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Liu Y, Dong Y, Xie F. Global research hotspots and trends of iodinated contrast agents in medical imaging: a bibliometric and visualization analysis. Front Med (Lausanne) 2024; 11:1506634. [PMID: 39650193 PMCID: PMC11620865 DOI: 10.3389/fmed.2024.1506634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2024] [Accepted: 11/12/2024] [Indexed: 12/11/2024] Open
Abstract
Objective This study employs bibliometric methods to explore the global research dynamics of iodine contrast agents in medical imaging. Through the visualization of knowledge maps, it presents research progress and reveals the research directions, hotspots, trends, and frontiers in this field. Methods Using Web of Science Core Collection database, CiteSpace and VOSviewer were employed to conduct a visual analysis of the global application of iodine contrast agents in medical imaging over the past four decades. The analysis focused on annual publication volume, collaboration networks, citation characteristics, and keywords. Results A total of 3,775 studies on the application of iodine contrast agents in medical imaging were included. The earliest paper was published in 1977, with a slight increase in publications from 1991 to 2004, followed by a significant rise after 2005. The United States emerged as the leading country in publication volume. Harvard University was identified as a globally influential institution with 126 publications. Although a large author collaboration cluster and several smaller ones were formed, most collaborations between authors were relatively weak, with no high-density integrated academic network yet established. Pietsch Hubertus was the most prolific author, while Bae KT was the most highly co-cited author. The most highly cited journal was Radiology, with 2,384 citations. Co-occurrence analysis revealed that the top three keywords by frequency were "agent," "CT," and "image quality." Keyword clustering analysis showed that the top three clusters were "gadolinium," "gold nanoparticles," and "image quality." The timeline analysis indicated that clusters such as "gadolinium," "gold nanoparticles," "image quality," and "material decomposition" exhibited strong temporal continuity, while the keyword with the highest burst value was "digital subtraction angiography" (19.38). Burst term trend analysis suggested that recent research has been focusing on areas like "deep learning," "risk," "radiation dosage," and "iodine quantification." Conclusion This study is the first to systematically reveal the global trends, hotspots, frontiers, and development dynamics of iodine contrast agents in medical imaging through the use of CiteSpace and VOSviewer. It provides a novel perspective for understanding the role of iodine contrast agents in imaging and offers valuable insights for advancing global research in medical imaging.
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Affiliation(s)
- Yun Liu
- Department of Imaging, Jiangxi Provincial People’s Hospital (The First Affiliated Hospital of Nanchang Medical College), Nanchang, Jiangxi, China
| | - Yonghai Dong
- Jiangxi Provincial Key Laboratory of Major Epidemics Prevention and Control, Young Scientific Research and Innovation Team, Jiangxi Provincial Center for Disease Control and Prevention, Nanchang, Jiangxi, China
| | - Fei Xie
- Guangdong Medical University, Guangzhou, Guangdong, China
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2
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Li L, Wang ZY, Liu B. Ultrasound-guided carotid angioplasty and stenting in a patient with iodinated contrast allergy: A case report. World J Clin Cases 2023; 11:5926-5933. [PMID: 37727497 PMCID: PMC10506023 DOI: 10.12998/wjcc.v11.i25.5926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/03/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND Ischemic stroke is an entity with high incidence, morbidity, and mortality rates. Carotid artery stenosis is an important and independent risk factor for ischemic stroke. The three current approaches for treating carotid artery stenosis are drug treatment, carotid endarterectomy (CEA), carotid angioplasty and stenting (CAS). The approach is chosen based on the degree of stenosis. CEA or CAS could have been chosen for the current patient, who had severe carotid stenosis and an iodinated contrast allergy. After thoroughly communicating with the patient, the patient chose CAS for treatment. Therefore, we performed ultrasound-guided CAS to avoid the use of iodinated contrast. CASE SUMMARY The main symptoms of the patient were numbness and weakness of the left limb. Computed tomography angiography of the head and neck at another hospital indicated multiple sites of stenosis in the arteries of the head and neck. The patient requested CAS for treatment but was allergic to iodinated contrast media. Thus, routine digital subtraction angiography (DSA) with iodinated contrast could not be used for the procedure. The diagnosis of this patient was as follows: (1) Right parietal lobe cerebral infarction; (2) multiple sites of stenosis in the arteries of the head and neck (severe stenosis of the right internal carotid artery, severe stenosis of the right subclavian artery); (3) right subclavian steal syndrome; and (4) hypertension (stage 3, high risk). The interventions included routine treatment for cerebral infarction, oral administration of clopidogrel (75 mg qd) and aspirin (100 mg qd), ultrasound-guided CAS, and postoperative follow-up. Postoperative color Doppler ultrasound and cerebrovascular magnetic resonance angiography of the carotid artery showed good vascular recovery, and the postoperative follow-up indicated a good prognosis. CONCLUSION This case study suggests that ultrasound-guided endovascular treatment is a potential option for patients with contraindications to the iodinated contrast agents used in DSA-guided surgery, although excellent surgical operating skills are needed.
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Affiliation(s)
- Le Li
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
- Department of Neurology, The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang 621000, Sichuan Province, China
| | - Zi-Yan Wang
- Department of Neurology, The Third Hospital of Mianyang (Sichuan Mental Health Center), Mianyang 621000, Sichuan Province, China
- Department of Clinical Medicine, North Sichuan Medical College, Nanchong 637000, Sichuan Province, China
| | - Bo Liu
- Department of Neurology, Shenzhen Longhua District Central Hospital, Shenzhen 518110, Guangdong Province, China
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3
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Grist TM, Canon CL, Fishman EK, Kohi MP, Mossa-Basha M. Short-, Mid-, and Long-Term Strategies to Manage the Shortage of Iohexol. Radiology 2022; 304:289-293. [PMID: 35587228 DOI: 10.1148/radiol.221183] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Recent disruptions in a pharmaceutical supply chain critical to radiologic imaging has impacted the global availability of iohexol iodinated contrast media (ICM). The shortage of iohexol has created a national crisis in the ability of radiology departments to provide health care to patients needing contrast-enhanced exams. Radiology departments are familiar with crisis management after more than two years of clinical and operational disruptions associated with the COVID-19 pandemic. The implications of this shortage has near-term (weeks), mid-term (months), and long term (years) impact. The purpose of this report is to provide the reader with strategies for dealing with the shortage of ICM in the near term and discuss long-term issues and potential solutions to supply chain problems impacting radiology departments.
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Affiliation(s)
- Thomas M Grist
- Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Cheri L Canon
- Department of Radiology, University of Alabama-Birmingham, Birmingham, AL, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
| | - Maureen P Kohi
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Mahmud Mossa-Basha
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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4
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Interventional Radiology Approach to Contrast Media Preservation Strategies. J Vasc Interv Radiol 2022; 33:1021-1024. [DOI: 10.1016/j.jvir.2022.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/17/2022] [Indexed: 11/23/2022] Open
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5
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Liu X, Zhang Y, Cui X, Fan T, Shu J, Li H, Huo X, Lu C. Gadopentetate meglumine activates mast cells to cause IgE-independent allergic reactions both in vitro and in vivo. Int Immunopharmacol 2022; 106:108602. [DOI: 10.1016/j.intimp.2022.108602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Revised: 01/19/2022] [Accepted: 01/30/2022] [Indexed: 11/05/2022]
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6
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Saito S, Ikeda N, Toi S, Nakamura M. Gadolinium contrast balloon pulmonary angioplasty for a patient with chronic thromboembolic pulmonary hypertension and severe iodine allergy. Catheter Cardiovasc Interv 2020; 97:E525-E531. [PMID: 32478464 DOI: 10.1002/ccd.29004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/01/2020] [Accepted: 05/12/2020] [Indexed: 11/08/2022]
Abstract
Chronic thromboembolic pulmonary hypertension (CTEPH) is group 4 pulmonary hypertension caused by organized thrombi in the pulmonary arteries. Balloon pulmonary angioplasty (BPA) is an emerging treatment option for patients with inoperable CTEPH but needs contrast media. Therefore, management can be very difficult in patients who have severe iodine allergies. We present a case of a 61-year-old female with CTEPH. Right heart catheterization showed that the mean pulmonary arterial pressure (mPAP) was 47 mmHg. Her organized thrombi were not surgically accessible, so we performed BPA to improve her hemodynamic status. One session of BPA was performed, but the second session was halted because of iodine-induced anaphylactic shock. Despite the administration of pulmonary arterial hypertension-specific drugs for 3 months, the patient's mPAP was still 33 mmHg. CTEPH patients with mPAP ≥30 mmHg have a poor prognosis, so we decided to perform BPA using gadolinium contrast media. A total of six sessions of gadolinium contrast BPA (Gd-BPA) improved the patient's mPAP to the normal range. Gadolinium contrast media could also be used for visualizing pulmonary arteries during BPA. Our report is the first successful case of Gd-BPA, which improved the patient's hemodynamic status to the almost normal range. Gd-BPA may be an attractive treatment option for patients with inoperable CTEPH and severe iodine allergy.
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Affiliation(s)
- Shota Saito
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Nobutaka Ikeda
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Satoru Toi
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
| | - Masato Nakamura
- Division of Cardiovascular Medicine, Toho University Ohashi Medical Center, Tokyo, Japan
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Mallio CA, Quattrocchi CC, Rovira À, Parizel PM. Gadolinium Deposition Safety: Seeking the Patient's Perspective. AJNR Am J Neuroradiol 2020; 41:944-946. [PMID: 32381539 DOI: 10.3174/ajnr.a6586] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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8
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Transarterial chemoembolization in a patient with severe reactions to iodinated contrast: Successful treatment using gadolinium contrast with C-arm computed tomography. Radiol Case Rep 2019; 14:299-303. [PMID: 30546812 PMCID: PMC6280638 DOI: 10.1016/j.radcr.2018.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 11/14/2018] [Accepted: 11/14/2018] [Indexed: 11/21/2022] Open
Abstract
Severe reactions to modern iodinated contrasts are uncommon. Breakthrough reactions in the setting of pretreatment with corticosteroids are even rarer. Patients with a history of these refractory reactions can create challenging situations in the diagnostic and therapeutic process. Here, we present a case of an 83-year-old male with hepatocellular carcinoma and a history of multiple severe reactions to iodinated contrast. The patient required a transarterial chemoembolization but the conventional technique was unavailable due to the allergy. Gadolinium-based contrast was substituted and used in conjunction with C-arm CT and a percutaneous ethanol injection to treat the tumor. After nearly 3 years, there is no evidence of residual or recurrent hepatocellular carcinoma.
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9
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Takahashi EA, Kallmes DF, Mara KC, Harmsen WS, Misra S. Nephrotoxicity of gadolinium-based contrast in the setting of renal artery intervention: retrospective analysis with 10-year follow-up. ACTA ACUST UNITED AC 2019; 24:378-384. [PMID: 30406762 DOI: 10.5152/dir.2018.18172] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
PURPOSE We aimed to determine the incidence rate and potential risk factors for postcontrast acute kidney injury (PC-AKI) as well as the long-term clinical implications on dialysis and mortality in patients with chronic kidney disease (CKD) who underwent renal artery stent placement exclusively with gadolinium-based contrast agents. METHODS This retrospective study reviewed 412 patients with CKD who underwent renal artery stent placement. Sixty-eight patients underwent intervention exclusively with gadolinium-based contrast agents and were analyzed. Criteria for PC-AKI included either an absolute serum creatinine increase >0.3 mg/dL or percentage increase in serum creatinine >50% within 48 hours of intervention. Logistic regression analysis was performed to identify risk factors for PC-AKI. The cumulative proportion of patients who died or went on to hemodialysis was determined using Kaplan-Meier survival analysis. RESULTS The incidence of PC-AKI was 14.7%. The rate of AKI decreased for every 1 unit increase in glomerular filtration rate ( GFR, odds ratio [OR]=0.91, P = 0.047). Prehydration was associated with a lower PC-AKI rate (OR=0.17; P = 0.015). Acute kidney injury after intervention was associated with an increased rate of dialysis (Hazard ratio [HR]=4.51, P = 0.002) and mortality (HR=2.52; P = 0.027). CONCLUSION Gadolinium-based contrast agents are potentially nephrotoxic when used for endovascular intervention in patients with CKD. The risk of PC-AKI increased with lower GFR and decreased with prehydration. Dialysis and mortality risk were increased in patients who developed PC-AKI.
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Affiliation(s)
| | | | - Kristin C Mara
- Department of Clinical Statistics, Mayo Clinic, Minnesota, USA
| | - William S Harmsen
- Department of Radiology, Mayo Clinic, Department of Clinical Statistics, Mayo Clinic, Minnesota, USA
| | - Sanjay Misra
- Department of Radiology, Division of Vascular and Interventional Radiology, Mayo Clinic, Minnesota, USA
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10
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Male S, Mehta T, Tore H, Quinn C, Grande AW, Tummala RP, Jagadeesan BD. Gadolinium to the rescue for mechanical thrombectomy in acute ischemic stroke. Interv Neuroradiol 2018; 25:301-304. [PMID: 30567455 DOI: 10.1177/1591019918815298] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Mechanical thrombectomy in the setting of acute ischemic stroke (AIS) requires cerebral digital subtraction angiography (DSA), typically performed with iodinated contrast medium. We present a case of emergent cerebral DSA and mechanical thrombectomy using gadolinium-based contrast for cerebral DSA in a patient with a history of anaphylaxis to iodinated contrast agents (ICs). CASE REPORT A 72-year-old man developed left ventricle assist device thrombus while on anticoagulation. During hospitalization he suffered right middle cerebral artery occlusion with a National Institutes of Health stroke scale score of 10. He had a history of anaphylaxis and the advanced directives revealed do not resuscitate/do not intubate status. We performed an emergent DSA as part of thrombectomy procedure using gadolinium-based contrast mixed in 1:1 proportion with normal saline. The images obtained were of adequate quality and the patient underwent successful thrombectomy with modified thrombolysis in cerebral infarction 2B recanalization. CONCLUSION Gadolinium-based contrast agents could be effective alternatives for cerebral DSA in patients undergoing mechanical thrombectomy for AIS who have a history of anaphylactic reaction to ICs.
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Affiliation(s)
- Shailesh Male
- 1 Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Tapan Mehta
- 1 Department of Neurology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Huseyin Tore
- 2 Department of Radiology, University of Minnesota, Minneapolis, Minnesota, USA
| | - Coridon Quinn
- 3 Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew W Grande
- 3 Department of Neurosurgery, University of Minnesota, Minneapolis, Minnesota, USA
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11
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Zani DD, Rabbogliatti V, Ravasio G, Pettinato C, Giancamillo MD, Zani DD. Contrast enhanced magnetic resonance imaging of the foot in horses using intravenous versus regional intraarterial injection of gadolinium. Open Vet J 2018; 8:471-478. [PMID: 30775287 PMCID: PMC6356101 DOI: 10.4314/ovj.v8i4.19] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2018] [Accepted: 11/20/2018] [Indexed: 12/27/2022] Open
Abstract
The use of contrast enhanced magnetic resonance imaging (MRI) for the detection of orthopedic pathologies in equine patients is poorly described. In few studies, enhanced MRI allowed to differentiate active lesions from chronic ones and to classify ambiguous lesions. The aim of this clinical prospective pilot study is to describe and compare the MRI lesions observed in horses with lameness localized to the foot using a single intravenous bolus dose of gadolinium contrast versus regional intraarterial bolus of contrast agent. Ten horses that underwent contrast enhanced MRI were included in the study. Gadolinium was injected intravenously in 3 patients and in 7 horses contrast agent was administered by intraarterial regional delivery. Regions of interest (ROI) were collected from both pre- and post-contrast images and ratios between pre- and post-contrast ROIs were calculated. No adverse reactions were noted after contrast agent injection. Injured structures that revealed greater increase in signal in post-contrast images were the deep digital flexor tendon (DDFT), the navicular spongiosa and the peritendinous tissues. Regional intraarterial administration of gadolinium provided higher ratio of contrast enhancement. Enhanced MRI using both intravenous or intraarterial injection of gadolinium, increased the diagnostic capability of MRI in horses with foot lesions. Nevertheless, regional intraarterial administration of gadolinium was considered the best choice due to the higher signal and lower volumes of contrast agent required.
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Affiliation(s)
- Donatella De Zani
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Vanessa Rabbogliatti
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Giuliano Ravasio
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Cinzia Pettinato
- Department of Medical Physics, Policlinico S.Orsola-Malpighi, Bologna, Italy
| | - Mauro Di Giancamillo
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
| | - Davide Danilo Zani
- Dipartimento di Medicina Veterinaria, Centro Clinico Veterinario e Zootecnico Sperimentale, Università degli Studi di Milano, Italy
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12
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Mechlem K, Sellerer T, Ehn S, Munzel D, Braig E, Herzen J, Noel PB, Pfeiffer F. Spectral Angiography Material Decomposition Using an Empirical Forward Model and a Dictionary-Based Regularization. IEEE TRANSACTIONS ON MEDICAL IMAGING 2018; 37:2298-2309. [PMID: 29993572 DOI: 10.1109/tmi.2018.2840841] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
By resolving the energy of the incident X-ray photons, spectral X-ray imaging with photon counting detectors offers additional material-specific information compared to conventional X-ray imaging. This additional information can be used to improve clinical diagnosis for various applications. However, spectral imaging still faces several challenges. Amplified noise and a reduced signal-to-noise ratio on the decomposed basis material images remain a major problem, especially for low-dose applications. Furthermore, it is challenging to construct an accurate model of the spectral measurement acquisition process. In this paper, we present a novel algorithm for projection-based material decomposition. It uses an empirical polynomial model that is tuned by calibration measurements. We combine this method with a statistical model of the measured photon counts and a dictionary-based joint regularization approach. We focused on spectral coronary angiography as a potential clinical application of projection-based material decomposition with photon counting detectors. Numerical and real experiments show that spectral angiography with realistic dose levels and gadolinium contrast agent concentrations are feasible using the proposed decomposition algorithm and currently available photon-counting detector technology.
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13
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Sterner G, Nyman U. Contrast medium-induced nephropathy. Aspects on incidence, consequences, risk factors and prevention. Libyan J Med 2016. [DOI: 10.3402/ljm.v2i3.4710] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Gunnar Sterner
- Department of Nephrology and Transplantation, Malmö University Hospital, Malmö, Sweden
| | - Ulf Nyman
- Department of Diagnostic Radiology, Lasarettet Trelleborg, Trelleborg, Sweden
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14
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Krasilnikova AA, Solovieva AO, Trifonova KE, Brylev KA, Ivanov AA, Kim SJ, Shestopalov MA, Fufaeva MS, Shestopalov AM, Mironov YV, Poveshchenko AF, Shestopalova LV. Cellular internalization and morphological analysis after intravenous injection of a highly hydrophilic octahedral rhenium cluster complex - a new promising X-ray contrast agent. CONTRAST MEDIA & MOLECULAR IMAGING 2016; 11:459-466. [PMID: 27491502 DOI: 10.1002/cmmi.1707] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 06/24/2016] [Accepted: 07/01/2016] [Indexed: 11/05/2022]
Abstract
The octahedral cluster compound Na2 H8 [{Re6 Se8 }(P(C2 H4 CONH2 )(C2 H4 COO)2 )6 ] has been shown to be highly radio dense, thus becoming a promising X-ray contrast agent. It was also shown that this compound had low cytotoxic effect in vitro, low acute toxicity in vivo and was eliminated rapidly from the body through the urinary tract. The present contribution describes a more detailed cellular internalization assay and morphological analysis after intravenous injection of this hexarhenium cluster compound at different doses. The median lethal dose (LD50 ) of intravenously administrated compound was calculated (4.67 ± 0.69 g/kg). Results of the study clearly indicated that the cluster complex Hn [{Re6 Se8 }(P(C2 H4 CONH2 )(C2 H4 COO)2 )6 ]n-10 was not internalized into cells in vitro and induced only moderate morphological alterations of kidneys at high doses without any changes in morphology of liver, spleen, duodenum, or heart of mice. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Anna A Krasilnikova
- Federal State Budgetary Scientific Institution "Scientific Institute of Clinical and Experimental Lymphology", Novosibirsk, Russian Federation.,Novosibirsk State University, Novosibirsk, Russian Federation.,Federal State Budgetary Scientific Institution "Research Institute of Experimental and Clinical Medicine", Novosibirsk, Russian Federation
| | - Anastasiya O Solovieva
- Federal State Budgetary Scientific Institution "Scientific Institute of Clinical and Experimental Lymphology", Novosibirsk, Russian Federation
| | - Kristina E Trifonova
- Federal State Budgetary Scientific Institution "Scientific Institute of Clinical and Experimental Lymphology", Novosibirsk, Russian Federation.,The State Research Center of Virology and Biotechnology VECTOR, Koltsovo, Novosibirsk Region, Russian Federation
| | - Konstantin A Brylev
- Novosibirsk State University, Novosibirsk, Russian Federation.,Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk, Russian Federation.,Department of Chemistry and Nano Science, Ewha Womans University, Seoul, Korea
| | - Anton A Ivanov
- Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk, Russian Federation
| | - Sung-Jin Kim
- Department of Chemistry and Nano Science, Ewha Womans University, Seoul, Korea
| | - Michael A Shestopalov
- Novosibirsk State University, Novosibirsk, Russian Federation.,Federal State Budgetary Scientific Institution "Research Institute of Experimental and Clinical Medicine", Novosibirsk, Russian Federation.,Nikolaev Institute of Inorganic Chemistry SB RAS, Novosibirsk, Russian Federation
| | - Maria S Fufaeva
- Federal State Budgetary Scientific Institution "Research Institute of Experimental and Clinical Medicine", Novosibirsk, Russian Federation
| | - Alexander M Shestopalov
- Federal State Budgetary Scientific Institution "Research Institute of Experimental and Clinical Medicine", Novosibirsk, Russian Federation
| | - Yuri V Mironov
- Novosibirsk State University, Novosibirsk, Russian Federation.,Federal State Budgetary Scientific Institution "Research Institute of Experimental and Clinical Medicine", Novosibirsk, Russian Federation
| | - Alexander F Poveshchenko
- Federal State Budgetary Scientific Institution "Scientific Institute of Clinical and Experimental Lymphology", Novosibirsk, Russian Federation
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15
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Krasilnikova AA, Shestopalov MA, Brylev KA, Kirilova IA, Khripko OP, Zubareva KE, Khripko YI, Podorognaya VT, Shestopalova LV, Fedorov VE, Mironov YV. Prospects of molybdenum and rhenium octahedral cluster complexes as X-ray contrast agents. J Inorg Biochem 2015; 144:13-7. [DOI: 10.1016/j.jinorgbio.2014.12.016] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2014] [Revised: 12/15/2014] [Accepted: 12/16/2014] [Indexed: 11/28/2022]
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16
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Racadio JM, Kashinkunti SR, Nachabe RA, Racadio JM, Johnson ND, Kukreja KU, Patel MN, Privitera MB, Hales JE, Abruzzo TA. Clinically useful dilution factors for iodine and gadolinium contrast material: an animal model of pediatric digital subtraction angiography using state-of-the-art flat-panel detectors. Pediatr Radiol 2013; 43:1491-501. [PMID: 23736781 DOI: 10.1007/s00247-013-2723-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/01/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Iodinated and gadolinium contrast agents pose some risk for certain pediatric patients, including allergic-like reactions, contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF). Digital flat-panel detectors enhance image quality during angiography and might allow use of more dilute contrast material to decrease risk of complications that might be dose-dependent, such as CIN and NSF. OBJECTIVE To assess the maximum dilution factors for iodine- and gadolinium-based contrast agents suitable for vascular imaging with fluoroscopy and digital subtraction angiography (DSA) on digital flat-panel detectors in an animal model. MATERIALS AND METHODS We performed selective catheterization of the abdominal aorta, renal artery and common carotid artery on a rabbit. In each vessel we performed fluoroscopy and DSA during contrast material injection using iodinated and gadolinium contrast material at 100%, 80%, 50%, 33% and 20% dilutions. An image quality score (0 to 3) was assigned by each of eight evaluators. Intracorrelation coefficient, paired t-test, one-way repeated analysis of variance, Spearman correlation and receiver operating characteristic curve analysis were applied to the data. RESULTS Overall the image quality scores correlated linearly with dilution levels. For iodinated contrast material, the optimum cut-off level for DSA when a score of at least 2 is acceptable is above 33%; it is above 50% when a score of 3 is necessary. For gadolinium contrast material, the optimum cut-off for DSA images is above 50% when a score of at least 2 is acceptable and above 80% when a score of 3 is necessary. CONCLUSION Knowledge of the relationship between image quality and contrast material dilution might allow a decrease in overall contrast load while maintaining appropriate image quality when using digital flat-panel detectors.
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Affiliation(s)
- John M Racadio
- Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3030, USA,
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Contrast alternatives for iodinated contrast allergy and renal dysfunction: options and limitations. J Vasc Surg 2012; 57:593-8. [PMID: 23246079 DOI: 10.1016/j.jvs.2012.10.009] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/13/2012] [Accepted: 10/02/2012] [Indexed: 12/19/2022]
Abstract
Diagnostic angiography and vascular interventions make routine use of iodinated contrast material (ICM). Patients with renal disease or contrast allergy pose limitations on the use of ICM. In such cases, alternative contrast media may be used to carry out the procedure. Current alternatives include carbon dioxide, gadolinium, and dilute ICM. Each of these alternatives has its own unique features and limitations. In the present review article, the current alternatives to ICM are explored, with a focus on the applications and restrictions of each.
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[Combined use of contrast media containing iodine and gadolinium for imaging and intervention : A hitherto widely ignored topic in radiological practice]. Radiologe 2012; 52:167-72. [PMID: 22271324 DOI: 10.1007/s00117-011-2279-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The synchronous use of chemically different contrast media in the same body compartment is a challenge for the radiologist, whether it is scheduled or unexpected. However, to inject contrast media containing iodine and gadolinium at the same time can be a prerequisite for the examination of several organs or organ systems. Unlike other topics of contrast-enhanced imaging procedures, the difficulties encountered with double contrast injections have been widely ignored in the literature. In the absence of reliable data from experimental and clinical studies the radiologist is dependent on case reports, information provided by the contrast media manufacturers, personal communications, mostly scanty personal experiences and a skilful time management, in order to overcome the situation. Only the combination of X-ray, computed tomography and magnetic resonance arthrography can be performed without another thought. However, the more or less synchronous vascular application of contrast media containing iodine and gadolinium requires vigilance. The more seriously ill the patient is, the more caution is advised even if the decision on the combined administration has to be reached urgently. The following overview gives a description of the properties of contrast media containing iodine and gadolinium as far as interactions following simultaneous administration are concerned. Subsequently, the clinically relevant situations and constellations are outlined and analyzed.
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Martín Arranz E, Rey Sanz R, Martín Arranz MD, Gea Rodríguez F, Mora Sanz P. [Use of gadolinium as contrast agent in endoscopic retrograde cholangiopancreatography in patients with iodine allergy]. GASTROENTEROLOGIA Y HEPATOLOGIA 2011; 34:672-7. [PMID: 22119016 DOI: 10.1016/j.gastrohep.2011.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Revised: 08/21/2011] [Accepted: 09/01/2011] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Radiologic contrasts are required during endoscopic retrograde cholangiopancreatography (ERCP). The most frequently used are iodine-based contrast media. Controversy still surrounds the optimal strategy in patients with previous adverse reactions to iodine contrasts that need to undergo an ERCP. OBJECTIVE To evaluate the safety and efficacy of a gadolinium-derived contrast medium in patients with previous reactions to iodine-derived agents during ERCP. MATERIAL AND METHODS Thirteen ERCP were performed in 11 patients with well-established adverse reactions to iodine compounds. ERCP was carried out with gadobutrol, a non-ionic gadolinium compound and without prophylaxis. RESULTS In all patients, ERCP were satisfactorily completed. Thirteen cholangiograms and one pancreatogram were obtained. All procedures were technically successful, allowing diagnosis and endotherapy. The quality of the images was good, similar to those obtained with standard contrast media, and did not represent a limitation. No contrast-related adverse events were observed, and there were no post-ERCP complications. CONCLUSIONS Gadolinium-derived agents are a safe and effective alternative in iodine-allergic patients.
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Li YF, Chen C. Fate and toxicity of metallic and metal-containing nanoparticles for biomedical applications. SMALL (WEINHEIM AN DER BERGSTRASSE, GERMANY) 2011; 7:2965-80. [PMID: 21932238 DOI: 10.1002/smll.201101059] [Citation(s) in RCA: 139] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2011] [Indexed: 05/09/2023]
Abstract
It is important to obtain a better understanding of the uptake, trafficking, pharmacokinetics, clearance, and role of nanomaterials in biological systems, so that their possible undesirable effects can be avoided. A number of metallic or metal-containing nanomaterials, such as gold nanoparticles and nanorods, quantum dots, iron oxides nanoparticles, and endohedral metallofullerenes, have already been or will soon become very promising for biomedical applications. This review presents a summary of currently available data on the fate and toxicity of these metallic or metal-containing nanoparticles based on animal studies. Several issues regarding the nanotoxicity assessment and future directions on the study of the fate of these nanoparticles are also proposed.
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Affiliation(s)
- Yu-Feng Li
- CAS Key Laboratory for Biomedical Effects of Nanomaterials and Nanosafety and CAS Key Laboratory of Nuclear Analytical Techniques, Institute of High Energy Physics, Chinese Academy of Sciences, China
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Bello N, Manning WJ. Acute Adverse Reactions to Gadolinium in CMR. JACC Cardiovasc Imaging 2011; 4:1177-9. [DOI: 10.1016/j.jcmg.2011.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Accepted: 08/04/2011] [Indexed: 11/26/2022]
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Kim H, Folks KD, Guo L, Stockard CR, Fineberg NS, Grizzle WE, George JF, Buchsbaum DJ, Morgan DE, Zinn KR. DCE-MRI detects early vascular response in breast tumor xenografts following anti-DR5 therapy. Mol Imaging Biol 2011; 13:94-103. [PMID: 20383593 DOI: 10.1007/s11307-010-0320-2] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
PURPOSE Dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) measured the early vascular changes after administration of TRA-8, bevacizumab, or TRA-8 combined with bevacizumab in breast tumor xenografts. PROCEDURES Groups 1-4 of nude mice bearing human breast carcinoma were injected with phosphate-buffered saline, TRA-8, bevacizumab, and TRA-8 + bevacizumab on day 0, respectively. DCE-MRI was performed on days 0, 1, 2, and 3, and thereafter tumors were collected for terminal deoxynucleotidyl transferase-mediated dUT nick end labeling and CD31 staining. RESULTS DCE-MRI measured a significant K (trans) change within 3 days after TRA-8 therapy that correlated with tumor growth arrest, which was not shown with statistical significance by histopathology at these early time points posttreatment. The K (trans) changes followed quadratic polynomial curves. CONCLUSION DCE-MRI detected significantly lower K (trans) levels in breast tumor xenografts following TRA-8 monotherapy or combined therapy with bevacizumab.
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Affiliation(s)
- Hyunki Kim
- The Department of Radiology, University of Alabama at Birmingham, AL 35294, USA.
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Intraindividual comparison of gadolinium- and iodine-enhanced 64-slice multidetector CT pulmonary angiography for the detection of pulmonary embolism in a porcine model. Emerg Radiol 2010; 18:189-95. [DOI: 10.1007/s10140-010-0926-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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Feasibility of gadolinium-enhanced dual energy CT pulmonary angiography: a pilot study in rabbits. Int J Cardiovasc Imaging 2010; 27:1069-80. [DOI: 10.1007/s10554-010-9755-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Accepted: 11/12/2010] [Indexed: 10/18/2022]
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Off-label use of intravascular iodinated organic and MR contrast media. Radiol Med 2010; 116:1-14. [PMID: 20981503 DOI: 10.1007/s11547-010-0601-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 03/11/2010] [Indexed: 10/18/2022]
Abstract
UNLABELLED This paper analyses off-label prescribing of the iodinated organic and magnetic resonance (MR) contrast media used in diagnostic imaging and evaluates the liability profiles and medicolegal issues associated with such use. The term off-label generally indicates the use of known drugs for which new scientific evidence suggests use in a manner and in clinical scenarios not explicitly addressed by the drug data sheet and is outside the indications for which the medication was approved. In addition, the term also indicates the use of drugs with a different route of administration and dosage from those indicated in the information leaflet. Intravascular contrast media used in diagnostic imaging are drugs in the complete sense of the term, even though they have unique characteristics which in many ways distinguish them from other pharmacological agents. The off-label use of contrast media in diagnostic imaging is a little-investigated field and most commonly, but not exclusively, applies to gadolinium-based contrast media used in MR angiography as well as cardiac and paediatric applications. In particular, the off-label use of contrast media mostly concerns deviations from the recommended dose. As contrast media are to all effects pharmaceutical agents, their off-label use can be considered admissible within the limitations laid down by the Italian law in force (Article 3 of Law 94/98) and its interpretation, i.e. the following criteria must be present: the lack of a valid diagnostic alternative; written informed consent by the patient; the presence of scientific publications validated at the international level; assumption of responsibility by the radiologist. CONCLUSIONS The use of contrast media in modern image-guided medicine is essential. In cases in which the information contained in the information leaflet is modified and updated in any way whatsoever (indications, dosage, at others), specifically if restrictions are introduced in accordance with the law in force, the pharmaceutical industry must provide formal and timely notification to radiologists. On their part as prescribers and users of contrast media, radiologists must remain up to date regarding any changes in indications, dosage and route of administration. Lastly, we propose that the radiology report includes not only the type but also the dose of contrast medium used.
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Iodine contrast iso-attenuating with diagnostic gadolinium doses in CTA and angiography results in ultra-low iodine doses. A way to avoid both CIN and NSF in azotemic patients? Eur Radiol 2010; 21:326-36. [DOI: 10.1007/s00330-010-1924-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2010] [Revised: 07/15/2010] [Accepted: 07/16/2010] [Indexed: 11/30/2022]
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Bickham P, Golembiewski J. Contrast Media Use in the Operating Room. J Perianesth Nurs 2010; 25:94-103. [DOI: 10.1016/j.jopan.2010.01.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2010] [Accepted: 01/22/2010] [Indexed: 11/17/2022]
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Spectroscopic (multi-energy) CT distinguishes iodine and barium contrast material in MICE. Eur Radiol 2010; 20:2126-34. [PMID: 20309554 DOI: 10.1007/s00330-010-1768-9] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2009] [Revised: 01/15/2010] [Accepted: 01/20/2010] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Spectral CT differs from dual-energy CT by using a conventional X-ray tube and a photon-counting detector. We wished to produce 3D spectroscopic images of mice that distinguished calcium, iodine and barium. METHODS We developed a desktop spectral CT, dubbed MARS, based around the Medipix2 photon-counting energy-discriminating detector. The single conventional X-ray tube operated at constant voltage (75 kVp) and constant current (150 microA). We anaesthetised with ketamine six black mice (C57BL/6). We introduced iodinated contrast material and barium sulphate into the vascular system, alimentary tract and respiratory tract as we euthanised them. The mice were preserved in resin and imaged at four detector energy levels from 12 keV to 42 keV to include the K-edges of iodine (33.0 keV) and barium (37.4 keV). Principal component analysis was applied to reconstructed images to identify components with independent energy response, then displayed in 2D and 3D. RESULTS Iodinated and barium contrast material was spectrally distinct from soft tissue and bone in all six mice. Calcium, iodine and barium were displayed as separate channels on 3D colour images at <55 microm isotropic voxels. CONCLUSION Spectral CT distinguishes contrast agents with K-edges only 4 keV apart. Multi-contrast imaging and molecular CT are potential future applications.
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Contrast Material for Abdominal Dynamic Contrast-Enhanced 3D MR Angiography With Parallel Imaging: Intraindividual Equimolar Comparison of a Macrocyclic 1.0 M Gadolinium Chelate and a Linear Ionic 0.5 M Gadolinium Chelate. AJR Am J Roentgenol 2010; 194:821-9. [DOI: 10.2214/ajr.09.3306] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Kunishima K, Takao H, Akahane M, Yoshioka N, Ohtomo K. Safety of using iodized oil in chemoembolization for liver tumors in patients with previous adverse reactions to iodinated contrast media. Clin Imaging 2009; 33:365-8. [PMID: 19712816 DOI: 10.1016/j.clinimag.2008.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 12/01/2008] [Indexed: 11/18/2022]
Abstract
PURPOSE To evaluate the safety of using iodized oil in chemoembolization for liver tumors in patients with previous adverse reactions to iodinated contrast media. MATERIALS AND METHODS Records were retrospectively reviewed for all patients with a history of an adverse reaction to iodinated contrast media who underwent angiography using gadolinium-based contrast media and/or carbon dioxide at our institution from January 1998 to September 2006. Patients who underwent chemoembolization or hepatic artery infusion for liver tumors using iodized oil were identified. RESULTS There were 84 procedures with use of iodized oil performed in 36 patients. Mild adverse reactions potentially related to iodized oil were seen in two procedures (2.4%). There were no moderate or severe adverse reactions (0.0%). CONCLUSION Iodized oil can be safely used in patients with previous adverse reactions to iodinated contrast media.
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Affiliation(s)
- Kanako Kunishima
- Department of Radiology, Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan
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Ledneva E, Karie S, Launay-Vacher V, Janus N, Deray G. Renal Safety of Gadolinium-based Contrast Media in Patients with Chronic Renal Insufficiency. Radiology 2009; 250:618-28. [DOI: 10.1148/radiol.2503080253] [Citation(s) in RCA: 104] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Ruangkanchanasetr P, Rojanamethin S, Ruamthanthong A, Chaiprasert A, Supaporn T. USE OF HIGH-DOSE GADOLINIUM AS CONTRAST MEDIA TO AVOID RADIOCONTRAST MEDIA-INDUCED NEPHROPATHY. J Ren Care 2009; 35:11-5. [DOI: 10.1111/j.1755-6686.2009.00085.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Josephs SC, Rowley HA, Rubin GD. Atherosclerotic Peripheral Vascular Disease Symposium II: vascular magnetic resonance and computed tomographic imaging. Circulation 2009; 118:2837-44. [PMID: 19106405 DOI: 10.1161/circulationaha.108.191173] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Sakakibara M, Tsutsui H. Successful non contrast percutaneous coronary intervention for patient with unstable angina and prior anaphylactic reaction to iodinated contrast medium. Intern Med 2009; 48:1753-7. [PMID: 19797832 DOI: 10.2169/internalmedicine.48.2437] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
A 53-year-old man, who had a history of angina treated by percutaneous coronary intervention without allergic reaction to contrast and coronary bypass surgery, was hospitalized due to epigastralgia and tarry stool. During an enhanced computed tomography for the evaluation of abdominal diseases, he became hypotensive and had chest pain. To diagnose acute coronary syndrome, coronary angiography (CAG) was performed after the intravenous administration of hydrocortisone. He became hypotensive again during the CAG, which revealed significant coronary artery stenosis in the right coronary artery. Despite the intensive medical treatment, he had angina even while walking in the ward. By using an intravascular ultrasound for coronary stent implantation and the second wire as a marker for the stent implantation, we performed coronary interventional procedures successfully for this patient without the use of iodinated contrast media.
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Affiliation(s)
- Mamoru Sakakibara
- Department of Cardiovascular Medicine, Hokkaido University Graduate School of Medicine, Sapporo.
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36
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Weinreb JC. Which Study When? Is Gadolinium-enhanced MR Imaging Safer than Iodine-enhanced CT?1. Radiology 2008. [DOI: 10.1148/radiol.2491080075] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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van der Molen AJ. Nephrogenic systemic fibrosis and the role of gadolinium contrast media. J Med Imaging Radiat Oncol 2008; 52:339-50. [DOI: 10.1111/j.1440-1673.2008.01965.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Boyden TF, Gurm HS. Does gadolinium-based angiography protect against contrast-induced nephropathy?: a systematic review of the literature. Catheter Cardiovasc Interv 2008; 71:687-93. [PMID: 18360867 DOI: 10.1002/ccd.21459] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
UNLABELLED We evaluated the incidence of contrast-induced nephropathy (CIN) in patients exposed to gadolinium for diagnostic or therapeutic procedures. BACKGROUND CIN with iodinated contrast agents is a leading cause of acute renal failure. Gadolinium is often used as an alternative to iodinated contrast in patients at increased risk of CIN. The safety of gadolinium in patients at increased risk of CIN has not been established. METHODS AND RESULTS The authors performed a systematic review by searching MEDLINE, ISI Web of Knowledge, Current Contents, Embase, and the Cochrane Central Register of Controlled Trials to identify relevant studies evaluating gadolinium and its associated incidence of CIN. They identified 17 studies that reported both favorable and negative results with regard to the association of gadolinium and CIN. The differences in the results appeared to be dose related. When gadolinium was used in doses of 0.4 mmol/kg or higher, there appeared to be an increased incidence of ARF particularly in patients with preexisting renal insufficiency. CONCLUSIONS Although the evidence base is limited, gadolinium does not appear to be safer than iodinated contrast in patients at risk of CIN. Given the lack of randomized data to support its safety, gadolinium in lieu of iso-osmolar iodinated contrast cannot be advocated in patients at high risk of contrast nephropathy.
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Affiliation(s)
- Thomas F Boyden
- Division of Cardiovascular Medicine, University of Michigan, Ann Arbor, Michigan 48109-5853, USA
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Kim HS, Tsai J, Paxton BE. Safety and utility of uterine artery embolization with CO2 and a gadolinium-based contrast medium. J Vasc Interv Radiol 2008; 18:1021-7. [PMID: 17675621 DOI: 10.1016/j.jvir.2007.03.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
The authors evaluated the safety and clinical outcomes of uterine artery embolization (UAE) without the use of conventional iodinated contrast media for symptomatic uterine leiomyomata. Patients underwent UAE with use of CO(2) gas and a gadolinium-based contrast medium. The safety and feasibility of the technique were assessed. Patients were followed up at 24 hours, 1 month, and 6 months after UAE and yearly thereafter. UAE without iodinated contrast medium was attempted in eight patients (mean age, 42.7 years +/- 4.1), and bilateral UAE was successful in all patients. The mean fluoroscopy time was 14.9 minutes. The mean amount of gadolinium-based contrast medium used was 30.6 mL or 0.181 mmol/kg. No major complications were noted. The mean improvement in the symptom severity score was 53.8. The mean reduction in leiomyoma volume was 42%. To date, no repeat interventions have been performed. UAE with CO(2) and a gadolinium-based contrast medium is a viable treatment option for patients with a severe allergy to iodinated contrast media or renal insufficiency.
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Affiliation(s)
- Hyun S Kim
- Division of Vascular and Interventional Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N Wolfe St, Blalock 545, Baltimore, MD, 21287-4010, USA.
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Nephrogenic systemic fibrosis--implications for nephrologists. Eur J Radiol 2008; 66:208-12. [PMID: 18342470 DOI: 10.1016/j.ejrad.2008.01.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2008] [Revised: 01/04/2008] [Accepted: 01/08/2008] [Indexed: 11/23/2022]
Abstract
Nephrogenic systemic fibrosis (NSF) is a debilitating disorder seen in-patient with advanced chronic kidney disease (CKD). Recent evidence suggests a link between NSF and the administration of gadolinium-based contrast agents (Gd-CA). In addition, other risk factors have also been suggested to facilitate the development of NSF in this population after Gd-CA. These include metabolic acidosis, high-dose erythropoietin therapy, and the altered mineral metabolism of CKD. While it is possible that these factors may increase the risk of NSF after Gd-CA exposure, they may also simply reflect conditions that increase the risk of getting exposed to Gd-CA, particularly at high doses. Furthermore, given the risk of NSF in CKD, physicians must weigh the risks of NSF versus the risk of contrast-induced nephropathy (CIN) with iodinated agents in this population. In this review, we will provide a nephrologist's perspective on these issues and the nephrologist's role in the prevention of NSF.
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Sterner G, Nyman U. Contrast medium-induced nephropathy. Aspects on incidence, consequences, risk factors and prevention. Libyan J Med 2007; 2:118-24. [PMID: 21503209 PMCID: PMC3078203 DOI: 10.4176/070402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Contrast media-induced nephropathy (CIN) is a well-known complication of radiological examinations employing iodine contrast media (I-CM). The rapid development and frequent use of coronary interventions and multi-channel detector computed tomography with concomitant administration of relatively large doses of I-CM has contributed to an increasing number of CIN cases during the last few years. Reduced renal function, especially when caused by diabetic nephropathy or renal arteriosclerosis, in combination with dehydration, congestive heart failure, hypotension, and administration of nephrotoxic drugs are risk factors for the development of CIN. When CM-based examinations cannot be replaced by other techniques in patients at risk of CIN, focus should be directed towards analysis of number and type of risk factors, adequate estimation of GFR, institution of proper preventive measures including hydration and post-procedural observation combined with surveillance of serum creatinine for 1-3 days. For the radiologist, there are several steps to consider in order to minimise the risk for CIN: use of "low-" or "iso-osmolar" I-CM and dosing the I-CM in relation to GFR and body weight being the most important as well as utilizing radiographic techniques to keep the I-CM dose in gram iodine as low as possible below the numerical value of estimated GFR. There is as yet no pharmacological prevention that has been proven to be effective.
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Affiliation(s)
- Gunnar Sterner
- Department of Nephrology and Transplantation, Malmö University Hospital, Malmö, Sweden
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Shetty SK, Nelson EN, Lawrimore TM, Palmer WE. Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction. Skeletal Radiol 2007; 36:301-7. [PMID: 17187289 DOI: 10.1007/s00256-006-0228-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 09/24/2006] [Accepted: 09/26/2006] [Indexed: 02/02/2023]
Abstract
OBJECTIVE When performing epidural steroid injections for the management of chronic back pain, imaging guidance and a limited epidurogram improve accuracy of needle placement and ensure appropriate delivery of the injectate into the epidural space. We describe our experience using a gadolinium chelate as an alternative contrast agent for limited epidurography in patients with a history of an iodinated contrast reaction. DESIGN Thirty-eight of 2,067 (1.8%) epidural steroid injections performed in our department over a 25-month period (December 2003-January 2006) employed gadolinium. All injections were performed in the lumbar spine employing a paramedian interlaminar approach. Procedural notes and patient charts were reviewed to evaluate for immediate or delayed complications related to incorrect intrathecal or intravascular needle placement. A retrospective analysis of selected fluoroscopic spot images was performed to evaluate confidence of epidural needle placement; this analysis compared these spot images against those obtained from age- and gender-matched control patients in whom iodinated contrast was used to confirm needle placement. RESULTS Real-time fluoroscopic guidance permitted confident visualization of an epidurogram at the time of procedure in all 38 cases as documented in the procedural report, and no procedure resulted in a complication due to incorrect needle placement. Retrospective review of fluoroscopic spot images revealed at least moderate confidence of epidural needle placement by both readers in 29/38 cases (76.3%). Fluoroscopic spot images obtained using gadolinium yielded significantly less confidence than images obtained in control patients whose procedures were performed using iodinated contrast (P < 0.01). However, operators were sufficiently confident in needle placement based on real-time fluoroscopic images (not available in our subsequent review) to inject anesthestic in all 38 cases, despite the immediate consequences that could result from intrathecal administration. During the same time period, there were 11/2,067 (0.5%) instances of intrathecal needle placement discovered during attempted epidurography despite the use of fluoroscopy for needle guidance and reliance on loss-of-resistance technique. CONCLUSION Gadolinium chelate represents a safe and useful alternative contrast agent for confirmation of epidural needle placement in patients with an iodinated contrast allergy.
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Affiliation(s)
- Sanjay K Shetty
- Division of Musculoskeletal Radiology, Department of Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
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Chewning RH, Murphy KJ. Gadolinium-based Contrast Media and the Development of Nephrogenic Systemic Fibrosis in Patients with Renal Insufficiency. J Vasc Interv Radiol 2007; 18:331-3. [PMID: 17377176 DOI: 10.1016/j.jvir.2007.01.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
Abstract
Gadolinium-based contrast media are important tools in diagnostic and interventional radiology that are particularly useful in patients with renal insufficiency. Recent reports in which exposure to gadolinium compounds has been linked to the development of nephrogenic systemic fibrosis in this patient population, however, are quite concerning. It is of great importance that radiologists be aware of this serious disease and exercise caution when considering the use of gadolinium-based contrast media in patients with moderate (glomerular filtration rate, <60 mL/min/1.73 m(2)) to severe (glomerular filtration rate, <15 mL/min/1.73 m(2)) renal disease.
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Affiliation(s)
- Rush H Chewning
- Division of Interventional Neuroradiology, Johns Hopkins Hospital, 600 N Wolfe St, Baltimore, MD 21287, USA
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Abstract
As the associated risks of infrainguinal balloon angioplasty and stenting have fallen and the relative success rates have risen in recent years, the threshold for offering endovascular treatment to patients with claudication has significantly decreased. Patients once considered appropriate only for risk-factor modification, exercise therapy, and medical treatment are now increasingly being offered percutaneous revascularization as a primary treatment option. Similarly, occlusive disease of the tibial vessels, once thought to be the exclusive domain of operative bypass, is increasingly being treated percutaneously. Over this same period, results of operative infrainguinal arterial reconstruction have also considerably improved. In modern times, excellent outcomes following bypass grafting with autogenous vein to the tibial level have been demonstrated, with morbidity, mortality, and long-term patency equivalent to that of more proximal bypasses. Evidence supports the view that the anatomic level of the distal anastomosis is less critical to the long-term outcome of the procedure than factors such as operative indication and conduit quality. Within the context of this changing climate, it is an appropriate time to examine and potentially redefine the role of both endovascular and open surgical intervention for a population that has not traditionally been offered revascularization, patients with claudication secondary to infrageniculate occlusive disease.
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Affiliation(s)
- Matthew T Menard
- Division of Vascular and Endovascular Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA
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Esteban JM, Alonso A, Cervera V, Martínez V. One-molar gadolinium chelate (gadobutrol) as a contrast agent for CT angiography of the thoracic and abdominal aorta. Eur Radiol 2007; 17:2394-400. [PMID: 17285280 DOI: 10.1007/s00330-007-0590-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2005] [Revised: 12/13/2006] [Accepted: 01/11/2007] [Indexed: 10/23/2022]
Abstract
The aim of our study was to evaluate the use of a 1-molar gadolinium chelate (gadobutrol) as an alternative contrast medium for computed tomography angiography (CTA) exams of the aorta. CTA exams of the thoracic and/or abdominal aorta were performed on 15 patients with contraindications for the use of iodine who were not suitable for magnetic resonance examinations. The exams were performed with a 16-detector row scanner, injecting a mean dose of 0.37 mmol Gd/kg of body weight at a flow rate of 4 ml/s. Creatinine levels were obtained prior to the exam in patients with impaired renal function, and 24 and 48 h afterwards. The mean attenuation values obtained in the middle ascending and middle descending thoracic aorta were 202.3 and 216.8, respectively. The mean HU values of the abdominal aorta were 210.4 at the level of the renal arteries and 186.8 in the aortic bifurcation. All the exams were considered diagnostically adequate. No significant increase in serum creatinine was observed 24 and 48 h after the exam. We believe that gadobutrol could be an alternative contrast medium for CTA exams with 16-detector row scanners in patients with contraindications for iodinated contrast medium.
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Affiliation(s)
- José M Esteban
- ERESA, Department of Radiology, Consorcio Hospital General Universitario de Valencia, Avenida Tres Cruces s/n, 46014 Valencia, Spain.
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Steen H, Schwenger V. Good MRI images: to Gad or not to Gad? Pediatr Nephrol 2007; 22:1239-42. [PMID: 17574478 PMCID: PMC6904413 DOI: 10.1007/s00467-007-0509-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2007] [Revised: 04/08/2007] [Accepted: 04/11/2007] [Indexed: 11/02/2022]
Abstract
Gadolinium-based magnetic resonance imaging (MRI) contrast agents (Gad-CA) were formerly considered as alternatives to X-ray-employed iodinated media. Although originally thought to be nonnephrotoxic and proven to be nonhazardous in a healthy population, the Gad-CA safety issue is progressively more controversial in the high-risk group of end-stage renal disease (ESRD) patients. Recently, Gad-CAs have not only been blamed for harmless side effects such as dizziness or nausea but also for much more severe complications such as acute renal failure, pancreatitis, or even the development of so-called "nephrogenic systemic fibrosis" in patients with renal failure, culminating in the prohibition of gadodiamide (Omniscan) administration in ESRD patients and, due to renal-organ immaturity, in newborns and infants up to 1 year old. This editorial is written to give insights into the molecular structure of Gad-CAs as well as into the potential biochemical pathomechanisms underlying the aforementioned severe clinical manifestations. Furthermore, a review about the latest literature on Gad-CA nephrotoxicity is provided. Potential risk factors are mentioned and strategies to avoid deterioration of renal function are presented. Cases with Gad-CA-associated adverse events should be adequately documented and reported appropriately. MRI professionals should collaborate closely with their colleagues from other medical specialties to identify patients with adverse events.
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Affiliation(s)
- Henning Steen
- Department of Cardiology, University Hospital Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Germany
| | - Vedat Schwenger
- Department of Nephrology, University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany
- Medizinische Universitätsklinik Heidelberg, Im Neuenheimer Feld 162, 69120 Heidelberg, Germany
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Abstract
Branchio-oto-renal syndrome (BOR, Melnick-Fraser syndrome, MIM#113650) refers to a rare autosomal dominant disorder characterized by branchial cysts or fistulas, hearing loss, external ear malformation, preauricular pits and renal abnormalities. The authors present three episodes of significant bradycardia in two siblings diagnosed with BOR syndrome during the sevoflurane general anesthesia. There is no published experience of anesthesia with this syndrome. Bradycardia occurred variously at induction, maintenance and immediately prior to emergence and required surgical stimulation, atropine, or epinephrine to treat. We seek to raise awareness of the potential for bradycardia during the procedures in patients with this syndrome requiring volatile anesthesia, especially sevoflurane.
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Affiliation(s)
- Matthew H G Taylor
- Department of Anaesthesia and Operating Rooms, Starship Children's Hospital, Auckland, New Zealand.
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Heinrich MC, Kuhlmann MK, Kohlbacher S, Scheer M, Grgic A, Heckmann MB, Uder M. Cytotoxicity of iodinated and gadolinium-based contrast agents in renal tubular cells at angiographic concentrations: in vitro study. Radiology 2006; 242:425-34. [PMID: 17179401 DOI: 10.1148/radiol.2422060245] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE To test in vitro whether gadolinium-based contrast agents induce fewer toxic effects on renal tubular cells than does an iodinated contrast medium at concentrations used for angiography. MATERIALS AND METHODS LLC-PK1 cells were incubated with iomeprol, gadopentetate dimeglumine, gadobenate dimeglumine, gadoterate meglumine, gadodiamide, and corresponding mannitol solutions for 24 hours at 37 degrees C in two experimental settings: measurements with equally attenuating solutions and measurements with equimolar solutions. Cytotoxicity was assessed with 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyl tetrazolium bromide (MTT) assay, trypan blue testing, and an assay to detect apoptosis and necrosis. Data were analyzed with analyses of variance and post hoc tests. RESULTS Yielding the same x-ray attenuation, iomeprol-300 and iomeprol-150 at concentrations of 2.34-18.75 mg of iodine per milliliter induced significantly (P < .001) lower inhibition of MTT conversion (74%-102% of undamaged control cells) compared with 15.63-125.00 mmol/L concentrations of the gadolinium-based agents (mean percentages of undamaged control cells: 48%-80%, 50%-87%, 60%-95%, and 56%-92% with gadopentetate dimeglumine, gadobenate dimeglumine, gadoterate meglumine, and gadodiamide, respectively). At equimolar concentrations (62.5 mmol/L), iomeprol-190 induced a mean extent of inhibition of MTT conversion (69% of undamaged control cells) similar to that induced by gadoterate meglumine (71%) and gadodiamide (70%), whereas gadopentetate dimeglumine and gadobenate dimeglumine induced stronger effects (63% and 64%, respectively; P < .001). At trypan blue testing, there were more dead cells after incubation with 125 mmol/L gadopentetate dimeglumine than after incubation with iomeprol-190 (57% vs 19%, P < .001). The 125 mmol/L gadopentetate and gadobenate formulations induced more necrosis and apoptosis than did gadoterate meglumine, gadodiamide, and iomeprol (mean percentage difference between treated and untreated control cells: for necrosis, +124%, +95%, +17%, -6%, and +3%, respectively; for apoptosis, +34%, +35%, +13%, +4%, and +5%, respectively; P < .001). CONCLUSION At angiographic concentrations, gadolinium-based contrast agents do not induce fewer cytotoxic effects on cultured renal tubular cells than does iomeprol.
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Affiliation(s)
- Marc C Heinrich
- Institute of Diagnostic Radiology, University Hospital of Erlangen, Maximiliansplatz 1, 91054 Erlangen, Germany.
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Akgun H, Gonlusen G, Cartwright J, Suki WN, Truong LD. Are Gadolinium-Based Contrast Media Nephrotoxic?: A Renal Biopsy Study. Arch Pathol Lab Med 2006; 130:1354-7. [PMID: 16948524 DOI: 10.5858/2006-130-1354-agcmna] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2006] [Indexed: 11/06/2022]
Abstract
Abstract
Gadolinium-based contrast media were originally introduced as alternatives to iodinated media for magnetic resonance imaging. Although originally thought to be nonnephrotoxic, gadolinium-based contrast media have recently been reported to be associated with acute renal failure; the mechanism and the underlying renal injury are not completely understood. We report what is, to our knowledge, the first renal biopsy in this context. A 56-year-old patient underwent 2 consecutive vascular imaging procedures in conjunction with gadolinium-based contrast medium administration. A few days later, the patient developed acute renal failure. A renal biopsy showed acute tubular cell injury including patchy tubular cell necrosis, tubular cell degeneration, and marked proliferation of tubular cells, together with mild interstitial edema and interstitial inflammation, but without significant glomerular or vascular changes. During supportive therapy, renal function was partially regained. This case emphasizes the potential nephrotoxicity of gadolinium-based contrast media and suggests that the nephrotoxicity is related to potentially reversible acute tubular cell injury.
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Affiliation(s)
- Hulya Akgun
- Departments of Pathology, Nephropathology Service, The Methodist Hospital, Houston, TX 77030, USA
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