Stolberg H O, McClennan B L
McMaster University Medical School, Hamilton General Hospital, Ontario, Canada.
Curr Probl Diagn Radiol. 1991 Mar-Apr;20(2):47-88. doi: 10.1016/0363-0188(91)90019-x.
It has taken many years of research, development and intense scientific investigation to produce intravascular contrast media. Research on relations between chemical structure, animal toxicity, and water-solubility has produced a number of highly water-soluble, iodinated compounds for use in diagnostic radiology as intravascular contrast agents. The currently used intravascular agents may be classified into four groups according to their chemical structure: 1. Ionic monomers 2. Ionic monoacid dimers 3. Nonionic monomers 4. Nonionic dimers It is the objective of this publication to review the history and development of intravascular contrast media as well as their properties, general effects and clinical use. The four types of contrast media differ significantly in their chemical structure and physico-chemical properties, and these differences determine their osmotoxicity, chemotoxicity, and ion toxicity. We analyze the organ specific toxic effects of intravascular contrast media upon the central nervous system, the cardiovascular system, and the renal system. We also review the secondary effects, clinical manifestations, and the incidence of adverse events associated with different types of contrast. The choice of contrast media has become critical since the introduction of nonionic agents because their toxicological and pharmacological properties differ from those of the ionic agents. The application of basic concepts involved in the use of contrast media in excretory urography, computed tomography, angiography, and angiocardiography is discussed, and the advantages of the use of nonionic contrast agents are outlined. Economic and ethical issues are presented with emphasis upon strategies to reduce the risk associated with the injection of intravascular contrast and to curtail consumption according to rational principles of use.
生产血管内造影剂历经了多年的研究、开发和深入的科学调查。对化学结构、动物毒性和水溶性之间关系的研究已产生了许多高水溶性的碘化化合物，用于诊断放射学作为血管内造影剂。目前使用的血管内造影剂根据其化学结构可分为四类：1. 离子单体；2. 离子单酸二聚体；3. 非离子单体；4. 非离子二聚体。本出版物的目的是回顾血管内造影剂的历史和发展，以及它们的特性、一般作用和临床应用。这四种造影剂在化学结构和物理化学性质上有显著差异，这些差异决定了它们的渗透毒性、化学毒性和离子毒性。我们分析了血管内造影剂对中枢神经系统、心血管系统和肾脏系统的器官特异性毒性作用。我们还回顾了与不同类型造影剂相关的副作用、临床表现和不良事件的发生率。自从引入非离子造影剂以来，造影剂的选择变得至关重要，因为它们的毒理学和药理学特性与离子造影剂不同。讨论了在排泄性尿路造影、计算机断层扫描、血管造影和心血管造影中使用造影剂所涉及的基本概念的应用，并概述了使用非离子造影剂的优点。提出了经济和伦理问题，重点强调了根据合理的使用原则降低与注射血管内造影剂相关风险和减少消耗的策略。
