Effect of Different Iodine Concentrations on Patient-Reported Discomfort in Contrast-Enhanced Computed Tomography: A Prospective Comparative Trial

Abstract

Purpose Reducing contrast media injection speed while maintaining iodine flux is a promising workaround to lower or avoid contrast media-related discomfort during CT examinations. This approach demands contrast media with a higher concentration to guarantee excellent image quality. It remains unclear whether these concentration changes affect the patient’s experience. Thus, the aim of this study was to evaluate the influence of different concentrations of intravenous iodinated contrast media on patient discomfort during and after contrast media delivery.

Materials and Methods Patients were randomized to receive either Iomeprol 400 mg/ml (group A) or 300 mg/ml (group B) during routinely scheduled CT examinations at our department. The iodine delivery rate and injection time were kept constant in both groups. After examination, study subjects completed a digital questionnaire on different CM-related sensation items using digital visual analogue scales.

Results 253 consecutive patients were enrolled in a 6-month period. Most of the patients reported heat sensation in both groups (mean VAS: 5.3 mm in group A vs. 5.0 mm in group B, p = 0.5). Taste sensation also did not differ significantly between both groups (2.4 mm vs. 2.0 mm, p = 0.08). Pain sensation was reported to be significantly lower in group B patients (1.3 mm vs. 1.0 mm, p = 0.005), even though pain sensation in general was reported on a very low level. Other injection-related sensations were rarely reported.

Conclusion Patient-reported discomfort during intravenous injection of high-concentration contrast media (400 mg/ml) was low and only marginally different when compared to the injection of contrast media with a lower concentration. The injection of highly concentrated contrast media showed comparable overall patient acceptance, allowing a reduction of the injection speed and volume during examinations.

Key Points: 

• Patient-reported, contrast-related discomfort was very low in this study.

• High-concentration contrast media (HCCM) showed comparable overall patient acceptance.

• HCCM allow a reduction of injection speeds while keeping iodine flux constant.

Citation Format

• Vahldiek JL, Schaafs LA, Niehues BK et al. Effect of Different Iodine Concentrations on Patient-Reported Discomfort in Contrast-Enhanced Computed Tomography: A Prospective Comparative Trial. Fortschr Röntgenstr 2020; 192: 945 – 951

Zusammenfassung

Ziele Die Reduktion der Injektionsgeschwindigkeit von jodhaltigen Kontrastmitteln kann kontrastmittelassoziierte Missempfindungen während CT-Untersuchungen reduzieren. Um eine exzellente Kontrastierung der Bilder zu garantieren, erfordert dieser Ansatz höher konzentrierte Kontrastmittel. Ob hochkonzentrierte Kontrastmittel die Patientenwahrnehmung während der CT-Untersuchung beeinflussen, ist bislang unzureichend untersucht. Das Ziel der vorliegenden Studie war es zu untersuchen, ob verschiedene Konzentrationen von intravenös verabreichtem, jodhaltigem Kontrastmittel einen Einfluss auf patientenberichtete Missempfindungen während der Untersuchung haben.

Material und Methoden Patienten wurde in 2 Gruppen randomisiert und erhielten entweder Iomeprol 400 mg/ml (Gruppe A) oder Iomeprol 300 mg/ml (Gruppe B) während Routine-CT-Untersuchungen. Jodinjektionsrate und Injektionszeit waren in beiden Gruppen gleich. Nach der kontrastmittelgestützten CT-Untersuchung beantworteten die Studienpatienten Fragen zu verschiedenen kontrastmittelassoziierten Missempfindungen mittels digitalen, visuellen Analogskalen (VAS).

Ergebnisse Innerhalb von 6 Monaten konnten 253 konsekutive Patienten eingeschlossen werden. In beiden Studiengruppen berichtete die Mehrheit der Patienten Wärme-Missempfindungen (Mittelwert VAS: 5,3 mm bei Gruppe A vs. 5,0 mm bei Gruppe B; p = 0,5). Geschmackssensationen traten ebenso ohne signifikanten Unterschied in beiden Gruppen auf (2,4 mm vs. 2,0 mm; p = 0,08). Schmerzempfindungen traten signifikant geringer bei Studiengruppe B auf (1,3 mm vs. 1,0 mm; p = 0,005), obwohl Schmerzen während der Injektion bei beiden Studiengruppen auf sehr geringem Niveau berichtet wurden. Andere kontrastmittelassoziierte Missempfindungen wurden sehr selten angegeben.

Schlussfolgerungen Patientenberichtete Missempfindungen waren in beiden Studiengruppen (Iomeprol 400 mg/ml vs. 300 mg/ml) auf einem sehr geringen Niveau und unterschieden sich nur geringfügig zwischen beiden Studiengruppen. Die Injektion von höherkonzentriertem Kontrastmittel zeigte eine vergleichbare Patientenakzeptanz, was eine Reduktion der Injektionsgeschwindigkeit und des Injektionsvolumens während CT-Untersuchungen erlaubt.

Kernaussagen: 

• Patientenberichtete Missempfindungen waren in dieser Studie auf einem sehr geringen Niveau.

• Das höherkonzentrierte Kontrastmittel (HKKM) zeigte im Vergleich eine analog hohe Patientenakzeptanz.

• HKKM erlauben geringere Injektionsraten bei gleichbleibender Jod-Flussrate.

Key words

adults - contrast media - iodine - computed tomography - high-concentration contrast media

Publication History

Received: 09 May 2019

Accepted: 21 February 2020

Article published online:
26 March 2020

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