Contrast media angiography

Diabetes is a major risk factor for deterioration in renal function after angiography (2,7,13). Other factors variably associated with increased rates of CIN include age over 75 years, anemia, female gender, periprocedural volume depletion, heart failure, cirrhosis, hypertension, proteinuria, concomitant use of nonsteroidal anti-inflammatory drugs, and intra-arteriai injection (2,4,5,7,10,13,14,19,43,44). In the setting of acute myocardial infarction or PCI, hypotension or use of an intra-aortic balloon pump has been associated with a higher rate of acute renal failure after exposure to a contrast medium (13,50). Finally, high doses of CM also increase the likelihood of renal dysfunction (51). 

Stehling MK, Niedermeyer M, Laub G (1997) [Contrast medium enhanced magnetic resonance angiography. Theory, technique and practical implementation], Radio-loge 37 501-507... 

A 70-year-old woman with a history of mastectomy developed syncope which lasted a few seconds. She had taken tamoxifen 10 mg bd for 10 years and had no history of allergic reactions. Doppler ultrasound showed aortic stenosis and coronary angiography was performed using 150 ml of iopromide (a non-ionic contrast medium, iodine 370 mg/ml). She had visual hallucinations (spiders on the wall, moving curtains) 30 minutes after the injection of iopromide. The symptoms resolved 72 hours later without any specific treatment. Neurological and psychiatric examinations were normal, as were brain MRI and Doppler ultrasound of the carotid and vertebral arteries. 

Furuse, J., Maru, Y., Yoshino, M., Mera, K., Suml, H., Seklgnchl, R., Sataka, M., Hasebe, T., Ochlal, A. Assessment of arterial tumor vascularity in small hepatocellular carcinoma. Comparison between color Doppler ultrasonography and radiographic imagings with contrast medium dynamic CT, angiography, and CT hepatic arteriography. Eur. J. Radiol. 2000 36 20-27... 

Computer tomography, especially when coupled with a contrast medium and in the form of CTAP, is an excellent tool for analyzing the venous blood flow and detecting any disturbances in inflow or outflow. Thrombosed hepatic veins are not visible the parenchyma is characterized by an inhomogeneous, patch-like enhancement. (s. fig. 39.6) MRI provides reliable evaluation by means of multiphase, contrast-enhanced, three-dimensional MR angiography. 

The best explanation of this observation is that a large amount of contrast medium entered the vertebral artery and passed upwards, passing a defective blood-brain barrier. Similar complications have been described in other patients, sometimes with amnesia, after cardiac catheterization and angiography (SEDA-18, 444). 

The right hemisphere was more affected in this case, because the contrast medium injected into the left ventricle or ascending aorta during angiography is likely to reach the right brachiocephalic artery first. The hyperdensity of the affected cerebral hemisphere seen on CT scanning was due to leakage of the iodinated contrast medium into the extracellular space, because of an increase in the permeability of the blood-brain barrier. 

Infarction of the bowel was formerly a very occasional complication of abdominal aortography and was due to injection of contrast medium into the mesenteric arteries. Most of these cases were due to the older media, such as acetrizoate however, small bowel injury has occurred after injection of a concentrated bolus of sodium iotala-mate (144). Ileus has been reported after mesenteric angiography in a patient with renal insufficiency (SED-12,1177) (145). 

Theophylline, a non-selective adenosine receptor antagonist, has also been recommended, since adenosine has been suggested to be an important mediator of contrast-induced nephrotoxicity. Patients undergoing coronary angiography with the high-osmolar contrast medium dia-trizoate (iodine 370 mg/ml) were randomized to receive either theophylline (200 mg bd orally 24 hours before and for 48 hours after coronary angiography, n = 35, mean age 54 years, mean dose of contrast medium 78 ml) or placebo (n = 35, mean age 52 years, mean dose of contrast medium 80 ml) (197). The glomerular filtration rate... 

Blann AD, Adams R, Ashleigh R, Naser S, Kirkpatrick U, McCollum CN. Changes in endothelial, leucocyte and platelet markers following contrast medium injection during angiography in patients with peripheral artery disease. Br J Radiol 2001 74(885) 811-17. 

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