Association between acute adverse reactions to iodinated contrast media and anxiety in patients undergoing contrast-enhanced CT examination / 中南大学学报(医学版)

OBJECTIVES@#As the use of iodinated contrast media has become more widely with advances in imaging, several guidelines have suggested that anxiety increases the risk of acute adverse reactions associated with iodinated contrast media. This study aims to evaluate the impact of anxiety on the occurrence of acute adverse reactions (AAR) to iodinated contrast media in patients undergoing contrast-enhanced CT examinations.@*METHODS@#Inpatients who underwent contrast-enhanced CT examinations at the Third Xiangya Hospital between February and October 2021 were prospectively recruited. Prior to the imaging examinations, all patients completed the Generalized Anxiety Disorder Scale-7 (GAD-7) assessment before the imaging examinations to determine the severity of anxiety, which was categorized as mild, moderate, or severe. Based on the occurrence of AAR, patients were classified into an AAR group and a non-AAR group. The difference in anxiety was compared between the 2 groups. Multivariate logistic regression analysis was used to identify independent risk factors associated with AAR. To ensure comparability between the 2 groups, propensity score matching (PSM) was utilized to align the clinical characteristics. Subsequently, the difference in anxiety within the matched groups was analyzed.@*RESULTS@#The study comprised 880 patients, with 80 patients in the AAR group and 800 patients in the non-AAR group. There was a significant difference in proportion of patients with mild-severe anxiety between the 2 groups (75% in the AAR group and 36% in the non-AAR group, P<0.001). Additionally, differences were also observed in occupation, income, underlying diseases, and allergy history (all P<0.001). The results of multivariate logistic regression analysis revealed that patients' income, allergy history, and anxiety were independent risk factors for AAR to iodinated contrast media (all P<0.05). Following PSM, each matched group included 66 cases, and no significant differences in clinical characteristics were observed between the 2 groups (all P>0.05). However, the proportion of patients with mild-severe anxiety remained significantly higher in the AAR group compared to the non-AAR group (75% in the AAR group and 31% in the non-AAR group, P<0.001).@*CONCLUSIONS@#Anxiety is associated with an increased risk of AAR to iodinated contrast media in patients undergoing contrast-enhanced CT examinations, suggesting the clinical importance of screening for anxiety before imaging examinations.

Research progress on desensitization of hypersensitivity reaction to iodinated contrast media / 浙江大学学报·医学版

Desensitization therapy for iodinated contrast media (ICM) aims to induce drug tolerance in patients with a history of severe allergic reactions to ICM in a short time. Currently, there is no widely accepted consensus on inducing desensitization to avoid severe allergic responses to ICM. The clinically successful cases have shown that prophylactic use of antihistamines and glucocorticoids can increase the desensitization effect; repeatedly desensitizing and gradually increasing the dose can be conducive to establishing better tolerance to ICM. Most desensitization effects, including stress resistance, can endure 24-48 h. The mechanisms of desensitization therapy remain unclear, the initial dose, administration interval and dose gradient are largely based on clinical experiences and the reaction of patients. This article reviews the current research progress on ICM-related allergies, desensitization methods and related mechanisms, as well as the benefits and hazards of desensitization, to provide a reference for desensitization treatment of hypersensitivity to ICM .

Radiación y medios de contraste en embarazo y lactancia: lo que el clínico necesita saber / Radiation and contrast media in pregnancy and lactation: what the clinician needs to know

Introducción: el uso de técnicas de imagenología es habitual e incluso indispensable en algunos procesos diagnósticos. Sin embargo, su indicación en mujeres embarazadas y en período de lactancia es controvertida. Objetivo: presentar una revisión narrativa sobre los riesgos asociados al uso de imágenes con radiación y medio de contraste en embarazo y periodo de lactancia, con énfasis en las recomendaciones y aplicaciones clínicas que el médico tratante debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de la literatura relevante sobre los riesgos y consideraciones especiales del uso de medios de contraste en el embarazo y lactancia. Resultados: los riesgos de la radiación ionizante sobre el feto varían de acuerdo al estadio del embarazo, por lo que la indicación del estudio debe ponderar los riesgos y beneficios. En las dosis clínicas en embarazo y lactancia, el uso de contraste yodado como basados en gadolinio no tienen efectos deletéreos en la salud de la madre ni la del feto. Sin embargo, las sociedades internacionales recomiendan limitar su uso. Conclusión: si bien la indicación de estudios de imagen que utilizan radiación ionizante en el embarazo y lactancia es seguro, el médico clínico debe conocer los posibles riesgos de la radiación ionizante en este grupo de pacientes. Respecto a los medios de contraste, el único efecto adverso reportado es la disfunción tiroidea transitoria en hijos de madres que recibieron medios de contraste yodado.

Introduction: the use of imaging techniques is essential in some diagnostic processes. However, its indication in pregnant and lac-tating women is controversial. Objective: To present a narrative review of the risks associated with using images with radiation and contrast media in pregnancy and lactation. Emphasis will be put on the recommendations and clinical applications that the physician must consider before its indication. Methods: a bibliographic review of the relevant literature on the risks and special considerations of contrast media in pregnancy and lactation was performed. Results: the risks of ionising radiation on the fetus vary according to the stage of pregnancy, so the indication of the study must balance the risks and benefits. The use of iodinated and gadolinium-based con-trast agents in clinical doses in pregnancy and lactation has no effects on the health of the mother or the fetus. However, international societies recommend limiting its use. Conclusion: Although the indication for imaging studies using ionising radiation in pregnancy and lactation is safe, the clinician must be aware of the possible risks of ionising radiation in this group of patients. The only adverse effect reported is transient thyroid dysfunction in children of mothers who received iodinated contrast media.

Safety of a rapid outpatient hydration protocol for patients with renal impairment requiring intravenous iodinated contrast media for computed tomography

INTRODUCTION@#Patients receiving intravenous iodinated contrast media for computed tomography (CT) are predisposed to contrast-induced nephropathy. Chronic kidney disease is an important risk factor, and hydration is the mainstay of prevention. While inpatients can undergo intravenous hydration, limited knowledge exists regarding regimens for outpatients. We employed a rapid outpatient hydration protocol to reduce postponement of imaging appointments for patients with suboptimal estimated glomerular filtration rate (eGFR).@*METHODS@#From June 2015, we amended our CT preparation protocol to mandate rapid hydration (oral, intravenous or both) for patients with an eGFR of 30-60 mL/min/1.73 m@*RESULTS@#226 outpatients received the hydration protocol, which correlated with a 95% reduction in postponement of imaging appointments. No complications of fluid overload from hydration were encountered. A significant association was observed between age and decrease in eGFR, but this was not significant when stratified by drop in eGFR category. No statistical significance was found between decrease in eGFR and gender or race. Higher baseline eGFR was less likely to be associated with decrease in eGFR after imaging. Type of hydration was not related to a drop in eGFR category for patients with an eGFR of 45-59 mL/min/1.73 m@*CONCLUSION@#We defined a shorter hydration regimen that is safe to use in the outpatient setting.

Medios de contraste intravascular en tomografía computada y resonancia magnética: lo que el clínico necesita saber / Intravascular contrast media in computed tomography and magnetic resonance imaging: what the clinician needs to know

Introducción: los medios de contraste en radiología se utilizan para mejorar la visibilidad de los tejidos normales y patológicos, lo que permite distinguirlos entre sí mediante la modificación de las características de imagen de los tejidos. Permite no solo una mejor evaluación morfológica de las lesiones, sino también una evaluación cinética funcional y de contraste. Objetivos: presentar una revisión actualizada sobre los medios de contraste intravascular en radiología, con énfasis en los conceptos que el médico clínico no radiólogo debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de literatura radiológica relevante sobre medios de contraste intravascular: clasificación, indicaciones, contraindicaciones y precauciones que debe adoptar el médico clínico. Resultados: aunque los medios de contraste en radiología tienen un excelente perfil de seguridad, su uso no está exento de riesgos y debe basarse en criterios apropiados después de una evaluación clínica exhaustiva, ponderando riesgos y beneficios para cada paciente individual. Conclusión: la comunicación entre médicos tratantes, nefrólogos y radiólogos es funda-mental para evaluar casos clínicos complejos o que requieran consideraciones especiales al momento de indicar la administración de un medio de contraste intravascular.

Introduction: Imaging contrast media are used to enhance the visibility of normal and pathologic tissues, allowing distinction of one another by modifying tissue imaging characteristics. This allows both enhanced morphologic assessment of lesions and also contrast kinetics evaluation. Objectives: To present an updated review on intravascular imaging contrast media. Emphasis will be put on useful concepts that general physicians must take into account when indicating contrast-enhanced imaging studies.Methodology: A bibliographic review of relevant imaging literature on intravascular contrast media was performed: classification, appropriate indications, contraindications, and tips for proper use by the general physician. Results: Although imaging contrast media have an excellent safety profile, its use is not risk-free and must be based on appropriateness criteria applied after a thorough clinical evaluation, balancing the risks and benefits for each patient. In particular, intravascular contrast media, such as those based on iodine for computed tomography and gadolinium chelates for magnetic resonance imaging, must be used with caution. Conclusion: Effective communication between radiologists and referring physicians is key in the evaluation of complex cases that require protocol adjustments when considering the use of intravascular contrast media for imaging studies.

Ultrassonografia modo B e Doppler na avaliação renal de cães submetidos à tomografia computadorizada após administração intravenosa de diferentes meios de contraste iodado / B-mode and Doppler ultrasonography in the renal evaluation of dogs undergoing computed tomography after intravenous administration of different iodinated contrast media

A nefropatia induzida por contraste (NIC) é uma doença de caráter agudo, secundária à administração intravascular de meios de contraste iodado (MCI). Dentre os mecanismos fisiopatológicos desta enfermidade destacam-se a vasoconstrição intrarrenal prolongada, consequente redução da perfusão renal, hipóxia e isquemia medulares, associada ao dano tubular renal devido à citotoxicidade do contraste. Frente à existência de poucas informações relacionadas a estes mecanismos na literatura médico-veterinária, objetivaram-se comparar os efeitos renais da administração intravenosa de MCI não iônicos de diferentes osmolaridades, em grupos de cães com fatores de risco para o desenvolvimento da NIC, por meio das avaliações ultrassonográficas modo B, Doppler colorido, de amplitude e pulsado, pareada aos exames laboratoriais, a fim de estimar indiretamente o potencial nefrotóxico de cada contraste. Constituíram-se dois grupos de acordo com o MCI utilizado: o grupo GIH [11 cães receberam iohexol (baixa osmolaridade)] e o grupo GID [sete cães receberam iodixanol (isosmolar)]. Administrou-se a dose de 600mgI/kg/IV em ambos. Avaliaram-se os seguintes aspectos renais antes da administração do MCI (momento basal) e após 1h30min, 24 horas e 48 horas: morfometria (comprimento e volume), morfologia, ecogenicidade cortical e perfusão renais e resistência vascular intrarrenal (índices hemodinâmicos de resistividade e pulsatilidade). Realizou-se ainda exame de urina e se mensuraram as razões gama-glutamil transferase:creatinina (GGT:C) e proteína:creatinina (RPC) urinárias e a concentração sérica de creatinina. Os grupos apresentaram comportamentos similares para comprimento, volume, RPC, exame de urina e creatinina sérica. Em relação ao índice de pulsatilidade (IP), os grupos apresentaram comportamentos não similares, mas sem diferenças significantes entre o momento basal e os demais. Para o índice de resistividade (IR) e a razão GGT:C urinária, os grupos revelaram comportamentos não similares e se constataram aumentos significantes do IR e da razão GGT:C urinária no período de 1h30min após a administração do contraste, somente para o grupo que recebeu iohexol. Concluiu-se que o IR pode ser utilizado para monitorar a hemodinâmica intrarrenal, visto que junto com a razão GGT:C urinária, demonstrou a existência de maior potencial nefrotóxico do iohexol, quando comparado ao iodixanol. Dessa forma, considera-se o uso do iodixanol, opção favorável para cães com fatores de risco para o desenvolvimento da NIC.(AU)

Contrast-induced nephropathy (CIN) is an acute disease, secondary to intravascular administration of iodinated contrast media (ICM). The most important mechanisms of this nephropathy are intrarenal prolonged vasoconstriction, medular hypoxia, and ischemia associated with renal tubular damage due to contrast cytotoxicity. Owing to the limited information available in veterinary literature regarding these mechanisms this study aims to compare the renal effects of intravenous administration of two nonionic ICM of different osmolarities in groups of dogs with risk factors for CIN development, by using a B-mode, color, power- and pulsed-wave Doppler ultrasonography, and other laboratory tests, in order to indirectly estimate the nephrotoxic potential of each contrast. The following two groups were established according to the nonionic ICM used: the GIH group [11 dogs administered iohexol (low osmolarity)] and the GID group [seven dogs administered iodixanol (iso-osmolarity)]. Both the groups were administered the same dose (600mgI/kg/IV). The following renal aspects were evaluated before administration of ICM (baseline) and after 1h30min, 24h, and 48h: renal morphometry (length and volume), renal morphology, cortical echogenicity, renal perfusion, and intrarenal vascular resistance (resistive and pulsatility indices); in addition, urinalysis was performed, and urinary gamma-glutamyl transferase:creatinine ratio (GGT:C), urinary protein:creatinine ratio (UPC), and serum creatinine were also measured. Both groups showed similar characteristics with respect to the length, volume, UPC ratio, urinalysis, and serum creatinine levels. No similarity was observed with respect to the pulsatility index (PI) in both the groups and there were no significant differences between baseline and 1h30min, 24h and 48h time points. With respect to the IR and urinary GGT:C, both groups showed no similarity, and significant increases were observed in the resistive index (RI) and urinary GGT:C only in the GIH group, 1h30min after contrast administration. In conclusion, RI can be used to monitor intrarenal hemodynamics, and along with the urinary GGT:C, revealed that iohexol had higher nephrotoxic potential than iodixanol. Thus, iodixanol is considered a favorable option for dogs with risk factors for CIN development.(AU)

Risk Factors for Adverse Reactions to Iodinated Contrast Media in Computed Tomography

OBJECTIVE: The increasing use of imaging examinations such as computed tomography (CT) results in increased contrast media use, which increases contrast media-induced adverse reactions (AR). This study investigated the risk factors of ARs to nonionic iodinated contrast media. METHODS: This study evaluated patients who were administered iodinated contrast media during CT scanning in Yeouido St. Mary's Hospital in Seoul, Korea in 2012. Among the subjects, those with contrast media-induced ARs were classified as the AR group. The control group included individuals without ARs who were selected through simple random sampling. The effects of sex, age, contrast media type and dose, CT region, previous contrast media administration, allergy history, and comorbidity were analyzed in the AR and control groups. RESULTS: Multivariate logistic regression analyses were performed to evaluate the identified AR risk factors in 103 subjects in the AR group and 412 subjects in the control group. The results confirmed that the risk of developing ARs was significantly higher in females [odds ratio (OR): 2.206; 95% confidence interval (CI): 1.353-3.598], in individuals administered Iohexol (OR: 9.981; 95% CI: 2.361-42.193), in individuals with an allergy history (OR: 3.982; 95% CI: 1.742-9.101), and in individuals with comorbid asthma (OR: 6.619; 95% CI: 1.377-31.826). Most of the ARs were mild and immediate. CONCLUSION: In patients who were administered contrast media during CT scans, female gender, Iohexol use, allergy history, and asthma were risk factors for ARs. Therefore, special care is required for patients with such risk factors to prevent ARs.

Analysis of Allergic Adverse Reaction Caused by Non-ionic Iodinated Contrast Media in 52 Patients With Coronary Angiography / 中国循环杂志

Objective: To analyze the current status of allergic adverse reactions caused by non-ionic iodinated contrast media in patients with coronary angiography (CAG). Methods: A total of 1 225 patients who received non-ionic iodinated contrast media for CAG in our hospital from 2011-02 to 2013-09 were retrospectively studied. There were 52 patients suffered from allergic adverse reactions including 47 (90.38%) male and 5 (9.62%) female. The allergic reaction to iodixanol, iohexol, iopamidol and iopromide were in 34, 3, 3 and 12 patients respectively. The clinical symptoms and outcomes of allergic reaction in 4 iodinated contrast media were analyzed. Results: There were 40/52 (76.92%) patients with mild allergic reaction, 11(21.15%) with moderate and 1 (1.92%) with severe reaction. 13 patients had the reaction within 1 hour of contrast media injection and 39 had the reaction between 1 hour to 3 days of contrast media injection. There 34 patients were cured by symptomatic and anti-allergic treatment, 1 patient was rescued from allergic shock and no death occurred. Conclusion: Application of non-ionic iodinated contrast media in CAG is safe, while closely observe the allergic adverse reaction with the in time and symptomatic treatment is very important in clinical practice.

The influence of different kinds of iodine contrast media on thyroid function / 介入放射学杂志

With the rapid development of medical imaging technique, iodinated contrast media (IOCM) has become the most commonly used agent in performing imaging diagnosis and interventional therapy. The use of IOCM, especially the use of non-ionic iodine contrast media, has been swiftly increased in recent years. The accompanying untoward reactions, such as allergic reactions, cardiovascular reactions, contrast media nephropathy, thyroid toxicity, etc. prove to be the new problems that greatly perplex the medical circle. With the continuous improvement of the knowledge to the untoward reactions, more and more physicians have paid attention to contrast media induced thyroid toxicity. At present, researches concerning iodine contrast media thyroid toxicity are still few, and the relevant research is particularly rare in China. This paper aims to make a review about the influence of different kinds of iodine contrast media on thyroid function.

Adverse reactions to intravenous iodinated contrast media: a prospective study.

Background: Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be sub classified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. This study was done to determine clinical adverse effects of the iodinated contrast media. Methods: Data of 899 consecutive patients at C.U. Shah Medical College and Hospital, Surendranagar, who received sodium meglumine diatrizoate intravenous iodinated contrast media during the period of May 2011 to April 2012, were collected for any adverse drug reactions. Results: Out of 899, 189 patients developed adverse contrast reactions. The incidences of mild, moderate and severe adverse reactions were 19.47%, 1.33% and 0.28%, respectively. There were no differences in the incidence of adverse reactions according to gender (males 21.1%; females 20.7%; p= >0.05) or age (p= >0.05). The incidence of adverse reactions was significantly higher in patients with a history of previous reactions (50%) than in those with no history (21.25%; p= <0.05). Conclusions: The skin was the most commonly affected site of reactions. In reactions, mild forms were more common compared to moderate and severe.

Evaluation of the safety of patients with pheochromocytoma during enhanced CT examination / 中国实用护理杂志

[Objective] To assess the safety of patients with pheochromocytoma receiving iodinated contrast media injection during enhanced CT examination.[Methods] The systolic pressure,diastolic pressure,heart rate of 205 patients with suspected diagnosis of adrenal pheochromocytoma were continuously recorded 10 minutes before the examination,and 5 minutes,10 minutes,20 minutes,30 minutes,and 24 hours after the examination.Among them,50 patients whose diagnosis were confirmed by pathology as pheochromocytoma were set as group A.Others were excluded pheochromocytoma and 50 were extracted from them and named as the control group(group B).The changes of blood pressure and heart rate were analyzed at different time points.[Results] The changes of blood pressure and heart rate before and after the examination in two groups showed no significant difference,as well as those at different time points between two groups.[Conclusions] Intravenous injection of low-osmolar iodinated contrast media does not induce changes of blood pressure and heart rate in pheochromocytoma patients.Pheochromocytoma patients have the same safety as patients with other adrenal carcinoma during enhanced CT examination.