Intravenous Administration Of Contrast Material Research Articles

MO419THE ROLE OF SHORT-TERM, HIGH-DOSE ATORVASTATIN FOR PREVENTION OF CONTRAST-INDUCED ACUTE KIDNEY INJURY (CI-AKI) IN PATIENTS WITH CARDIOVASCULAR DISEASES UNDERGOING COMPUTED TOMOGRAPHY WITH INTRAVENOUS CONTRAST ADMINISTRATION

Abstract Background and Aims Computed tomography with intravenous contrast media is widely used in hospitals. The incidence of CI-AKI due to intravenous contrast media administration in high-risk patients remains not studied as well as CI-AKI after intraarterial contrast media administration is. According to other researchers, the use of statins in the prevention of AKI after intra-arterial administration of a contrast agent is currently considered an efficient preventive measure. The aim of our study is to assess the incidence of contrast-induced acute kidney injury in patients with cardiovascular diseases during CT scan with intravenous contrast media and analyze the efficacy and safety of various statin dosing regimens for prevention of CI-AKI. Method A randomized controlled open prospective study is planned. Statin naive patients with cardiovascular diseases will be divided into 3 groups. Patients in the first group will receive atorvastatin 80mg 24 hours and 40mg 2 hours before CT scans and 40 mg after. The second group – 40 mg 2 hours before CT scans and 40 mg after. A third group is a control group. Exclusion criteria were current or previous statin treatment, contraindications to statins, severe renal failure, acute coronary syndrome, administration of nephrotoxic drugs. The primary endpoint will the development of CI-AKI, defined as an increase in serum Cr concentration 0.5 mg/dl (44.2 mmol/l) or 25% above baseline at 72 h after exposure to the contrast media. Results We assume a higher incidence of contrast-induced acute kidney injury in the group of patients not receiving statin therapy (about 5-10%). At the same time, it is unlikely to get a significant difference between statin dosing regimens. Risk factors such as age over 75 years, the presence of chronic kidney disease, diabetes mellitus, and chronic heart failure increase the risk of contrast-induced acute kidney injury. Conclusion Despite the significantly lower incidence of CI-AKI with intravenous contrast compared to intra-arterial, patients with CVD have a greater risk of this complication even with intravenous contrast. Therefore, the development of prevention methods and scales for assessing the likelihood of CI-AKI is an important problem. As a result of the study, we expect to conclude the benefits of statins in CI-AKI prevention and the optimal dosage regimen. This information will help us to reduce the burden of CI-AKI after CT scanning in statin naive patients with cardiovascular diseases in everyday clinical practice. ClinicalTrials.gov ID: NCT04666389

A fast and reproducible method to estimate left atrial volume using cardiac computed tomography

PurposeThe purpose of this study was to do better than the simple maximal axial area (MAreaax) and to validate simple, fast and robust orthogonal methods for determining the left atrium volume (LAV) with cardiac CT (CCT). Material and methodsA total of 60 patients who underwent CTT were retrospectively included. There were 30 men and 30 women with a mean age of 59±12 (SD) years (range: 27–80 years), using four methods to assess LAV beyond the MAreaax: two orthogonal methods requiring the measurements of axial, coronal and sagittal planes of 3 diameters LAV3diam or 3 area LAV3Areas; Area-length biplane method LAVbiplane; and volumetric method LAVvolumetric using a semi-automated tool that served as the reference standard. The orthogonal methods were applied on contrast-enhanced (IV+) and unenhanced (IV-) CCT images. Comparisons were performed using Pearson correlation test (r) and Bland-Altman analysis. Inter- and intra-observer variability were assessed using intraclass correlation coefficient (ICC) with a two-way mixed-effects model. ResultsOn IV+ CCT, LAVbiplane, LAV3diam-IV+, LAV3Areas-IV+ underestimated LAV (-15±1.99mL; -21±1.37mL; -15±1.98mL; all P<0.001). LAV3diam-IV+, LAV3Areas-IV+ better correlated with reference standard (r=0.97 and 0.98) than LAVbiplane (r=0.79) as well as MAreaax (r=0.90). Estimating LAV on IV- further showed high correlation against the reference (r=0.93 and 0.95 for LAV3diam-IV- and LAV3Areass-IV-, respectively). Intra- and inter-observer ICC increased from LAVvolumetric (2.43% and 3.09%); LAV3Areas-IV+ (3.04 and 3.30%); LAV3Areas-IV-(3.34 and 4.23%), LAV3diam-IV+ (3.36 and 5.11%); LAV3diam-IV- (5.16 and 6.90%); to LAVbiplane (9.65 and 10.28%). ConclusionsBetter than MAreaax, orthogonal methods using either diameter or surface are fast and reproducible methods to assess LAV on CCT when performed with or without intravenous administration of contrast material.

Non-contrast MRI can accurately characterize adnexal masses: a retrospective study

ObjectiveTo determine the accuracy of interpretation of a non-contrast MRI protocol in characterizing adnexal masses.Methods and materialsTwo hundred ninety-one patients (350 adnexal masses) who underwent gynecological MRI at our institution between the 1st of January 2008 and the 31st of December 2018 were reviewed. A random subset (102 patients with 121 masses) was chosen to evaluate the reproducibility and repeatability of readers’ assessments. Readers evaluated non-contrast MRI scans retrospectively, assigned a 5-point score for the risk of malignancy and gave a specific diagnosis. The reference standard for the diagnosis was histopathology or at least one-year imaging follow-up. Diagnostic accuracy of the non-contrast MRI score was calculated. Inter- and intra-reader agreement was analyzed with Cohen’s kappa statistics.ResultsThere were 53/350 (15.1%) malignant lesions in the whole cohort and 20/121 (16.5%) malignant lesions in the random subset. Good agreement between readers was found for the non-contrast MRI score (к = 0.73, 95% confidence interval [CI] 0.58–0.86) whilst the intra-reader agreement was excellent (к = 0.81, 95% CI 0.70–0.88). The non-contrast MRI score value of ≥ 4 was associated with malignancy with a sensitivity of 84.9%, a specificity of 95.9%, an accuracy of 94.2% and a positive likelihood ratio of 21 (area under the receiver operating curve 0.93, 95% CI 0.90–0.96).ConclusionAdnexal mass characterization on MRI without the administration of contrast medium has a high accuracy and excellent inter- and intra-reader agreement. Our results suggest that non-contrast studies may offer a reasonable diagnostic alternative when the administration of intravenous contrast medium is not possible.Key Points• A non-contrast pelvic MRI protocol may allow the characterization of adnexal masses with high accuracy.• The non-contrast MRI score may be used in clinical practice for differentiating benign from malignant adnexal lesions when the lack of intravenous contrast medium precludes analysis with the O–RADS MRI score.

Liposarcoma mixoide: características por resonancia magnética con correlación histológica

Background and aimsMyxoid liposarcoma is classified in the group of sarcomas with adipose differentiation, which is the second most common group of sarcomas. However, myxoid liposarcoma is not a homogeneous entity, because the behavior and clinical course of these tumors can vary widely. This study aimed to describe the magnetic resonance imaging (MRI) features of myxoid liposarcomas and to determine whether the MRI features are associated with the histologic grade and can differentiate between low-grade and high-grade tumors and thus help in clinical decision making. Material and methodsWe studied 36 patients with myxoid liposarcomas treated at our center between 2010 and 2018. We analyzed clinical variables (age, sex, and tumor site) and MRI features (size, depth, borders, fatty component, myxoid component, non-fatty / non-myxoid component, apparent diffusion coefficient (ADC), and type of enhancement after the administration of intravenous contrast material). We correlated the MRI features with the histologic grade and the percentage of round cells. ResultsIn our series, patients with myxoid liposarcomas were mainly young adults (median age, 43 years). There were no differences between sexes; 97.2% were located in the lower limbs, 86.1% were deep, and 77.8% had well-defined borders. Of the 23 myxoid liposarcomas that contained no fat, 16 (69.6%) were high grade (p=0.01). All the tumors with a myxoid component of less than 25% were high grade (p=0.01); 83.3% of those with a non-fatty / non-myxoid component greater than 50% were high grade (p=0.03) and 61.5% had more than 5% round cells (p=0.01). Diffusion sequences were obtained in 14 of the 36 patients; ADC values were high (median, 2 x 10-3 mm2/s), although there were no significant associations between low-grade and high-grade tumors. Contrast-enhanced images were available for 30 (83.3%) patients; 83.3% of the tumors with heterogeneous enhancement were high grade (p=0.01). ConclusionsMRI can be useful for differentiating between high- and low-grade myxoid liposarcomas and can help in clinical decision making.

Invited Commentary: Infiltrative Growth Pattern in Renal Malignancy-A Clue to Diagnosis and Prognosis.

Invited Commentary: Infiltrative Growth Pattern in Renal Malignancy-A Clue to Diagnosis and Prognosis.

Magnetic Resonance Enterography Findings and Correlation of Apparent Diffusion Coefficient Values with Clinical Response in Inflammatory Bowel Disease Patients

Aim: We aimed to evaluate the relationship between magnetic resonance (MR) enterography and diffusion magnetic resonance imaging (MRI) investigations in inflammatory bowel disease (IBD) patients during active inflammation and remission phases. Patients and Methods: We included patients diagnosed with IBD between 01.12.2015-31.08.2016 at our hospital. 47 patients were included; 30 were male (63.8%) and 17 were female (36.2%). Thirty two (68.1%) of them had ulcerative colitis and 15 (31.9%) had Crohn’s disease. Standard institutional sequences for upper and lower abdomen scan included: sagittal and axial T2 TRUFI, axial and coronal fat suppressed T2 TRUFI and coronal and axial T1 VIBE following intravenous (at 60 seconds) contrast medium administration. First group of patients (n=10) had MRI investigations both at active and remission phases, whereas in the second group of patients (n=37) apparent diffusion coefficient (ADC) values, bowel wall thickness and contrast enhancement grades were compared between actively inflamed and non-inflamed bowel segments. Results: A statistically significant difference was found regarding ADC values and bowel wall thickness measurements in the first group of patients when compared between active and remission phase MRI investigations (p=0.005). Bowel wall contrast enhancement degree did not differ between active and remission phases in the first group (p=0.059). In the second group, there was a statistically significant difference between active and normal bowel segments regarding ADC values, bowel wall thickness and contrast enhancement (p<0.001). Conclusion: MR enterography and diffusion MRI may be beneficial to determine the degree of inflammation and response to treatment in IBD patients.

Multiparametric MRI: Local Staging of Prostate Cancer

To highlight the recent evidence about the use of mp-MRI in the local staging of prostate cancer, enhancing the potential benefits compared to the known and more invasive canonical staging methods. Multiparametric magnetic resonance (mp-MRI) plays a key role not only in diagnosis, but also in local staging of prostate cancer, as it can assess with high accuracy the extracapsular extension of the tumor, invasion of seminal vesicles, the involvement of lymph nodes and the presence of possible bone metastases. Prostate cancer is currently the most common male cancer in Europe and it is associated with a high mortality rate, which is why it is necessary to make an early and accurate diagnosis. Firstly, it is important to distinguish between a disease confined to the gland and a disease with a loco regional or remote extension, since neoplastic staging is the starting point for risk stratification, prognosis and therapeutic planning. According to the PI-RADS guidelines v 2.1 the main mp-MRI sequences necessary to obtain a complete and accurate resonance imaging are the T2-weighted sequences (T2WI), which represent the pivotal morphological sequences for local staging, together with the diffusion-weighted imaging (DWI) and dynamic sequences acquired after intravenous contrast medium administration (DCE). However, due to some limitations, mp-MRI does not have the same diagnostic power in the evaluation of lymph nodes, for which the gold standard remains the extended pelvic nodal dissection (ePLND), nor in the detection of distant metastases. For this last aspect, the next generation imaging foresees the use of whole-body MRI (WB-MRI), especially for the high accuracy in the early detection of local and remote bone metastases.

Quantification of iodine concentration by dual-energy CT in patients with acute pancreatitis

ObjectiveTo determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. Material and methodsWe compared findings on single-phase dual-energy CT images acquired 55s after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48–72h after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging post-processing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalising the density of iodine with the aorta. ResultsThe mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p=0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. ConclusionsThe concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease.

Assessment of Celiac Axis and Hepatic Artery Variations in Hepatobiliary and Pancreatic Malignancy with Multidetector Computed Tomography Angiography

Introduction Delineation of variant anatomy in celiac trunk and superior mesenteric artery including its origin and branching pattern and variations in branching pattern of hepatic artery in patients of hepatopancreaticobiliary malignancy with the use of mutidetector CT (computed tomography) angiograpgy was performed. Materials and Methods All CT examinations were performed on a 64-multidetector computed tomography (MDCT) scanner. Technical features of multislice computed tomography (MSCT) are as follows: 64 mm × 1 mm collimation, minimum slice thickness of 0.625, gantry rotation time of 320 ms, 120 kV, and 320 mAs. CT angiography was performed with intravenous (IV) administration of nonionic contrast material, that is, iodixanol (Visipaque). The contrast medium and saline solution were injected with a Medrad power injector at 3 mL/sec through an 18-gauge plastic intravenous catheter placed in an antecubital vein in most of the cases. Contrast medium volumes varied between 100 and 150 mL at 1.5 mL/kg. Images were obtained in triphasic pattern at arterial (20–30 seconds), portal (60–70 seconds), and equilibrium (at 3 minutes) phases. Results Five types of celiac axis anatomic variations and nine type of variants in celiac axis branching was found in the study sample of 124 patients. Classical celiac axis anatomy was seen in 92.7% of the cases, while the five types of variation in branching were found in nine patients. Majority of cases showed pattern I (59.6%) followed by patterns V (12.1%), II (9.7%), and III (8.9%). There were three (2.4%) cases each showing pattern VIII and AA, and two (1.6%) cases each showing patterns IV and VI, respectively. There was one (0.8%) case each showing pattern VII and IX. A total of three (2.4%) cases showed right hepatic artery arising from celiac axis. Conclusion We conclude that most common pattern of celiac axis and superior mesenteric artery (SMA) branching is classical pattern (92.7%) which is in concordance with literature. Type-I pattern of hepatic artery branching was most common (59.6%), similar to that documented in literature. Although the most common variation in our study is type V (12.1%), followed by types II (9.7%) and III (8.9%), the most common variation in most of the literature was found to be type III. CT angiography hence is an excellent diagnostic modality for depiction of arterial anatomic variations and provides a roadmap for surgical treatment.

A clinical analysis of 14 cases of prostatic stromal tumor of uncertain malignant potential

To investigate the clinical and pathologic characteristics, diagnosis, treatment, prognosis and survival of prostatic stromal tumor of uncertain malignant potential. Overall 14 patients with prostatic stromal tumor of uncertain malignant potential were treated from October 2008 to April 2020, the patient age ranged from 27 to 78 years (mean 54 years). The disease duration was 1 to 180 months (mean duration of 46 months). The clinical manifestations mainly included urinary obstructive symptoms and urethral irritating symptoms. The tumors were located in the peripheral zone or the transition zone. Digital rectum examination indicated prostatic tumor. Serum prostatic specific antigen level was always normal or elevated. Transrectal ultrasonography and magnetic resonance imaging indicated prostatic tumor. Magnetic resonance imaging in showed large, round, well-defined masses, which were diffusely heterogeneous signal on T2 weighted imaging. Following the administration of intravenous contrast medium, the lesion had diffuse and heterogeneous enhancement. In the study, 3 cases underwent prostate biopsy, 2 cases underwent transurethral resection of the prostate, 9 cases underwent radical excision or transurethral resection of the prostate with definite diagnosis of pathologic features. Under the light microscope, the interstitial cells of stromal tumor of uncertain malignant potential were overgrowth and fusiform cells showed some degree of pleomorphism, nuclei with few mitotic figures, and necrosis was not often seen. Immunohistochemical staining showed that prostate specific antigen was negative, while vimentin was positive in the tumor tissue, CD34, progesterone receptor and smooth muscle actin were positive in the majority, and Ki67 positive index was 1%-20% (mean 6%). Twelve cases were followed-up, and the time of survival varied from 10 to 96 months (mean 65 months), two cases were lost to the follow-up, one case died of disease at the end of 10 months, nine cases were free of disease recurrence after surgery, two cases underwent more transurethral resection of the prostate due to local recurrence. STUMP is a very rare tumor of the specialized prostatic stroma with an unpredictable clinical behavior. The clinical manifestations, transrectal ultrasonography and magnetic resonance imaging are valuable for the diagnosis of prostatic stromal tumor of uncertain malignant potential. Its definite diagnosis depends on pathological examination. Up to now, early surgery and combined therapy are effective treatments for prostatic stromal tumor of uncertain malignant potential.

A Case of Severe COVID-19 Who Developed Acute Pulmonary Embolism and Mediastinal Emphysema

A man in his fifties visited another hospital with fever and cough. The patient was diagnosed as having coronavirus disease 2019 (COVID-19) on the basis of the results of a reverse transcription polymerase chain reaction (RT-PCR) test. Chest CT revealed multiple ground-glass opacities in both the lower lobes. Subsequently, the patient developed dyspnea and was initiated on oxygen supplementation via a nasal cannula. Chest CT showed rapid progression of the ground-glass opacities and consolidation in both lower lung lobes,and the patient was started on treatment with favipiravir. At this stage, he was transferred to our hospital for intensive care. Two days after he was transferred, the condition progressed to acute respiratory failure,necessitating mechanical ventilation. The serum D-dimer levels were significantly increased (115μg/mL). In addition to exacerbation of the primary lung disease, we diagnosed the patient as also having acute pulmonary embolism and mediastinal emphysema on the basis of the findings on a CT obtained after intravenous administration of contrast material, and he was started on therapy with an anticoagulant. He became hypotensive and required norepinephrine and vasopressin, and also developed severe acute kidney injury. His lung condition gradually improved, and on day 12 after he was intubated, he was successfully weaned from mechanical ventilation. We have presented a report of this case owing to the extremely rapid progression of the disease in this patient.

Risk of acute kidney injury after contrast-enhanced computed tomography in emergency department

Background: Despite its risks associated with renal injury, intravenous contrast media increases diagnostic efficacy and hence the chance of early diagnosis and treatment, which leaves clinicians in a dilemma regarding its use in emergency settings. Objective: The aim of this study was to determine the risk and predictors of contrast-induced acute kidney injury following intravenous contrast media administration for computed tomography in the emergency department. Methods: All patients aged 18 years and older who had a basal creatinine measurement within the last 8 h before contrast-enhanced computed tomography and a second creatinine measurement within 48–72 h after computed tomography scan between 1 January 2015 and 31 December 2017 were included in the study. Characteristics of patients with and without contrast-induced acute kidney injury development were compared. Multivariate regression analysis was used to assess the predictors for contrast-induced acute kidney injury. Results: A total of 631 patients were included in the final statistical analysis. After contrast media administration, contrast-induced acute kidney injury developed in 4.9% ( n = 31) of the patients. When the characteristics of patients are compared according to the development of contrast-induced acute kidney injury, significant differences were detected for age, initial creatinine, initial estimated glomerular filtration rate, and all acute illness severity indicators (hypotension, anemia, hypoalbuminemia, and need for intensive care unit admission). A multivariate logistic regression analysis was performed. The need for intensive care unit admission (odds ratio: 6.413 (95% confidence interval: 1.709–24.074)) and hypotension (odds ratio: 5.575 (95% confidence interval: 1.624–19.133)) were the main factors for contrast-induced acute kidney injury development. Conclusion: Our study results revealed that hypotension, need for intensive care, and advanced age were associated with acute kidney injury in patients receiving contrast media. Therefore, we believe that to perform contrast-enhanced computed tomography in emergency department should not be decided only by checking for renal function tests and that these predictors should be taken into consideration.

Technical note on the administration of intravenous contrast media in hybrid imaging.

This article summarises the proceedings of a continuing professional development session on the use of intravenous contrast media in hybrid imaging for radiographers, technologists, and nurses. The session was jointly organised by the British Nuclear Medicine Society Radiographer, Technologist, and Nurses Group and the Society of Radiographers at the 47th Annual Spring Meeting of the British Nuclear Medicine Society held in Oxford, UK, on 1-3 April 2019.

Cuantificación de la concentración del iodo con TC de doble energía en pacientes con pancreatitis aguda

ObjectiveTo determine whether pancreatic iodine concentrations quantified by dual-energy CT differ between patients with acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease. Material and methodsWe compared findings on single-phase dual-energy CT images acquired 55seconds after the intravenous administration of contrast material in 27 patients with acute pancreatitis who underwent the examination 48 to 72hours after the onset of symptoms versus in 11 patients (controls) with no imaging findings suggestive of pancreatic disease and normal amylase and lipase who underwent the examination with the same protocol for other purposes. Imaging postprocessing included the generation of iodine maps. Three regions of interest were selected (pancreatic head, body, and tail) to obtain iodine concentrations (mg/ml) to compare between groups. Iodine concentrations were also calculated a second time by normalizing the density of iodine with the aorta. ResultsThe mean density of iodine was 2.5mg/ml in patients with pancreatitis vs. 3.65mg/ml in controls (p = 0.02). In three patients with glandular necrosis, the density of iodine was 1.53mg/ml. ConclusionsThe concentration of iodine in the pancreas measured with dual-energy CT differs significantly between patients with initial-stage acute pancreatitis and those without imaging or laboratory findings indicative of pancreatic disease.

Optimal acquisition time to discriminate between breast cancer subtypes with contrast-enhanced cone-beam CT

PurposeTo identify the optimal acquisition time to best discriminate between benign and malignant breast lesions on contrast-enhanced cone beam CT (CE-CBCT) and evaluate the potential of CE-CBCT to differentiate between breast cancer subtypes. Material and methodA total of 98 women with a mean age of 49±10 (SD) years (range: 29–77 years) with 100 BI-RADS 4 or 5 breast lesions were prospectively included. CE-CBCT images were obtained at 1- and 2-min after intravenous administration of iodinated contrast material. Contrast enhancement of breast lesions on CE-CBCT were evaluated and compared between different subtypes. Cut-off values for best discriminating between benign and malignant breast lesions with CE-CBCT were obtained from receiver operating characteristic curves. ResultsMalignant breast lesions showed greater enhancement than benign ones at 1-min (67.28±39.79 [SD] HU vs. 42.27±40.31 [SD] HU, respectively; P=0.007) and 2-min (70.93±38.05 [SD] HU vs. 48.94±41.83 [SD] HU, respectively; P=0.016) after intravenous administration of contrast material. At 1-min after intravenous administration of contrast material, an optimal cut-off value of 54.43 HU was found to best discriminate between malignant and benign breast lesions (AUC=0.681; 95%CI: 0.558–0.805; P=0.006) yielding 69.0% sensitivity (95%CI: 56.9–79.5%) and 69.2% specificity (95% CI: 48.2–85.7%). At 2-min, an optimal cut-off value of 72.65 HU was found to best discriminate between malignant and benign breast lesions (AUC=0.654; 95%CI: 0.535–0.774; P=0.020) yielding 50.7% sensitivity (95%CI: 38.6–62.8%) and 80.8% specificity (95%CI: 60.6–93.4%). CE-CBCT helped differentiate between immunohistochemical subtypes of breast lesions with lowest enhancement for triple negative lesions. No differences in enhancement were found among histopathological subtypes lesions at 1-min (P=0.478) and 2-min (P=0.625). ConclusionCE-CBCT helps discriminate between malignant and benign breast lesions, with best capabilities obtained at 1-min after intravenous administration of contrast material. For malignant lesions, quantitative analysis of enhancement on CE-CBCT helps differentiate between immunohistochemical subtypes.

DYNAMIC FOLLOW-UP AND PROVING THROUGH COMPUTED TOMOGRAPHY AND MAGNETIC RESONANCE IMAGING OF CHANGES IN SECONDARY MENINGOENCEPHALITIS FROM SUPPURATIVE LEFT MAXILLARY SINUSITIS

Infections of the nervous system and its belonging structures have often been reported as life-threatening conditions. Purpose: the results of dynamic follow-up and proving of changes in secondary meningoencephalitis from suppurative left maxillary sinusitis are presented using the imaging methods - CT and MRI. Methods: diagnostic imaging (CT, MRI), of acute disease in a 13-year-old child with progressive development and proving of secondary bacterial meningoencephalitis. Result: the control CT after two days showed dynamics in the imaging CT finding with the appearance of changes in the type of brain oedema and development of pansinusitis. The MRI data described corresponded to changes as at meningoencephalitis in progress.Conclusion: The extension of the diagnostic algorithm with MRI, with the administration of intravenous contrast medium, clearly demonstrated changes characteristic of meningoencephalitis.

An interesting case of atypical venous thrombosis with low red blood cells

Sex: F Age: 65 years. Recent abdominal colic. Petechial-like manifestations with painful discolored skin lesions (suggestive of dermal veins thromboses) on the chest and abdomen. Blood levels of glucose, electrolytes, amylase, lipase, total protein, renal-function tests, the prothrombin time, the international normalized ratio, the partial-thromboplastin time and albumin were normal. Laboratory testing revealed hemolytic anemia: red cells 2.94×106/UL; hemoglobin 8.9 g/dL; lactate dehydrogenase 950 IU/L. Computed tomography of the abdomen and pelvis performed after the administration of intravenous contrast material, revealed a central filling defect in the hepatic veins and their branches that was compatible with acute thrombosis of the hepatic veins and their branches. It was suspected paroxysmal nocturnal hemoglobinuria for which flow cytometric analysis was requested.

Case 273.

HistoryA 55-year-old man with a history of chronic pancreatitis secondary to chronic alcohol abuse presented to the hospital with acute abdominal pain, generalized weakness, weight loss, and pyrexia. A clinical examination revealed he was tender to touch in the upper abdomen. Laboratory tests revealed a serum alkaline phosphatase level of 370 U/L (6.1 µkat/L) (normal range, 30-130 U/L [0.5-2.2 µkat/L]), a lipase level of 172 U/L (2.9 µkat/L) (normal range, 0-60 U/L [0-1.0 µkat/L]), a C-reactive protein level of 159 mg/L (1514 nmol/L) (normal value, <8.0 mg/L [76.2 nmol/L]), and a white cell count of 7 × 109/L (normal range, [4-11] × 109/L). During the present admission, the patient underwent urgent CT for his acute symptoms. His relevant medical history included a hospital admission 2 months earlier for abdominal discomfort. Given his history of chronic pancreatitis, baseline abdominal MRI was performed to determine the cause of his symptoms and to assess the pancreas (Figs 1-3).Figure 1a:(a, b) Images from axial fat-suppressed T2-weighted MRI (repetition time msec/echo time msec, 1000/87; section thickness, 6 mm) of the upper abdomen obtained 2 months prior to admission. (c, d) Images from axial fat-suppressed T1-weighted MRI (3.69/1.62; section thickness, 4 mm) of the upper abdomen acquired 60 seconds after intravenous administration of gadopentetate dimeglumine (0.1 mL per kilogram of body weight; Magnevist; Bayer Healthcare, East Mississauga, Ontario) during the current admission.Figure 1b:(a, b) Images from axial fat-suppressed T2-weighted MRI (repetition time msec/echo time msec, 1000/87; section thickness, 6 mm) of the upper abdomen obtained 2 months prior to admission. (c, d) Images from axial fat-suppressed T1-weighted MRI (3.69/1.62; section thickness, 4 mm) of the upper abdomen acquired 60 seconds after intravenous administration of gadopentetate dimeglumine (0.1 mL per kilogram of body weight; Magnevist; Bayer Healthcare, East Mississauga, Ontario) during the current admission.Figure 1c:(a, b) Images from axial fat-suppressed T2-weighted MRI (repetition time msec/echo time msec, 1000/87; section thickness, 6 mm) of the upper abdomen obtained 2 months prior to admission. (c, d) Images from axial fat-suppressed T1-weighted MRI (3.69/1.62; section thickness, 4 mm) of the upper abdomen acquired 60 seconds after intravenous administration of gadopentetate dimeglumine (0.1 mL per kilogram of body weight; Magnevist; Bayer Healthcare, East Mississauga, Ontario) during the current admission.Figure 1d:(a, b) Images from axial fat-suppressed T2-weighted MRI (repetition time msec/echo time msec, 1000/87; section thickness, 6 mm) of the upper abdomen obtained 2 months prior to admission. (c, d) Images from axial fat-suppressed T1-weighted MRI (3.69/1.62; section thickness, 4 mm) of the upper abdomen acquired 60 seconds after intravenous administration of gadopentetate dimeglumine (0.1 mL per kilogram of body weight; Magnevist; Bayer Healthcare, East Mississauga, Ontario) during the current admission.Figure 2:Coronal T2-weighted MRI (repetition time msec/echo time msec, 1000/89; section thickness, 4 mm) of the upper abdomen obtained 2 months prior to admission.Figure 3:Coronal CT image of the abdomen acquired 60 seconds after administration of intravenous contrast material (100 mL of iohexol, Omnipaque 350; GE Healthcare, Princeton, NJ). This CT examination was performed during the current admission.

Non-contrast-enhanced magnetic resonance angiography of facial arteries for pre-operative evaluation of vascularized submental lymph node flaps

BackgroundThe aim of this study was to compare non-contrast-enhanced 3D phase contrast magnetic resonance angiography (3D PC-MRA) and conventional intravenous administration of contrast media, i.e., contrast-enhanced MRA (CE-MRA), to evaluate the courses of facial arteries for the preparation of vascularized submental lymph node flap (VSLN flap) transfer.MethodsThe head and neck regions of 20 patients with limb lymphedema were imaged using a 3 T MRI scanner. To improve the evaluation of facial artery courses, MRA was fused with anatomical structures generated by high-resolution T1-weighted imaging. The diagnostic and image qualities of facial arteries for VSLN flap planning were independently rated by two radiologists. Interobserver agreement was evaluated using Cohen’s kappa. Differences between 3D PC-MRA and CE-MRA in terms of the diagnostic quality of facial arteries were evaluated using McNemar’s test.ResultsCohen’s kappa indicated fair to good interobserver agreement for the diagnostic and image qualities of the bilateral facial arteries. No significant difference in terms of the diagnostic quality of the left and right facial arteries between 3D PC-MRA and CE-MRA, respectively, was identified.ConclusionsNon-contrast 3D PC-MRA is a reliable method for the evaluation of facial artery courses prior to VSLN flap transfer and could serve as an alternative to CE-MRA for patients with renal insufficiency or severe adverse reactions to contrast media.

SUN-164 ASSOCIATION BETWEEN INTRAVENOUS CONTRAST MEDIA AND NON-RECOVERY FROM DIALYSIS-REQUIRING SEPTIC ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT PATIENTS: A NATIONWIDE OBSERVATIONAL STUDY

Although the concern of the effect of iodinated contrast media on acute kidney injury (AKI) affects physician’s decision on the usage of contrast media with computed tomography (CT), recent reports have questioned the causal relationship between administration of intravenous contrast media and the subsequent AKI, and its causal relationship is still controversial. However, there are no previous reports about whether iodinated-contrast media increase non-renal recovery in critically ill patients who require renal replacement therapy (RRT) early after admission. In this retrospective observational study using the Japanese Diagnosis Procedure Combination inpatient database during a period between July 1, 2011 and March 31, 2017, we identified patients with septic AKI who required continuous renal replacement therapy (CRRT) within 1 day after admission. Patients were divided into those who received computed tomography with intravenous contrast media and those without contrast media. We performed propensity score matching to control potential confounders and analyzed associations between exposure to intravenous contrast media and outcomes, including major adverse kidney events (MAKE) which was defined as death and RRT-dependence at discharge, and duration of RRT. A total of 9,055 patients (3293 with contrast media and 5762 without contrast media) were eligible. Propensity score matching analyses showed MAKE at discharge was not statistically different between the groups with and without contract media (49.6% vs 50.7%, p=0.441). RRT duration was median 5 days and also not significantly different between the groups. Use of intravenous contrast media was not associated with increase in MAKE or RRT duration in patients with septic dialysis-requiring AKI.