Iodinated contrast is a form of water-soluble, intravenous radiocontrast agent containing iodine, which enhances the visibility of vascular structures and organs during radiographic procedures. Some pathologies, such as cancer, have particularly improved visibility with iodinated contrast. The radiodensity of iodinated contrast is 25–30 Hounsfield units (HU) per milligram of iodine per milliliter at a tube voltage of 100–120 kVp.
Types Iodine-based contrast media are usually classified as ionic or nonionic. Both types are used most commonly in radiology due to their relatively harmless interaction with the body and their solubility. Contrast media are primarily used to visualize vessels and changes in tissues on radiography and CT (computerized tomography). Contrast media can also be used for tests of the urinary tract, uterus, and fallopian tubes. It may cause the patient to feel as if they have had urinary incontinence. It also puts a metallic taste in the patient's mouth. The iodine may be bound either in an organic (nonionic) compound or an ionic compound. Ionic agents were developed first and are still in widespread use depending on the requirements, but may result in additional complications due to the high concentration of ions (hyperosmolality). Organic agents that covalently bind the iodine have fewer side effects as they do not dissociate into component molecules. Many of the side effects are due to the hyperosmolar solution being injected. i.e., they deliver more iodine atoms per molecule. The more iodine, the more "dense" the X-ray effect. Organic iodine molecules used for contrast include iohexol, iodixanol, and ioversol. Iodine-based contrast media used nowadays are water-soluble. These contrast agents are sold as clear, colorless water solutions, with the concentration usually expressed as mg I/ml. Modern iodinated contrast agents can be used almost anywhere in the body. Most often they are used intravenously, but for various purposes they can also be used intra-arterially, intrathecally (as in diskography of the spine), and intra-abdominally – just about any body cavity or potential space. Heating non-ionic contrast agent to human body temperature reduces its viscosity. The amount of iodine administered in children in the United States in 2010 was 272 to 740 mg/kg for CT scan. Iodine contrast agents are used for the following:
Contrast CTs Angiography (arterial investigations) Myelography (spinal investigations) Venography (venous investigations) VCUG (voiding cystourethrography) HSG (hysterosalpingogram) IVU (intravenous urography)
Adverse effects Iodinated contrast agents may cause allergic reactions, contrast-induced nephropathy, hyperthyroidism, and possibly metformin accumulation. However, there are no absolute contraindications to iodinated contrast, so the benefits need to be weighed against the risks. Hypersensitivity towards iodinated contrast agent is associated with increase in histamine and tryptase concentration in blood. Diphenhydramine (Benadryl) 50 mg orally or intravenously one hour before contrast administration can reduce the risk of urticaria, angioedema, and respiratory symptoms. An observational study conducted across 133,331 patients concluded that iodinated contrast injected through veins has more hypersensitivity reactions than when injected through arteries. However, the cause for this phenomenon is unknown. In people with myasthenia gravis, older forms of iodinated contrast have caused an increased risk of exacerbation of the disease, but modern (low-osmolar) forms have no immediate increased risk.
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