Comparison of hepatic damage from direct injections of iodinated contrast agents and carbon dioxide.
OBJECTIVE
This study guides the choice of contrast agent for localization of portal veins during transjugular intrahepatic portosystemic shunt (TIPS) placement or use in percutaneous transhepatic cholangiography (PTC) by providing gross anatomic and histologic comparison of effects from parenchymal injections of iodinated contrast agents and carbon dioxide.


METHODS
Eighteen New Zealand White rabbits received direct injections of 2-5 mL of either the nonionic contrast agent iohexol 300 mgI or the ionic contrast agent diatrizoate meglumine 60% into one lobe of the liver and the same volume of CO2 into the other lobe. The rabbits were killed at 2-7 days for gross and histologic evaluation of the livers.


RESULTS
At the time of injection, the diatrizoate and iohexol sites showed persistent dark discoloration, whereas CO2 sites showed minimal visible changes. On gross examination at death, all diatrizoate sites showed severe scarring and also commonly showed areas of necrosis. CO2 and iohexol sites showed only minimal discoloration and needle-puncture scars (P < .0001). The histologic grade for diatrizoate sites was significantly more severe than paired CO2 sites (P < .016). Iohexol sites showed mild histologic changes similar to paired CO2 sites (P = .375).


CONCLUSIONS
Iohexol and CO2 produce less severe hepatic damage and are preferred to meglumine diatrizoate for hepatic injection.
Culp
W C
WC
University of Florida Veterans Administration Medical Center, Gainesville, USA. wculp@unmc.edu
Mladinich
C R
CR
Hawkins
I F
IF
D000818:Animals; D002245:Carbon Dioxide / Q000494:pharmacology / Q000633:toxicity*; D002758:Cholangiography / Q000379:methods*; D003287:Contrast Media / Q000494:pharmacology / Q000633:toxicity*; D003974:Diatrizoate Meglumine / Q000494:pharmacology / Q000633:toxicity*; D005260:Female; D007472:Iohexol / Q000494:pharmacology / Q000633:toxicity*; D008099:Liver / Q000187:drug effects* / Q000473:pathology; D008297:Male; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods*; D011817:Rabbits
D003287:Contrast Media; D002245:Carbon Dioxide; D003974:Diatrizoate Meglumine; D007472:Iohexol