mL Of Iohexol Research Articles

#1983 In vitro iohexol adsorption in cartridges with mesoporous styrene-divinylbenzene sorbent

Abstract Background and Aims Patients with pre-existing chronic kidney disease (CKD) present the highest risk of developing contrast-associated acute kidney injury (CA-AKI). Iodinated contrast agents such as iohexol (molecular weight 821 Da) don't bind to proteins and are easily removed by hemodialysis filters. However, the session time necessary to remove approximately 75% of the injected iohexol load is around six hours. Due to lack of evidence, current guidelines do not recommend to start hemodialysis in CKD patients in conservative management after the administration of iodinated contrast media to prevent or mitigate CA-AKI. Still, a strong rationale supports the removal of iodinated contrast media because of its nephrotoxicity. In this study, we aimed to investigate the capability of a mesoporous styrene-divinylbenzene sorbent to bind iohexol in vitro. Method We used 1,000 mL of saline solution spiked with 40 mL of iohexol 350 mg/mL in a closed-loop configuration. Iohexol concentration was 14 mg/mL. The amount of the iodinated radiocontrast was proportional to the amount used in complex percutaneous coronary interventions (worst-case scenario), around 200 mL, in a 70 kg person with an estimated blood volume of 5,000 mL. The solution circulated through a HA380 mini-module cartridge filled with 75g of mesoporous styrene-divinylbenzene sorbent beads at 250 ml/min. The experiment was carried out twice with the same setup. Samples were collected at eight-time points (0, 5, 10, 15, 20, 30, 40, and 60 minutes) from the reservoir to measure iohexol concentration. The analysis of the samples was carried out in duplicate. The removal ratio (RR) was calculated considering the initial concentration (C(0)) and the variation of the concentration during the experiment (C(t), where t is the time point), as follows: $RR( \% ) = \frac{{C( 0 ) - C( t )}}{{C( 0 )}}100$ Results In the first experiment, the removal ratios after 5, 30, and 60 minutes were 23.4%, 45.8%, and 52.9%, respectively on average. In the second experiment, the reduction ratios after 5, 30, and 60 minutes were 23.4%, 45.5%, and 53.1%, respectively on average. After 30 minutes, the adsorption curved plateaued, indicating cartridge saturation (Fig. 2). Conclusion This in vitro model demonstrated that HA380 sorbent cartridge was effective in removing iohexol. The use of hemoadsorption as a strategy to remove iodinated contrast media warrants further investigation because of its clinical potential to reduce the exposure to nephrotoxic contrast agents and CA-AKI.

High-Pitch Multienergy Coronary CT Angiography in Dual-Source Photon-Counting Detector CT Scanner at Low Iodinated Contrast Dose.

The aim of this study was to evaluate the high-helical pitch, multienergy (ME) scanning mode of a clinical dual-source photon-counting detector (PCD) computed tomography (CT) and the benefit of virtual monoenergetic images (VMIs) for low-contrast-dose coronary CT angiography (CTA). High-pitch (3.2) ME coronary CTA was performed in PCD-CT in 27 patients using low contrast dose (30 mL of iohexol 350 mg/mL) and in 26 patients at routine contrast dose (60 mL). Low-energy-threshold 120 kV images (also known as T3D images) and 50 kiloelectron volts (50 keV) and 100 kiloelectron volts (100 keV) VMIs were reconstructed using a 1024 × 1024 matrix and 0.6-mm slices. The CT numbers, noise, and contrast-to-noise ratio (CNR) were measured in the ascending aorta (AA), left main coronary artery (LMCA), and distal left anterior descending (LAD) artery. Confidence in grading luminal stenosis with calcific plaque, noncalcific plaque, and stent was evaluated by 2 independent readers on a 0-100 scale (0 the lowest), and a CAD-RADS score was assigned. Image contrast enhancement, sharpness, noise, artifacts, and overall image quality were rated using a 5-point ordinal scale (1 the lowest). The radiation doses (CTDI) in low- and routine-contrast cohorts were 2.5 ± 0.6 mGy and 3.1 ± 1.7 mGy, respectively ( P = 0.12). At all measured locations, the mean CT number was >300 HU in 120 kV (LMCA 382.9 ± 76.2, distal LAD 341.0 ± 53.9, AA 399.5 ± 76.1) and 50 keV images (LMCA 667.5 ± 139.9, distal LAD 578.1 ± 121.5, AA 700.8 ± 142.5) in the low-contrast cohort, with a 96% increase in CT numbers for 50 keV over 120 kV. The CT numbers were significantly higher ( P < 0.0001) in 50 keV than 120 kV and 100 keV VMI. The CNR was also significantly ( P < 0.0001) higher in 50 keV than 120 kV and 100 keV images in all vessels. Confidence in the assessment of luminal stenosis in the presence of calcific plaque was significantly higher ( P = 0.001) with the addition of 100 keV VMI (median score, 100) than using 50 keV alone (median score, 70) and 120 kV (median score, 70) for reader 1, but no significant differences were seen for reader 2 who had same median scores of 100 for all image types. The confidence in the assessment of luminal stenosis within a stent improved with the use of 100 keV images for both readers (reader 1: median scores for 50 + 100 keV = 100, 50 keV = 82.5, 120 kV = 82.5; reader 2: 50 + 100 keV = 100, 50 keV = 90, 120 kV = 90). There were no significant differences in confidence scores for assessment of luminal stenosis from noncalcific plaques for both readers. The reader-averaged qualitative scores for vascular enhancement and overall image quality were significantly higher for 50 keV VMI than for 120 kV images in both low- and routine-contrast dose cohorts. The image sharpness was nonsignificantly higher at 50 keV VMI than 120 kV images, and the artifact score was comparable for 50 keV VMI and 120 kV images. The noise was higher in 50 keV VMI than in 120 kV images. High-pitch ME PCD-CT mode produced diagnostic quality coronary CTA images at low radiation and iodinated contrast doses. The availability of ME VMIs significantly improved the CNR, overall image quality, and confidence in assessment of luminal stenosis in the presence of calcific plaques and stents, and resulted in change of CAD-RADS categories in 9 patients.

Confirmation of pleural displacement of central venous catheter tip in an infant, by bedside contrast injection.

A 14-week infant, with respiratory distress since birth, was referred to our institution. Chest radiography and ultrasonographic examination confirmed right-sided diaphragmatic eventration. Owing to difficulty in securing a peripheral venous access, a double-lumen 4-Fr central venous catheter (CVC) was inserted into the right internal jugular vein, under ultrasonographic guidance. Aspiration of blood from both ports confirmed intravascular placement. A frontal radiograph done after the procedure showed the catheter tip in the right atrium, hence it was withdrawn to a level just below the carina. Surgical plication of the right dome of the diaphragm was performed, following which an intercostal tube was placed. After 3 days, there was increased drainage of clear fluid. Biochemical analysis ruled out exudative effusion, hence displacement of the CVC into the pleural cavity was suspected. A frontal chest radiograph was done to confirm this, but it did not suggest CVC tip displacement. Bedside ultrasonography was done but the CVC tip could not be visualized. The patient was too unstable to perform a chest CT scan or echocardiography. Therefore, a bedside chest radiograph was taken while injecting 1 ml of iohexol (diluted with 4 ml of normal saline) into the CVC. This showed the contrast leaking out of the CVC, flowing into the mediastinal pleural space, and ultimately into the ICD tube, confirming displacement of the CVC tip. The catheter was immediately removed, and an alternate venous access was established.

CT Enterography Using Four Different Endoluminal Contrast Agents: A Comparative Study

Abstract Objectives To determine the most preferable endoluminal contrast agent among mannitol, polyethylene glycol (PEG), iohexol, and water by comparing various qualitative (distension, fold visibility, and homogeneity) and quantitative parameters (distension) along with artifacts and patient feedback for computed tomography enterography (CTE). Methods This was a prospective study including 120 patients of age more than or equal to 18 years who were randomized equally into four groups. Group 1 was given 1500 mL of 3% mannitol solution, group 2 was given 1500 mL of PEG, group 3 was given 20 mL of iohexol dissolved in 1500 mL of water, and group 4 was given 1500 mL of plain water. CTE was done and images were evaluated in axial and coronal planes. Various quantitative and qualitative parameters were taken at the level of second part of duodenum, jejunum, ileum and ileocecal junction (ICJ). Artifacts and patient feedback were also taken into consideration. Results The quantitative distension and grading, qualitative distension, fold visibility, and homogeneity of the second part of duodenum, jejunum at the level of superior mesenteric artery, inferior mesenteric artery and renal artery on both sides of abdomen, ileum at the level of aortic bifurcation, common iliac bifurcation, and deep pelvis on both sides of abdomen and ICJ were significantly more in PEG group as compared with mannitol group, followed by iohexol and water group. The results were calculated by ANOVA test using p-value. In terms of patient feedback and artifacts, water was the best agent. Conclusions PEG is the most suitable contrast agent to carry out CTE. Distension, fold visibility, and homogeneity are the essential features for a better diagnostic outcome of CTE, which was better with PEG.

Effect of stifle flexion on the position of the cranial tibial artery relative to the proximal tibia in dogs.

To determine the effect of stifle flexion on the proximity of the cranial tibial artery to the proximal tibia in canine stifles with an intact or transected cranial cruciate ligament (CCL). Ex vivo randomized blinded computed tomographic angiographic study. Fifteen pelvic limbs from eight greyhound cadavers. The femoral artery and vein were cannulated and injected with 10 mL of iohexol. Each limb was placed in lateral recumbency on an acrylic sheet with predrawn femoral and tibial lines representing angles of stifle extension. Computed tomography was performed before (limbs 1-15) and after (limbs 10-15) CCL transection. The shortest distance between the cranial tibial artery and proximal tibia (dCrTA-PT) was measured at a distance of one patellar length from medial intercondylar tubercle. Median dCrTA-PT in intact specimens at 70°, 90°, 110°, and 135° was 2.04, 2.05, 2.28, and 2.51 mm, respectively (P = .008). Pairwise comparisons identified a difference between 70° and 135° (P = .007). Mean dCrTA-PT in transected specimens at 70°, 90°, 110°, and 135° was 2.60, 2.57, 2.90, and 2.79 mm, respectively (P = .208). Median overall dCrTA-PT was 2.24 mm in intact specimens (limbs 1-15, all four angles of extension combined) and 2.76 mm in transected specimens (limbs 10-15, all angles combined; P = .01). Flexion of the stifle resulted in a negligible decrease in dCrTA-PT in intact specimens but had no effect in CCL transected stifles. The angle of stifle extension does not appear to have any clinically significant effect on the proximity of cranial tibial artery to the proximal tibia.

The Effect of Electrical Stimulation in Reducing Experimental Edema in Rats

Edema, if not reduced, can limit functional ability and cause pain and discomfort. Thus, this study aimed to determine whether electrical stimulation can reduce abdominal edema in rats. Rats were anesthetized with 0.9 mL of iohexol, which is a radiopaque agent that was injected into their abdomens. This contrast agent was used as a marker to enable the observation of its re-absorption time in the presence of an applied electrical current. Contrast agent spreading was monitored through radiographies every 30 min, which started at time 0 (T0) and lasted for 90 min (T90). Duration a session that lasted for 1 h, the amplitude of the stimulatory pulse was adjusted to 90% of the animals’ motor threshold, with a frequency of 120 Hz, and a 12.8-µs pulse. Edema reduction was not statistically significant at T0 (p = 0.515), T30 (p = 0.460), and T60 (p = 0.237) compared to the test and control groups; although, greater edema spreading was observed in the treated group at time T90 (p = 0.055). However, a statistically relevant difference occurred when the time intervals within the same group were compared (p < 0.001). This means that the spreading of the contrast agent occurred owing to a reduction in the intensity in the inspected area. High-voltage electrical stimulation (HVES) reduced simulated edema in the abdominal cavity of rats in the test group compared to that in the control group during the 90-min evaluation time, primarily during the last 30 min.

Abstract No. 377 A quantitative angiography technique using time-resolved two-dimensional digital subtraction angiography for determining treatment endpoints during partial splenic embolization

There is a relationship between extent of embolization and severity of post procedure complications for partial splenic embolization (PSE), but determining appropriate treatment endpoints is difficult due to the use of subjective angiographic assessments. The objective of this study was to determine the feasibility of using time-resolved two-dimensional digital subtraction angiography (2D-DSA, qDSA) for quantifying changes in splenic arterial and venous flow rates during PSE as a flow-based endpoint rather than a volume based one. Two female domestic swine underwent splenic artery embolizations using 100- to 300-um embolic particles reconstituted in 20 mL of iohexol 300 contrast and delivered in 1-mL aliquots. In the first embolization, blood velocity changes were assessed using DSA (2 mL/s injections) and indwelling intravascular Doppler wires (in the splenic artery and vein) after each incremental delivery of particles. In the 2nd embolization, DSAs and 4D Flow MRIs were acquired before and after embolization to analyze blood velocity changes. A post-hoc analysis of the DSA sequences used a shifted least-squares approach for calculating blood velocities1. Exceptionally high velocities were excluded from analysis due to sampling insufficiency. During incremental embolization, qDSA calculations showed a linear decrease in splenic arterial blood velocity. There was a 7.4% calculated reduction (from baseline) in velocity per 1 mL of particles delivered (R2 = 0.90). Indwelling Doppler wires in the splenic artery and vein showed correlative changes of 11.0% (R2 = 0.98) and 9.7% (R2 = 0.94) reductions in velocities per 1 mL of particles delivered respectively. In multimodal comparison, a 40.3% reduction in splenic arterial velocity was calculated via qDSA corresponding to a 64.1% reduction in velocity on MRI, and a 23.2% reduction in portal vein cross-sectional area. The calculated splenic arterial velocity decreased progressively during PSE as the degree of embolization increased. The qDSA calculations correlated with changes in splenic and portal hemodynamics measured via intravascular Doppler and MRI. With further development, qDSA may be useful for intraprocedural quantification of the degree of embolization in PSE.

Case 273.

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

Feasibility study of iterative model reconstruction combined with low tube voltage, low iodine load, and low iodine delivery rate in craniocervical CT angiography

To investigate the feasibility of iterative model reconstruction (IMR) combined with low tube voltage, low iodine load, and low iodine deliver rate in craniocervical computed tomography angiography (CTA). Sixty patients were randomly divided into two groups (n=30 for each): group A: 120 kVp, 50 ml of iopromide at a flow rate of 5 ml/s; filtered back projection (FBP) reconstruction; group B: 80 kVp, 30 ml of iohexol at 4.5 ml/s; hybrid iterative reconstruction (HIR) for group B1 and IMR for group B2. CT attenuation values, image noise, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), subjective image quality, effective dose (ED), iodine load, and iodine delivery rate (IDR) were compared. CT attenuation values of the arteries were higher in groups B1 and B2 than group A. The SNR and CNR were higher, while image noise was lower, for group B2 compared with groups B1 and A. The best subjective image quality was obtained with group B2. ED, iodine load, and IDR reduction of 69.6%, 51.4%, 27%, respectively, was obtained in group B compared with group A. IMR combined with 80 kVp and 30 ml of iohexol at a flow rate of 4.5 ml/s for craniocervical CTA can reduce ED, iodine load, and IDR, while improving image quality.

Ultralow Iodine Dose Transarterial Catheter-Directed CT Angiography for Fenestrated Endovascular Aortic Repair Planning

Preoperative planning for fenestrated endovascular aortic repair (fEVAR) requires high-quality cross-sectional imaging, most commonly computed tomography angiography (CTA). However, in the setting of chronic kidney disease (CKD), the iodine load delivered during conventional CTA is associated with risk for acute kidney injury (AKI). In this report, we describe the feasibility of using transarterial catheter directed CT angiography (tcd-CTA) with ultralow-dose iodine as an alternative for fEVAR planning in patients with stage 3-4 CKD to lower the risk of AKI. Preserum and postserum creatinine levels were retrospectively evaluated from 8 patients with stage 3-4 CKD who underwent tcd-CTA with 20mL of Iohexol for fEVAR planning for the treatment of pararenal abdominal aortic aneurysms. The tcd-CTA images were evaluated by two vascular surgeons for adequacy for fEVAR planning and progression to fEVAR completion was recorded. The mean serum creatinine before tcd-CTA was 2.1 ± .32mg/dL, and the mean estimated glomerular filtration rate was 29.7 ± 6.31mL/min/1.73m(2). After tcd-CTA, the mean serum creatinine was 1.9 ± .25mg/dL and the mean estimated glomerular filtration rate was 32.9 ± 5.12mL/min/1.73m(2). All 8 of the studies were determined to be adequate for fEVAR planning independently by two vascular surgeons. Six of the patients underwent successful fEVAR and 2 opted for watchful waiting. tcd-CTA with ultralow-dose iodine is a feasible option for pre-fEVAR planning in patients with stage 3-4 CKD.

Contrast-induced nephropathy in outpatients with preexisting renal impairment: a comparison between intravenous iohexol and iodixanol

BackgroundConcern for contrast-induced nephropathy (CIN) may result in administration of more costly agents. We prospectively compared outpatient CIN incidence of iodixanol to iohexol. MethodsPatients were randomized to receive 100ml of iohexol (n=47) or iodixanol (n=55). We compared patients who developed CIN using the Wilson score interval and also calculated an odds ratio for the development of CIN. ResultsCIN rate for iohexol was 2% compared to 9% for iodixanol. Those receiving iodixanol were almost 5 times more likely to experience CIN. ConclusionThese results do not suggest a benefit of iodixanol over iohexol in the study population.

Very low intravenous contrast volume protocol for computed tomography angiography providing comprehensive cardiac and vascular assessment prior to transcatheter aortic valve replacement in patients with chronic kidney disease

BackgroundTranscatheter aortic valve replacement (TAVR) is a lifesaving procedure for many patients high risk for surgical aortic valve replacement. The prevalence of chronic kidney disease (CKD) is high in this population, and thus a very low contrast volume (VLCV) computed tomography angiography (CTA) protocol providing comprehensive cardiac and vascular imaging would be valuable. Methods52 patients with severe, symptomatic aortic valve disease, undergoing pre-TAVR CTA assessment from 2013–4 at Columbia University Medical Center were studied, including all 26 patients with CKD (eGFR<30 mL/min) who underwent a novel VLCV protocol (20 mL of iohexol at 2.5 mL/s), and 26 standard-contrast-volume (SCV) protocol patients. Using a 320-slice volumetric scanner, the protocol included ECG-gated volume scanning of the aortic root followed by medium-pitch helical vascular scanning through the femoral arteries. Two experienced cardiologists performed aortic annulus and root measurements. Vascular image quality was assessed by two radiologists using a 4-point scale. ResultsVLCV patients had mean (±SD) age 86 ± 6.5, BMI 23.9 ± 3.4 kg/m2 with 54% men; SCV patients age 83 ± 8.8, BMI 28.7 ± 5.3 kg/m2, 65% men. There was excellent intra- and inter-observer agreement for annular and root measurements, and excellent agreement with 3D-transesophageal echocardiographic measurements. Both radiologists found diagnostic-quality vascular imaging in 96% of VLCV and 100% of SCV cases, with excellent inter-observer agreement. ConclusionsThis study is the first of its kind to report the feasibility and reproducibility of measurements for a VLCV protocol for comprehensive pre-TAVR CTA. There was excellent agreement of cardiac measurements and almost all studies were diagnostic quality for vascular access assessment.

Neutrophil Gelatinase-Associated Lipocaline (NGAL) an early predictive biomarker than Urea in contrast induced Nephropathy

Coronary angiography and percutaneous coronary interventions depend on iodinated and non- iodinated contrast media and consequently pose the risk of contrast induced acute kidney injury (AKI). This is an important complication that accounts for significant number of cases of hospital acquired renal failure, with adverse effects on prognosis and health care. Aim of this study is to evaluate Neutrophil Gelatinase- Associated Lipocalin (NGAL) as an early biomarker in AKI than that of urea. 30 animals were randomly divided into 10 different cages having 3 animals in each cage. Further cages were randomly divided into 5 groups (6 animals in a group). Dose of 0.5ml of iohexol was intraperitonealy injected into animals. Blood samples were collected by bleeding retroorbital plexus before and after inducing contrast and centrifuged serum was stored at -200c for further analysis. Increased levels of NGAL was indicated in group 2 (6 hours) and remained elevated in group 3 (12 hours) when compared to that of baseline levels before contrast. The levels of urea were increased in group 1 (3 hours) and group 3 (12 hours) after contrast when compared to level of baseline before contrast. Elevated levels of NGAL among the groups was statistically significant p&lt;0.05. The increased level of urea at the end of 3 hours is probably due to dehydration after contrast induction. Estimation of serum NGAL after contrast induced radiological procedures especially after coronary angiogram may help to detect early kidney injury, so that preventive measures can be adopted to decrease the damage caused by the contrast induction.

Efficient Loading of cisplatin into Superabsorbent Polymer Microsphere in the treatment of hepatocellular carcinoma.

Background: Although Superabsorbent Polymer (SAP) microsphere has been useful in treatment of multiple and large hepatocellular carcinoma, efficient loading procedure of cisplatin onto SAP was not established. Loading efficiency of cisplatin was evaluated from the viewpoint of passive concentration gradient and ionic strength. Methods: To load cisplatin into SAP particle, 50mg of cisplatin powder was dissolved in three manners of aqueous solutions: (a) 50mg of cisplatin powder plus 35ml of warmed physiological saline solution (0.9%), (b) 5ml of physiological saline solution (0.9%) plus a half of solution (5ml) of the product made from 50mg of cisplatin powder in 10ml of iohexol 350mgI/ml, and (c) 10ml of iohexol 350mgI/ml plus 0.25ml of 10% NaCl solution Results: Cisplatin dissolved sufficiently in all the three methods. Average amounts of loaded cisplatin into SAP particles were 1.7mg in solution (a), 6.6mg in solution (b), and 11.8mg in solution (c). Since alteration of ionic strength in the method (c) significantly affect the extent of SAP swelling, addition of 0.25ml of 10% NaCl was unquestionably necessary. Release of cisplatin from SAP was evidently gradual, showing 83.1% after 6 hours in static elution experiment and 68.6% after 1 hour in dynamic elution experiment. Conclusions: Cisplatin-loaded SAP may act as a drug delivery system for treatment of liver cancer, and loading of cisplatin should be consciously performed considering cisplatin concentration and ionic strength. (225words)

CT Ventriculography for diagnosis of occult ventricular cysticerci

Background:Neurocysticercosis is the most common parasitic infection of the central nervous system (CNS). Intraventricular lesions are seen in 7–20% of CNS cysticercosis. Intraventricular lesions can be missed by computed tomography (CT) and magnetic resonance imaging (MRI) as they are typically isodense/isointense to the cerebrospinal fluid. We present our experience with CT ventriculography to visualize occult cysts.Case Description:Two patients presented with hydrocephalus and suspected neurocysticercosis were evaluated with CT and MRI with and without contrast failing to reveal intraventricular lesions. CT-ventriculography was used: 10 ml of cerebrospinal fluid was drained from the ventriculostomy catheter, and 10 ml of iohexol 240 diluted 1:1 with preservative-free saline was injected through the ventriculostomy catheter. Immediate CT of the brain was performed. The first patient had multiple cysts located throughout the body of the left lateral ventricle. The second patient had a single lesion located in the body of the lateral ventricle. The CT-ventriculography findings helped in identifying the lesions and plan the surgical intervention that was performed with the aid of an endoscope to remove the cysts.Conclusions:Intraventricular neurocysticercosis is a common parasitic disease which can be difficult to diagnose. We used CT-ventriculography with injection of contrast through the ventriculostomy catheter in two patients where CT and MRI failed to demonstrate the lesions. This technique is a safe and useful tool in the imaging armamentarium when intraventricular cystic lesions are suspected.

Case 146: Benign Multicystic Mesothelioma

History A 27-year-old gravida 1, para 1 woman who had a history of pelvic inflammatory disease presented to the emergency department with lower abdominal pain, nausea, vomiting, and chills. She began menstruating the night before presentation and reported an acute exacerbation of her chronic abdominal pain, which typically worsened with her menses. Her surgical history included one caesarean section and laparoscopic excision of a tubo-ovarian abscess. She was afebrile. Physical examination revealed mild diffuse abdominal tenderness and tenderness of the cervix. Laboratory findings revealed a white blood cell count of 17 000 cells per cubic millimeter. (A normal white blood cell count is between 4800 and 11 000 cells per cubic millimeter.) Ultrasonography (US) of the pelvis was performed. A computed tomographic (CT) examination of the abdomen and pelvis was subsequently performed after intravenous administration of 125 mL of iohexol (Omnipaque; Amersham Health, Princeton, NJ). We acquired 5-mm axial sections and performed 3-mm coronal reconstruction.

Case 146

HomeRadiologyVol. 250, No. 2 PreviousNext Diagnosis PleaseFree AccessCase 146Phillip J. Koo, John S. WillsPhillip J. Koo, John S. WillsAuthor Affiliations1From the Department of Radiology, Pennsylvania Hospital, University of Pennsylvania Health System, 800 Spruce St, Philadelphia, PA 19107. Received July 13, 2007; revision requested September 10; revision received October 8; accepted December 17; final version accepted February 19, 2008.Address correspondence to P.J.K. (e-mail: [email protected]).Phillip J. KooJohn S. WillsPublished Online:Feb 1 2009https://doi.org/10.1148/radiol.2502071233MoreSectionsPDF ToolsImage ViewerAdd to favoritesCiteTrack CitationsPermissionsReprints ShareShare onFacebookTwitterLinked InEmail HISTORYA 27-year-old gravida 1, para 1 woman who had a history of pelvic inflammatory disease presented to the emergency department with lower abdominal pain, nausea, vomiting, and chills. She began menstruating the night before presentation and reported an acute exacerbation of her chronic abdominal pain, which typically worsened with her menses. Her surgical history included one caesarean section and laparoscopic excision of a tubo-ovarian abscess. She was afebrile. Physical examination revealed mild diffuse abdominal tenderness and tenderness of the cervix. Laboratory findings revealed a white blood cell count of 17 000 cells per cubic millimeter. (A normal white blood cell count is between 4800 and 11 000 cells per cubic millimeter.)Ultrasonography (US) of the pelvis was performed (,Figs 1, ,2). A computed tomographic (CT) examination of the abdomen and pelvis was subsequently performed after intravenous administration of 125 mL of iohexol (Omnipaque; Amersham Health, Princeton, NJ). We acquired 5-mm axial sections and performed 3-mm coronal reconstruction (,Figs 3, ,4).Submit the most likely diagnosis to http://rsna.org/dxplease (use only for submission of diagnosis). Select the case from the Active Case List for which you are submitting a diagnosis. Only one case, one name, and one diagnosis per e-mail submission. Multiple diagnoses and multiple submissions will not be considered. Deadline: Midnight U.S. Central Time, April 10, 2009. Answer will appear in the June issue. Authors wishing to submit cases for Diagnosis Please should first write to the Editor to obtain approval for the case and further information.Figure 1: Sagittal transabdominal US image of the left adnexa.Figure 1:Download as PowerPointOpen in Image Viewer Figure 2: Axial transabdominal Doppler US image of the right lower quadrant of the abdomen.Figure 2:Download as PowerPointOpen in Image Viewer Figure 3: Oral (20 mL iohexol diluted with 430 mL of water) and intravenous contrast material–enhanced axial CT image of the pelvis.Figure 3:Download as PowerPointOpen in Image Viewer Figure 4: Oral and intravenous contrast-enhanced coronal CT image of the abdomen and pelvis.Figure 4:Download as PowerPointOpen in Image Viewer Authors stated no financial relationship to disclose.Article HistoryPublished in print: 2009 FiguresReferencesRelatedDetailsRecommended Articles Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic CorrelationRadioGraphics2016Volume: 36Issue: 5pp. 1579-1596Case 268Radiology2019Volume: 291Issue: 1pp. 259-260Imaging of Peritoneal Dialysis Complications in ChildrenRadioGraphics2022Volume: 42Issue: 2pp. 559-578Interventional Radiology Placement and Management of Tunneled Peritoneal Dialysis Catheters: A Pictorial ReviewRadioGraphics2020Volume: 40Issue: 6pp. 1789-1806Imaging Evaluation of Fallopian Tubes and Related Disease: A Primer for RadiologistsRadioGraphics2020Volume: 40Issue: 5pp. 1473-1501See More RSNA Education Exhibits Pelvic Inflammatory Disease: Essentials of ImagingDigital Posters2018Danger in the Pelvis!!: A Case-based Review of Female Pelvic Emergencies on MDCTDigital Posters2020A Trainee’s Guide to Ovarian Emergencies in the EDDigital Posters2018 RSNA Case Collection Early pelvic inflammatory diseaseRSNA Case Collection2020Meckel's diverticulitisRSNA Case Collection2021Fitz-Hugh-Curtis syndromeRSNA Case Collection2021 Vol. 250, No. 2 Metrics Downloaded 323 times Altmetric Score

Case 127: Henoch-Schonlein Purpura

Pamela T. Johnson, MD Karen M. Horton, MD Elliot K. Fishman, MD History A 37-year-old man presented to his physician with sharp and continuous upper abdominal pain. Upper endoscopy was performed for evaluation and revealed Helicobacter pylori–negative gastritis. Treatment with a proton pump inhibitor failed to alleviate his symptoms. The patient subsequently developed diarrhea and dark stools, followed by a petechial rash that involved his lower extremities. At this point, he was admitted to an outside hospital for evaluation. Colonoscopy and repeat endoscopy revealed nothing that could account for his symptoms. After an observation period, he was discharged. The patient’s abdominal pain persisted and worsened. In addition, he felt feverish and developed joint pain, which was most severe in his knees and wrists. Three weeks after the initial episode, he was readmitted to the hospital with intractable abdominal pain and new onset of vomiting. At admission, a petechial rash with regions of purpura was noted on his thighs and calves. A similar rash with a maculopapular appearance was apparent on his upper extremities. Laboratory tests revealed an elevated erthrocyte sedimentation rate and a minimally elevated platelet count. Antinuclear antibody test results were negative. Intravenous contrast material–enhanced multidetector computed tomography (CT) of the abdomen and pelvis was performed the next day, with 120 mL of iohexol (Omnipque 350; GE Healthcare, Princeton, NJ) infused at a rate of 3 mL/sec.

Pancreas: Patient Body Weight–tailored Contrast Material Injection Protocol versus Fixed Dose Protocol at Dynamic CT

To prospectively compare the effect of a protocol with a fixed contrast material injection dose and one with a dose tailored to patient body weight on pancreatic enhancement at dynamic computed tomography (CT) of the pancreas. This study was approved by the institutional review board, and patients gave informed consent. Seventy-eight patients suspected of having pancreatic tumor were randomly assigned to one of two protocols (39 patients in each protocol). In protocol 1, a fixed contrast material dose (120 mL of iohexol 300) was delivered at an injection rate of 4.0 mL/sec; in protocol 2, a dose tailored to the patient's body weight (2.0 mL/kg) was injected over the course of 30 seconds. Scans were started 25, 45 (pancreatic parenchymal phase [PPP]), and 70 (portal venous phase [PVP]) seconds after the initiation of contrast material injection. Pancreatic enhancement during the PPP and hepatic enhancement during the PVP were compared by using the Student t test in patients whose body weight was less than 60 kg (group A) or 60 kg or greater (group B). A radiologist who was blinded to the injection protocol used measured the CT number of each organ. With protocol 1, mean pancreatic enhancement during the PPP was 94.1 HU in group A and 76.1 HU in group B; the difference was statistically significant (P = .02). With protocol 2, mean pancreatic enhancement was 89.5 HU in group A and 84.7 HU in group B; there was no significant difference (P = .45). Mean hepatic enhancement with protocol 1 during the PVP was 59.6 HU in group A and 48.5 HU in group B (P < .01); with protocol 2, it was 55.4 HU in group A and 58.3 HU in group B. The difference was not statistically significant (P = .34). The dose protocol tailored to the patient's body weight yielded satisfactory pancreatic and hepatic enhancement irrespective of patient weight.

Case 120: Ischemic Colitis Limited to the Cecum

A 75-year-old woman presented to the emergency department and reported new onset of diffuse abdominal cramps, nausea, fever, and chills. The patient had an extensive history of cardiac procedures, including placement of an aortic valve prosthesis and cardiac catheterization performed 10 days prior to the current admission. Her medical history was also notable for long-standing celiac sprue and acute appendicitis at age 13 that was treated with appendectomy. The patient denied recent foreign travel. Physical examination revealed mild right lower quadrant tenderness without signs of peritonitis and a fever of 100.4°F (38.0°C). White blood cell count, including absolute neutrophil count, was normal. Computed tomographic (CT) examination of the abdomen and pelvis was performed with only intravenous contrast material (100 mL of iohexol, Omnipaque 300; Amersham Health, Princeton, NJ) on day 1 and with both oral (15 g of diatrizoate sodium in 24 oz of water; Hypaque Sodium, Amersham Health) and intravenous contrast material on day 2.