Iodinated Contrast Medium in Clinical Neurology Practice: All Questions Answered
Keywords:
iodinated contrast medium, neurology, adverse reactions, contrast extravasation, contrast-induced nephropathyAbstract
Iodinated contrast medium (ICM) has been widely used for opacification of vascular structures, cerebrospinal fluid and other pathologies in neuroimaging via intravenous, intra-arterial and intrathecal routes. In this article, the authors explore several aspects of ICM use in clinical neurology practice using a question-and-answer format. This encompasses the molecular basis, categories, mechanisms of action, effects to the body, side effects, complications, preventive measures and managements of these unwanted effects
References
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Justesen P, Downes M, Grynne BH, et al. Injection-associated pain in femoral arteriography: a European multicenter study comparing safety, tolerability, and efficacy of iodixanol and iopromide. Cardiovasc Intervent Radiol. 1997;20(4):251-6.
Wang CL, Cohan RH, Ellis JH, et al. Frequency, Management, and Outcome of Extravasation of Nonionic Iodinated Contrast Medium in 69 657 Intravenous Injections. Radiology. 2007;243(1):80-7.
Thomsen HS, Webb JA. Contrast media: Berlin Heidelberg, Springer; 2014:245-51.
ACR Committee on Drugs and Contrast Media. ACR manual on contrast media: version 10.2: American College of Radiology Web site; Published 2016 [cited 2016 August, 15]. Available from: http://www.acr.org/~/media/37D84428BF1D4E1B9A3A2918DA9E27A3.pdf/.
Heinrich MC, Haberle L, Muller V, et al. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. Radiology. 2009;250(1):68-86.
U.S. Food and Drug Administration. FDA Approved Drug Products: FDA/Center for Drug Evaluation and Research; [cited 2016 August, 25]. Available from: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm.
Widmark JM. Imaging-related medications: a class overview. Proc (Bayl Univ Med Cent). 2007;20(4):408-17.
Bae KT. Intravenous Contrast Medium Administration and Scan Timing at CT: Considerations and Approaches. Radiology. 2010;256(1):32-61.
Smirniotopoulos JG, Murphy FM, Rushing EJ, et al. Patterns of contrast enhancement in the brain and meninges. Radiographics. 2007;27(2):525-51.
Shrier DA, Tanaka H, Numaguchi Y, et al. CT angiography in the evaluation of acute stroke. AJNR Am J Neuroradiol. 1997;18(6):1011-20.
Pinto RS, Berenstein A. The Use of Iopamidol in Cerebral Angiography. Investigative Radiology. 1984;19(5):S222-4.
Bettmann M. Angiographic contrast agents: conventional and new media compared. AJR Am J Roentgenol. 1982;139(4):787-94.
Pfeiffer FE, Homburger HA, Houser OW, et al. Elevation of serum creatine kinase B-subunit levels by radiographic contrast agents in patients with neurologic disorders. Mayo Clin Proc.1987 May;62(5):351-7.
Pasternak JJ, Williamson EE. Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist. Mayo Clin Proc. 2012;87(4): 390-402.
American College of Radiology. ACR–ASNR–SIR–SNIS Practice Parameter for the Performance of Diagnostic Cervicocerebral Catheter Angiography in
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Menon BK, d’Esterre CD, Qazi EM, et al. Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke. Radiology. 2015;275(2):510-20.
Yang CY, Chen YF, Lee CW, et al. Multiphase CT angiography versus single-phase CT angiography: comparison of image quality and radiation dose. AJNR Am J Neuroradiol. 2008;29(7):1288-95.
Barrett BJ, Parfrey PS, Vavasour HM, et al. A comparison of nonionic, low-osmolality radiocontrast agents with ionic, high-osmolality agents during cardiac catheterization. N Engl J Med.1992;326(7):431-6.
Bøhn H, Reich L, Suljaga-Petchel K. Inadvertent intrathecal use of ionic contrast media for myelography. AJNR Am J Neuroradiol. 1992;13(6):1515-9.
Visipaque (iodixanol) injection [prescribing information]. Princeton, NJ: GE Healthcare, May 2006. [ cited September 20, 2016].
McClennan B. Contrast media alert. Radiology. 1993;189(1):35.
Van der Leede H, Jorens P, Parizel P, et al. Inadvertent intrathecal use of ionic contrast agent. Eur Radiol. 2002;12(3):S86-S93.25. Omnipaque (iohexol) injection [product insert]. Princeton, NJ: GE Healthcare, May 2006. [cited September 20, 2016].
Lee BY, Ok JJ, Abdelaziz Elsayed AA, et al. Preparative fasting for contrast-enhanced CT: reconsideration. Radiology. 2012;263(2):444-50.
Beckett KR, Moriarity AK, Langer JM. Safe Use of Contrast Media: What the Radiologist Needs to Know. Radiographics. 2015;35(6):1738-50.
Morcos S, Thomsen H. Adverse reactions to iodinated contrast media. Eur Radiol. 2001;11(7):1267-75.
Schopp JG, Iyer RS, Wang CL, et al. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol. 2013;20(4):299-306.
Davenport MS, Cohan RH, Caoili EM, et al. Repeat Contrast Medium Reactions in Premedicated Patients: Frequency and Severity. Radiology. 2009;253(2):372-9.
Thomsen HS. European Society of Urogenital Radiology guidelines on contrast media application. Curr Opin Urol. 2007;17(1):70-6.
Namasivayam S, Kalra MK, Torres WE, et al. Adverse reactions to intravenous iodinated contrast media: a primer for radiologists. Emerg Radiol. 2006;12(5):210-5.
Duncan L, Heathcote J, Djurdjev O, et al. Screening for renal disease using serum creatinine: who are we missing? Nephrol Dial Transplant. 2001;16(5):1042-6.
Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009 Nov;4(11):1832-43.
European Society of urogenital radiology. ESUR guidelines on contrast media. European Society of urogenital radiology: European Society of urogenital radiology Website; [updated 2012; cited 2016 August, 10]. Available from: http://www.esur.org/guidelines/#.
Mruk B. Renal Safety of Iodinated Contrast Media Depending on Their Osmolarity–Current Outlooks. Pol J Radiol. 2016;81:157.
Nguyen SA, Suranyi P, Ravenel JG, Randall PK, Romano PB, Strom KA, et al. Iso-Osmolality versus Low-Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function. Radiology. 2008;248(1):97-105.
Hopyan J, Gladstone D, Mallia G, et al. Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol. 2008;29(10):1826-30.
Lima F, Lev M, Levy R, et al. Functional contrast-enhanced CT for evaluation of acute ischemic stroke does not increase the risk of contrast-induced nephropathy. AJNR Am J Neuroradiol. 2010;31(5):817-21.
Sudarsky D, Nikolsky E. Contrast-induced nephropathy in interventional cardiology. Int J Nephrol Renovasc Dis. 2011;4:85-99.
Bettmann MA. Frequently Asked Questions: Iodinated Contrast Agents. Radiographics. 2004;24:S3-S10.
Webb JAW, Thomsen HS, Morcos SK. The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005;15(6):1234-40.
Katzberg RW, Newhouse JH. Intravenous Contrast Medium–induced Nephrotoxicity: Is the Medical Risk Really as Great as We Have Come to Believe? Radiology. 2010;256(1):21-8.
Tao SM, Wichmann JL, Schoepf UJ, et al. Contrast-induced nephropathy in CT: incidence, risk factors and strategies for prevention. Eur Radiol. 2015:1-9.
Bruce RJ, Djamali A, Shinki K, et al. Background fluctuation of kidney function versus contrastinduced nephrotoxicity. AJR Am J Roentgenol. 2009;192(3):711-8.
McDonald RJ, McDonald JS, Bida JP, et al. Intravenous contrast material–induced nephropathy: causal or coincident phenomenon? Radiology. 2013;267(1):106-18.
Justesen P, Downes M, Grynne BH, et al. Injection-associated pain in femoral arteriography: a European multicenter study comparing safety, tolerability, and efficacy of iodixanol and iopromide. Cardiovasc Intervent Radiol. 1997;20(4):251-6.
Wang CL, Cohan RH, Ellis JH, et al. Frequency, Management, and Outcome of Extravasation of Nonionic Iodinated Contrast Medium in 69 657 Intravenous Injections. Radiology. 2007;243(1):80-7.
Thomsen HS, Webb JA. Contrast media: Berlin Heidelberg, Springer; 2014:245-51.
ACR Committee on Drugs and Contrast Media. ACR manual on contrast media: version 10.2: American College of Radiology Web site; Published 2016 [cited 2016 August, 15]. Available from: http://www.acr.org/~/media/37D84428BF1D4E1B9A3A2918DA9E27A3.pdf/.
Heinrich MC, Haberle L, Muller V, et al. Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. Radiology. 2009;250(1):68-86.
U.S. Food and Drug Administration. FDA Approved Drug Products: FDA/Center for Drug Evaluation and Research; [cited 2016 August, 25]. Available from: http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm.
Widmark JM. Imaging-related medications: a class overview. Proc (Bayl Univ Med Cent). 2007;20(4):408-17.
Bae KT. Intravenous Contrast Medium Administration and Scan Timing at CT: Considerations and Approaches. Radiology. 2010;256(1):32-61.
Smirniotopoulos JG, Murphy FM, Rushing EJ, et al. Patterns of contrast enhancement in the brain and meninges. Radiographics. 2007;27(2):525-51.
Shrier DA, Tanaka H, Numaguchi Y, et al. CT angiography in the evaluation of acute stroke. AJNR Am J Neuroradiol. 1997;18(6):1011-20.
Pinto RS, Berenstein A. The Use of Iopamidol in Cerebral Angiography. Investigative Radiology. 1984;19(5):S222-4.
Bettmann M. Angiographic contrast agents: conventional and new media compared. AJR Am J Roentgenol. 1982;139(4):787-94.
Pfeiffer FE, Homburger HA, Houser OW, et al. Elevation of serum creatine kinase B-subunit levels by radiographic contrast agents in patients with neurologic disorders. Mayo Clin Proc.1987 May;62(5):351-7.
Pasternak JJ, Williamson EE. Clinical Pharmacology, Uses, and Adverse Reactions of Iodinated Contrast Agents: A Primer for the Non-radiologist. Mayo Clin Proc. 2012;87(4): 390-402.
American College of Radiology. ACR–ASNR–SIR–SNIS Practice Parameter for the Performance of Diagnostic Cervicocerebral Catheter Angiography in
Adults. American College of Radiology Web site: American College of Radiology Website; [updated 2016; cited 2016 September, 20]. Available from: http://www.acr.org/~/media/261A171F55D744439FAACD9C61B0D462.pdf.
American College of Radiology. ACR-ASNR-SPR practice parameter for the performance of myelography and cisternography: American College of Radiology Website; [updated 2013; cited 2016 October 10, 2016]. Available from: http://www.acr.org/~/media/ACR/Documents/PGTS/guidelines/Myelography.pdf.
Menon BK, d’Esterre CD, Qazi EM, et al. Multiphase CT Angiography: A New Tool for the Imaging Triage of Patients with Acute Ischemic Stroke. Radiology. 2015;275(2):510-20.
Yang CY, Chen YF, Lee CW, et al. Multiphase CT angiography versus single-phase CT angiography: comparison of image quality and radiation dose. AJNR Am J Neuroradiol. 2008;29(7):1288-95.
Barrett BJ, Parfrey PS, Vavasour HM, et al. A comparison of nonionic, low-osmolality radiocontrast agents with ionic, high-osmolality agents during cardiac catheterization. N Engl J Med.1992;326(7):431-6.
Bøhn H, Reich L, Suljaga-Petchel K. Inadvertent intrathecal use of ionic contrast media for myelography. AJNR Am J Neuroradiol. 1992;13(6):1515-9.
Visipaque (iodixanol) injection [prescribing information]. Princeton, NJ: GE Healthcare, May 2006. [ cited September 20, 2016].
McClennan B. Contrast media alert. Radiology. 1993;189(1):35.
Van der Leede H, Jorens P, Parizel P, et al. Inadvertent intrathecal use of ionic contrast agent. Eur Radiol. 2002;12(3):S86-S93.25. Omnipaque (iohexol) injection [product insert]. Princeton, NJ: GE Healthcare, May 2006. [cited September 20, 2016].
Lee BY, Ok JJ, Abdelaziz Elsayed AA, et al. Preparative fasting for contrast-enhanced CT: reconsideration. Radiology. 2012;263(2):444-50.
Beckett KR, Moriarity AK, Langer JM. Safe Use of Contrast Media: What the Radiologist Needs to Know. Radiographics. 2015;35(6):1738-50.
Morcos S, Thomsen H. Adverse reactions to iodinated contrast media. Eur Radiol. 2001;11(7):1267-75.
Schopp JG, Iyer RS, Wang CL, et al. Allergic reactions to iodinated contrast media: premedication considerations for patients at risk. Emerg Radiol. 2013;20(4):299-306.
Davenport MS, Cohan RH, Caoili EM, et al. Repeat Contrast Medium Reactions in Premedicated Patients: Frequency and Severity. Radiology. 2009;253(2):372-9.
Thomsen HS. European Society of Urogenital Radiology guidelines on contrast media application. Curr Opin Urol. 2007;17(1):70-6.
Namasivayam S, Kalra MK, Torres WE, et al. Adverse reactions to intravenous iodinated contrast media: a primer for radiologists. Emerg Radiol. 2006;12(5):210-5.
Duncan L, Heathcote J, Djurdjev O, et al. Screening for renal disease using serum creatinine: who are we missing? Nephrol Dial Transplant. 2001;16(5):1042-6.
Schwartz GJ, Work DF. Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol. 2009 Nov;4(11):1832-43.
European Society of urogenital radiology. ESUR guidelines on contrast media. European Society of urogenital radiology: European Society of urogenital radiology Website; [updated 2012; cited 2016 August, 10]. Available from: http://www.esur.org/guidelines/#.
Mruk B. Renal Safety of Iodinated Contrast Media Depending on Their Osmolarity–Current Outlooks. Pol J Radiol. 2016;81:157.
Nguyen SA, Suranyi P, Ravenel JG, Randall PK, Romano PB, Strom KA, et al. Iso-Osmolality versus Low-Osmolality Iodinated Contrast Medium at Intravenous Contrast-enhanced CT: Effect on Kidney Function. Radiology. 2008;248(1):97-105.
Hopyan J, Gladstone D, Mallia G, et al. Renal safety of CT angiography and perfusion imaging in the emergency evaluation of acute stroke. AJNR Am J Neuroradiol. 2008;29(10):1826-30.
Lima F, Lev M, Levy R, et al. Functional contrast-enhanced CT for evaluation of acute ischemic stroke does not increase the risk of contrast-induced nephropathy. AJNR Am J Neuroradiol. 2010;31(5):817-21.
Sudarsky D, Nikolsky E. Contrast-induced nephropathy in interventional cardiology. Int J Nephrol Renovasc Dis. 2011;4:85-99.
Bettmann MA. Frequently Asked Questions: Iodinated Contrast Agents. Radiographics. 2004;24:S3-S10.
Webb JAW, Thomsen HS, Morcos SK. The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol. 2005;15(6):1234-40.
Katzberg RW, Newhouse JH. Intravenous Contrast Medium–induced Nephrotoxicity: Is the Medical Risk Really as Great as We Have Come to Believe? Radiology. 2010;256(1):21-8.
Tao SM, Wichmann JL, Schoepf UJ, et al. Contrast-induced nephropathy in CT: incidence, risk factors and strategies for prevention. Eur Radiol. 2015:1-9.
Bruce RJ, Djamali A, Shinki K, et al. Background fluctuation of kidney function versus contrastinduced nephrotoxicity. AJR Am J Roentgenol. 2009;192(3):711-8.
McDonald RJ, McDonald JS, Bida JP, et al. Intravenous contrast material–induced nephropathy: causal or coincident phenomenon? Radiology. 2013;267(1):106-18.
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2019-02-13
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เจนจิตรานันท์ พ, แก้วลาย ร. Iodinated Contrast Medium in Clinical Neurology Practice: All Questions Answered. J Thai Stroke Soc [Internet]. 2019 Feb. 13 [cited 2024 Nov. 13];16(1):23-4. Available from: https://he01.tci-thaijo.org/index.php/jtss/article/view/172086
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