Contrast Administration Research Articles

Contrast enema, CT, and small bowel series of the ileal pouch.

This manuscript is part of the ileal pouch symposium and will describe the water-soluble contrast enema, CT, and small bowel series. MRI and other imaging modalities are discussed elsewhere in the symposium. Water-soluble contrast enema and CT are excellent for the evaluation of the ileal pouch. Contrast enema and CT with anal contrast administration can allow for anastomotic integrity and pouch assessment. Pre-pouch ileum, extra-intestinal manifestations, and acute symptomatology are best assessed with CT. The contrast small bowel examination is of limited utility in pouch patients and should not be performed. Indications, imaging technique, and anatomic pouch assessment with water-soluble contrast enema, CT, and contrast small bowel examination will be reviewed here.

Rationale and design of the Dynamic Coronary Roadmap for Contrast Reduction (DCR4Contrast) in PCI randomized controlled trial

The clinical and anatomic complexity of patients undergoing percutaneous coronary interventions (PCI) has increased significantly over the past two decades. Contrast induced nephropathy (CIN) significantly impacts prognosis after PCI, therefore minimising the risk of CIN is important in improving clinical outcomes. Dynamic Coronary Roadmap (DCR) is a PCI navigation support tool which may decrease CIN by projecting a virtual coronary roadmap on the moving angiogram, potentially reducing iodinated contrast volume during PCI. The Dynamic Coronary Roadmap for Contrast Reduction trial (DCR4Contrast) is a multi-center, prospective, unblinded, stratified 1:1 randomised controlled trial investigating if DCR use reduces the total contrast volume administered during PCI compared to PCI performed without DCR guidance. DCR4Contrast aims to recruit 394 patients undergoing PCI. The primary endpoint is the total undiluted iodinated contrast volume administered during the PCI, performed with or without DCR. As of November 14, 2022, 346 subjects have been enrolled. The DCR4Contrast study will investigate the potential contrast-sparing effect of the DCR navigation support tool in patients undergoing PCI. By reducing iodinated contrast administration, DCR has the potential to contribute to reduced risk of CIN and thus increase PCI safety.

Sclerosing angiomatoid nodular transformation of the spleen: multimodality imaging features and literature review

ObjectiveThe purpose of this study was to evaluate the CT and MRI findings, clinicopathologic features, and differential diagnosis of Sclerosing angiomatoid nodular transformation (SANT).Methods and materialsSeven men and seven women with pathological diagnoses of SANT were included in this retrospect study. Patients underwent at least one radiological examination before surgery. The number, shape, margin, size, attenuation, signal intensity, homogeneity, and enhancing pattern of the lesion were evaluated by two abdominal radiologists independently. Immunohistochemistry reports were available for 11 patients. The immunoreactivity to the vascular markers CD8, CD31, and CD34 was assessed.ResultsThe 14 SANT patients (7 men, 7 women; mean age, 43.5 years; age range, 24–56 years) presented with a single lesion and showed no specific clinical symptoms. Among 14 patients, 12 patients underwent MR scan, 5 patients underwent CT scan and 3 patients underwent PET-CT. On CT, all 5 lesions showed hypodensity on non-contrast images and spoke-wheel enhancing pattern after contrast administration, and calcification was observed. On T2WI, 10 cases(83.3%)showed hypointensity and 2 cases (16.7%) showed hyperintensity with central hypointensity. On T1WI, 10 cases (83.3%) were isointense and 2 cases (16.7%) were slightly hypointense. 10 cases (83.3%) showed hypointensity on DWI and 2 cases (16.7%) showed slightly hyperintensity on DWI. After contrast administration, all 12 lesions showed progressive enhancement. 18 F-fluorodeoxyglucose (FDG) uptake in the tumor was seen in all three cases that underwent PET-CT. The maximum standardized uptake value (SUVmax) was 4.5, 5.1, and 3.8 respectively.ResultsApart from the progressive spoke-wheel enhancing pattern, DWI and ADC findings will add value to the diagnosis of SANT.

Contrast removal from coronary sinus for prevention of contrast-induced nephropathy: a review.

The occurrence of contrast-induced-nephropathy (CIN) is related to the amount of contrast administration. Any removal of contrast from systemic circulation before reaching the kidneys might be beneficial using a device that removes contrast from a coronary sinus (CS). This manuscript aims to review the available literature regarding contrast removal from CS during coronary angiography or intervention for the prevention of CIN.

Clinical outcomes and management of contrast hypersensitivity in patients requiring repeated computed tomography imaging.

In collaboration with the Department of Rheumatology, Allergy and Immunology, our study aims to review the outcomes of and propose an improved workflow for the management of patients with prior hypersensitivity reactions to iodinated contrast media (ICM). Outpatients coming for contrast-enhanced computed tomography (CECT) were stratified into 3 categories (definite, unconfirmed and inaccurate) based on likelihood of their contrast hypersensitivity label. Patients could be offered a different ICM, receive the same ICM, or be referred to an allergist for further evaluation. There were 4 outcomes: (1) alternative ICM tolerated; (2) same ICM tolerated again; (3) patient developed a hypersensitivity reaction to either alternative or original ICM; and (4) CECT was deferred until assessment by an allergist. Comparison was made pre- and post-intervention to see if patient outcomes were improved. There were 132 patients who made a total of 154 visits (90.3% had documented contrast hypersensitivity). Post-intervention, the number of visits postponed for premedication decreased (81.0% to 34.7%). There was a reduction in hypersensitivity reactions (from 42.9% to 14.3%). Of the 12 patients assessed by the allergist, 6 could continue using the same or alternative ICM, 4 were advised to abstain from further contrast administration and 2 were pending testing with a third agent. Active intervention by the radiologist can decrease the number of postponed, converted or cancelled CECT studies as well as reduce the number of adverse allergic-like events. Direct collaboration between radiologist and allergist for specific cases may be helpful in patients who will likely need future/repeated CECTs.

Procedural and Technological Innovations Facilitating Ultra-low Contrast Percutaneous Coronary Interventions.

Ultra-low-dose contrast percutaneous coronary intervention (PCI) is a valuable approach in selected complex high-risk patients with renal failure. One of the objectives of ultra-low contrast PCI is to decrease the probability of developing postprocedural contrast-induced nephropathy (CIN), which predominately affects patients with baseline renal dysfunction. CIN is associated with poor clinical outcomes and increased healthcare-related costs. Another two clinical scenarios in which reduced dependence on contrast administration by the operator may contribute to improved safety are PCI in complex, high-risk indicated patients and in shock. In this review, we discuss the procedural techniques and recent technological innovations that enable ultra-low-dose contrast PCI to be performed in the cardiac cath lab.

Unusual Progressive Hepatic Echogenicity of the Pediatric Liver Following Intravenous Sonographic Contrast Administration

Contrast-enhanced ultrasound is a valuable tool to evaluate liver lesions in a pediatric patient cohort. Unusual progressive hepatic echogenicity (UPHE) is a self-limiting phenomenon noted in a cohort of children after administration of ultrasonographic contrast agents (UCAs). UPHE appears initially as heterogeneous branching similar to portal venous gas, culminating in a diffuse globular appearance. The etiology of UPHE is unclear and may be from underlying hepatic microvascular disease or altered gut permeability. This case series describes pediatric patients with UPHE following UCA bolus and discusses its potential mechanisms in children.

NGAL as Biomarker of Clinical and Subclinical Damage of Kidney Function after Coronary Angiography.

Contrast-induced acute kidney injury (CI-AKI) is a serious complication after angiographic examinations in cardiology. Diagnosis may be delayed based on standard serum creatinine, and subclinical forms of kidney damage may not be detected at all. In our study, we investigate the clinical use in these directions of a "damage"-type biomarker-neutrophil gelatinase-associated lipocalin (NGAL). Among patients with a high-risk profile undergoing scheduled coronary angiography and/or angioplasty, plasma NGAL was determined at baseline and at 4th and 24th h after contrast administration. In the CI-AKI group, NGAL increased significantly at the 4th hour (Me 109.3 (IQR 92.1-148.7) ng/mL versus 97.6 (IQR 69.4-127.0) ng/mL, p = 0.006) and at the 24th hour (Me 131.0 (IQR 81.1-240.8) ng/mL, p = 0.008). In patients with subclinical CI-AKI, NGAL also increased significantly at the 4th hour (Me 94.0 (IQR 75.5-148.2) ng/mL, p = 0.002) and reached levels close to those in patients with CI-AKI. Unlike the new biomarker, however, serum creatinine did not change significantly in this group. The diagnostic power of NGAL is extremely good-AUC 0.847 (95% CI: 0.677-1.000; p = 0.001) in CI-AKI and AUC 0.731 (95% CI: 0.539-0.924; p = 0.024) in subclinical CI-AKI. NGAL may be a reliable biomarker for the early diagnosis of clinical and subclinical forms of renal injury after contrast angiographic studies.

Intravascular Ultrasound Versus Computed Tomography Angiography in Sizing and Operative Management of Endovascular Aortic Aneurysm Repair.

An abdominal aortic aneurysm (AAA) is a potentially life-threatening condition, the management of which has dramatically evolved over the past 2 decades with an increasing tendency toward endovascular repair (EVAR) rather than open surgical repair. Classically, contrast-enhanced multislice computed tomography (CT) angiography (CTA) is performed preoperatively for procedure sizing and EVAR planning. This entails voluminous contrast injection with risk of allergic reaction, nephropathy, and radiation exposure. Intra-vascular ultrasound (IVUS) has been increasingly used to guide EVAR procedures intraoperatively. The aim of this study is to investigate the accuracy of IVUS in sizing AAAs, device selection, and EVAR planning compared to the gold standard CTA. This is a prospective observational study enrolling 10 patients who underwent standard infrarenal EVAR procedures performed for unruptured infrarenal AAAs over the course of 1 year. All patients had a preoperative CTA done upon which aneurysm sizing and device planning were performed, and the measurements obtained were compared to those obtained from intraoperative IVUS. All participating patients had unruptured infrarenal AAA, had no renal impairment, and had anatomical suitability for EVAR according to the instructions for use (IFU) of the device manufacturer. Primary endpoint was comparing anatomical measurements recorded by IVUS with those obtained from the preoperative CTA. Mean age was 65.6 (±6.19), all patients were males and hypertensives and 4 (40%) had a positive family history for AAA. On comparing mean measurements taken by CTA and IVUS, there was no statistically significant differences with exception of maximal aortic diameter and aortic diameter at site of bifurcation (both p-values <.001). There were no statistically significant differences in length measurements between the 2 imaging modalities. Computed tomography angiography was more associated with neck thrombus detection, and IVUS was more associated with calcification detection. Although CT angiography is still the gold standard imaging modality for AAA, IVUS use is very beneficial in EVAR sizing and planning, in addition to intra-operative guidance of the procedure, saving the patient significant time, contrast administration, and radiation exposure, especially in patients with renal impairment and contrast allergy. A preoperative CT angiogram is the gold standard required investigation for planning and sizing EVARs, with subsequent contrast injection entailing a risk of contrast induced nephropathy and allergic reactions. IVUS has been used as an adjuvant technique to guide EVAR stent graft deployment. However, our study concluded that it can also be reliably used in sizing and planning of the EVAR stent graft along with complementary non contrast imaging, especially in patients with high risk for contrast induced nephropathy and contrast allergy.

Best crossing of peripheral chronic total occlusions.

Together with colleagues from different disciplines, including cardiologists, interventional radiologists and vascular surgeons, committee members of the of the German Society of Angiology (Deutsche Gesellschaft für Angiologie [DGA]), developed a novel algorithm for the endovascular treatment of peripheral chronic total occlusive lesions (CTOs). Our aim is to improve patient and limb related outcomes, by increasing the success rate of endovascular procedures. This can be achieved by adherence to the proposed crossing algorithm, aiding the standardization of endovascular procedures. The following steps are proposed: (i) APPLY Duplex sonography and if required 3D techniques such as computed tomography or magnetic resonance angiography. This will help you to select the optimal access site. (ii) EVALUATE the CTO cap morphology and distal vessel refilling sites during diagnostic angiography, which are potential targets for a retrograde access. (iii) START with antegrade wiring strategies including guidewire (GW) and support catheter technology. Use GW escalation strategies to penetrate the proximal cap of the CTO, which may usually be fibrotic and calcified. (iv) STOP the antegrade attempt depending on patient specific parameters and the presence of retrograde options, as evaluated by pre-procedural imaging and during angiography. (v) In case of FAILURE, consider advanced bidirectional techniques and reentry devices. (vi) In case of SUCCESS, externalize the GW and treat the CTO. Manage the retrograde access at the end of the endovascular procedure. (vii) STOP the procedure if no progress can be obtained within 3 hours, in case of specific complications or when reaching maximum contrast administration based on individual patient's renal function. Consider radiation exposure both for patients and operators. In this manuscript we systematically follow and explain each of the steps (i)-(vi) based on practical examples from our daily routine. We strongly believe that the integration of this algorithm in the daily practice of endovascular specialists, can improve vessel and patient specific outcomes.

Utility of Abbreviated Small Bowel Follow Through Study in the Management of Small Bowel Obstruction.

Small bowel obstruction is a common surgical complaint. Most small bowel obstructions are managed successfully nonoperatively. Unanimous guidelines for nonoperative management of small bowel obstruction do not exist. A standardized protocol for water-soluble contrast administration and abbreviated small bowel follow through imaging was implemented in January of 2021. A retrospective chart review identified 111 patients admitted for SBO from 6/2019 to 9/2019 for a control group. A planned follow-up review identified 158 patients managed according to the new protocol from 3/2021 to 10/2021. The primary outcome was in-hospital length of stay. Standard statistical analyses were performed and pre-specified. Before implementation of the standardized protocol patients that were managed strictly nonoperatively, the mean length of stay (LOS) was 8.3 days. After implementation, the average LOS was 4.8 (P < .0001). Comparatively, patients admitted after protocol implementation were more likely to undergo CT scan with PO contrast on admission (98.1% vs 90.1%; P < .005), undergo NG tube decompression (84.7% vs 68.5%; P < .005), and undergo water-soluble contrast with abbreviated or formal SBFT (75.3% vs 37.8%; P < .0001). Implementation of a standardized protocol utilizing abbreviated SBFT with water-soluble contrast for the management of SBO at our institution resulted in a decrease in the average length of stay for patients definitively managed in a nonoperative fashion.

Screening of liver cancer with abbreviated MRI.

Current recommendations for the surveillance of HCC are based on the semiannual liver ultrasound (with or without serum alpha-fetoprotein) in patients with cirrhosis and in subgroups with chronic hepatitis B infection. However, the sensitivity of this strategy is suboptimal for the detection of early-stage tumors, especially in obese patients, due to interoperator variability and poor adherence. The detection rate of focal liver lesions is excellent with MRI, making it the best alternative candidate for surveillance. However, performing a full contrast-enhanced MRI is unrealistic because of limited availability and health economics. Abbreviated MRI (AMRI) corresponds to the acquisition of a limited number of sequences with a high detection rate. The theoretical benefits of AMRI are a reduced acquisition time (≤10 min) with improved time-effectiveness and cost-effectiveness compared with conventional MRI, and greater accuracy than ultrasound. Numerous protocols may be performed, including T1-weighted, T2-weighted, and DWI sequences, with or without contrast administration. Although published studies report promising per-patient results, they should be interpreted with caution. Indeed, most studies were simulated, retrospectively reviewing a subset of sequences in relatively small populations who underwent a full MRI. They also included groups that were not representative of screening populations. In addition, most were published by Asian groups, with at-risk populations that were different from Western populations. There are no existing longitudinal studies that directly compare the different AMRI approaches or AMRI to ultrasound. Finally, it is possible that 1 approach will not fit all patients and that strategies should be tailored to the risk of HCC, in particular in relation to the cost and availability of AMRI. Several trials are ongoing to evaluate these questions.

Non-enhanced abdominal Computed tomography (CT) for demonstration of painful abdominal conditions in patients not candidates for contrast-enhanced study, how does it help?

Background: There is a wide variety of abdominal painful conditions that necessitate computed tomography (CT) imaging; our study was aimed to demonstrate the utility of non-enhanced computed tomography (NECT) of the abdomen as a standalone study to detect the cause of abdominal pain in patients who are not candidates for iodinated contrast administration.

Contrast-Associated Acute Kidney Injury in High-Risk Patients Undergoing Peripheral Vascular Interventions.

Objective: This study aims to evaluate the use of prophylactic intravenous hydration (IV prophylaxis) and carbon dioxide (CO2) angiography in reducing contrast associated-acute kidney injury (CA-AKI) and determine the overall incidence and risk factors of CA-AKI in high-risk patients undergoing peripheral vascular interventions (PVI). Method: Only patients undergoing elective PVI from 2017 to 2021 with chronic kidney disease (CKD) stage 3-5 in the Vascular Quality Initiative (VQI) database were included. Patients were grouped into IV prophylaxis vs no prophylaxis. The study's primary outcome was CA-AKI, defined as a rise in creatinine (>.5mg/dL) or new dialysis within 48hours following contrast administration. Standard univariate and multivariable (logistic regression) analyses were conducted. Results: A total of 4497 patients were identified. Of these, 65% received IV prophylaxis. The overall incidence of CA-AKI was .93%. No significant difference was seen in overall contrast volume (mean (SD): 66.89(49.54) vs 65.94(51.97) milliliters, P > .05) between the 2 groups. After adjusting for significant covariates, the use of IV prophylaxis (OR (95% CI): 1.54(.77-3.18), P = .25) and CO2 angiography (OR (95%CI): .95(.44-2.08), P = .90) was not associated with a significant reduction in CA-AKI compared to the patients with no prophylaxis. The severity of CKD and diabetes were the only predictor of CA-AKI. Compared to patients with no CA-AKI, patients with CA-AKI were at risk of higher 30-day mortality (OR (95% CI): 11.09 (4.25-28.93)) and cardiopulmonary complications (OR (95% CI): 19.03 (8.74-41.39) following PVI (Both P < .001). Conclusion: Using a large national vascular database, our study demonstrates that prophylactic use of IV hydration and CO2 angiography in high-risk CKD patients is not associated with a reduction in renal injury following PVI. Reduced kidney function and history of diabetes is an independent predictor of CA-AKI and patients that develop post-procedural AKI are at an increased risk of morbidity and mortality.

Enhancing the Reliability of Intraoperative Ultrasound in Pediatric Space-Occupying Brain Lesions

Intraoperative ultrasound (IOUS) may aid the resection of space-occupying brain lesions, though technical limits may hinder its reliability. IOUS (MyLabTwice®, Esaote, Italy) with a microconvex probe was utilized in 45 consecutive cases of children with supratentorial space-occupying lesions aiming to localize the lesion (pre-IOUS) and evaluate the extent of resection (EOR, post-IOUS). Technical limits were carefully assessed, and strategies to enhance the reliability of real-time imaging were accordingly proposed. Pre-IOUS allowed us to localize the lesion accurately in all of the cases (16 low-grade gliomas, 12 high-grade gliomas, eight gangliogliomas, seven dysembryoplastic neuroepithelial tumors, five cavernomas, and five other lesions, namely two focal cortical dysplasias, one meningioma, one subependymal giant cell astrocytoma, and one histiocytosis). In 10 deeply located lesions, IOUS with hyperechoic marker, eventually coupled with neuronavigation, was useful to plan the surgical route. In seven cases, the administration of contrast ensured a better definition of the vascular pattern of the tumor. Post-IOUS allowed the evaluation of EOR reliably in small lesions (<2 cm). In large lesions (>2 cm) assessing EOR is hindered by the collapsed surgical cavity, especially when the ventricular system is opened, and by artifacts that may simulate or hide residual tumors. The main strategies to overcome the former limit are inflation of the surgical cavity through pressure irrigation while insonating, and closure of the ventricular opening with Gelfoam before insonating. The strategies to overcome the latter are avoiding the use of hemostatic agents before IOUS and insonating through normal adjacent brain instead of corticotomy. These technical nuances enhanced the reliability of post-IOUS, with a total concordance to postoperative MRI. Indeed, the surgical plan was changed in about 30% of cases, as IOUS showed a residual tumor that was left behind. IOUS ensures reliable real-time imaging in the surgery of space-occupying brain lesions. Limits may be overcome with technical nuances and proper training.

Brain tumour segmentation with incomplete imaging data.

Progress in neuro-oncology is increasingly recognized to be obstructed by the marked heterogeneity-genetic, pathological, and clinical-of brain tumours. If the treatment susceptibilities and outcomes of individual patients differ widely, determined by the interactions of many multimodal characteristics, then large-scale, fully-inclusive, richly phenotyped data-including imaging-will be needed to predict them at the individual level. Such data can realistically be acquired only in the routine clinical stream, where its quality is inevitably degraded by the constraints of real-world clinical care. Although contemporary machine learning could theoretically provide a solution to this task, especially in the domain of imaging, its ability to cope with realistic, incomplete, low-quality data is yet to be determined. In the largest and most comprehensive study of its kind, applying state-of-the-art brain tumour segmentation models to large scale, multi-site MRI data of 1251 individuals, here we quantify the comparative fidelity of automated segmentation models drawn from MR data replicating the various levels of completeness observed in real life. We demonstrate that models trained on incomplete data can segment lesions very well, often equivalently to those trained on the full completement of images, exhibiting Dice coefficients of 0.907 (single sequence) to 0.945 (complete set) for whole tumours and 0.701 (single sequence) to 0.891 (complete set) for component tissue types. This finding opens the door both to the application of segmentation models to large-scale historical data, for the purpose of building treatment and outcome predictive models, and their application to real-world clinical care. We further ascertain that segmentation models can accurately detect enhancing tumour in the absence of contrast-enhancing imaging, quantifying the burden of enhancing tumour with an R 2 > 0.97, varying negligibly with lesion morphology. Such models can quantify enhancing tumour without the administration of intravenous contrast, inviting a revision of the notion of tumour enhancement if the same information can be extracted without contrast-enhanced imaging. Our analysis includes validation on a heterogeneous, real-world 50 patient sample of brain tumour imaging acquired over the last 15 years at our tertiary centre, demonstrating maintained accuracy even on non-isotropic MRI acquisitions, or even on complex post-operative imaging with tumour recurrence. This work substantially extends the translational opportunity for quantitative analysis to clinical situations where the full complement of sequences is not available and potentially enables the characterization of contrast-enhanced regions where contrast administration is infeasible or undesirable.

Managing patients with left ventricular thrombosis after acute myocardial infarction: current evidence, uncertainties, and future perspectives

The incidence of left ventricular thrombosis (LVT) after acute myocardial infarction has declined significantly in recent decades, thanks to advances in the field of revascularization and antithrombotic therapy. Despite oral anticoagulation, embolic events are the most feared complication of LVT. From a pathophysiological point of view, the development of LVT depends on Virchow's triad, that is, endothelial damage caused by myocardial infarction, blood stasis due to left ventricular dysfunction, and hyper-coagulability determined by inflammation. The diagnostic modalities of LVT include transthoracic echocardiography preferably implemented by contrast administration, and cardiac magnetic resonance. Most thrombi develop in the first 2 weeks after acute myocardial infarction, so the role of systematic screening with short to medium term repeated imaging appears limited. Vitamin K antagonists remain the cornerstone of therapy, since the effectiveness of direct oral anticoagulants remains to be established. Only weak evidence supports the routine use of prophylactic anticoagulant therapy, even in high-risk patients.

ESTIMATION OF PETRIFYING TRENDSETTING TWINGE BY VIBRATION PARAPHRASE

Introduction- Petrifying trendsetting twinge may be a common problem with varied aetiologies. MRI has excellent soft tissue resolution and sensitive for detecting osseous, chondral, marrow abnormality and will be the simplest modality for various intra-articular and extra-articular causes of trendsetting twinge. Material and method- this study was done at our tertiary health care centre for 2 years during which 125 patients with a history of petrifying trendsetting twinge were included. Clinical history, laboratory parameters with proper MRI protocol with contrast administration wherever indicated was under taken to guage various causes of trendsetting twinge and to assess MRI appearances of trendsetting pathologies. the main target of our study was to seek out MR characteristics of the varied disease and to guage the simplest sequence for various trendsetting pathologies. We also evaluated various clinical and radiological parameters related to future femoral head collapse. Results- Amongst 125 patient evaluated commonest pathology for the explanation for petrifying trendsetting twinge was avascular necrosis of femoral head. red blood cell disease, chronic alcohol and steroid use were common causes for AVN. Site and percentage of femoral head involvement are essential predictors for future collapse of the femoral head. Amongst paediatric age bracket, transient synovitis followed by osteomyelitis may be a commonest cause for trendsetting twinge. Contrast-enhanced MRI can help within the differentiation of Pyogenic vs Tubercular arthritis. Gadolinium administration should be wiped out all cases of inflammatory arthritis to detect associated synovitis, enthesitis, bursitis. Conclusion- Various trendsetting pathologies cause progressive destruction of trendsetting where early diagnosis help in arresting the disease progression and prompt management of the patient.MRI is non-invasive, accurate and sensitive for trendsetting pathologies and proves to be the modality of choice within the guesstimation of trendsetting twinge altogether the age groups.

Advantages of the Use of Axial Traction Magnetic Resonance Imaging (MRI) of the Shoulder in Patients with Suspected Rota-Tor Cuff Tears: An Exploratory Pilot Study

Magnetic Resonance Imaging (MRI) with axial traction is a tool for the assessment of musculoskeletal pathology. Previous reports have demonstrated a better distribution of intra-articular contrast material. No investigations were performed to evaluate glenohumeral joint axial traction MRI in patients with suspected rotator cuff tears. This study aims to assess the morphological changes and the potential advantage of glenohumeral joint axial traction MRI without intra-articular contrast administration in patients with suspected rotator cuff tears. Eleven patients with clinical suspicion of rotator cuff tears underwent a shoulder MRI scan with and without axial traction. PD weighted images with SPAIR fat saturation technique and T1 weighted images with TSE technique were acquired in the oblique coronal, oblique sagittal and axial planes. Axial traction allowed a significant widening of the subacromial space (11.1 ± 1.5 mm vs. 11.3 ± 1.8 mm; p = 0.001) and inferior glenohumeral space (8.6 ± 3.8 mm vs. 8.9 ± 2.8 mm; p = 0.029). With axial traction, there was a significant decrease in measurements of the acromial angle (8.3 ± 10.8° vs. 6.4 ± 9.8°; p < 0.001) and gleno-acromial angle (81 ± 12.8° vs. 80.7 ± 11.5°; p = 0.020). Our investigation demonstrates for the first time significant morphological changes in the shoulder of patients with suspected rotator cuff tears who underwent a glenohumeral joint axial traction MRI.

Case Report: Contrast Imaging in the Setting of Cerebral Venous Thrombosis

Disruption to contrast agent supply chains for radiology investigations has become an additional consequence of the COVID-19 pandemic. Various recommendations, including dose reductions and choices of alternative agents, have been made to help account for this limited availability. This case demonstrated how two separate computed tomography (CT) venograms with different contrast agents and similar timing, undertaken on the same day for the same patient, yielded different results; cerebral venous thromboses were more prominent in the subsequent scan. Although there were features suggestive of thrombosis on the first scan, repeat imaging was required to further characterize the lesions identified. The case exemplifies the notion that diagnostic imaging should always be guided by a detailed history and examination. It also raises the discussion point of whether more strict or uniform protocols should be developed to facilitate contrast administration for radiology investigations. It is important that appropriate doses are always administered to maximize diagnostic yield.