iopromide and Urologic-Diseases

Iomeprol (B16880) is a new non-ionic tri-iodinated radiographic contrast medium. It was the aim of this double blind randomized phase III clinical trial to compare the local and systemic tolerance of iomeprol-300 (300 mg I ml-1) with the commercially available iopromide-300 (300 mg I ml-1) in a group of 198 patients needing intravenous urography. The contrast medium was injected rapidly into an antecubital vein within 2-3 min in most cases, using a standard dosage of 1 ml kg-1 body weight. The proportion of patients with an allergic diathesis was 25% in the iomeprol group and 17.3% in the iopromide group. There were no life-threatening adverse reactions. Eight patients (8%) receiving iomeprol and 6 (6.1%) receiving iopromide had a sensation of heat related to the injection of contrast medium. Only one patient (1%) in the iomeprol group and two patients (2%) in the iopromide group noted pain on injection. Although the incidence of all other side-effects was relatively high (7% after iomeprol and 11.2% after iopromide) these reactions were generally harmless. The most common symptom was nausea and/or vomiting, which occurred with the same incidence (5%) in both groups. Only one patient in each group developed urticaria or erythema. Vital parameters remained essentially unchanged in all patients. The results suggest that iomeprol is a safe contrast medium, with a tendency to produce fewer side effects than iopromide, which is known to be particularly well tolerated.

Topics: Adult; Aged; Aged, 80 and over; Double-Blind Method; Female; Humans; Hypersensitivity; Iohexol; Iopamidol; Male; Middle Aged; Urography; Urologic Diseases

The purpose of this study is to assess the feasibility of low-tube-voltage images during excretory phase CT urography.. In this retrospective study, we examined 70 consecutive CT urograms (35 men and 35 women; mean age, 58.5 years) performed on a dual-energy CT scanner and compared excretory phase images obtained at 80 kVp and 340 mAs with blended images (0.3 × 140 kVp and 80 mAs; and 0.7 × 80 kVp and 340 mAs). Quantitative measurements of urinary system opacification (Hounsfield units), image noise (Hounsfield units), and effective dose (millisieverts) were compared using Student paired t test. Image noise was correlated with patient thickness. Two independent blinded readers qualitatively assessed opacification, image quality (both compared using Wilcoxon test), overall acceptability (compared using McNemar test), and detectability of urinary and extraurinary findings.. The 80-kVp images yielded significantly higher opacification of renal pelvis (p < 0.0001), ureter (p < 0.0001), bladder (p < 0.0001), and aorta (p < 0.0001); higher image noise (p < 0.0001); and lower radiation dose (5.2 vs 11.9 mSv). Image noise increased along with increasing patient thickness (r = 0.86 for 80-kVp images). Qualitative opacification scores were better only in the bladder on 80-kVp images (p = 0.002). Although 80-kVp image quality was lower (p < 0.0001), the overall acceptability was similar. Of 42 urinary findings, 40 were detected on 80-kVp images (< 2-mm calyceal calculus and tiny foci of collecting system gas were missed in one patient each, both large patients). Of 137 extraurinary findings, 130 were detected on 80-kVp images (no findings of high clinical significance were missed).. Low tube voltage (80 kVp) during excretory phase CT urography is feasible, with improved urinary system opacification, acceptable image quality, and lower radiation dose.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Feasibility Studies; Female; Humans; Iohexol; Male; Middle Aged; Retrospective Studies; Statistics, Nonparametric; Tomography, X-Ray Computed; Urography; Urologic Diseases

Technologic advances in both computed tomography (CT) and magnetic resonance (MR) imaging have resulted in the ability to image the urinary tract in ways that surpass the prior mainstay of urinary tract imaging, the intravenous urogram. In adults, for most, if not all, historical indications for intravenous urography, CT urography or MR urography is now the preferred examination. Although a variety of techniques for both examinations have been described, each test provides more diagnostic information than does intravenous urography. With the introduction of multidetector technology, CT urography, to date, has emerged as the initial heir apparent to intravenous urography; many years of experience have now clearly demonstrated that CT is the test of choice for many urologic problems, including urolithiasis, renal masses, urinary tract infection, trauma, and obstructive uropathy. CT urography provides a detailed anatomic depiction of each of the major portions of the urinary tract--the kidneys, intrarenal collecting systems, ureters, and bladder--and thus allows patients with hematuria to be evaluated comprehensively. MR urography can be used also to evaluate the urinary tract and has the advantage of not using ionizing radiation and the potential to provide more functional information than CT. However, MR urography is less established and less reliably results in diagnostic image quality relative to CT urography. Although both tests can be used to evaluate the urinary tract, several issues remain and include reaching a consensus on the optimal protocols and appropriate utilization in an era of cost containment and heightened concerns about radiation exposure.

Topics: Adult; Aged; Aged, 80 and over; Contrast Media; Female; Gadolinium; Humans; Image Enhancement; Image Processing, Computer-Assisted; Imaging, Three-Dimensional; Iohexol; Magnetic Resonance Imaging; Male; Middle Aged; Radiation Dosage; Sensitivity and Specificity; Tomography, X-Ray Computed; Urography; Urologic Diseases