XRAY AND CT

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
• Contrast media are divided into two main
categories.
• The first is negative contrast media,
• Radiolucent
• Low atomic number, causing the part in which they
are placed to be more readily penetrated by X-rays
than the surrounding tissue; as they attenuate the
X-ray beam less effectively than body tissue.
• Appear darker on the X-ray image. Gases are
commonly used to produce negative contrast on
radiographic images.
• The second type is positive contrast media
• Radio-opaque
• High atomic number, causing the part in which they are placed to
be less readily penetrated by X-rays than the surrounding tissue.
• Consequently, this contrast agent-filled area appears denser than
body tissue.
• Example: 1) Barium sulfate
USE: GI Studies.
• 2) Iodine compounds:
• USE: angiography, intravenous and retrograde urography,
hysterosalphingography ,sialography myelography
,cholangiography.
 IDEAL CONTRAST MEDIA

• High water solubility.

• Heat & chemical stability(shelf life) ideally- 3 to 5yrs.
• Biological inertness( non antigenic).
• Low viscosity.
• Low or iso-osmolar to plasma.
• Selective excretion, like excretion by kidney is favorable.
• Safety: LD50 (lethal dose) should be high.
• Reasonable cost.
CLASSIFICATION
 BARIUM SULPHATE

• Atomic number:56 • Can be used for double contrast studies.

• Route: Orally Or Rectally (aqueous suspension
• Highly radiopaque
with 0.3 to 1 g dry weight per milliliter)
• Non absorbable. • Uses:
• Non toxic. 1. Barium swallow

• Insoluble in water/lipid. 2. Barium meal

• Inert to tissues. 3. Barium meal follow through

4. Enteroclysis
5. Barium enema
 CONTRAINDICATION

• Integrity of gut wall compromised or GI Perforation.

• Previous allergic reactions to barium.
• Suspected fistula between oesophagus and lung.
WATER SOLUBLE IODINATED CONTRAST MEDIA

• Majority of I.V contrast media used in CT contain Iodine,

• It is preferred because:

1. High contrast density due to high atomic number.(53)

2. Low toxicity
3. Allows firm binging to highly variable benzene ring.
• Radio-opacity depends on: Iodine concentration of the solution, so dependent on number of iodine atoms
in each molecule of the contrast medium.
• Iodine particle ratio: The ratio of number of iodine atoms per molecule to the number of osmotically
active particles per molecule of solute in solution.
• Not used in MRI
WATER SOLUBLE IODINATED CONTRAST MEDIA

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
• Dissolve into solution into anion and
cation
• Usually have high osmolality
• Associated with more Adverse Effects
Non-Ionic
• Dissolve into water; but do not dissociate
• Lower osmolality (fewer particles in a
solution compared to ionic)
• 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

• Each molecule contains 2 non ionising

triiodinated benzene rings linked
together
• Iodine:Particle ratio is 6:1
• Molecular weight= 1550-1626
• Osmolality is around 300 mosmols/kg
• Eg: Iotrol, Iotrolan(Isovist)
 ADDITIVES USED IN CONTRAST MEDIA

• 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

• Contrast media used for myelography- non-ionic CM.

• CM used for cerebral angiography- only meglumine salt.
• Least osmolar- Ioxaglate (Hexabrix).
• Most hyperosmolar- Iohexol.
• Max nausea & vomiting- Ioxaglate (Hexabrix).
• Bronchospasm- Meglumine salts.
• Least viscosity- Omnipaque240
• Meticulous heparinization is required during angiography as incidence of thromboembolic
phenomenon is high when contrast is mixed with blood.
THANK YOU