Current perspectives on intravascular contrast agents for radiological imaging

Effects of Mn-DPDP and manganese chloride on hemodynamics and glucose tolerance in anesthetized rats

BACKGROUND

Previous studies have demonstrated that magnetic resonance imaging may be a method of choice to visualize transplanted pancreatic islets. However, contrast agents may interfere with microcirculation and affect graft function.

PURPOSE

To evaluate the effects manganese-containing contrast media on regional blood flow and glucose tolerance.

MATERIAL AND METHODS

Anesthetized rats were injected intravenously with MnCl2 (10 µM/kg body weight) or Mn-DPDP (Teslascan™; 5 µM/kg body weight). Blood flow measurements were made with a microsphere technique 10 min later. In separate animals vascular arteriolar reactivity in isolated, perfused islets was examined. Furthermore, an intraperitoneal glucose tolerance test was performed in separate rats.

RESULTS

Glucose tolerance was unaffected by both agents. No changes in regional blood flow were seen after administration of Mn-DPDP, except for an increase in arterial liver blood flow. MnCl2 increased all blood flow values except that of the kidney. MnCl2, but not Mn-DPDP, caused a vasoconstriction in isolated rat islet arterioles but only at very high doses.

CONCLUSION

Mn-DPDP administration does not affect glucose tolerance or regional blood flow, besides an increase in arterial hepatic blood flow, and may therefore be suitable for visualization of islets.

Evaluation of the patient with hematuria

There is little controversy regarding whether gross or visible hematuria requires complete upper and lower urinary tract evaluation. With regard to microscopic hematuria, investigators have disagreed on precisely which patients require a complete work-up. Most agree that older patients (> 40 years), patients with a history of cigarette use, and those with occupational exposure or history of chronic phenacetin use should absolutely undergo upper tract imaging, cystourethroscopy, and cytologic examination of the urine in addition to a thorough history and physical examination. A multidisciplinary group of oncologists, radiologists, urologists, and internists has published its recommendations as part of the American Urological Association best practice policy. The formal guidelines, which were distributed, rereviewed, and modified following a nationwide survey of clinicians, recommend complete urologic evaluation for all patients with microscopic hematuria who are over 40 years of age, and younger patients with a history suspicious for urologic disease. This identifies those at highest risk for malignancy while minimizing the number of evaluations in patients unlikely harboring significant disease.

The differential effect of contrast agents on endothelial cell and smooth muscle cell growth in vitro

PURPOSE

This study was designed to evaluate the effects of ionic and nonionic contrast agents on endothelial cell (EC) and smooth muscle cell (SMC) proliferation, and to determine the role of osmolality as the etiology of these effects.

METHODS

Cultured bovine aorta EC and SMC were exposed to ionic (iothalamate meglumine) or nonionic (ioversol or iopamidol) contrast, or varying osmolar solutions of mannitol, for periods of 1, 3, 5, 10, or 20 minutes. Cells were then incubated in growth media at 37 degrees C and proliferation and structure were assessed 1, 3, 5, and 7 days later.

RESULTS

Both EC and SMC showed decreased proliferation after brief exposure to both ionic and nonionic contrast. Proliferation was markedly decreased at 24 hours after exposure, and began to recover by day 3 after exposure. EC showed a significant decrease up to 7 days after exposure to ionic contrast (p < 0.03), whereas SMC showed a significant decrease up to 7 days after exposure to nonionic contrast (p < 0.001). The decrease in proliferation was directly dependent on the length of exposure to the contrast and the concentration of the contrast. EC proliferation decreased in proportion to increasing osmolality of the test solution (p < 0.05). SMC proliferation did not show a decrease proportional to osmolality. No change was observed in cell viability as assessed by LDH activity studies. After contrast exposure, bare areas with no cells present were noted in the previously confluent EC and SMC culture wells. Cell structure was altered immediately after exposure to contrast, with normal structure recovered by 24 hours after exposure.

CONCLUSION

This study demonstrates that brief exposure to contrast agents injures EC and SMC, altering their structure and decreasing proliferation for up to 7 days in vitro. This response is both dose and time dependent. EC are more severely affected by ionic contrast, and SMC are more severely affected by nonionic contrast. EC injury appears to be mediated by the osmolar effect of the contrast, but the effects of contrast on SMC seem to be due to a different mechanism.