Trends In Contrast Media

A different approach to contrast media, discussed primarily from the point of view of the radiologist. Comprehensive sections are devoted to iodinated contrast media and to the contrast media employed in magnetic resonance imaging and ultrasonography. The latest agents available receive due attention, as do adverse reactions. A final section considers the use of contrast media in nuclear medicine.

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].

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.

This revised edition of Contrast Media: Safety Issues and Guidelines, updates the successful first edition and contains new chapters. It provides an invaluable, unique and unparalleled source of information on the safety issues relating to contrast media.

Section I:Principles and challenges of MDCT / Introduction-I.1.MDCT:Technical principles and future trends-I.2.Contrast medium administration and scan timing for MDCT Section II:Abdominal imaging / Introduction-II.1.MDCT:Secondary malignancies and benign liver lesions-II.2.Primary liver malignancies-II.3.MDCT of the pancreas-II.4.Abdominal imaging:Use of high concentration contrast media Section III:Cardiac and vascular imaging / Introduction-III.1.Use of high concentration contrast media in CT angiography:Principles and rationale-III.2.Cardiac and vascular imaging:Cardiology indications-III.3.Aorta, peripheral and renal vessels-III.4.MDCT for diagnosis of pulmonary embolism: Have we reached our goal? Section IV:Future prospects in MDCT imaging / Introduction-IV.1.Interventional MDCT-IV.2.Functional CT imaging in stroke and oncology-IV.3.From acquisition to report: managing the information overload-IV.4.Recent update on contrast media safety

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.

Chronic kidney disease (CKD) is a major global public health problem, affecting nearly one in seven adults in the United States alone. It is a disease that integrates chronic illness at several levels, and the progressive condition is associated with high rates of co-morbidity. This text provides a comprehensive, current state-of-the art review of this field, serving as a valuable resource for primary care providers and non-nephrology clinicians that treat patients with CKD. It is comprised of 24 chapters focused on specific aspects of the disease. The first 2 chapters provide a bit of background on the disease, describing the anatomy and physiology of the kidney as well as the definition and epidemiology of the disease. The following 3 chapters discuss the detection, prevention and progression of the disease. The next 6 chapters describe the relationship of the disease with other conditions and most common co-morbidities such as diabetes and hypertension. The chapters, that follow focus on the CKD associated complications and the CKD within special populations such as the elderly and minorities as well as dietary restrictions and drug dosing. The book concludes with discussion on preparation for renal replacement therapy and preemptive organ transplantation as an alternative to dialysis in the management of the advanced CKD. Written by experts in the field, Approach to Chronic Kidney Disease is a comprehensive guide for clinicians, especially primary care providers including residents and fellows in training, who take care of chronic kidney disease patients. It is also a useful tool for researchers dealing with this challenging field.

This volume highlights and broadens our understanding of the correct use and the possible contraindications of contrast agents applied in radiology. Written by experts in the field, it not only focuses on the chemistry, physiochemical properties and pharmacokinetics of both iodinated and gadolinium-containing contrast agents, but also on the relevant safety issues such as frequency of their short- and long-term side effects and ways to avoid them nephrotoxicity risk related to the iodinated contrast agents NSF (nephrogenic systemic fibrosis) accumulation of gadolinium in the brain use of contrast agents in pediatric patients and pregnancy It also includes essential data on the use of contrast agents, such as scanning protocols, in the context of various clinical conditions. This comprehensive manual addresses all professionals involved in radiological imaging and is an invaluable tool for radiologists and technologists, as well as for residents and clinicians.