Intravenous Contrast Medium Research Articles

Tomographic findings in a domestic rabbit (Oryctolagus cuniculus) with nasal adenocarcinoma

A 6-year-old female rabbit (Oryctolagus cuniculus) showed signs of upper respiratory disease unresponsive to antibiotic therapy. Knowing the limitations of plain radiography for evaluating the upper tract in rabbits, a computed tomography scan was requested, which revealed the presence of an amorphous, expansive neoformation with partially defined limits, high uptake to the vascular contrast medium, with areas of necrosis. Material was collected where the histopathological diagnosis of the mass was conclusive for nasal adenocarcinoma. Computadorized tomography revealed important information for the identification of the mass and the prognosis of the animal. This reported case study of adenocarcinoma of the nasal mucosa in a female rabbit is the first to use computed tomography and intravenous contrast media to assess the nasal lesion. Diseases of the upper respiratory tract must be very well evaluated in cases that do not respond to the therapy established by the veterinarian, and it must be taken into account that nasal adenocarcinoma is a differential diagnosis that must be respected.

Analisis Prosedur Pemeriksaan Multislice Computed Tomography Urografi pada Pasien dengan Klinis Urolithiasis

Backgroud: Urolithiasis is the formation of crystalline mineral deposits in the urinary system. Examination of MSCT Urographic with and without administration of intravenous contrast media is used to detect various abnormalities in the urinary tract area. This study aims to analyze MSCT Urographic examination procedures in patients with clinical Urolithiasis at the Radiology Unit of Premier Bintaro Hospital.Methods: Type of study is qualitative with a case study approach. Collection data was conducted at the Radiology Unit of Premier Bintaro Hospital with specialists and documentation observation methods, interviews with radiographers and radiology. Data processing and analysis are carried out descriptively related to the results of observation, interviews and documentation so that conclusions and suggestions can be drawn.Results: Urographic MSCT examination in patients with clinical Urolithiasis performed with patient preparation by laboratory check to check kidney function (urea and creatinine), examination was performed using the MSCT rutine protocol with the addition of contrast media by scanning the unenhance phase, enhance phase includes arterial phase, phase portal vein and delay phase which is 7 minutes and 15 minutes with prone patients in the kidney vesica urinaria area, and post void. The addition of contrast media is intended to show enhancement and narrowing of the urinary tract.Conclusion: Examination of MSCT Urography in patients with clinical Urolithiasis in the Radiology Unit of Premier Bintaro Hospital is done with patient preparation laboratory check, the protocol is done by scanning the unenhance and enhance phases.

Radiomic Phenotypes for Improving Early Prediction of Survival in Stage III Non-Small Cell Lung Cancer Adenocarcinoma after Chemoradiation.

We evaluate radiomic phenotypes derived from CT scans as early predictors of overall survival (OS) after chemoradiation in stage III primary lung adenocarcinoma. We retrospectively analyzed 110 thoracic CT scans acquired between April 2012-October 2018. Patients received a median radiation dose of 66.6 Gy at 1.8 Gy/fraction delivered with proton (55.5%) and photon (44.5%) beam treatment, as well as concurrent chemotherapy (89%) with carboplatin-based (55.5%) and cisplatin-based (36.4%) doublets. A total of 56 death events were recorded. Using manual tumor segmentations, 107 radiomic features were extracted. Feature harmonization using ComBat was performed to mitigate image heterogeneity due to the presence or lack of intravenous contrast material and variability in CT scanner vendors. A binary radiomic phenotype to predict OS was derived through the unsupervised hierarchical clustering of the first principal components explaining 85% of the variance of the radiomic features. C-scores and likelihood ratio tests (LRT) were used to compare the performance of a baseline Cox model based on ECOG status and age, with a model integrating the radiomic phenotype with such clinical predictors. The model integrating the radiomic phenotype (C-score = 0.69, 95% CI = (0.62, 0.77)) significantly improved (p<0.005) upon the baseline model (C-score = 0.65, CI = (0.57, 0.73)). Our results suggest that harmonized radiomic phenotypes can significantly improve OS prediction in stage III NSCLC after chemoradiation.

Comparison of Abdominopelvic CT Diagnoses at Academic Teaching Hospitals in Rwanda and the United States

Purpose: The purpose of this study was to compare the disease processes encountered on abdominal and pelvic CT examinations at academic teaching hospitals in Rwanda and the United States and to highlight how these differences may impact a global radiology collaboration. Materials and Methods: In this retrospective study, we included 130 patients (mean 59 +/-17 years, range 20-91, F:M 74:56) who underwent abdominal/pelvic CT examinations between April 1st-12th, 2019. CT examinations were prospectively encountered in clinical work at the Centre Hospitalier Universitaire de Kigali or University Teaching Hospital of Kigali (CHUK) in Kigali, Rwanda, where the radiology report impression, patient age, gender, study indication, CT protocol, and clinical diagnosis were recorded when available. Abdominal/pelvic CT examinations at the Massachusetts General Hospital (MGH) in Boston, Massachusetts, United States were then retrospectively reviewed for the same information. Patient age and gender were compared using Student’s t-test and Chi-square statistic. Frequency of formal recommendations in radiology reports, available comparison of CT examinations, presence of known diagnoses, and intravenous and oral contrast media use were compared using Fisher’s exact test. Diagnostic categories were qualitatively compared. Results: A wide variety of pathology was encountered by abdominal/pelvic CT at both sites of imaging, with qualitative differences observed in cancer types, infectious agents, and how imaging guides care. Patients in Rwanda were older (p=0.0017), more likely to receive intravenous (p &lt; 0.05) and positive oral contrast (p &lt; 0.05) media and less likely to receive a formal recommendation in their radiology report (p &lt; 0.05). Patients in the United States were more likely to have an available prior abdominal/pelvic CT (p &lt; 0.05), to present for follow-up of a known diagnosis (p &lt; 0.05), and to receive a formal recommendation in their radiology report (p &lt; 0.05). Conclusion: Participation in global radiology collaborations is beneficial for radiologists by broadening exposure to pathologies and practice different from their own institution and region.

Management of Acute Uncomplicated Diverticulitis: Inpatient or Outpatient.

Diverticular disease is a highly frequent condition and affects 50% of the population in the 9th decade in Western society. Acute diverticulitis is the most prevalent complication. The patients who are clinically stable and tolerate fluid should be hospitalized if fluid intake tolerance worsens, fever occurs, or pain increases. Bowel rest, intravenous fluid therapy, and empiric antibiotic therapy are the traditional treatments for patients admitted to the hospital. This retrospective study aimed to determine the parameters that will affect the outpatient or inpatient treatment of patients diagnosed with uncomplicated acute diverticulitis. Patients who presented to the emergency department with abdominal pain between January 2018 and December 2020 and were diagnosed with uncomplicated diverticulitis (modified Hinchey 1a) on computed tomography (CT) taken after intravenous contrast material shoot up were included in the study. Patient records were recorded retrospectively in the Excel file. After being seen in the emergency department, a comparison was performed between the inpatient group (Group 1) and the outpatient follow-up group (Group 2). The study comprised 172 patients with acute uncomplicated diverticulitis (modified Hinchey 1a). While 110 (64.0%) patients were followed up and treated as inpatients (Group 1), 62 (36.0%) patients were followed up as outpatients (Group 2). There was no statistically significant difference between the two groups in terms of patients readmitted to the hospital in the first 30 days after discharge (both for outpatient follow-up in the emergency department and after treatment in the inpatient group). In this retrospective study, in which we evaluated the hospitalization criteria in uncomplicated Modified Hinchey 1a patients, it was found that patients can be safely treated as an outpatient if they have poor physical examination findings. Although there was no difference between the two groups in terms of hospital readmission after discharge and it was thought that follow-up of patients with Modified Hinchey 1a diverticulitis with outpatient oral antibiotic therapy might be reliable, prospective studies with larger numbers of patients are needed.

Contrast-induced acute kidney injury after computed tomography with contrast media in patients with cardiovascular diseases

Aim. To assess the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media.&#x0D; Materials and methods. In prospective observational study (ClinicalTrials.gov ID NCT04666389) were included 51 patients with CVD undergoing CT with intravenous contrast media administration. The primary endpoint was CI-AKI according to KDIGO criteria [the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 4872 hours after administration of contrast media]. There were 51% of women included in the study. The average age was 61.741.5. The most frequent cardiovascular disease was hypertension in both men and women 52 and 39% respectively.&#x0D; Results. CI-AKI was diagnosed in 2 (3.92%) patients. At the same time, it was not possible to establish statistically significant relationship (p0.05) between risk factors and the development of CI-AKI.&#x0D; Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after CT with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.

Continuous use of metformin in patients receiving contrast medium: what is the evidence? A systematic review and meta-analysis.

Substantial inconsistencies exist in current guidelines regarding recommendations of metformin usage with the administration of a contrast medium. We aimed to perform a meta-analysis to determine whether the risks of contrast-induced acute kidney injury (CI-AKI) and lactic acidosis increase with metformin use in diabetic patients receiving a contrast medium. Studies were retrieved from databases from inception to May 15, 2021. Studies that compared the outcomes of using metformin with not using metformin during contrast medium administration were included. The primary outcomes were incidence of CI-AKI and lactic acidosis. The secondary outcomes were renal function changes from baseline. Data analysis was using risk ratio (RR) for dichotomous outcomes and mean differences (MD) with 95% confidence intervals (CI) for continuous outcomes. Analyses of two randomized controlled trials and four retrospective cohorts examining a total of 1459 patients revealed no significant differences in the incidence of CI-AKI (RR = 1.08; 95% CI, 0.72 to 1.63) and in changes in renal function measurements (serum creatinine: MD = 0.00mg/dL, 95% CI, - 0.05 to 0.05; estimated glomerular filtration rate: MD = 0.22, 95% CI, - 2.47 to 2.91) after contrast medium administration between patients using and not using metformin. There is no evidence that continuing metformin during contrast medium administration is associated with a higher risk of CI-AKI, lactic acidosis, or renal function deterioration compared to patients who discontinued metformin or who were not metformin users. The limited quality of the included studies may compromise the strength of evidence provided in this meta-analysis. There is no need to discontinue metformin either before or after intravenous contrast medium exposure in patients with eGFR > 30mL/min/1.73 m2. In patients receiving intra-arterial contrast medium with first-pass renal exposure, there is no need to withhold metformin if eGFR is above 60mL/min/1.73 m2. For patients who have an eGFR level between 30 and 60mL/min/1.73 m2 and are receiving intra-arterial contrast medium with first-pass renal exposure, no case of lactic acidosis was observed based on present data, but further evidence is needed to make a strong suggestion regarding its safety.

Percutaneous Angiographically Assisted Cryoablation of Renal Cell Carcinoma under the Control of Flat-Detector Computed Tomography: Capabilities and Potential Advantages of the Technique

Purpose: Percutaneous cryoablation (PCA) of renal cell carcinoma (RCC) stage T1a (≤4 cm) generally performed using MDCT with intravenous contrast material administration. Most interventional radiology departments are not equipped MDCT scanners and this is holding back widespread adoption of this technique into practical medicine. Flat-detector computed tomography (FDCT) is included in the standard equipment of modern angiographic systems, which makes it possible to combine the technologies of computed tomography with various technologies of intra-arterial contrasting and endovascular treatment. The purpose of the study was to assess the possibilities and potential advantages of using intraarterial contrasting during FDCT-controlled PCA of RCC T1a.Material and methods: Since 2017 angiographically assisted PCA under the FDCT control performed in 14 patients with RCC T1a. The procedure was performed in the X-ray operating room on an Artis Zee Floor angiographic unit with FDCT function and iGuide Needle Guidance and 3D/3D Fusion technologies (Siemens, Germany) using the SeedNet Gold system and IceEDGE 13 G, IceRod 17 G or IceSphere 17 G cryoprobes (Galil Medical, USA). At all stages of the procedure, FDCT-arteriography of the kidney (FDCT-A) performed according to the original technique: injection into the renal artery 12 ml of non-ionic contrast materials at a rate of 1 ml/s and performing scanning 5 s after the start of contrast materials injection.Results: The primary technical efficiency of FDCT-controlled PCA of RCC T1a was 92.9 %, the secondary — 100 %. Complications of grade 3 according to the CIRSE classification were identified in three patients (21.4 %), complications of grade 4, 5 and 6 not observed. The use of arterial access and the FDCT-A execution at different stages of PCA had the following advantages: 1) high-quality visualization of the tumor with minimal consumption of contrast materials; 2) simple and accurate positioning of cryoprobes using the iGuide Needle Guidance program; 3) estimation of the future ablative margin by fusion FDCT data about tumor with FDCT data about ice ball; 4) reliable diagnosis of bleeding after removal of cryoprobes with the possibility of immediate performing of endovascular hemostasis.Conclusion: Percutaneous angiographically assisted cryoablation under the FDCT control is an affordable, safe and effective technology for the treatment of RCC T1a, which has a number of potential advantages compared to performing procedures using MDCT control. Further research is advisable to study of this PCA technique with its subsequent possible introduction into the routine practice in Interventional Radiology departments of multidisciplinary oncological hospitals.

Determination of differences in dosimetry with and without intravenous contrast media for radiotherapy planning in the anatomical region of the head and neck

In radiotherapy (RT), to determine the tumor volume (TV) and its morphology, computed tomography (CT) is used, acquiring images without and with intravenous iodinated contrast media (CM), where its influence has been poorly studied usually in artificial phantoms. Computerized dosimetries without and with CM from 10 CT of head and neck were analyzed using a before-after design. The same study group served as a control. Point doses and dose-area histogram (DAH) were evaluated, as well as a dose-volume histogram (DVH), using Student's t-test with 5% significance. Before and after administering CM, the average difference between point doses was –0.09% within the confidence interval (CI) 0.27% and –0.45%, with a standard deviation (SD) 0.52%. The average doses using DAH, resulted in a mean difference of 0.02%, within the 0.2% CI and -0.16%, with 0.27% SD. The standard volume within 100% of the dose utilizing DVH analysis resulted in an average of the differences of 0.1%, with CI 1.34% and –1.14% and SD 1.76%. The t-test of difference of means for paired designs, with α=0.05 found that there are no significant differences between the study and control groups for the different dose reading methods.

Intravenous CT Contrast Media and Acute Kidney Injury: A Multicenter Emergency Department–based Study

Background Although the historical risk of acute kidney injury (AKI) after intravenous administration of contrast media might be overstated, the risk in patients with impaired kidney function remains a concern. Purpose To investigate whether intravenous contrast media administration during CT is associated with a higher risk of AKI and further hemodialysis compared with the risk in patients undergoing unenhanced CT. Materials and Methods This retrospective study evaluated patients who underwent contrast-enhanced or unenhanced CT in five Taiwanese emergency departments between 2009 and 2016. The outcomes were AKI within 48-72 hours after CT, AKI within 48 hours to 1 week after CT, or further hemodialysis within 1 month after CT. The associations between contrast media exposure and outcome were estimated by using an overlap propensity score weighted generalized regression model. Subgroup analyses were performed according to the estimated glomerular filtration rate (eGFR). Results The study included 68 687 patients (median age, 68 years; interquartile range, 53-74 years; 39 995 men) with (n = 31 103) or without (n = 37 584) exposure to contrast media. After propensity score weighting, contrast media exposure was associated with higher risk of AKI within 48-72 hours after CT (odds ratio [OR], 1.16; 95% CI: 1.04, 1.29; P = .007) but no significant risk at 48 hours to 1 week after CT (OR, 1.00; 95% CI: 0.93, 1.08; P = .90). Among patients with eGFR less than 30 mL/min/1.73 m2, exposure to contrast media was associated with a higher AKI risk (48-72 hours after CT: OR, 1.36; 95% CI: 1.09, 1.70; P = .007) (48 hours-1 week after CT: OR, 1.49; 95% CI: 1.27, 1.74; P < .001) and a higher risk of hemodialysis (OR, 1.36; 95% CI: 1.09, 1.70; P = .008). For patients with eGFR greater than 45 mL/min/1.73.m2, contrast media exposure was not associated with higher AKI risk (P > .05). Conclusion Contrast-enhanced CT was associated with higher risk of acute kidney injury and further hemodialysis among Taiwanese patients with an estimated glomerular filtration rate (eGFR) of less than 30 mL/min/1.73 m2 but not those with an eGFR of more than 45 mL/min/1.73 m2. © RSNA, 2021 Online supplemental material is available for this article.

Use of Deep Learning to Predict Acute Kidney Injury After Intravenous Contrast Media Administration: Prediction Model Development Study.

BackgroundPrecise prediction of contrast media–induced acute kidney injury (CIAKI) is an important issue because of its relationship with poor outcomes.ObjectiveHerein, we examined whether a deep learning algorithm could predict the risk of intravenous CIAKI better than other machine learning and logistic regression models in patients undergoing computed tomography (CT).MethodsA total of 14,185 patients who were administered intravenous contrast media for CT at the preventive and monitoring facility in Seoul National University Hospital were reviewed. CIAKI was defined as an increase in serum creatinine of ≥0.3 mg/dL within 2 days or ≥50% within 7 days. Using both time-varying and time-invariant features, machine learning models, such as the recurrent neural network (RNN), light gradient boosting machine (LGM), extreme gradient boosting machine (XGB), random forest (RF), decision tree (DT), support vector machine (SVM), κ-nearest neighbors, and logistic regression, were developed using a training set, and their performance was compared using the area under the receiver operating characteristic curve (AUROC) in a test set.ResultsCIAKI developed in 261 cases (1.8%). The RNN model had the highest AUROC of 0.755 (0.708-0.802) for predicting CIAKI, which was superior to that obtained from other machine learning models. Although CIAKI was defined as an increase in serum creatinine of ≥0.5 mg/dL or ≥25% within 3 days, the highest performance was achieved in the RNN model with an AUROC of 0.716 (95% confidence interval [CI] 0.664-0.768). In feature ranking analysis, the albumin level was the most highly contributing factor to RNN performance, followed by time-varying kidney function.ConclusionsApplication of a deep learning algorithm improves the predictability of intravenous CIAKI after CT, representing a basis for future clinical alarming and preventive systems.

Effect of contrast medium on treatment modalities planned with different photon beam energies: a planning study.

Routinely, patient's planning scans are acquired after administration of iodinized contrast media but they will be treated in the absence of that. Similarly, high energy photons have a better penetrating power, while low energy photons will result in tighter dose distribution and negligible neutron contamination. The aim of the study was to investigate a suitable photon beam energy in the presence of intravenous contrast medium. An indigenously made original-contrast (OC) phantom was mentioned as virtual-contrast (VC) and virtual-without-contrast (VWC) phantom were generated by assigning the Hounsfield Units (HU) to different structures. Intensity-modulated (IMRT) and volumetric-modulated-arc (VMAT) plans were generated as per criteria of the TG-119 protocol. It was observed that the maximum dose to the spinal cord was better with 6 mega-voltage (MV) in IMRT. The coverage of Prostate PTV (PR PTV) was similar with all the photon energies and was comparable with TG-119, except for original-contrast (OC) phantom using the VMAT technique. Homogeneity-index (HI) was comparatively better for VMAT plans. The contrast CT images lower the dose to targets. IMRT or VMAT plans, generated on such CT images will be delivered with higher doses than evaluated. However, the overdose remains non-significant.

Power-Injectable Peripherally Inserted Central Catheter Tip Malposition After Power Injection of Intravenous Contrast Media for Computed Tomography Examinations

The aim of this study is to describe the incidence of peripherally inserted catheter tip (PICC) migration after power injection of intravenous contrast for computed tomography (CT) examinations. Retrospective review was conducted of all PICC power injections for CT examinations during the study period: October 16, 2017 through October 23, 2018. Review included evaluation of preinjection and postinjection topograms to assess PICC tip position. Chi-squared statistical analysis was applied. A total of 594 topograms were obtained of power-injectable PICCs during the study period in anticipation of power injection with iodinated contrast media. Of those, 550 patients had satisfactory preinjection topograms and available postinjection topograms; 43 (7.8%) demonstrated tip malposition attributable to power injection of contrast media. Anatomic side of PICC placement and subsequent malposition were independent variables by chi-square test (chi-square = .09, P = .76); 32 of 429 (7.5%) right-sided PICCs versus 11 of 121 (9.1%) left-sided PICCs demonstrated new malposition after contrast media power injection. No complications related to power injection of contrast media through these PICCs were observed. PICC tip malposition secondary to power injection of iodinated contrast media is common and readily identifiable. Obtaining both preinjection and postinjection topograms ensures appropriate catheter position during injection and upon patient departure. Rapid saline flush is a noninvasive maneuver that allows a high chance of successful repositioning of catheter tips. Power injection of contrast media through a power injectable PICC is safe.

Does intravenous contrast medium administration result in altered renal biomarkers? A study in clinically stable cats with and without azotemia.

The aim of this study was to determine the prevalence of post-contrast acute kidney injury or comparable side effects on kidney function in cats receiving the non-ionic, iodinated agent ioversol and/or paramagnetic agent gadoteric acid. Fifty-two animals were divided into four groups on the basis of contrast medium administration for imaging: ioversol (n = 27), gadoteric acid (n = 12), dual contrast media (n = 4) or control, which received an infusion of isotone intravenous fluids only during anaesthesia (n = 9). Blood and urine samples were obtained three times after contrast administration and compared with values obtained prior to administration of the contrast medium. Creatinine (<1.60 mg/dl), symmetric dimethylarginine (SDMA; ⩽14 μg/dl), urine protein:creatinine ratio (UPC; <0.2) and critical differences for creatinine (<0.3 mg/dl) and SDMA (<5.98 μg/dl) were measured. No significant short-term effects on mean creatinine, SDMA and UPC measurements were seen. Borderline proteinuria (UPC, 0.2-0.4) was detected in 11.4% of cases after contrast media administration. A UPC of more than 0.2 in five cases indicated that contrast media may affect kidney function, leading to (transient) proteinuria. This study found no side effect on renal function following the administration of ioversol or gadoteric acid, provided patients were adequately hydrated. However, the clinical relevance of proteinuria in some cats needs to be evaluated in future studies.

Advanced Imaging of the Vestibular Endolymphatic Space in Ménière's Disease.

The diagnosis of “definite” Méniére's disease (MD) relies upon its clinical manifestations. MD has been related with Endolymphatic Hydrops (EH), an enlargement of the endolymphatic spaces (ES) (cochlear duct, posterior labyrinth, or both). Recent advances in Magnetic Resonance (MR) imaging justify its increasing role in the diagnostic workup: EH can be consistently recognized in living human subjects by means of 3-dimensional Fluid-Attenuated Inversion-Recovery sequences (3D-FLAIR) acquired 4 h post-injection of intra-venous (i.v.) Gadolinium-based contrast medium, or 24 h after an intratympanic (i.t.) injection. Different criteria to assess EH include: the comparison of the area of the vestibular ES with the whole vestibule on an axial section; the saccule-to-utricle ratio (“SURI”); and the bulging of the vestibular organs toward the inferior 1/3 of the vestibule, in contact with the stapedial platina (“VESCO”). An absolute link between MD and EH has been questioned, since not all patients with hydrops manifest MD symptoms. In this literature review, we report the technical refinements of the imaging methods proposed with either i.t. or i.v. delivery routes, and we browse the outcomes of MR imaging of the ES in both MD and non-MD patients. Finally, we summarize the following imaging findings observed by different researchers: blood-labyrinthine-barrier (BLB) breakdown, the extent and grading of EH, its correlation with clinical symptoms, otoneurological tests, and stage and progression of the disease.

Pure muscle tenosynovial giant cell tumor mimicks a metastasis in patient with melanoma

Tenosynovial Giant Cell Tumor (TGCT) is a rare benign synovial tumor arising from the tendon sheath, bursae, synovium or adjacent soft tissue. TGCT typical occurs in intra-articular site but can be rarely extra- articular. A 50-years-old woman already affected by malignant melanoma was submitted to PET/CT scan for routine diagnostic examinations during follow up; an intense FDG focal uptake corresponding to peritrochanteric medial part of right iliopsoas muscle was detected. Corresponding MRI images demonstrated a lesion with well-defined margins, slightly hyperintense in T1, low to intermediate signal intensity in T2 weighted scans, no significant restriction in DWI, and intense enhancement in T1 after intravenous contrast medium administration. There wasn’t evidence of extra-lesional spread. MRI findings oriented for benign lesion, but according to intermediate signal intensity in T2, intense enhancement in T1 after intravenous contrast medium, the presence of intense FDG uptake as well as history of aggressive malignancy, a local excision was done; then the final diagnosis of TGCT has been proven. Our case shows TGCT lesions may reproduce malignant appearance on FDG-PET, while MRI may be useful tool to properly manage affected patients. Keywords: Tenosynovial giant cell tumor; Melanoma metastasis; Diffusion-MRI; FDG-PET/CT.

Cost-effectiveness of point-of-care creatinine testing to assess kidney function prior to contrast-enhanced computed tomography imaging

BackgroundPatients undergoing contrast-enhanced computed tomography (CECT) imaging in a non-emergency outpatient setting often lack a recent estimated Glomerular Filtration Rate measurement. This may lead to inefficiencies in the CECT pathway. The use of point-of-care (POC) creatinine tests to evaluate kidney function in these patients may provide a safe and cost-effective alternative to current practice, as these can provide results within the same CECT appointment. MethodsA decision tree model was developed to characterise the diagnostic pathway and patient management (e.g., intravenous hydration) and link these to adverse renal events associated with intravenous contrast media. Twelve diagnostic strategies including three POC devices (i-STAT, ABL800 Flex and StatSensor), risk factor screening and laboratory testing were compared with current practice. The diagnostic accuracy of POC devices was derived from a systematic review and meta‐analysis; relevant literature sources and databases informed other parameters. The cost-effective strategy from a health care perspective was identified based on highest net health benefit (NHB) which were expressed in quality-adjusted life years (QALYs) at £20,000/QALY. ResultsThe cost-effective strategy, with a NHB of 9.98 QALYs and a probability of being cost-effective of 79.3%, was identified in our analysis to be a testing sequence involving screening all individuals for risk factors, POC testing (with i-STAT) on those screening positive, and performing a confirmatory laboratory test for individuals with a positive POC result. The incremental NHB of this strategy compared to current practice, confirmatory laboratory test, is 0.004 QALYs. Results were generally robust to scenario analysis. ConclusionsA testing sequence combining a risk factor questionnaire, POC test and confirmatory laboratory testing appears to be cost-effective compared to current practice. The cost-effectiveness of POC testing appears to be driven by reduced delays within the CECT pathway. The contribution of intravenous contrast media to acute kidney injury, and the benefits and harms of intravenous hydration remain uncertain.

THE ROLE OF DIFFUSION WEIGHTED IMAGING IN DIFFERENTIATION BETWEEN BENIGN AND MALIGNANT OVARIAN LESIONS

• Ovarian carcinomas represent 6th most common cancer, the second most common gynecologic cancer and 4th leading cause of cancer death in women. With no viable screening estimates accessible, 70% of ovarian malignancies are diagnosed at a late stage. Separation of benign lesions from the malignant ones is of foremost significance to direct the correct clinical management. Imaging modalities, particularly ultrasonography (US), computed tomography (CT), and magnetic resonance (MR) imaging have become the first line for ovarian lesions diagnosis. • US remains the study of choice in the initial evaluation of suspected adnexal masses because it is relatively inexpensive, noninvasive, and widely available. Transabdominal US, endovaginal US, or both should be performed for the evaluation of adnexal masses. • MR imaging is a useful modality for differentiating benign and malignant ovarian tumors, and a specific diagnosis can be made for certain pathologic entities. Morphologic appearance, signal intensity characteristics, DWI and adequate use of intravenous contrast material provide information for arriving at the correct diagnosis.

EEG NEUROFEEDBACK IN THE TREATMENT OF COGNITIVE DYSFUNCTIONS AFTER THE INFECTION OF SARS-COV-2 AND LONG COVID-19

Coronavirus disease 2019 (COVID-19) is likely to have long-term mental health effects on individuals who have recovered from COVID-19. According to Centers for Disease Control and Prevention (CDC), individuals diagnosed with COVID-19 can see a range of long-term side effects. The aim of the study was to evaluate the effectiveness of neurotherapy (EEG neurofeedback and goal-oriented cognitive training) in the treatment of neurocognitive dysfunctions in a patient after the infection of SARS-CoV-2 and the long long-term side effects after the contraction of COVID-19. The 48-year-old woman ZR, an accountant by profession, an employee of the administration of the Municipal Board of Municipal Resources, fell ill on October 13, 2020. The disease began with very severe burning headache, eyeballs pain, muscle aches. Ten days later more symptoms joined: loss of smell (anosmia) and loss of taste (ageusia), hearing disorders, shortness of breath and chest pains. The symptoms were associated with SARS-CoV-2 coron- avirus infection confirmed by an rt-PCR genetic test. Brain MRI with intravenous paramagnetic contrast medium injection did not show either lesions of acute microischemic significance or areas of pathological enhancement after paramagnetic contrast medium ad- ministration. The patient was treated at home. In mid-November 2020, about a month after the infection of SARS-CoV-2 and con- tracting NeuroCOVID-19, neurocognitive impairment developed and after half a year she was deteriorating and not able to live in- dependently in society because of her condition. She called her problem "brain fog", and was referred for further diagnosis and therapy to the Reintegration and Training Center of the Polish Neuropsychological Society. We diagnosed a range of long-term side effects and introduced neurotherapy (EEG neurofeedback and goal-oriented cognitive training) in the treatment of neurocognitive dysfunctions. It was found that almost all the long-term side effects were reduced in magnitude. The patient improved and she was able to return to work. EEG neurofeedback and goal-oriented cognitive training might be helpful in the reduction of neurocognitive dysfunctions in patients following the infection of SARS-CoV-2 and long-term side effects after the contraction of COVID-19.

Thrombosis and Anticoagulation in Malignant Superior Vena Cava Syndrome

▪Background:Superior Vena Cava (SVC) Syndrome (SVCS), defined by obstruction of blood flow through the SVC, is commonly caused by a mediastinal tumor (i.e. malignant SVCS, m-SVCS). Little is known regarding co-existing SVC thrombosis at diagnosis in this high risk setting. Anticoagulation (AC) is often utilized even in the absence of thrombosis or stents, but evidence is lacking.Aims:1) To determine factors associated with thrombosis and AC at m-SVCS diagnosis; 2) To evaluate the effect of baseline AC and SVC thrombosis on outcomes.Methods:The electronic records of 2 academic medical centers in Israel were screened for diagnostic codes compatible with SVCS and malignancy between 2007 and 2015. Patients were included if they had active cancer and m-SVCS reported in chest computerized tomography (CT) with intravenous (IV) contrast medium. Records were followed from m-SVCS diagnosis for 6 months.Baseline patient, cancer and m-SVCS-related characteristics were collected. AC use and endovascular SVC stent placement were recorded throughout the study. Accessible diagnostic and follow-up IV contrast CTs were reviewed by two radiologists to confirm m-SVCS diagnosis and evaluate thrombosis. The primary endpoint was death from any cause. Secondary endpoints included new/recurrent SVC thrombosis. Baseline variables that had a statistically significant association with baseline thrombosis or death on univariate analysis were entered into a General Linear Model and multivariable cox regression model, respectively, for multivariable analysis. Significance was set at p < 0.05.Results:The cohort included the 183 patients, 70% (129) of whom had a reviewable baseline CT. Baseline characteristics are shown in Table 1. Briefly, 65% (119/183) had newly diagnosed cancer of any histology, 22% (40/183) had hematological malignancy (mainly aggressive lymphoma), and 16% (29/183) had no symptoms attributable to m-SVCS (i.e. clinical grade 0). Thrombosis of the SVC or tributaries at diagnosis was seen in 24% (30/127). Baseline AC (within 21 days of m-SVCS diagnosis) was used in 51% of patients for a median duration of 68 days [range: 14-179]. Thirty percent of thrombotic cases received no AC, while 52% of non-thrombotic cases received AC at varying doses. Patients receiving baseline AC were more likely to have had a SVC stent placed at baseline, and had higher grade venous occlusion and a trend to more thrombosis of SVC and tributaries (univariate analysis; Table 1). On multivariate analysis, only symptomatic m-SVCS (P<0.01) and increasing Khorana score (p<0.05) were associated with baseline thrombosis (univariate analysis shown in Table 1).Over a median FU of 44 [IQR 22-93] days, 49% (90/182) of patients died. A follow up CT was performed in 61/129 (47%) patients at a median of 138 days [IQR 71-182] from diagnosis, 30% (18) of whom died. New thrombosis of SVC and tributaries was identified in 10/61 (16%) at a median of 74 days [IQR: 53-150]. Patients with baseline AC had thrombosis on follow-up CT in 21% of cases (8/40) compared to 10% (2/20) in those without baseline AC (p=0.471). Among the 68/129 without a follow up CT, 45 (66%) died over a median follow up of 72 days (IQR 23-182).In time dependent cox analysis, baseline AC (compared to none) was not associated with risk of death (HR 0.85; 95% CI 0.55-1.29). In multiple regression analysis of baseline variables, increasing age (HR 1.04, 95% CI 1.02-1.06), malignancy stage IV (HR 4.57, 95% CI 2.29-9.13) and refractory cancer (HR 1.95, 95% CI 1.17-3.25) were associated with death.Conclusion:Thrombosis of SVC and tributaries is a common complication of m-SVCS, and is associated with symptomatic presentation and a high Khorana score. Prognosis in m-SVCS is dismal and appears to be determined by the prognosis of the underlying cancer and responsiveness to prior anticancer therapy and not by the presence of thrombosis at diagnosis. The high early death rate, low numbers of thrombotic events and confounding by AC indication, preclude ruling out a role for AC in selected cases. We propose that therapeutic dose AC in thrombotic m-SVCS and prophylactic AC in non-thrombotic m-SVCS be evaluated prospectively in newly diagnosed patients. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.