Nonionic Iodinated Contrast Media Research Articles

Safety of non-ionic contrast media in CT examinations for out-patients: retrospective multicenter analysis of 473,482 patients.

This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China. A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type. Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p = 0.035) and autumn (adjusted OR = 1.925; p < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence. The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol. In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity. • The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn.

Safety asssessment of iopromide contrast media: a narrative review focusing on adverse events

Abstract Many clinical contexts require radiological exams based on contrast media administration. Iodinated contrast media (ICM) represents one of the most studied contrast agents often used in radiological examinations. ICM vary widely in their physicochemical properties, clinical uses, as well as in the incidence of adverse reactions (ARs). Therefore, a basic understanding of ARs occurrence, risk factors, clinical features, and management of ICM is increasingly important in clinical practice. Iopromide is a nonionic ICM widely used in clinical practice due to its favourable safety profile and numerous applications. This narrative review provides a comprehensive report of the available data concerning iopromide ARs. It also analyses iopromide ARs occurrence and frequency with diverse potential risk factors such as age, sex and pre-existing conditions.

Incidence and severity of nonionic low-osmolar iodinated contrast medium-related adverse drug reactions in the Republic of Korea: Comparison by generic.

We aimed to report the incidence and severity of nonionic low-osmolar iodine contrast medium (ICM)-related adverse drug reactions (ADRs) in the Republic of Korea, by analyzing data from our single tertiary institution and published Korean reports, and to determine whether there is a difference in the incidence of ICM-related ADR by ICM generics. A total of 1,161,419 consecutive contrast-enhanced computed tomography (CT) examinations between January 2016 and December 2021 at Asan Medical Center were included. A systematic search of the literature investigating the incidence of ICM-related ADR in the Republic of Korea published up to December 31, 2021 was performed. We pooled these outcomes with those of our study using a binomial-normal model, and the pooled incidences of ADRs were compared among ICM generics using chi-square tests. Seven studies with a total of 2,570,986 contrast-enhanced CT examinations from 12 institutions were included. The pooled incidences of overall, mild, moderate, and severe ICM-related ADRs in the Republic of Korea were 0.82% (95% CI: 0.61%-1.10%), 0.72% (95% CI: 0.50%-1.04%), 0.11% (95% CI: 0.08%-0.15%), and 0.013% (95% CI: 0.010%-0.018%), respectively. In multiple pairwise comparisons, there were no significant differences in the overall incidence of ADRs between ICM generics, except iomeprol versus iobitridol and iomeprol versus iohexol. For moderate and severe ADRs, there were no significant differences in ADR incidence between ICM generics. The incidence of moderate and severe ICM-related ADRs did not differ among ICM generics. Our results suggest that no restriction is required for selection among nonionic low-osmolar ICMs.

Effects of Fasting versus Non-Fasting on Emetic Complications in Radiological Examinations Using Intravascular Non-Ionic Iodinated Contrast Media: A Systematic Review and Meta-Analysis.

To compare the incidence of aspiration pneumonia, nausea, and vomiting after intravascular administration of non-ionic iodinated contrast media (ICM) between patients who fasted before contrast injection and those who did not. Ovid-MEDLINE and Embase databases were searched from their inception dates until September 2022 to identify original articles that met the following criteria: 1) randomized controlled trials or observational studies, 2) separate reports of the incidence of aspiration pneumonia, nausea, and vomiting after intravascular injection of non-ionic ICM, and 3) inclusion of patients undergoing radiological examinations without fasting. A bivariate beta-binomial model was used to compare the risk difference in adverse events between fasting and non-fasting groups. The I² statistic was used to assess heterogeneity across the studies. Ten studies, encompassing 308013 patients (non-fasting, 158442), were included in this meta-analysis. No cases of aspiration pneumonia were reported. The pooled incidence of nausea was 4.6% (95% confidence interval [CI]: 1.4%, 7.8%) in the fasting group and 4.6% (95% CI: 1.1%, 8.1%) in the non-fasting group. The pooled incidence of vomiting was 2.1% (95% CI: 0.0%, 4.2%) in the fasting group and 2.5% (95% CI: 0.7%, 4.2%) in the non-fasting group. The risk difference (incidence in the non-fasting group-incidence in the fasting group) in the incidence of nausea and vomiting was 0.0% (95% CI: -4.7%, 4.7%) and 0.4% (95% CI: -2.3%, 3.1%), respectively. Heterogeneity between the studies was low (I² = 0%-13.5%). Lack of fasting before intravascular administration of non-ionic ICM for radiological examinations did not increase the risk of emetic complications significantly. This finding suggests that hospitals can relax fasting policies without compromising patient safety.

Transient Small Bowel Angio-oedema Secondary to Intravenous Iodinated Contrast Medium

We report the clinical profile and computed tomography (CT) findings of a rare case of transient angio-edema of the small bowel following intravenous administration of non-ionic iodinated contrast material in a 36-year-old woman. The pre-contrast CT showed normal small bowel and large bowel wall thickness. Findings included long segment, circumferential bowel wall thickening involving the duodenum, jejunum, and almost the entire ileum on CT scan obtained following the intravenous contrast material injection. The large bowel wall appeared normal in post contrast images also. There was no mesenteric fat stranding, ascites or significant lymphadenopathy. This entity, like most contrast-induced adverse reactions, has a favorable clinical outcome with aggressive clinical monitoring and supportive measures.

Comparing the toxicity of iodinated X-ray contrast media on eukaryote- and prokaryote-based quantified microarray assays

This study compared the toxicity mechanisms of four X-ray-based iodinated contrast media (ICM) on Escherichia coli (E. coli) and yeast microarray assays, aiming to determine the diverse toxicity mechanisms among different exposed organisms and the relationship between toxicity and their physical and chemical characteristics. The conventional phenotypic endpoint cytotoxicity and the change in reactive oxygen species (ROS) level were employed in conjunction with toxicogenomics to quantify changes in the gene/protein biomarker level in the regulation of different damage/repair pathways. The results showed that molecular toxicity endpoints, named transcriptional effect level index (TELI) and protein effect level index (PELI) for E. coli and yeast, respectively, correlated well with the phenotypic endpoints. Temporal altered gene/protein expression profiles revealed dynamic and complex damage/toxic mechanisms. In particular, compared with E. coli cells, yeast cells exposed to ICM exhibited significantly higher stress intensity and diverse stress types, resulting in stress or damage to the organism. The toxic mechanisms of ICM are concentration/property-dependent and relevant to the cellular structure and defense systems in prokaryotes and eukaryotes. In particular, the toxicity of ionic ICM is higher than that of non-ionic ICM, and eukaryotes are more susceptible than prokaryotes to ICM exposure.

TEKNIK SPLIT BOLUS TERHADAP INFORMASI ANATOMIS PADA PEMERIKSAAN CT SCAN UROGRAFI

Background : The split bolus technique in CT Scan urography is an intravenous contrast media insertion technique by combining two phases, namely the nephrography phase and the excretory phase in one scan acquisition. In general, the CT Scan urography examination uses 3 phases, non-contrast phase, the nephrographic phase, and the excretory phase. In the role of the split bolus technique, the combination of two phases, namely the nephrographic and excretory phases. The purpose of this study was to explain the split bolus technique and the role of the split bolus technique on anatomical information in CT Scan urography.&#x0D; Methods : This type of descriptive research using a literature review approach. The keywords used are "Split-bolus", "CT Scan Urography". Articles were obtained based on inclusion and exclusion criteria and 7 relevant scientific articles were obtained and were used as literature sources. Data processing through article extraction.&#x0D; Result : The split bolus technique in CT Scan urography examination is a technique of intravenous contrast media that combines two nephrographic and excretory phases in one image acquisition with an average flow rate of 1.5 ml - 3 ml / s. This technique uses a non-ionic iodine contrast medium with a volume of 90 ml - 135 ml and a concentration of 300 mg/ml-370 mg/ml. The role of the split bolus technique on radiation dose and anatomical image information is due to the merging of the two phases in one scan which addresses the anatomy of the urinary system. In addition, the split bolus technique when combined with several reconstructions is able to increase contrast resolution and increase organ enhancement. In this technique, it is better to use the addition of a reconstruction algorithm such as 3D MIP, so that the anatomical image information obtained is more optimal.

A systematic review of the incidence of hypersensitivity reactions and post-contrast acute kidney injury after ioversol: part 2—intra-arterial administration

ObjectivesTo evaluate the incidence of adverse drug reactions (ADRs), including hypersensitivity reactions (HSRs) and post-contrast acute kidney injury (PC-AKI), after intra-arterial (IA) administration of ioversol.Methods and materialsA systematic literature search was performed (1980–2021) and studies documenting IA use of ioversol, and reporting safety outcomes were selected. Key information on study design, patients’ characteristics, indication, dose, and type of safety outcome were extracted.ResultsTwenty-eight studies (including two pediatric studies) with 8373 patients exposed to IA ioversol were selected. Studies were highly heterogenous in terms of design, PC-AKI definition, and studied population. PC-AKI incidence after coronary angiography was 7.5–21.9% in a general population, 4.0-26.4% in diabetic patients, and 5.5–28.9% in patients with chronic kidney disease (CKD). PC-AKI requiring dialysis was rare and reported mainly in patients with severe CKD. No significant differences in PC-AKI rates were shown in studies comparing different iodinated contrast media (ICM). Based on seven studies of ioversol clinical development, the overall ADR incidence was 1.6%, comparable to that reported with other non-ionic ICM. Pediatric data were scarce with only one study reporting on PC-AKI incidence (12%), and one reporting on ADR incidence (0.09%), both after coronary angiography.ConclusionsAfter ioversol IA administration, PC-AKI incidence was highly variable between studies, likely reflecting the heterogeneity of the included study populations, and appeared comparable to that reported with other ICM. The rate of other ADRs appears to be low. Well-designed studies are needed for a better comparison with other ICM.Key Points• PC-AKI incidence after IA administration of ioversol appears to be comparable to that of other ICM, despite the high variability between studies.• The need for dialysis after IA administration of ioversol is rare.• No obvious difference was found regarding the safety profile of ioversol between IA and IV administration.

Mortality rate of birds following intravenous administration of iodinated contrast medium for computed tomography.

To identify potential risk factors for death following IV or intraosseous (IO) administration of contrast medium in birds undergoing CT scans. 120 birds that underwent 134 contrast-enhanced CT scans. Medical records of birds of any species that underwent a CT scan which included administration of nonionic iodinated contrast medium from June 2013 to February 2020 were included. Information on birds and use of contrast medium was extracted from the medical records as well as information on deaths following IV or IO administration of contrast medium. 6 birds died shortly following administration of contrast medium. Necropsies were performed in 3 birds (2 cockatiels and 1 macaw), and all had lesions associated with the respiratory tract. When body weight was used as a binary variable to compare odds of death between small birds (≤ 150 g [0.33 lb]) and large birds (> 150 g), small birds had a 97-fold increased odds (OR, 97.5; 95% CI, 9.8 to 966.0) of dying following contrast medium administration. Following 131 CT scans with contrast medium administration (3 scans were excluded because of perivascular or subcutaneous leakage of contract medium), small birds had a mortality rate of 45.4% (5/11), compared with a mortality rate of 0.8% (1/120) for large (> 150 g) birds. Other variables (ie, sex, age, anesthesia or sedation, sedation protocol, and type of contrast medium) were not significantly associated with death after contrast medium administration. Although the administration of contrast medium cannot be conclusively confirmed as the cause of death in these birds, the high mortality rate for small birds coupled with the temporality of the event following contrast medium administration justifies the cautious use of contrast medium in small sick psittacine birds.

Practice parameters for diagnosing and managing iodinated contrast media hypersensitivity.

Immediate and nonimmediate hypersensitivity reactions to iodinated contrast media (ICM) have been reported to occur in a frequency of about 0.5%-3% of patients receiving nonionic ICM. The diagnosis and management of these patients vary among guidelines published by various national and international scientific societies, with recommendations ranging from avoidance or premedication to drug provocation test. This position paper aims to give recommendations for the management of patients with ICM hypersensitivity reactions and analyze controversies in this area. Skin tests are recommended as the initial step for diagnosing patients with immediate and nonimmediate hypersensitivity reactions; besides, they may also help guide on tolerability of alternatives. Re-exposition or drug provocation test should only be done with skin test-negative ICMs. The decision for performing either re-exposition or drug provocation test needs to be taken based on a risk-benefit analysis. The role of in vitro tests for diagnosis and pretreatment for preventing reactions remains controversial.

Frequency of Acute and Late Reaction of Non-Ionic Iodinated Contrast Media in Contrast Enhanced Computed Tomography

Introduction: A contrast agent is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, and enhance the radio density in a target tissue or structure. Contrast agents are commonly used to improve the visibility of blood vessels and the gastrointestinal tract. Several types of contrast agent are in use in medical imaging and they can roughly be classified based on the imaging modalities where they are used and the purposes of this study to find out the frequency of adverse reactions of non-ionic iodinated contrast media in contrast enhanced Computed Tomography. Material Methods: It was cross-sectional observational study conducted on 133 patients who visited Al-Razi healthcare hospital, Lahore for a CT (computed Tomography) scan. 36 of them got adverse reactions to the non-ionic contrast media. The frequency of adverse reactions happening with the non-ionic contrast usage was determined Results: In this study, one hundred and thirty-three patients who fulfilled the criteria were included in the study. 36 of the patients had adverse reactions to the non-ionic contrast media which included shivering, fatigue, headache, nausea and rashes. All of the patients had no previous history of allergies or contrast reactions. The mean age of patients ranged from 51.49 ± 16.19years. Conclusion: In conclusion, the use of non-ionic contrast media as a CT contrast agent has a safety profile. It is concluded that a non-ionic iodinated contrast media reaction rarely results in long-term sequelae as it is less severe and easily treatable. Keywords: Non-Ionic Iodine Contrast Media, Computed Tomography, Adverse Reactions DOI: 10.7176/JHMN/88-05 Publication date: April 30 th 2021

Contrast-induced acute kidney injury in acute ischaemic stroke patients.

The potential nephrotoxicity of intravenous iodinated contrast media is a major concern for acute ischaemic stroke imaging evaluation. This study aimed to assess the incidence of acute kidney injury after intravenous iodinated contrast media exposure in acute ischaemic stroke patients. We conducted a retrospective cohort analysis between January 2012 and July 2018 to select adult patients admitted to the emergency department with acute ischaemic stroke. The exposed patients received a uniform intravenous dose of low osmolar non-ionic iodinated contrast media, as part of the imaging protocol for acute ischaemic stroke. The unexposed patients underwent a non-enhanced cranial computed tomography scan. Acute kidney injury was defined according to the Kidney Disease Improving Global Outcomes criteria, limited to the first 72 hours. A total of 161 and 105 patients were included in the exposed and unexposed groups, respectively. The median age was 72.8 years (interquartile range 20), 53% were men and 97% were white. Demographic and baseline characteristics were similar between the groups. The incidence of acute kidney injury between exposed (n = 10, 6.2%) and unexposed (n = 1, 1%) groups (P = 0.073) was similar and contrast exposure was not a significant predictor of acute kidney injury. Intravenous iodinated contrast media exposure during acute ischaemic stroke imaging protocols is not an independent predictor of acute kidney injury in patients with normal or near-normal renal function. Studies with larger sample sizes would help to clarify if patients with both cardiovascular risk factors and impaired renal function could benefit from prophylactic measures.

PNS39 Wastage and Costs of Contrast MEDIA in Computed Tomography in the UK: Comparison of MULTI-Dose Versus Single-Dose Bottles

Iodinated contrast media for computed tomography (CT) imaging are often available in single-dose bottles where any unused amount must be discarded after one utilization, while multi-dose bottles allow multiple dosages with lower amount of waste. Iomeron (iomeprol) is a non-ionic iodinated contrast medium used in numerous indications including CT enhancement. In addition to different sizes and concentrations of single-dose bottles, Iomeron is approved in the UK also in multi-dose 500 ml bottles (300–350–400 mgI/ml). The objective of this analysis was to compare the amount of wasted contrast media and total costs for multi-dose and single-dose bottles, respectively. A cost-calculator was developed to compare a current scenario for which all CTs were performed using 300 mgI/ml in 100 ml single-dose bottles (applied with syringe power injector) versus two future scenarios considering either a) concentration of 300 mgI/ml in 500 ml multi-dose bottles or b) 400 mgI/ml in 500 ml multi-dose bottles (both applied with syringeless power injector). For each scenario the amount of wastage, the price of contrast media (assuming costs per iodine gram were equal for each bottle size and concentration), cost of radiographer and consumables were considered. Average iodine dose and number of contrast enhanced CTs (CE-CT) were derived from a market research database, other costs and resource uses were derived from economic literature. Based on an estimated number of 2.06 million CE-CTs performed in 2019 in the UK with contrast media containing 300 mgI/ml, the total costs in current scenario were £40.8 million, compared to £26.9 and £25.4 million in scenario a) and b), respectively. Switching to multi-dose bottles could reduce wastage of contrast media by up to 86%. Switching from single-dose to multi-dose bottles of contrast media and from syringe to syringeless power injector can significantly reduce wastage and associated costs of performing CE-CTs scans.

Experimental studies on computed tomographic peritoneography. Peritoneal and residual renal function tolerance to iodinated contrast media injected into the peritoneal cavity.

Computed tomographic (CT) peritoneography has been widely used as reference standard to evaluate continuous ambulatory peritoneal dialysis-related complications. However, given the varying CT peritoneography approaches used across different institutions, there is no standard value for non-ionic iodinated contrast media (ICM) concentration. Few studies have currently investigated whether non-ionic iodinated contrast media (non-ionic ICM) affects peritoneal function or residual renal function (RRF). This study aimed to determine whether different non-ionic ICM concentrations affect peritoneum and RRF and attempted to evaluate CT peritoneography images to identify the optimal non-ionic ICM concentrations in animals. To this end, 25 male Sprague-Dawley rats were used to establish uraemic models, after which they were injected with a 40-mL mixture of peritoneal dialysate and iohexol at varying concentrations prior to CT peritoneography. Thereafter, two experienced radiologists blinded to the rat groupings evaluated image quality, peritoneal morphology and thickness were assessed using hematoxylin and eosin and Masson staining, and RRF was evaluated using serum creatinine levels hematoxylin and eosin staining of pathological kidney sections. Briefly, non-ionic ICM had negligible effects on the peritoneum and RRF. Our results suggest that a mixture containing 50mL (350mgI/mL) iohexol/2L peritoneal dialysate can be used as reference in rats.

MDCT angiographic findings of various congenital pulmonary artery anomalies in pediatric patients

BackgroundCongenital pulmonary artery anomalies are variable and need proper diagnosis and treatment. CT angiography with multiplanar reconstruction has the main role in the assessment of these anomalies and this non-invasive method should be the method of choice for preoperative planning and postoperative follow up.The aim of the study is to assess the value of MDCT in the detection of pulmonary arteries anomalies in the pediatric population with complex congenital heart disease in conjunction with echocardiography as an alternative to conventional angiography and to determine the superiority of MDCT in the assessment of other abnormalities such as airway anomalies.ResultsIn our retrospective study, 52 patients (28 male and 24 females, aged 1 day to 4 years: mean age 2 years) were examined with contrast-enhanced CT. CT examinations were done using a 128-section CT scanner (Siemens Somatom Definition AS) using non-ionic iodinated contrast media. 2D and 3D reconstructions were performed. The correlation was made with echocardiograms. All imaging studies were reviewed. The echo was done to all patients. Surgery and/or catheter angiography performed to all patients, their findings were reviewed and compared to CTA findings. Other abnormalities such as congenital airway anomalies are detected using axial MDCT images and reconstructed imaging techniques.MDCT was accurate in revealing pulmonary artery anomalies. The commonest pulmonary artery anomaly was atresia, stenosis then hypoplasia. These anomalies may be isolated or associated with other congenital heart diseases. In the current study, MDCT could diagnose all cases of pulmonary arterial anomalies with 96% sensitivity, 100% specificity, 98% accuracy, 100% positive, and 94% negative predictive values. CT scans provide accurate information to assess complex spatial relationships of vascular airway compression frequently associated with CHD in the pediatric population.ConclusionMDCT scanner can be an alternative to diagnostic conventional angiography for the non-invasive assessment of the pulmonary artery. Higher quality multiplanar and 3D reconstruction achieved by the MDCT scanners offer a rapid, reliable and non-invasive technique that can be used for the evaluation and preoperative assessment of thoracic vascular and extra-vascular anatomy in infants and children with suspected congenital heart disease. CT technologies are constantly developing collaboration between radiologists, pediatric cardiologists, and anesthesiologists, which is essential for improving CT performance.

Acute Adverse Reactions to Nonionic Iodinated Contrast Media: A Meta-Analysis.

We aimed to meta-analytically compare the incidence of acute adverse reactions (AARs) to nonionic iodinated contrast media (ICM) according to the type of ICM in patients who underwent radiologic examinations with administration of ICM via intravascular route. A systematic literature search identified studies evaluating the incidence of AARs to 7 nonionic ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, ioversol, and iodixanol) with extractable outcomes. These outcomes were pooled using a random-effects model, and the effect of ICM type on the incidence of overall and severe AARs was evaluated using meta-regression analysis. Thirty studies with 1,360,488 exposures to ICM were included. The pooled incidences of overall and severe AARs to nonionic ICM were 1.03% (95% confidence interval [CI], 0.81%-1.30%; I = 0.99) and 0.0141% (95% CI, 0.0108%-0.0183%; I = 0.56), respectively. Iomeprol had the highest overall AAR incidence (1.74%; 95% CI, 0.79%-3.76%; I = 0.99), followed by iohexol (1.21%; 95% CI, 0.67%-2.17%; I = 0.99), iopamidol (1.10%; 95% CI, 0.60%-2.03%; I = 0.99), ioversol (0.88%; 95% CI, 0.43%-1.83%; I = 0.96), iodixanol (0.85%; 95% CI, 0.36%-1.95%; I = 0.99), iopromide (0.82%; 95% CI, 0.43%-1.55%; I = 0.99), and iobitridol (0.77%; 95% CI, 0.36%-1.62%; I = 0.99). Multivariable meta-regression analysis revealed that study design (P = 0.0014) and premedication (P = 0.0230) were statistically significant determinants affecting the incidence of overall AARs. Iodinated contrast media type did not affect the incidence of overall and severe AARs (P = 0.1453 and 0.4265, each). The varying pooled incidences of overall and severe AARs to specific types of nonionic ICM do not remain as significant after adjusting confounders. Our results may support nonrestriction of certain types of nonionic ICM in the context of AAR avoidance.

Multi-detector CT enterography in active inflammatory bowel disease: Image quality and diagnostic efficacy of a low-radiation high contrast protocol

PurposeTo prospectively evaluate image quality and diagnostic efficacy of a low radiation-high contrast (LR-HC) CT Enterography (CTE) in active Inflammatory Bowel Disease (IBD). Materials and methodsEighty-five (36M; 49F; 17–75 yrs) patients with active IBD underwent contrast-enhanced CTE and were stratified in two groups according to age (< or ≥45 yrs): Group A (N = 45; 32 ± 9 yrs; 58 ± 10 kg) and Group B (N = 40; 58 ± 10 yrs; 61 ± 13 kg). Each group received a different amount of radiation (Noise Index, NI) and non-ionic iodinated contrast media (LOCM) as follows: Group A (NI = 15; 2.5 ml/kg) and Group B (NI = 12.5; 2 ml/kg). Thyroid functional tests were performed in all patients of group A at 4–6 wks. Signal- and contrast-to-noise ratios were calculated for liver (L) and abdominal aorta (A). Statistical analysis was performed by Student's t- or Chi-square test for continuous and categorical data, respectively. ResultsNo patient of Group A developed signs of thyrotoxicosis. SNRL, CNRL and diagnostic accuracy of CTE were 8.4 ± 1.7 vs 8.9 ± 2.1 (p = 0.256), 5.4 ± 1.5 vs 5.6 ± 1.7 (p = 0.486) and 91.1 vs 92.5% (p = 0.764) whereas the effective dose and the LOCM administered were 6.7 ± 2.2 vs 13.9 ± 6.0 mSv (p < 0.001) and 144 ± 25 vs 122 ± 25 ml (p < 0.001) for Group A and B, respectively. ConclusionLR-HC CTE is a dose-effective protocol in the evaluation of active IBD in young patients.

Adverse Drug Reactions to Radiographic Contrast Media in a Teaching Hospital in North India: An Observational Study.

Radiocontrast media are used extensively nowadays to visualize internal organs. Currently, non-ionic iodinated contrast media are used which are generally considered to be safe but some adverse reactions have been reported. Thus, the present study was carried out to analyze the nature and incidence of adverse drug reactions (ADRs) to radiographic contrast media in a teaching hospital. An observational study carried out for a period of six months in a teaching hospital. Contrast media induced adverse reactions were analyzed in terms of affected organs, rate, causality assessment, severity and preventability. The treatment and outcomes of adverse events were also recorded. Naranjo Probability Scale was used to evaluate the relationship between the contrast agent used and the suspected ADR. The severity of the suspected ADRs was determined using Hartwig Scale and preventability was assessed using modified Schumock and Thornton criterion. A total of 15 suspected ADRs occurred in 11 patients with an incidence of 1.4%. It included 5 (45.4%) males and 6 (54.5%) females (p < 05). The highest percentage (72.7 %) of ADRs was seen in adult patients, the mean age being 40.8 years. Vomiting (33.3%) was the most common ADR noted followed by severe nausea and rashes. 64.7 % of ADRs were categorized as probable and 35.3 % were possible. Adverse reactions required treatment in 46.6% patients. There was no fatality reported. The reactions observed were mild to moderate in severity and occurred within 30 minutes of the administration of the contrast.

The Rise of Off-Label Iron-Based Agents in Magnetic Resonance Imaging

Gadolinium-based contrast agents (GBCAs) used in MRI have come under fire due to concerns about nephrogenic systemic fibrosis (NSF) and gadolinium retention. These concerns have prompted a search for alternatives to GBCAs. One attractive candidate is superparamagnetic iron oxide (SPIO). Over the past 20 years, several SPIO agents have been developed and approved for niche clinical applications in MRI. One interesting SPIO agent is ferumoxytol (Feraheme®), an FDA-approved intravenous medication used to treat iron-deficiency anemia in patients with chronic kidney disease. In preliminary studies examining its off-label use as an intravenous contrast agent, ferumoxytol appeared promising for MRI and MR angiography. However, experience with this agent remains limited. One key benefit of ferumoxytol is that it carries no risk of NSF in patients with impaired renal function. On the other hand, ferumoxytol has been reported to cause severe adverse events, including hypotension, hypersensitivity reactions, anaphylaxis, and death. Moreover, the rate of such events has been substantially greater than those observed with GBCAs or nonionic iodinated contrast media. In response to these data, the FDA issued a black box warning for ferumoxytol in 2015. To ensure patient safety, hospitals and imaging facilities must develop a plan to train MRI personnel to recognize and manage adverse reactions to ferumoxytol. Another challenge of using ferumoxytol concerns its pharmacokinetics and biodistribution, which differ from those of GBCAs. These differences can lead to unexpected patterns or persistence of tissue enhancement on MRI. In particular, ferumoxytol can remain in the body for days, weeks, or months after intravenous administration, potentially causing an unsuspecting radiologist to misinterpret an MRI. The decision to use ferumoxytol for a specific patient and clinical indication requires the radiologists to carefully weigh risk-benefit tradeoffs and consider alternative diagnostic tests.

DIAMETER, THICKNESS AND DISCORDANCE DEGREE OF SOLITARY PULMONARY CAVITARY LESION TO DIFFERENTIATE BENIGN FROM MALIGNANT LESIONS, A MUTLISLICE CT STUDY.

DIAMETER, THICKNESS AND DISCORDANCE DEGREE OF SOLITARY PULMONARY CAVITARY LESION TO DIFFERENTIATE BENIGN FROM MALIGNANT LESIONS, A MUTLISLICE CT STUDY. Ammar Mosa Jawad *, Mohammed Abd kadhim# & Husham Jubran Mousa@ *MB,ChB, Radiologist in The Medical Collage, Al-Nahrain University. #MB,ChB, FIBMS, Radiologist, Professor in The Medical Collage, Al-Nahrain University, Consultant Radiologist in Al-Imamain AlKadhimain Medical City, Baghdad Iraq. @MB,ChB, FIBMS, Specialist Radiologist in Al-Sader Teaching hospital, Basrah, IRAQ. Absctract Cavities are frequent image findings in a variety of pulmonary diseases including both lung cancer and pulmonary tuberculosis, Computed Tomography (CT) is accepted as the modality of choice for detection of possible cavitating pulmonary nodules. The aim of this study is to assess the role of diameter, thickness and discordance degree of solitary pulmonary cavitary lesion to differentiate benign from malignant lesions in multislice CT. This cross sectional study was done in the Computed Tomography Unit of Al-Imamain Al Kadhimain Medical City, Baghdad, Iraq and Al-Sader Teaching Hospital, Basrah, Iraq between October 2016 and June 2017. All patients are with solitary pulmonary cavitary lesions detected by chest x-ray referred for different reasons. Exclusion criteria included: multiple cavitary lung lesions, patients with known lung carcinoma or pulmonary tuberculosis on treatment, and patients receiving chest radiotherapy for different reasons. CT examination of the chest was performed by multi-detector CT (Somatom definition edge, SIEMENS (256 slices)) with 2 sets of CT examination one before and another after giving IV nonionic iodinated contrast medium (Ultravist 370 mg /ml), 1.5 ml/kg Body weight. The final diagnosis was obtained depending on the sputum culture for AFB, bronchoscopy and biopsy, bronchoscopy and brush cytology and true cut biopsy. Eighty percent of the patients were diagnosed as having benign lesions and 20% were diagnosed as having malignant lesions, the most frequent diagnosis was TB (60%), followed by squamous cell carcinoma (14%), lung abscess (10%), hydatid cyst (10%), adenocarcinoma (4%), and metastasis (2%). The discordance of CT scan (FDCW3) show highly significant association with malignant solitary cavitary lesions, while CT concordance (FCCW1 and FCCW2) were significantly associated with benign solitary cavitary lesions (p