Intravenous Administration Of Contrast Material Research Articles

The Effect of Contrast Rationing on the Development of Acute Kidney Injury During the Global Contrast Shortage

BackgroundIn April of 2022, the COVID-19 pandemic resulted in a global shortage of intravenous contrast media (ICM), which led our health care system to implement rationing measures. Study ObjectivesWe set out to determine if the reduction in ICM use was associated with a change in the incidence of acute kidney injury (AKI). MethodsWe conducted a multicenter retrospective cohort analysis to compare the incidence of AKI in patients who presented before and after ICM rationing. Adult patients who had a CT of the abdomen performed who had at least 2 creatinine measurements, at least 24 h apart, were included. The maximum increase in creatinine was determined by subtracting the maximal creatinine obtained within 7 days with the initial creatinine. The primary outcome was the development of AKI. ResultsA total of 2168 patients met inclusion criteria (1082 before; 1086 after). There was no significant difference in age, gender, comorbid conditions, disposition, or initial estimated glomerular filtration rate between groups. In the prerationing group, 87.7% of patients received ICM compared to 42.7% after. There was no significant difference in the development of AKI between groups (11.1% vs. 11.0%), including when stratified by baseline renal function and adjusted for age, sex, race, comorbid conditions, and emergency severity index. ConclusionsThe dramatic reduction in ICM use that resulted from the global shortage was not associated with a change in the incidence of AKI. This reinforces the results of previous studies which have failed to find evidence of a relationship between ICM administration and AKI.

Detection of pathological contrast enhancement with synthetic brain imaging from quantitative multiparametric MRI.

We aimed to test whether synthetic T1-weighted imaging derived from a post-contrast Quantitative Transient-state Imaging (QTI) acquisition enabled revealing pathological contrast enhancement in intracranial lesions. The analysis included 141 patients who underwent a 3 Tesla-MRI brain exam with intravenous contrast media administration, with the post-contrast acquisition protocol comprising a three-dimensional fast spoiled gradient echo (FSPGR) sequence and a QTI acquisition. Synthetic T1-weighted images were generated from QTI-derived quantitative maps of relaxation times and proton density. Two neuroradiologists assessed synthetic and conventional post-contrast T1-weighted images for the presence and pattern of pathological contrast enhancement in intracranial lesions. Enhancement volumes were quantitatively compared. Using conventional imaging as a reference, synthetic T1-weighted imaging was 93% sensitive in revealing the presence of contrast enhancing lesions. The agreement for the presence/absence of contrast enhancement was almost perfect both between readers (k = 1 for both conventional and synthetic imaging) and between sequences (k = 0.98 for both readers). In 91% of lesions, synthetic T1-weighted imaging showed the same pattern of contrast enhancement visible in conventional imaging. Differences in enhancement pattern in the remaining lesions can be due to the lower spatial resolution and the longer acquisition delay from contrast media administration of QTI compared to FSPGR. Overall, enhancement volumes appeared larger in synthetic imaging. QTI-derived post-contrast synthetic T1-weighted imaging captures pathological contrast enhancement in most intracranial enhancing lesions. Further comparative studies employing quantitative imaging with higher spatial resolution is needed to support our data and explore possible future applications in clinical trials.

Imaging after kidney transplantation in childhood and adolescence

The ultrasound (US) examination is the most important imaging procedure in the clinical care of children with chronic kidney disease, the assessment before kidney transplantation and in the acute and chronic phase after successful kidney transplantation. In trained hands, particularly with experience in Doppler sonography, US ensures that vascular complications, such as occlusions, thrombosis, stenosis as well as non-vascular complications, e.g., urinary tract dilatation, abscesses, hematomas, urine leaks or lymphoceles, are cost-effectively and rapidly diagnosed at any time. For the diagnosis of acute rejection, the US signs in the intraindividual course are only suggestive, but not specific. The gold standard for the diagnosis of acute rejection is a kidney biopsy. In these cases, US serves to exclude other causes. The use of multimodal techniques, various Doppler techniques and microvascular procedures, such as superb microvascular imaging (SMI) or B‑flow and contrast-enhanced ultrasonography (CEUS), optimizes the imaging in the context of transplantations in children. Magnetic resonance imaging with diffusion-weighed imaging (DWI), magnetic resonance angiography (MRA) and magnetic resonance urography (MRU) as well as functional MRU (fMRU) performed with the administration of gadolinium-containing contrast agents, are part of the extended diagnostics and possibly necessary for surgical planning in the early phase after kidney transplantation and for long-term assessment after transplantation. Excretory urography is associated with ionizing radiation and intravenous administration of iodine-containing contrast medium and is obsolete in children. Computed tomography (CT) using age-adapted and weight-adapted dose protocols is an alternative in emergencies if MRI is not available.

Comparison of Blood Pressure Variation among Patients Undergoing CECT Thorax and NCCT Thorax: A Cross-sectional Study

Introduction: Advancements in Computed Tomography (CT) have been continuously updated with the intravenous administration of contrast media, which enhances the visibility of internal organs and structures in CT scans. Contrast media administration often alters blood pressure. Aim: To observe the blood pressure variations among patients undergoing Contrast-enhanced Computed Tomography (CECT) thorax and Non Contrast Computed Tomography (NCCT) thorax. Materials and Methods: A cross-sectional study was conducted at the Department of Radiodiagnosis and Medical Imaging at Yenepoya Medical Hospital, Deralakatte, Mangaluru, Karnataka, India from February 2022 to August 2022. Patients who underwent examinations of NCCT thorax and CECT thorax within the age group of 20-80 years, involving 62 participants (31- CECT, 31- NCCT) were included. Intravascular contrast material was administered to the patient during a CECT thorax scan. One reader independently recorded the Systolic Blood Pressure (SBP) and Diastolic Blood Pressure (DBP) five minutes before and five minutes after the venous phase in the CECT thorax and five minutes prior to and five minutes after in the NCCT thorax group.. A paired t-test was used for the comparison of SBP and DBP within the group. Results: The mean SBP before the scan was 120.7 mmHg {Standard Deviation (SD)=13.6} and after the scan was 130.7±12.1 mmHg. The mean DBP before the scan was 78.9±8.9 mmHg, and after the scan was 84.2±12.0 mmHg, respectively, before and after the injection of contrast. Therefore, a significant difference was found in the mean SBP and DBP before and after the injection of contrast within the CECT thorax group. Conclusion: There was an increase in blood pressure in patients who had undergone CECT thorax in both males and females. Hence, evaluating BP will provide awareness of different risk factors that can be caused due to the administration of contrast media

Understanding of Saudi Population on the Usage of Intravenous Contrast Media Injections in Radiology

Background: Intravenous contrast media (IVCM) in radiology are extremely important for accurate diagnosis and are used daily all over the globe. These contract media are very safe if administered correctly. However, adverse events have also been reported. This study was undertaken to determine the understanding of the patients towards the usage of IVCM in radiology. Methods: This is a cross-sectional study conducted on patients recommended for IVCM-mediated radiological examinations. The data were collected by face-to-face interactions using the self-administered questionnaire before IVCM administration. The questionnaire was all about patient’s information for IVCM usage, their associated benefits and risks. Results: Out of 225 patients who participated, a majority (72%) had insufficient knowledge of IVCM-associated risks and benefits. Both male and female patients showed a similar understanding of IVCM (p>0.05). Educated patients showed better understanding than uneducated patients (p<0.001). Similarly, employed patients demonstrated a higher level of understanding of IVCMs compared to unemployed patients (p<0.05). Moreover, 63.5%, 45.3% and 62.2% of patients believed that IVCM caused cancer, cardiovascular disorders, and adverse allergic reactions, respectively. Moreover, 52.4%, 33.3% and 49.3% of patients believed that IVCM caused shortness in breath, loss of consciousness and increase of heart rate, respectively. In addition, 29.3%, 62.2% and 20.0% of patients also advised diarrhea, itching and convulsion, respectively. Conclusion: Overall, patients’ knowledge was unsatisfactory for understanding contrast media in radiology. This study recommends that the Ministry of Health, Saudi Arabia, should arrange frequent awareness programs on contrast media in Qassim.

Contrast-associated acute kidney injury following intravenous contrast media computed tomography; new concept and future directions: A systematic review study on emergencies patients

Introduction: Computed tomography (CT) is a key method for various disorders. Image can be more quality with intravenous contrast media, however in some cases may be accompanied by a risk of kidney impairment. Objectives: This study aimed to investigate the association between acute kidney injury incidence and intravenous contrast media for CT in emergency patients. Methods and Materials: Search strategies were performed using standard keywords across international databases such as Web of Science, Scopus, Cochrane, PubMed, and Embase. Dimension, OpenGrey, DOAJ, CINAHL, and Google Scholar search engines were searched for a complete search. Additionally, manual searching was conducted using the references of related articles. Studies that reported the correlation between acute kidney injury incidence and intravenous contrast media were included in this systematic review. Results: First, 1185 studies were identified. After duplication, 533 studies remained and 417 were excluded. Out of 116 evaluated studies for retrieval, 49 were eliminated and 67 were assessed for eligibility. Ultimately, 28 studies with 48878 patients were included in the final review. Most of the studies were retrospective cohorts and have found no significant correlation between the incidence of acute kidney injury and intravenous contrast media administration (ICMA) for CT. Conclusion: Intravenous contrast media with a conventional dose for CT does not cause acute kidney injury unless in the presence of a particular condition. Registration: This study was compiled following the PRISMA checklist and its protocol was registered on the PROSPERO (CRD42023448461) and Research Registry (UIN: reviewregistry1690) websites.

Case 324.

A 69-year-old right-handed man with a history of substance use disorder, hypertension, and diabetes presented to the emergency department in an unresponsive state. Upon examination, apart from tachycardia (heart rate, 108 beats per minute), vital signs were within normal ranges (blood pressure, 134/102 mm Hg; temperature, 97.9°F [36.6°C]; respiratory rate, 16 breaths per minute; oxygen saturation, 96%). He had a Glasgow coma scale score of 8. Otherwise, the physical examination revealed no abnormalities. His prior psychiatric and surgical histories were unremarkable. There was no history of recent travel, camping, hiking, or vaccination. No family history could be obtained. Laboratory work-up revealed an elevated creatine kinase level (49 006 U/L [818.4 μkat/L]; normal reference range, 10-205 U/L [0.17-3.42 μkat/L]). An electrocardiogram showed sinus tachycardia without evidence of cardiac ischemia. An echocardiogram was unremarkable. Alanine aminotransferase (126 U/L [2.10 μkat/L]; normal reference range, 0-40 U/L [0-0.67 μkat/L]) and aspartate aminotransferase (488 U/L [8.15 μkat/L]; normal reference range, 3-44 U/L [0.05-0.74 μkat/L]) levels were elevated. Polymerase chain reaction results were negative for HIV-1, HIV-2, syphilis treponemal, and COVID-19 antibodies. The rest of the routine laboratory work-up findings were within normal limits. Urine drug screening was positive for cocaine, marijuana, fentanyl, and benzodiazepines. Naloxone was administered, but the patient remained unresponsive. Intubation was performed for airway protection. Noncontrast and contrast-enhanced CT of the head (Fig 1) and CT angiography were performed in the emergency department to rule out an acute intracranial abnormality. Multisequence MRI of the brain with administration of intravenous contrast material was ordered for further assessment (Figs 2-4). CT of the abdomen and pelvis was unremarkable (images not shown).

Infection prevention and control in CT Part 2: Radiographers' and radiology nurses' perceptions of high-risk scenarios contributing to non-adherence to IPC protocols

IntroductionAdherence to standard and transmission-based precautions in the computed tomography (CT) setting is central to effective infection prevention and control (IPC), yet there is limited evidence about medical imaging (MI) professionals' self-reported predictors of IPC breaches. This is the second of a two-part series on IPC in the CT setting. Part 1 reported on Australian baseline data relating to intravenous contrast media administration and power injectors. Part 2 presents Australian radiographers' and radiology nurses' perceptions of clinical situations that reduce adherence to standard and transmission-based precautions in CT. MethodsA self-administered survey was distributed to Australian radiographers and radiology nurses working in CT. Responses to an open-ended question “If I was to not adhere to the standard and transmission-based precautions in the CT department, it is most likely when …” was analysed using inductive coding for themes, followed by deductive analysis mapped to the Systems Engineering Initiative for Patient Safety (SEIPS) model. ResultsStudy participants (n = 136) were radiographers (n = 119; 87.5%) and nurses (n = 17; 12.5%). ‘Four themes were derived from the inductive analysis: (1) high-risk working conditions, (2) compliance with good practice, (3) attitudes and practice, and (4) quality of communication. Deductive analysis, using the SEIPS domains revealed that predominant issues related to ‘Tasks’ (43.7%) and ‘Organisation’ (30.6%) followed by issues related to ‘Person’ (16.9%), ‘Tools and technology’ (6.9%) and ‘Environment’ (1.9%). ConclusionMulti-faceted pressures on radiology staff may compromise adherence to standard and transmission-based precautions in CT. Task difficulty, time pressures whilst undertaking tasks, and reduced staffing could lead to lower adherence to standard and transmission-based precautions. Implications for practiceFuture studies that focus on evaluation of ‘Tasks’ and ‘Organisation’ domains of the SEIPS model may provide further insights to non-adherence behaviours in MI.

Infection prevention and control in CT Part 1: An Australian study of roles, responsibilities and practices

IntroductionThe computed tomography (CT) suite presents Infection Prevention and Control (IPC) risks for staff and patients. This is the first of a two-part series on IPC in the CT setting and reports on Australian baseline data related to intravenous contrast media administration and the use of power injectors in the CT suite, including knowledge sources related to the delivery of contrast media. The second part provides insights into CT staff's perceptions of high-risk scenarios for non-adherence to standard or transmission-based precautions. MethodsThe study employed an online survey design, directed at radiographers and radiology nurses working in Australia. The survey included questions relating to CT workplace staffing and equipment, contrast media use and occupational roles, and knowledge sources used for infection control and contrast injectors. ResultsOverall, 160 study participants completed the survey (radiographers: n = 138, 86.3%; nurses: n = 22, 13.7%). Differences were identified between public and private practice. Public hospitals completed more contrast-enhanced scans, and with dual injecting systems, operated and cleaned by radiographers and nurses. Private clinics generally used single-system, power injectors. Radiographers and nurses relied heavily on their colleagues and product guidelines for IPC information. IPC teams were uncommon in private clinics, very common in public departments and 50% of respondents had undertaken IPC training in the last 12 months. ConclusionInsights into use and duties of professionals delivering intravenous contrast media administration using power injectors in the CT suite will help to inform decision-making processes on IPC education strategies and map risk. Implication for practiceFuture research should focus on how radiology workers in CT perceive IPC risk and/or might vary from best practice, which has direct clinical implications for safety if contamination, or incorrect information is routinely applied.

Diagnostic accuracy of Perfusion Computed tomography (PCT) for diagnosis of colorectal carcinoma (CRC) taking histopathology as gold standard.

Objective: To determine diagnostic accuracy of Profusion Computed tomography (PCT) for diagnosis of colorectal carcinoma (CRC) taking histopathology as gold standard. Study Design: Descriptive, Cross-sectional. Setting: Department of Radiology, Allied Hospital Faisalabad. Period: 10th March 2022 to 9th September 2022. Material & Methods: A total of 451 patients with colorectal cancer suspicion and ages 50-80 years of either gender were included in the study. Patients having severe renal disease, preoperative radiation therapy or chemotherapy, no surgical intervention after CT, contrast media contraindication, pathologically benign colorectal mass, and tumor depth less than 2 cm based on CT were not included. Pre-operative perfusion CTs was performed on all patients. Dynamic perfusion CTs were performed for 65 seconds following intravenous administration of contrast media, and blood flow (BF) and blood volume (BV) in the tumor were assessed. The surgical specimens were forwarded to the hospital's pathology laboratory, where the presence of CRC was labeled according to operational definitions. CT perfusion was performed in radiology department and results of PCT were compared with that of histopathology. Results: Sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy of Profusion Computed tomography (PCT) in diagnosing colorectal carcinoma (CRC) with histopathology being gold standard was 90.26%, 88.59%, 91.98%, 86.24% and 89.58% respectively. Conclusion: This study concludes that Profusion Computed tomography (PCT) is a highly sensitive and accurate modality for the diagnosis of colorectal carcinoma.

The Role of Multiparametric MRI in the Local Staging of Prostate Cancer.

Prostate cancer ranks as the second most frequently diagnosed cancer globally among men and stands as the fifth leading cause of cancer-related death in males. Hence, an early and precise diagnosis and staging are critical. Traditional staging is based on clinical nomograms but presents a lower performance than prostate multiparametric magnetic resonance imaging (mpMRI). Since tumor staging serves as the basis for risk stratification, prognosis, and treatment decision-making, the primary objective of mpMRI is to distinguish between organ-confined and locally advanced diseases. Therefore, this imaging modality has emerged as the optimal selection for the local staging of prostate cancer, offering incremental value in evaluating pelvic nodal disease and bone involvement, and supplying supplementary insights regarding the precise location and disease extension. As per the Prostate Imaging Reporting & Data System v2.1 guideline, a comprehensive and accurate mpMRI requires several key sequences, which include T1-weighted imaging (T1WI) and T2-weighted imaging (T2WI) for morphological assessment, with T2WI serving as the cornerstone for local staging. Additionally, diffusion-weighted imaging (DWI) and dynamic sequences acquired with intravenous administration of paramagnetic contrast medium (DCE) are crucial components. It is worth noting that while MRI exhibits high specificity, its sensitivity in diagnosing extracapsular extension, seminal vesicle invasion, and lymph node metastases is limited. Moreover, mpMRI has its own constraints and is not as effective in detecting distant metastases or evaluating lymph nodes, for which extended pelvic lymph node dissection remains the gold standard. This review aims to highlight the significance of mpMRI in prostate cancer staging and provide a practical approach to assessing extracapsular extension, seminal vesicle invasions, and the involvement of adjacent organs and lymph nodes.

An interdigitated capacitive sensor for early detection of contrast media extravasation

Contrast Media Extravasation (CMEV) is a well-known complication of intravenous administration of contrast media during computed tomography (CT) scans. It refers to the leakage of contrast media from the blood vessel into the surrounding soft tissues. As contrast media are vesicant solutions, extravasation can result in the development of adverse side effects such as erythema, tissue necrosis, and compartment syndrome. Therefore, there is an urgent clinical need to develop a device that can detect extravasation early and minimize the severity of extravasation injuries. In this work, we present a cost-effective and wearable sensor patch to aid in the early detection of extravasation via capacitive sensing. The technical feasibility of the proposed sensor was then evaluated through a series of bench-top tests and ex-vivo tests. The results showed that the sensor patch is able to distinguish between normal contrast media administration and contrast media extravasation scenarios. Our proposed sensor has shown potential for early detection of CMEV, with a decrease in capacitance being a promising indicator of extravasation. This sensor also has the potential to reduce the occurrence of extravasation events in the hospital, especially for patients at risk of extravasation. Future work includes optimizing the sensor and validating it through a clinical trial to bring it a step closer to actual commercial use.

Advanced Magnetic Resonance Imaging Sheds Light on the Distinct Pathophysiology of Various Types of Acute Sensorineural Hearing Loss.

To compare the findings of magnetic resonance imaging (MRI) with advanced protocols in patients with various types of acute sensorineural hearing loss (ASNHL). Retrospective case review. Tertiary referral center. Two hundred eighty-seven patients with ASNHL. All patients underwent MRI scanning, including heavily T2-weighted three-dimensional fluid-attenuated inversion recovery before and 4 hours after the intravenous administration of gadolinium contrast medium (delayed 3D-FLAIR). A hybrid of the reversed image of the positive endolymph signal and the native image of the perilymph signal image was constructed to visualize the endolymphatic space. The detection rates of abnormal MRI findings vary significantly among different types of ASNHL. A hyperintense signal on delayed 3D-FLAIR was observed in all patients with intralabyrinthine schwannoma or vestibular schwannoma and 20.5% of patients with idiopathic sudden sensorineural hearing loss (ISSNHL) but was rarely observed in definite Ménière's disease (MD, 2.6%). In contrast, endolymphatic hydrops (EH) was frequently observed in patients with definite MD (79.5%) but was observed much less frequently in patients with ISSNHL (11.0%). In patients with cochlear MD and ALHL, detection rates of cochlear EH were similar to those with definite MD, whereas detection rates of vestibular EH were significantly lower than in patients with definite MD. The significantly different detection rates of abnormal MRI findings among various types of ASNHL shed light on the distinct pathophysiology of each disorder. A diagnosis based on MRI findings with advanced protocols may help select treatment strategies and provide prognostic information for patients.

Feasibility of periprocedural decision on the administration of intravenous contrast media in MRI for endometriosis

PurposeTo assess the feasibility of a periprocedural decision on the administration of intravenous contrast media in MRI for endometriosis and to evaluate the frequency and reasons of contrast administrations, the corresponding MRI diagnoses, and outcome. MethodsIn this retrospective, descriptive cross-sectional single-center study all patients were included, who received a pelvic MRI for evaluation of endometriosis between April 2021 and February 2023. Frequency and reasons of optional intravenous administration of contrast media, corresponding MRI diagnoses and clinical outcome data were noted after re-review of all images, review of radiology reports and review of patients’ medical records. The decision on the administration of intravenous contrast media had been made by experienced radiologists, depending on the findings of the non-contrast sequences and the presence of ancillary questions. Results303 consecutive patients (mean age, 33.4 years +/− 8.3 [standard deviation]) were evaluated. Periprocedural decision on the administration of intravenous contrast media had been made in all cases. For 219/303 (72.3%) patients, it was decided after review of the non-contrast sequences and exclusion of ancillary questions that contrast administration was not required. 84/303 (27.7%) patients received contrast media, and the most frequent reasons were indeterminate ovarian lesion (41/84 cases, 48.8%) or suspicion of pelvic venous congestion syndrome (26/84 cases, 31.0%). No relevant differences in patient outcomes could be noted (non-contrast/contrast MRI). ConclusionsA periprocedural decision on the administration of contrast media in MRI for endometriosis is feasible with little effort. It allows the administration of contrast media to be avoided in most cases. If the administration of contrast media is deemed necessary, repeat examinations can be avoided.

#5848 ROLE OF STATINS IN THE CONTRAST-INDUCED ACUTE KIDNEY INJURY PREVENTION AFTER COMPUTED TOMOGRAPHY WITH CONTRAST MEDIA

Abstract Background and Aims Contrast-induced acute kidney injury (CI-AKI) is a serious complication of the use of iodinated contrast media (CM). A number of researches have shown that statins have a protective role in the prevention of CI-AKI due to their pleiotropic effects. The aim of the study was to assess the influence of statins on the incidence of CI-AKI after intravenous CM administration. Method A randomized controlled open-label prospective study was conducted. Statin naive patients with cardiovascular diseases referred for contrast-enhanced computed tomography (CT) were included. Exclusion criteria were the use of statins and chronic kidney disease (CKD) stages 4-5. Acute kidney injury was defined as an increase in serum creatinine level by more than 44 μmol/L (0.5 mg/dL) or 25% from baseline within 48 hours after CM administration according to KDIGO guidelines. Glomerular filtration rate was calculated using the CKD-EPI formula. Overall, 181 patients were included in the study and divided into two groups. The first group (120 people) received high doses of atorvastatin (80mg or 40mg) 24 hours after and before the CM administration, while the second group (61 people), the control group, did not receive any statin therapy. Low-osmolar solutions in an amount of 100 ml were used. All patients were given intravenous hydration with saline before the study and 24 hours later. The statistical analysis was done using IBM SPSS Statistics v26.0. Results The patients in both groups did not significantly differ in age, BMI, coexisting conditions, and medications taken (Table 1). Both groups showed an increase in average creatinine levels after CT with intravenous CM administration, however, in the group of patients receiving high doses of statins, the average level increased less, p = 0.092 (Table 2). AKI developed in 12 individuals (6.7%), 9 of them were in the control group, and 3 were in the group receiving high doses of statins, p = 0.003. The chances of AKI development in the group receiving high doses of statins were 6.95 times lower compared to the control group (OR = 6.05, 95% CI: 1.7-21.5). Most of the patients had preserved kidney function and did not suffer from diabetes mellitus. There were statistically significantly more patients with preserved kidney function in the statin group, p = 0,007, OR: 2,374 (CI 95% 1,258 - 4,479), and fewer patients with CKD 3a stage, p = 0,05, OR: 0,406 (CI 95% 0,195 – 0,844). Conclusion Despite the presence of patients at risk, the incidence of CI-AKI was 6.7%, possibly due to additional prevention of this complication with intravenous saline before and after administration of the CM. In this trial, we observed that periprocedural administration of atorvastatin in high doses for a short duration, reduced the incidence of CI-AKI.

Structural changes in lung morphology detected by MRI after modulating therapy with elexacaftor/tezacaftor/ivacaftor in adolescent and adult patients with cystic fibrosis

IntroductionElexacaftor/tezacaftor/ivacaftor (ELX/TEZ/IVA) improves CFTR function in cystic fibrosis (CF) patients homozygous or heterozygous for F508del mutation. The aim of the study was to evaluate the response to ELX/TEZ/IVA treatment both clinically and morphologically in terms of bronchiectasis, bronchial wall thickening, mucus plugging, abscess and consolidations. MethodsWe retrospectively collected data from CF patients followed at Parma CF Centre (Italy) treated by ELX/TEZ/IVA between March and November 2021. Post-treatment changes in respiratory function, quality of life, sweat chloride concentration, body mass index, pulmonary exacerbations and lung structure by chest magnetic resonance imaging (MRI) were assessed. T2-and T1-weighted sequences were acquired with a 20 min-long scanning protocol on a 1.5T MRI scanner (Philips Ingenia) without administration of intravenous contrast media. Results19 patients (32.5 ± 10.2 years) were included in the study. After 6 months of treatment with ELX/TEZ/IVA, MRI showed significant improvements in the morphological score (p < 0.001), with a reduction in bronchial wall thickening (p < 0.001) and mucus plugging (p 0.01). Respiratory function showed significant improvement in predicted FEV1% (58.5 ± 17.5 vs 71.4 ± 20.1, p < 0.001), FVC% (79.0 ± 11.1 vs 88.3 ± 14.4, p < 0.001), FEV1/FVC (0.61 ± 0.16 vs 0.67 ± 0.15, <0.001) and LCI2.5% (17.8 ± 4.3 vs 15.8 ± 4.1 p < 0.005). Significant improvement was found in body mass index (20.6 ± 2.7 vs 21.9 ± 2.4, p < 0.001), pulmonary exacerbations (2.3 ± 1.3 vs 1.4 ± 1.3 p 0.018) and sweat chloride concentration (96.5 ± 36.6 vs 41.1 ± 16.9, p < 0.001). ConclusionsOur study confirms the efficacy of ELX/TEZ/IVA in CF patients not only from a clinical point of view but also in terms of morphological changes of the lungs.

Acute severe thrombocytopenia following iodinated radiographic contrast medium infusion: a case report.

The authors report the case of a 79-year-old male patient with severe, life-threatening thrombocytopenia after administration of intravenous nonionic low-osmolarity contrast medium. His platelet count dropped from 179×109/l to 2×109/l after 1h of radiocontrast infusion. Which has returned gradually to normal level within days with corticosteroid administration and platelet transfusion. Iodinated contrast-induced thrombocytopenia is a rare complication with an unknown causative mechanism. There is no definitive treatment for this condition, with corticosteroids being used in most cases. The platelet count normalizes within a few days regardless of any interventions, but supportive treatment is important to avoid any unwanted complications. Further studies are still needed for a better understanding of the exact mechanism of this condition.

Renal outcomes following intravenous contrast administration in patients with acute kidney injury: a multi-site retrospective propensity-adjusted analysis.

Evidence of an association between intravenous contrast media (CM) and persistent renal dysfunction is lacking for patients with pre-existing acute kidney injury (AKI). This study was designed to determine the association between intravenous CM administration and persistent AKI in patients with pre-existing AKI. A retrospective propensity-weighted and entropy-balanced observational cohort analysis of consecutive hospitalized patients ≥ 18years old meeting Kidney Disease Improving Global Outcomes (KDIGO) creatinine-based criteria for AKI at time of arrival to one of three emergency departments between 7/1/2017 and 6/30/2021 who did or did not receive intravenous CM. Outcomes included persistent AKI at hospital discharge and initiation of dialysis within 180days of index encounter. Our analysis included 14,449 patient encounters, with 12.8% admitted to the intensive care unit (ICU). CM was administered in 18.4% of all encounters. AKI resolved prior to hospital discharge for 69.1%. No association between intravenous CM administration and persistent AKI was observed after unadjusted multivariable logistic regression modeling (OR 1; 95% CI 0.89-1.11), propensity weighting (OR 0.93; 95% CI 0.83-1.05), and entropy balancing (OR 0.94; 95% CI 0.83-1.05). Sub-group analysis in those admitted to the ICU yielded similar results. Initiation of dialysis within 180days was observed in 5.4% of the cohort. An association between CM administration and increased risk of dialysis within 180days was not observed. Among patients with pre-existing AKI, contrast administration was not associated with either persistent AKI at hospital discharge or initiation of dialysis within 180days. Current consensus recommendations for use of intravenous CM in patients with stable renal disease may also be applied to patients with pre-existing AKI.

Contrast-induced acute kidney injury and its contemporary prevention.

The complexity and application range of interventional and diagnostic procedures using contrast media (CM) have recently increased. This allows more patients to undergo procedures that involve CM administration. However, the intrinsic CM toxicity leads to the risk of contrast-induced acute kidney injury (CI-AKI). At present, effective therapy of CI-AKI is rather limited. Effective prevention of CI-AKI therefore becomes crucially important. This review presents an in-depth discussion of CI-AKI incidence, pathogenesis, risk prediction, current preventive strategies, and novel treatment possibilities. The review also discusses the difference between CI-AKI incidence following intraarterial and intravenous CM administration. Factors contributing to the development of CI-AKI are considered in conjunction with the mechanism of acute kidney damage. The need for ultimate risk estimation and the prediction of CI-AKI is stressed. Possibilities of CI-AKI prevention is evaluated within the spectrum of existing preventive measures aimed at reducing kidney injury. In particular, the review discusses intravenous hydration regimes and pre-treatment with statins and N-acetylcysteine. The review further focuses on emerging alternative imaging technologies, alternative intravascular diagnostic and interventional procedures, and new methods for intravenous hydration guidance; it discusses the applicability of those techniques in complex procedures and their feasibility in current practise. We put emphasis on contemporary interventional cardiology imaging methods, with a brief discussion of CI-AKI in non-vascular and non-cardiologic imaging and interventional studies.

Intravenous contrast induced acute kidney injury prevention with high doses of statins

Aim. The aim of our study was to assess the frequency of contrast-induced acute kidney injury (CI-AKI) in patients undergoing computed tomography (CT) with intravenous contrast media and to evaluate the effects of statins in the prevention of CI-AKI. Materials and methods. 181 patients undergoing CT with intravenous contrast media administration were included in prospective observational study (ClinicalTrials.gov ID NCT04666389). The primary endpoint was CI-AKI according to KDIGO criteria (the 25 % rise (or 0,5 mg/dl) of serum creatinine from baseline assessed 48–72 hours after administration of contrast media). There were 120 patients in the group with high dose of statins administration and 60 patients without statin treatment. The most frequent cardiovascular disease was hypertension in both groups — 93 % and 85 % respectively. Results. CI-AKI was diagnosed in 12 (6,7 %) patients — 9 patients in the no statins group and 3 patients in the statins group. The high dose statin administration statistically significant had less frequency of CI-AKI (p = 0,003) compare with no statins group (OR = 0,144, 95 %CI: 0,037–0,554). Conclusion. Statin pretreatment is effective at preventing CI-AKI and should be considered in high-risk patients.