[Comparison of iodinated and barium-containing contrast media of different viscosity in the detection of pharyngeal perforation].
OBJECTIVE
In contrast to esophageal perforations, the more radiopaque barium-suspensions are not as important as iodinated aqueous contrast agents for the detection of pharyngeal perforations. This study was performed to find out whether the highly different viscosities (of iodinated and barium-containing contrast agents with comparable radiopacities) are a reason for this.


METHODS
Viscosity, subjective difference in contrast, and CT-density of an iodinated aqueous (Telebrix) and a 50 wt/vol% barium-containing contrast agent (Micropaque) were determined. Moreover, to exclude postoperative perforation, 104 patients were prospectively examined by pharyngography using both contrast media. Pharyngographies of patients with perforation were later compared by two independent readers. All patients with perforation were followed up clinically to exclude complications due to barium administration.


RESULTS
In-vitro comparison showed comparable radiopacity but the 50 wt/vol% barium-suspension was much more viscous than the iodinated contrast agent. During pharyngography, totally, 14 perforations were clearly delineated with the iodinated aqueous contrast agent. However, two of them were not detected with the barium-suspension. All the other perforations presented equally.


CONCLUSIONS
Given a sufficient radiopacity, a low viscosity appears to be essential for a contrast agent to detect especially pharyngeal perforations. Thus, we recommend the sole use of an iodinated contrast agent (at suspicion of aspiration as isoosmolar variant) for this purpose.
Keberle
M
M
Institut für Röntgendiagnostik, Universität Würzburg. marc.keberle@mail.uni-wuerzburg.de
Wittenberg
G
G
Trusen
A
A
Baumgartner
W
W
Hahn
D
D
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001466:Barium Sulfate; D003287:Contrast Media; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007482:Iothalamate Meglumine; D007483:Iothalamic Acid / Q000031:analogs & derivatives; D008297:Male; D008875:Middle Aged; D019047:Phantoms, Imaging; D010608:Pharyngeal Diseases / Q000000981:diagnostic imaging*; D010611:Pharyngectomy; D010614:Pharynx / Q000000981:diagnostic imaging* / Q000601:surgery; D011183:Postoperative Complications / Q000000981:diagnostic imaging*; D011446:Prospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014783:Viscosity
D003287:Contrast Media; D007483:Iothalamic Acid; D001466:Barium Sulfate; C002587:ioxitalamic acid; D007482:Iothalamate Meglumine