Contrast Media in Imaging

1. IN THE NAME Of GOD
Amir al-Muminin, peace be upon him, said:
There is no wealth like wisdom, no destitution like ignorance, no
inheritance like refinement and no support like consultation.
‫املومنين‬‫ر‬‫امي‬(‫ع‬)‫فرمودند‬:
‫هيچ‬‌‫ي‬‫‌نياز‬‫ي‬‫ب‬‌‫ن‬‫چو‬،‫عقل‬‌‫و‬‫هيچ‬‌‫ي‬‫فقر‬‌‫ن‬‫چو‬‫ناداني‬،‫نيست‬‫هيچ‬‫ثي‬‫ر‬‫ا‬‌‫ن‬‫چو‬،‫ادب‬‌‫و‬‫هيچ‬
‫پشتيباني‬‌‫ن‬‫چو‬‫ت‬‫ر‬‫مشو‬‫نيست‬.

2. Contrast Media
September, 2014
Prepared by:
Behzad Ommani
Bachelor of Radiology
Master of Medical Engineering
Instructor Radiology Group

3. Iodinated Contrast Agents

4. Chemical Structure
Iodinated contrast media :
a) Inorganic iodine compounds
b) Organic iodine compounds
c) Iodized oils
Whole-body angiogram of human fetus

5. Iodized oils

6. Iodized oils
Lipiodol, the first of these uses was as a contrast media used in medical
radiology. The origin of this use is attributed to Jean-Athanase Sicard and
Jacques Forestier.
Be presented in 1922.
Lipiodol is a Poppyseed oil .
 Current Examination
a) Lymphangiography
b) Hysterosalpingography
c) Bronchography
d) Myelography
e) sialography

7. Lipiodol type
 High viscosity
Descending lipiodol
40% I , high viscid than C.S.F
 Low viscosity
Ascending lipiodol
10% I , low viscid than C.S.F

8. Disadvantages
 Toxicity
 Infection
 Excitation
 High concentration
 Non adherence to canal
 Problem in drive out after use
 Non absorption or slow absorption (1 ml in year)

9. substitute
Ethiodil, (Ultra fluid lipiodol)
Iodipin
Iodocholral
Dionosil oily
Myodil(Panopaque or Ethiodan)

10.  Just free Study
INDICATIONS:
Lymphography
Diagnosis of liver lesions
Embolization in association with surgical glues during vascular embolizations
Prevention of iodine deficiency disorders
Lymphography:
5 to 7 ml by intralymphatic injection only for opacification of a limb
(the dose being adapted to the height of the patient), i.e. 10 to 14
ml for bilateral pedal lymphography.

11.  Just free Study
Diagnosis of liver lesions:
The standard dose depends on lesion size and can vary from 2 to 10
ml per patient. LIPIODOL® ULTRA-FLUIDE is sometimes mixed
with small amounts of water-soluble iodinated contrast agents. The
CT scan should be performed 7 to 15 days after the selective
injection to allow the LIPIODOL® ULTRA-FLUIDE to be
eliminated from the non-tumoral liver tissue.

12. Organic iodine compounds

13. History
As early as 1886 the first Arteriography was performed in an amputated hand. A
contrast medium consisting of a suspension of chalk in water was injected into
the arteries.
The first water soluble iodine contrast medium was used in 1920 and was
discovered because patients with syphilis in those days were treated with sodium
iodide. The sodium iodide was observed in an image of the abdomen as an
"increased density" of the kidneys.
One especially interesting image is the
photograph of the hand of a corpse, taken by
means of the Roentgen rays, by Mr. Haschek and
Dr. Lindenthal, in Professor Franz Exner's
physicochemical institute in Vienna.

14. Applications & Type
A major development occurred in the beginning of the 1950s when it was found
that contrast media with three iodine atoms bound to a benzene ring had low
toxicity.
Water soluble iodinated contrast agents which diffuse throughout the
extracellular space are principally used for angiography, during computed
tomography (CT) and conventional radiography
They can also be administered directly into the body cavities, for example the
gastrointestinal tract and urinary tract.
Iodonated contrast
Non Ionic
Ionic

15. Chemical Structure
Iodinated contrast media compose:
a) I
b) Carrier molecule Benzen Ring
C6 H 6

16. Chemical Structure
COOH COOHI
I
I
Benzoic AcidBenzen Ring Tri-iodinated
Benzoic Acid
COOHI
I
I
R1 R2

17. Chemical Structure
 COOH
• Solve ability in water
 Siding Chain
• Toxicity & Solve ability in water
Note :
 Every change in Siding chain = change in Physico-chemistry properties
 Physiologic Absorption & Excitation
 Iodinated contrast media can be divided into two groups, ionic and nonionic
based on their water solubility

18. Ionic & Non Ionic Structure
R1
COOH
R2 R2R1
R3/ = I C=O- + R3

19. Ionic
Ionic contrast media chemically are salts of weak organic acids containing
iodine. Like most salts they will split into two particles, called an anion and a
cation, when dissolved in water.
The anions are iodinated benzene rings, where one of the side chains is a weak
organic acid (benzoic acid). They are either single benzoic rings (monomeric
contrast media) like diatrizoate, metrizoate or iothalamate, or as two linked
rings (dimeric contrast media) like iocarmate or ioxaglate.
The cations are either metals like Na+ (sodium), Ca++ (calcium) or Mg++
(magnesium) or organic cations like meglumine (methylglucosamine).

20. Compare meglumine and sodium salts
 Sodium
Higher water solubility than meglumin
Higher iodine than meglumin
Lower viscosity than megumin
 Meglumin
Lower crick and pain than sodium
Lower huart to intima

21. Non-ionic
Non-ionic contrast media are contrast media that do not dissociate when solved
in water.
In this group, sides chain (that do not dissociate ) put instead COOH.
First non ionic contrast media is Amipaque.
It was a revolution in compose contrast media.
But it has some disadvantages such as Cost sterilize and Non stable in solution
form.
Today, it has been applied in myelography

22. AMIPAQUE Discoverer
Nycomed develops the world's first non-ionic X-ray contrast
medium, Amipaque™ (first registration 1974), in collaboration
with Professor Torsten Almén of Lund University, Sweden. This
product introduced a new era in diagnostic imaging, providing
excellent images with far greater safety and comfort for the
patients and at the same time commanding a premium price.

23. Iodinated Contrast Media Characteristics
Favorite contrast media should be have :
1. Water solubility
2. Osmolality
3. Viscosity
4. Charge

24. Water solubility
Water is the most common molecule in the human body, both inside and outside
the cells. In order to enable a high contrast medium concentration in
extracellular water, high water solubility is necessary for contrast media in
urography, angiography, etc.
This water solubility is achieved in different ways by ionic and by non-ionic
contrast media.
Water is a polar solvent; the water molecules are electrically neutral (equal
numbers of positive and negative unit charges within the water molecule), but
the positive and negative charges are distributed so that there is a surplus of
positive charges (lack of electrons) at the site of the hydrogen atoms (which form
positive poles) and a surplus of negative charges (excess of electrons) around
the oxygen atom (which forms a negative pole).

25. Water solubility
 Ionic contrast media dissociate in water into electrically charged
particles named ions.
The positively charged ion may be a sodium ion or a meglumine
ion.
The negatively charged ion is the benzene derivative with three
iodine atoms and a negatively charged carboxyl group.
The ionic contrast media are water soluble because the positive
and negative ions are attracted to the negative and positive poles
of the water molecules.

26. Water solubility
Non-ionic contrast media are electrically neutral like the water
molecules.
The nonionic contrast media are water soluble because they
contain polar groups (OH-groups, hydroxyl groups) which have an
uneven distribution of electrical charges with excess electrons
around the oxygen atoms (forming negative poles) and a deficit of
electrons around the hydrogen atoms (forming positive poles).
The electrical poles in the OH-groups of the contrast media are
attracted to the electrical poles in the water molecules - thus
achieving water solubility.

27. Osmolality
A measure of total number of particles dissolved in a fluid, usually in
water. Particles can be small or large, have an electrical charge
(ions from salts, acids or bases) or be electrically neutral (sugars,
proteins). (mosm/kg)
Ionic contrast media are salts and split into an anion and a cation
when dissolved, while non-ionic contrast media result in a solution
of solution of intact molecules. This means that ionic contrast
media will have 2 particles per 3 iodine atoms ("ratio 1.5 ") while
non-ionic monomeric contrast media will have only particle per 3
iodine atoms ("ratio 3"), i.e. more iodine per unit.

28. Osmolality
Ionic monomeric contrast media will have an osmolality of more them 7 times
the osmolality of blood at the highest clinically used concentrations.
Ionic dimeric contrast media have a lower osmolality but unfortunately at the
cost of increased chemotoxicity. Ionic monomeric contrast media are also called
high osmolar contrast media, (HOCM).+
Non-ionic monomeric contrast media consist of one benzene ring with 3 iodine
atoms ("Ratio 3 "). Their osmolalities are about half that of ionic monomeric
contrast media, or 2.5-3 times the osmolality of blood at the highest available
concentrations.
Non-ionic dimeric contrast media have two linked iodinated benzene rings.
These molecules have 6 iodine atoms per particle ("Ratio 6 "). Non-ionic
contrast media are more physiological than the older, ionic ones, resulting in
examinations hampered by fewer and milder adverse reactions and discomfort.

29. Osmolality
Ionic dimeric contrast media behave like "ratio 3" contrast media
or low-osmolar contrast media.
Dimeric non ionic contrast media have 6 iodine atoms per particle
("ratio 6 "), and are isosmolar with blood and body fluids at all
available concentrations.

30. Osmolality

31. Viscosity
Viscosity is a measure of the resistance of a fluid which is being deformed by
either shear or tensile stress.
Cp (centipoise) or mpa/sec (mega pascal/sec)
Viscosity is measured with various types of viscometers and rheometers.
For some fluids, viscosity is a constant over a wide range of
shear rates (Newtonian fluids). The fluids without a constant
viscosity (non-Newtonian fluids) cannot be described by a
single number.

32. Viscosity depends on this factors:
 Liquid concentration
 Temperature
 Molecular size
T ----- move ability ----- flow
M.S ----- Viscosity ----- Dispose
C ----- number of particle solve ----- flow
Viscosity

33. Charge
Protein bonding
Enzyme blocking function
Heart muscle
Nervous system
Electrolyte balance

34. Compare ionic and non ionic
1. lower toxicity
2. Myelography
3. Chemical toxicity
4. Lower allergic reactions