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X-ray computed tomography (CT) imaging can produce three-dimensional and high-resolution anatomical images without invasion, which is extremely useful for disease diagnosis in the clinic. However, its applications are still severely limited by the intrinsic drawbacks of contrast media (mainly iodinated water-soluble molecules), such as rapid clearance, serious toxicity, inefficient targetability and poor sensitivity. Due to their high biocompatibility, flexibility in preparation and modification and simplicity for drug loading, organic nanoparticles (NPs), including liposomes, nanoemulsions, micelles, polymersomes, dendrimers, polymer conjugates and polymeric particles, have demonstrated tremendous potential for use in the efficient delivery of iodinated contrast media (ICMs). Herein, we comprehensively summarized the strategies and applications of organic NPs, especially polymer-based NPs, for the delivery of ICMs in CT imaging. We mainly focused on the use of polymeric nanoplatforms to prolong circulation time, reduce toxicity and enhance the targetability of ICMs. The emergence of some new technologies, such as theragnostic NPs and multimodal imaging and their clinical translations, are also discussed.

Contrast-induced nephropathy (CIN) represents a significant complication associated with the use of iodinated contrast media (ICM), especially in individuals with preexisting renal impairment. The pathophysiology of CIN encompasses oxidative stress, inflammation, endothelial dysfunction, and hemodynamic disturbances, resulting in acute kidney injury (AKI). Early detection is essential for effective management; however, conventional markers like serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) exhibit limitations in sensitivity and timeliness. This review emphasizes the increasing significance of novel biomarkers in enhancing early detection and risk stratification of contrast-induced nephropathy (CIN). Recent advancements in artificial intelligence and computational analytics have improved the predictive capabilities of these biomarkers, enabling personalized risk assessment and precision medicine strategies. Additionally, we discuss mitigation strategies, including hydration protocols, pharmacological interventions, and procedural modifications, aimed at reducing CIN incidence. Incorporating biomarker-driven assessments into clinical decision-making can enhance patient management and outcomes. Future research must prioritize the standardization of biomarker assays, the validation of predictive models across diverse patient populations, and the exploration of novel therapeutic targets. Utilizing advancements in biomarkers and risk mitigation strategies allows clinicians to improve the safety of contrast-enhanced imaging and reduce the likelihood of renal injury.

Iodinated X-ray contrast media (ICM) such as diatrizoate, iohexol, iomeprol, iopamidol, and iopromide are commonly used in medical imaging for radiological visualization of a variety of anatomic structures. Because of their highly persistent nature and poor removal by conventional wastewater treatment, ICM can often remain unchanged after entering the environment or they are transformed into many different by-products in complex physical, chemical, and biological processes. Large amounts of ICM and their by-products are found in natural waters, groundwater, drinking water (up to 100 µg/L), and even in soil, where they can be a potential threat to the inhabitants of these environments. Because knowledge about the fate of ICM in various environments is dispersed and it concerns specific areas, the main purpose of this review is to summarize the available information about their occurrence, chemical and biological transformation/degradation, and toxicity to living organisms. The topics discussed particularly focus on mechanisms of ICM degradation/transformation in water using advanced oxidation processes and the biotransformation/biodegradation of ICM by microorganisms under different conditions, as well as the toxicity of ICM and their transformation by-products to humans and other organisms. Although environmental risk is not expected from the parent compounds of ICM, their continuous input to the water and the formation of toxic by-products may constitute a long-term potential risk for living organisms. Therefore, monitoring the transport and fate of ICM in various environments seems necessary.

Background and aims Contrast-induced acute kidney injury (CI-AKI) is the third leading cause of hospital-acquired acute kidney injury. It is more commonly observed following intra-arterial administration of iodinated contrast media (CM) for cardiac procedures in patients with pre-existing chronic kidney disease (CKD), and is associated with increased short- and long-term morbidity and mortality. This review investigates the key current evidence on CI-AKI definition, epidemiology and pathogenesis, as a basis for recommending preventive measures that can be implemented in clinical practice. Methods An extensive literature search was performed to identify the relevant studies describing the epidemiology, pathogenesis, outcome and prevention of CI-AKI. Results and conclusion Pre-existing CKD, intra-arterial administration and CM volume are the most important risk factors for CI-AKI. Since risk factors for CI-AKI are well defined, and the timing of renal insult is known, patients should be carefully stratified before the administration of CM, in order to reduce the negative impact of modifiable risk factors on renal function. The intravenous administration of moderate amounts of isotonic saline solution or bicarbonate solution still represents the principal intervention with documented and acceptable effectiveness for CI-AKI prevention. More data are needed on aggressive volume expansion strategies along with diuretics, targeting forced diuresis with high urinary output. The role of antioxidant agents remains controversial, and only moderate evidence exists in favour of N -acetylcysteine. Statins could contribute to reducing the incidence of CI-AKI, although their mechanism of action is not fully ascertained. No robust data demonstrate a reduction of CI-AKI incidence by peri-procedural hemodialysis/hemofiltration; renal replacement therapies may carry instead unnecessary risks. Remote ischemic preconditioning might represent a simple, non-invasive and cost effective preventive measure for CI-AKI prevention, but few data are currently available about its clinical application in patients at high risk of CI-AKI.

Objectives This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China. Materials and methods A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type. Results Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p  = 0.035) and autumn (adjusted OR = 1.925; p  < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence. Conclusion The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol. Clinical relevance statement In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity. Key Points • The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn.

Objectives The purpose of this study was to assess the protective effect of premedication and changing contrast media (CM) against repeat adverse reactions (ARs) to iodinated CM. Methods Between January 2006 and September 2014, 771 cases with previous ARs to CM were administered CM. The same CM that had caused ARs previously was administered to 491 cases (220 without premedication [defined as the control group], and 271 with premedication [the premedication alone group]). A different CM from the previous CM was given to 280 cases (58 without premedication [the changing CM alone group], and 222 with premedication [the premedication and changing CM group]). Results The control group had 61 repeat ARs (27.7%). The premedication alone group had 47 ARs (17.3%, p<0.01). The changing CM alone group had 3 ARs (5.2%, p<0.001). Three ARs (7.9%) were observed in 38 cases changing from one to another low-osmolar nonionic CM. Twenty cases with previous ARs to the high-osmolar CM and to the low-osmolar ionic CM showed no ARs. The premedication and changing CM group had 6 ARs (2.7%, p<0.001). Conclusion Premedication prior to contrast for patients with previous ARs may be protective, however, changing CM was more effective. Key Points • In patients with previous adverse reactions, changing contrast media is recommended. • Premedication is unnecessary against previous reactions to high-osmolar or ionic CM. • Changing from one to another low-osmolar non-ionic CM may be effective.

Iodine-based contrast agents (ICMs) are crucial substances in medical imaging because of their potent X-ray characteristics and chemical stability. However, their persistence and poor removal in conventional wastewater treatment have led to increasing environmental concern. Although ICMs exhibit low acute toxicity, their transformation during water disinfection can generate iodine-based disinfection by-products (I-DBPs), like iodo-trihalomethanes, which display notable cytotoxic, genotoxic, and ecotoxic effects and compromise drinking water quality. Advanced oxidation processes (AOPs) have become promising methods for breaking down persistent ICMs and limiting the formation of I-DBPs. Techniques including ozonation, UV/H2O2, UV/chlorine, photocatalysis with TiO2, Fenton reactions, and electrochemical oxidation utilize highly reactive radicals to decompose persistent compounds like iopamidol, iohexol, iopromide, and diatrizoate. Despite high degradation efficiencies under laboratory conditions, limitations such as incomplete mineralization, secondary product formation, and elevated operational costs hinder large-scale implementation. Future research should focus on optimizing AOP conditions under realistic water matrices, evaluating by-product toxicity, and developing cost-effective hybrid systems. Advancing these technologies is critical to reducing the environmental burden of ICMs and safeguarding aquatic ecosystems and public health.

Repeated exposure to iodinated contrast media (ICM) may induce thyroid dysfunction but supporting radiological and histological evidence remains limited. This study aimed to evaluate whether repeated ICM administration induces iodine accumulation and related functional and histological changes in the thyroid. This prospective 8-week study involved 30 male New Zealand white rabbits (0.8–1.2 kg, < 1 year) assigned to four groups. The control group ( n  = 8) received 0.9% sodium chloride solution, while experimental groups received intravenous iohexol three times weekly at 1.6 mL/kg ( n  = 7), 6.0 mL/kg ( n  = 7), or 12.0 mL/kg ( n  = 8). Non-contrast thyroid dual-energy computed tomography (DECT) was performed weekly to quantify iodine accumulation, expressed as the thyroid enhancement ratio (TER) relative to paraspinal muscle. Serum free thyroxine (fT4), free triiodothyronine (fT3), thyroid-stimulating hormone, and creatinine were measured at baseline, week 4, and week 8. Histological analysis was performed at week 8. At week 8, TER was significantly higher in the 6.0 mL/kg (2.59 ± 0.89) and 12.0 mL/kg (2.79 ± 0.77) groups than in controls (1.15 ± 0.42) and the 1.6 mL/kg group (1.32 ± 0.46) (all P  < 0.05). While transient fT4 and fT3 elevations occurred and nodular hyperplasia, follicular atrophy, and inflammation were more frequent in high-dose groups, neither showed statistically significant intergroup differences (both P  > 0.05). In conclusion, repeated intravenous administration of high-dose ICM in rabbits was associated with increased iodine accumulation in the thyroid gland, as quantified by DECT. However, a transient rise in serum thyroid hormone levels, as well as more frequent histopathological changes, did not reach statistical significance.

Fluorescence resonance energy transfer (FRET)-based ADAMTS13 activity assays are critical for the diagnosis of thrombotic thrombocytopenic purpura. However, these assays are susceptible to interference. As iodide has been suggested to interfere in laboratory testing via fluorophore quenching or promotion, we aimed to determine whether iodinated contrast (Omnipaque) interferes with the ATS-13 ADAMTS13 Activity Assay 2.0. We evaluated the excitation, emission, and absorbance spectrum of Omnipaque alone and spiked in patient plasma with known ADAMTS13 activity and ADAMTS13 activity on Omnipaque alone, an abnormal control of patient plasma previously observed to display elevated baseline relative fluorescent units, and variable concentrations of patient plasma with known ADAMTS13 activity spiked with Omnipaque. No atypical fluorescent peaks were observed on any sample (Omnipaque alone or spiked in plasma) between 250 and 700 nm. There was no difference in the mean ADAMTS13 activity among the various concentrations of plasma spiked with Omnipaque or plasma spiked with saline. Iodinated contrast does not appear to interfere-either via spectral overlap of the fluorophore or through physiologic inhibition of the ADAMTS13 enzyme-with ADAMTS13 activity FRET-based assays based on the findings from this in vitro analysis. Delaying sample collection for ADAMTS13 activity testing from suspected patients with thrombotic thrombocytopenic purpura following administration of iodinated radiocontrast agents is not necessary, and recent contrast administration should not yield erroneous ADAMTS13 activity results.

The incidence of iodinated contrast media (ICM)-related adverse drug reactions (ADRs) varies significantly by procedure type. Compared other procedure types, cerebrovascular interventional procedures substantially increase the incidence of contrast-induced encephalopathy (0.38-2.90%). The associations of ioversol (nonionic low-osmolal ICM) with central nervous system (CNS) ADRs and iodixanol (nonionic ios-osmolal ICM) with cutaneous ADR manifestations have been establishe. This study aimed to compare the incidence of CNS ADRs and evaluate the occurrence, extent, and risk factors for ADRs associated with ioversol and iodixanol use during cerebrovascular interventional procedures. We conducted a prospective study involving 1,015 participants with suspected cerebrovascular diseases from July 2019 to July 2022. Participants underwent cerebrovascular interventional procedures with either iodixanol or ioversol administration. Data on ioversol and iodixanol-related CNS ADRs, data on other ADRs, and participants’ baseline information were collected. Out of 848 participants (average age, 61.5 ± 12.6 years; 205 females) who received ICM, 16.7% (142 of 848) experienced CNS ADRs. Compared with iodixanol, ioversol was associated with a greater rate of CNS ADRs (12.6% vs. 21.1%, P  = 0.001, RR = 1.666). Iodixanol was associated with higher rates of numbness and blurred vision (29.1% vs. 14.9%, P  = 0.042), whereas ioversol was associated with higher incidences of headache and overall ADRs during the procedures (20.0% vs. 46.0%, P  = 0.002). Logistic regression analysis revealed that a history of allergic diseases was a risk factor for iodixanol-related ADRs (odds ratio [OR], 2.5; 95% confidence interval [CI]: 1.2–4.9; P  = 0.010). Severe cerebral vascular stenosis (OR, 2.8; 95% CI: 1.8–4.4; P  < 0.001), female sex (OR, 0.5; 95% CI: 0.3–0.8; P  = 0.005) and relatively young age (OR, 0.97; 95% CI: 0.95–0.99; P  = 0.004) were risk factors for ioversol-related ADRs. Iodixanol appears to have a lower likelihood of causing ICM-related CNS ADRs than does ioversol during cerebrovascular interventional procedures.