imaging, virtual cystoscopy, virtual colonoscopy, CT urography and CT densitometry.

See also Contrast Enhanced Computed Tomography.
Gas Ventilation Scintigraphy
A gas ventilation scintigraphy is a diagnostic imaging test of lung ventilation with radioactive noble gases during breathing maneuvers, e.g. with krypton (81mKr) or xenon (133Xe).
The radioactive gas is administered by a mask and requires a special delivery and trapping system (gas trap). The radioactivity in the lungs is measured with a gamma camera and is subsequently evaluated.
The use of krypton or xenon gases involves problems like the relatively short half-lives (about 15-30 seconds) and relatively high costs of xenon and krypton. The short half-life requires that the scan is performed directly after administration of the gas. In addition, the gaseous radiopharmaceutical is expelled from the body almost quantitatively within a few minutes of completing the study.
A ventilation scintigraphy combined with a pulmonary perfusion scintigraphy is highly sensitive for the detection of pulmonary embolism.
Radioactive noble gases are widely used as a ventilation agent to diagnose pulmonary embolism. However, 81mKr and 133Xe are rare and expensive, which limits their continuous availability. Tc99m-Technegas can be an alternative ventilation agent with the advantage of being less expensive and available daily.

See also Inhalation Scintigraphy.
Biliscopin® Infusion
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.

Drug Information and Specification
NAME OF COMPOUND
Meglumine iotroxate
INDICATION
Cholecystography, cholecystangiography
APPLICATION
Intravenous
PHARMACOKINETIC
Biliary excretion
0.29 mosm/kgH2O
IODINE CONCENTRATION
105 mg/mL
100 mL
PREPARATION
Ready-to-use product
STORAGE
Protect from light and x-rays
PRESENTATION
100 mL bottle
DO NOT RELY ON THE INFORMATION PROVIDED HERE, THEY ARE NOT A SUBSTITUTE FOR THE ACCOMPANYING PACKAGE INSERT!
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