Gadolinium-based Contrast Media Research Articles

Efficacy of Native T1 Mapping for Patients With Non-Ischemic Cardiomyopathy and Ventricular Functional Mitral Regurgitation Undergoing Transcatheter Edge-to-Edge Repair.

We investigated the efficacy of left ventricular (LV) myocardial damage by native T1mapping obtained with cardiac magnetic resonance (CMR) for patients undergoing transcatheter edge-to-edge repair (TEER).Methods and Results: We studied 40 symptomatic non-ischemic heart failure (HF) patients and ventricular functional mitral regurgitation (VFMR) undergoing TEER. LV myocardial damage was defined as the native T1Z-score, which was converted from native T1values obtained with CMR. The primary endpoint was defined as HF rehospitalization or cardiovascular death over 12 months after TEER. Multivariable Cox proportional hazards analysis showed that the native T1Z-score was the only independent parameter associated with cardiovascular events (hazard ratio 3.40; 95% confidential interval 1.51-7.67), and that patients with native T1Z-scores <2.41 experienced significantly fewer cardiovascular events than those with native T1Z-scores ≥2.41 (P=0.001). Moreover, the combination of a native T1Z-score <2.41 and more severe VFMR (effective regurgitant orifice area [EROA] ≥0.30 cm2) was associated with fewer cardiovascular events than a native T1Z-score ≥2.41 and less severe VFMR (EROA <0.30 cm2; P=0.002). Assessment of baseline LV myocardial damage based on native T1Z-scores obtained with CMR without gadolinium-based contrast media is a valuable additional parameter for better management of HF patients and VFMR following TEER.

MRI Gadolinium-Based Contrast Media: Meeting Radiological, Clinical, and Environmental Needs.

Gadolinium-based contrast agents (GBCAs) are routinely used in magnetic resonance imaging (MRI). They are essential for choosing the most appropriate medical or surgical strategy for patients with serious pathologies, particularly in oncologic, inflammatory, and cardiovascular diseases. However, GBCAs have been associated with an increased risk of nephrogenic systemic fibrosis in patients with renal failure, as well as the possibility of deposition in the brain, bones, and other organs, even in patients with normal renal function. Research is underway to reduce the quantity of gadolinium injected, without compromising image quality and diagnosis. The next generation of GBCAs will enable a reduction in the gadolinium dose administered. Gadopiclenol is the first of this new generation of GBCAs, with high relaxivity, thus having the potential to reduce the gadolinium dose while maintaining good in vivo stability due to its macrocyclic structure. High-stability and high-relaxivity GBCAs will be one of the solutions for reducing the dose of gadolinium to be administered in clinical practice, while the development of new technologies, including optimization of MRI acquisitions, new contrast mechanisms, and artificial intelligence may help reduce the need for GBCAs. Future solutions may involve a combination of next-generation GBCAs and image-processing techniques to optimize diagnosis and treatment planning while minimizing exposure to gadolinium. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 3.

Gadolinium-Based Contrast Media Nephrotoxicity. Overview and Recommendations

Gadolinium-Based Contrast Media Nephrotoxicity. Overview and Recommendations

Safe use of contrast media in myasthenia gravis: systematic review and updated European Society of Urogenital Radiology Contrast Media Safety Committee guidelines

Abstract Objectives It is uncertain whether modern iodine-based or gadolinium-based contrast media (CM) administration can lead to increased symptoms in patients with myasthenia gravis. Methods A systematic search in Medline was conducted for studies describing the symptomatology of myasthenia gravis patients before and after receiving intravenous (IV) CM and having a matched control group of myasthenia gravis patients who did not receive IV CM. Results Three retrospective studies were selected with a total of 374 myasthenia gravis patients who received iodine-based CM and a total of 313 myasthenia gravis patients who underwent unenhanced CT and served as controls. Pooling of the data from the three retrospective studies showed that in 23 of 374 patients, increased symptoms after iodine-based CM administration were described (6.1%). Increased symptomatology also occurred in 11 of 313 patients after unenhanced CT (3.5%). When looking more deeply into the data of the three studies, conflicting results were found, as two articles did not find any relationship between CM and myasthenia gravis symptoms. The remaining study only found a significant increase in symptomatology within 1 day after CT scanning: seven patients (6.3%) in the contrast-enhanced CT group and one patient (0.6%) in the unenhanced CT group (p = 0.01). Conclusions There is limited evidence on the relationship between CM and myasthenia gravis symptoms. In the vast majority of myasthenia gravis patients, CM are safe. Probably, in less than 5% of the patients, iodine-based CM administration may lead to increased severity of the symptoms within the first 24 h after administration. Clinical relevance statement Be aware that intravenous administration of iodine-based contrast media can lead to an increase of symptoms in patients with myasthenia gravis within the first 24 h. This can probably happen in less than 5% of the patients. Key Points • It is unclear whether modern contrast media can lead to increased symptoms in myasthenia gravis patients after intravenous administration. • There seems to be a small risk of increased myasthenia gravis symptoms within 24 h after intravenous administration of iodine-based contrast media, probably in less than 5% of the administrations. • Gadolinium-based contrast media are safe for patients with myasthenia gravis.

Hidden risk of gadolinium-based contrast agents during interventional pain medicine procedures: a retrospective chart review

IntroductionEpidural steroid injections and epidural blood patches commonly involve the injection of a small amount of radiocontrast media under fluoroscopy to properly identify the target tissue or anatomic space and...

A Survey of Practicing Radiologists on the Use of Premedication Before Intravenous Iodinated Contrast Medium Administration

ObjectiveTo determine whether updated guidance by the ACR in 2017 advocating use of intravenous (IV) premedication in emergency department (ED) patients and inpatients with reported iodinated contrast allergy was associated with a change in clinical practice. MethodsAn anonymous survey was distributed via e-mail in October 2020 to practicing radiologist members of the ACR interrogating use of corticosteroid premedication for two clinical vignettes: an indicated routine (perform within 24 hours) inpatient contrast-enhanced CT (CE-CT) and an indicated urgent (perform within 6 hours) ED CE-CT. In both scenarios, the patient had a prior moderate hypersensitivity reaction to iodinated contrast media. Clinical management was evaluated. Data were compared to historical controls from 2009. ResultsThe response rate was 11% (724 of 6,616). For the inpatient scenario, 72% (518 of 724) would use corticosteroid premedication with CE-CT, and 28% (200 of 724) would perform noncontrast CT. For the ED scenario, 67% (487 of 724) would use corticosteroid premedication with CE-CT, and 30% (217 of 724) would perform noncontrast CT. Oral premedication (85%, 439 of 518) was preferred for routine inpatients, and rapid IV premedication (89%, 433 of 487) was preferred for urgent ED patients. Of those who provided rapid IV dosing data in the ED, two doses of corticosteroids were used by 53% (216 of 410) and one dose was used by 45% (185 of 410), with academic radiologists more likely than private or hybrid practice radiologists to administer two doses (74% [74 of 100] versus 48% [151 of 312], P < .001, odds ratio, 3.03; 95% confidence interval, 1.84-5.00). Rapid IV premedication was more commonly used in 2020 than in 2009 (60% [433 of 724] versus 29% [20 of 69], P < .001, odds ratio, 3.65; 95% confidence interval, 2.12-6.26). Antihistamine use was common in both inpatient (93%, 480 of 518) and ED settings (92%, 447 of 487). Only 32% (229 of 721) of radiologists practiced in accordance with ACR guidelines, suggesting no need for routine premedication before CE-CT in patients with prior severe hypersensitivity reaction to gadolinium-based contrast media. Nonetheless, most (93%, 670 of 724) said the ACR Manual on Contrast Media was a major determinant of their practice. ConclusionsUse of rapid IV premedication in urgent settings has increased since 2009, following updated ACR guidelines, but there is disagreement over whether one or two corticosteroid doses is required. Despite reported high reliance on ACR guidelines, deviations from those guidelines remain common. In general, when ACR guidelines were not followed, it was in a risk-averse direction.

#4168 RISK FACTORS FOR POST-CONTRAST AKI IN PATIENTS MIXEDLY ADMINISTERED BOTH IODINE- AND GADOLINIUM-BASED CONTRAST MEDIA ON VISITING EMERGENCY ROOM

Abstract Background and Aims This study aimed to investigate the incidence of post-contrast acute kidney injury (PC-AKI) and its risk factor in patients administered iodine-based contrast media alone and mixed use of iodine-based contrast media and gadolinium-based contrast media. Method This retrospective study analyzed the data from 2016 to 2021. Patients who had end-stage of renal disease or missing data for estimating renal function were excluded. The primary outcome was the development of PC-AKI, i.e., an increase in creatinine of ≥25% or 0.5 mg/dL over the baseline or reduction in eGFR of ≥25% within 72 h. We compared the primary outcomes between the iodine-based contrast media alone and Mixed groups using a propensity score matching (PSM) analysis, and its risk factors were assessed from multivariable logistic regression. Results Of the 29,635 patients administrated iodine-based contrast media, 6,318 were included. There were 139 patients who mixedly administered iodine-based contrast media and GBCA. Mixed group showed significant higher rate of development of PC-AKI compared with iodine-based contrast media alone group in total cohort (adjusted OR, 3.09 [95% CI, 2.09 – 4.58]) and PSM cohort (adjusted OR, 2.38 [95% CI, 1.25 – 4.55]). On multivariate analysis to investigate risk factors in Mixed group, osmolality (adjusted aOR, 1.05 [95% CI, 1.01–1.10]) and eGFR (adjusted OR, 0.931; 95% CI, 0.883–0.983) were associated with PC-AKI. Conclusion Mixed administration of iodine-based contrast media and GBCA on same day at ED visit may be a risk factor for PC-AKI compared with single administration of iodine-based contrast media alone. Osmolality and eGFR may be independently associated with PC-AKI after mixed administration of iodine-based contrast media and GBCA

What you need to know about: imaging in patients with renal failure.

Contrast-enhanced medical imaging is commonly requested in clinical practice. Contrast media provide better differentiation of tissue enhancement, improves the soft tissue contrast resolution, and enhances the ability to study the physiology and function of the organs and/or systems. However, contrast media may cause complications, especially in patients with renal failure. This article discusses the use of contrast media in common imaging modalities and the relationship between contrast media and renal function. Administration of iodinated contrast media in computed tomography may cause contrast-associated acute kidney injury; the risk factors and preventive strategies for this are elaborated in this article. Administration of gadolinium-based contrast media in magnetic resonance imaging may lead to nephrogenic systemic fibrosis. Therefore, precautions should be taken when planning for medical imaging for patients with pre-existing acute kidney injury or end-stage chronic kidney disease, for whom contrast media administration in computed tomography or magnetic resonance imaging may be relatively contraindicated. Alternatively, ultrasound contrast agents can be safely used in patients with acute kidney injury or chronic kidney disease. Clinical teams should discuss these patients with radiologists, taking into account the risk-benefits of contrast media, to determine the optimal imaging protocol or modality to answer the clinical query.

Risk factors for post-contrast acute kidney injury in patients sequentially administered iodine- and gadolinium-based contrast media on the same visit to the emergency department: a retrospective study.

This study compares the incidence of post-contrast acute kidney injury (PC-AKI) in patients who received a single administration of iodine-based contrast medium (ICM) with that in patients who received a sequential administration of ICM and gadolinium- based contrast agents (GBCA) in a single visit to an emergency department (ED) to determine the risk factors for PC-AKI. Patients who received one or more contrast media in the ED from 2016 to 2021 were included in this retrospective study. They were divided into the ICM alone and ICM + GBCA groups, and the incidence of PC-AKI was compared between the groups. The risk factors were assessed using a multivariable analysis after propensity score matching (PSM). Overall, 6,318 patients were analyzed, of whom 139 were in the ICM + GBCA group. The incidence of PC-AKI was significantly higher in the ICM + GBCA group than in the ICM alone group (10.9% vs. 27.3%, p &lt; 0.001). In the multivariable analysis, sequential administration was a risk factor for PC-AKI, and single administration was not (adjusted odds ratio [95% confidence interval] in the 1:1, 2:1, and 3:1 PSM cohorts: 2.38 [1.25-4.55], 2.13 [1.26-3.60], and 2.28 [1.39-3.72], respectively). In subgroup analyses of the ICM + GBCA group, osmolality (1.05 [1.01-1.10]) and estimated glomerular filtration rate (eGFR, 0.93 [0.88-0.98]) were associated with PC-AKI. Compared with a single administration of ICM alone, sequential administration of ICM and GBCA during a single ED visit might be a risk factor for PC-AKI. Osmolality and eGFR might be associated with PC-AKI after sequential administration.

WCN23-1001 Risk factors for post-contrast acute kidney injury in patients mixedly administered both iodine- and gadolinium-based contrast media on the same visit to the emergency department

WCN23-1001 Risk factors for post-contrast acute kidney injury in patients mixedly administered both iodine- and gadolinium-based contrast media on the same visit to the emergency department

Can I Diagnose a Vestibular Schwannoma Using Non-Contrast Imaging?

&#x0D; &#x0D; &#x0D; &#x0D; “I have an adult patient with new-onset unilateral sensorineural hearing loss. I would like to rule out a vestibular schwannoma by performing an MRI exam. However, the patient has a kidney problem that prevents him from receiving contrast material. Can I still diagnose a vestibular schwannoma using a non-contrast imaging study?”&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; The answer to this question is ... YES! At the current time, gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) is considered the gold standard for the diagnosis of vestibular schwannomas.1 However, the use of gadolinium-based contrast material may be contraindicated in patients with impaired renal function, in those who have had an allergic reaction to such contrast material, and in patients who are or may be pregnant.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; High-resolution T2-weighted MR sequences as a means of visualizing the fluid-filled inner ear and the 7th and 8th cranial nerves in the internal auditory canal and cerebellopontine angle cistern was described in the early 1990’s.2 These steady-state imaging sequences currently include various manufacturer-specific sequences such as CISS (Constructive Interference into Steady State, Siemens), FIESTA-C (Fast Imaging Employing Steady-state Acquisition Cycled Phases, GE), DRIVE (Driven Equilibrium Radiofrequency Reset Pulse, Philips), bFFE (Balanced Fast Field Echo, Philips) and SPACE (Sampling Perfection with Application optimized Contrasts using different flip angle Evolutions, Siemens).3 The submillimeter-resolution images from these sequences can be manipulated on computer-based DICOM imaging software to provide reformatted images in non-orthogonal planes that allow visualization of the entire 8th cranial nerve, from the brainstem to the fundus of the internal auditory canal. In these sequences, cerebrospinal fluid (CSF) displays a high signal intensity that provides an excellent contrasting background to the inherent low signal intensity of the 7th and 8th cranial nerves. (Figure 1)&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Similar to the nerves, a vestibular schwannoma will appear as a low-intensity (dark) filling defect that may be nodular, oblong, or ice cream cone-shaped, and located in the internal auditory canal and/or the cerebellopontine angle cistern immediately adjacent to it. (Figure 2)&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; In evaluating a patient for the presence of a vestibular schwannoma, the current medical literature indicates that high-resolution T2- weighted imaging sequences have a high sensitivity and specificity compared to gadolinium-enhanced T1-weighted imaging. However, T2-weighted imaging alone may not detect inflammatory, infectious or malignant conditions that may also present with sensorineural hearing loss.1 As such, a gadolinium-enhanced T1-weighted sequence will be needed when such conditions are suspected.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; Finally, local experience with institutions that perform imaging of the internal auditory canal and cerebellopontine angle shows that not all centers routinely perform the high-resolution T2-weighted imaging sequences. Therefore, it would be prudent to specifically indicate the need for “a T2-weighted imaging sequence with submillimeter- resolution, such as the CISS or FIESTA-C sequence” in the imaging request, in order to ensure the performance of the appropriate imaging strategy.&#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D; &#x0D;

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.

The feasibility of superparamagnetic iron oxide-enhanced magnetic resonance imaging for assessing liver lesions in patients with contraindications for iodine CT contrast media or gadolinium-based MR contrast media: a retrospective case-control study.

BackgroundThe detection and characterization of liver lesions are problematic in patients with bronchial asthma, renal dysfunction, or a history of allergy to gadolinium-based magnetic resonance contrast media or iodine-computed tomography contrast media because these contrast media cannot be used. Hence, the information on the lesion vascularity cannot be obtained. Therefore, this retrospective case-control study evaluated the feasibility of superparamagnetic iron oxide (SPIO) in patients with one or more of these contraindications who underwent SPIO-enhanced magnetic resonance imaging for the assessment of liver lesions.MethodsTwenty-six patients with a total of 48 lesions were analyzed. SPIO was used in the case of all patients because each patient had at least one reason not to use iodine contrast or gadolinium-based contrast media. Additionally, all patients were subjected to the perfusion study. A total volume of 1.3 mL of SPIO was injected via the cubital vein at a rate of 3 mL per second, followed by 40 mL saline at the same speed. The scanning of the perfusion study was started 4 s after the beginning of superparamagnetic iron oxide injection and scanning took 50 s. Two radiologists independently evaluated whether the lesion was malignant or benign. Receiver operating characteristic analysis (ROC) was performed to determine the additional benefit of the perfusion study.ResultsThere were no adverse effects associated with SPIO. The area under the curve (AUC) value without perfusion study for observers 1 and 2 were 0.473 (P=0.794, 95% CI: 0.275–0.672) and 0.602 (P=0.305, 95% CI: 0.407–0.798), respectively, whereas the Az values with perfusion study for observers 1 and 2 were 0.782 (P=0.011, 95% CI: 0.565–0.998) and 0.784 (P=0.004, 95% CI: 0.591–0.977), respectively. Az value became significantly better when the perfusion study has added (P=0.001 and 0.012 by observers 1 and 2).ConclusionsSPIO can be used safely in patients with bronchial asthma, renal dysfunction, or a history of contrast media allergy. Furthermore, the diagnostic accuracy of SPIO was acceptable.

Contrast-enhanced MR Angiography without Gadolinium-based Contrast Material: Clinical Applications Using Ferumoxytol

Vascular imaging can be challenging because of the wide variability of contrast dynamics in different vascular territories and potential safety concerns in patients with renal insufficiency or allergies. Off-label diagnostic use of ferumoxytol, a superparamagnetic iron nanoparticle approved for therapy, is a promising alternative to gadolinium-based contrast agents for MR angiography (MRA). Ferumoxytol has exhibited a reassuring safety profile when used within the dose range recommended for diagnostic imaging. Because of its prolonged and stable intravascular residence, ferumoxytol can be used in its steady-state distribution for a wide variety of imaging indications, including some where conventional MRA is unreliable. In this article, authors discuss some of the major vascular applications of ferumoxytol and highlight how it may be used to provide highly diagnostic images and improve the quality, workflow, and reliability of vascular imaging. Keywords: MR Angiography, MRI Contrast Agent, Cardiac, Vascular © RSNA, 2022

Invited Commentary: Role of the Radiologist in Pregnancy-associated Cancer.

Invited Commentary: Role of the Radiologist in Pregnancy-associated Cancer.

Imaging Cancer in Pregnancy.

Pregnancy-associated cancer (PAC) is defined as cancer that is detected during pregnancy and up to 1 year postpartum. Although rare (~1:1000 pregnancies), PAC is increasing owing to postponed childbearing and advanced maternal age at conception. Cancer-related symptoms masked by physiologic gestational changes may delay diagnosis. Imaging, clinical management, and treatment require a carefully choreographed multidisciplinary team approach. The risk-benefit of every imaging modality, the strategies to balance the safety of mother and fetus, and the support of the patient and family at every step are crucial. US and MRI are preferred imaging modalities that lack ionizing radiation. Radiation dose concerns should be addressed, noting that most imaging examinations (including mammography, radiography, CT, and technetium 99m-labeled sulfur colloid sentinel lymph node staging) are performed at radiation levels below thresholds at which deterministic side effects are seen. Dose estimates should be provided after each examination. The use of iodinated intravenous contrast material is safe during pregnancy, but gadolinium-based contrast material should be avoided. Accurate diagnosis and staging combined with gestational age affect decisions about surgery and chemotherapy. Whole-body MRI with diffusion-weighted sequences is ideal to screen for primary and metastatic sites, determine disease stage, identify biopsy targets, and guide further cancer site-specific imaging. The authors provide an update of the imaging triage, safety considerations, cancer-specific imaging, and treatment options for cancer in pregnancy. An invited commentary by Silverstein and Van Loon is available online. Online supplemental material is available for this article. ©RSNA, 2022.

Fully Automated 3D Vestibular Schwannoma Segmentation with and without Gadolinium-based Contrast Material: A Multicenter, Multivendor Study.

To develop automated vestibular schwannoma measurements on contrast-enhanced T1- and T2-weighted MRI scans. MRI data from 214 patients in 37 different centers were retrospectively analyzed between 2020 and 2021. Patients with hearing loss (134 positive for vestibular schwannoma [mean age ± SD, 54 years ± 12;64 men] and 80 negative for vestibular schwannoma) were randomly assigned to a training and validation set and to an independent test set. A convolutional neural network (CNN) was trained using fivefold cross-validation for two models (T1 and T2). Quantitative analysis, including Dice index, Hausdorff distance, surface-to-surface distance (S2S), and relative volume error, was used to compare the computer and the human delineations. An observer study was performed in which two experienced physicians evaluated both delineations. The T1-weighted model showed state-of-the-art performance, with a mean S2S distance of less than 0.6 mm for the whole tumor and the intrameatal and extrameatal tumor parts. The whole tumor Dice index and Hausdorff distance were 0.92 and 2.1 mm in the independent test set, respectively. T2-weighted images had a mean S2S distance less than 0.6 mm for the whole tumor and the intrameatal and extrameatal tumor parts. The whole tumor Dice index and Hausdorff distance were 0.87 and 1.5 mm in the independent test set. The observer study indicated that the tool was similar to human delineations in 85%-92% of cases. The CNN model detected and delineated vestibular schwannomas accurately on contrast-enhanced T1- and T2-weighted MRI scans and distinguished the clinically relevant difference between intrameatal and extrameatal tumor parts.Keywords: MRI, Ear, Nose, and Throat, Skull Base, Segmentation, Convolutional Neural Network (CNN), Deep Learning Algorithms, Machine Learning Algorithms Supplemental material is available for this article. © RSNA, 2022.

Contrast Media Adverse Drug Reactions in Highly Polluted Environment.

Iodinated- (ICM) and gadolinium-based (GCM) contrast media are used in radiology imaging techniques, such as computer tomography (CT) and magnetic resonance (MR), respectively. The paper aims to analyze the adverse drug reactions of ICM and GCM on different sites of the body in a highly polluted environment. We analyzed the pharmacovigilance in contrast media on the basis of reports submitted to the Regional Center for Monitoring of Adverse Drug Reactions (ADR) at the Department of Clinical Pharmacology in Wrocław. Safety profiles were compared between different ICM and GCM and at the system organ level using the proportional reporting ratio (PRR). We analyzed 124 reports of adverse reactions related to contrast agents between 2006 and 2021. Our findings revealed that ADR combinations occurred more frequently after the use of iodinated contrast agents (72.08%) than gadolinium contrast agents (27.92%). Iomeprol and Iopromide were identified as the most frequently reported media. Each medium presented a different safety profile. Skin disorders are the most common adverse drug reactions among patients using both iodine- and gadolinium-based contrast media. Gadolinium-based contrast agents are characterized by similar organ toxicity. Conversely, iodine-based contrast agents are more diverse—some of which show tissue specificity, such as Iodixanol for the gastrointestinal system or Iohexol for the respiratory tract. This study shows relatively high occurrence of respiratory tract related ADRs in Wrocław. We also prove that it is possible to choose the most optimal contrast agent for patients with specific organ site problems to omit the possible complications.

Cardiac sarcoidosis: Difficulties and possibilities of differential diagnosis for acute coronary syndrome without ST segment elevation in real clinical practice

Here we present a clinical case of cardiac sarcoidosis. The article discusses the difficulties of differential diagnosis in patients emergently hospitalized in the cardiology department with recurrent chest pain, no changes in the electrocardiogram (ECG), and a presumptive diagnosis of acute coronary syndrome without ST segment elevation (NSTE-ACS). A careful history taking, invasive coronary angiography, and contrast-enhanced (gadolinium-based contrast media) cardiac magnetic resonance imaging (CMR) contributed to the correct diagnostic decision in search for and identification of cardiac sarcoidosis in the patient.

Contrast Medium Hypersensitivity: A Large Italian Study with Long-Term Follow-Up.

Hypersensitivity reactions (HRs) to contrast media (CM) are a major problem. We compared differences of HRs to iodinated contrast media (ICM) versus gadolinium-based contrast media (GBCM), collecting data on prevalence, type, latency and severity. Secondly, the predisposition to perform new contrast tests, use of premedication and possible appearance of new reactions were explored in a long-term follow-up of 5 years. Clinical data, comorbidities, skin test (ST) results, re-exposure to CM procedures with any new reactions, premedication and CM used were collected. In a retrospective single-center study, 350 patients with mild to moderate HRs were enrolled. Asthma, food allergy, non-allergic drug hypersensitivity and neurologic disease were significantly more frequent in patients with HRs to GBCM compared to the high evidence of cardiovascular disease and history of cancer in patients with HRs to ICM. A marked delay in performing STs was reported by patients with negative results (66 months, p < 0.01). Iomeprol, iopamidol and gadobenic acid were the culprit CM most involved in HRs in patients with positive STs. During follow-up, 7.1% of responders reported new HRs to CM despite negative STs, premedication and infusion of alternative CM in most cases.