Xray and CT Contrast Agents
Xray and CT Contrast Agents
Xray and CT Contrast Agents
CONTRAST AGENTS
BY DRNISHANT RAJ
POST GRADUATE RESIDENT
DMIMS, WARDHA
DEFINITION
Contrast media are substances used to highlight areas of the body in radiographic contrast to
their surrounding tissues.
Contrast media enhance the optical density of the area under investigation so that the tissue
absorption differentials are sufficient to produce adequate contrast with adjacent structures,
thus enabling imaging to take place.
TYPES OF CONTRAST
Routes of Administration:
1. Oral
2. Rectal
3. Intravenously
4. Intravertebral
5. Intrathecal (iohexol) & Intravesical
WATER SOLUBLE IODINATED CONTRAST MEDIA
• Basic building block is benzene ring with three iodine molecules attached at positions 2,
4, and 6.
• Side chains (at positions 3 and 5) are modified with hydroxyl groups or other molecules
that further define an agent’s properties.
• Exist as monomers (one benzene ring) or dimers (two benzene rings).
• Three defining physical characteristics of iodinated contrast agents: ionicity, osmolality,
and viscosity—play a distinct role in the tolerance and adverse reaction profiles.
IONICITY: IONIC VS NON-IONIC
Ionic Non-Ionic
• Dissolve into solution into anion and • Dissolve into water; but do not dissociate
cation • Lower osmolality (fewer particles in a
• Usually have high osmolality solution compared to ionic)
• Associated with more Adverse Effects • Lower incidence of AEs – hydrophilic,
reduced protein binding, low tendency to
cross cell membranes
OSMOLALITY
• In general, the higher the osmotic pressure the poorer the tolerance. Ionic contrast media
undergo this dissociation, whilst newer, non-ionic contrast media do not.
• Osmolality is directly responsible for a number of clinically important effects
• Both the viscosity of a contrast medium and its osmolality are INVERSELY related to
tolerance but directly to degree of opacification.
• With increasing strength of contrast medium, the opacifying power of the solution
increases, but so, of course, do the osmolality and viscosity, while tolerance tends to
decline.
VISCOSITY
• The practical importance of viscosity of a contrast medium relates chiefly to the force that
is required to inject .
• Viscosity increases as concentration increases and tends to be higher for big size
molecules. (Dimers).
• High viscosity interferes with mixing of contrast media with plasma and body fluids.
IODINATED CONTRAST MEDIA
IODINATED
CONTRAST
MEDIA
HIGH LOW
OSMOLAR OSMOLAR
IONIC
MONOMER NON-IONIC NON-IONIC IONIC
DIMER MONOMER DIMER
IONIC MONOMER/CONVENTIONAL CONTRAST
MEDIA
• Salts with sodium or meglumine(N-methylglucamine) as the non-radiopaque
cation and a radiopaque tri-iodinated fully substituted benzoic acid ring as the
anion.
• Triiodinated at C2, C4 & C6 of benzene ring.
• Completely dissociates in water solution therefore provides 3 iodine atoms for
two ions, giving iodine : particle ratio of 3:2
• Hypertonic, 6-8 times higherosmolality (>1400mosm/kg) than human plasma.
• Examples: Diatrizoic Acid: Urograffin, Trazograff etc
• Iothalamic acid(Conray, Triovideo)
• Replaced by non-ionic low osmolar contrast media
DISADVANTAGES OF HIGH OSMOLAR
CONTRAST MEDIA
• Osmolar concentration is very high i.e upto 8 times of the physiological level.
• Osmolar challenge to every cell, tissue and fluid in the body is responsible for their
adverse effects.
LOW OSMOLAR CONTRAST MEDIA
• Ionic Dimer
• Non-Ionic Monomer
• Non-Ionic Dimer
IONIC DIMER
• Ioxaglate (Hexabrix)
• Only compound, mixture of sodium and
meglumine salts .
• Two benzene rings (each with 3 iodine atoms) are
linked by a bridge to form a large compound,
carries only one carboxyl group, so known as
monoacid dimers.
• Molecular weight is= 1269
• Osmolality : 560 osmol/kg H2O
• Iodine Particle ratio is 6:2
NON-IONIC MONOMER
• Carboxyl group (-COOH) at C-1 is replaced by non ionising radical & CONH2
• Iodine:Particle ratio is 3:1
• Metrizamide(Amipaque) was the earliest non-ionic monomer and proved as an
excellent contrast media but was very expensive, impossible to autoclave and
unstable in solution.
• Osmolality is around 600 mosmols/kg
• Second Generation NIM are:
• Iohexol(omnipaque)
• Iopamidol(Iopamiro)
• Ioversol(optiray)
• Iopromide(Ultravist)
NON-IONIC DIMER
• Stabilizer: Ca or Na EDTA
• Buffers: Stabilizes pH during storage- Na Acid Phosphatases
• Preservatives.
PHYSIOLOGY OF WATER SOLUBLE IODINATED
CONTRAST MEDIA
• Concentration and Excretion mainly via
passive glomerular filtration.
• Net Tubular Excretion and protein
binding is negligible in the dose used.
• Liver and Intestine excrete 1% of these
compounds.
• Plasma life is 30-60 mins
IMPORTANT POINTS