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Plain films have for some time offered a method of estimating spleen size when the organ is visible by reason of surrounding fat, adjacent bowel gas, or radiopaque substances such as Thorotrast or calcium. When visualized on routine radiographs, the lower portion of the spleen is usually seen, but the upper half of the spleen is rarely demonstrable without special technics. This problem has limited the possible approaches to routine spleen measurement. Judging spleen size by the size of the renal outline, estimating the spleen from its width at a uniform distance above the tip, and measuring the vertical length from the midpoint of the spleen tip to its interception with the diaphragm have been proposed (2–4, 8). The difficulty of estimating spleen size by palpation is well known, and the problem of its clinical and radiographic estimation has recently been discussed by Riemenschneider and Whalen (6), who have also proposed a two-dimensional method of measurement. Rosch (7) has likewise recently discussed...

The problem presented by patients with persistent lumbago, sciatica, and sacro-iliac strain is a challenge to the acumen of most diagnosticians. Particularly does this apply to those patients who give a history of recurrent attacks over a long period of time, with no permanent relief in spite of running the gantlet of therapeutic measures reputed to cure such affections, as braces, rest in bed, physiotherapy, sacro-iliac fusion, osteopathic treatments, chiropractic adjustment, deep injection of such drugs as chloroform, and many other bizarre measures, not excluding Haarlem oil. These patients present themselves in a condition of despondency, feeling that no permanent relief is possible. In such cases our attention should immediately turn to the possibility of a protrusion or herniation of an intervertebral disc in the lower lumbar spine. Posterior protrusion of an intervertebral disc may produce symptoms of cord compression or may simulate a tumor if the mass is large. Smaller lesions will usually compre...

Thorotrast is a radiopaque medium widely employed in recent years, notably in angiography. Its use, however, is followed at times by damaging effects on tissues which become apparent in years rather than months, stemming most frequently from its accidental perivascular deposition (3). Rarely, its deposition within the cells of the reticulo-endothelial system leads to aplastic anemia (10, 16, 27) and neoplastic growth (16). In both instances, the effects are the result of the radioactive properties of the thorium salt. Thorotrast is a 25 per cent solution, by volume, of colloidal thorium dioxide in a dextrin medium. The element thorium contained in this preparation is the parent substance of a series of compounds constituting one of the three naturally occurring radioactive families, the others being radium and actinium. It has an estimated half-life of 1.34 billion years (13). The radioactive decay of the thorium series releases alpha particles, beta rays, and gamma rays. Biological effects are due chiefl...

Since thorotrast has been found useful as a contrast medium, it is of considerable interest to find out how thorium and its products are distributed in the body and to what extent these radioactive elements are eliminated. The danger from the continued exposure of the tissues to the emitted alpha, beta, and gamma rays makes such information still more important. It is well known that thorotrast is absorbed rapidly by the reticulo-endothelial system and deposited for the most part in the liver and spleen. Previous studies by other investigators have contributed much information and have proved that the thorium remains long in these tissues. Pohle and Ritchie (1) report that the roentgen ray shadows cast by livers of rabbits, in which thorotrast was deposited, decreased slightly after considerable periods of time. Rigler (2) states that in man there is a noticeable decrease in the density of livers containing thorotrast after intervals of several years. This may be due to a redistribution of the thorium, as...

Cerebral angiography is becoming a common diagnostic procedure for three principal reasons: First, it is now recognized that disorders and malformations of the cerebral vascular system occur far more frequently than was generally believed. Second, angiography affords the best and, in most instances, the only means of demonstrating and localizing these abnormalities. Third, the improvements in the technic of injection of contrast media, and more especially the development of equipment for the automatic serialization of x-ray exposures, have made angiography a practical procedure. We have had very few indications for injecting the vertebral arteries which supply the posterior cerebral arteries and those in the posterior fossa, and for that reason this discussion will be confined to the technic and results of injection of the internal carotid arteries. Contrast Media The choice of a contrast medium is limited to 35 or 50 per cent diodrast, 50 per cent neo-iopax, and 24 to 26 per cent thorotrast. Recently we ...

The authors evaluated radiation-related morbidity in a follow-up study involving 724 patients who received Thorotrast for cerebral angiography and 315 control patients who underwent similar diagnostic examinations with use of nonradioactive media. Intensive clinical and laboratory examinations were conducted on 42 of the Thorotrast patients and 29 of the controls. In the Thorotrast series there were 2 cases of thorotrastoma, abnormalities in Brom-sulphalein and serum alkaline phosphatase values, a high frequency of chromosome aberrations, and 1 instance each of liver neoplasm, granulocytic leukemia, and nonalcoholic hepatic cirrhosis. Anemia, elevated white cell counts, and disturbances in red cell morphology were not found.

AS with many another substance which may eventually prove to be harmful if used indiscriminately, the status of thorium dioxide solution (thorotrast) in the literature appears to be determined largely by each author's inclination to approve or disapprove of its use. Either contention may be supported by experimental evidence based on the results of the administration of comparatively large doses in both animals and humans. This substance, in small amounts, probably possesses no greater potentialities for harmful effects in the body than many other diagnostic and therapeutic substances now in use. If given in carefully calculated doses which are below the minimal estimated toxic level, we feel that it may be possible to take advantage of some of its valuable properties. In the report of the Council on Pharmacy and Chemistry (1), the properties of thorium dioxide solution (thorotrast) are outlined. Its composition, as given by the manufacturer, is said to be a stabilized thorium dioxide solution containing ...

Under normal circumstances, the roentgen visualization of the deep organs and soft-tissue structure in the body is dependent on the contrast between calcium, fat, soft tissue, and air. If an organ or soft-tissue structure cannot be adequately outlined by virtue of these naturally occurring substances, an opaque medium must be introduced. Any method that permits visualization of vessels which could hitherto not be demonstrated because of their inaccessibility is bound to increase the diagnostic potentialities. Demonstration of the lymphatic system by the injection of radiopaque material is such a procedure. The lymphatic system was visualized roentgenographically as early as 1930 by the Japanese investigator, Funaoka (5), who injected mercury, lead, and iodine salts into the lymph vessels. Carvalho et al. (2) reported on the radiographic demonstration of lymphatics in 1931 and again in 1934 with Thorotrast as the contrast medium. Other opaque compounds were injected into the lymph nodes or into the region ...

Contrast myelography has been practised for the past twenty-five years with various media and technics. Dandy (5) was the first to employ air for the purpose, and Coggeshall and von Storch (4) and Chamberlain and Young (3) were among the early and most enthusiastic advocates of air as a medium. Chamberlain and Young found that “in each case in which operation was performed, the exact level of the lesion determined by myelographic examination was verified by laminectomy.” Camp (1) also reported on the use of air. He stated that the positive findings were 90 per cent accurate, but 74 per cent of those operated upon after a negative myelographic examination proved actually to have lesions of the spinal canal. Hampton and Robinson (8) and Camp and Addington (2) are among the advocates of lipiodol for myelography, Hampton (7) claiming 93 per cent accuracy for that medium. Thorotrast has been employed by Nosik and Mortensen (10, 11). In a recent communication, Dandy (6) recommended establishing a diagnosis on t...

VARIOUS complications have been reported following the diagnostic use of colloidal thorium dioxide (Thorotrast) since its introduction by Radt (9) in 1929. These have included aplastic anemia, thrombosis, and the production of sarcomata (3, 4, 5, 7, 8, 14). By far the most frequent complication, however, has been the formation of fibrous nodules and masses following inadvertent perivascular injection of the radioactive medium (1, 2, 6, 10, 11, 15, 16, 17). This communication is concerned with a case in which sequelae of major import developed eleven years after the injection of Thorotrast into the soft tissues of the neck during attempted carotid arteriography. Of special interest is an estimate of the total tissue radiation dosage, made according to the method suggested by Rundo (13). Case Report A 35-year-old white woman was first admitted to the hospital in June 1945, complaining of sudden onset of severe frontal headache during exertion. Shortly thereafter she experienced aphasia, incontinence, and a ...

As the treatment of intraspinal protrusion of intervertebral disks becomes more common, increasing efforts are being made to find a simple and accurate but safe objective method for the diagnosis of this disorder. Without entering into a detailed discussion, it is safe to state that neither air, lipiodol, nor thorotrast has proved to be the ideal contrast medium. With air there is often insufficient contrast for clear definition of minor protrusions. With lipiodol the removal of the oil is often inadequate and at times uncomfortable for the patient. Removal of thorotrast is time-consuming and usually incomplete, so that its use is not without risk. In an effort to find a more satisfactory medium, Warren, Strain, Plati, and associates (1, 2) developed ethyl iodophenylundecylate, a mixture of isomers obtained by the addition of iodobenzene to ethyl undecylate in the presence of aluminum chloride. It contains 30.5 per cent of iodine in firm organic combination. It is called “Pantopaque.” The chemistry and th...

Thorotrast, or colloidal thorium dioxide, has been used as a diagnostic agent in intracranial lesions in a number of ways—in carotid arteriography, in ventriculography and in outlining cerebral abscesses and cystic brain tumors. The late results of the injection of this medium into a cavity in the brain is the subject of the present paper. A twenty-four-year-old, white male was brought into an emergency hospital in another city by the police on May 1, 1951. He had an odor of alcohol to his breath; he was confused and disorientated. There was a contusion of the scalp in the left parietal region and a laceration of the face. He appeared to understand questions but did not talk, and no history was available. Neurologic examination revealed no localizing signs. The spinal fluid was under increased pressure and was xanthochromic. Roentgenograms of the skull were negative (Fig. 1). A second spinal puncture showed persistent increase in pressure and old blood. The patient continued to be confused. An electroence...

THE introduction of colloidal thorium into commercial use under the name of “thorotrast” aroused many hopes in the field of radiologic diagnosis of diseases of the liver and spleen. I became interested in the subject in the early months of 1932, and decided to study the value of colloidal thorium in radiologic visualization of lymphatics of the abdominal cavity. This necessarily led to a comparison of findings in the intravenous and intraperitoneal use of the colloidal metal, and further comparison of these findings with those obtained by a simultaneous intraperitoneal injection of colloidal thorium with other substances, namely, pure silica, as SiO2, known as a colloidal poison. Experiment 1 (R1) Twelve c.c. of thorotrast, diluted in ten c.c. of sterile saline, was injected intravenously into a rabbit that weighed four pounds. Exposures were made from then on, at first daily and then weekly, until the time of autopsy which was performed 60 days after the injection. As long as the rabbit lived, no ill eff...

A REVIEW of the literature to date regarding the use of thorotrast reveals no report of its use or attempted use in the diagnosis of trauma of the liver and spleen. It has been used in the diagnosis of pathologic conditions affecting these organs, but not in traumatic surgery. All the cases recorded have been observed for some time and in many instances normal structures were found. In some cases the drug was administered to normal patients and in other cases animal experimentation served the observers' purpose. Herein, therefore, is presented what is believed to be the first case on record in the use of thorotrast in the diagnosis of traumatism of the liver and spleen. Case History A colored male was admitted to the Alexandria Hospital, May 1, 1932, on the service of Dr. M. D. Delaney, Sr., as the result of an automobile accident. He was unconscious and from the physical signs and the testimony of his companions was in the state of acute alcoholism. Differentiation between surgical shock and alcoholic in...

IN recent years thorotrast, “a stabilized colloidal thorium dioxide preparation,” has been used extensively for radiologic visualization of a great variety of structures. The most common uses have been in hepatolienography and as a contrast medium in angiography, mammography, encephalography, and ventriculography. Since its introduction a voluminous literature has arisen in which are found several reviews dealing with various phases of the subject. Among these we may mention those of Shute and Davis (9), Allen (1), Cooke (2), and Reeves and Stuck (7). Various complications may occur following the diagnostic use of thorium dioxide. Of these, one of the most common is due to the accidental injection of the material into the perivascular tissues. In the present paper we wish to present the radiologic and histologic findings in two such cases. In the first case a bulky mass of scar tissue developed at the site of injection and gradually increased in size over a period of almost three years. In the second case...

How do you know where you're going if you don't know where you have been? A review of hepatolienography was presented before the Radiological Society of North America at its annual meeting in December 1950 and published in 1951 (24). This was an attempt to bring the literature on the subject into focus and to report our own investigations. The purpose of the present communication is to review the published (English) work done by others since our earlier paper and again to exhibit our own studies. Thorotrast Most of the literature concerning hepatolienography in the last decade has been concerned with Thorotrast and its effects. Fibrosis: Reports on the effects of extra vascular injection of Thorotrast with fibrosing sequelae have further emphasized our statement concerning “the serious problem in the late fibrosis and scar formation which may occur either in the liver or spleen or at sites of accidental extravascular injection” (24). A recent paper by Brady et al. (4) exemplifies these findings. This revi...

The lymphatic involvement of lung cancer plays an important part in deciding on the treatment policy and the estimation of its prognosis (13, 29). The development of a satisfactory primary examination of the pulmonary and mediastinal lymphatic system has therefore been greatly desired. Since the development of Kinmonth's method of lymphography (11), thoracic ductography has been frequently performed for the detection of invasive intrathoracic malignant tumor. Its diagnostic value is limited, however, by the anatomic variation of the thoracic duct and also by difficulty in visualizing it continuously with a conventional amount of oily contrast medium. It has been proved experimentally that an injection of oily contrast medium as well as of Thorotrast or of Micropaque into the peritoneal or pleural cavity stains the retrosternal lymphatics but few of the mediastinal lymphatics relating to the lung (9, 10, 15, 18, 26). The authors have attempted pulmonary and mediastinal lymphography by contrast injection in...

Egas Moniz (2), in 1927, introduced a specialized roentgen technic whereby it is possible, with the aid of certain radioopaque substances injected into the vascular supply of the brain, to visualize normal and abnormal cerebral vessels. The illustrations of his monograph, covering a wide variety of pathological conditions, can be duplicated with a relatively simple procedure now used in our department. The purpose of this communication is to present briefly this simple technic. Robb and Steinberg (14), in 1939, and Stewart, Breimer, and Maier, in 1941 (16), reported the successful use of diodrast to demonstrate the chambers of the heart and the pulmonary circulation. Gross (5, 6), after experience with cerebral arteriography in dogs, expressed a preference for a 50 per cent solution of diodrast rather than colloidal thorium dioxide, or thorotrast, which Egas Moniz believed most suitable of the available radio-opaque substances. Eisenstein and Taylor (3), who reported a case of porencephalic cyst with arte...

RECENTLY there has been considerable discussion as to whether or not thorotrast should be used for visualization in radiography of the liver and spleen. Thorotrast contains “25 per cent by volume of thorium dioxide (19 per cent to 20 per cent by weight), about the same amount of protective colloid, said to be of a carbohydrate nature and further defined as a dextrin preparation. It contains as a preservative 0.15 per cent of methyl phydroxy benzoate” (1). Report of Case The patient, female, white, by occupation housewife, aged 73, was admitted to the Montefiore Hospital on May 18, 1937, with complaints of weakness, vertigo, palpitation, shortness of breath, a choking sensation in the chest, insomnia, anorexia, and nervousness. In 1932 she had been admitted to another institution for increasing weakness and loss of weight of five months' duration, together with anorexia, palpitation, and dyspnea on exertion. Five months before, she had had a three-day period of chills, fever, and malaise. On physical exami...

Roentgen examination of the alimentary tract in infants and children has its greatest application in the diagnosis of obstruction. Most obstructions are related to faulty embryonic development; the signs may appear during the neonatal period or later in childhood. In a panel discussion on Intestinal Obstruction in Infancy at a meeting of the American Academy of Pediatrics in 1941, Gross (4) listed approximately 2,000 cases seen at the Boston Children's Hospital in the preceding twenty years. Almost 1,300 cases were congenital in origin, an incidence of 2 to 1 with reference to acquired obstruction. Motor activity of the alimentary tract begins long before birth. In a study of intra-uterine respiration (1), thorotrast was injected into the amniotic cavity of pregnant women prior to therapeutic abortion. After delivery, roentgen examination showed opaque material distributed through the alimentary tract of the fetus. There was no evidence of defecation of the thorotrast ingested in utero. The demonstration ...

Introduction THE usefulness of thorium dioxide sol in the roentgen diagnosis of diseases of the liver and spleen has been well demonstrated by numerous articles in the recent medical literature (23, 24, 15, 16, 7, 33, 13). Its utility, however, has been greatly restricted by the fear, which has been so frequently expressed, that ill effects may follow its injection. The dangers associated with the use of this substance have been abundantly described and numerous conflicting opinions have been presented regarding the justification for its employment. While the original protagonists for the utilization of this colloidal suspension of thorium dioxide (thorotrast), Radt (24) and Kadrnka (16), apparently are satisfied that it presents no real danger; others, such as Anders and Leitner (1), Buchner (2), Cooke (4), Hanke (8), Shute and Davis (29), Pohle and Ritchie (21) and others, criticize the use of this material most emphatically. Naegeli and Lauche (20) take a middle ground, while numerous other authors, su...

Abdominal radiography, excretory urography, retrograde pyelography, and computed tomography were performed in two patients who had undergone retrograde pyelography with thorium dioxide (Thorotrast) approximately 40 years ago. Both patients developed a transitional cell carcinoma due to suburothelial thorium deposition. Typical thorium densities were demonstrated at CT in the peripelvicalyceal area as well as in retroperitoneal lymph nodes. Elderly patients in whom radiographic examination reveals retained Thorotrast in the kidney should be followed up because of the high risk of renal carcinoma.

SINCE thorium dioxide solution was first used clinically by Radt (1), little has been learned about its rate of elimination from the body. We have been able to determine by roentgenograms that the liver and spleen retain some qualitatively large portion of the compound, but it is most logical that the radio-activity of the thorium series, which has engendered much of the prevalent suspicion of its physiological effects, should be chosen as an indicator for actual measurement of retention by the organism. The Geiger-Muller counter offers a sufficiently sensitive, simple, and rapid method for measuring such small intensities of radiation directly from the patient. Experimental work was, therefore, undertaken with this type of instrument to determine the average retention of intravenously administered thorium dioxide in the human organism. The absolute intensity of gamma radiation from fresh commercial thorotrast has been determined, in the course of our preliminary calibrations, to be equivalent to approxim...

THE present communication will describe a method for decalcifying bones of the skull which has made roentgen visualization of the intracranial structures possible. We believe the method may be of value in the study of certain experimental problems in animals, as it has allowed us to demonstrate thorotrast within perineural sheathes of certain cranial nerves. Thirty albino rats and eight cats were used for these experiments. Previous studies concerning hypertension following intracisternal kaolin injection in rats have suggested that kaolin blocks perineural channels. During the course of these experiments, we (J. Q. G. and W. A. J.) repeatedly noticed that thorotrast injected intracisternally appeared in the cervical, lymph nodes in normal rats soon after infection, whereas those rats in which kaolin had been injected previously failed to demonstrate similar perineural extension. While these experiments suggested that kaolin blocked perineural channels, roentgen evidence of this intracranial block could n...

Human data on the effects of chronic low-dose internal-emitter radiation are limited. Most information, until this time, has been provided by study of radium dial painters (1). This paper, a study of patients who received Thorotrast, describes another source of information. Following the introduction of a commercially available product named Thorotrast in 1930, it became an important contrast material until the late 1940's. While it was used primarily by injection for hepatolienography and cerebral and peripheral arteriography, it was also employed for opacification of the nasal sinuses, retrograde pyelography, mammography, hysterosalpingography, seminal vesiculography, and sinus tract identification. Thorotrast fell into disrepute because of the severe localized fibrotic reaction it incited if extravasation occurred at the site of injection with resulting thorotrastoma and because of the increasing knowledge of the hazards of chronic, low-dose, alpha radiation (2). Thorotrast is a colloidal solution cont...

Seventeen proved cases of intrahepatic cholangiocarcinoma (ICAC) were reviewed to establish a radiologic-pathologic correlation. The most common appearance of ICAC at computed tomography (CT) is that of a single, homogeneous low-attenuation mass. Multiple low-attenuation lesions were present in four cases. Calcification was depicted by CT in three cases. At angiography, ICAC has a variable appearance with avascular, hypovascular, and hypervascular patterns possible. Portal obstruction was seen in only one case. The most common appearance of ICAC at sonography is that of a homogeneously hyperechoic mass, either single or multiple. In only one case was ICAC hypoechoic. Plain abdominal radiography demonstrated calcification in three patients and evidence of Thorotrast (thorium dioxide) deposition in one. Upper gastrointestinal series demonstrated abnormal gastric folds in two cases, corresponding to gastric invasion by ICAC. There were no characteristic radiographic findings, but the following features may be helpful in differentiating ICAC from other primary intrahepatic tumors, particularly typical hepatocellular carcinoma: a homogeneously echogenic or high-attenuation appearance on images that reflects the uniform nature observed at pathologic examination, the presence of calcification, and the uncommon invasion of portal or hepatic veins. Conversely, the presence of satellite lesions may blur the the distinction between ICAC and metastatic liver disease.

The history of myelography and reactions to various contrast media is reviewed. Air is completely absorbed without producing long-term side effects. Lipiodol and Pantopaque are not absorbed and residual medium in the spinal canal can cause arachnoiditis. Other agents as Diodrast and Thorotrast never gained widespread acceptance. The water-soluble Dimer-X and Conray 60 have come into prominence but they are not totally without reactions. Recently a new water-soluble nonionic contrast medium has been developed in Norway. Metrizamide (Amipaque) has the same overall density as other water-soluble media but produces fewer reactions.

The characteristic roentgenologic features of Thorotrast deposition in the perihepatic and parapancreatic lymphatics are described. Minimal deposits of Thorotrast were seen in the liver and spleen on the abdominal radiograph in 6 patients who had no clinical symptoms. Inquiry into the patient's history invariably disclosed angiography for vascular surgery several years earlier. The typical configuration of the affected lymph node is an oval, heavy density with a long tail, resembling a tadpole or teardrop. Other irregular radiopacities in the same area, including linear ones, probably represent colloid deposition along the lymphatics. Roentgenologic differentiation of Thorotrast deposits from pancreas stones and calcified lymph nodes is discussed.

In 2 adults who had received thorotrast intravenously at ages 2 and 3 years, respectively, radiopaque outlines of their infantile vertebrae were seen in the adult vertebrae. Similar “ghosts” of the hemipelves were present in the pelvis of 1 patient. Autopsy findings and autoradiographs in 1 patient strongly suggest that persisting thorotrast deposits in the infantile vertebrae and pelvis have produced a chronic radiation osteitis and dense thickened bone trabeculae, which are more radiopaque than the surrounding adult bone.

A long and generally unsuccessful search has been made for a safe radiopaque colloid or emulsion to be employed in intravenous hepatosplenography. We should like to report our recent experiences in the development and experimental use of such an agent, as well as its apparent benefit in a number of other fields of contrast radiography. The most widely used colloid has been Thorotrast, a 25 per cent colloidal suspension of thorium dioxide. Although it produces a satisfactory opacification of the liver and spleen, it has been almost completely abandoned because it is radioactive and has been shown to produce malignant tumors secondary to its permanent deposition and long half-life, at least 50 such cases having been reported (1, 2, 3). Preparations of nonradioactive, insoluble, heavy-metal salts such as barium sulfate (4), zinc, and tantalum oxide (5) have been prepared and tested. These have been suspensions rather then true colloids and, because of their subsequent instability and large particle size, hav...

In the presence of Thorotrast in the human body a fraction of the radium daughters produced in vivo by radioactive decay hecome available to the circulation and are therefore deposited in part in the skeleton. If the assumption is made that the radium available to the circulation is retained according to the law R(t) = Af(t)-b, it is possible to calculate the elimination of radium daughters from the body and the radioactivity ratio of radium to thorium in vivo, both as a function of time. From data available in the literature, one can calculate within certain limits what fraction, f. of the radium daughters produced become available to the general circulation. From this figure, it is then possible to calculate the skeletal burden by using the values of A and b obtained in humans injected with Ra226. These calculations imply that in an average Thorotrast patient (4 gm. of Th232 = 0.44 μ.c) the activity of the skeleton in curies is between a minimum of 1.8 × 10-9 Ra228 + 1.8 × 10-9 Th228 + 1.9 × 10-8 Ra224 ...

The Use of thorium dioxide (Thorotrast) for hepatolienography was first described by Radt in 1930. It was widely employed before its delayed toxic effects were appreciated and served to demonstrate the clinical value of roentgen opacification of the liver and spleen (1). At present, however, the liver and spleen remain among the few structures of the body for which a safe, reliable diagnostic radiographic technic is not available. This communication reports studies with a microparticulate suspension of tetraiodophenolphthalein, a compound of iodine having low solubility in water. After intravenous injection, this radiopaque material is deposited in the reticuloendothelial cells of the liver and spleen (Fig. 1). Although the solubility of tetraiodophenolphthalein is low, it is slowly released from the reticuloendothelial cells of the liver and spleen and is ultimately excreted from the body. Methods Microparticulate suspensions of tetraiodophenolphthalein were prepared by prolonged wet grinding in a roller...

Positive contrast radiographic studies of the central nervous system were first reported by Sicard and Forestier in 1922, using Lipiodol (8). Other substances investigated since that time include Abrodil (1), Thorotrast (5), Perabrodil or Diodrast (2), Pantopaque (4, 6, 9, 10, 11), Hypaque (3), and various chelate compounds (7). Failures with air, Pantopaque, and Lipiodol at stereotaxic surgery and in suspected midline tumors aroused our interest in absorbable positive contrast media. This paper reviews our investigations with Conray and other water-soluble positive contrast agents. Laboratory Investigations LD50 Study: A previous report indicated that Conray was less toxic than other similar compounds when injected cisternally in the rabbit. Toxicity studies were carried out in our laboratory with Conray, Hypaque, Skiodan, and a series of experimental compounds. These will be reported in detail later, but Conray was found to be considerably less toxic than either Hypaque or Skiodan. Isotope Studies: l131...

There is definite evidence both that the lymph node is an effective lymph filter (4, 12) and that its lymphatic tissues are rapidly depleted following irradiation (2, 3, 9). It is of obvious interest to evaluate the effect of radiation on the barrier function of the lymph node. Clinical radiation therapy often encompasses regional lymph nodes in order to eradicate a neoplastic process. Theoretically it would be disadvantageous if, following such treatment, the barrier function of the lymph node were greatly compromised. In our experiments we studied the filtering efficiency of irradiated popliteal lymph nodes of the dog. The evaluation was based on microradiographs of midplane sections of the lymph node which had been challenged, before removal, by subcutaneous administration of Thorotrast. The quantity and the distribution of the Thorotrast particles provided information concerning the barrier function of these nodes. Review Of Literature In 18, 58 Virchow (11) stated that, in the lymph node, “the elemen...

DENAL VEINS are normally observed during the venous phase of selective renal arteriography, but the contrast density is low because of dilution and excretion of the medium in the kidney. Cortical veins are never seen because they are concealed by the dense, contrastfilled parenchyma. Density in the venous phase has been improved in animals by using radiopaque agents which are not filtered by the kidney, such as Thorotrast (3) and emulsified oil (12), but because of their toxicity these agents cannot be employed in man. The most common method of demonstrating renal vein morphology is by catheterization of that vein, followed by retrograde injection of contrast medium against renal blood flow (5, 10). This flow quickly rinses out the medium and prevents adequate filling of the peripheral renal veins. Good filling of the peripheral renal veins has been obtained by injecting contrast material at high pressures between the balloons of a double-balloon catheter, which have been inflated on either side of the re...

The liver and spleen are among the few structures in the body for which safe and reliable primary contrast roentgen diagnostic procedures have not been established. Hepatolienography with colloidal thorium dioxide2 has been widely performed for many years (65), but this material has fallen into disfavor with many workers, though not all, as a result of a number of cases in which injurious effects presumably related to its use have been reported. Since thorotrast has been in clinical use for over twenty years, there is available a rather large body of pathological and clinical material in which its long-term effects may be studied. It has seemed desirable to attempt an evaluation of these effects, to formulate criteria for an ideal medium for opacification of the liver and spleen, and to report preliminary studies with other media. I. Evaluation of the Effects of Thorotrast Thorotrast is a 25 per cent suspension of thorium dioxide (15 to 20 per cent by weight) with an average particle size of 3 to 10 milli...

The most frequently injured organ in cases of blunt abdominal trauma is the spleen (10). Numerous reports have dealt with attempted roentgen diagnosis of splenic trauma on routine abdominal films (4, 8, 11, 13). More recently arteriography has been utilized in an effort to effect a greater accuracy in diagnosing this condition. Of historical interest is Burke and Madigan's 1933 report (3) of the diagnosis of a ruptured spleen with Thorotrast. The first case in which arteriography via a retrograde femoral route was used was diagnosed by Norell (6). Various other methods, such as selective celiac or splenic arteriography and intravenous aortography, have added only 5 other cases to the English literature (2, 5, 7, 9). At a large trauma center we have had the opportunity to evaluate a number of suspect splenic injury patients and have made the correct preoperative diagnosis with arteriography in 17 instances of splenic rupture. Our purpose is to present the arteriographie findings in these cases and discuss ...

Roentgen examination of the lymphatics in vivo has a relatively meager history as compared with arteriovenous studies. This may be accounted for by the fundamental differences between the two systems. Monteiro (1) and his collaborators (Rodriguez, Sousa Pereira, and Carvallo) in 1930 performed adenolymphography in animals; Thorotrast injected into the lymph nodes entered the lymphatic trunks, rendering them demonstrable roentgenographically. Menville and Ane (2) in 1932 reported studies in rats and dogs in which they were able to visualize the popliteal, inguinal, axillary, and mesenteric nodes following subcutaneous injections of thorium dioxide into the tails and legs. Zhdanov (3) was one of the first to inject the contrast medium directly into the lymphatics in experimental animals and human cadavers (1932). In the ensuing decade, numerous investigators sought to obtain visualization of the lymph channels by injection of contrast media into the various body cavities and soft tissues—into the peritoneum...

The purpose of this paper is to re-emphasize the real and potential dangers of the use of thorotrast as a diagnostic agent. It is hoped by adding to the literature several cases, in which the perivascular injection of thorotrast has produced disabling results, to accentuate the real danger that accompanies its use. Further, we would like to point out the problem of the roentgen diagnosis of thorotrast in the soft tissues when a history of its injection cannot be elicited. Review of Literature An extensive and controversial literature has been built up on the subject of thorotrast since its introduction by Radt in 1929 (15). Excellent reviews have been published by Orr, Popoff et al. (11), Stewart and Ghiselin (19), Yater and Coe (23), and others. Taft (20, 21) has reported volumetric studies on radiation from thorotrast in the tissues and calculated radium equivalents. As a result of his observations, he concluded that the use of 75 c.c. of thorotrast is dangerous, due to the continuous bombardment of the...

In 1959 Edling and Helander reported an experimental study of the normal angionephrographic effect in dogs following simultaneous injection of sodium diprotrizoate 50 per cent into one renal artery and a colloidal solution of thorium dioxide 25 per cent (Thorotrast) into the other. This experiment was performed in one animal, and the thorium dioxide was injected into only one renal artery. The vascular contrast filling associated with the nephrographic effect by the organic compound was compared with the angiogram produced by thorium dioxide where the arterial and venous filling were demonstrated in separate exposures. For more complete investigation, thorium dioxide has again been used experimentally in a series of renal arteriographies in dogs. Methods and Material The methods are reported in detail by Edling and Ovenfors (1962). The dogs were kept under superficial general anesthesia. The aorta and the renal arteries were catheterized with red Odman catheters, according to Seldinger. In renal aortograp...

Patients who have received injections of Thorotrast for radiographic procedures are burdened with small quantities of radioactive material and will be exposed to a nearly constant amount of highly ionizing radiation for the remainder of their lives. Thorotrast is a contrast medium containing thorium dioxide and is rapidly taken up by the reticuloendo-thelial system, particularly the liver and spleen. A better correlation between absorbed dose and histo-logical change may be obtained by a systematic study of patients who have received Thorotrast injections. The thorium family is made up from Th232, an alpha emitter with a half-life of 1010 years, and eleven daughter products which emit alpha, beta, and gamma rays of a variety of energies. The accompanying table lists these products, indicating the energies of their corpuscular emissions. At the bottom is given the summation of the energies carried by the alpha and beta particles which result from the complete decay of one Th-232 nucleus. A determination of...

Cerebral arteriography was introduced by Moniz in 1927 (1). After experimenting with several radio-opaque substances he chose a colloidal preparation of thorium dioxide, thorotrast, as the most suitable. The objections and potential dangers in the use of this drug have been repeatedly pointed out (2). Diodrast (3,4-diiodo-4-pyridon-N-acetic acid diethanolamine) has been used for many years for intravenous pyelography and more recently for the visualization of the chambers of the heart and great blood vessels (3). Experiences with the use of diodrast for the visualization of the cerebral circulation of the dog and in man have been reported (4). At first a solution of 70 per cent diodrast was injected into the common carotid artery. Three of 12 patients so injected, however, developed jacksonian seizures immediately following the injection. Following this, 35 per cent diodrast, which is available commercially, was used, but adequate visualization of the cerebral circulation was not obtained in every case. W...

In a study of possible vascular changes in bone following irradiation and an evaluation of microangiography in their demonstration, the right hind legs of 17 albino rats ten weeks old were irradiated, with an air-exposure dose of 1,020 r generated at 130 kv and filtered by 5 mm. Al. The animals were sacrificed two to thirty days thereafter. Both hind legs of each were perfused with either a 50 per cent suspension of finely divided barium sulfate (Micropaque) or a 25 per cent suspension of thorium dioxide (Thorotrast). The femurs were decalcified and embedded in wax, and sections 100 microns thick were made for microradiography. The primary equipment for radiography was a General Electric x-ray diffraction tube with a beryllium window and Kodak 2-in.-square high-resolution plates. The tube was operated at 15 kv, 25 ma, and the film was exposed for fifteen seconds. Micropaque provided good demonstration of the larger vessels in the cancellous bone and marrow cavity. Thorotrast, on the other hand, showed sma...