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Review ArticleContinuing Education

Pharmacology, Part 5: CT and MRI Contrast Media

Geoffrey M. Currie
Journal of Nuclear Medicine Technology September 2019, 47 (3) 189-202; DOI: https://doi.org/10.2967/jnmt.118.220012
Geoffrey M. Currie
Faculty of Science, Charles Sturt University, Wagga Wagga, Australia, and Regis University, Boston, Massachusetts
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  • FIGURE 1.
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    FIGURE 1.

    Chemical structure of iodinated CT contrast agents is based on 2,4,6-triiodinated benzene ring and provides 4 major classifications of iodinated CT contrast agents: ionic monomer, ionic dimer, nonionic monomer, and nonionic dimer. For ionic contrast media, carboxyl group (COOH) ionizes (COO−) with sodium or meglumine to form anion and cation pairs. Side chains (R) vary but tend to be longer for nonionic contrast media.

  • FIGURE 2.
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    FIGURE 2.

    Schematic representation on log–log scales of mass attenuation coefficient against x-ray energy. Iodine K edge at 33 keV demonstrates abrupt increase in attenuation that produces equivalent attenuation greater than lead and several orders of magnitude greater than bone and soft tissue. Within range of 30–100 keV, attenuation coefficients for biologic tissues remain fairly uniform whereas contrast agent (iodine) varies substantially. (Adapted from (15).)

  • FIGURE 3.
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    FIGURE 3.

    Modified 2-compartment model for iodinated CT or gadolinium MRI contrast media administered intravenously. Second extravascular compartment represents pathologic tissue that may enhance with contrast administration and, therefore, be differentiated by surrounding normal tissue by greater rate constant (k5 over k3 or k4 over k6). A previous article (2) in this series provides a more detailed interpretation of compartment models and rate constants.

  • FIGURE 4.
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    FIGURE 4.

    Flowchart of iodinated and gadolinium contrast reaction classification.

  • FIGURE 5.
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    FIGURE 5.

    Flowchart outlining interplay between factors contributing to development of contrast-induced nephrotoxicity. As outlined by bold boxes, vasoconstriction, oxidative stress, tubular cell damage, and increased tubular pressure are key drivers associated with cytotoxicity and viscosity as mediators.

  • FIGURE 6.
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    FIGURE 6.

    Chemical structure of gadolinium contrast agents adopts either macrocyclic base (left) or linear base (right), with major differences between each agent being changes to R groups.

  • FIGURE 7.
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    FIGURE 7.

    Schematic representation of principle of T1 and T2 contrast enhancement in MRI. As represented at bottom of figure, hydrogen (protons) initially aligns with magnetic field. Radiofrequency (RF) excitation pulse is applied to proton, which flips into transverse plane. RF pulse ends, allowing proton to relax back to longitudinal plane. T1 plot (top left) shows effect of shortening relaxation time with gadolinium contrast and resultant positive enhancement of contrast. Likewise, T2 plot (top right) shows effect of shortening relaxation time with iron oxide contrast and resultant negative enhancement of contrast.

Tables

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    TABLE 1

    Key Properties of Iodinated Contrast Agents That Influence Their Behavior, Efficiency, and Adverse Reaction Risk

    Contrast agentIodine concentration (mg/mL)Osmolality (mOsm/kg water)Viscosity (mPa/s) (37°C)
    Ionic monomer (HOCM)Up to 4001,400–2,100
    Ionic dimer (HOCM)320600
    Nonionic monomer (LOCM)Up to 350600–800
    Nonionic dimer (IOCM)320290
    Human serum3.2–42901.5–2.0
    Ionic monomers
     Amidotrizoic acid1461,6908.5
     Amidotrizoate-meg3501,5307.5
    Ioxitalaminic acid2,130
    Nonionic monomers
     Iohexol240, 300, 350500, 690, 8803.3, 6.1, 10.6
     Iopamidol200, 300, 370413, 616, 7962.0, 4.7, 8.6
     Ioxilan3506954.6
     Iopromide3707809.5
     Ioversol3207025.8
     Iomeprol3506187.5
     Iobitridol35091510.0
     Ionic dimers ioxaglate3205807.5
    Nonionic dimers
     Iodixanol32029011.4
     Iotrolan3003208.1
    • Optimizing key properties of intravenous CT contrast agents has resulted in evolution to those that are easier to use, with lower intravenous toxicity and fewer adverse effects (frequency and severity) (6,8,12).

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    TABLE 2

    Incidence of Adverse Reactions to Iodinated Intravenous Contrast Agents (10–13,16–18)

    Reaction typeIonicNonionicIonic HOCMNonionic LOCM/IOCM
    Mild15%3%
    Moderate1%–2%0.2%–0.4%
    Severe0.2%0.04%0.22%0.04%
    Fatal0.0006%0.0006%
    Overall13%3%
    Delayed2%–4% for nonionic dimer0.5%–1% for ionic and nonionic monomers12.5% for CT with intravenous contrast10% for CT without intravenous contrast
    Extravasation0.04%–0.2% for mechanical power injectors0.04%–0.2% for mechanical power injectors
    Contrast-induced nephropathy1%–3% in normal renal function12%–27% in renal impairment50% in diabetic nephropathy
    • View popup
    TABLE 3

    Comparison of Key Properties of Main Gadolinium Contrast Agents

    Contrast agentStructureIonicityClearance T0.5 (h)Osmolality (mOsm/kg water)Viscosity at 37°C (cP)T1 relaxivity (L/mmol-s)
    Gadopentetate dimeglumineLinearIonic1.61,9602.94.1
    GadoteridolMacrocyclicNonionic1.576301.34.1
    GadodiamideLinearNonionic1.37891.44.3
    GadoversetamideLinearNonionic1.731,1102.05.2
    Gadobenate dimeglumineLinearIonic1.2–21,9705.36.3
    GadoterateMacrocyclicIonic1.61,3502.43.6
    GadobutrolMacrocyclicNonionic1.811,6035.05.2
    GadoxetateLinearIonic0.936881.26.9
    GadofosvesetLinearIonic1,1103.019
    Blood2901.5–2
    • With exception of gadoxetate, dose is 0.1 mmol/kg. Gadoxetate dose is 0.025 mmol/kg (27,29,31).

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Journal of Nuclear Medicine Technology: 47 (3)
Journal of Nuclear Medicine Technology
Vol. 47, Issue 3
September 1, 2019
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Pharmacology, Part 5: CT and MRI Contrast Media
Geoffrey M. Currie
Journal of Nuclear Medicine Technology Sep 2019, 47 (3) 189-202; DOI: 10.2967/jnmt.118.220012

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Pharmacology, Part 5: CT and MRI Contrast Media
Geoffrey M. Currie
Journal of Nuclear Medicine Technology Sep 2019, 47 (3) 189-202; DOI: 10.2967/jnmt.118.220012
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