meios de contraste na rm
TRANSCRIPT
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MEIOS DE CONTRASTE EM
RESSONÂNCIA MAGNÉTICA
Herculys Douglas
Teresina
2015
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Introdução ao meio de contraste
Tipos de meios de contraste
Vias de administração
Gadolínio e outros meios de contraste na RM
Indicações
Reações adversas ao meio de contraste
Injetora
Casos especiais
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COMPLETE A FRASE.
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CONTRASTE
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CONTRASTE RADIOLÓGICO
• Distancia entre o branco e preto.
• Tons de cinza
• Qualidade da imagem
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MEIOS DE CONTRASTE
• Definição das imagens
• Qualidade da informação morfológica
• Diferenciação de estruturas anatômicas e/ou patológicas.
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MEIOS DE CONTRASTE
• Raios-X
• TC
• Hemodinâmica
• RM
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RM X RADIOGRAFIA
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TC X RM
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TC X RM
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MEIOS DE CONTRASTE
• Baixa toxicidade
• Fácil administração
• Fácil eliminação
• Fornecer contraste adequado.
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COMPOSIÇÃO
• Elemento da solução:
• Sulfato de bário
• Iodo
• Gadolínio
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SOLUBILIDADE
• Substâncias hidrossolúveis (iodado e gadolínio)
• Substâncias lipossolúveis
• Substâncias insolúveis
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VIAS DE ADMINISTRAÇÃO
• Via oral
• Via parental (endovenosa, arterial, etc).
• Endocavitária (reto e uretra).
• Intratecal e intra-articular.
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TIPOS DE MEIOS DE CONTRASTE
• Sulfato de bário (BaSO4).
• Meios de contraste iodado: iônico e não iônico.
• Gadolínio-DTPA
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GADOLÍNIO (Gd)
• Elemento químico metálico, maleável e estrutura cristalina.
• Aspecto semelhante ao aço.
• Tóxico
• Johan Gadolin
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QUELANTES
Clorofila-absorção de fótons de luz, é um quelato de Mg.
Hemoglobina-transporte de O2 é um quelato de ferro.
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QUELANTES
• “Sequestrantes de materiais ou substância “.
• Evita a absorção
• Excreção renal
• Acidente de Goiânia-Azul da Prússia.
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QUEM CHUPA O VENENO DA COBRA?
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QUEM CHUPA O VENENO DA COBRA? QUELANTE!
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INTOXICAÇÃO POR CHUMBO?
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INTOXICAÇÃO POR CHUMBO? QUELANTE!
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GADOLÍNIO+QUELANTE
• GADOLÍNIO+DIETILENOTRIAMINA PENTA-ACÉTICO.
• Excreção renal
• União quase perfeita
• Gadolínio DTPA
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GADOLÍNIO-DTPA
• Redução do tempo de relaxamento T1.
• Doses baixas-0,1 a 0,2 mmol/Kg
• Baixa viscosidade
• Excreção entre 1,3 e 4 h.
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T1 e T2
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SEQUÊNCIAS T1 PRÉ E PÓS-Gd
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GADOLÍNIO-DTPA
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GADOLÍNIO-DTPA
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SUPRESSÃO DE GORDURA-FAT SAT
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REAÇÕES ADVERSAS
• Efeito nocivo ou indesejado
• Grau de severidade
• Tempo decorrido
• Reação anafilactóides e quimiotóxicas.
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GRAU DE SEVERIDADE
• Reações leves
• Reações moderadas
• Reações graves
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QUANTO AO TEMPO DECORRIDO
• Agudas ou imediatas (entre 5 e 20 min).
• Tardia (após o paciente deixar o serviço de radiologia).
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FATORES DE RISCO
• Idade
• Medicamentos
• Alérgicos
• Doenças subjacentes
• Insuficiência renal
• Desidratação
• Lactante
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HEMODIÁLISE
• Insuficiência renal
dialítica.
• Realizar hemodiálise no mesmo dia que injetar o meio de contraste.
• Processo de filtração do
sangue de uma forma artificial.
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TRATAMENTO DAS REAÇÕES ADVERSAS
• Vaso(neuro)-vagal
• Estabilizar condições
psicológicas • Estar preparado para iniciar
medidas terapêuticas
• Corticóides e anti-
histamínicos (hidrocortisona).
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KIT DE REAÇÃO ALÉRGICA
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INJETORA
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RISCO DA INJETORA
• Extravassamento
• Evitar o uso de veia da mão, pé, tornozelo e acesso venoso central.
• Não usar scalp (butterfly).
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EM CASO DE EXTRAVASAMENTO
• Elevar a extremidade afetada para cima.
• Gelo por 15 a 30 min.
• Observação de 1 a 4 h.
• Informar o médico radiologista
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DIFERENÇA DO CONTRASTE DA RM E TC
• Viscosidade
• Osmolaridade e osmolalidade
• Quantidade
• Índices de reações adversas
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PRINCIPAL DÚVIDA DOS CLIENTES
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EXEMPLOS
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BAYER
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BAYER
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AÇAÍ NA RM
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ABACAXI NA RM
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ERVA MATE NA RM
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ÁGUA NA RM
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GEL DE ULTRASSOM
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VITAMINA E NA RM
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ENTERO-RM
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COLÂNGIO-RM
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PRIMOVIST-FASE HEPATOBILIAR
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GADOVIST- 0,1 ML POR KG
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ARTRO-RM
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FERIDEX-T2
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