contrast agent
Jump to navigation
Jump to search
Classification
1st generation agents:
- iodinated, ionic
- very hyperosmolar (1500-1800 mOsm/kg of water).
2nd generation agents: (i.e. iohexol)
- non-ionic
- lower osmolarity (780 mOsm/kg of water)
3rd generation agent: (iodixanol)
- iso-osmolar to blood (290 mOsm/kg of water)
- least nephrotoxic agent
Indications
- for use in conjunction with diagnostic imaging
Contraindications
(cautions)
- sensitivity to contrast
- allergies to shellfish?[3]
- no reliable evidence that seafood allergy increases risk for allergic reaction to contrast media*[10]
- renal failure
- no need to avoid iodinated IV contrast agents in patients with mild-to-moderate renal dysfunction[14]
* contrast-enhanced CTs can be performed using the standard contrast medium without premedication in patients with seafood allergies[10]
Adverse effects
- anaphylactoid
- occur with 2-6% of procedures
- may have the clinical appearance of anaphylaxis, but are more appropriately termed anaphylactoid, because they do not involve IgE
- complement activation
- low ionic strength contrast agents are less likely to result in an adverse reaction
- For patients with prior radiocontrast hypersensitivity reactions, switching to a different contrast agent is recommended over premedication[13]
- previously, patients with a history of contrast reaction could be pretreated with the following protocol:
- 50 mg of prednisone every 6h for 3 doses, or 30 mg every 6 hours for 4 doses[3]
- last dose 1 hour before procedure
- 50 mg of diphenhydramine (Benadryl) at time of last dose
- guidelines (2023) recommend proceeding with non-ionic, low ionic or iso-osmolar contrast with consideration of premedication with glucocorticoid & antihistamine[11]
- nephrotoxicity (see contrast nephropathy)
- selection of alternative diagnostic procedure
- generally low morbidity & mortality
- contrast-enhanced CT not associated with contrast nephropathy in the emergency department[6][7]
- safe when GFR > 30 mL/min[9]
- iodinated contrast agents are associated with
- hypothyroidism (HR=1.6)
- hyperthyroidism (HR=3.0)[4]
- patients with underlying thyroid disease, most commonly multinodular goiter (toxic multinodular goiter)[11]
- extravasation of iodinated contrast*[12]
* image
Management
- patients with previous adverse reactions to contrast typically receive prednisone (50 mg) at 13 hours, 7 hours, & 1 hour before intravenous low-osmolality contrast material plus diphenhydramine (50 mg) at 1-hour prior[5]
- > 500 patients need pretreatment to prevent 1 severe reaction
patients with seafood allergy (shellfish allergy) should receive standard contrast agent[10]
More general terms
More specific terms
- barium sulfate (BaSO4, Baricon, Barite)
- contrast for evaluation of gastrostomy/duodenostomy/jejunostomy/cecostomy
- contrast for laryngography/bronchography
- diatrizoate
- ethiodized oil (Ethiodol)
- ferumoxides (Feridex)
- ferumoxsil (Gastromark)
- ferumoxytol (Feraheme, ferrosoferric oxide)
- flutemetamol F18
- gadolinium contrast (Omniscan)
- hippuran
- indigotindisulfonate (Indigo Carmine)
- iodamide meglumine (Renovue-65, Renovue-DIP)
- iodixanol (Visipaque)
- iohexol (Omnipaque)
- iopamidol (Isovue)
- iopanoic acid (Telepaque)
- iothalamate (Conray, Conray-400)
- ioversol (Optiray)
- ioxaglate (Hexabrix)
- ioxilan (Oxilan)
- ipodate (Oragrafin)
- iso-sulfan blue (Lymphazurin)
- mangafodipir (Teslascan)
- micro-bubble contrast agent
- sulfur hexafluoride (SonoVue, Lumason)
- tyropanoate (Bilopaque)
Additional terms
References
- ↑ Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 31, 598, 625
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, 15, American College of Physicians, Philadelphia 1998, 2009
- ↑ 3.0 3.1 3.2 Veterans Administration, Dept. of Radiology
- ↑ 4.0 4.1 Rhee CM et al. Association between iodinated contrast media exposure and incident hyperthyroidism and hypothyroidism. Arch Intern Med 2012 Jan 23; 172:153. PMID: https://pubmed.ncbi.nlm.nih.gov/22271121
- ↑ 5.0 5.1 Mervak BM et al. Rates of breakthrough reactions in inpatients at high risk receiving premedication before contrast-enhanced CT. AJR Am J Roentgenol 2015 Jul; 205:77 PMID: https://pubmed.ncbi.nlm.nih.gov/26102383
- ↑ 6.0 6.1 Hinson JS, Ehmann MR, Fine DM et al. Risk of acute kidney injury after intravenous contrast media administration. Ann Emerg Med 2017 Jan 19 PMID: https://pubmed.ncbi.nlm.nih.gov/28131489
- ↑ 7.0 7.1 Aycock RD et al. Acute kidney injury after computed tomography: A meta-analysis. Ann Emerg Med 2017 Aug 12 PMID: https://pubmed.ncbi.nlm.nih.gov/28811122
- ↑ American College of Radiology Manual on Contrast Media. v 10.3 https://www.acr.org/-/media/ACR/Files/Clinical-Resources/Contrast_Media.pdf
- ↑ 9.0 9.1 Davenport MS, Perazella MA, Yee J, et al. Use of intravenous iodinated contrast media in patients with kidney disease: Consensus statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020 Mar; 294:660. PMID: https://pubmed.ncbi.nlm.nih.gov/31961246 https://pubs.rsna.org/doi/10.1148/radiol.2019192094
- ↑ 10.0 10.1 10.2 10.3 NEJM Knowledge+ Question of the Week. Nov. 29, 2022 https://knowledgeplus.nejm.org/question-of-week/1239/
- ↑ 11.0 11.1 11.2 NEJM Knowledge+ Endocrinology
- ↑ 12.0 12.1 Corbella-Bagot L, Luque-Luna M Images in Dermatology Extravasation of Iodine Contrast JAMA Dermatol. 2023;159(11):1268-1269. PMID: https://pubmed.ncbi.nlm.nih.gov/37792372 https://jamanetwork.com/journals/jamadermatology/fullarticle/2810089
- ↑ 13.0 13.1 Wang C et al. Management and prevention of hypersensitivity reactions to radiocontrast media: A consensus statement from the American College of Radiology and the AAAAI. J Allergy Clin Immunol Pract 2025 May; 13:1029 Not yet indexed in PubMed https://www.jaci-inpractice.org/article/S2213-2198(25)00191-6/fulltext
- ↑ 14.0 14.1 Coleman C, Trubitt M, Topf J, Amin M. Things We Do for No Reason <TM>: Avoiding intravenous iodinated contrast material in patients with acute kidney injury or chronic kidney disease. J Hosp Med. 2025 Apr 21. PMID: https://pubmed.ncbi.nlm.nih.gov/40255127 https://shmpublications.onlinelibrary.wiley.com/doi/10.1002/jhm.70063
Goulden R, Rowe BH, Abrahamowicz M, Strumpf E, Tamblyn R. Association of Intravenous Radiocontrast With Kidney Function: A Regression Discontinuity Analysis. JAMA Intern Med. 2021 Jun 1;181(6):767-774. PMID: https://pubmed.ncbi.nlm.nih.gov/33818606 PMCID: PMC8022267 Free PMC article. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2778363 - ↑ Bednarczuk T, Brix TH, Schima W, et al. 2021 European Thyroid Association guidelines for the management of iodine-based contrast media-induced thyroid dysfunction. Eur Thyroid J. 2021;10:269-284. PMID: https://pubmed.ncbi.nlm.nih.gov/34395299