II. Contraindications

  1. Pregnancy (risk of fetal Thyroid toxicity with iodinated contrast)

III. Indications

  1. General imaging
    1. IV Contrast
      1. Vascular structures (or vascular injury)
        1. Aneurysm
        2. Dissection
      2. Solid organs (especially Abdomen and Pelvis)
      3. Pulmonary Embolism
        1. Consider CT angiogram with venous phase CT of Pelvis and lower extremities (for combination DVT evaluation)
      4. Cancer Staging
    2. Non-contrast
      1. Head Trauma (Closed Head Injury)
      2. Acute Cerebrovascular Accident (<3 hours from onset)
        1. Typically followed immediately by CT-Angiogram (unless Hemorrhagic CVA identified)
      3. Spine Trauma
      4. Extremity Trauma
        1. Use IV contrast if vascular injury suspected
      5. Nephrolithiasis
      6. Diffuse lung disease (unless Lung Mass evaluation)
    3. With and without contrast
      1. Calcified lesion evaluation (obscured by contrast)
  2. CT Abdomen and Pelvis
    1. Oral and IV contrast
      1. Indicated in most cases
      2. Appendicitis
      3. Diverticulitis
      4. Inflammatory Bowel Disease related complications
      5. Pancreatitis
        1. If evaluating Chronic Pancreatitis (calcifications), obtain CT with and without contrast
    2. No contrast
      1. Nephrolithiasis
    3. Rectal and IV contrast
      1. Suspected penetrating colonic injury
      2. Rapid evaluation for Appendicitis (Rectal contrast may not pass above cecum)
  3. Upper GI series (Fluoroscopy)
    1. High concentration Oral Contrast
  4. Barium Enema (Fluoroscopy)
    1. High concentration rectal contrast
  5. Intrathecal Contrast for Myelography (XRay, Fluoroscopy, or CT)
    1. Spinal or basal cistern disease
    2. Cerebrospinal fluid leak

IV. Preparations: IV Contrast Agents

  1. Iodinated, water-soluble IV contrast agents (CT contrast)
    1. Ionic Agents (replaced in large part by nonionic contrast agents listed below)
      1. Diatrizoate Sodium (Hypaque)
      2. Iothalamate meglumine (Conray)
      3. Ioxaglate meglumine (Hexabrix)
        1. Low osolality (contrast with other ionic agents) is associated with lower complication rate
    2. Nonionic Agents with low osmolality (LOCM are associated with lower complication rates)
      1. Iodixanol (Visipaque)
      2. Iopamidol (Isovue)
      3. Iopromide (Ultravist)
      4. Ioversol (Optiray)
  2. Gadolinium-based agents (MRI)
    1. See Gadolinium-Associated Nephrogenic Systemic Fibrosis
    2. Avoid Gadolinium in pregnancy (see MRI)
    3. Gadodiamide (Omniscan)
    4. Gadoteridol (ProHance)

V. Preparations: Oral Contrast (or rectal contrast)

  1. Barium Contrast
    1. Fluoroscopy (Upper GI series, Barium Enema) concentration is 20-fold higher than standard Abdominal CT Oral Contrast
    2. High concentration contrast obscures CT Abdomen and Pelvis with artifact
    3. Barium Contrast at any concentration does not obscure MRI
    4. Oral or rectal Barium Contrast has no nephrotoxicity (safe in Renal Failure)
  2. Water-soluble, Iodine-based contrast
    1. Significantly more concentrated form used for fluoroscopy (as with barium)
    2. Oral Iodine-based contrast has no nephrotoxicity (safe in Renal Failure)
    3. Risk of aspiration-induced pulmonary edema (with concentrated oral Iodine-based contrast)
      1. Consider alternative agents if Vomiting or aspiration risk or
      2. Consider contrast delivery via Nasogastric Tube

Images: Related links to external sites (from Bing)

Related Studies (from Trip Database) Open in New Window

Ontology: Barium Sulfate (C0004754)

Definition (MSHCZE) Minerál baryt, krystalická nerozpustná sůl BaSO4. Při malé rozpustnosti je pro lidské tělo nejedovatý, v důsledku své radioopacity se používá jako rtg kontrastní látka pro vyšetřování trávicího traktu. Rovněž průmyslově významná běloba. (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) The sulfate salt of barium, an alkaline, divalent metal. Barium sulfate is quite insoluble in water, and is used as a radiopaque agent to diagnose gastrointestinal medical conditions. Barium sulfate is taken by mouth or given rectally. (NCI04)
Definition (MSH) A compound used as an x-ray contrast medium that occurs in nature as the mineral barite. It is also used in various manufacturing applications and mixed into heavy concrete to serve as a radiation shield.
Definition (PDQ) The sulfate salt of barium, an alkaline, divalent metal. Barium sulfate is quite insoluble in water, and is used as a radiopaque agent to diagnose gastrointestinal medical conditions. Barium sulfate is taken by mouth or given rectally. Check for "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=483042&idtype=1" active clinical trials or "http://www.cancer.gov/Search/ClinicalTrialsLink.aspx?id=483042&idtype=1&closed=1" closed clinical trials using this agent. ("http://nciterms.nci.nih.gov:80/NCIBrowser/ConceptReport.jsp?dictionary=NCI_Thesaurus&code=C28859" NCI Thesaurus)
Concepts Indicator, Reagent, or Diagnostic Aid (T130) , Inorganic Chemical (T197)
MSH D001466
SnomedCT 407958001, 353934005, 25419009, 396014007
English Barium Sulfate, Sulfate, Barium, Sulfuric acid, barium salt (1:1), BARIUM SULFATE @ @ EACH, BARIUM SULFATE EACH, Barium Sulfate [Chemical/Ingredient], BARIUM SULFATE, barium sulphate, barium sulfate, Barium sulphate (product), Barium sulfate, Barium sulphate, Barium sulfate (product), Barium sulfate (substance), Barium sulfate [dup] (substance)
French Sulfate de baryum
Swedish Bariumsulfat
Czech síran barnatý
Finnish Bariumsulfaatti
Russian BARIIA SUL'FAT, BARII SERNOKISLYI, БАРИЙ СЕРНОКИСЛЫЙ, БАРИЯ СУЛЬФАТ
Japanese 硫酸バリウム
Croatian BARIJEV SULFAT
Polish Siarczan barowy
Norwegian Bariumsulfat
Spanish sulfato de bario [dup] (sustancia), sulfato de bario (producto), sulfato de bario (sustancia), sulfato de bario, Sulfato de Bario
German Bariumsulfat
Italian Solfato di bario
Portuguese Sulfato de Bário

Ontology: Contrast Media (C0009924)

Definition (CHV) a material used to improve the visibility of internal bodily structures in an X ray image.
Definition (CHV) a material used to improve the visibility of internal bodily structures in an X ray image.
Definition (CHV) a material used to improve the visibility of internal bodily structures in an X ray image.
Definition (CHV) a material used to improve the visibility of internal bodily structures in an X ray image.
Definition (CHV) a material used to improve the visibility of internal bodily structures in an X ray image.
Definition (MSHCZE) Látky užívané ke zvýšení vizualizace tkání.
Definition (NCI_CDISC) Substances administered during diagnostic procedures that allows delineation of internal structures. Contrast agents appear opaque due to the difference in absorption of X-rays or other electromagnetic waves and surrounding tissue.
Definition (NCI) Substances administered during imaging procedures that allows delineation of internal structures. Contrast agents appear opaque due to the difference in absorption of X-rays or other electromagnetic waves and surrounding tissue.
Definition (NCI_NCI-GLOSS) A dye or other substance that helps show abnormal areas inside the body. It is given by injection into a vein, by enema, or by mouth. Contrast material may be used with x-rays, CT scans, MRI, or other imaging tests.
Definition (CSP) substances used in radiography that allow visualization of certain tissues.
Definition (MSH) Substances used to allow enhanced visualization of tissues.
Concepts Indicator, Reagent, or Diagnostic Aid (T130)
MSH D003287
SnomedCT 7140000, 385420005, 407935004
LNC LA20339-0
English Media, Contrast, Contrast Media, Agents, Contrast, Contrast Agents, Contrast Materials, Materials, Contrast, contrast agents, contrast agent, contrast agent (procedure), contrast media, radiographic contrast media, radiographic contrast material, CONTRAST MEDIA, contrast material, Contrast media, Contrast media (substance), Contrast media (product), Contrast media, NOS, Contrast, Contrast Agent, Contrast Drugs, Contrast Medium
Swedish Kontrastmedel
Czech verografin, kontrastní látky
Finnish Varjoaineet
Russian KONTRASTNYE VESHCHESTVA, RENTGENOKONTRASTNYE VESHCHESTVA, КОНТРАСТНЫЕ ВЕЩЕСТВА, РЕНТГЕНОКОНТРАСТНЫЕ ВЕЩЕСТВА
Japanese 造影剤, 放射線不透剤, 放射線不透過性物質, 造影薬
Italian Mezzi di contrasto radiopachi, Mezzi di contrasto
Croatian KONTRASTNA SREDSTVA
French Produits de contraste, Agents de contraste, Opacifiants
German Roentgenkontrastmittel, Kontrastmittel, Röntgenkontrastmittel
Polish Środki kontrastowe, Środki cieniujące
Portuguese Meio Radiopaco, Meios de Contraste
Spanish medios de contraste (sustancia), medios de contraste, medio de contraste, medio de contraste (producto), Medios de Contraste