CONTRAST MEDIA

• Vashist B. Mhalsekar
•III year Medical Imaging Technology
•Goa medical college.
 Definition

 The contrast media are the agents

which are administered inside the body
to enhance the visualization of the
anatomical image.
 CONTRAST MEDIA

X-RAY & CT

ULTRA SOUND
Positive CM
MRI
Negative CM Air,CO2
BaSO4 Oily CM Iodinated CM Water soluble
 IODINE
 Most of the I.V. contrast media contain
Iodine which has an atomic number 53 and
atomic weight 127.
 Total Iodine content in the body is 50 mg.
 It’s preferred because
1. High contrast density due to high atomic
number.
2. Allows firm binding to highly variable
benzene ring.
3. Low toxicity.
 It’s not suitable for MRI..
WATER SOLUBLE IODINATED CONTRAST MEDIA

CLASSIFICATION

I. CONVENTONAL CONTRAST MEDIA/ HIGH

OSMOLAR/IONIC MONOMERS SALTS OF
 Diatrizoic acid
(Urovedeo,Trazograff,Urograffin,Angiograffin and
contrastin)
 Iodamic Acid
 Ioglicic Acid
 Iothalamic Acid (Conray , Triovideo)
 Ioxithalamic Acid
 IONIC DIMER

 Salts of
 Ioxaglic Acid ( Hexabrix)
 Iocarmic Acid
 NON-IONIC MONOMER

 Iohexol – (Omnipaque)
 Iopamidol –(Iopamiro)
 Ioversol –(Optiray)
 Iopromide –(Ultravist)
 Iopentol
 NON-IONIC DIMER

 Iotrol
 Iotrolan (Isovist)
 Iodixol
 PHYSIOLOGY
 Concentration and excretion of these contrast media
are predominantly by passive glomerular filtration.
Net tubular excretion and protein binding is
negligible in thee dose used. Liver and intestine
excrete 1% of these compounds.
 After Intravascular administration, first it diffuses into
the extravascular space (whole body opacification) and
is simultaneously excreted.Then equilibrium is
reached between intra and extravascular space in 10
min.Continued excretion and reentry of contrast
media from E.C.F. to I.C.F. lead to decrease in
plasma half life is 30-60 min.
 Contrast media are filtered from blood into Bowman’s
capsule by passive glomerular filtration.
 In the Bowman’s capsule, plasma concentration of contrast
media is the same as the blood.
 In Proximal Convulated Tubule, resorption of Na and H2O
causes 5-10 times concentration of contrast media.
 If the patient is on diuretics, the concentration does not
occur.
 Further increase in concentration of contrast media occurs
by counter current mechanism in the loop of Henle.
 In Distal Convulated Tubule by the action of ADH, the
concentration of contrast media further increases.
 CONTRAST MEDIA USED IN GIT

 INTRODUCTION
 The earliest contrast medium used in the GIT was iodised oil
( lipiodol ). However, due to its oily nature, it did not coat the
mucosa. Hence, later, Bismuth sulphate came to be used .
 At present the contrast medium of choice is Barium
Sulphate for GI studies are :
 (a) Ba has a high atomic number 56 . Therefore, it is highly
radiopaque.
 (b) Non absorbable, non – toxic.
 (c) Insoluble in Water or lipid .
 (d) Inert to tissues.
 (e) Can be used for double contrast studies.
 PROPERTIES OF AN IDEAL
BARIUM PREPARATION
1. High density for optimum study being
performed.
2. Stable suspension which does not settle.
3. Should not flocculate with secretions.
4. Low melting characteristics to give a good
and stable mucosal coating.
Other Contrast Media Used In
GIT
1. Gastrograffin
2. Non-Ionic Contrast media : Low osmolar
contrast media give better opacification of the
GIT and due to low osmolarity because less
electrolyte imbalance and can delineate small
intestine better than ionic media due to less
dilution.
(a) Oral cocktail
(b) Air or CO2
(c) Water
Contrast Media for CT in
GIT
 Contrast Media for MRI in
GIT
 GI contrast agents for MRI are being
developed with the dual aims of improving
anatomic delineation and permitting better
diagnosis of functional disosrders.
 TYPES

(A) POSITIVE CONTRAST AGENTS

 Water soluble :
(1) Ferric ammonium citrate.
(2) Manganese chloride. {e.g., Lumentlance -
BRACCO}
(3) Metal chelates including Gd-DTPA.

 Water immiscible :
1. Olive oil.
 (B) NEGATIVE CONTRAST AGENTS
 Water soluble :
1. CO2 tablets
2. Perfluorocarbons
3. Magnetites
 CONTRAST MEDIA USED IN ULTRASOUND

 Ideal Qualities of Ultrasound Contrast Agent

 High echogenicity
 Low attenuation
 Low blood solubility
 Low Diffusivity
 Ability to pass through pulmonary capillary bed
 Lack of biological effects with repeated doses
 Current generations of microbubbles have a diameter from 1-5
micrometer. The success of agents depends on the small and on the
stability of their shell.
 Also newer ultrasound contrast agent have prolonged persistence in the
vascular bed which provides consistence enhancement of the arterial
doppler signal.
 Also it is possible to perform dynamic and perfusionn studies
 The main mechanism for signal
enhancement are backscattering, bubble
resonance, and bubble rupture that is
highly dependentt on the acoustic power
of the transmitted ultrasound also known
as MECHANICAL INDEX.
Types of Ultrasound Contrast
Agent
A. Tissue Specific Ultrasound Contrast Agent
 Improves the assessment of certain organs like Liver,
Kidney, Pancreas, Prostate, and Ovary by improving the
acoustic differences between normal and abnormal
portions of organs.
 Levovist
 Sonovist (Schering)
 Sonozoid (Nycomed - Amersham)
 The bubbles rupture produces a transient pressure wave,
resulting in characteristic mosaic pattern from the
tissues, which is termed as induced acoustic emission.
 1. LEVOVIST

 First generation ultrasound contrast agent consisting

of galactose (milk sugar) ground into crystal whose
irregular surface acts as nidation sites on which air
pockets form when suspended in water.
 Used in echocardiography.
 In Vascular phase also it can be exhibit a tissue or
organ specific action. Gets accumulated in liver and
Spleen and improves detection of focal liver lesion.
 Levovist has been developed by SCHERING – AG.
The shell stabilizer is galactose or palmitic acid and
the gas used is air.
2.SONOVIST(from schering AG)
 A biodegradable synthetic capsule filled
with sulphurhexa fluoride.
 It is stable contrast media
 Microbubbles are stationary in this phase.
 Sonovist has been developed by
SCHERING – AG. The shell stabilizer is
cyanoacrylate and the gas used is sulphur
hexaflouride.
 B.Vascular Ultrasound
Contrast Agent
 These are gas microbubbles with a diameter less
than 5 to 10 micrometer to pass through lung
capillaries and into the systemic circulation.
 These are used in Imaging of Malignant tumours
in Liver, kidney, ovary, pancreas, and prostate.
 Also used in cardiac evaluation.
 Example:- Albunex and Infosan.
 Albunex has been developed by MALLICNODT
INC. The shell stabilizer is albumin and the gas
used is air.
 C. Contrast Agent for
Targeted Imaging
 Improve the Image contrast resolution
through differential uptake.
 High sensitivity and specificity.
 These agents permit noninvasive detection
of thrombus, carcinoma, Inflammation and
other sites where specific integrins or
adhesion molecules are expanded.
 Possible targets are molecular makers on
thrombus, endothelial cells and leucocytes.
 Types of Agents

 Schering produces three parenteral agents:

1. ECHOVIST
2. LEVOVIST
3. CAVISOMES
 Contrast Media used in
M.R.I.
 MRI is the modality of choice for study of
the central nervous system with its
extension into imaging of abdomen, pelvis
and musculoskeletal system because of its
high spatial resolution, soft tissue contrast
and multiplanar imaging.
 Requirements of an Ideal
Contrast Media
1. Image contrast
2. Tissue specific
3. Low toxicity and stability in vivo
4. Suitable shelf life
 Rapid clearance from the target tissue and safe
excretion through renal or hepatobiliary routes.
 MR is unique in that there are multiple parameters
responsible for signal sensitivity . so the contrast
agent must have the ability to influence these
parameters at low concentration to minimize dose
and potential toxicity.
 MRI Contrast Agents

(A) INTRAVENOUS
1. Ionic (Gd-DTPA)
2. Non-Ionic (Gadodiamide)
(B). INTRAVASCULAR
1. Gd – Labeled albumin
2. Chromium-labeled Red Blood Cells
3. Chromium- labeled Red Blood Cells
 (C) HEPATOBILIARY
1. Manganese chloride
2. Chelates
 (D) TUMOR SPECIFIC
1. Monoclonal Antibodies or
Metalloporphyrins or Nitroxides or
Ferrioxamine
 (E) RETICULOENDOTH
1. Gadolinium Oxide
2. Superparamagnetic Iron Oxide
3. Liposomes
 (F) GASTROINTESTINAL
1. Positive Contrast Agents: Paramagnetic
Agents or short H-relaxation Agents or
Combination Contrast Agents
2. Negative Contrast Agents: Diamagnetic
Contrast Agents or Superparamagnetic
Contrast Agents or Perfluorochemicals.