(CA) Contrast agents are used to change the imaging characteristics, resulting in additional information about anatomy, morphology or physiology of the human body. Radiocontrast agents (also called photon-based imaging agents) are used to improve the visibility of internal body structures in x-ray and CT procedures. Contrast agents are also used to increase the contrast between different tissues in MRI (magnetic resonance imaging) and ultrasound imaging. The ideal imaging agent provides enhanced contrast with little biological interaction.
First investigations with radiopaque materials are done shortly after the discovery of x-rays. These positive contrast agents attenuate x-rays more than body soft tissues due to their high atomic weight. Iodine and barium have been identified as suitable materials with high radiodensity and are used until today in x-ray and CT contrast agents. Iodine-based contrast agents are water-soluble and the solutions are used nearly anywhere in the body. Iodinated contrast materials are most administered intravenous, but can also be introduced intraarterial, intrathecal, oral, rectal, intravesical, or installed in body cavities. Barium sulfate is only used for opacification of the gastrointestinal tract. Negative contrast agents attenuate x-rays less than body soft tissues, for example gas.

Iodinated contrast media are differentiated in;

Intravascular iodinated contrast agents are required for a large number of x-ray and CT studies to enhance vessels and organs dependent on the blood supply. Injectable contrast agents are diluted in the bloodstream and rapidly distributed throughout the extracellular fluid. The main route of excretion is through the kidneys, related to the poor binding of the agent to serum albumin. The liver (gall bladder) and small intestine provide alternate routes of elimination particularly in patients with severe renal impairment. The use of special biliary contrast agents is suitable for gallbladder CT and cholecystograms because they are concentrated by the liver to be detectable in the hepatic bile.
The introduction of fast multi-detector row CT technology, has led to the development of optimized contrast injection techniques. The amount of contrast enhancement depends on the contrast agent characteristics, such as iodine concentration, osmolality, viscosity, and the injection protocol, such as iodine flux and iodine dose. Adverse reactions are rare and have decreased with the introduction of nonionic contrast agents.
See also Contrast Enhanced Computed Tomography, Abdomen CT, Contrast Media Injector, Single-Head CT Power Injector, Multi-Head Contrast Media Injector, Syringeless CT Power Injector, CT Power Injector.

Iodinated contrast agents (typically iodine-substituted benzene derivatives) are bound either in nonionic or ionic compounds. Ionic contrast agents consist of the negatively charged anion and the positively charged cation. Used components of the anion are for example diatrizoate, iodamide, iothalamate or metrizoate and of the cation the sodium or meglumine ion. The osmotic pressure depends on the number of particles in solution. Ionic contrast agents have a greater osmolarity; double that of nonionic contrast agents due to delivering more iodine atoms per molecule.
Ionic contrast agents were developed first and are still in use depending on the examination. Iodine based contrast media are water soluble and as harmless as possible to the body. However, ionic agents have more side effects compared to nonionic contrast agents due to their high osmolarity.

See also Ionic Dimer.

The molecular structure of some iodinated contrast agents makes them suitable for the computer-tomographic examination of the biliary tract. Organic iodine compounds increase the attenuation of x-rays and the contrast between body tissues containing iodine and those tissues that do not contain iodine. The degree of opacification is directly proportional to the concentration and volume of the iodinated contrast agent (the total amount of iodine).
Biliary contrast agents can be taken orally, for example calcium iopodate, or intravenous meglumine iotroxate. The contrast media are excreted by the liver and concentrate in the gallbladder after passing the intrahepatic biliary tree and cystic duct.
Oral biliary contrast agents usually opacify the gallbladder after a few hours. If the gallbladder is removed, an intravenous cholegraphic agent is required and gallbladder CT can start 60 minutes after the beginning of contrast medium infusion.
The main limitation of the use of biliary contrast agents is the high rate of allergic reactions and of renal or hepatic toxicity. Caused by the potential for systemic toxicity with intravenous cholangiography, ultrasonography should be the preferred method for evaluation of the gallbladder and the bile ducts.

Nonionic contrast agents are a group of contrast media that do not dissociate into charged particles. Many of the side effects of contrast agents are due to the injection of a solution with high osmolality compared to blood. Nonionic contrast agents have a low osmolality and tend to have less toxicity. However, as with all iodinated contrast agents, serious or fatal reactions have been associated with their use.
Due to their lower neurotoxicity, nonionic contrast agents can also be used for myelography. The only FDA approved agent, iodixanol, is iso-osmolar to blood, which makes it preferable for examinations of the central nervous system and cardiovascular studies. Because of its higher costs relative to other nonionic agents, the use is sometimes reserved for patients with high risk of nephrotoxicity.

See also Nonionic Dimer, Nonionic Monomer and CM Ratio.

Radiographic contrast media (RCM) contributes important information to the diagnostic process. Actual contrast agents are safe drugs. Adverse reactions are rare, the incidence and severity of side effects decrease with the use of nonionic and low-osmolar contrast media. Adverse reactions are diverse, ranging from mild physiological disturbances to very rare life-threatening anaphylactic or anaphylactoid reactions. Users of contrast agents must be aware of the risk factors and be prepared to promptly manage adverse effects.
Side effects that may occur with intravascular administration of contrast agents are also possible after administration by other paths. Increased risk to an adverse reaction includes patients with a history of a previous reaction to a contrast medium, a known sensitivity to iodine, or a known clinical hypersensitivity (bronchial asthma, hay fever, and food allergies).

See also Contrast-Induced Nephropathy, Iodide-Induced Hyperthyroidism and Idiosyncratic Reactions.