Use Of Contrast Media Research Articles

CONTRAST INDUCED ACUTE KIDNEY INJURY IS NOT A SITUATION TO BE AFRAID OF.

Acute kidney injury (AKI), formerly called acute renal failure (ARF), is clinically manifested as a reversible acute increase in nitrogen waste products, as measured by blood urea nitrogen (BUN) and serum creatinine levels. Contrast induced acute kidney injury (CIAKI) is a potentially fatal complication of angiographic procedures caused by the use of contrast media (CM). It is the third most prevalent cause of hospital acquired acute renal damage, accounting for around up to 30% of cases. Contrast induced nephropathy (CIN) is defined as a greater than 25% or 0.5 mg/dl (44 μmol/l) increase in serum creatinine (Scr) from baseline within 3 days. More sensitive indicators of renal damage are sought, hence numerous tubular injury biomarkers are being studied. Multiple risk factors may lead to the development of CIN; these risk factors are classified as patient-related and procedure-related. Treatment of CIN Is primarily symptomatic and consist firstly of careful fluid and electrolyte management, although dialysis may be necessary in some cases. With available treatment options, prevention is the cornerstone of management.

PUNÇÃO VENOSA PERIFÉRICA E CONTRASTE NOS EXAMES RADIOLÓGICOS: REPRESENTAÇÕES SOCIAIS ANCORADAS NOS ESTRESSORES DE NEUMAN

ABSTRACT Objective: to discuss the social representations about peripheral venipuncture and the use of contrast media of people submitted to radiological examinations, referring to stressor concept. Method: this is qualitative research, outlined in the procedural approach of the Social Representation Theory, carried out with 57 users undergoing computed tomography and magnetic resonance imaging at a university hospital in Juiz de Fora, Minas Gerais, Brazil. In-depth individual interviews triggered by guiding questions were conducted in January 2019. The contents of the interviews were fully transcribed and content analysis was carried out in three stages (pre-analysis, material exploration and treatment/interpretation of results). We established thematic analysis based on the dimensions and representational origins, which made it possible to discuss the findings anchored in the concepts of stressors, allowing the identification of three categories based on intrapersonal, interpersonal and transpersonal stressors. Results: puncture and examination were represented by individual, group, professional and therapeutic environment experiences, classified into the following categories: itinerary and conceptions on puncture and contrasted examinations based on intrapersonal stressors; shared relationships on puncture and examination, based on interpersonal stressors; and experiences in the therapeutic environment of a diagnostic imaging service, based on transpersonal stressors. Conclusion: the social representations were signified by examination, results and impacts on life, portraying stressors based on images/feelings of doubt and positive behaviors rationally justified, which explain human responses to reified content, enabling the restructuring of health care and nursing.

The accuracy of first metatarsophalangeal joint palpation guided injections. An arthrography cadaveric study

BackgroundInjectable glucocorticoids are widely used in the management of foot pathology, in particular for the treatment of osteoarthritis of the great toe - hallux limitus/rigidus. Injections can be performed using anatomical (blind) guided methods or performed with needle placement aided by the use diagnostic imaging with ultrasound or fluoroscopy, with or without the use of contrast media. AimPalpation and image guided injection techniques have been studied in other joints of the body but less so for the first metatarsophalangeal joint of the foot, where palpation guidance is commonly performed. The aim of this study was to investigate the injection accuracy of palpation guided injections of the first metatarsophalangeal joint in six cadaveric feet using radio-opaque contrast media. MethodsThe injection equipment consisted of a 2.5 ml Luer lock syringe and a 23-gauge needle used to inject iohexol (Omnipaque 300) into the first metatarsophalangeal joint in six cadaveric specimens. The needle was placed into the joint space by a single practitioner using palpation guidance. The contrast media was injected under live (cine) view without further movement or ingress of the needle. The injectate was considered accurate if the media coated the inside of the synovial membrane and/or outlined the joint shape. FindingsFailure of technique was seen in one of six feet, and extravasation of contrast media beyond the joint margins noted in three out of six feet. ConclusionsFurther study on a large sample of live subjects using a variance of technique is required to expand the confidence of these findings but the high failure rate calls into question the confidence of palpation guided techniques for injection of the first metatarsophalangeal joint.

Tolvaptan Improves Contrast-Induced Acute Kidney Injury.

Objective Contrast-induced acute kidney injury (CI-AKI) is a serious side effect of contrast media use. The purpose of this study was to investigate the role and mechanism of tolvaptan (TOL) in CI-AKI. Methods 24 Wistar male rats were randomly divided into 4 groups (n = 6). And a rat model of CI-AKI was established. Then, the blood and urine of rats in each group were collected to detect relevant parameters. HE staining was utilized for the observation of the pathological changes of rat kidney tissues, TUNEL assay for the detection of tubular cell apoptosis, biochemical detection for the confirmation of oxidative stress level in kidney tissues, and western blot for the test of the expression of apoptotic proteins and the Nrf2 signaling pathway-related proteins in kidney tissues. Results TOL could significantly reduce the serum level of urea nitrogen, creatinine, and neutrophil gelatinase-associated lipocalin and decrease serum Cys-C and urine KIM-1 in CI-AKI rats. The result above meant that TOL could improve kidney injury and reduce tubular cell apoptosis in CI-AKI rats. In addition, TOL contributed to a reduction of oxidative stress level by downregulating myeloperoxidase level and increasing the activities of superoxide dismutase and glutathione peroxidase in the kidney tissue of CI-AKI rats. After the pretreatment of TOL, the expression of proapoptotic proteins cleaved-caspase 3 and BAX, as well as mitochondrial fusion proteins DRP1 and MFN2 was downregulated, while the expression of Bcl-2 and PINK1 was upregulated in the kidney tissue of CI-AKI rats. Further, TOL could activate the Nrf2 signaling pathway, and the Nrf2 inhibitor ML385 reversed the effect of TOL on CI-AKI. Conclusion TOL can improve CI-AKI by activating the Nrf2/HO-1 signaling pathway, inhibiting oxidative stress response, and reducing tubular cell apoptosis.

Contrast allergies for neurological imaging: When to proceed.

Contrast-enhanced neuroimaging is often necessary for the diagnosis and care of patients with diseases of the central nervous system. Although contrast is generally well tolerated and allergy to contrast is rare, allergic reactions can be severe and life threatening. Therefore, physicians should take care to prevent severe contrast allergy. In this review, we will discuss contrast allergy as well as potential strategies to reduce the risk of severe reactions in patients who require neuroimaging techniques with contrast. First, we discuss the clinical presentation and pathogenesis of contrast allergy and the risk factors associated with reactions. We then review methods to reduce the risk of future contrast reactions through improved patient education and documentation strategies, use of alternate imaging modalities or contrast media, premedication, and desensitization.

Chinese expert consensus on management strategies for adverse events related to intra-arterial use of iodine contrast media during cardiovascular intervention (2021)

含碘对比剂广泛应用于经动脉心血管介入诊疗。近年来，随着患者疾病特征的变化和介入诊疗技术的发展，对含碘对比剂相关不良反应的防治提出了更高的要求。同时，自2012年《含碘对比剂在心血管疾病中临床应用的专家共识（2012）》发布以来，在对比剂相关不良反应的防治领域积累了较多新的循证医学证据。鉴于此，中华医学会心血管病学分会介入心脏病学组及大血管病学组组织国内相关学科专家，对最新证据进行同行评议，同时参考国外最新指南、结合我国心血管介入诊疗的临床实践经验，制定了该专家共识，以期推进我国经动脉心血管介入诊治过程中含碘对比剂的规范应用，为相关不良反应的预防和处理提供参考。.

Equine flexor tendon imaging part 2: Current status and future directions in advanced diagnostic imaging, with focus on the deep digital flexor tendon

Flexor tendon injuries are a common cause of lameness and early retirement in equine athletes. While ultrasonography is most frequently utilised, advanced diagnostic imaging modalities are becoming more widely available for detection and monitoring of flexor tendon lesions. Part two of this literature review details current experience with low- and high-field magnetic resonance imaging (MRI) and computed tomography (CT) for the diagnosis of equine flexor tendinopathy with a focus on the deep digital flexor tendon. Implications of the ‘magic angle’ artefact as well as injection techniques and the use of contrast media are discussed. Future developments in tendon imaging aim to gain enhanced structural information about the tendon architecture with the prospect to prevent injury. Techniques as described for the assessment of the human Achilles tendon including ultra-high field MRI and positron emission tomography are highlighted.

Trends in contrast media research the last 100 years

This review focuses on the trends in contrast media (CM) research published in Acta Radiologica during the last 100 years, since the first edition in 1921. The main topics covered are the developments of iodine- and gadolinium-based CM. Other topics include manganese-based CM for magnetic resonance imaging (MRI) and barium for the investigation of the alimentary tract. From a historic point of view, special CM for use in cholegraphy and myelography are addressed in the review. Today, these imaging procedures are obsolete due to the development of computed tomography, MRI, and ultrasound. The historical use of radioactive thorium-based CM for angiography is also addressed. Furthermore, publications on adverse reactions to CM are reviewed.

Influence of Contrast Material Temperature on Patient Comfort and Image Quality in Computed Tomography of the Abdomen: A Randomized Controlled Trial.

International guideline recommendations on safe use of contrast media (CM) are conflicting regarding the necessity to prewarm iodinated CM. Aim of the study was to evaluate the effects of room temperature CM compared with prewarmed CM on image quality, safety, and patient comfort in abdominal computed tomography (CT). CATCHY (Contrast Media Temperature and Patient Comfort in Computed Tomography of the Abdomen) is a double-blinded, randomized noninferiority trial. Between February and August 2020, 218 participants referred for portal venous abdominal CT were prospectively and randomly assigned to 1 of 2 groups. All patients received iopromide at 300 mg I/mL: group 1 at room temperature (~23°C [~73°F]) and group 2 prewarmed to body temperature (37°C [99°F]). A state-of-the-art individualized CM injection protocol was used, based on body weight and adapted to tube voltage. Primary outcome was absolute difference in mean liver attenuation between groups, calculated with a 2-sided 95% confidence interval. The noninferiority margin was set at -10 HU. Secondary outcomes were objective (signal-to-noise ratio and contrast-to-noise ratio) and subjective image quality; CM extravasations and other adverse events; and participant comfort (5-point scale questionnaire) and pain (numeric rating scale). This trial is registered with ClinicalTrials.gov (NCT04249479). The absolute difference in mean attenuation between groups was + 4.23 HU (95% confidence interval, +0.35 to +8.11; mean attenuation, 122.2 ± 13.1 HU in group 1, 118.0 ± 15.9 HU in group 2; P = 0.03). Signal-to-noise ratio, contrast-to-noise ratio, and subjective image quality were not significantly different between groups (P = 0.53, 0.23, and 0.99 respectively). Contrast extravasation occurred in 1 patient (group 2), and no other adverse events occurred. Comfort scores were significantly higher in group 1 than in group 2 (P = 0.03); pain did not significantly differ (perceived P > 0.99; intensity P = 0.20). Not prewarming iodinated CM was found noninferior in abdominal CT imaging. Prewarming conferred no beneficial effect on image quality, safety, and comfort, and might therefore no longer be considered a prerequisite in state-of-the art injection protocols for parenchymal imaging.

THE EFFECT OF ADMINISTRATION OF ASCORBIC ACID IN PREVENTION OF CONTRAST INDUCED NEPHROPATHY IN PATIENTS WITH RENAL IMPAIRMENT UNDERGOING CORONARY INTERVENTION

ABSTRACT Background: Contrast-induced nephropathy is a potentially avoidable complication caused during procedures involving the use of radiographic contrast media. All subjects, especially the high-risk ones, should be subjected to available preventive protocols prior to and after such procedures. Objective: To evaluate the role of a hydration protocol involving the use of ascorbic acid plus the conventional sodium chloride hydration protocol N acetyl cysteine. Patients and methods: The current study was conducted on 86 patients presenting to the Cardiology Department at National Heart Institute to undergo elective percutaneous coronary intervention (PCI) during the period from April 2011 to November 2011. The study population was divided into two equal groups: Group 1 received ascorbic acid prior and after the procedure and group 2 received the conventional hydration measures without ascorbic acid. Both groups received normal saline and NAC (N Acetyl Cysteine). Results: There were no significant group differences regarding sex, incidence of diabetes mellitus, pre-existing renal impairment, age, hypertension, dyslipidemia, and the type and amount of contrast. Addition of ascorbic acid by hydration with normal saline and N- acetyle cysteine decreased significantly the rise in serum creatinine 48 hours (P=0.023) and 7 days (P=0.001) following coronary intervention. CIN occurred in one patient in ascorbic acid group versus 4 patients in the control group (P=0.36). Ascorbic acid did not show a significant effect regarding the protection against the contrast induced nephropathy versus the conventional hydration therapy. Conclusion: Ascorbic acid did not show a significant effect regarding the protection against the contrast induced nephropathy versus the conventional hydration therapy.

Clinical practice guidelines for hepatocellular carcinoma between Korea, Europe, and United States

Clinical practice guidelines for hepatocellular carcinoma between Korea, Europe, and United States

Correlations between cardiovascular parameters and image parameters on dynamic chest radiographs in a porcine model under fluid loading.

Latest digital radiographic technology permits dynamic chest radiography during the cardiac beating and/or respiration, which allows for real-time observation of the lungs. This study aimed to assess the capacity of dynamic flat-panel detector (FPD) imaging without the use of contrast media to estimate cardiovascular parameters based on image parameters of a porcine model under fluid loading. Three domestic pigs were intubated, and mechanical ventilation was provided using a ventilator under anesthesia. A porcine model involving circulatory changes induced by fluid loading (fluid infusion/blood removal) was developed. Sequential chest radiographs of the pigs were obtained using a dynamic FPD system within the first 5 min after fluid loading. Image parameters such as the size of the heart shadow and mean pixel values in the lungs were measured, and correlations between fluid loading and cardiovascular parameters (blood pressure [BP], cardiac output [CO], central venous pressure [CVP], and pulmonary arterial pressure [PAP]) were analyzed based on freedom-adjusted coefficients of determination (Rf2). Fluid loading was correlated with radiographic lung density and the size of the heart shadow. Radiographic lung density was correlated with the left and right heart system-related parameters BP, CO, CVP, and PAP. The size of the heart shadow correlated with the left heart system-related parameters CO and BP. Dynamic FPD imaging allows for the relative evaluation of cardiovascular parameters based on image parameters. This diagnostic method provides radiographic image information and estimates relative circulatory parameters.Supplementary InformationThe online version contains supplementary material available at 10.1007/s12194-021-00626-2.

« Iodide mumps » after injection of contrast media imaging

The most common side effects of iodinated contrast media are hypersensitivity reactions and kidney failure. Aseptic sialadenitis or iodide mumps is a rare complication. Herein we report a case of “iodide mumps” that occurred in a patient without renal failure following administration of an iodinated contrast medium for a thoracic-abdominal scan. The outcome was favorable after 2 to 3 days. The pathogenesis of this side effect remains unclear but it consists of non-allergic reactions, making allergological exploration unnecessary, and subsequent use of contrast media is not contraindicated.

Whole-body Composition Profiling Using a Deep Learning Algorithm: Influence of Different Acquisition Parameters on Algorithm Performance and Robustness.

To develop, test, and validate a body composition profiling algorithm for automated segmentation of body compartments in whole-body magnetic resonance imaging (wbMRI) and to investigate the influence of different acquisition parameters on performance and robustness. A segmentation algorithm for subcutaneous and visceral adipose tissue (SCAT and VAT) and total muscle mass (TMM) was designed using a deep learning U-net architecture convolutional neuronal network. Twenty clinical wbMRI scans were manually segmented and used as training, validation, and test datasets. Segmentation performance was then tested on different data, including different magnetic resonance imaging protocols and scanners with and without use of contrast media. Test-retest reliability on 2 consecutive scans of 16 healthy volunteers each as well as impact of parameters slice thickness, matrix resolution, and different coil settings were investigated. Sorensen-Dice coefficient (DSC) was used to measure the algorithms' performance with manual segmentations as reference standards. Test-retest reliability and parameter effects were investigated comparing respective compartment volumes. Abdominal volumes were compared with published normative values. Algorithm performance measured by DSC was 0.93 (SCAT) to 0.77 (VAT) using the test dataset. Dependent from the respective compartment, similar or slightly reduced performance was seen for other scanners and scan protocols (DSC ranging from 0.69-0.72 for VAT to 0.83-0.91 for SCAT). No significant differences in body composition profiling was seen on repetitive volunteer scans (P = 0.88-1) or after variation of protocol parameters (P = 0.07-1). Body composition profiling from wbMRI by using a deep learning-based convolutional neuronal network algorithm for automated segmentation of body compartments is generally possible. First results indicate that robust and reproducible segmentations equally accurate to a manual expert may be expected also for a range of different acquisition parameters.

小児外傷患者におけるCT造影剤による腎機能への影響(Effects of CT contrast media on renal functions in pediatric trauma patients)

要旨【目的】小児外傷患者におけるCT造影剤の腎機能への影響を明らかにする。【対象】2012年10月から2018年9月に当院PICU入室した小児外傷患者を対象とした。血清クレアチニン（SCr）未再検，腎外傷は除外した。【方法】患者を造影CT群と非造影CT群に分け，CT施行72時間以内のSCr変化率を比較した。CT後腎機能低下例，腎代替療法施行例，死亡例も両群間で比較し，CT後腎機能低下に関連する因子をロジスティック回帰分析で探索した。【結果】対象者は造影群118人，非造影群65人。SCr変化率の平均値は造影群0.97，非造影群1.1と非造影群が高値であった（P<0.01）。CT後腎機能低下例は，造影群10人，非造影群17人と，非造影群が多く（P=0.002），腎代替療法施行例は両群なし，死亡例は造影群3人，非造影群0人で有意差はなかった（P=0.55）。ロジスティック回帰分析では，造影剤投与はCT後腎機能低下に関連しなかった。【結語】小児外傷患者において，CT造影剤は腎機能低下への関連を認めなかった。

DETECTION OF CHANGES IN RENAL BLOOD FLOW USING ARTERIAL SPIN LABELING MRI

Objective: Alteration in kidney perfusion is an early marker of renal damage. Magnetic resonance imaging (MRI) with arterial spin labeling (ASL) is a noninvasive approach to measure renal blood flow (RBF) without the use of contrast media. The purpose of this study consisting of two experiments was to evaluate whether both acute and short-term changes in RBF could be detected using ASL-MRI technique. Design and method: RBF as assessed by cortical (CRBF), medullary, and total renal blood flow (TRBF) were measured by ASL-MRI using FAIR True-FISP sequence. In the first experiment with 11 normotensive healthy individuals (NT) and 11 hypertensive patients (HT), RBF was measured at baseline and after both feet were covered with cold ice packs (cold pressor test) that activates the sympathetic nervous system. In the second experiment, RBF was measured in patients with chronic kidney disease (CKD) before and after a pharmacological intervention. Results: A significant reduction in CRBF (p = 0.042) and a trend in TRBF (p = 0.053) were observed in response to the activation of the sympathetic nervous system in both NT individuals and HT patients (Table 1). In the second experiment, a trend towards reduction of CRBF (p = 0.051) and TRBF (p = 0.059) has been detected after pharmacological intervention. An evaluation of RBF measurements between three different study populations reveals that TRBF were significantly lower in patients with HT (309.5 ± 17.3 mL/100 g/min) and CKD patients (260.4 ± 29.1 mL/100 g/min) compared to NT individuals (338.7 ± 30.0 mL/100 g/min) (NT vs. HT-p = 0.014, NT vs. CKD-p = 0.004). TRBF was also lower in patients with CKD compared to HT (p = 0.047). Conclusions: Our data indicate that both acute and short-term changes in RBF could be detected using ASL-MRI. Moreover, we were able to detect differences in RBF between healthy and diseased individuals by needing only small sample size per group. Thus, ASL-MRI offers an advantage in conducting clinical trials compared to other technologies.

POS-191 EXTERNAL VALIDATION AND COMPARISON OF RISK PREDICTION SCORING TOOLS FOR ACUTE KIDNEY INJURY IN PATIENTS WITH MYOCARDIAL INFARCTION IN A TERTIARY HOSPITAL IN DAVAO CITY

Patients with acute myocardial infarction are at high risk of developing acute kidney Injury (AKI). In settings where AKI biomarkers are not readily available, the use of a scoring system upon patient's admission may benefit those with high probability of developing AKI as this may allow prompt institution of renal protective measures such as avoidance of overzealous diuresis, wide variations in blood pressure, use of high volume contrast media, acute anemia from blood loss, and use of relatively nephrotoxic agents that may require renal dose adjustments and, perhaps, an early nephrology referral. From January 2015 to December 2019, a total of 384 charts were gathered based on inclusion criteria. After thorough chart review, 317 charts were excluded and 69 patient charts were included for the study. The continuous baseline characteristics of AKI and non-AKI patients in this study were analyzed using Shapiro-Wilk Test for normality. Comparison of these baseline characteristics was done using Independent Sample T-test and presented as mean and standard deviation otherwise, Mann-Whitney U Test was used and presented with mean rank. Pearson Chi Square or Fisher’s Exact Test was used to compare categorical characteristics. A p-value of <0.05 was considered statistically significant. Overall diagnostic accuracy of both scoring tools was assessed by area under the receiver operating characteristic (AUROC) curve. SPSS was used to determine the specificity, sensitivity and AUROC of all possible cut-off scores for each scoring tool. Online statistical calculators were used to calculate for the positive predictive value (PPV), negative predictive value (NPV), accuracy, and likelihood ratios. The study population consisted of 69 patients, 23 (33.3%) of whom developed acute kidney injury based on the KDIGO criteria. These patients were further categorized as having stage 1 (78.3%), stage 2 (17.4%), or stage 3 (4.3%) AKI. The two risk scoring tools used in this study to predict the occurrence of acute kidney injury in those who had an acute myocardial infarction are those of Abusaada et al and Xu et al. The cut-off scores for Abusaada’s and Xu’s tools are similar at >/= 4. Results showed a higher sensitivity analysis for Xu (91% vs 61%). However, Abusaada’s scoring tool had higher values for specificity (85% vs 7%), PPV (66.7% vs 32.8%), NPV (81.2% vs 60%), accuracy (76.8% vs 34.7%), and positive likelihood ratio (4 vs .98). For purposes of comparison, the scoring tool of Xu required adjustment to arrive at the cut-off score with the highest accuracy. After adjustment, AUROC values were calculated showing .717 (95% CI: .58-.86) for Abusaada and .764 (95% CI: .64-.89) for Xu which had no statistical difference (p-value .447). This study concluded that there is a high incidence of AKI in patients with acute myocardial infarction. Of the available recently validated risk assessment tools that can stratify patients in terms of developing AKI, between Xu et al and Abusaada et al, this study favors the use of the Abusaada scoring system because it did not require any adjustment to arrive at the highest accuracy level. This scoring can be employed immediately upon admission to aid in the preemptive management of AKI in patients with myocardial infarction. This was found to have a good predictive index for AKI occurrence in the setting of AMI.

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

The Use of Contrast Agents in Interventional Pain Procedures: A Multispecialty and Multisociety Practice Advisory on Nephrogenic Systemic Fibrosis, Gadolinium Deposition in the Brain, Encephalopathy After Unintentional Intrathecal Gadolinium Injection, and Hypersensitivity Reactions.

This Practice Advisory presents a comprehensive and evidence-based set of position statements and recommendations for the use of contrast media in interventional pain procedures. The advisory was established by an international panel of experts under the auspices of 11 multinational and multispecialty organizations based on a comprehensive review of the literature up to December 31, 2019. The advisory discusses the risks of using gadolinium-based contrast agents. These include nephrogenic systemic fibrosis, gadolinium brain deposition/retention, and encephalopathy and death after an unintentional intrathecal gadolinium injection. The advisory provides recommendations on the selection of a specific gadolinium-based contrast agent in patients with renal insufficiency, those who had multiple gadolinium-enhanced magnetic resonance imaging examinations, and in cases of paraspinal injections. Additionally, recommendations are made for patients who have a history of mild, moderate, or severe hypersensitivity reactions to contrast medium.

Prophylaxis of Contrast-Induced Nephropathy in Intravascular Contrast Computed Tomography Procedures by Use of Low Osmolality Contrast Media and Good Hydration

Consequent to the extended use of intravenous iodinated contrast media, increased adverse effects have been recognized, with Contrast-Induced Nephropathy (CIN) constituting one of the most serious of these adverse effects. The purpose of the current study was to investigate a prophylaxis strategy for reducing the effect of intravenous contrast on the development of CIN. Data were collected from 120 patients who received intravenous iodinated contrast agents during CT procedures. CIN was defined as a relative increase of more than 25% or an absolute increase of ≥ 0.5 mg/dL (44 µmol/L) in serum creatinine levels within 48-72 hours post-CT. Our prophylaxis strategy involved intravenous administration of 500 ml normal saline within one hour before the CT procedure and 3 liters of oral hydration within 12 hours post-CT. Additionally, the volume of administered low osmolality contrast media was based on the weight of the patient. A paired t-test revealed no statistically significant differences in creatinine (t = 0.07, P = 0.942) or urea (t = 0.52, P = 0.608) pre-CT vs. post intravenous iodinated contrast media-enhanced CT. Use of low osmolality contrast media and good hydration pre and post intravenous iodinated contrast administration are effective approaches to the prevention of CIN.