, Volume 40, Issue 5, pp 713–721 | Cite as

The Clinical Application of Radiopharmaceuticals

  • Norman E. Leeds
Practical Therapeutic


This article highlights the choices and the arguments in the selection of appropriate contrast materials in radiological examinations — nonionic versus ionic contrast material- and aims to assist the physician in decision-making.

Various authors have raised questions concerning the proposed advantages of nonionic contrast material. However, studies in low risk patients have shown more complications with the use of ionic contrast than nonionic contrast materials; this is the important group of patients since in high risk patients nonionics are used almost exclusively.

The important factor that increases the controversy is cost, which is significant since nonionic agents cost 10 to 15 times more than ionic agents in the USA. Thus, cost-benefit considerations are important because price sensitivity and cost may determine fund availability for equipment or materials that also may be necessary or important in improving patient care.

In magnetic resonance imaging (MRI), as in computed tomography (CT), the use of contrast material has improved diagnostic accuracy and the ability to reveal lesions not otherwise easily detected in brain and spinal cord imaging. These include separating scar from disc, meningitis, meningeal spread of tumour, tumour seeding, small metastases, intracanalicular tumours, separating major mass from oedema, determining bulk tumour size and ability to demonstrate blood vessels so dynamic circulatory changes may be revealed.


Contrast Agent DTPA Meglumine Diatrizoate Nonionic Contrast Material 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


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  1. Almen T. Contrast agent design: some aspects on the synthesis of water soluble contrast agents of low osmolality. Journal of Theoretical Biology 24: 216–226, 1969PubMedCrossRefGoogle Scholar
  2. Ansell G. Adverse reactions to contrast agents: scope of problems. Investigative Radiology 5: 374–384, 1970PubMedCrossRefGoogle Scholar
  3. Brasch RC. Work in progress; methods of contrast enhancements for MR imaging and potential applications, a subject review. Radiology 147: 781–788, 1983PubMedGoogle Scholar
  4. Brasch RC. Decisions about radiographic and MRI contrast media. Proceedings of the 74th annual meeting of the Radiological Society of North America, Chicago, course no. 607, November 1988Google Scholar
  5. Dawson P. Chemotoxicity of contrast media and clinical adverse effects: a review. Investigative Radiology 20: 584–591, 1985CrossRefGoogle Scholar
  6. Dawson P, Edgerton D. Contrast media and enzyme inhibition: I. cholinesterase. British Journal of Radiology 56: 653–656, 1983CrossRefGoogle Scholar
  7. Elkin CM, Le Van AT, Leeds NE. Tolerance of iohexol, iopamidol and metrizamide in lumbar myelography. Surgical Neurology 26: 542–546, 1986PubMedCrossRefGoogle Scholar
  8. Fisher HW. Catalog of intravascular contrast media. Radiology 159: 561–563, 1986Google Scholar
  9. Howell MJ, Dawson P. Contrast agents and enzyme inhibition: II. mechanisms. British Journal of Radiology 58: 845–848, 1985CrossRefGoogle Scholar
  10. Ing JJ, Smith DC, Bull BS. Differing mechanisms of clotting inhibition by ionic and nonionic contrast agents. Radiology 172: 345–347, 1989PubMedGoogle Scholar
  11. Jacobson TJ, Rosenquist J. The introduction of low-osmolar contrast agents in radiology; medical economic legal and public policy issues. Journal of the American Medical Association 260: 1586–1592, 1988PubMedCrossRefGoogle Scholar
  12. ayama H, Kozuka T, Takashima T, Matsuura K, Yamaguchi K. Adverse reactions to contrast media: high-osmolality versus low-osmolality media. A scientific exhibit presented at the annual meeting of the Radiological Society of North America, November 1988Google Scholar
  13. Kilgore DP, Breger RK, Daniels DL, et al. Cranial tissue, normal MR appearance after intravenous injection of GD-DTPA. Radiology 160: 757–761, 1986PubMedGoogle Scholar
  14. Kinnison ML, Powe NR, Steinberg EP. Results of randomized control trials of low versus high osmolality contrast agents. Radiology 170: 381–389, 1989PubMedGoogle Scholar
  15. Lasser EC. Etiology of anaphylactoid responses: the promise of non-ionics. Investigative Radiology 1: 579–583, 1985Google Scholar
  16. Lasser EC, Berry CC. Commentary: nonionic vs ionic contrast media. What does the data tell us? American Journal of Roentgenology 152: 945–946, 1989Google Scholar
  17. Mattrey RE. Perfluorooctylbromide: a new contrast agent for CT, sonography, and MR imaging. American Journal of Roentgenology 152: 247, 1989PubMedGoogle Scholar
  18. McClennan BL. Low-osmolality contrast media, premises and promises. Radiology 162: 1–8, 1987PubMedGoogle Scholar
  19. Palmer FJ. The RACR survey of intravenous contrast media reactions: a preliminary report. Australasian Radiology 32: 8–11, 1988PubMedCrossRefGoogle Scholar
  20. Powe NR, Steinberg EP, Erickson JE, Moore BD, Smith CR, et al. Contrast medium-induced reactions: economic outcome. Radiology 169: 163–168, 1988PubMedGoogle Scholar
  21. Ross JS, Delamarter H, Alfidi MG, et al. Gadolinium-DTPA enhanced MR imaging of the post-operative lumbar spine: time course and mechanism of enhancement. American Journal of Neuroradiology 10: 37–46, 1989Google Scholar
  22. Runge VM, Clanton JA, Lukehart KM, et al. Paramagnetic agents for contrast; enhanced NMR imaging, a review. American Journal of Roentgenology 141: 1209–1215, 1983PubMedGoogle Scholar
  23. Russell EJ, Geremia GK, Johnson CE, Huckman MS, Ramsey RG, et al. Multiple cerebral metastases: detectability with Gd-DTPA-enhanced MR imaging. Radiology 165: 609–617, 1987PubMedGoogle Scholar
  24. Russell EJ, Schaible TF, Dillon W, et al. Multicenter double-blind placebo controlled study of gadopenetate meglumine as an MR contrast agent: evaluation in patients with cerebral lesions. American Journal of Neuroradiology 10: 53–63, 1989Google Scholar
  25. Steinberg EP, Anderson GF, Powe NR, Sakin JW, Kinnison ML, et al. Use of low-osmolality contrast media in a price-sensitive environment. American Journal of Roentgenology 151: 271–274, 1988PubMedGoogle Scholar
  26. Sze G, Abramson A, Krol G. Gadolinium-DTPA in the evaluation of intradural extramedullary spinal disease. American Journal of Neuroradiology 9: 153–163, 1988Google Scholar
  27. Sze G, Shin J, Krol G. Intraparenchymal brain métastases: MR imaging versus contrast-enhanced CT. Radiology 168: 187–194, 1988PubMedGoogle Scholar
  28. G, Shin J, Krol G. Temporal and quantitative enhancement of gadolinium-DTPA in spinal tumors: proceedings of the 7th annual meeting of the Society of Magnetic Resonance in Medicine, San Francisco, p. 9, 1988Google Scholar
  29. Weinmann HJ, Brasch RC, Press WR, Wesbey GE. Characteristics of gadolinium-DTPA complex: a potential NMR contrast agent. American Journal of Roentgenology 142: 619–624, 1984PubMedGoogle Scholar
  30. White RI, Halden Jr WJ. Liquid gold: low-osmolality contrast media. Radiology 159: 559–560, 1986PubMedGoogle Scholar
  31. Witwer G, Cacayorin ED, Bernstein AD, Hubballah MY, Yuan HA, et al. Iopamidol and metrizamide for myelography: prospective double blind clinical trial. American Journal of Roentgenology 143: 869–873, 1984PubMedGoogle Scholar
  32. Wolf GL. Current status of MR imaging agents: special report. Radiology 170: 311, 1989PubMedGoogle Scholar
  33. Wolf GL, Arenson RL, Cross AP. A prospective trial of ionic vs nonionic contrast agents in routine clinical practice: comparison of adverse effects. American Journal of Roentgenology 152: 939–944, 1989PubMedGoogle Scholar

Copyright information

© Adis International Limited 1990

Authors and Affiliations

  • Norman E. Leeds
    • 1
  1. 1.Department of RadiologyBeth Israel Medical Center and Mt Sinai School of MedicineNew YorkUSA

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