The typical dose is 100 mL Biliscopin (105 mg meglumine iotroxate/ml; 5.0 g iodine), which is administered via slow IV infusion (over 30-60 minutes) to optimise biliary concentration.
Biliary opacification may be limited in cases of hyperbilirubinaemia (due to stasis or poor hepatocyte function), hyperproteinaemia, or in patients with excessively dilated ducts. Preferential renal excretion may occur in these patients 4. Bilirubin levels should be < 30 mmol/L to ensure optimal opacification, as opacification drops off when bilirubin levels are greater than 2-3 times normal 6.
Contraindications include (but not limited to) 3:
- hyperbilirubinaemia: limited biliary opacification due to stasis or poor hepatocyte function
- severe heart failure
- iodinated-contrast hypersensitivity or allergy
- severe hepatic or renal dysfunction
- pregnancy: safety has not been established; demonstrated to be embryotoxic in rabbits 3
Adverse reactions are uncommon (~2%; range 0.8-3.4%) with no fatal reactions recorded and severe reactions (e.g. anaphylaxis) rare. Common reactions include pruritus, rash, hives and nausea 1,2.
- 1. Persson A, Dahlström N, Smedby O et-al. Three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective analysis of feasibility and adverse reaction to contrast material. BMC Med Imaging. 2006;6 (1): 1. doi:10.1186/1471-2342-6-1 - Free text at pubmed - Pubmed citation
- 2. Hyodo T, Kumano S, Kushihata F et-al. CT and MR cholangiography: advantages and pitfalls in perioperative evaluation of biliary tree. Br J Radiol. 2012;85 (1015): 887-96. doi:10.1259/bjr/21209407 - Free text at pubmed - Pubmed citation
- 3. Bayer Resources. Production information: Biliscopin for infusion.
- 4. Hashimoto M, Itoh K, Takeda K et-al. Evaluation of biliary abnormalities with 64-channel multidetector CT. Radiographics. 2008;28 (1): 119-34. doi:10.1148/rg.281075058 - Pubmed citation
- 5. Royal Australian and New Zealand College of Radiologists. Notes on radiographic contrast material. September 2004.
- 6. Alibrahim E, Gibson RN, Vincent J et-al. Spiral computed tomography-intravenous cholangiography with three-dimensional reconstructions for imaging the biliary tree. Australas Radiol. 2006;50 (2): 136-42. doi:10.1111/j.1440-1673.2006.01557.x - Pubmed citation
computed tomography (CT)
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- CT dose
- CT contrast
- patient-based artifacts
- physics-based artifacts
- hardware-based artifacts
- helical and multichannel artifacts
- CT safety
- history of CT