Contrast Agents Ii

The introduction of multidetector spiral CT into clinical practice is without any doubt one of the most important technical developments in the field of computed tomography in general, and spiral CT in particular, in recent years. Indeed, multislice CT technology, based on the spiral CT technique invented by W. Kalender almost 20 years ago, has opened immense and totally new perspectives for better utilisation of contrast medium during the examination, for optimal multiplanar reconstruction and for increased patient throughput. The potential applications, more specifically in the area of CT angiography of the brain and the heart and vessels, are most interesting and definitely contribute to better patient care as well as to more effi cient utilisation of equipment. These exciting new clinical applications explain the keen desire of radiologists and other clinicians to hear and learn more about the first results obtained with this new equipment in daily clinical practice. This book will satisfy their needs. Professor Maximilian F. Reiser was among the first to install multidetector CT in his department in Munich and to gain experience with this new radiological tool. He was also able to organise a very successful and well attended international meeting on this hot topic as early as z 2000 in Starnberg, Germany.

Two years only after the publication of the ? rst edition of “Contrast media – Safety issues and ESUR guidelines” in our book series Medical Radiology in 2006, it appeared that a second edition was urgently needed. The ? rst edition was indeed an exceptional success with our readership and sold out rapidly, but moreover the safety of MR contrast media urgently required a reappraisal after the publication of a new and dramatic adverse reaction to some of the gadolini- based agents: the so called NSF syndrome. I am very much indebted to Professor Henrik S. Thomsen and his academic colleagues from the ESUR Contrast Medium Safety Committee for accepting the task to prepare a second edition of their remarkable book.Within a record short period of time they have been able to complete this fully revised new volume. It offers to the readers a comprehensive overview of all problems related to the use of contrast media in modern radiology and of our latest knowledge and insights in the mechanisms of adverse reactions related to contrast media. It answers all questions that radiologists and referring physicians are confronted with in their daily practice when they consider the administration of these agents to their patients.

Journalists, always very direct and in search of sensation, essentially asked me two questions on the occasion of this workshop: What were the goals of the meeting? With the improvement of diagnosis through the development of image techniques, didn't the contrast media already have their future behind them? Many answers were provided during the course of the workshop, and in order to best answer the journalists I proposed the following synopsis. 1. Since the 1979 Colorado Springs workshop organized by E. Lasser, progress has been so rapid and the newly available works so numerous that another meeting on an international level for the purpose of pre senting and discussing these advances appeared indispensable. Why not then in Europe and why not in Lyon? To expand on this progress, by 1981 the new contrast media with less-hyperosmolar molecules, still in the trial stage in 1979, were al most all available commercially for angiography, albeit at prohibitive prices. The advantages of these various media are becoming better known; moreover, in the wake of Lasser's work, our understanding of the pathophysiology of their noxious effects is also advancing rapidly owing to the use of models (for the target organs: heart, vessel wall, nervous system, kidney; and for the more general reactions: blood cells, coagulation, complement system, circulating enzymatic systems). In addition, further new molecules are currently being studied in re search laboratories. 2.

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Extracellular MRI and X-ray contrast agents are characterized by their phar- cokinetic behaviour.After intravascular injection their plasma-level time curve is characeterized by two phases. The agents are rapidly distributed between plasma and interstitial spaces followed by renal elimination with a terminal half-live of approximatly 1–2 hours. They are excreted via the kidneys in unchanged form by glomerular filtration. Extracellular water-soluble contrast agents to be applied for X-ray imaging were introduced into clinical practice in 1923. Since that time they have proved to be most valuable tools in diagnostics.They contain iodine as the element of choice with a sufficiently high atomic weight difference to organic tissue. As positive contrast agents their attenuation of radiation is higher compared with the attenuation of the surrounding tissue. By this contrast enhancement X-ray diagnostics could be improved dramatically. In 2,4,6-triiodobenzoic acid derivatives iodine is firmly bound. Nowadays diamides of the 2,4,6-triiodo-5-acylamino-isophthalic acid like iopromide (Ultravist, Fig. 1) are used as non-ionic (neutral) X-ray contrast agents in most cases [1].

Radiology Secrets Plus—a Secrets Series title in the new PLUS format—offers an easy-to-read, information-at-your-fingertips approach to radiology. Drs. E. Scott Pretorius and Jeffrey A. Solomon provide the expert perspective you need to grasp the nuances of this specialty. This new edition offers more information and expanded full color visual elements to provide an overall enhanced learning experience. All this, along with the popular question-and answer approach, makes it a perfect concise board review tool and a handy clinical reference. Maintains the popular and trusted Secrets Series® format, using questions and short answers for effective and enjoyable learning. Provides the most current overview and authoritative coverage of all topics thanks to contributions from an impressive list of experts in the field of radiology. Introduces the new PLUS format, with an expanded size and layout and full color for easier review, more information, and more visual elements for an overall enhanced experience. Provides the current standards of radiology practice through thorough updates to every chapter that reflect the most up-to-date information. Contains more, larger images (including new full color PET and CT images), to offer a clearer picture of what is seen is practice.