Intravenous Contrast Administration Research Articles

Effect of In Utero Exposure of Iodinated Intravenous Contrast on Neonatal Thyroid Function

Administration of radioactive iodine to a pregnant woman for thyroid ablation has been shown to affect neonatal thyroid levels. Thus, there is a theoretical risk in affecting a neonate's thyroid level upon birth with prior administration of intravenous contrast containing iodine to a pregnant woman during a computed tomographic scan. However, there is no literature to support this theoretical risk. This study attempted to determine if there is any effect on a newborn's thyroid levels after exposure to this type of contrast material in utero. The medical charts of 96 pregnant women during the years 2004 through 2009 on whom computed tomographic scans were performed were reviewed. A total of 29 charts were excluded secondary to missing neonatal records, missed abortions, and intrauterine fetal demise. The rest were subdivided into those who received intravenous (IV) ± oral contrast material and those who did not. The medical records of the newborns of these patients were also reviewed. The subject group consisted of 61 pregnant women who received IV ± oral contrast and their 64 neonates. The control group consisted of 6 pregnant patients who did not receive IV contrast and their 6 neonates. Of the 64 neonates in the subject group, only one neonate was found to have a low thyroxine level with a normal thyroid stimulating hormone level. This infant was severely premature, being born at the 25th week of gestation, and developed respiratory distress syndrome and sepsis, which were potential confounding factors. All of the 6 neonates in the control group had normal thyroid levels. This study concludes that there is no significant adverse clinical risk of thyroid function abnormalities to the fetus after IV iodinated contrast material to their mothers.

Dual source computed tomography coronary angiography in new onset cardiomyopathy

To evaluate safety and utility of coronary computed tomography angiography (CCTA) compared to invasive coronary angiography (ICA) in new cardiomyopathy. Eighteen patients (mean age 56.5 years, 10 males) who presented for evaluation of new onset heart failure with evidence of systolic dysfunction (ejection fraction < 40%) on echocardiography and recent ICA were prospectively enrolled. Patients with known coronary artery disease, atrial fibrillation, creatinine > 1.5 g/dL, and contraindication to intravenous contrast administration were excluded. CCTA was performed using a dual source 64-slice scanner. Mean heart rate was 75 beats per minute. Stenosis was graded for each coronary segment as: none, mild (< 50%), moderate (50%-70%), severe (> 70%), or non-evaluable. Ischemic cardiomyopathy (ICM) was diagnosed if severe stenosis was present in the left main, proximal left anterior descending artery, or two or more major arteries. Two patients were diagnosed with ICM by ICA. CCTA correctly identified 2 patients with ICM and 16 patients as non-ICM. CCTA successfully evaluated 240/246 coronary segments with an accuracy of 97.5%, sensitivity 70%, specificity 98.7%, positive predictive value of 70%, and negative predictive value of 98.7% for identifying severe stenosis on a per-segment level. Dual source 64-slice multi-detector CCTA is a safe, accurate, and non-invasive technique for diagnosing ICM in patients presenting during the acute phase of newly diagnosed cardiomyopathy.

P-498 - Brain epidermoid cyst and depression in a 32-year old man: a case report

Cysts are common findings at magnetic resonance (MR) and computed tomographic(CT) brain imaging. Their histopathologic spectrum is broad, and differentiation of these cysts on the basis of imaging findings alone can be problematic This is a case of a 32 year old man reported depressive syptomatology and after brain MRI examination a epidermoid cyst was found. The relation between brain epidermoid cyst and depressive symptomatology The patient had suddenly symptoms of severe headache accompanied, fatigue, depressed mood most of the day, marked diminished interest or pleasure in all, or almost all activites, insomnia and diminished ability to think or concentrate. There was no organic problem in his medical history and there were any difficulties in his professional or his personal life. There was no family history for neurological diseases but his brother is suffering from Gille de la tourette. The symptoms progressively increased and patient visited a psychiatrist who recommended an MRI examination and the result was the following: Brain MRI Examination revealed a cystic lesion in the posterior part of the 3rd ventricle, with a maximum diameter of 2.8 cm approximatelly and obstucts the Sylvious aqueduct which causes more centrally dilatation of the 3rd ventricle and the lateral ventricles too. The images after the intravenous contrast administration show no abnormal enhancement. Pituitary gland and paranasal sinuses appeared normal. Orbital structures appeared normal. After a surgical intervention depressive symptomatology was remised. Epidermoid cysts can be masked from depressive syptomatology.

Letters to Editor Hypertension without renovascular stenosis: a rare case of abdominal aorta coarctation treated with percutaneous transluminal angioplasty

Letters to Editor Hypertension without renovascular stenosis: a rare case of abdominal aorta coarctation treated with percutaneous transluminal angioplasty

Clinical decision making and research in hepatocellular carcinoma: Pivotal role of imaging techniques

Clinical decision making and research in hepatocellular carcinoma: Pivotal role of imaging techniques

A randomized trial of intravenous N‐acetylcysteine to prevent contrast induced nephropathy in acute coronary syndromes

Pharmacokinetic data suggests that the intravenous form of n-acetylcysteine (NAC) may be more effective than the oral formulation in preventing contrast induced nephropathy (CIN). NAC owing to its anti-oxidant properties might be beneficial for patients with acute coronary syndromes (ACS) who are at increased risk for CIN. The aim of this prospective randomized, single-center, double-blind, placebo controlled trial (NCT00939913) was to assess the effect of high-dose intravenous NAC on CIN in ACS patients undergoing coronary angiography and/or percutaneous coronary intervention (PCI). We randomized 398 ACS patients scheduled for diagnostic angiography ± PCI to an intravenous regimen of high-dose NAC (1,200 mg bolus followed by 200 mg/hr for 24 hr; n = 206) or placebo (n = 192). The primary end-point was incidence of CIN defined as an increase in serum creatinine concentration ≥ 25% above the baseline level within 72 hr of the administration of intravenous contrast. There was no difference found for the primary end point with CIN in 16% of the NAC group and in 13% of the placebo group (p = 0.40). Change in serum cystatin-C, a sensitive marker for renal function, was 0.046 ± 0.204 in the NAC group and 0.002 ± 0.260 in the control group (p = 0.07). In ACS patients undergoing angiography ± PCI, high-dose intravenous NAC failed to reduce the incidence of CIN.

Neuroimaging during Pregnancy

Pregnancy can be associated with a wide variety of neurologic problems, resulting from alterations in physiology of the pregnant state. The pregnant patient presenting with neurologic symptoms poses both diagnostic and therapeutic challenges. The physician will often require some form of neuroimaging as part of their ongoing evaluation. This review discusses potential risks to the embryo and fetus that can be caused by undergoing computed tomography (CT) and magnetic resonance imaging (MRI), including those associated with the administration of intravenous contrast. Neurologic diseases or syndromes specifically associated with pregnancy are also discussed.

Usefulness of computed tomography performed immediately after excretory urography in patients with delayed opacification or dilated upper urinary tract of unknown cause

To evaluate the diagnostic value of computed tomography (CT) performed immediately after excretory urography (EU) in patients with delayed renal opacification or dilated upper urinary system with nonconclusive diagnosis after EU. CT was performed immediately after EU in 39 patients with delayed opacification or dilated upper urinary system of unknown cause, without additional intravenous contrast administration for the CT study. We classified EU + CT findings as benign or malignant causes and we compared our results with the final diagnosis. The combination of EU + CT correctly diagnosed 38 out of the 39 cases with a sensitivity of 97%. Correct diagnosis was established in all malignant cases (n = 17) but one benign case consistent with blood clots in the upper urinary tract was incorrectly diagnosed as a multicentric urothelial carcinoma. Sensitivity, specificity, and accuracy for the diagnosis of the underlying cause with EU + CT was 100%, 95%, and 97%, respectively. The final diagnoses were: urothelial carcinoma (n = 10), stone disease (n = 10), bladder tumor (n = 4), benign post-treatment ureteral stenosis (n = 4), ureteral invasion (n = 3), benign bladder disease (n = 2), urinary tract infections (n = 2), crossing vessels (n = 1), ureteropelvic junction obstruction (n = 1), retrocaval ureter (n = 1), and blood clots in the upper urinary tract due to bleeding renal metastasis from lung cancer (n = 1). Combined EU and CT study allowed correct diagnosis of the underlying cause of delayed excretion or upper urinary tract dilatation in 97% of cases. The combination of EU and CT provides diagnosis reducing time and radiation.

Is hepatotropic contrast enhanced MR a more effective method in differential diagnosis of hemangioma than multi-phase CT and unenhanced MR?

BackgroundCavernous hemangiomas are the most frequent neoplasms of the liver and in routine clinical practice they often need to be differentiated from malignant tumors and other benign focal lesions. The purpose of this study is to evaluate whether diagnostic accuracy of magnetic resonance imaging (MRI) of hepatic hemangiomas, showing atypical pattern on US, improves with the use of Gd-BOPTA in comparison with contrast-enhanced multi-phase computed tomography (CT).Methods178 consecutive patients with ambiguous hepatic masses showing atypical hyperechoic pattern on grey-scale US, underwent unenhanced and contrast-enhanced multi-phase multi-detector CT and MR (1.5T) with the use of liver-specific contrast medium gadobenate dimeglumine (Gd-BOPTA). After intravenous contrast administration arterial (HAP), venous-portal (PVP), equilibrium phases (EP) both in CT and MR and additionally hepatobiliary phase (HBP) in MR were obtained. 398 lesions have been detected including 99 hemangiomas and 299 other lesions.ResultsIn non-enhanced MDCT examination detection of hemangiomas was characterized by sensitivity of 76%, specificity of 90%, PPV of 71%, NPV of 92% and accuracy of 86%.Non-enhanced MR examination showed sensitivity of 98%, specificity of 99%, PPV of 99%, NPV of 99% and accuracy of 99%.After intravenous administration of contrast medium in MR the mentioned above parameters did not increase significantly.ConclusionGd-BOPTA-enhanced MR in comparison with unenhanced MRI does not improve diagnostic accuracy in discriminating hemangiomas that show non-specific appearance in ultrasound examination. Unenhanced MR as a method of choice should directly follow US in course of diagnostic algorithm in differentiation of hemangiomas from other liver tumors.

Spinal Extradural Meningeal Cysts

Case series and literature review. To analyze the characteristics of extradural spinal meningeal cysts (SMCs) by magnetic resonance imaging (MRI) and discuss their classifications and etiology, as well as exploring the choice of treatment. Spinal extradural meningeal cysts are a rare type of SMC. They are also known as extradural/epidural spinal arachnoid cysts. According to Nabors' classification, they belong to the category of types I and II meningeal cysts. The etiology of spinal extradural cysts remains unclear. We retrospectively analyzed the MRI scans of 18 cases of extradural arachnoid cyst, which were consecutively treated surgically at our institutions between June 1990 and November 2009. All cases were confirmed by surgery. Disonics 0.35T and Philips Gyroscan Intera 1.5T scanner with surface coils were used for patient scanning. MRI examination included routine sagittal T1-weighted/spin-echo , sagittal, and transverse T2-weighted scanning. The above scans were repeated after the administration of intravenous contrast 3 medium (gadolinium) in 12 patients. Seven of the 18 cases were located in the middle and lower thoracic spine, 3 in the lumbar spine, and 8 in the thoracolumbar junction. All cystic lesions were isointense compared with cerebrospinal fluid on the T1 and T2-weighted images. The lesions showed no enhancement after gadolinium administration. MRI had great sensitivity to and specificity for extradural arachnoid cysts and seemed to be the diagnostic procedure of choice before and after surgery. Accurate understanding of MRI features helps clinicians make preoperative diagnoses and guides the operation. The definitive treatment of SMCs involves total removal of the cyst and repair of the dural defect.

Semiautomated Motion Correction of Tumors in Lung CT-perfusion Studies

To compare the relative performance of one-dimensional (1D) manual, rigid-translational, and nonrigid registration techniques to correct misalignment of lung tumor anatomy acquired from computed tomography perfusion (CTp) datasets. Twenty-five datasets in patients with lung tumors who had undergone a CTp protocol were evaluated. Each dataset consisted of one reference CT image from an initial cine slab and six subsequent breathhold helical volumes (16-row multi-detector CT), acquired during intravenous contrast administration. Each helical volume was registered to the reference image using two semiautomated intensity-based registration methods (rigid-translational and nonrigid), and 1D manual registration (the only registration method available in the relevant application software). The performance of each technique to align tumor regions was assessed quantitatively (percent overlap and distance of center of mass), and by a visual validation study (using a 5-point scale). The registration methods were statistically compared using linear mixed and ordinal probit regression models. Quantitatively, tumor alignment with the nonrigid method compared to rigid-translation was borderline significant, which in turn was significantly better than the 1D manual method: average (± SD) percent overlap, 91.8 ± 2.3%, 87.7 ± 5.5%, and 77.6 ± 5.9%, respectively; and average (± SD) DCOM, 0.41 ± 0.16 mm, 1.08 ± 1.13 mm, and 2.99 ± 2.93 mm, respectively (all P < .0001). Visual validation confirmed these findings. Semiautomated registration methods achieved superior alignment of lung tumors compared to the 1D manual method. This will hopefully translate into more reliable CTp analyses.

Angiomatous Meningioma: CT and MR Imaging Features

hancement, intratumoral cystic change, and peritumoral edema. Results: Most tumors showed high signal intensity on T2-weighted images, and low signal intensity on diffusion-weighted images. After intravenous contrast administration, the tumor showed heterogeneous strong enhancement. Most tumors had a lobulated margin with prominent intratumoral signal voids. Four patients showed marked or small intratumoral cystic changes. Conclusion: Typically, angiomatous meningiomas were dura-based masses characterized by lobulated margins with high signal intensity on T2-weighted imaging (T2WI), low signal intensity on diffusion-weighted imaging (DWI), prominent intratumoral signal voids, intratumoral cystic changes, and marked enhancement after intravenous contrast administration.

Hepatocellular Carcinoma Presenting as an Incidental Isolated Malignant Portal Vein Thrombosis

Portal vein thrombosis is frequently associated with hepatocellular carcinoma (HCC). Tumor invasion into the portal vein by direct venous extension or metastasis occurs in up to 70% of HCC patients (Cedrone et al., Liver 16:94-8, 1996). However, presentation as an isolated malignant portal vein thrombosis without any evidence of obvious hepatoma-like lesions in the liver by imaging studies is extremely uncommon. We present an unusual case of HCC presenting as a malignant portal vein thrombus, proven on biopsy of the thrombus without any evidence of primary liver lesion. This, to our knowledge, is the first case of HCC presenting as an incidental isolated malignant portal vein thrombosis. The importance of doing delayed enhancement imaging studies to rule out malignant portal vein thrombosis is emphasized. A 60-year-old man presented with acute substernal chest pain. Physical examination revealed icterus. Examination of the abdomen did not reveal any organomegaly. Liver function test revealed a predominantly conjugated bilirubinemia. Abdominal sonogram revealed thrombosis and occlusion of the posterior right portal vein. Liver parenchyma was homogenous with no intrahepatic mass. Computed tomography (CT) of the abdomen and pelvis after administration of oral and intravenous contrast with delayed views revealed arterial enhancement of the right portal vein thrombus with delayed washout. MRI of the abdomen with gadolinium confirmed the right portal vein thrombus without focal hepatic mass. Aspiration of the right portal vein thrombus under CT guidance revealed hepatocellular carcinoma which was confirmed by immunohistochemistry. Serum alpha-fetoprotein level was very high. Patient was started on sorafenib with subsequent decrease in alpha-fetoprotein level. He was doing well till the date of this report. This unusual case of hepatocellular carcinoma presenting as an incidental malignant portal vein thrombosis without any primary liver lesion is extremely rare. Other reported cases of malignant portal vein thrombosis have been in patients with underlying hepatoma, cirrhosis, or with intrabiliary hepatocelluar carcinoma. In the clinical setting of portal vein thrombosis, imaging studies showing enhancement of the thrombus in the arterial phase are important in leading to the diagnosis of malignancy.

Does the prophylactic administration of N-acetylcysteine prevent acute kidney injury following cardiac surgery?

A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was 'does prophylactic administration of N-acetylcysteine (NAC) prevent acute kidney injury (AKI) following cardiac surgery?' More than 60 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. The administration of NAC prior intravenous radioactive contrast has been shown to reduce the incidence of contrast-induced nephropathy. There have been two recent meta-analyses and several randomised controlled trials (RCTs) and investigating the effectiveness of prophylactic administration of NAC in the prevention of AKI following cardiac surgery. The RCTs have investigated the use of NAC to prevent AKI in low-risk patients, high-risk patients and high-risk patients with pre-existing chronic kidney disease. The meta-analyses and RCTs demonstrated that the prophylactic administration of NAC did not reduced the incidence of AKI, postoperative complications, postoperative interventions, mortality or length of ICU stay. We conclude that prophylactic administration of NAC does not prevent AKI or reduce mortality following cardiac surgery.

Creatinine Increases After Intravenous Contrast Administration

The incidence of creatinine increases after intravenous contrast (postcontrast creatinine increases, PCCI) is controversial, ranging from 0% to >25%. We sought to determine what factors influenced these divergent estimates of PCCI incidence. Where possible, the association of PCCI with long-term adverse outcomes was also studied. Both observational studies and prospective randomized trials were reviewed. Definitions of clinically significant PCCI, incidence of PCCI, and its association with baseline kidney function, the setting in which intravenous contrast was administered, and the short- and long-term consequences of PCCI were extracted. Baseline renal function impairment and inpatient versus outpatient status are the major risk factors for PCCI. PCCI is possibly associated with clinically significant short- and long-term adverse events. PCCI occurs despite a number of potential confounding issues. The incidence is increased as kidney function at baseline is diminished and for inpatients. There is limited data on long-term outcomes following PCCI in this setting.

Osteoblastoma of the Frontal Sinuses Presenting with Headache and Blurred Vision: Case Report and Review of the Literature

Osteoblastoma is a rare benign bone tumor that usually arises in the vertebral column and long bones of young adults. Craniofacial involvement is extremely rare. To date, osteoblastoma of the frontal sinus has not been reported in the English literature. We report an osteoblastoma of both frontal sinuses in a 23-year-old male who presented with headache and blurry vision in the left eye. Computed tomography (CT) demonstrated an expansile lesion involving both frontal sinuses with sclerotic and fibrous components, eroding into the roof of the left orbit. On magnetic resonance imaging (MRI) the dense portion of the lesion showed signal void on all sequences, while the fibrous matrix was isointense to grey matter on T1-weighted and T2-weighted images and showed avid enhancement following intravenous contrast administration. Surgical resection was performed and histology was consistent with osteoblastoma.

MALT lymphoma of the lacrimal gland in the context of systemic lupus erythematosus: complete remission after treatment with rituximab

Mucosa-associated lymphoid tissue (MALT) lymphoma of the lacrimal glands has been reported in only two patients with systemic lupus erythematosus (SLE) in the literature. We describe a 41-year-old female with SLE who had multiple relapses and remissions of her disease during the last 20 years and developed a right eyelid swelling. Magnetic resonance imaging showed a lesion in the right lacrimal gland with increased enhancement on T1- and T2-weighted images after intravenous contrast administration, and the biopsy of lacrimal gland was consistent with the diagnosis of marginal zone B-cell lymphoma of MALT type. The patient received treatment with four once-weekly doses of rituximab 375 mg/m(2) every 6 months for 2 years resulting in complete remission. Lacrimal gland MALT lymphoma is mainly treated with local radiotherapy, or chemotherapy in cases with systemic lymphoma. This is the first case of rituximab treatment in a patient with SLE who developed lacrimal gland MALT lymphoma, resulting in complete durable remission.

Contrast-enhanced MRI of the small bowel in Crohn’s disease

Recently, magnetic resonance imaging has emerged as a valuable tool in evaluation of small bowel Crohn's disease. MRI provides several advantages to other imaging modalities, including the lack of ionizing radiation, multiplanar capability, and functional information. Intravenous contrast administration is a routine portion of MR enterography protocol, and aids in detection of disease extent, extramural complications such as fistula and abscess, and assessment of activity. Additionally, promising techniques such as dynamic contrast-enhanced MRI may provide quantitative measures to assess bowel perfusion, which may enhance evaluation of disease activity. This article will provide an overview of the technical aspects of contrast-enhanced MR enterography, describe common pathologic findings involving the small bowel in Crohn's disease, summarize its role in determination of activity with an emphasis on endoscopic and histologic correlation, and compare its efficacy with other imaging modalities.

Extra-adrenal retroperitoneal ganglioneuroma

A 74-year-old woman presented to the hospital complaining of fatigue and atypical epigastric discomfort. Physical examination revealed epigastric tenderness. She had no relevant clinical history. Laboratory findings were within normal limits. A CT scan of the abdomen was performed and showed a large well-defined, lobulated hypodense mass in the retroperitonium (Fig. A, arrows), containing small punctate calcifications (Fig. A, arrowheads). After intravenous contrast administration the mass showed slight and inhomogeneous enhancement. The mass surrounded the celiac trunc (Fig. B, arrowhead) and superior mesenteric artery, without evidence of luminal narrowing. On MRI, the lesion was homogeneous and hypointense relatively to the liver on T1, and heterogeneous and hyperintense on T2. Axial contrast-enhanced dynamic T1- weighted MR images obtained 40 seconds (Fig. C1, arrows) and 100 seconds (Fig. C2, arrows) after contrast material injection showed gradual but heterogeneous enhancement of the mass. The radiological differential diagnosis included lymphadenopathy and neurogenic tumor. No malignancy was found elsewhere in the body. CT guided percutaneous biopsy of the mass was performed and pathology revealed an extra-adrenal ganglioneuroma. Encasement of the vascular structures made radical excision impossible. Followup by imaging after 6 months was recommended.

The Pontomedullary Region: Role in Affect, Behavior, and Appetite Regulation

Back to table of contents Previous article Next article LETTERFull AccessThe Pontomedullary Region: Role in Affect, Behavior, and Appetite RegulationPrashanth R. M.B.B.S.,Yatan Pal Singh Balhara M.D., DNB(Psychiatry), MNAMS,Rajesh Sagar M.D.,Prashanth R. M.B.B.S.Search for more papers by this author,Yatan Pal Singh Balhara M.D., DNB(Psychiatry), MNAMSSearch for more papers by this author,Rajesh Sagar M.D.Search for more papers by this author,Published Online:1 Apr 2010https://doi.org/10.1176/jnp.2010.22.2.247.e14AboutSectionsPDF/EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail To the Editor: “Sam,” an 8-year-old boy with unremarkable past history, sustained an injury on his head while playing with his friends. The patient appeared to be fine for the initial 2 hours following the injury except for a slight bleed from the scalp as the only apparent consequence of the fall. The patient suddenly became unresponsive and was rushed to the hospital; a CT scan revealed a bleed in the brain stem. He required ventilator support for the next 1 1/2 months. On regaining consciousness, the patient was left with scanning speech, vertical nystagmus, and ataxia while walking. The patient also developed behavioral changes such as being very demanding and constantly requesting things from his parents. Food was a high priority, and he would exhibit an increase in appetite. He would exhibit irritability on these occasions and would bite and physically hurt others if his demands were not met. Apart from these situations, he was cheerful and enjoyed being with others and watching TV, and the other spheres of his life remained unaffected. A brain MRI was carried out using the echo-speed gradient 1.5 T MR system using a dedicated head coil. We obtained serial T1- and T2-weighted images followed by special fact FLAIR axial images. T1-weighted spin echo images were repeated in the sagittal, axial, and coronal planes following administration of intravenous contrast (Gd-DTPA). MRI findings suggested focal areas of signal alteration in periaqueductal region and the pontomedullary junction—likely representing sequelae of hemorrhagic contusion with focal gliosis. Changes in behavior and appetite have been reported following head injury. Different regions of the brain have been implicated in the manifestations of these disorders. 1 , 2 However, to the best of our knowledge, this is the first case of this kind where the altered behavior with change in appetite and irritability was reported with a pontomedullary junction lesion in a child. This region has not been implicated in the usual regulation of the human behavior, affect, and appetite. However, the findings in this particular case could suggest the role of the pontomedullary structures or the connecting tract in the regulation of human behavior, affect, and appetite and could be explored further. Department of Psychiatry, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaDepartment of Psychiatry and De-addiction, Dr RML PGIMER and Hospital, New Delhi, IndiaDepartment of Psychiatry, All India Institute of Medical Sciences, New Delhi