Nonionic low-osmolality versus ionic high-osmolality contrast material for intravenous use in patients perceived to be at high risk: randomized trial.

Barrett, Brendan; Parfrey, Patrick S.; McDonald, Jay R.; Hefferton, Donna; Reddy, E. Ramanjaneya; McManamon, P J

doi:10.1148/radiology.183.1.1549654

Cited by 63 publications

(21 citation statements)

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“…The advent of a new generation of low-osmolality contrast media in the middle and late 1980s supposed an opportunity to reduce patient's discomfort and the incidence of adverse reactions, although these new contrast media were clearly more expensive than conventional HOCM. All reported series agree that LOCM cause fewer adverse reactions than HOCM [7,8,9]. But the use of LOCM has not been shown to reduce mortality.…”

Section: Discussionmentioning

confidence: 89%

Selective use of low-osmolality contrast media in computed tomography

2003

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The aim of this study was to describe our experience and institutional savings with a selective use of low-osmolality contrast media (LOCM) in CT. From 1995 to 1998, a total of 19,834 contrast-enhanced CT examinations were performed at our institution. Contrast was injected with a power injector and large venous catheter, 20-G for 2- to 3-ml rate and 18-G for 3- to 5-ml rate. High-osmolality contrast media was used in 13,670 patients (71%). The LOCM was used in 5884 (29%) patients. Our guidelines for the use of LOCM included cardiac dysfunction, severe pulmonary impairment, history of allergy or prior moderate reaction to HOCM and severe debilitation. Prior to the injection of HOCM, 10 mg of metoclopramide (Primperan, Delagrange Quétigny, France) were administered to reduce nausea and vomiting. In the HOCM group there were 304 minor or mild adverse reactions (2.2%), and 10 severe adverse reactions (0.08%). In the LOCM there were 34 mild or moderate adverse reactions (0.59%) and 3 severe adverse reactions (0.05%). Significant differences in terms of mild adverse reactions were found between HOCM and LOCM (Fischer's test, p<0.001). No significant differences were found in terms of severe adverse reactions ( p=0.27). After subtracting the cost of treating additional adverse reactions, the net differential cost between universal and selective use of LOCM was 565,285 Euro (601,067 US dollars). This means a net increase of 41.4 Euro per patient or 414,000 Euro per 10,000 patients (438,840 US dollars). Selective use of LOCM in CT is safe and effective and results in a substantial reduction in costs.

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Section: Discussionmentioning

confidence: 89%

Selective use of low-osmolality contrast media in computed tomography

2003

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“…Patients with a prior allergic reaction to intravenous contrast material, patients with asthma, and patients with cardiac or renal disease are at risk for having adverse reactions after the administration of contrast medium, especially ionic contrast medium (10). Patients in the emergency room are sometimes irritable and may be critically ill with acute abdominal pain.They may be in hypovolemic shock, or they may even lose consciousness during traumatic events.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of significance of clinical information and intravenous contrast administration for diagnostic accuracy during emergent abdominal computed tomographic examination

Yeung

Sheu

Chen

et al. 1997

Emergency Radiology

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The purpose of this study was to evaluate the need for clinical information and intravenous iodine contrast administration for disease diagnosis in patientslinical history is considered to improve the diagnostic rate of plain radiographs (1-3). Contrast-enhanced and nonenhanced computed tomographic (CT) studies are also important in the diagnosis of abdominal trauma (4, 5) and solid organ minors (6, 7). CT has been used as a good imaging modality to evaluate patients who present with acute abdominal pain from such conditions as appendicitis, diverticulitis, mechanical bowel loop obstrucuon, abdominal abscess, acute inflammatory lesions, bowel ischemia, liver abscess, acute pancreatitis, and abdominal trauma (8,9). Patients who present with an acute abdomen are frequently encountered in the emergency room. Emergent abdominal CT provides additional information for prompt diagnosis and management. Interventional or surgical decisions can be made quickly on the basis of the CT results (8). To our knowledge, a comparison study of the importance of clinical history and emergent CT with and without contrast enhancement has not 276 9 Diagnostic Accuracy in Abdominal CT Examination Emergency Radiology 9 September/October 1997 been described. This study was carried out to evaluate the influence of clinical history and nonenhanced and/or enhanced CT examinations on the diagnostic accuracy rate and to examine the possible controversial conditions. MATERIALS AND METHODSA prospective study of emergent abdominal CT examinations was randomly performed. One hundred fifty patients (85 males and 65 females; ages 2-98 years; mean age = 52.4 years) who presented with an acute abdomen were surveyed during a period of 3 consecutive months.The patients were scanned in a helical CT scanner (CT ProSpeed; General Electric Medical Systems, Milwaukee, WI). Nonenhanced and enhanced CT were both obtained for the same region of interest and using the same slice thickness of 10 mm and slice interval of ]0 n~n throughout the abdomen and pelvis. Oral contrast medium was not routinely used in our emergent abdominal CT study. Enhanced CT was obtained with an intravenous infusion of ]00 ml of contrast medium (meglumine iothalamate USR 60%). The nonenhanced and enhanced CT images of the same study were recorded on separate CT films so that the radiologists studying the nonenhanced images would obtain no information from the enhanced study.All diagnostic interpretations were provided sequentially in three phases: (1) nonenhanced CT studies with no available clinical history, (2) nonenhanced CT studies with clinical history provided, and (3) combined nonenhanced and enhanced CT studies with available clinical information. A total of 450 CT studies were thus evaluated. Three radiology specialists (G-C. L., K-W. Y., and Y-T. K.) participated in the research. At first, they interpreted the nonenhanced CT films with no available clinical information. Second, with clinical information provided, they studied the nonenhanced CT images again, but they were not ...

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“…Low-osmolal contrast media have been associated with smaller incidences of immediate hypersensitivity reactions than high-osmolal media [6][7][8]. Similarly, ionic media have been associated with higher risk of these reactions than nonionic media with higher adverse reactions attributable to cardiopulmonary decompensation [9,10].…”

Section: Hypersensitivity Reactionsmentioning

confidence: 99%

The use of gadolinium in patients with contrast allergy or renal failure requiring coronary angiography, coronary intervention, or vascular procedure

Saleh

Juneman

Movahed

2011

Cathet Cardio Intervent

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Coronary artery angiography remains an important procedure for the assessment of coronary arteries. It requires injection of iodinated contrast for the opacification of coronary arteries. Severe allergy to iodine contrast and renal insufficiency are two main problems with iodine-based contrast media. Gadolinium (Gd) has different chemical structure with no cross reactivity with iodine-based contrast media in patients with iodine allergy. The use of Gd is commonly used in contrast-enhanced magnetic resonance imaging for image enhancement, making it a potential alternative in patients in whom iodine is contraindicated. The aim of this manuscript is to review the available literature on the use of Gd in patients with contraindication to iodine contrast due to allergy or in patients with severe renal failure requiring coronary or vascular procedures.

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Nonionic low-osmolality versus ionic high-osmolality contrast material for intravenous use in patients perceived to be at high risk: randomized trial.

Cited by 63 publications

References 0 publications

Selective use of low-osmolality contrast media in computed tomography

Selective use of low-osmolality contrast media in computed tomography

Evaluation of significance of clinical information and intravenous contrast administration for diagnostic accuracy during emergent abdominal computed tomographic examination

The use of gadolinium in patients with contrast allergy or renal failure requiring coronary angiography, coronary intervention, or vascular procedure

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