The Routine Use of Higher Volumes of Contrast Material to Improve Intravenous Urography

Abstract

Abdominal roentgenography after the intravascular injection of a large volume of highly concentrated contrast material for cardiac and peripheral angiography usually demonstrates excellent opacification of the urinary tract. The dosage injected in these studies generally is determined by the patient's weight. This method of dosage calculation has obvious merit for cardiovascular examinations and may be equally desirable for intravenous urography. To evaluate this thesis, a study was undertaken to determine the worth and hazard of the routine use of higher volumes of contrast material for intravenous urography, based upon the patient's body-surface area. Material and Methods A total of 867 intravenous urographic examinations were performed in 787 patients, 304 men and 483 women. Table I indicates their ages according to decade. Six hundred were hospitalized, and 187 were out-patients. The contrast material, either 50 per cent sodium diatrizoate2 or 60 per cent methyl glucamine diatrizoate,3 was injected manually and as rapidly as possible into an antecubital vein through a 21-gauge needle. High-volume urography was performed according to the following arbitrarily determined dosage schedule: In all cases roentgenograms were obtained with the patient in the supine position five, ten, and fifteen minutes after completion of the injection, and at twenty minutes with the patient erect or prone. Additional roentgenograms (one-minute, three-minute, oblique, delayed, in the Trendelenburg position, etc.) were exposed as indicated by the clinical and roentgeno-graphic findings. Ureteral compression, unless contraindicated by the clinical problem, was applied routinely after exposure of the five-minute film and released immediately before exposure of the fifteen-minute film. The quality of all examinations was classified as excellent, good, fair, or poor upon the agreement of 2 observers. “Excellent” indicated that both renal outlines were visualized completely, the renal collecting systems were demonstrated clearly, both ureters were opacified almost entirely, and the bladder was filled densely with contrast material. In a “good” examination the renal collecting systems were visualized adequately but were not opacified with “retrograde” quality, the ureters were opacified partially, and the bladder was filled sufficiently to exclude gross abnormality. A study was considered “fair” if the renal collecting systems, ureters, and bladder were opacified enough to make their gross evaluation possible, although precise morphologic detail was lacking. An examination was considered “poor” when opacification of the renal collecting systems, ureters, and bladder was not sufficient to permit even their gross evaluation. All side-effects and reactions to the injection of contrast material were recorded. No patient was excluded from any part of this study because of his clinical status. The subjects were divided into 3 groups (Table I).