Administration Of Contrast Medium Research Articles

Acute severe thrombocytopenia following iodinated radiographic contrast medium infusion: a case report.

The authors report the case of a 79-year-old male patient with severe, life-threatening thrombocytopenia after administration of intravenous nonionic low-osmolarity contrast medium. His platelet count dropped from 179×109/l to 2×109/l after 1h of radiocontrast infusion. Which has returned gradually to normal level within days with corticosteroid administration and platelet transfusion. Iodinated contrast-induced thrombocytopenia is a rare complication with an unknown causative mechanism. There is no definitive treatment for this condition, with corticosteroids being used in most cases. The platelet count normalizes within a few days regardless of any interventions, but supportive treatment is important to avoid any unwanted complications. Further studies are still needed for a better understanding of the exact mechanism of this condition.

Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.

Evidence of an association between intravenous contrast media (CM) and persistent renal dysfunction is lacking for patients with pre-existing acute kidney injury (AKI). This study was designed to determine the association between intravenous CM administration and persistent AKI in patients with pre-existing AKI. A retrospective propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients ≥ 18years old meeting Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI at time of arrival to one of three emergency departments between 7/1/2017 and 6/30/2021 who did or did not receive intravenous CM. Outcomes included persistent AKI at hospital discharge and initiation of dialysis within 180days of index encounter. Our analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). CM was administered in 18.4% of all encounters. AKI resolved prior to hospital discharge for 69.1%. No association between intravenous CM administration and persistent AKI was observed after unadjusted multivariable logistic regression modeling (OR 1; 95% CI 0.89-1.11), propensity weighting (OR 0.93; 95% CI 0.83-1.05), and entropy balancing (OR 0.94; 95% CI 0.83-1.05). Sub-group analysis in those admitted to the ICU yielded similar results. Initiation of dialysis within 180days was observed in 5.4% of the cohort. An association between CM administration and increased risk of dialysis within 180days was not observed. Among patients with pre-existing AKI, contrast administration was not associated with either persistent AKI at hospital discharge or initiation of dialysis within 180days. Current consensus recommendations for use of intravenous CM in patients with stable renal disease may also be applied to patients with pre-existing AKI.

Fluoroscopy guided without contrast injection for ganglion impar blockade in traumatic coccydynia: Description a modified approach and 1-year results.

This study presents a new fluoroscopy-controlled approach in patients with chronic traumatic coccydynia by applying ganglion impar block using the needle-inside-needle technique from the intercoccygeal region without the administration of contrast material. With this approach, the cost and possible side effects of using contrast material can be prevented. In addition, we examined the long-term effect of this method. The study was designed retrospectively. The marked area was entered with a 21-gauge needle syringe, and 3 cc of 2% lidocaine was administered subcutaneously by local infiltration. A 25-gauge 90 mm spinal needle was inserted into the guide 21-gauge 50 mm needle tip. The location of the needle tip was controlled under fluoroscopy, and 2 mL of 0.5% bupivacaine and 1 mL of be-tamethasone acetate were mixed and administered. A total of 26 patients with chronic traumatic coccydinia participated in the study between 2018 and 2020. The average procedure time was approximately 3.19 min. The mean time of pain relief of more than 50% was 1.25±1.22 (1st min-72 h) min. The mean Numerical pain rating scale scores were 2.38±2.26 at 1 h, 2.50±2.30 at 6 h, 2.50±2.21 at 24 h, 3.73±2.20 at 1 month, 4.46±2.14 at 6 months 1 and 5.23±2.52 at 1 year. Our study shows that as an alternative in patients with chronic traumatic coccydynia, the long-term results of the needle-inside-needle method from the intercoccygeal region without contrast material are safe and feasible.

Burden and Risk Factors of Contrast-Associated Acute Kidney Injury in Hospitalized Zambian Children: A Prospective Cohort Study at the University Teaching Hospitals.

Contrast-associated acute kidney injury (CAAKI) is defined as acute kidney injury (AKI) occurring within 72 hours of administration of contrast media (CM) and is linked to adverse outcomes including longer hospital stay, increased hospital mortality, and a higher risk of chronic kidney disease in later life. Risk factors for the development of CAAKI in the Zambian pediatric population have not been well studied. The objective of this study was to assess the burden of CAAKI, ascertain its risk factors, and describe short-term outcomes in hospitalized children at the University Teaching Hospitals (UTH) undergoing contrast-enhanced radiological investigations. This was a prospective observational study of in-patients undergoing contrast-enhanced radiological procedures, between September 2020 and September 2021. The participants were recruited from the Children's Hospital, the Cancer Diseases Hospital, and the Pediatric Surgical Ward at the University Teaching Hospital in Lusaka, Zambia. The primary outcome variable was occurrence of AKI at 48 hours post CM administration. We used 2 criteria to define CAAKI in our study-the European Society of Urogenital Radiology (ESUR) and the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Multivariable logistic regression models were formulated to assess for risk factors of CAAKI. Of the 201 enrolled participants, 123 (61.2%) were male and the median age of the participants was 5 years (interquartile range [IQR] = 3-10). The mean hemoglobin was 103 g/L (standard deviation [SD] = 26), median creatinine was 30.9 µmol/l (IQR = 22.6-43), and the glomerular filtration rate (GFR) was 102.5 mL/min/1.73 m2 (IQR = 76.2-129.4). Forty-six (22.9%) developed CAAKI using the ESUR compared with 4.5% (9/201) using the KDIGO criteria. Independent risk factors of CAAKI were receiving a higher dose of CM (adjusted odds ratio [aOR] = 2.54; 95% confidence interval [CI] = [1.12-5.74]), prematurity (aOR = 4.6; 95% CI = [1.05-16.7]), and a higher eGFR (aOR= 1.01; 95% CI = [1.01-1.02]). Females had higher odds of CAAKI (aOR = 2.48; 95% CI = [1.18-5.18]) when compared with males. One CAAKI participant (2.2%) died; none of the participants who developed CAAKI and survived required dialysis and most of them (90%) were discharged before day 7. Day 7 eGFR results had returned to or near baseline values for those whose creatinine results were available. Using the ESUR criteria, a significant proportion (22.9%) of children undergoing contrast-enhanced computed tomography (CT) scans at the UTH developed CAAKI. In contrast, using the KDIGO criteria only 4.5% had CAAKI. Being born as a preterm baby, being female, having a higher eGFR at baseline, and receiving a higher dose of CM were found to be independent risk factors for CAAKI development in Zambian children. Most of the cases of CAAKI in children were transient and of little clinical significance as only a minority of patients developing CAAKI required kidney replacement therapy and all resolved by day 7 post administration of CM.

Quantitative T1 mapping detects blood–brain barrier breakdown in apparently non-enhancing multiple sclerosis lesions

ObjectivesThe disruption of the blood–brain barrier (BBB) is a key and early feature in the pathogenesis of demyelinating multiple sclerosis (MS) lesions and has been neuropathologically demonstrated in both active and chronic plaques. The local overt BBB disruption in acute demyelinating lesions is captured as signal hyperintensity in post-contrast T1-weighted images because of the contrast-related shortening of the T1 relaxation time. On the contrary, the subtle BBB disruption in chronic lesions is not visible at conventional radiological evaluation but it might be of clinical relevance. Indeed, persistent, subtle BBB leakage might be linked to low-grade inflammation and plaque evolution. Here we hypothesised that 3D Quantitative Transient-state Imaging (QTI) was able to reveal and measure T1 shortening (ΔT1) reflecting small amounts of contrast media leakage in apparently non-enhancing lesions (ANELs). Materials and methodsThirty-four patients with relapsing remitting MS were included in the study. All patients underwent a 3 T MRI exam of the brain including conventional sequences and QTI acquisitions (1.1 mm isotropic voxel) performed both before and after contrast media administration. For each patient, a ΔT1 map was obtained via voxel-wise subtraction of pre- and post- contrast QTI-derived T1 maps. ΔT1 values measured in ANELs were compared with those recorded in enhancing lesions and in the normal appearing white matter. A reference distribution of ΔT1 in the white matter was obtained from datasets acquired in 10 non-MS patients with unrevealing MR imaging. ResultsMean ΔT1 in ANELs (57.45 ± 48.27 ms) was significantly lower than in enhancing lesions (297.71 ± 177.52 ms; p < 0. 0001) and higher than in the normal appearing white matter (36.57 ± 10.53 ms; p < 0.005). Fifty-two percent of ANELs exhibited ΔT1 higher than those observed in the white matter of non-MS patients. ConclusionsQTI-derived quantitative ΔT1 mapping enabled to measure contrast-related T1 shortening in ANELs. ANELs exhibiting ΔT1 values that deviate from the reference distribution in non-MS patients may indicate persistent, subtle, BBB disruption. Access to this information may be proved useful to better characterise pathology and objectively monitor disease activity and response to therapy.

Comparison of the Efficacy of Diluted Polyethylene Glycol and Low-Density (0.1% w/v) Barium Sulfate Suspension for CT Enterography.

To compare small bowel distension and side effects between a diluted polyethylene glycol (PEG) solution and a low-density (0.1% w/v) barium sulfate suspension (LDBSS) for CT enterography (CTE) preparation. Total 173 consecutive patients who underwent CTE were enrolled in this study. The LDBSS (1 L) was used in 50 patients, and the diluted iso-osmotic PEG solution (1 L) was used in 123 patients. Two blinded radiologists independently scored jejunal and ileal distensions on a 5-point scale. To compare side effects between the two groups, the patients reported whether they had immediate complications after the administration of the oral contrast media. For ileal and jejunal distension, the diluted PEG solution showed no difference from the LDBSS for either reader (ileum: reader 1, median, 4; 4, interquartile range, 3-4; 3-4, p = 0.997; reader 2, median, 4; 4, interquartile range, 3.3-4.0; 3-4, p = 0.064; jejunum: reader 1, median, 2; 2, interquartile range, 2-3; 2-3, p = 0.560; reader 2, median, 3; 2, interquartile range, 2-3; 2-3, p = 0.192). None of the patients complained of immediate complications following administration of either of the oral contrast media. The diluted PEG solution showed comparable bowel distension compared to LDBSS and no immediate side effects; thus, it can be a useful alternative.

Comparison of Colour Doppler Ultrasonography and Indirect Computer Tomography Venography for the Diagnosis of Deep Venous Thrombosis in Patients with Suspected Pulmonary Thromboembolism at a Tertiary Care Centre in Chennai, Tamil Nadu, India

Introduction: Pulmonary Thromboembolism (PTE) and Venous Thromboembolism (VTE) are prevalent conditions with a high mortality rate and need immediate medical attention. The initial and standard imaging techniques are Computed Tomography Pulmonary Angiography (CTPA) for the diagnosis of PTE and Colour Doppler Ultrasonography (CDUS) for Deep Vein Thrombosis (DVT). However, there can be some issues when using these two different approaches, like the requirement for a separate area and more time. With the so-called indirect Computed Tomography Venography (CTV) approach, thrombi in the deep venous system that may cause PTE can be examined right after pulmonary CT Angiography (CTA) without the need for additional contrast agent. Aim: To determine the accuracy of indirect CTV for the diagnosis of deep venous thrombosis in patients with suspected PTE. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology in Government Stanley Medical College, Chennai, Tamil Nadu, India, India from June 2021 to May 2022. A total of 50 patients with a probable diagnosis of PTE and was established with CTA were included. All 50 patients underwent indirect CTV and CDU on the same day. For indirect CTV lower extremities between the iliac crest and the popliteal region were scanned without administration of extra contrast medium. Colour Doppler Ultrasound (CDUS) was considered as Gold standard. To find the efficacy of CTV in determining DVT the Receiver Operating Characteristics curve (ROC) was used. Results: Of the total 50 patients, who were enrolled in the study, 21 (42%) patients were females and 29 (58%) patients were males. The mean age of the study subjects was 43.5±12.1 years. Among these DVT was detected in 25/50 patients (50.0%) by Doppler Sonography, Similarly DVT was detected in 23/50 patients (46%) by CTV. The sensitivity of CTV was 76% and the specificity was 84%, Positive Predictive Value (PPV) of 82.6%, Negative Predictive Values (NPV) of 77.8%. The p-value and kappa value between CTV and CDUS was calculated as 0.0005 and 0.600, respectively. Conclusion: According to the results of the present study, a combined CTA indirect CTV method can determine the DVT with a moderate level of sensitivity and specificity

Contrast-induced nephropathy; an update on pathophysiology

Contrast-induced nephropathy (CIN) is a well-known complication of contrast media administration for diagnostic and therapeutic purposes. The incidence of CIN has increased with the widespread use of diagnostic imaging and contrast media. CIN is a pathological condition that typically occurs within 48 hours of exposure to contrast material and results in an increase in serum creatinine levels of more than 44 µmol/L (0.5 mg/dL) or 25% above baseline or an increase in serum creatinine of more than 1.5 times the baseline level within 7 days of exposure to contrast material or a reduction in urine output to less than 0.5 mL/h for at least 6 hours after exposure to contrast material. The mechanism of CIN is not fully understood, but it is thought to involve direct nephrotoxic effects of contrast particles, hemodynamic changes, hypoxia and oxidative stress, apoptosis, inflammation, and immune responses. Prevention of CIN involves identifying the risk factors and taking appropriate measures to mitigate them. Currently, there is no definitive treatment for CIN, and treatment is mainly symptomatic, with supportive care being the mainstay. Experimental treatments such as renal replacement therapy, extracorporeal blood purification, and stem cell therapy are being investigated, but their clinical efficacy is yet to be established.

Use of questionnaires in outpatients at low-risk for post-contrast acute kidney injury scheduled for intravenous iodine-based contrast media administration: a proposal for computed tomography coronary angiography

Use of questionnaires in outpatients at low-risk for post-contrast acute kidney injury scheduled for intravenous iodine-based contrast media administration: a proposal for computed tomography coronary angiography

Smart Visualization of Medical Images as a Tool in the Function of Education in Neuroradiology.

The smart visualization of medical images (SVMI) model is based on multi-detector computed tomography (MDCT) data sets and can provide a clearer view of changes in the brain, such as tumors (expansive changes), bleeding, and ischemia on native imaging (i.e., a non-contrast MDCT scan). The new SVMI method provides a more precise representation of the brain image by hiding pixels that are not carrying information and rescaling and coloring the range of pixels essential for detecting and visualizing the disease. In addition, SVMI can be used to avoid the additional exposure of patients to ionizing radiation, which can lead to the occurrence of allergic reactions due to the contrast media administration. Results of the SVMI model were compared with the final diagnosis of the disease after additional diagnostics and confirmation by neuroradiologists, who are highly trained physicians with many years of experience. The application of the realized and presented SVMI model can optimize the engagement of material, medical, and human resources and has the potential for general application in medical training, education, and clinical research.

548 ROLE OF NEW ANTIDIABETIC DRUGS IN THE PREVENTION OF CONTRAST-INDUCED NEPHROPATHY IN DIABETIC PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION

Abstract Background Contrast-Induced Acute Kidney Injury (CI-AKI) is a complication of patients undergoing percutaneous coronary intervention (PCI) associated with high morbidity and mortality and higher incidence is in patients with type II diabetes mellitus. Recently several randomized controlled trials have shown a clear benefit of new anti-diabetic drugs (GLP-1 analogues, DPP-4 inhibitors and SGLT-2 inhibitors) in the prevention of kidney damage but no study has evaluated their possible role in the prevention of CI-AKI in patients undergoing percutaneous coronary intervention. Methods The study enrolled 408 patients undergoing PCI and divided them into three groups: 136 with type 2 diabetes mellitus treated with new-antidiabetic drugs, 136 with type 2 diabetes mellitus treated with standard-antidiabetic therapy, and 136 non-diabetic patients. Patients were evaluated for serum creatinine (measured at the time of hospitalization, 24-hour and 48-hour post-PCI), glomerular filtration rate (eGFR) estimated using the Cockcroft-Gault equation before and after the procedure, and markers of myocardial damage at the admission and 24 hours after PCI. CI-AKI was defined as an increase in serum creatinine levels ≥ 0.3 mg / dL (26.5 μmol / L) or greater than 25% of the base value, occurred 24-48 hours after administration of the contrast medium. Results It was observed a significant increase in delta creatinine between pre and post PCI in the group treated with standard-antidiabetic therapy (0.91 ± 0.22 mg / dL vs 0.94 ± 0.23 mg / dL, p= 0.008), but not in the group treated with new-antidiabetic drugs that showed a delta creatinine close to zero (1.01 ± 0.33 mg / dL vs 1.01 ± 0.35 mg / dL, p = 0.945), similar to that observed in non-diabetic patients (1.01 ± 0.30 mg / dL vs 0.99 ± 0.31 mg / dL, p = 0.020). The patients treated with SGLT-2 inhibitors presented pre-PCI mean creatinine levels significantly lower (0.83 ± 0.16 mg / dL) than those treated with DPP-4 inhibitors (1.04 ± 0.34 mg / dL) and GLP-1 analogues (1.05 ± 0.39 mg / dL), (p for trend = 0.009). However, the creatinine delta between the pharmacological classes was similar (p = 0.881). The incidence of CI-AKI, defined as an increase ​​of serum creatinine 24-48 hours after contrast medium administration ≥ 25%, was 9.6% in patients treated with standard-antidiabetic therapy, 4.4% in patients treated with new-antidiabetic drugs and 3.7% in non-diabetic patients (p for trend = 0.080). The incidence of CI-AKI, defined as an increase of serum creatinine 24-48 hours after contrast medium administration ≥0.3 mg / dL, was 5.1% in the standard-antidiabetic therapy group, 3.8% in the new-antidiabetic drugs group and 2.9% in the non-diabetic patients (p for trend = 0.911). Conclusions The study demonstrated in diabetic patients undergoing PCI and in treatment with new anti-diabetic drugs (GLP-1 analogues, DPP-4 inhibitors, SGLT-2 inhibitors) a reduced incidence of CI-AKI compared to diabetic patients in treatment with traditional antidiabetic drugs (metformin, sulfonylureas, thiazolidinediones, insulin) and a similar incidence of CI-AKI compared to non-diabetic patients. The results of this study underline a possible protective role of new anti-diabetic drugs for the prevention of CI-AKI.

Contrast-induced acute kidney injury and its contemporary prevention.

The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.

Neutrophil gelatinase-associated lipocalin monitoring reveals persistent subclinical kidney injury following intraarterial administration of iodinated contrast agents

Clinically overt contrast-induced nephropathy (CIN) is one of the most feared complications in patients exposed to iodinated contrast media and has been extensively studied over the years. Meanwhile, the incidence and evolution of subclinical contrast-induced kidney injury remain elusive. With the continuous increase in the number of patients that are repeatedly exposed to contrast media, elucidating these issues is of critical importance. Accordingly, we aimed to evaluate the incidence and the evolution of clinical and subclinical kidney injury in patients exposed to contrast media. A total of 178 patients who underwent elective percutaneous angioplasty procedures were evaluated prospectively. Serum creatinine and neutrophil gelatinase-associated lipocalin (NGAL) levels were evaluated pre-procedurally, 48 h and 1 month after administration of contrast media. The evolution of creatinine and NGAL levels was analyzed at the three time points, and the potential predictors of contrast-induced clinical and subclinical renal injury were evaluated. Clinically overt CIN occurred in 10 (5.6%) patients. Baseline serum creatinine and the volume of contrast media were the only independent predictors of CIN and in all 10 patients creatinine levels returned to baseline by 1 month (p = 0.32). Subclinical contrast-induced kidney injury was much more common, affecting 32 (17.9%) patients, was only predicted by the baseline serum creatinine, and persisted in 53.1% of patients after 1 month. This study showed that whereas clinically overt CIN is rather rare and regressive, subclinical contrast-induced kidney injury is considerably more frequent, affecting almost 18% of patients that receive intraarterial contrast media. More importantly, subclinical kidney injury persisted after 1 month in more than 50% of the initially affected patients, who may thus be at increased risk for further renal impairment, particularly if exposed to nephrotoxic agents or repeated administration of contrast media.

Value of diffusion-weighted magnetic resonance imaging (DWI) in differentiating orbital lymphoma from idiopathic orbital inflammatory pseudotumor

BackgroundDiffusion-weighted MR imaging can provide physiological information complementing morphological findings from conventional MRI. It detects early tissue changes associated with changes in water content, such as changes in the permeability of cell membranes, cell swelling or cell lysis. Areas of diseased tissue are highlighted with increased signal intensity on diffusion-weighted MR imaging. A decrease in the ADC is expected with increased intracellular tissue caused by either cell swelling or increased cellular density. DWI can be performed without the need for the administration of exogenous contrast medium, so it may of use when contrast administration is contraindicated. It yields quantitative and qualitative information that reflects changes at the cellular level and indicates the integrity of cell membranes. The purpose of this study was mainly to assess the diagnostic value of DWI for the discrimination of orbital lymphoma from idiopathic orbital inflammatory pseudotumor.ResultsOf our 53 cases presented with proptosis or visual disturbances, 32 cases (60.4%) had found to be present with idiopathic orbital inflammatory pseudotumor and 21 cases (39.6%) had orbital lymphoma. On conventional MR imaging, ill-defined tumor margin and orbital preseptal space involvement had a significant association with orbital lymphoma, whereas intense post-contrast enhancement of lesion and radiologic evidence of sinusitis were associated with orbital inflammatory pseudotumor. The mean ADC value of orbital lymphoma was significantly lower than those of benign inflammatory pseudotumor, yielding 100% sensitivity, 99% specificity, and 90.5% accuracy for differentiating both entities.ConclusionsDiffusion-weighted MR imaging (DWI) is valuable in discriminating orbital inflammatory pseudotumor from malignant orbital lymphoma that help patients to initial management.

Contrast-Enhanced Three-Dimensional Fluid-Attenuated Inversion Recovery Imaging with an Optimal Scan Interval and Angulation to Visualize Endolymphatic Hydrops

Background: There is no gold standard diagnostic test for endolymphatic hydrops (EH). Three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) imaging has been reported to depict EH with administration of gadolinium-based contrast media (GBCM). However, the optimal scan interval and angulation remain unknown in 3D-FLAIR labyrinthine imaging following double-dose injections of a gadolinium-based contrast agent in patients with vertigo and sensorineural hearing loss. Objectives: This study aimed to determine the optimal parameters of 3D-FLAIR labyrinthine imaging, including the optimal scan angulation and scan interval, for patients with sensorineural hearing loss and vertigo. Patients and Methods: In this cross-sectional clinical study, following the double-dose administration of a gadolinium contrast agent, 3D-FLAIR labyrinthine images were acquired from 22 patients with unilateral vertigo and sensorineural hearing loss at different intervals after injection. The corresponding contrast-to-noise ratios (CNRs) and signal-intensity ratios (SIRs) of these images, acquired at different intervals, were measured. Moreover, separate visualization of endolymphatic and perilymphatic spaces was scored, and angulation of the anterior skull base scan was investigated in the sagittal position. Results: The 3D-FLAIR images showed the strongest image contrast in the cochlea with a double-dose gadolinium-based contrast injection at six hours post-injection. Significantly higher SIR and CNR values were reported at six hours post-injection in both unaffected and affected ears compared to other intervals (4 h vs. 6 h in the affected side, SIR: 1.65 ± 0.24 vs. 2.09 ± 0.47, CNR: 13.88 ± 5.54 vs. 19.17 ± 6.81; in the unaffected side, SIR: 1.58 ± 0.27 vs. 1.82 ± 0.34, CNR: 12.20 ± 3.88 vs. 15.42 ± 4.58, P &lt; 0.001 for all; 6 h vs. 8 h in the affected side: SIR: 2.09 ± 0.47 vs. 1.72 ± 0.43, CNR: 19.17 ± 6.81 vs. 12.22 ± 4.96; in the unaffected side, SIR: 1.82 ± 0.34 vs. 1.57 ± 0.30, CNR: 15.42 ± 4.58 vs. 10.61 ± 3.87, P &lt; 0.001 for all). Visualization of the endo- and perilymphatic spaces for both the cochlea and vestibule was significantly better at six hours post-injection compared to four hours post-injection in both affected sides (P &lt; 0.05 for both). The optimal angulation ranged from 6.20° to 13.6° (P &lt; 0.001). Conclusion: By using an optimal scan interval, together with an optimal scan angulation, 3D-FLAIR imaging can reliably visualize the endolymphatic space and sensitively indicate cochlear blood-labyrinth barrier disruptions without requiring extra image reconstruction.

Intravenous contrast induced acute kidney injury prevention with high doses of statins

Aim. The aim of our study was to assess the frequency of contrast-induced acute kidney injury (CI-AKI) in patients undergoing computed tomography (CT) with intravenous contrast media and to evaluate the effects of statins in the prevention of CI-AKI. Materials and methods. 181 patients undergoing CT with intravenous contrast media administration were included in prospective observational study (ClinicalTrials.gov ID NCT04666389). The primary endpoint was CI-AKI according to KDIGO criteria (the 25 % rise (or 0,5 mg/dl) of serum creatinine from baseline assessed 48–72 hours after administration of contrast media). There were 120 patients in the group with high dose of statins administration and 60 patients without statin treatment. The most frequent cardiovascular disease was hypertension in both groups — 93 % and 85 % respectively. Results. CI-AKI was diagnosed in 12 (6,7 %) patients — 9 patients in the no statins group and 3 patients in the statins group. The high dose statin administration statistically significant had less frequency of CI-AKI (p = 0,003) compare with no statins group (OR = 0,144, 95 %CI: 0,037–0,554). Conclusion. Statin pretreatment is effective at preventing CI-AKI and should be considered in high-risk patients.

Feasibility of Arterial Spin Labeling Magnetic Resonance Imaging for Musculoskeletal Tumors with Optimized Post-Labeling Delay.

Arterial spin labeling (ASL) magnetic resonance imaging (MRI) is used to perform perfusion imaging without administration of contrast media. However, the reliability of ASL for musculoskeletal tumors and the influence of post-labeling delay (PLD) have not been fully clarified. This study aimed to evaluate the performance of ASL with different PLDs in the imaging of musculoskeletal tumors. Forty-five patients were enrolled and were divided into a malignant group, a hypervascular benign group, a hypovascular benign group and a control group. The tissue blood flow (TBF) of the lesions and normal muscles was measured and the lesion-to-muscle TBF ratio and differences were calculated. The results showed that both the TBF of lesions and muscles increased as the PLD increased, and the TBF of muscles correlated significantly and positively with the TBF of lesions (all p < 0.05). The TBF and lesion-to-muscle TBF differences of the malignant lesions were significantly higher than those of the hypovascular benign lesions and the control group in all PLD groups (all p < 0.0125) and only those of the hypervascular benign lesions in the longest PLD (3025 ms) group (p = 0.0120, 0.0116). In conclusion, ASL detects high TBF in malignant tumors and hypervascular benign lesions, and a longer PLD is recommended for ASL to differentiate musculoskeletal tumors.

An in vivo and in vitro model on the protective effect of cilnidipine on contrast-induced nephropathy via regulation of apoptosis and CaMKⅡ/mPTP pathway.

Contrast-induced nephropathy (CIN) is an acute kidney injury (AKI) observed after the administration of contrast media. Calcium channel blockers (CCBs) have been reported to exert a renal protective effect. This study aims to investigate the role of cilnidipine, a novel CCBs, on CIN by regulating the calcium/calmodulin-dependent protein kinase Ⅱ(CaMKⅡ)/mitochondrial permeability transition pore(mPTP) pathway. Here, iohexol, a representative contrast media, was used to establish CIN model. KN-93 (CaMKⅡ inhibitor) and atractyloside (mPTP opener) were administered in rats, and CaMKⅡ overexpression was used in Human proximal tubular epithelial cells. Markers of renal injury (serum creatinine, blood urea nitrogen, and urinary NAGL), hematoxylin-eosin stain, oxidative stress (ROS, superoxide dismutase[SOD], and malondialdehyde [MDA] levels), cell death (MTT and terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate nick end labeling[TUNEL]), mitochondrial function (mPTP, mitochondrial membrane potential[MMP], and ATP) were assessed. Western blots were used to measure the expression levels of Bax/Bcl-2, caspase-3, CaMKⅡ/mPTP signaling pathways. Results showed that cilnidipine markedly improved kidney function, and alleviated tubular cell apoptosis, oxidative stress and mitochondrial damage induced by iohexol in vitro and in vivo. The underlying mechanism may be that cilnidipine relieved CaMKⅡ activation and mPTP opening induced by iohexol. All of these protective effects of cilnidipine were attenuated by CaMKⅡ overexpression and atractyloside (mPTP opener) pretreatment. Moreover, KN-93 (CaMKⅡ inhibitor) treatment showed a similar renal protective effect with cilnidipine, while the protective effect of cilnidipine on kidney in CIN rats was not further suppressed by KN-93 cotreatment. These in vitro and in vivo results point towardthe fact that cilnidipine might be a novel therapeutic drug against contrast-induced nephrotoxicity in a CaMKⅡ-dependent manner.

Contrast Medium Use in Computed Tomography for Patients Presenting with Headache: 4-year Retrospective Two-Center Study in Central and Western Regions of Ghana.

Background Contrast medium (CM) administration during computed tomography (CT) enhances the accuracy in the detection and interpretation of abnormalities. Evidence from literature also validate the essence of CM in imaging studies. CT, by virtue of its ubiquity, ease of use, speed, and lower financial footprint, is usually the first investigation in cases of headache. Through a multicenter retrospective analysis, we compared findings of contrast-enhanced CT (CECT) to noncontrast-enhanced CT (NCECT) head examinations among patients presenting with headache. Methods A multicenter retrospective analysis of four years' CT head examination data at two radiology centers located in Central and Western Regions of Ghana were reviewed. Records of patients who presented with headache as principal complaint between January 2017 and December 2020 were reviewed. A total of 477 records of patients with headache were identified, retrieved and evaluated. A Chi-square test and Fisher exact test were used to compare the CECT and NCECT groups. Binary logistic regression analysis was computed to assess association between CECT and each CT findings. Statistical significance was considered at p < 0.05 with a 95% confidence interval. Results A significant proportion of the patients was females (51.8% in CECT and 60% in NCECT). The NCECT group (40.06 ± 14.76 years) was relatively older than the CECT group (38.43 ± 17.64 years). There was a significant difference between the CECT and NCECT in terms of age (p=0.002) and facility CT was performed (p < 0.0001). The rate of abnormalities was higher in CECT (43.5%, 166/382) compared NCECT (37.9%, 36/95). There was no significant association between CT head findings and contrast enhancement. Conclusion CECT examination accounted for 5.6% increase in the detection of head abnormalities. Efforts required to establish local standard operation procedures (SOPs) for contrast medium use especially in CT head examinations. Further studies to improve the knowledge of agents, mechanism of action, and safety of contrast media used among practitioners in Ghana is recommended.

Incidence, predictors and clinical implications of new renal impairment following percutaneous coronary intervention

BackgroundRenal impairment post-percutaneous coronary intervention (post-PCI) is a well-described adverse effect following the administration of contrast media. Within a large cohort of registry patients, we aimed to explore the incidence,...