Use Of Contrast Media Research Articles

Cost-Minimization Analysis of Multidose and Single-Dose Packaging of Contrast Media for Contrast-Enhanced CT: Results From Real-World Data in China.

OBJECTIVE. Utilization and waste in diagnostic imaging have substantially increased worldwide. The purpose of this study was to highlight the utilization of contrast material and cost savings resulting from implementation of a multidose bulk IV contrast delivery system. MATERIALS AND METHODS. An observational study was conducted in October-November 2018 in eight hospitals in eight provinces in China. Contrast media specifications were 100-mL single-use IV contrast vials and 200-mL and 500-mL bulk packaging. Linear regression analysis was performed to identify the factors influencing contrast media use. Cost-minimization and sensitivity analyses were performed from patient and payer perspectives. RESULTS. A total of 1032 patients, some of whom underwent more than one CT examination, were enrolled in this study (100-mL package, 776 CT examinations; 200-mL package, 382 CT examinations). The mean injected volume of contrast medium was 75.46 mL. Number of scanned body parts, specification of amount of contrast medium (0, 100 mL; 1, 200 mL), whether the examination was CT angiography (CTA) (0, not CTA; 1, CTA), and patient weight all had a positive impact on the injected volume of contrast medium (p < 0.001 for all variables). Implementation of a multidose bulk IV contrast delivery system combined with different reimbursement units resulted in substantial waste reduction, estimated at US$5.59-6.04 per contrast-enhanced CT examination from the payer perspective, US$12.84-14.66 per examination from the patient perspective, and a total reduction of US$18.29-20.70 per examination. CONCLUSION. Use of multidose packaging of contrast media combined with reimbursement units for patients undergoing IV contrast-enhanced CT was found to be cost saving compared with use of single-dose packaging.

Noninvasive muscle activity imaging using magnetography

A spectroscopic paradigm has been developed that allows the magnetic field emissions generated by the electrical activity in the human body to be imaged in real time. The growing significance of imaging modalities in biology is evident by the almost exponential increase of their use in research, from the molecular to the ecological level. The method of analysis described here allows totally noninvasive imaging of muscular activity (heart, somatic musculature). Such imaging can be obtained without additional methodological steps such as the use of contrast media.

Imaging evaluation of nonobstetric conditions during pregnancy: what every radiologist should know.

In recent decades, there has been a significant increase in the number of imaging examinations performed on pregnant patients. That increase has occurred across the various modalities, including ultrasound, computed tomography, and magnetic resonance imaging. However, little is known about the risks that these examinations generate for the mother and fetus, related to the use of ionizing radiation or the use of contrast media. When pregnant patients are submitted to imaging studies, the principles of protection established by the International Commission on Radiological Protection should always be respected, to avoid injury to the pregnant woman and the fetus. The potential deleterious effects on the fetus must be weighed against the damage caused by not performing an examination that is clearly indicated, given that a delayed or missed diagnosis can be even more harmful to the health of the mother and of the fetus itself. The purpose of this review article is to address concerns regarding the safety of imaging methods used during pregnancy, as well as to identify typical clinical situations that require decisions to be made about the indication and optimal planning of imaging examinations.

Comparison of Oral and Intravenous N-acetyl Cysteine in Preventing Contrast Nephropathy.

Introduction:Despite high rates of morbidity and mortality in patients with contrast-induced nephropathy (CIN), there is no consensus regarding prevention of this well-known complication of contrast media use. One agent that has been widely used in this regard is N-acetyl cysteine (NAC). Nevertheless, its efficacy is still controversial. The aim of this study was to assess the efficacy of NAC, both in the oral and intravenous forms, for the prevention of CIN.Methods:This study is a double-blind randomized placebo controlled clinical trial. We randomized 434 adult patients with chronic kidney disease (constant serum creatinine ≥1.5 mg/dL) who were candidates for coronary angiography/plasty. The patients were categorized into three groups. One group received 1,200 mg NAC intravenously half an hour before the procedure and oral placebo starting 3 days before angiography. The second group received oral NAC 600 mg twice daily for 3 days, starting the day before the intervention and intravenous placebo half an hour before intervention. The third group received both oral and intravenous placebo. CIN was defined as a 25% relative increase in serum creatinine from baseline value, 48 h after use of contrast medium.Results:Of the 434 patients, 149 received intravenous NAC, 145 received oral NAC, and the remaining 140 received placebo. The incidence of CIN in the three groups was 6.1%, 7.6%, and 10.8%, respectively (p = 0.34).Conclusion:In patients with chronic kidney disease, neither intravenous nor oral NAC is superior to placebo for preventing CIN.

Overconsumption of Contrast Media in Percutaneous Coronary Intervention: Focusing on Cost and Acute Kidney Injury

Irrational use of medicines is a major problem worldwide. Since iodixanol (Visipaque®) was categorized in Category I based on the ABC-VED analysis in our hospital, we evaluated the amount of visipaque use and estimated the incremental cost based on the Maximum Contrast Dose (MCD) following irrational use of contrast media. This retrospective study was conducted on 100 admitted patients aged 18 to 80 years old undergoing elective Percutaneous Coronary Intervention (PCI) who received visipaque during February 2016 to January 2017. All of the patients’ information was collected from medical records and Hospital Information System (HIS). MCD was calculated by using the formula proposed by Cigarroa and colleagues: MCD (mL) =5× body weight (kg)/ Serum Creatinine (SCr) (mg/dl). The amount of contrast media administered ranged from 200 to 600 mL (mean, 348 mL ± 80). 57 % of patients received the visipaque more than MCD. Only 25 patients were evaluated SCr after PCI and in 11 (44%) of these patients SCr increased and 3 (12%) patients developed CI-AKI. Consumption of the contrast media was 2 to 3 times more than previous studies which could be the cause of acute kidney injury besides the extra cost. In our study about six liters more of contrast agent was used which is more than standard values with a cost of approximately $2,000 for 100 patients. Therefore, in order to reduce costs and complications, appropriate clinical protocol of contrast media, more supervision on medical residents and contrast infusion pumps, as well as a periodic evaluation study are highly recommended.

Development of Frog Neck After Coronary Angiography: Contrast-Induced Sialadenitis

Iodine-related submandibular sialadenitis is a rare complication among the causes of sialadenitis. To date, the pathogenesis of iodide mumps has not yet been ascertained. This situation is a late reaction to iodinecontaining contrast agents and can manifest in any patient receiving iodinated contrast agents and repeated exposure. Fortunately, this condition does not require specific treatment and resolution can be expected within one or two weeks. We report an 82-year-old man suffering from iodide-induced sialadenitis following coronary angiography with the use of non-ionic low osmolar contrast media.

Does the Use of Low Osmolality Contrast Medium Reduce the Frequency of Post-Endoscopic Retrograde Cholangiopancreatography Pancreatitis: A Comparative Study between Use of Low and High Osmolality Contrast Media

Introduction: A few reports stating that differences in the various types of contrast media injected into the pancreatic duct are related to the onset of post-endoscopic retrograde cholangiopancreatography (ERCP) pancreatitis (PEP) have been published, and it was indicated that iodixanol which is a nonionic iodide radiographic contrast medium with a dimeric (2 dimers) structure may reduce the incidence of PEP. The aim of this retrospective study is to evaluate the usefulness of iodaxanol for prevention PEP in comparison with megulamine amidototrizoate. Methods: Two hundred and ninety-one patients were enrolled and divided into the 2 groups according to the contrast medium used. One hundred and fifty-five patients underwent ERCP with meglumine amidotrizoate, and 136 patients underwent ERCP with iodaxanol. The primary outcome of this study was the incidence of PEP associated with the use of each contrast medium. Results: In this study, comparison of the meglumine amidotrizoate treatment and iodaxanol treatment groups showed no significant difference with respect to the incidence of PEP. In addition, there was also no difference between the groups with respect to PEP severity. Conclusion: Our study suggested that iodaxanol does not necessarily contribute to the prevention of PEP in comparison with meglumine amidotrizoate.

Urinary transferrin pre-emptively identifies the risk of renal damage posed by subclinical tubular alterations

Nephrotoxicity is an important limitation to the clinical use of many drugs and contrast media. Drug nephrotoxicity occurs in acute, subacute and chronic manifestations ranging from glomerular, tubular, vascular and immunological phenotypes to acute kidney injury. Pre-emptive risk assessment of drug nephrotoxicity poses an urgent need of precision medicine to optimize pharmacological therapies and interventional procedures involving nephrotoxic products in a preventive and personalized manner. Biomarkers of risk have been identified in animal models, and risk scores have been proposed, whose clinical use is abated by their reduced applicability to specific etiological models or clinical circumstances. However, our present data suggest that the urinary level of transferrin may be indicative of risk of renal damage, where risk is induced by subclinical tubular alterations regardless of etiology. In fact, urinary transferrin pre-emptively correlates with the subsequent renal damage in animal models in which risk has been induced by drugs and toxins affecting the renal tubules (i.e. cisplatin, gentamicin and uranyl nitrate); whereas transferrin shows no relation with the risk posed by a drug affecting renal hemodynamics (i.e. cyclosporine A). Our experiments also show that transferrin increases in the urine in the risk state (i.e. prior to the damage) precisely as a consequence of reduced tubular reabsorption. Finally, urinary transferrin pre-emptively identifies subpopulations of oncological and cardiac patients at risk of nephrotoxicity. In perspective, urinary transferrin might be further explored as a wider biomarker of an important mechanism of predisposition to renal damage induced by insults causing subclinical tubular alterations.

Performance of contrast-enhanced ultrasound (CEUS) compared to MRI in the diagnostic of gallbladder diseases.

Conventional ultrasound and MRI are very important techniques for the detection of gallbladder alterations. In the past years, studies showed that the additional use of contrast media to the conventional ultrasound allows the early depiction of pathological microvessels and their flow elucidating suspect findings stipulating the prompt therapy approach. The study aims to evaluate the performance of CEUS in gallbladder diseases and compare it to MR imaging using histopathological findings as a gold standard. The retrospective mono-center study analysed 18 patients with gallbladder alterations between 2009 and 2017. All patients underwent CEUS and MRI examinations and all results were confirmed in the pathology. CEUS images were performed and interpreted by a single experienced physician. CEUS imaging results compared to MR imaging of the gallbladder demonstrated a sensitivity of 100%, specificity of 93%, a positive predictive value of 67% and a negative predictive value of 100%. CEUS enables the depiction and characterization of important vascularization's patterns facilitating the early differentiation between malignant and benign findings. In this study, CEUS displayed a better diagnostic accuracy than MRI proving to be a valuable additional tool to the established imaging modalities.

Risk for Anaphylactic Reaction from Cardiac Catheterization in Patients Receiving β-Adrenergic Blockers or Angiotensin-Converting Enzyme-Inhibitors

β-Adrenergic blockers (BBs) have been associated with increased risk for severe anaphylactic reaction (AR) from contrast media; however, this was shown with intravenous contrast media, before widespread use of low osmolar contrast media, angiotensin-converting enzyme-inhibitors (ACE-Is), and cardioselective BBs. To assess the risk for AR during cardiac catheterization (CC) associated with BB or ACE-I exposure. Patients who experienced adverse reactions during CC from January 2004 to December 2013 were identified; 1 to 2 matched controls were assigned for each case. We analyzed AR rates in association with demographic variables, medication exposures (BBs, ACE-Is, angiotensin-receptor blockers, aspirin), and comorbidities: cardiovascular disorders, asthma, and atopy. We analyzed 71,782 CCs. Of these, severe 70 reactors were identified-46 (0.06%) fulfilled AR criteria. There were 35 cases of mild to moderate AR and 11 cases of severe AR (0.015%). There were no significant differences in age (61.3% vs 61.5%), sex (63% vs 64% males), cardiovascular disorder rate (78% vs 93%), and exposure to BBs (46% vs 51%; cardioselective: 77% vs 80%) and ACE-Is (37.0% vs 37.2%) in cases versus controls. Via multivariate logistic regression, BB exposure was not associated with greater AR frequency (P= .35) or severity (P= .40). Neither cardioselective BBs (P= 0.2) nor noncardioselective BBs (P= .5) influenced AR severity. ACE-Is had no effect on AR frequency (P= .35) or severity (P= .14). Lower AR frequency was associated with cardiovascular disorder (P= .01). In this case-control study, severe AR was rarely observed. Exposure to BBs or ACE-Is did not significantly influence AR frequency or severity; however, most BBs were cardioselective. Our findings imply that cardioselective BB or ACE-I suspension is not warranted in association with CC.

TCT-31 Use of Iso-Osmolar Contrast Media in High-AKI-Risk Patients Undergoing Peripheral Revascularization Procedures Is Associated With Lower Incidence of Major Adverse Renal or Cardiac Events (MARCE)

TCT-31 Use of Iso-Osmolar Contrast Media in High-AKI-Risk Patients Undergoing Peripheral Revascularization Procedures Is Associated With Lower Incidence of Major Adverse Renal or Cardiac Events (MARCE)

TCT-609 Use of Iso-Osmolar Contrast Media in High AKI Risk Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Is Associated With Lower Incidence of Major Adverse Renal or Cardiac Events (MARCE)

TCT-609 Use of Iso-Osmolar Contrast Media in High AKI Risk Patients Undergoing Endovascular Abdominal Aortic Aneurysm Repair (EVAR) Is Associated With Lower Incidence of Major Adverse Renal or Cardiac Events (MARCE)

Incidental mastoid opacification on computed tomography in the pediatric population

ObjectivesIncidental mastoid opacification (IMO) is a common radiologic finding and source of referral to otolaryngologists. Our objectives were to: 1) determine the rate of IMO in our pediatric population; 2) identify those with clinical mastoiditis; and 3) identify factors necessitating an otolaryngology consultation. MethodsThis was a retrospective chart review at an academic, tertiary, pediatric hospital in an urban setting. Pediatric patients with the keyword ‘mastoid’ on a computed tomography (CT) scan report were reviewed. The effect of age, gender, season and the use of contrast media on the rate of IMO was also analyzed. Chi-square analysis was used to compare the significance of categorical frequencies. ResultsThe rate of IMO in our cohort was 14.2% (164/1157). In children <8 years of age, the IMO rate was 22.0% compared to 5.6% in children 8–17 years of age (p < .001). The IMO rate in male children was 16.6% compared to 11.0% in female children (p = .007). There was no statistically significant higher rate of IMO during winter (15.1%) compared to summer (9.0%) and in CT scans with contrast (16.0%) compared to without contrast (14.0%). Our department of otolaryngology was formally consulted in 3% (5/164) of IMO cases. None of those patients had clinical mastoiditis. ConclusionsThis is the largest study identifying IMO on CT and in children to date. Although the overall rate of IMO in the pediatric population is 14.2%, it is rarely clinically significant.

Safety and tolerability of iobitridol in cerebral angiography: a prospective, multicenter study.

Background To date, only a few data have demonstrated the safety of iodinated contrast media for cerebral angiography. Purpose To assess contrast-related adverse events after cerebral angiography using iobitridol. Material and Methods A total of 790 patients who underwent cerebral angiography at three tertiary hospitals in the Republic of Korea between November 2017 and October 2018 were prospectively enrolled in this study. We interviewed all patients and recorded their symptoms before they left the interventional clinic after the angiography procedure and during the seven-day follow-up visit. The primary endpoints were acute (within 1 h) and delayed (1 h–7 days) adverse events associated with iobitridol injection. We also visually graded the radiographic density and image quality as secondary endpoints. Results Acute adverse events were more common than delayed adverse events. Most adverse events were either mild (96.5%) or moderate (3.45%). Among the contrast-related adverse events, feeling of warmth (59.1%) and altered taste (17.5%) were the most common acute events, whereas headache (41.9%) and allergic skin reactions (20.0%) were the most common delayed events. All cerebral angiography showed optimal density and good/excellent image quality. Conclusion The findings of this study suggest that iobitridol is a safe and effective iodinated contrast medium for use in cerebral angiography.

Analysis of a multicentre cloud-based CT dosimetric database: preliminary results

BackgroundTo manage and analyse dosimetric data provided by computed tomography (CT) scanners from four Italian hospitals.MethodsA radiation dose index monitoring (RDIM) software was used to collect anonymised exams stored in a cloud server. Since hospitals use different names for the same procedure, digital imaging and communications in medicine (DICOM) tags more appropriate to describe exams were selected and associated to study common names (SCNs) from a radiology playbook according to scan region and use of contrast media. Retrospective analysis was carried out to describe population and to evaluate dosimetric indexes and inaccuracies associated with SCNs.ResultsMore than 400 procedures were clustered into 95 SCNs, but 78% of exams on adults were described with only 10 SCNs. Median values of dose-length product (DLP) and volumetric CT dose index (CTDIvol) for three analysed SCNs were in agreement with those previously published. The percentage of inaccuracies does not heavily affect the dosimetric analysis on the whole cloud, since variations in median values reached at most 8%.ConclusionsImplementation of a cloud-based RDIM software and related issues were described, showing the strength of the chosen playbook-based clustering and its usefulness for homogeneous data analysis. This approach may allow for optimisation actions, accurate assessment of the risk associated with radiation exposure, comparison of different facilities, and, last but not least, collection of information for the implementation of the 2013/59 Euratom Directive.

SUN-164 ASSOCIATION BETWEEN INTRAVENOUS CONTRAST MEDIA AND NON-RECOVERY FROM DIALYSIS-REQUIRING SEPTIC ACUTE KIDNEY INJURY IN INTENSIVE CARE UNIT PATIENTS: A NATIONWIDE OBSERVATIONAL STUDY

Although the concern of the effect of iodinated contrast media on acute kidney injury (AKI) affects physician’s decision on the usage of contrast media with computed tomography (CT), recent reports have questioned the causal relationship between administration of intravenous contrast media and the subsequent AKI, and its causal relationship is still controversial. However, there are no previous reports about whether iodinated-contrast media increase non-renal recovery in critically ill patients who require renal replacement therapy (RRT) early after admission. In this retrospective observational study using the Japanese Diagnosis Procedure Combination inpatient database during a period between July 1, 2011 and March 31, 2017, we identified patients with septic AKI who required continuous renal replacement therapy (CRRT) within 1 day after admission. Patients were divided into those who received computed tomography with intravenous contrast media and those without contrast media. We performed propensity score matching to control potential confounders and analyzed associations between exposure to intravenous contrast media and outcomes, including major adverse kidney events (MAKE) which was defined as death and RRT-dependence at discharge, and duration of RRT. A total of 9,055 patients (3293 with contrast media and 5762 without contrast media) were eligible. Propensity score matching analyses showed MAKE at discharge was not statistically different between the groups with and without contract media (49.6% vs 50.7%, p=0.441). RRT duration was median 5 days and also not significantly different between the groups. Use of intravenous contrast media was not associated with increase in MAKE or RRT duration in patients with septic dialysis-requiring AKI.

Long-term development of radiation exposure, fluoroscopy time and contrast media use in daily routine in cryoballoon ablations after implementation of intracardiac echocardiography and other radioprotective measures: experiences from a large single-centre cohort.

The concern of higher radiation exposure during cryoballoon ablation (CBA) compared with radiofrequency ablation for atrial fibrillation (AF) was raised before. Previously, we compared CBA plus intracardiac echocardiography (ICE) to our former standard approach without ICE. A substantial reduction of radiation exposure without compromising safety or outcome was observed. We now investigate if at all and possibly to which amount radiation reduction can be achieved with growing experience. We retrospectively analysed procedure time, dose area product (DAP), fluoroscopy time (FT) and contrast media (CM) use for all patients receiving CBA between 2013 and 2017 for AF. In 1131 procedures, procedure time decreased significantly between 2013 and 2017 (2013 111 ± 26min, 2017 99 ± 25min, p = 0.005). DAP halved between 2013 and 2014 without further significant decline (2013 1428 ± 1276cGycm2, 2014 725 ± 551cGycm2, p < 0.001). FT demonstrated a constant decrease from 2013 to 2017 (2013 11.7 ± 5.5min, 2017 5.1 ± 3.5min, p < 0.001). CM use did not show a significant reduction comparing 2013 to 2017 (2013 62 ± 19ml, 2017 59 ± 18ml, 2013/2017 p = 0.584). Given the imminent negative effects of radiation, every effort should be undertaken for its reduction. Feasible protocols can be kept simple by technical changes as reducing frame rates and basic radiation reduction strategies such as collimation, but ICE might add additional benefit. With growing experience and awareness of radioprotection, DAP and FT as low as or lower than in radiofrequency ablations seem possible.

Statins role in preventing contrast-induced acute kidney injury: a scoping review.

Acute renal failure secondary to contrast-induced acute kidney injury (CI-AKI) is one of the most commonly encountered problems in hospitalised patients. The CI-AKI may lead to the development of persistent renal disease, causing significant morbidity and mortality in high-risk patients. Statins are increasingly recognised as effective in preventing CI-AKI. In this review, we reviewed the literature on statin use for prophylaxis of CI-AKI, its potential benefits, and adverse effects. The aim of the present review was to reveal gaps and discrepancies in the available literature, and to identify areas for future research. We searched PubMed for articles published up to 2018, using keywords including: "Statins AND contrast-induced kidney injury", "3-hydroxy-3-methyl-glutaryl-CoA reductase inhibitors AND contras-induced kidney injury", and "HMG-CoA reductase inhibitors AND contrast induced nephropathy". Various trials and reviews have yielded promising results in terms of statin efficacy. However, conflicting results and a lack of homogeneity in the protocols of these trials have limited the applicability of statin-based therapy in clinical practice. Despite the reported beneficial therapeutic effects of short-term high-dosage statin use in preventing CI-AKI, statin therapy is not yet the standard prophylactic regimen due to widespread heterogeneity in the clinical trials. Statin therapy can be used as an adjunct to usual prophylactic measures such as adequate hydration and use of low-volume contrast media. Large well-designed trials on the effects of short-term high-dose statin use in preventing CI-AKI should be conducted, to eliminate any form of discrepancy among results, and to clarify any potential adverse effects.

Early clinical experiences with a novel contrast volume reduction system during invasive coronary angiography

The use of contrast media (CM) in diagnostic and interventional cardiology is increasing worldwide, while treated patients become older and suffer from more comorbidities. CM is associated with multiple adverse effects (AE) - ranging from clinically insignificant to life-threatening [1]. Guidelines recommend reducing the amount of administered CM as low as reasonably possible [2]. However, following this recommendation in daily practice remains difficult and CM volumes vary greatly [3]. Great efforts have been undertaken to develop contrast-sparing devices [4]: One of the first was the manual stopcock-manifold and hand-held syringe arrangement, which has been used as the standard technique for CM administration for decades. Later, automated contrast injection systems have been developed to optimize workflow efficiency and reduce both CM volume delivery and fluoroscopy time under controlled injection settings [5]. Parallel, the DyeVert system was introduced [6,7]. In brief, this system works as a fluid pathway resistance modulator to reduce CM over-injection via a dedicated diversion valve. The valve is connected to a secondary fluid pathway and works dependent on the injection pressure. In consequence, it diverts some of the CM into the reservoir chamber within the module. The saved overflow would otherwise be injected to the patient as aortic reflux without any positive effects on angiographic image quality. So far, the DyeVert™ Plus was incompatible with power injection systems and was thus restricted to use with the conventional stopcock-manifold-syringe system. However, the DyeVert™ Power XT Contrast Reduction System (DyeVert Power XT System; Osprey Medical, Minnetonka, MN, USA) has now been specifically designed to work in combination with ACIST CVi Contrast Delivery System (ACIST, ACIST Medical Systems, Eden Prairie, MN, USA). This short report summarizes our first experience combining the DyeVert Power XT System with ACIST in a consecutive patient population undergoing diagnostic or interventional ICA at our institution.

Insights and Clinical Implications from the pELVIS Registry for the Treatment of Aneurysms Involving the Iliac Bifurcation

The pErformance of iLiac branch deVIces for aneurysmS (pELVIS) Registry is the largest retrospective analysis of prospectively collected data on the use of iliac branch devices (IBD) for the treatment of iliac and aortoiliac aneurysms. It shows the feasibility of the technique with good short- and mid-term results. The most common anatomical challenge for IBD use is the presence of aneurysmal deterioration of the internal iliac arteries (IIA). Experience acquired in the registry treating concomitant aneurysmal lesions of the IIA provides significant information on the performance of IBDs for this specific clinical presentation. Treatment of isolated aneurysms in the common iliac artery without extension to the infrarenal aorta showed favourable results with lower costs, and lower use of irradiation and contrast media. Overall, the relatively low procedure-related complications and repeat interventions show broad applicability of the technique. Further analysis is required to evaluate the longstanding performance of IBD.