Injection Of Iodinated Contrast Media Research Articles

Evaluation of pulmonary computed tomography angiography protocols: A multicenter audit in Togo

Introduction : Pulmonary CT angiography is among the most challenging protocols to execute, with significant inter-center variability in image acquisition protocols and iodinated contrast media injection. This study aimed to ascertain whether the use of iodinated contrast media (ICM) and acquisition protocols are optimized during pulmonary CT angiography procedures.
 Materials and methods : This multicentric cross-sectional study, descriptive and analytical with a prospective data collection was conducted in three radiology departments in Togo. It encompassed all pulmonary CT angiography examinations carried out from March 1st to June 30th, 2023.
 Results : In total, 89 patients, of which 52 were females (58.43%), were registered. The average age was 59.97±14.34 years. The average volume of injected ICM was 67.08±14.21 ml. The mean iodine dose was 0.31±0.07 gI/Kg. Catheters of 20 G (44.94%) and 18 G (43.82%) were most frequently used. The mean injection rate was 4.22±0.64 ml/s. The bolus test technique was the most employed (75.28%). The average acquisition delay was 17.77±12.26 seconds, while the average acquisition duration was 10.56±2.56 seconds. The average dose-length product (DLP) was 390.09±236.69 mGy.cm, and the average volumetric computed tomography dose index (CTDI_vol) was 12.31±11.69 mGy. Vascular enhancement was insufficient in 7.87% of cases. No statistically significant difference was found on the rate of insufficient enhancement and optimization factors. Similarly, there was no enhancement difference between bolus test and bolus tracking techniques.
 Conclusion : The vast majority of examinations allowed for optimal opacification of the pulmonary arteries. However, the optimization measures for the use of iodinated contrast media are not consistently applied.

Stratified assessment and warning regimen for prevention of acute adverse reactions to iodinated contrast media: results of 150,343 cases in a tertiary hospital

For contrast-enhanced CT examinations, there is a lack of comprehensive optimal management strategies of risk factors to reduce the risk of iodinated contrast media (ICM)–induced acute adverse reactions (AAR). Here, we determine the relationship between the rate of ICM-AAR and a stratified assessment and warning (SAW) regimen, which integrated risk identification, stratification, early warning, and prevention. A total of 120,822 cases in the conventional assessment period (58 years ± 15, 55.25% men) and 150,343 cases (58 years ± 14, 55.83% men) in the SAW period were enrolled. The results showed that the total AAR incidence in the SAW period (414/150,343, 0.28%) was lower than that in the conventional assessment period (506/120,822, 0.42%, P < 0.001), in which the proportion of AAR patients decreased by one-third. It mainly presented as decreases in mild and moderate reactions (P < 0.001), and a decrease in the proportion of moderate AAR patients (P = 0.001). Subgroup analysis showed lower mild and moderate AAR incidence in patients with different risk levels and with different ICM injection parameters following SAW regimen. We concluded that SAW regimen was associated with lower incidence of mild and moderate AAR, and decreased proportion of moderate AAR patients, which held potential for improved ICM safety.Graphical abstract

Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media: A Systematic Review and Meta-Analysis.

To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of non-ionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not. Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria: 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I² statistic was used to assess heterogeneity across the studies. Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI]: 1.4%, 7.8%) in the fasting group and 4.6% (95% CI: 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI: 0.0%, 4.2%) in the fasting group and 2.5% (95% CI: 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group-incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI: -4.7%, 4.7%) and 0.4% (95% CI: -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I² = 0%-13.5%). Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.

Contrast-induced encephalopathy following intra- arterial iodinated contrast media injection in patients with atherosclerotic cardiovascular disease: A retrospective analysis

Background &amp; Objective: This study examined the current status of contrast-induced encephalopathy (CIE) following intra-arterial iodinated contrast media injection in patients with atherosclerotic cardiovascular disease (ASCVD). Specifically, we aimed to examine the clinical, epidemiological characteristics, pathogenic mechanisms, and clinical symptoms of CIE in patients with ASCVD in order to promote its prompt diagnosis and treatment. Methods: Chinese and English scientific databases were searched using the following search terms: atherosclerotic cardiovascular disease, contrast- induced encephalopathy, neurotoxicity, encephalopathy, brain injury, cortical blindness, cerebral/carotid arteriography, cardiac catheterization, coronary angiography, percutaneous coronary intervention, and peripheral arteriography. The retrieved articles and references of the primary articles were used to collect the basic information. SPSS 20.0 and Excel statistic software were used to conduct this retrospective analysis. Results: A total of 89 cases consisting of 87 patients were identified. Of all the patients, 59 (67.05%) were male. Patients had an average age of 67.12 + 10.51 years. In addition, 64 (73.56%) had hypertension, 26 (29.89) had diabetes mellitus, 14 (16.09%) had renal impairment, and 5 (5.75%) had old cerebral infarction or transient cerebral ischemia. The mean and median volumes of administered iodinated contrast media were 228.41 and 190 ml, respectively (range: 25–1500 ml). The symptoms included cortical blindness (24.72%), delirium (13.48%), hemiplegia (10.11%), seizure (8.99%), and ophthalmoplegia (5.62%). The symptoms typically appeared within minutes to hours following the contrast administration and always resolved entirely within 24–72 hours. Only 4 patients suffered irreversible damage; 1 of these patients died after 56 days of treatment. Conclusions: CIE is a rare complication during the intervention procedure. It has variable presentations with an excellent prognosis. Nevertheless, it can result in clinical complications, such as neurological sequelae or even death on rare occasions. Therefore, physicians should pay close attention to implementing appropriate measures.

Fully Ultrasound-Assisted Endovascular Aneurysm Repair: Preliminary Report

Reducing fluoroscopy times and iodine contrast administration during endovascular repair (EVAR) of infrarenal aortic aneurysms remains a challenge. The purpose of this study is to evaluate the preliminary results of a fully ultrasound-assisted EVAR without iodine contrast administration. Twenty-seven consecutive patients underwent an elective intravascular ultrasound (IVUS)-assisted EVAR with final contrast-enhanced ultrasound (CEUS) control of correct aneurysm exclusion. In no case intraprocedural injection of iodine contrast medium was performed. The primary study's end points were the overall duration of the procedure, duration of fluoroscopy, cumulative radiation dose, the length of intraoperative CEUS control, and the comparison of findings between intraoperative CEUS and computed tomography (CT) scan at 1 month. Mean duration of the procedure was 130±35min. Overall duration of fluoroscopy was22±18min. Mean radiation dose was 66mGy (range 24-82). The mean length of CEUS final control was 8±2min. No type I or type III endoleak was detected either at CEUS or at angio-CT scan at 1 month from EVAR. CEUS revealed a type II endoleak in 6 patients (22%), compared to 9 type II endoleaks (33%) detected at angio-CT scan 1 month after the procedure (P=0.5). Fully ultrasound (IVUS and CEUS)-assisted EVAR is safe, feasible, and reliable, completely eliminating the need for iodine contrast medium and reducing the radiation exposure for both patients and surgeons.

Safety of intravenous iodinated contrast medium injection in rabbits undergoing conscious computed tomography.

BackgroundContrast media in CT is widely used in dogs and cats to provide superior tissue delineation and increase the diagnostic capabilities. These contrast‐enhanced imaging techniques are gaining popularity in rabbits; published studies reporting the safety of doing so are lacking.MethodsThis retrospective observational study aimed to determine the incidence of adverse events following the intravenous administration of iodinated non‐ionic contrast medium in 350 rabbits. The medical records of this subset of rabbits admitted between January 2009 and November 2018, that underwent CT examination and received intravenous contrast media, were evaluated.ResultsFrom the 350 rabbits, 342 rabbits were still alive 7 days after the scan. A total of eight rabbits died within 7 days of the scan, seven of which within the first 24 h. All deaths were presumed to be sequelae to the diseases they were being investigated for and not thought to be related to the administration of intravenous contrast medium.ConclusionsThe results indicated that the use of intravenous non‐iodinated contrast medium was well tolerated and safe in rabbits undergoing conscious CT examination.

Iodixanol activation of mast cells: Implications in the pathogenesis of iodixanol-induced delayed cutaneous adverse reactions

Iodinated contrast media (ICM) is widely used in radiological examination and interventional therapy. In the commonly used ICM, iodixanol is considered to be the safer one. However, compared with other ICMs, it has a higher incidence of delayed cutaneous adverse reactions. The underlying mechanisms are unclear. In this study, mice with positive allergic reactions were selected based on the mouse clinical allergy symptom score and skin and blood samples taken 1, 6, 24, 48, and 72 h after ICMs (6 g iodine/kg) injection for histological and blood analyses. ICMs-induced pseudo-allergic reactions were investigated through in vivo intravital vascular imaging and passive cutaneous anaphylaxis (PCA) not mediated by IgE and through, calcium imaging degranulation of mast cells (MCs), and western blot assays in vitro. Results shows iodixanol-induced systemic anaphylaxis caused severe extravasation of plasma proteins and degranulation of skin MCs, and increased levels of plasma histamine, cytokines and inflammatory chemokines. Mechanistically, iodixanol increases degranulation of MCs and promotes the synthesis of inflammatory factors by activating PLC-γ and PI3K-related pathways. Trigonelline inhibit iodixanol-induced MC-related pseudo-allergic reactions in vitro and in vivo. These results suggest that mice in the iodixanol group had a higher incidence of delayed cutaneous reactions, characterized by cytokine release over time and delayed cutaneous MC degranulation. Iodixanol’s delayed cutaneous adverse reactions may be due to a delayed phase of MC-related pseudo-allergic reactions. Trigonelline revealed anti-allergic activity in iodixanol-induced MC-related pseudo-allergic reactions.

Acute Urticaria in Inpatients Undergoing Non-emergent Coronary Angiography With Corticosteroid Prophylaxis: A Retrospective Study.

Background and Aims: Acute urticaria (AU) is the most frequently reported immediate hypersensitivity reaction in skin by administration of iodinated contrast media (ICM). We aimed to establish the pattern and identify the risk factors of AU among inpatients undergoing non-emergent coronary angiography (CAG) with prophylactic corticosteroids in China.Methods: Medical records of 19,326 adult inpatients undergoing non-emergent CAG with prophylactic methylprednisolone in 2013–2019 were retrospectively investigated. AU was identified within 1 h post-ICM administration, and diffuse involvement was defined when wheals occur in two or more body parts, including the back, abdomen, chest, and extremities. Age- and sex-matched inpatients (1:4) without AU were randomly selected for assessment of risk factors.Results: Approximately 0.8% of CAG inpatients had AU, including 101 diffuse and 64 limited form. The diffuse AU was more common in settings of non-diagnostic CAG, iohexol used, average ICM injection≥3 ml/min, recurrent CAG, and past history of immediate hypersensitivity to ICM. Inpatients with preexisting allergies, decreased evaluated glomerular filtration rate, and increased high sensitivity C reactive protein or neutrophil-to-lymphocyte ratio prior to CAG had a higher probability of AU (odds ratio >1, P < 0.05 for all variables). All AU inpatients complained of pruritus, and mild itching predominated. AU dissipated in several days under treatment of ebastine or levocetirizine 10 mg/daily, but ebastine showed superiority.Conclusions: ICM-induced AU is not uncommon in non-emergent CAG inpatients with prophylactic methylprednisolone. Preexisting allergies, renal dysfunction, and mild inflammation are high-risk factors, and antihistamine monotherapy is a favorable candidate for ICM-related AU.

Comprehensive analysis of the long non-coding RNA expression profile and functional roles in a contrast-induced acute kidney injury rat model.

Long non-coding RNAs (lncRNAs) have been identified as a class of regulatory RNAs that participate in both physiological and pathological conditions, including acute kidney injury. However, the roles of lncRNA dysregulation in the pathogenesis of contrast-induced acute kidney injury (CI-AKI) are largely unknown. In the present study, the expression profiles of lncRNAs in kidney tissue were compared between rats with CI-AKI and controls using high-throughput RNA sequencing. In total, 910 differentially expressed (DE) lncRNAs (DElncRNAs), including 415 downregulated and 495 upregulated lncRNAs, were identified at 12 h after intra-arterial iodinated contrast medium injection (fold change ≥2; P<0.05). Eight DElncRNAs were further selected and validated using reverse transcription-quantitative polymerase chain reaction. A previous study defined microRNA (miRNA) and mRNA expression changes in the same CI-AKI model. In the present study, a lncRNA-mRNA co-expression network comprising 349 DElncRNAs and 202 DEmRNAs was constructed. The function of these DElncRNAs was mainly associated with oxidative stress and inflammation. Additionally, lncRNA-associated competing endogenous RNA (ceRNA) analysis revealed a network comprising 40 DElncRNA nodes, 5 DEmiRNA nodes and 59 DEmRNA nodes. Among which, the carnosine dipeptidase 1-specific and the transmembrane protein 184B-specific networks were likely to be associated with CI-AKI. The results of the present study revealed the expression profile and potential roles of lncRNAs in CI-AKI, and provide a framework for further mechanistic studies.

3D-segmentation and characterization of visceral and abdominal subcutaneous adipose tissue on CT: influence of contrast medium and contrast phase.

Adipose tissue as part of body composition analysis may serve as a powerful biomarker. Validation of segmented adipose tissue and correlation to clinical data has been performed on non-enhanced scans (NES). As many patients require a contrast enhanced scan (CES) for other aspects of clinical decision making, the utility of CES for body composition analysis would be most useful. Therefore, we analyzed the influence of iodinated contrast medium (ICM) and contrast phase on the characterization and segmentation of adipose tissue. Exams of 31 patients undergoing multi-phasic CT at identical scan settings containing an NES were retrospectively included. In addition to NES, patients received an arterial (ART) (n=23), portal-venous (PVN) (n=10), and/or venous scan (VEN) (n=31) after intravenous injection of 90 mL ICM. Density and volume of adipose tissue were quantified semi-automatically with thresholds between -190 HU and -30 HU and recorded separately for visceral (VAT) and subcutaneous adipose tissue (SAT). Density and volume of total adipose tissue (TAT) were computed. For conversion of values from CES into those of NES regression analyses were performed and tested. Density of adipose tissue increased after application of ICM more on later scans (VEN ≈ PVN > ART) and more markedly in VAT than SAT (VAT > TAT > SAT). Except in SAT on ART, all changes were significant (P<0.001). Measured volume of adipose tissue decreased on all CES (VEN ≈ PVN > ART) (P<0.001), but only reached statistical significance for VAT and TAT (VAT > TAT) on all CES (P<0.05). Density and volume in CES correlate extremely well with NES and may be calculated from one another [root-mean-square error (RMSE): <6 HU; <0.85 dm3]. Density and volume of segmented adipose tissue are altered by the injection of ICM in differing degrees between compartments and contrast phases. However, as the effect of ICM is fairly constant for a given compartment and contrast phase, values may be converted into those of NES with relative precession. This conversion allows body composition analysis to be carried out also in contrast enhanced CT examinations, e.g., for risk stratification and the comparison of the obtained results to previous studies.

Reduced iodinated contrast media dose and injection speed for CT: how much does this decrease the risk of a hypersensitivity reactions?

Adverse reactions developing after administration of iodinated contrast media (ICM) can either constitute hypersensitivity reactions, toxic reactions, or even events unrelated to ICM exposure, such as acute spontaneous or infection-induced urticaria (1). Toxicity-related reactions (also called “physiologic” or “chemotoxic” reactions) are more common than hypersensitivity reactions and often manifest with mild unspecific symptoms, such as pruritus, heat sensation, transient erythema, dizziness, nausea, sneezing, chest tightness, arrhythmia, hypertension, and vasovagal signs (i.e., hypotension and bradycardia). Immediate hypersensitivity reactions (IHR) (acute hypersensitivity reactions) occur within 1 hour after ICM administration and either present with full anaphylaxis, involving skin, gastrointestinal, respiratory and/or cardiovascular organ systems simultaneously, sometimes with bronchospasm and/or hypotension, but may also manifest as fractions of anaphylaxis, such as urticaria, or angioedema only (2,3). Fatalities do occur (4). Among IHR, there is growing evidence that particularly severe reactions may be immunoglobulin E (IgE)-mediated and skin test- positive, whereas mild to moderate hypersensitivity reactions are mostly non-allergic (5-7). IHR have been reported in a frequency of about 0.3–3% of ICM injections (1).

Prevention of contrast-associated acute kidney injury in cancer patients undergoing radiologic investigation using contrast media; a short-review to current knowledge

Contrast agents are non-biologically active substances required for various diagnostic imaging procedures. Exposure to contrast materials, predispose some patients to renal disturbances entitled as contrast-associated acute kidney injury. Nephropathy of contrast medium is a deterioration of renal function which happens within 24 to 72 hours after iodinated contrast medium injection. Cancer individuals have several risk factors for contrast-associated acute renal failure, consisting of administration of chemotherapy regimen, which are mainly nephrotoxic, presence of diabetes or chronic renal failure, hypertension, taking of non-steroidal anti-inflammatory drugs, simultaneous use of nephrotoxic drugs, aminoglycosides, cisplatin, cyclosporine A or amphotericin B, increases the risk of contrast-associated acute renal failure. Similarly, age more than65 years old and anemia is an independent risk factor for contrast-associated acute kidney injury and also timing of CT within 45 days after last chemotherapy and low fluid intake, as the common risk factors in cancer individuals.

Increased frequency of acute reactions to iodinated contrast media in cancer patients treated with anti-CTLA-4 immunomodulatory antibodies

Contrast-enhanced computed tomography (CECT) is an indispensable tool in the management of cancer patients. However, this procedure can be complicated by the development of acute adverse reactions (ARs) to iodinated contrast media (ICM). On the basis of the hypothesis that cancer immunotherapy, in particular with immune checkpoint inhibitors, increases the incidence of allergic-like immediate ARs to ICM with respect to “standard” cancer chemotherapy/targeted therapy (CHT) we retrospectively evaluated the incidence of CECT-related immediate ARs in cancer patients undergoing cancer treatments. All patients who underwent at least one CECT scan after starting any cancer treatment between 2006 and 2014 were included in a mono-institutional radiological database. The staff of the Radiology Unit recorded any ARs that occurred within 30 min of the ICM injection and classified them as “allergic-like” or “physiologic” and graded as mild, moderate, or severe according to the American College of Radiology (ACR) Manual on Contrast Media, version 10.1. Fifty-nine of the 3,521 patients included in the database received ipilimumab (Ipi), 75 received cytokines (Cys), and the remaining 3,387 received non-immunologic agents (CHT). Overall, 71 (2%) patients suffered ICM-related ARs. The incidence of ICM-related ARs was higher in Ipi- and Cy-treated patients than in those who received CHT (12%, 5%, and 2%, respectively). Our data show that immunological cancer treatments, particularly Ipi, considerably increase the proportion of patients suffering CECT-related immediate ARs with respect to non-immunologic agents. Although these findings need to be validated in larger prospective studies, they serve as a “wake-up call” for radiologists to closely monitor patients who have previously received cancer immunotherapy with anti-cytotoxic T-lymphocyte antigen-4 antibodies when using ICM in order to reduce the risk of potentially severe immediate ARs.

STUDY OF SERUM NEOPTERIN, INTERLEUKIN-10 AND NEUTROPHIL TO LYMPHOCYTE RATIO IN CONTRAST INDUCED NEPHROPATHY

Background: Recent improvements in radio-diagnostic procedures and in cardiovascular percutaneous interventions, together with increased life expectancy, have resulted in the subjection of an increasing number of patients to contrast medium-enhanced examinations or cardiac and angiographic procedure requiring iodinated contrast medium injection.  Subjects and methods: This study was carried out at Internal Medicine, Cardiology, Radiology and Clinical Pathology departments, Zagazig University Hospitals. The study was approved by Institutional Review Board (IRB) and included a total of 60 patients.  Based on the development of contrast induced nephropathy after IV administration of high osmolar contrast agent, Patients were classified into CIN and NO CIN groups. We measured serum neopterin and IL-10 and calculating neutrophil to lymphocyte ratio before contrast administration, 24 and 48 hours after in 45 patients underwent coronary angiography for diagnostic and therapeutic purposes and 15 patients underwent renal angiography.  Results : About 25 % of the present studied patients (14 patients) fulfilled the criteria of contrast nephropathy with more cases in the percutaneous coronary angiography group (11 patients).This study revealed that serum neopterin, IL 10 and neutrophil to lymphocyte ratio were higher in patients with CIN following IV contrast media at 24 & 48 hours compared to patients without CIN. In our study; we found increased pre procedural and post-procedural CRP, ESR and uric acid levels at 48 hours in patients with CIN. We found a decreased basal serum total bilirubin level in patients with CIN following IV contrast media compared to patients without CIN.  Conclusion: Serum neopterin, IL 10 and neutrophil to lymphocyte ratio proved that they can be used as early biomarkers of contrast induced nephropathy instead of serum creatinine as they rise 24 hours before any change in the serum creatinine. Decreased serum total bilirubin levels had a higher incidence of CIN after the use of contrast media. Measuring ESR & CRP levels at admission may offer additional assistance in predicting the development of CIN. Elevated serum uric acid level is independently associated with an increased risk of CIN.  Abbreviations: CIN = Contrast induced nephropathy , AKI = Acute kidney injury, CRP = C-reactive protein, NLR = Neutrophil to lymphocyte ratio, ESR = Erythrocyte sedimentation rate, UA = Uric acid, eGFR = estimated glomerular filtration rate.  Keywords: Contrast induced nephropathy; Neopterin; IL-10; Neutrophil to lymphocyte ratio.

HARMless: Transient Cortical and Sulcal Hyperintensity on Gadolinium-Enhanced FLAIR after Elective Endovascular Coiling of Intracranial Aneurysms

Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR has been increasingly recognized after iodinated contrast medium exposure during angiographic procedures. The goal of this study was to assess the relationship of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR against various variables in patients following elective endovascular treatment of intracranial aneurysms. We performed a retrospective review of 58 patients with 62 MR imaging studies performed within 72 hours following endovascular treatment of intracranial aneurysms. Patient demographics, aneurysm location, and vascular territory distribution of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR were documented. Analysis of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR with iodinated contrast medium volume, procedural duration, number of angiographic runs, and DWI lesions was performed. Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR was found in 32/62 (51.61%) post-endovascular treatment MR imaging studies, with complete resolution of findings in all patients on the available follow-up studies (27/27). Angiographic iodinated contrast medium injection and arterial anatomy matched the vascular distribution of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR. No significant association was found between cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR with iodinated contrast medium volume (P = .56 value) and the presence of DWI lesions (P = .68). However, a significant association was found with procedural time (P = .001) and the number of angiographic runs (P = .019). No adverse clinical outcomes were documented. Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is a transient observation in the arterial territory exposed to iodinated contrast medium during endovascular treatment of intracranial aneurysms. Cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR is significantly associated with procedural time, and the frequency of angiographic runs suggesting a potential technical influence on the breakdown of the BBB, but no reported adverse clinical outcome or association with both iodinated contrast medium volume and DWI lesions was found. Recognition of cortical and sulcal hyperintensity on gadolinium-enhanced FLAIR as a benign incidental finding is vital to avoid unnecessary investigation.

RCR audit of compliance with UK guidelines for the prevention and detection of acute kidney injury in adult patients undergoing iodinated contrast media injections for CT

To determine radiology departmental compliance with current UK guidance on contrast-induced acute kidney injury (CI-AKI) and to provide data on the incidence of clinically significant post-contrast AKI (PC-AKI) in computed tomography (CT) practice. A questionnaire was sent to all UK acute National Health Service (NHS) providers (NHS boards in Scotland, local health boards in Wales, NHS trusts in England and health and social care trusts in Northern Ireland) to assess compliance of provider protocols with current UK guidelines for the prevention, recognition, and management of CI-AKI. Audit data were collected for 40 consecutive fit outpatients and 40 consecutive acutely unwell patients/inpatients from hospitals within each participating provider to assess clinical compliance. Eighty-nine of 172 (52%) health service providers responded, and data on 7,159 contrast-enhanced CT examinations were provided. Compliance with guidelines was poor with wide variation in clinical practice. The observed incidence of clinically significant (requiring treatment or resulting in death) PC-AKI was zero in 3,590 outpatients, although two patients developed AKI due to other causes (sepsis and progressive malignancy). Fourteen out of 3,569 (0.4%) patients in the inpatient group developed clinically significant PC-AKI, and a further 17 patients were identified who met the Kidney Disease Improving Global Outcomes (KDIGO) definition of AKI (Electronic Supplementary Material Appendix S1), but did not require active treatment, giving an overall incidence of AKI of 0.9%. In patients at high risk due to impaired renal function prior to the scan, there was no difference in the median serum creatinine (SCr) before and after contrast medium administration in either group. Health service provider protocols and clinical practice demonstrate poor compliance with current UK guidance on CI-AKI. A very low incidence of PC- AKI was demonstrated.

Non-ionic iodinated contrast media related immediate reactions: A mechanism study of 27 patients

The underlying mechanism of non-ionic iodinated contrast media-related immediate reactions was evaluated in this study. Patients presenting at least grade II immediate reactions after non-ionic iodinated contrast media injection were enrolled. Basophil activation was evaluated by flow cytometry. The plasma concentration of human terminal complement complex SC5b-9, as well as concentrations of serum chymase, tryptase, human mast cell carboxypeptidase A3, human prostaglandin D2, and total IgE were measured by enzyme-linked immunosorbent assay. The basophil activation percentage was significantly higher in the study group than in the control group (17.94±21.06% vs 3.45±1.49%). The plasma concentration of human terminal complement complex SC5b-9 and concentrations of serum chymase, human mast cell carboxypeptidase A3, prostaglandin D2, tryptase, and total IgE were also significantly increased (236.99±318.21 vs 49.70±30.41ng/mL, 0.41±0.49 vs 0.09±0.06ng/mL, 1.17±0.67 vs 0.30±0.17ng/mL, 203.52±137.27 vs 102.28±48.72pg/mL, 3.81±0.22 vs 2.70±0.16ng/mL, 102.00±51.84 vs 19.97±2.75ng/mL, respectively). Both mast cells and basophils were activated in non-ionic iodinated contrast media to mediate immediate hypersensitivity, and mast cells may be involved. Different mechanisms, including IgE-dependent, complement-dependent, and direct membrane effects, contributed to mast cell and basophil activation. Individual patients may use a single or combined mechanism involving single or combined mast cells and basophils. Immediate reactions following non-ionic iodinated contrast media injection may be a mechanically heterogenous disease.

Récidives de toxidermies après nouvelle injection de produit de contraste iodé chez des patients allergiques connus

Iodinated contrast media (ICM) are used extensively by both radiologists and cardiologists. Injection of such products can induce immediate hypersensitivity reactions, some of which are IgE-mediated, and delayed hypersensitivity reaction with all types of drug eruptions being reported. Allergy tests, whether patch-tests or intradermal tests, are useful to confirm whether patients are allergic. At the end of these tests, depending on the reaction (chronology and clinical symptoms) and the results of the skin tests, patients are given an allergy card as well as a detailed certificate indicating the various ICM contraindicated and those allowed. We report herein three cases of patients experiencing a confirmed allergic eruption after injection of ICM, and whose recommendations and contraindication were not taken into consideration, leading to recurrence of eruption after renewed ICM injection. The three cases we report herein underscore the lack of knowledge concerning eruptions induced by ICM, particularly among radiologists. Better dissemination of information about the existence of such reactions appears necessary amongst the medical professionals concerned.

Effect of intravenous infusion of iodinated contrast media on the coronary blood flow in dogs

BackgroundCoronary computed tomography angiography (CCTA) is obtained using peripheral intravenous iodinated contrast agents (ICA) injection. There is continuing attempts to derive coronary physiological information like coronary blood flow (CBF) and/or fractional flow reserve from CCTA images. However, no data is available regarding the effect of peripheral intravenous injection of ICA on CBF. MethodsA series of 4 experiments was performed using healthy mongrel dogs. All dogs underwent anesthesia and open thoracotomy with placement of ultrasound flowmeter to one of the coronary artery to provide real time absolute CBF measurements. Different infusion protocols of Isovue-370 and Visipaque-320 were injected into a peripheral vein. Similar doses of normal saline injection were performed to be used as controls. The effect of iodinated contrast media injection on absolute coronary blood flow was monitored and recorded. ResultsInjection of normal saline in the peripheral vein did not produce any significant increase in CBF. Peripheral intravenous injection of ICA resulted in a consistent increase of 40–73% in absolute CBF as recorded 5minutes post-contrast administration. The contrast effect starts about 30seconds and peaks at about 2minutepost-contrast injection then slowly fades away in the following 10–15min. The increase in the CBF was dose related. There was greater increase in the CBF to 50ml infusion compared to 25ml infusion of both Visipaque and Isovue. ConclusionsPeripheral venous administration of iodinated contrast-media in dogs results in a dose related, significant and prolonged increase in CBF.

Incidence of contrast-induced acute kidney injury in a pediatric setting: a cohort study.

Contrast-induced acute kidney injury (CI-AKI) is a common pathology among adult patients, with an incidence ranging from 3-25% depending on risk factors. Little information is available regarding CI-AKI incidence, risk factors, and prognostic impact in the pediatric population. We performed a retrospective study of pediatric patients who underwent computed tomography (CT) scan with iodinated contrast media injection between 2005 and 2014 in five pediatric units of a university hospital. CI-AKI was defined according to Kidney Disease/Improving Global Outcomes (KDIGO) criteria. Of 346 identified patients, 233 had renal function follow-up and were included in our analyses. CI-AKI incidence was 10.3% [95% confidence interval (CI) 6.4-14.2%]. CI-AKI was associated with 30-day unfavorable outcome before (45.8% vs. 19.7%, P = 0.007) and after [odds ratio (OR) 3.6; 95% CI 1.4-9.5] adjustment for confounders. No independent risk factors of CI-AKI were identified. CI-AKI incidence was as high as 10.3% following intravenous contrast media administration in the pediatric setting. As reported among adults, CI-AKI was associated with unfavorable outcome after adjustment for confounders. Although additional studies are needed in the pediatric setting, our data suggest that physicians should maintain a high degree of suspicion toward this complication among pediatric patients.