Injection Of Contrast Medium Research Articles

Comparison of value of 640-slice CT kidney scan and kidney ultrasound in the diagnosis of chronic kidney disease

ABSTRACT To explore the value of 640-slice CT kidney scan and kidney ultrasound (KUS) in the diagnosis of chronic kidney disease (CKD). The data of 120 CKD patients at our institution between June 2019 and September 2020 were analyzed, and they were randomly divided into ultrasound (US) group (n = 40, KUS), CT group (n = 40) first receiving a plane CT scan to determine the scope of dynamic volume scan, which was performed for scans in cortical, parenchymal, and delayed phases with bolus injection of contrast medium, and combined group (n = 40, KUS and 640-slice CT kidney scan), with the images obtained read and analyzed. The subjective scores and effective radiation doses of 640-layer CT kidney scan were counted to calculate the detection rates. The subjective scores of 640-slice CT kidney scan in plane scan, cortical phase, parenchymal phase, and delayed phase were (1.23 ± 0.42), (1.80 ± 0.40), (2.08 ± 0.26), (2.18 ± 0.38) in the CT group and (1.18 ± 0.38), (1.85 ± 0.36), (2.08 ± 0.26), (2.20 ± 0.40) in the combined group. The effective radiation doses in the CT and combined groups were (1.92 ± 0.32) mSv and (1.95 ± 0.35) mSv. The reading results showed that 26 cases (65.0%), 30 cases (75.0%), and 38 cases (95.0%) were detected in the US, CT and combined groups, respectively, with remarkably higher detection rate in the combined group than the US and CT groups (P < 0.05). 640-slice CT kidney scan and KUS can be adopted for the diagnosis of CKD; with low radiation dose, good image quality, and higher detection rate in the former, their combination can improve the clinical detection rate of CKD and is worth promoting.

Investigating the Prevalence of Contrast-associated Nephropathy and the Related Risk Factors in Patients Undergoing Elective Angioplasty.

Contrast-associated nephropathy (CAN) is a sudden decrease in kidney function following contrast media administration. Considering the importance of CAN in the patient's outcome and the high prevalence of this complication in cardiac catheterizing centers, this study was designed to investigate the prevalence and the related risk factors of CAN in patients undergoing angioplasty in Chamran Heart Hospital, Isfahan, Iran, from January 2022 to June 2022. The inclusion criteria were adult patients above 18 admitted for elective percutaneous coronary intervention (PCI). Patient demographic information, underlying diseases and medications, dehydration state, type and amount of contrast media, and serum levels of blood urea nitrogen (BUN) and serum creatinine (SrCr) at 24 and 72 h after contrast injection were all recorded. Out of 340, 128 patients developed CAN after PCI, giving an incidence of 37.64%. Adjusted analysis showed a significant relation between age over 65, the amount of contrast media administered, and the use of furosemide with the incidence of CAN. However, adjusted logistic regression analysis failed to show any significant relationship between the risk of CAN and the hydration status of the patients at 24 and 48 h after receiving contrast media as diagnosed by BUN/SrCr >20. The prevalence of CAN in this study was higher than in other studies since this high-risk population was under risk factors such as arterial injection of contrast material and a higher amount of contrast material administration. In addition, advanced age, volume of contrast material, and previous or concurrent furosemide administration were associated with an increased risk of CAN.

A comparison of the use of contrast media with different iodine concentrations for enhanced computed tomography.

Objective: In this study, we compared the enhancement of blood vessels and liver parenchyma on enhanced computed tomography (CT) of the upper abdomen with two concentrations of contrast media (400 and 300mg I/mL) based on similar iodine delivery rate (IDR) of 0.88 and 0.9g I/s and iodine load of 450mg I/kg. Methods: We randomly assigned 160 patients into two groups: iomeprol 400mg I/mL (A group) and iohexol 300mg I/mL (B group). The CT attenuation values of the main anatomical structures in the two groups with different scanning phases were measured and the image quality of the two groups was analyzed and compared. The peak pressure and local discomfort (including fever and pain) during contrast medium injection were recorded. Results: The mean attenuation value of the abdominal aorta was 313.6 ± 29.6 in the A group and 322.4 ± 30.1 in the B group during the late arterial phase (p = 0.8). Meanwhile, the mean enhancement values of the portal vein were 176.2 ± 19.3 and 165.9 ± 24.5 in the A and B groups, respectively, during the portal venous phase (p = 0.6). The mean CT values of liver parenchyma were 117.1 ± 15.3 and 108.8 ± 18.7 in the A and B groups, respectively, during the portal venous phase (p = 0.9). There was no statistical difference in image quality, peak injection pressure (psi), and local discomfort between the two groups (p > 0.05). Conclusion: When a similar IDR and the same iodine load are used, CT images with different concentrations of contrast media have the same subjective and objective quality, and can meet the diagnostic needs.

Optimal injection rate and catheter size for brain perfusion computed tomography using non-ionic contrast medium in clinically normal Beagles

To evaluate the effects of contrast medium injection rates and intravenous injection catheter sizes on the time-density curve (TDC) of brain perfusion computed tomography (PCT) images in clinically normal Beagles and provide a reference range for the perfusion parameters for clinical application of PCT in veterinary medicine. 5 healthy, sexually intact male Beagles. All dogs underwent general anesthesia for PCT. Contrast medium (350 mg I/kg) was injected at 3 different injection rates (2, 3, and 4 mL/second) and with 2 sizes of an intravenous catheter (20-gauge and 24-gauge). The rostral cerebral artery and dorsal sagittal sinus were selected as the regions of interest of the TDC. Initiation time of arterial inflow (ta), venous outflow (tv), peak time of arterial enhancement (Tap), and the peak time of venous enhancement (Tvp), were measured, and the difference between Tap and tv (Tap-tv) and between Tap and ta (Tap-ta) was calculated. Both Tap-tv and Tap-ta were significantly (P < .05) shorter at the rate of 3 mL/second than at 2 mL/second with the 24-gauge catheter. However, there was no significant difference according to catheter sizes. Particularly, a 4 mL/second injection rate using a 24-gauge catheter mostly resulted in contrast medium leakage and catheter rupture. At a rate of 3 mL/second and with a 24-gauge catheter ensures optimal image acquisition and stable contrast medium injection in brain PCT for small dogs. PCT may be useful for diagnosing cerebrovascular events and hemodynamic changes in small dogs.

Gadolinium-based MR cisternography with prepontine cisternal routine for evaluating distribution pattern of intrathecal targeted drug delivery in pain management

Gadolinium-based MR cisternography has been mainly applied in clinical evaluation of cerebrospinal fluid leaking, that is conducted by intrathecal administration of contrast media. Recently, we have reported one novel technique of intrathecal targeted drug delivery with prepontine cisternal routine to treat orofacial cancer pain. The aim of this study was to examine the distribution pattern of this intrathecal drug delivery strategy. Here, we introduce one case who suffered severe orofacial pain caused by sublingual gland tumor, and successfully attenuated by prepontine cisternal administration of analgesic agents. To assess the distribution of intrathecal drugs, postoperative MR images of brain, cervical, thoracic, and lumbar segments in axial, coronal, and sagittal planes were obtained after application of gadolinium. The perfusion rate of contrast medium was set at 0.01 mmol per hour for 24 hours prior to MR scanning. In the T1-weighted images, we can identify contrast spread not only locating around the site of the intrathecal catheter tip, but also concentrated to the lateral sides. None obvious side effect was found after intrathecal injection of contrast media. Thus, our finding demonstrated the local distribution phenomenon of intrathecal drugs through prepontine cisternal access, and the bilateral perfusion pattern may provide insights underlying the analgesic mechanism of trigeminal pain provided by this novel intrathecal therapy. Gadolinium-based MR cisternography may serve as a potential tool to confirm the therapeutic effect of intrathecal targeted drug delivery via prepontine cisternal routine in orofacial pain management.

"ASSESSING THE EFFECTIVENESS OF OPTIMIZED CONTRAST AGENT USAGE IN CT SCANNING"

Background: To assess individually optimized protocol of contrast medium injection in enhanced CT scan for liver imaging.Materials &amp; methods: 50 patients who underwent liver CT scan were included in the present study.Random division of all the patients was done into two study groups as follows:Group A and group B (25 patients in each group).All the patients were scanned using CT machine.All patients underwent both unenhanced and enhanced CT scans during hepatic arterial phase (HAP) and portal venous phase (PVP).All the enhanced CT scans during HAP and PVP started at thirty-five seconds and sixty-five seconds respectively, after the contrast injection, from the level of diaphragm to inferior hepatic edge. Both groups received the same contrast medium. Group A adopted an individually optimized protocol of the platform, which automatically calculated the contrast medium dose. Patients of group B received a standard contrast medium injection protocol with a contrast medium to weight dose of 1.5 ml/kg. CT values of unenhanced liver parenchyma, CT values of liver parenchyma during HAP and PVP, and CT values of the portal vein during PVP were measured.CT examinations were performed in both group A and group B patients.Analysis of results was done using SPSS software.Results: Mean CT value of liver parenchyma during HAP (HU) among patients of group A and group B was 78.3 and 77.1 respectively. Mean CT value of liver parenchyma during PVP (HU) among patients of group A and group B was 103.1 and 108.3 respectively.Mean CT value of portal vein during PVP (HU) among patients of group A and group B was 145.3 and 158.7 respectively.Mean Contrast medium dose (ml) among patients of group A and group B was 79.2 and 95.3 respectively.Significant results were obtained while comparing the outcome variables among the two study groups. Conclusion: From the above results, the authors concluded that in enhanced CT scan for liver imaging,individualizing the contrast dose on the basis of body weight through contrast medium injection protocol could efficaciously decrease contrast medium dose

Can Machine Learning Identify the Intravenous Contrast Dose and Injection Rate Needed for Optimal Enhancement on Dynamic Liver Computed Tomography?

This study aimed to investigate whether machine learning (ML) is useful for predicting the contrast material (CM) dose required to obtain a clinically optimal contrast enhancement in hepatic dynamic computed tomography (CT). We trained and evaluated ensemble ML regressors to predict the CM doses needed for optimal enhancement in hepatic dynamic CT using 236 patients for a training data set and 94 patients for a test data set. After the ML training, we randomly divided using the ML-based (n = 100) and the body weight (BW)-based protocols (n = 100) by the prospective trial. The BW protocol was performed using routine protocol (600 mg/kg of iodine) by the prospective trial. The CT numbers of the abdominal aorta and hepatic parenchyma, CM dose, and injection rate were compared between each protocol using the paired t test. Equivalence tests were performed with equivalent margins of 100 and 20 Hounsfield units for the aorta and liver, respectively. The CM dose and injection rate for the ML and BW protocols were 112.3 mL and 3.7 mL/s, and 118.0 mL and 3.9 mL/s ( P < 0.05). There were no significant differences in the CT numbers of the abdominal aorta and hepatic parenchyma between the 2 protocols ( P = 0.20 and 0.45). The 95% confidence interval for the difference in the CT number of the abdominal aorta and hepatic parenchyma between 2 protocols was within the range of predetermined equivalence margins. Machine learning is useful for predicting the CM dose and injection rate required to obtain the optimal clinical contrast enhancement for hepatic dynamic CT without reducing the CT number of the abdominal aorta and hepatic parenchyma.

Frecuencia de uso de los hallazgos de la discografía para el diagnóstico del dolor lumbar de origen discogénico. Revisión sistemática de la literatura

IntroductionThere are different techniques and interpretations of discography findings to determine it positive for the diagnosis of discogenic pain. This study aims to evaluate the frequency of use of discography findings for the diagnosis of low back pain of discogenic origin. Material and methodsA systematic review of the literature of the last 17 years was performed in MEDLINE and BIREME. A total of 625 articles were identified, 555 were excluded for duplicates, title and abstract. We obtained 70 full texts of which 36 were included in the analysis after excluding 34 for not meeting the inclusion criteria. ResultsAmong the criteria in discography to determine it as positive, 8 studies used only the pain response to the procedure, 28 studies used more than one criterion during discography to consider it as positive, the evaluation of at least one adjacent intervertebral disc with a negative result was necessary in 26 studies to consider a discography as positive. Five studies formally expressed the use of the technique described by SIS/IASP to determine a discography as positive. ConclusionsPain in response to contrast medium injection, assessed with the visual analog pain scale≥6, was the most used criterion in the studies included in this review. Although there are already criteria to determine a discography as positive, the use of different techniques and interpretations of discography findings to determine a positive discography for low back pain of discogenic origin persists.

Pressure cooker technique in cerebral AVMs and DAVFs: different treatment strategies.

The pressure cooker technique (PCT) was developed to enable safer and more extensive embolization of hypervascular lesions by simultaneously minimizing backflow of liquid embolic materials and thus reduce the risk of non-target embolization of adjacent healthy vessels. We report our experience in applying the PCT to cerebral arteriovenous malformations (AVMs) and dural arteriovenous fistulas (DAVFs) and additionally suggest our technical adjustments. We retrospectively reviewed all patients suffering from AVMs or DAVFs that were treated with the PCT between 2018 and 2020 in two university hospitals. The endpoints of the study were clinical safety and the technical efficacy. The endpoints of the study were clinical safety and the technical efficacy. Clinical safety was the absence of death, major or minor symptomatic stroke, TIA and procedure-related intracranial bleeding (SAH) in the peri-procedural period until dismission. Good clinical outcome was defined as no deterioration of the modified Rankin Scale (mRS) score (comparing the pre- and post-procedural mRS evaluated by a trained neurologist at admission and dismission). The technical efficacy was considered as the complete embolization occlusion of the target vessels of the lesion documented on the final control angiogram. Long-term follow-up evaluation was not intended for this study as it was not available for all patients. Fifteen consecutive patients (6 women; mean age 55 y; range 20-82 y) with seven AVMs and eight DAVFs met the inclusion criteria. The primary clinical safety end point was obtained in all cases as no intraprocedural complications were encountered. All patients had a good clinical outcome with no difference between the pre- and post-mRS scores. The primary efficacy end point was reached in all cases. The PCT is a safe and effective technique in the treatment of cerebral AVMs and DAVFs. Adding an easy and fast step to the procedure, namely the injection of contrast media to test the complete obstruction by the plug, the risk of reflux seems to additionally be reduced.

Analysis of the Reasons for Medical Malpractice Litigation Due to Facet Injections.

Introduction As the use of facet joint injections (FJI) increases, practitioners performing FJI may be at increased risk of legal liability.Malpractice claim analysis is performed by several specialties as it provides valuable insight into patient values and methods to mitigate the risk of malpractice litigation pertaining to a specific procedure or treatment. Malpractice analysis regarding FJI may provide clinicians with a better understanding of the reasons that lead to malpractice due to FJI, thereby allowing practitioners to improve the quality of care delivered to patients whilst mitigating the incidence of malpractice. The aim of our study was to analyze the reasons for malpractice litigation due to FJI by querying Westlaw and VerdictSearch, two well-established legal databases widely used in medicolegal research. Methods We queried the Westlaw Edge and VerdictSearchlegal databases utilizing the terms "facet injection" and "spine". Our database queries yielded 1026 results on Westlaw Edge and 545 results on VerdictSearch. Cases were reviewed and categorized by two independent reviewers based on the grievance(s) levied by the plaintiff. Discrepancies between reviewers were resolved by a third reviewer. Inclusion criteria for case relevance were defined as a basis of litigation resting on malpractice claims filed between the years 2000-2022 directly pertaining to FJI. Additional data collected included the date of the case hearing, verdict ruling, location of filed claim, payment or settlement amount, and sustained injuries. Results Of all 1571 cases reviewed, 1568 cases were excluded due to a basis of litigation unrelated to FJI. Of the three cases pertaining to FJI, the first case involved an alleged procedural error on the part of the anesthesiologist, whereby the anesthesiologist misplaced the needle during FJI, resulting in quadriplegia due to a cervical spine infarction. The plaintiff also contended that the pre-procedural timeout was improperly conducted as the practitioner utilized iohexol as the injected contrast material despite the patient's well-documented allergy to iohexol. The jury deemed both the practitioner and hospital negligent, and a plaintiff verdict was issued. The second case was filed under a basis of litigation alleging delayed diagnosis and treatment on the part of an emergency medicine physician. The court acquitted the physician, and a defense verdict was issued.The third case was filed under a basis of litigation of alleged deviation from the standard of care on the part of the anesthesiologist, whereby the anesthesiologist performing the FJI did not use fluoroscopy.The court affirmed fluoroscopy is not dictated as the standard of care for FJI and issued a defendant verdict. Conclusion This study provides insight into the risk of medical malpractice suits brought on by facet joint injection. Our findings suggest that despite the high prevalence of facet joint injections performed annually, there is limited legal liability associated with the procedure. Nevertheless, there are certain reasons a malpractice claim may be filed due to facet injection, including gross procedural error resulting in patient paralysis, delay in treatment or diagnosis, and deviation from the established standard of care.As such, treatment decisions regarding facet joint injection should not be influenced by medicolegal concerns and remain predicated on patient care needs and standard of care.

Evaluating the length, diameter, and stenosis of deep circumflex iliac artery and neighboring arteries based on digital subtraction angiography.

The vascularized iliac bone crest flap offers excellent usable bone in terms of volume and quality. Its nourishing vessel, the deep circumflex iliac artery (DCIA), although relatively short, is reliable vessel. Digital subtraction angiography presents still the gold standard for diagnostic purpose. However, computed tomography (CT) and magnetic resonance imaging (MRI) angiography is used for preoperative planning with low morbidity. The purpose of this study is to evaluate the gainable information using digital subtraction angiography (DSA) as compared to other imaging modalities. We evaluated information gainable from standard DSA of 130 consecutive patients (average age was 69.5 years [range 18-90 years]) concerning topography, dimension, and condition of the vessel wall. We looked for differences considering gender and side. DCIA could not be followed in the periphery constantly in all cases due to the small, illustrated field. Arteriosclerotic changes showed to be very low in DCIA as compared to the neighboring vessels. Diabetes mellitus and smoking had a significant impact on vessel condition. DCIA branched off into its main two branches early after 40 mm (11%), after 40-60 mm (30%), or late after 60 mm (59%). DCIA showed to be least affected by different risk factors that reported to affect the vessel condition. We present additional detailed topographic anatomy of DCIA and its variation that can be used intraoperative guide to harvest the flap and teaching purpose. Standard DSA delivers valuable preoperative data regarding stenosis in addition to the topographic anatomy of the flap pedicle. However, imaging of the distal parts of the DCIA, nourishing the skin paddle is limited by the detector field used. For a full imaging of both DCIAs from the origin to the perforators, the intraarterial injection of contrast medium, as applied in DSA, could be combined with different imaging modalities like CT-angiography.

Transarterial ethiodised oil marking before CT-guided renal cryoablation: evaluation of tumour visibility in various renal cell carcinoma subtypes

To evaluate ethiodised oil retention of transarterial embolisation using ethiodised oil (ethiodised oil marking) before computed tomography (CT)-guided percutaneous cryoablation (PCA) according to renal cell carcinoma (RCC) subtype. Ethiodised oil marking was performed 1-3 days before PCA in 99 patients with 99 RCCs from 2016 to 2020. Ethiodised oil retention on CT images was evaluated retrospectively and CT attenuation values in the tumour were measured. Regions of interest (ROI) were placed on the tumours to calculate: average (ROI-average), maximal (ROI-max), minimum (ROI-min), and standard deviation (ROI-SD). Qualitative scores comprising a five-point scale (5, excellent; 1, poor) were evaluated for the retention scores (RS) of ethiodised oil in the tumour (ethiodised oil-RS) and the visualisation scores (VS) of the boundary between the tumour and renal parenchyma (boundary-VS). The histological subtypes comprised clear cell (ccRCC; n=85), papillary (pRCC; n=6), and chromophobe/oncocytoma renal cell carcinoma (chrRCC; n=8). The mean ROI-average, ROI-max, and ROI-SD were significantly higher in ccRCCs than in chrRCCs and pRCCs (p<0.05). The mean ethiodised oil-RS was significantly lower in pRCCs than in ccRCCs (p=0.039), and the mean boundary-VS was >4 in all subtypes. Even with poor intratumour ethiodised oil retention (n=6), sufficient boundary-VS was obtained due to "inverted marking." All PCA procedures were completed without additional intravenous contrast material injection at the time of PCA. Regardless of the tumour subtypes, ethiodised oil marking aids in visualising the boundary between the tumour and parenchyma on non-contrast CT in PCA.

Contrast-enhanced spectral mammography: are kinetic patterns useful for differential diagnoses of enhanced lesions?

To investigate the diagnostic efficiency of the kinetic curves of enhanced lesions on contrast-en-hanced spectral mammography (CESM) and whether they were similar to those of magnetic resonance imaging (MRI). Two hundred and twelve patients with 222 enhanced lesions were included in this prospective study. Single-view craniocaudal of an affected breast was acquired at 3, 5, and 7 min after contrast media injection. The kinetic patterns of each lesion were evaluated and classified as elevated (type I), steady (type II), and depressed (type III). Statistical comparison used the chi-squared test, the receiver operating characteristic (ROC) curve, and Cohen's kappa. Of 222 enhanced lesions, 140 were breast cancers, and 82 were benign lesions. The distribution of the kinetic curves for breast cancer was type I, 3.57%, type II, 35.71%, and type III, 60.72%. As for benign lesions, the distribution was type I, 43.90%, type II, 45.12%, and type III, 10.98%. The difference in the enhancement patterns between benign lesions and breast cancers was significant (P < 0.001). The likelihood of breast cancer related to a type I, II, and III curve was 12.20%, 57.47%, and 90.43%, respectively. For the enhancement intensity, the area under curve (AUC) of the ROC curves was 0.702 ± 0.036; for enhancement patterns, the AUC increased to 0.819 ± 0.030. Cohen's kappa coefficient was 0.752 (P < 0.001) regarding the kinetic curves for CESM and MRI. The kinetic patterns on CESM show promise in differentiating between benign lesions and breast cancers, with good agreement, when compared with MRI.

PS-C07-8: CENTRAL BLOOD PRESSURE ESTIMATION USING THE RADIAL ARTERIAL PRESSURE WAVEFORM IN CHILDREN, ADOLESCENTS, AND YOUNG ADULTS

Objective: Evaluation of central blood pressure is useful in prevention and treatment of cardiovascular diseases. In this study, we examined the accuracy of non-invasively measured central blood pressure in children, adolescents, and young adults. Design and Method: This study enrolled 23 patients who had undergone a cardiac catheterization below 30 years old (10.4 ± 7.2 years, 16 males and 7 females). Ascending aortic blood pressure waveforms were invasively recorded using a pressure sensor-mounted catheter (model SPC-454D, Millar Instrument, Inc., Houston, Texas). Simultaneously, radial artery pulse waveforms were non-invasively recorded by tonometry (HEM-9000AI, Omron Healthcare Co., Ltd., Kyoto, Japan). The measurements were performed before and after angiogram (injection of contrast media) except for one case. We analyzed the degree of coincidence between ascending aortic systolic blood pressure (aSBP) and estimated central systolic blood pressure calculated by the instrument (estCBP) in 45 simultaneous recording of aSBP and estCBP. The HEM-9000AI calculates estCBP using rSBP2, which indicates reflected pressure on radial artery. Results: The aSBP was 96.2 ± 13.4 mmHg and estCBP was 92.9 ± 14.7mmHg. There was no significant correlation between the aSBPs before and after angiogram in the same case. There was a significant relationship between aSBP and estCBP (r = 0.83, p &lt; 0.0001). The mean difference of the estSBP minus aSBP was -3.3 ± 8.3 mmHg by Bland-Altman analysis. The relationship between aSBP and rSBP1, which indicates forward pressure on radial artery, was stronger than the relationship between aSBP and rSBP2 (r = 0.88, p &lt; 0.0001 vs. r = 0.83, p &lt; 0.0001). The relationship between aSBP and the average of rSBP1 and rSBP2 (r = 0.90, p &lt; 0.0001) was stronger than the relationship between aSBP and estCBP. Conclusions: The estSBP calculated using rSBP2 method by HEM 9000AI was significantly correlated to aSBP in children, adolescents, and young adults. However, the correlation coefficient between aSBP and rSBP2 was smaller than that between aSBP and rSBP1. The estCBP calculated by rSBP1 and rSBP2 was strongly correlated to aSBP rather than estCBP by rSBP2 alone.

Monitoramento não invasivo do formato das ondas de pressão intracraniana usando o monitor Braincare® BCMM 2000 em cães com mielopatias submetidos à mielografia

ABSTRACT: Intracranial pressure (ICP) monitoring is considered the gold standard for optimizing the treatment of humans in intensive care units. However, this procedure is not commonly performed in veterinary medicine because of the limitations and complications of the method. There are some new promising non-invasive techniques for monitoring ICP, but they have not been validated in veterinary medicine. This study aimed to correlate the non-invasive intracranial pressure (NI-ICP) waveforms obtained with the BCMM-2000 Brain4care monitor during myelography in dogs with myelopathies undergoing this exam for diagnostic purposes with the waveforms obtained through invasive monitoring of the subarachnoid pressure (SP). The NI-ICP waveform was monitored in six dogs with myelopathies before (M1), during (M2), and after (M3) contrast medium injection into the subarachnoid space. Cerebrospinal fluid (CSF) was collected before contrast injection. The SP waveform was simultaneously monitored in three of the six dogs. Correlations between the two methods were performed using Pearson’s coefficient. The analysis of the morphology and amplitude of the waves at each moment was performed, and at M2, an increase in the P2:P1 ratio (p&lt;0.05) was observed in both monitoring methods. In M3, the values were similar to those of M1, demonstrating the return of cerebral compliance. The comparison of the NI-ICP and SP had a positive correlation in those moments (Pearson’s coefficient r=0.76; p=0.027). The speed of contrast administration, degree of spinal cord compression, and volume of CSF previously collected may affect P2:P1 and ICP dynamics. The BCMM-2000 Brain4care monitor was effective in detecting changes in ICP dynamics and abnormal pulse waveforms in dogs with meningoencephalitis of unknown origin, vertebral neoplasm and intervertebral disc disease with and without hemorrhagic myelomalacia, suggesting increased ICP induced by myelography.

Renal Infarction: Clinical and Evolutionary Aspects in the Nephrology Department Ibn Sina University Hospital of Rabat-Morocco

Introduction: Renal infraction is a rare medical-surgical emergency that should be evoked before any lumbar pain syndrome. We report in this work, two cases of renal infraction with their clinical evolution. Clinical observation: These patients, aged respectively 48 and 70 years, were hospitalized in our department concomitant for low back pain. Emboligenic heart disease was responsible for the renal infraction in both cases. Diagnostic certainty was established by a CT scan with injection of contrast medium. Renal function was normal in the young patient versus renal insufficiency at 20mg/l creatinine for a GFR estimated at 35ml/minute according to MDRD in the elderly patient. We had a clinical and biological improvement with a curative anticoagulant treatment relayed by a long term treatment with an anti vitamin K in both cases but the elderly man kept a sequential renal insufficiency. Conclusion: Acute renal infarction is a rare pathology which must be systematically evoked in front of a lumbar pain syndrome. Angioscan with injection of contrast medium allows to make the diagnosis. Heparinization at an effective dose is the mainstay of treatment in the case of unilateral involvement, or surgery if bilateral.

Relationship between Abnormal Cervical Findings and Abnormal Results at Hysterosalpingography in Infertile Women

Background: Hysterosalpingography is an investigative modality used in the evaluation of the uterine cavity, fallopian tubes, and adjacent peritoneal cavity following the injection of contrast material through the cervical canal.&#x0D; Objective: To determine the relationship between abnormal cervical findings and abnormal results at hysterosalpingography in infertile women.&#x0D; Materials and Methods: This descriptive, cross-sectional study conducted at the Obstetrics and Gynaecology, and Radiology Departments of four health institutions in Bayelsa State, Nigeria, between June and December, 2022. Hysterosalpingography was done for 332 infertile women, after obtaining written informed consent. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions (SPSS) version 25.0. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables.&#x0D; Results: Cervical finding was normal in only 49.7% (n=165) of the participants undergoing HSG. The abnormal cervical findings include deformed (27.7%), hyperaemic (5.7%), dull (5.7%), hard (5.7%) and short (5.4%) cervix. There was a statistically significant relationship between abnormal cervical findings during HSG and tubal blockade (ꭓ2 = 196.7; p – 0.001), presence of salpingitis (ꭓ2 = 41.1; p – 0.001), peritubal adhesion (ꭓ2 = 19.9; p – 0.001) and intrauterine adhesion (ꭓ2 = 35.62; p – 0.001).&#x0D; Conclusion: Intrauterine adhesion, salpingitis, tubal blockade and peritubal adhesion on HSG are associated with some abnormal cervical findings in about half of infertile women in this study. The same pathological processes responsible for injury to the upper genital tract and tubal infertility may have caused injury to the cervix in the group of women.

Relationship between Abnormal Cervical Findings and Abnormal Results at Hysterosalpingography in Infertile Women

Background: Hysterosalpingography is an investigative modality used in the evaluation of the uterine cavity, fallopian tubes, and adjacent peritoneal cavity following the injection of contrast material through the cervical canal.&#x0D; Objective: To determine the relationship between abnormal cervical findings and abnormal results at hysterosalpingography in infertile women.&#x0D; Materials and Methods: This descriptive, cross-sectional study conducted at the Obstetrics and Gynaecology, and Radiology Departments of four health institutions in Bayelsa State, Nigeria, between June and December, 2022. Hysterosalpingography was done for 332 infertile women, after obtaining written informed consent. Data were entered into a pre-designed proforma, and analysed using Statistical Product and Service Solutions (SPSS) version 25.0. Results were presented in frequencies and percentages for categorical variables, and mean and standard deviation for continuous variables.&#x0D; Results: Cervical finding was normal in only 49.7% (n=165) of the participants undergoing HSG. The abnormal cervical findings include deformed (27.7%), hyperaemic (5.7%), dull (5.7%), hard (5.7%) and short (5.4%) cervix. There was a statistically significant relationship between abnormal cervical findings during HSG and tubal blockade (ꭓ2 = 196.7; p – 0.001), presence of salpingitis (ꭓ2 = 41.1; p – 0.001), peritubal adhesion (ꭓ2 = 19.9; p – 0.001) and intrauterine adhesion (ꭓ2 = 35.62; p – 0.001).&#x0D; Conclusion: Intrauterine adhesion, salpingitis, tubal blockade and peritubal adhesion on HSG is associated with some abnormal cervical findings in about half of infertile women in this study. The same pathological processes responsible for injury to the upper genital tract and tubal infertility may have caused injury to the cervix in the group of women.

286 A CASE REPORT OF TYPE II KOUNIS SYNDROME

Abstract Case presentation and management A 81-years old female presented to the emergency department of our hospital with dyspnea and chest pain. She had a history of chronic kidney disease and left bundle brunch block (LBBB) never further investigated. Non diagnostic ECG was performed in the setting of pre-existing LBBB. HS-T-Troponin level was significantly elevated (986 ng/L). A transthoracic echocardiogram (TTE) revealed inferior and posterior wall hypokinesis. NSTEMI was diagnosed and coronary angiography via the femoral artery revealed subocclusive stenosis of the right coronary artery (RCA) and 80% stenosis of left anterior descending artery (LAD). Coronary stent positioning was performed for the RCA culprit lesion and staged complete revascularization was planned. Complications After two days, the patient experienced sharp pain in the right groin and a femoral pseudoaneurysm was diagnosed by Ultrasound Color Doppler. Subsequently anemia suggested the development of retroperitoneal hematoma but it was excluded by contrast CT. Unfortunately, the patient developed acute chest pain, wheezing and erythematous pruritic rash 10 minutes after injection of contrast medium agent. The ECG didn't show any new ischemic abnormalities in the setting of pre-existing LBBB. The peak CK- MB level was significantly elevated (87 ng/mL). New onset apical region akinesia and anterior wall hypokinesia were detected on TTE. Acute coronary syndrome (ACS) was suspected consistent with symptoms, new onset wall motion abnormalities and CK-MB elevations. The patient was diagnosed with allergic reaction and coronary vessel spasm secondary to contrast agent injection in pre-existing atherosclerotic plaque. Due to the high probability of an hypersensitivity reaction to the contrast medium agent we did not perform a new coronary angiography to confirm the diagnosis. Promethazine, Urbason and Nitroglicerin were administered with clinical improvement. The next day we observed recovery of the anterior and apex wall motion abnormalities consistent with coronary vessel spasm. Echocardiographic wall motion abnormalities before and after coronary spasm: Take home message We presented the case of an allergic reaction leading to the release of inflammatory mediators responsible of coronary vessel spasm causing acute myocardial infarction. It can also be induced by injection of contrast medium like in the presented case. Therefore, clinicians and radiologist should recognize this rare but critical disease to ensure prevention and appropriate management.

986 LEFT VENTRICULAR LEAD PLACEMENT FOR BIVENTRICULAR PACING INTO A LEFT LATERAL VEIN IN PATIENT WITH CONGENITAL ATRESIA OF THE CORONARY SINUS OSTIUM WHO UNDERWENT AORTIC VALVE REPLACEMENT

Abstract Introduction Coronary sinus ostial atresia (CSOA) is a rare congenital heart anomaly consisting in the occlusion of the coronary sinus (CS) outlet in the right atrium. It is one of the causes of placement left lead failure in CS during cardiac resynchronization therapy (CRT) device implantation. The persistence of the left superior vena cava is the most common pathway that allows venous blood flow to drain into the right atrium and can represent a new possible way to reach a left ventricular vein from the CS. Methods A 66-year-old male suffering from sarcoidosis was studied after an episode of syncope under exertion. EKG showed a 1st degree atrioventricular block and a left bundle branch block (LBBB) with wide QRS (170 ms). Echocardiography found left ventricle dilatation, severe systolic dysfunction, and a severe low-flow low-gradient aortic stenosis for which he underwent aortic valve replacement. After surgery and finding of 2nd degree type II atrioventricular block, CRT implant was performed but the procedure was complicated by the finding of CSOA. The insertion of the left quadripolar lead along a left branch of the occluded CS was achieved with a push-and-pull technique of the lead over a guidewire, after the retrieval and the cannulation of the persistent left superior vena cava. Results A new approach was applied on a rare case of CSOA found during CRT procedure. The contrast medium (CM) in the left subclavian vein revealed the existence of the left superior vena cava that was than cannulated. CM injection in CS highlighted a posterior left branch that was approached with a specific guidewire and a subselector after selective venography. With a fine technique of sliding of the lead on a tensioned guidewire, the quadripolar catheter was successfully placed in the left ventricular vein. Left-ventricle-right ventricle delays and catheter thresholds were tested and a final QSR duration of 90 msec in CRT mode was obtained. Conclusions This case-report shows a complex technique, reported in parallel with other similar procedures, to help the approach toward a rare anatomical variant of CSOA accompanied by persistent left superior vena cava when a CRT implant is needed after cardiac valve surgery in a patient suffering from sarcoidosis.