CONTRAST MEDIA

Dr.R.ABHIMAN GAUTAM,
MCh UROLOGY
PROF.Dr.RK UNIT
STANLEY MEDICAL COLLEGE
 HISTORY

 Harry W.Fischer – tree growth

 Roentgen- soil of tree

 Bin & Rath-iodinated pyridine drugs

to treat syphilis
 HISTORY

 Swick- Selectan neutral,

Uroselectan, Sodium mono iodo
hippurate

 Hoppe- HOCM- Diatrizoates &

Iothalamates.

 Almen- LOCM- Metrizamide

 CLASSIFICATION

 Tri iodinated benzene ring

 Ionic, Non ionic
 HOCM,LOCM,IOCM
 Monomer, Dimer
 PROPERTIES
 Ionic- Dissociate into anion
(- iodine) and cation
(+ Na,Meglumine).
 Non ionic – Hydrophilic, Don't
dissociate.
 Ratio of iodine atoms to dissolved
particles – Important.
 Hydrogen atom- Protein binding –
Anaphylactoid reactions.
 PROPERTIES
 Coloumb Effect – Decrease osmotoxicity
and ionicity
 Reducing ionising carboxyl with
hydrophilic structures- Non ionic
 Reducing neurotoxicity – Increasing the
number of hydroxyl groups and even
distribution.
 Non ionic dimers- Higher viscosity-
Resistance to catheter injection- reduced
by warming.
 PROPERTIES

 Sovak – To reduce viscosity ,ring

substitution with primary
carboxamides and utilization of
iodine hydrophobicity.
 COMPOUNDS
 HOCM
- Ionic monomer
Acetrizoate (1.5)
- Ionic
- Hydrogen atom present
Diatrizoate (1.5)
Iothalamate (1.5)
- Ionic
- Hydrogen atom replaced
 COMPOUNDS
 LOCM
- Non ionic monomer
Metrizamide (1.5)
- OHs added for hydrophilicity but
not evenly distributed.
Iohexol (3)
Iopamidol (3)
Ioversol (3)
- Balanced OHs
 COMPOUNDS

 IOCM
- Non ionic dimer
Iodixanol (6)
Iotrol (6)
- More and balanced OHs
- Increased viscosity
 MOLECULAR CHARACTERISITCS

 Osmolality
- HOCM : 1.5 (3 atoms of Iodine
per 2 molecules)
- LOCM
Non ionic monomers :3 ( 3 atoms
of iodine per molecule)
Non ionic dimers :6 (6 atoms of
iodine per molecule)
 MOLECULAR CHARACTERISITCS
 Density
-Ideal density :300mg/ml (monomer: 3 atoms of
iodine)
o Viscosity
- Inversely proportional to
temperature
- More with globular shape
 MOLECULAR CHARACTERISITCS

 Partition co-efficient
- Lipid solubility – Substituted by
hydroxyl groups
o Stability
- Shelf life of 3-4 years when
when protected from light.
- Light causes de-iodination.
- Ca disodium EDTA prevents
de iodination.
 PHYSIOLOGICAL EFFECTS
 Increase in Osmolality –
Intravascular shift – Increase in
blood volume by 16%.
 Generalised stimulation of
peripheral receptors – heat, pain,
involuntary movements.
 Pulmonary edema, CNS damage.
 Transient hypocalcemia,
Hyperkalemia.
 CM-ARF
RISK FACTORS
o Pre existing RF and DM
o Dehydration
o CVS disease and on diuretics
o Age greater than 75
o Multiple myeloma
o Hypertension
o Uricosuria
 CM-ARF
Diagnosis
-Persistent dense nephrogram for
more than 24hours.
- Bilaterally enlarged kidneys with
smooth outline.
- Poor PCS opacification.
- Collecting system effaced by
edema.
- Delayed dense nephrogram in 25%
 PREVENTION OF CM-ARF

 In normal renal function- 0.5%

 Usage of LOCM
 IV 0.45% NaCl at 100ml/hr,12
hours before and 12 hours after
contrast.
THANK YOU