WorldWideScience

Sample records for contrast patients showed

  1. Herbarium specimens show contrasting phenological responses to Himalayan climate.

    Science.gov (United States)

    Hart, Robbie; Salick, Jan; Ranjitkar, Sailesh; Xu, Jianchu

    2014-07-22

    Responses by flowering plants to climate change are complex and only beginning to be understood. Through analyses of 10,295 herbarium specimens of Himalayan Rhododendron collected by plant hunters and botanists since 1884, we were able to separate these responses into significant components. We found a lack of directional change in mean flowering time over the past 45 y of rapid warming. However, over the full 125 y of collections, mean flowering time shows a significant response to year-to-year changes in temperature, and this response varies with season of warming. Mean flowering advances with annual warming (2.27 d earlier per 1 °C warming), and also is delayed with fall warming (2.54 d later per 1 °C warming). Annual warming may advance flowering through positive effects on overwintering bud formation, whereas fall warming may delay flowering through an impact on chilling requirements. The lack of a directional response suggests that contrasting phenological responses to temperature changes may obscure temperature sensitivity in plants. By drawing on large collections from multiple herbaria, made over more than a century, we show how these data may inform studies even of remote localities, and we highlight the increasing value of these and other natural history collections in understanding long-term change.

  2. Perfusion magnetic resonance imaging and magnetic resonance spectroscopy of cerebral gliomas showing imperceptible contrast enhancement on conventional magnetic resonance imaging

    International Nuclear Information System (INIS)

    Batra, A.; Tripathi, R.P.; Singh, A.K.

    2004-01-01

    The purpose of the present paper was to evaluate the utility of perfusion MRI in cerebral gliomas showing imperceptible contrast enhancement on conventional MRI, and to evaluate the relationships of perfusion MRI and magnetic resonance (MR) spectroscopic results in these tumours. Twenty-two patients with histopathologically proven cerebral gliomas and showing insignificant contrast enhancement on conventional MR were included in the present study. All patients underwent perfusion MRI and MR spectroscopy on a 1.5-T MR system. Significant differences of the relative cerebral blood volume (rCBV) values and the choline : creatine ratios were noted between low-grade and anaplastic gliomas (P < 0.01). Good correlation was found between the rCBV values and the choline : creatine values (y = 0. 532x + 1.5643; r = 0.67). Perfusion MRI can be a useful tool in assessing the histopathological grade of non-contrast-enhancing cerebral gliomas. Along with MR spectroscopic imaging it can serve as an important technique for preoperative characterization of such gliomas, so that accurate targeting by stereotactic biopsies is possible. Copyright (2004) Blackwell Science Pty Ltd

  3. Enhancing contrast of magnetic resonance imaging in patients with ...

    African Journals Online (AJOL)

    DTPA), a recent magnetic resonance imaging (MRI) contrast agent, in hepatobiliary system of patients with liver cirrhosis. Methods: Liver cirrhosis patients that underwent contrast MRI examination at Renai Hospital, Taipei City, Taiwan were ...

  4. Cheetahs and wild dogs show contrasting patterns of suppression by lions.

    Science.gov (United States)

    Swanson, Alexandra; Caro, Tim; Davies-Mostert, Harriet; Mills, Michael G L; Macdonald, David W; Borner, Markus; Masenga, Emmanuel; Packer, Craig

    2014-11-01

    Top predators can dramatically suppress populations of smaller predators, with cascading effects throughout communities, and this pressure is often unquestioningly accepted as a constraint on mesopredator populations. In this study, we reassess whether African lions suppress populations of cheetahs and African wild dogs and examine possible mechanisms for coexistence between these species. Using long-term records from Serengeti National Park, we tested 30 years of population data for evidence of mesopredator suppression, and we examined six years of concurrent radio-telemetry data for evidence of large-scale spatial displacement. The Serengeti lion population nearly tripled between 1966 and 1998; during this time, wild dogs declined but cheetah numbers remained largely unchanged. Prior to their local extinction, wild dogs primarily occupied low lion density areas and apparently abandoned the long-term study area as the lion population 'saturated' the region. In contrast, cheetahs mostly utilized areas of high lion density, and the stability of the cheetah population indicates that neither high levels of lion-inflicted mortality nor behavioural avoidance inflict sufficient demographic consequences to translate into population-level effects. Population data from fenced reserves in southern Africa revealed a similar contrast between wild dogs and cheetahs in their ability to coexist with lions. These findings demonstrate differential responses of subordinate species within the same guild and challenge a widespread perception that lions undermine cheetah conservation efforts. Paired with several recent studies that document fine-scale lion-avoidance by cheetahs, this study further highlights fine-scale spatial avoidance as a possible mechanism for mitigating mesopredator suppression. © 2014 The Authors. Journal of Animal Ecology © 2014 British Ecological Society.

  5. Preprocedural Prediction Model for Contrast-Induced Nephropathy Patients.

    Science.gov (United States)

    Yin, Wen-Jun; Yi, Yi-Hu; Guan, Xiao-Feng; Zhou, Ling-Yun; Wang, Jiang-Lin; Li, Dai-Yang; Zuo, Xiao-Cong

    2017-02-03

    Several models have been developed for prediction of contrast-induced nephropathy (CIN); however, they only contain patients receiving intra-arterial contrast media for coronary angiographic procedures, which represent a small proportion of all contrast procedures. In addition, most of them evaluate radiological interventional procedure-related variables. So it is necessary for us to develop a model for prediction of CIN before radiological procedures among patients administered contrast media. A total of 8800 patients undergoing contrast administration were randomly assigned in a 4:1 ratio to development and validation data sets. CIN was defined as an increase of 25% and/or 0.5 mg/dL in serum creatinine within 72 hours above the baseline value. Preprocedural clinical variables were used to develop the prediction model from the training data set by the machine learning method of random forest, and 5-fold cross-validation was used to evaluate the prediction accuracies of the model. Finally we tested this model in the validation data set. The incidence of CIN was 13.38%. We built a prediction model with 13 preprocedural variables selected from 83 variables. The model obtained an area under the receiver-operating characteristic (ROC) curve (AUC) of 0.907 and gave prediction accuracy of 80.8%, sensitivity of 82.7%, specificity of 78.8%, and Matthews correlation coefficient of 61.5%. For the first time, 3 new factors are included in the model: the decreased sodium concentration, the INR value, and the preprocedural glucose level. The newly established model shows excellent predictive ability of CIN development and thereby provides preventative measures for CIN. © 2017 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell.

  6. Evaluation of contrast visual acuity in patients with retinitis pigmentosa

    Science.gov (United States)

    Oomachi, Kazumi; Ogata, Kazuha; Sugawara, Takeshi; Hagiwara, Akira; Hata, Akira; Yamamoto, Shuichi

    2011-01-01

    Background The purpose of this study was to determine visual acuity at different contrast levels under photopic and mesopic conditions in patients with retinitis pigmentosa. Methods Sixty eyes of 31 normal controls, 92 eyes of 52 patients with retinitis pigmentosa without other ocular disorders (RP-1 group), and 20 eyes of 14 patients with retinitis pigmentosa with cataracts and without other ocular disorders (RP-2 group) were studied. Conventional visual acuity was measured using a conventional Landolt ring chart with 100% contrast and luminance of 150 cd/m2. All of the patients with retinitis pigmentosa had a decimal visual acuity better than 1.0. Contrast visual acuity was measured with the same Landolt ring chart with contrasts of 100% and 10% and under photopic (200 cd/m2) and mesopic (10 cd/m2) conditions. Decimal visual acuities were converted to logMAR units for the analyses. Results The 100% contrast visual acuity and the 10% contrast visual acuity determined under both photopic and mesopic conditions were significantly poorer in both the RP-1 and RP-2 groups than in the controls. The differences between the conventional visual acuity and the 100% contrast visual acuity were significantly greater in the RP-1 and RP-2 groups than in the controls under both photopic and mesopic conditions. The differences between the 100% contrast visual acuity and the 10% contrast visual acuity were not significant among the three groups under photopic and mesopic conditions. Conclusion Contrast visual acuities were greatly reduced in patients with retinitis pigmentosa with relatively well preserved conventional visual acuity, and the contrast visual acuity was largely influenced by ambient light levels in patients with retinitis pigmentosa. Although a longitudinal study for confirmation has to be performed, our findings indicate that contrast visual acuity is a better test to follow changes in visual function in patients with retinitis pigmentosa. PMID:22069346

  7. Bird diversity and dissimilarity show contrasting patterns along heavy metal pollution gradients in the Urals, Russia.

    Science.gov (United States)

    Belskii, Eugen A; Mikryukov, Vladimir S

    2018-05-07

    The effects of industrial pollution on bird diversity have been widely studied using traditional diversity measures, which assume all species to be equivalent. We compared species richness and Shannon index with distance-based measures of taxonomic, functional, and phylogenetic diversity (the abundance-weighted mean nearest taxon distances), which describe within-community dissimilarity at terminal branches. Analysis of dissimilarity can shed light on the processes underlying community assembly, i.e., environmental filtering decreases dissimilarity whereas competitive exclusion increases it. In the 2-year study near Karabash and Revda copper smelters in Russia, point counts of nesting birds and habitat descriptions were taken at 10 sites (40 plots) along each pollution gradient. The abundance and diversity of birds showed good repeatability in both regions. The total density of birds, number of species per plot, and Shannon diversity decreased at high toxic load in both regions. The taxonomic, functional, and phylogenetic nearest taxon distances showed the same pattern within regions. Species dissimilarity within communities increased with pollution in Karabash (due to loss of functionally similar species), but did not change in Revda (due to mass replacement of forest species by species of open habitats). Pollution-induced changes in bird communities near Karabash were greater due to the stronger deterioration of the forest ecosystems and less favorable natural conditions (more arid climate, lower diversity and vitality of the tree stand and understorey) compared to Revda. This study emphasizes the need for a multi-level approach to the analysis of bird communities using traditional indices of diversity, functional, taxonomic, or phylogenetic distances between species and environmental variables.

  8. Time dependent patient no-show predictive modelling development.

    Science.gov (United States)

    Huang, Yu-Li; Hanauer, David A

    2016-05-09

    Purpose - The purpose of this paper is to develop evident-based predictive no-show models considering patients' each past appointment status, a time-dependent component, as an independent predictor to improve predictability. Design/methodology/approach - A ten-year retrospective data set was extracted from a pediatric clinic. It consisted of 7,291 distinct patients who had at least two visits along with their appointment characteristics, patient demographics, and insurance information. Logistic regression was adopted to develop no-show models using two-thirds of the data for training and the remaining data for validation. The no-show threshold was then determined based on minimizing the misclassification of show/no-show assignments. There were a total of 26 predictive model developed based on the number of available past appointments. Simulation was employed to test the effective of each model on costs of patient wait time, physician idle time, and overtime. Findings - The results demonstrated the misclassification rate and the area under the curve of the receiver operating characteristic gradually improved as more appointment history was included until around the 20th predictive model. The overbooking method with no-show predictive models suggested incorporating up to the 16th model and outperformed other overbooking methods by as much as 9.4 per cent in the cost per patient while allowing two additional patients in a clinic day. Research limitations/implications - The challenge now is to actually implement the no-show predictive model systematically to further demonstrate its robustness and simplicity in various scheduling systems. Originality/value - This paper provides examples of how to build the no-show predictive models with time-dependent components to improve the overbooking policy. Accurately identifying scheduled patients' show/no-show status allows clinics to proactively schedule patients to reduce the negative impact of patient no-shows.

  9. Should nonionic radiographic contrast media be given to all patients?

    International Nuclear Information System (INIS)

    Parfrey, P.S.; Cramer, B.C.; McManamon, P.J.

    1988-01-01

    In the 1970s about one patient of every 40,000 who underwent intravenous urography died. It has been suggested that lives can be saved by using only nonionic or low-osmolarity contrast agents. The authors suggest a multicentre double-blind randomized controlled trial of nonionic versus ionic contrast media

  10. Contrast-enhanced spectral mammography in patients with MRI contraindications.

    Science.gov (United States)

    Richter, Vivien; Hatterman, Valerie; Preibsch, Heike; Bahrs, Sonja D; Hahn, Markus; Nikolaou, Konstantin; Wiesinger, Benjamin

    2017-01-01

    Background Contrast-enhanced spectral mammography (CESM) is a novel breast imaging technique providing comparable diagnostic accuracy to breast magnetic resonance imaging (MRI). Purpose To show that CESM in patients with MRI contraindications is feasible, accurate, and useful as a problem-solving tool, and to highlight its limitations. Material and Methods A total of 118 patients with MRI contraindications were examined by CESM. Histology was obtained in 94 lesions and used as gold standard for diagnostic accuracy calculations. Imaging data were reviewed retrospectively for feasibility, accuracy, and technical problems. The diagnostic yield of CESM as a problem-solving tool and for therapy response evaluation was reviewed separately. Results CESM was more accurate than mammography (MG) for lesion categorization (r = 0.731, P < 0.0001 vs. r = 0.279, P = 0.006) and for lesion size estimation (r = 0.738 vs. r = 0.689, P < 0.0001). Negative predictive value of CESM was significantly higher than of MG (85.71% vs. 30.77%, P < 0.0001). When used for problem-solving, CESM changed patient management in 2/8 (25%) cases. Superposition artifacts and timing problems affected diagnostic utility in 3/118 (2.5%) patients. Conclusion CESM is a feasible and accurate alternative for patients with MRI contraindications, but it is necessary to be aware of the method's technical limitations.

  11. The use of computerized tomography in patients showing tardive dyskinesia

    International Nuclear Information System (INIS)

    Themelis, I.

    1983-01-01

    29 patients showing moderate to markedly pronounced tardive dyskinesia (TD) and a further 29 control patients (C) under a similar long-term medication with neuroleptics that had been so chosen as to match the age and sex distributions of the former group were subjected to computered tomography, neurological examination and psychological testing. The results did not point to any correlations between the structural changes and duration of treatment and the clinical signs or symptoms of extrapyramidal disorder. This was taken as further evidence in support of the theory that the initial damage in tardive dyskinesia mainly is at the level of the basal ganglia. (orig./MG) [de

  12. Migraine patients consistently show abnormal vestibular bedside tests

    Directory of Open Access Journals (Sweden)

    Eliana Teixeira Maranhão

    2015-01-01

    Full Text Available Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs.Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls.Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls.Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity.Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

  13. Migraine patients consistently show abnormal vestibular bedside tests.

    Science.gov (United States)

    Maranhão, Eliana Teixeira; Maranhão-Filho, Péricles; Luiz, Ronir Raggio; Vincent, Maurice Borges

    2016-01-01

    Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs. To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR) responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls. Cross-sectional study including sixty individuals - thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls. Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity). Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

  14. Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance.

    Science.gov (United States)

    Hobbs, Max M; Taylor, Donna B; Buzynski, Sebastian; Peake, Rachel E

    2015-06-01

    Contrast-enhanced spectral mammography (CESM) may have similar diagnostic performance to Contrast-enhanced MRI (CEMRI) in the diagnosis and staging of breast cancer. To date, research has focused exclusively on diagnostic performance when comparing these two techniques. Patient experience is also an important factor when comparing and deciding on which of these modalities is preferable. The aim of this study is to compare patient experience of CESM against CEMRI during preoperative breast cancer staging. Forty-nine participants who underwent both CESM and CEMRI, as part of a larger trial, completed a Likert questionnaire about their preference for each modality according to the following criteria: comfort of breast compression, comfort of intravenous (IV) contrast injection, anxiety and overall preference. Participants also reported reasons for preferring one modality to the other. Quantitative data were analysed using a Wilcoxon sign-rank test and chi-squared test. Qualitative data are reported descriptively. A significantly higher overall preference towards CESM was demonstrated (n = 49, P < 0.001), with faster procedure time, greater comfort and lower noise level cited as the commonest reasons. Participants also reported significantly lower rates of anxiety during CESM compared with CEMRI (n = 36, P = 0.009). A significantly higher rate of comfort was reported during CEMRI for measures of breast compression (n = 49, P = 0.001) and the sensation of IV contrast injection (n = 49, P = 0.003). Our data suggest that overall, patients prefer the experience of CESM to CEMRI, adding support for the role of CESM as a possible alternative to CEMRI for breast cancer staging. © 2015 The Royal Australian and New Zealand College of Radiologists.

  15. Contrast-enhanced spectral mammography (CESM) and contrast enhanced MRI (CEMRI): Patient preferences and tolerance

    International Nuclear Information System (INIS)

    Hobbs, Max; Buzynski, Sebastian; Taylor, Donna B.; Peake, Rachel E.

    2015-01-01

    Contrast-enhanced spectral mammography (CESM) may have similar diagnostic performance to Contrast-enhanced MRI (CEMRI) in the diagnosis and staging of breast cancer. To date, research has focused exclusively on diagnostic performance when comparing these two techniques. Patient experience is also an important factor when comparing and deciding on which of these modalities is preferable. The aim of this study is to compare patient experience of CESM against CEMRI during preoperative breast cancer staging. Forty-nine participants who underwent both CESM and CEMRI, as part of a larger trial, completed a Likert questionnaire about their preference for each modality according to the following criteria: comfort of breast compression, comfort of intravenous (IV) contrast injection, anxiety and overall preference. Participants also reported reasons for preferring one modality to the other. Quantitative data were analysed using a Wilcoxon sign-rank test and chi-squared test. Qualitative data are reported descriptively. A significantly higher overall preference towards CESM was demonstrated (n = 49, P < 0.001), with faster procedure time, greater comfort and lower noise level cited as the commonest reasons. Participants also reported significantly lower rates of anxiety during CESM compared with CEMRI (n = 36, P = 0.009). A significantly higher rate of comfort was reported during CEMRI for measures of breast compression (n = 49, P = 0.001) and the sensation of IV contrast injection (n = 49, P = 0.003). Our data suggest that overall, patients prefer the experience of CESM to CEMRI, adding support for the role of CESM as a possible alternative to CEMRI for breast cancer staging.

  16. Contrast-Induced Nephropathy in Patients Undergoing Percutaneous Coronary Intervention

    Directory of Open Access Journals (Sweden)

    Sana Shoukat

    2010-01-01

    Full Text Available Contrast Induced Nephropathy (CIN is a feared complication of numerous radiological procedures that expose patients to contrast media. The most notorious of these procedures is percutaneous coronary intervention (PCI. Not only is this a leading cause of morbidity and mortality, but it also adds to increased costs in high risk patients undergoing PCI. It is thought to result from direct cytotoxicity and hemodynamic challenge to renal tissue. CIN is defined as an increase in serum creatinine by either ≥0.5 mg/dL or by ≥25% from baseline within the first 2-3 days after contrast administration, after other causes of renal impairment have been excluded. The incidence is considerably higher in diabetics, elderly and patients with pre-existing renal disease when compared to the general population. The nephrotoxic potential of various contrast agents must be evaluated completely, with prevention as the mainstay of focus as no effective treatment exists. The purpose of this article is to examine the pathophysiology, risk factors, and clinical course of CIN, as well as the most recent studies dealing with its prevention and potential therapeutic interventions, especially during PCI. The role of gadolinium as an alternative to iodinated contrast is also discussed.

  17. Non-asthmatic patients show increased exhaled nitric oxide concentrations

    Directory of Open Access Journals (Sweden)

    Beatriz M. Saraiva-Romanholo

    2009-01-01

    Full Text Available OBJECTIVE: Evaluate whether exhaled nitric oxide may serve as a marker of intraoperative bronchospasm. INTRODUCTION: Intraoperative bronchospasm remains a challenging event during anesthesia. Previous studies in asthmatic patients suggest that exhaled nitric oxide may represent a noninvasive measure of airway inflammation. METHODS: A total of 146,358 anesthesia information forms, which were received during the period from 1999 to 2004, were reviewed. Bronchospasm was registered on 863 forms. From those, three groups were identified: 9 non-asthmatic patients (Bronchospasm group, 12 asthmatics (Asthma group and 10 subjects with no previous airway disease or symptoms (Control group. All subjects were submitted to exhaled nitric oxide measurements (parts/billion, spirometry and the induced sputum test. The data was compared by ANOVA followed by the Tukey test and Kruskal-Wallis followed by Dunn's test. RESULTS: The normal lung function test results for the Bronchospasm group were different from those of the asthma group (p <0.05. The median percentage of eosinophils in induced sputum was higher for the Asthma [2.46 (0.45-6.83] compared with either the Bronchospasm [0.55 (0-1.26] or the Control group [0.0 (0] (p <0.05; exhaled nitric oxide followed a similar pattern for the Asthma [81.55 (57.6-86.85], Bronchospasm [46.2 (42.0 -62.6] and Control group [18.7 (16.0-24.7] (p< 0.05. CONCLUSIONS: Non-asthmatic patients with intraoperative bronchospasm detected during anesthesia and endotracheal intubation showed increased expired nitric oxide.

  18. Intravenous contrast medium application in elderly patients - evaluation of Iopentol (Imagopaque trademark 300)

    International Nuclear Information System (INIS)

    Rathsmann, P.; Jacobs, G.F.; Mueller, R.D.

    2004-01-01

    Purpose: We examined the subjective compatibility of elderly patients who received the intravenous contrast medium Iopentol (Imagopaque trademark 300). In addition, objective data were acquired to show possible interactions between contrast media and organ systems in old patients. Methods and materials: A CT scan with intravenous application of contrast media was performed on 132 patients ranging in age from 75 to 96 years. The patients were questioned about their individual sensations. In addition, blood pressure, creatinine and CT-densitometry were acquired as objective date. Results: The patients' individual sensations and clinical data show a very low rate of complications. Mild allergic reactions were noticed in two patients. No severe anaphylactic reactions were encountered. Statistically significant changes in blood pressure before and after administration of the contrast medium were not observed. The serum creatinine concentration was unchanged after application of contrast media. For CT-densitometry, the patients were divided into two groups, one group with patients 75-84 years and the other group with patients 85-96 years of age. CT-densitometry showed no age-related differences. The protocol of contrast administration resulted in excellent opacification of the examined regions, only the liver did not enhance in some cases before the opacification of the portal vein. Conclusion: It is shown that old age alone is no reason to withhold contrast media containing iodine when performing CT. For the evaluation of the liver, however, the peculiarities of old age have to be taken into account and the interval between injection of the contrast medium and beginning of the spiral-CT has to be extended. (orig.)

  19. Patient experience shows little relationship with hospital quality management strategies.

    NARCIS (Netherlands)

    Groene, O.; Arah, O.A.; Klazinga, N.S.; Wagner, C.; Bartels, P.D.; Kristensen, S.; Saillour, F.; Thompson, C.A.; Pfaff, H.; DerSarkissian, M.; Suñol, R.

    2015-01-01

    Objectives: Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes

  20. Patient Experience Shows Little Relationship with Hospital Quality Management Strategies

    NARCIS (Netherlands)

    Groene, Oliver; Arah, Onyebuchi A.; Klazinga, Niek S.; Wagner, Cordula; Bartels, Paul D.; Kristensen, Solvejg; Saillour, Florence; Thompson, Andrew; Thompson, Caroline A.; Pfaff, Holger; Dersarkissian, Maral; Sunol, Rosa

    2015-01-01

    Patient-reported experience measures are increasingly being used to routinely monitor the quality of care. With the increasing attention on such measures, hospital managers seek ways to systematically improve patient experience across hospital departments, in particular where outcomes are used for

  1. Contrast-enhanced MR imaging of the endolymphatic sac in patients with sudden hearing loss

    International Nuclear Information System (INIS)

    Naganawa, Shinji; Koshikawa, Tokiko; Fukatsu, Hiroshi; Ishigaki, Takeo; Nakashima, Tsutomu; Ichinose, Nobuyasu

    2002-01-01

    Our objective was to evaluate the frequency of contrast enhancement of the endolymphatic sac in patients with sudden hearing loss. Forty consecutive patients with sudden sensorineural hearing loss (20 males and 20 females; age range 11-82 years), 40 age-matched control subjects, and 5 patients with Meniere's disease were examined using the same imaging protocol on a 1.5-T MR system. Pre- and post-contrast-enhanced T1-weighted 3D spoiled gradient-echo sequence (3D SPGR; TR/TE=23/10 ms, no. of excitations=1, flip angle=30 ) images were obtained using a voxel size of 0.6 x 0.7 x 0.8 mm 3 . Contrast enhancement in the area of the endolymphatic sac was assessed by two radiologists, and the frequency of contrast enhancement was compared between the three study groups. Enhancement of the ipsilateral endolymphatic sac was observed in 30 of the 40 patients with sudden hearing loss (75%). Twenty of these 30 patients also showed enhancement on the contralateral side, and 1 patient showed enhancement only on the contralateral side. Only 1 of the 5 patients with Meniere's disease showed enhancement. Nine of the 40 control subjects (22.5%) showed enhancement (bilateral enhancement in 5 subjects, unilateral in 4). The frequency of enhancement in patients with sudden hearing loss was significantly higher than that in control subjects (P<0.0001) or patients with Meniere's disease (P<0.05). The frequency of contrast enhancement of the endolymphatic sac is significantly increased in patients with sudden hearing loss, but further study is necessary to clarify the relationship between this finding and the pathophysiology of sudden hearing loss. (orig.)

  2. Patients with polymyositis show changes in muscle protein charges

    DEFF Research Database (Denmark)

    Bartels, E M; Jacobsen, Søren; Rasmussen, L

    1989-01-01

    Polymyositis (PM) appears with indolent proximal muscle weakness and is an inflammatory disease with breakdown of muscle cells. In our study the protein charge concentrations of the contractile proteins in the A and I bands were determined, applying a microelectrode technique. Patients with PM sh...

  3. Contrast induced nephropathy in hypertensive patients after elective percutaneous coronary intervention

    Science.gov (United States)

    Aryfa Andra, Cut; Khairul, Andi; Aria Arina, Cut; Mukhtar, Zulfikri; Nyak Kaoy, Isfanuddin

    2018-03-01

    Contrast induced nephropathy (CIN) is the third lead cause of hospital acquired renal failure and was associated with significant morbidity and mortality. We hypothesized that hypertension is an independent risk factor for the development of CIN in patients undergoing elective percutaneous coronary intervention (PCI). The case-control method was used, 138 patients scheduled for elective PCI. We measured serum creatinine at baseline and after 24 hours of the procedure. CIN was defined as arising in serum creatinine of at least 44 μmol/l (0,5 mg/dl) or 25% rise from baseline. All patients received low osmolality nonionic contrast during PCI. Hypertension was defined as self-reported a history of treated or untreated diagnosed high blood pressure. One hundred thirty-eight patients (74,6%) were male, and 35 patients (25,4%) were female. Among the 138 patients, 86 (62,3%) were hypertensive patients whereas 52 (37,7%) were nonhypertensive patients. There was no difference in baseline serum creatinine levels and the amount of contrast media in patient with and without CIN. CIN developed in 42 patients, 39 patients (92,9%) were hypertensive compared to 3 patients (7,1%) without hypertension with p value < 0,05. (Odds ratio 16,8, 95% CI 4.542 - 62,412). This study showed that hypertension was a risk factor for the development of CIN

  4. PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients

    International Nuclear Information System (INIS)

    Berthelsen, A.K.; Holm, S.; Loft, A.; Klausen, T.L.; Andersen, F.; Hoejgaard, L.

    2005-01-01

    If the CT scan of a combined PET/CT study is performed as a full diagnostic quality CT scan including intravenous (IV) contrast agent, the quality of the joint PET/CT procedure is improved and a separate diagnostic CT scan can be avoided. CT with IV contrast can be used for PET attenuation correction, but this may result in a bias in the attenuation factors. The clinical significance of this bias has not been established. Our aim was to perform a prospective clinical study where each patient had CT performed with and without IV contrast agent to establish whether PET/CT with IV contrast can be used for PET attenuation without reducing the clinical value of the PET scan. A uniform phantom study was used to document that the PET acquisition itself is not significantly influenced by the presence of IV contrast medium. Then, 19 patients referred to PET/CT with IV contrast underwent CT scans without, and then with contrast agent, followed by an 18 F-fluorodeoxyglucose whole-body PET scan. The CT examinations were performed with identical parameters on a GE Discovery LS scanner. The PET data were reconstructed with attenuation correction based on the two CT data sets. A global comparison of standard uptake value (SUV) was performed, and SUVs in tumour, in non-tumour tissue and in the subclavian vein were calculated. Clinical evaluation of the number and location of lesions on all PET/CT scans was performed twice, blinded and in a different random order, by two independent nuclear medicine specialists. In all patients, the measured global SUV of PET images based on CT with IV contrast agent was higher than the global activity using non-contrast correction. The overall increase in the mean SUV (for two different conversion tables tested) was 4.5±2.3% and 1.6±0.5%, respectively. In 11/19 patients, focal uptake was identified corresponding to malignant tumours. Eight out of 11 tumours showed an increased SUV max (2.9±3.1%) on the PET images reconstructed using IV contrast

  5. Patient radiation dose during fluoroscopy testes with contrast medium

    International Nuclear Information System (INIS)

    Darsalih, Abir Abdelrady El noor

    2016-09-01

    The purpose of this study was to assess the patient radiation dose received in fluoroscopy examinations during contrast medium. The cumulative air kerma (Ck), kerma area product (KAP) and fluoroscopy time were measured for sixty ( male and female ) patients undergoing five fluoroscopy examinations KAP metre which was installed for the purpose of this study. The mean kerma area product were found to be 2.681, 5.1561, 9.85529. 5.7974 and 13.09 Gy.cm"2 for HSG, A.S and D.S, GI Track and sonogram tests, respectively. The obtained mean cumulative dose was were 6.31, 13.88, 24.61, 22.56 and 32.14 mGy for HSG, A.S, A.S and D.S , GI Track, respectively, the mean fluoroscopy time were. 0.18, 0.51,0.89,1.57 and 1.75 min, for HSG, A.S, A.S, and D.S, G1 Track and sonogram test respectively. Patient dose is mainly dependent on the patient size, procedure, equipment used exposure factor and user experience. As KV and mA were controlled by the AEC and it was found to be well calibrated, possible optimization could be achieved by radiologist by decreasing the exposure time if possible. (Author)

  6. Effect of contrast enhancement and its indication for CT studies in geriatric patients

    International Nuclear Information System (INIS)

    Yamada, Hideo

    1979-01-01

    Contrast enhancement CT study after drip infusion of 3 ml of 30% Conray for 15 min proved a safe and effective procedure even in geriatric patients with an avarage age of 72.4 years old. Mild untoward effect by contrast agent was observed in 2.5% of cases examined. Contrast study was considered not necessarily to be needed in cases with cerebral infarction showing well defined low density lesion and for evaluation of degree of ventricle enlargement, cerebral atrophy and so forth. On the contrary, contrast infusion study is indispensable in such cases that show mass effect or edema which is frequently observed in fresh cerebral infarction, haemorrhagic infarction, bleeding or tumor. CT studies of the abdomen and thorax were also discussed. (author)

  7. Chronic myeloid leukemia patients sensitive and resistant to imatinib treatment show different metabolic responses.

    Directory of Open Access Journals (Sweden)

    Jiye A

    Full Text Available The BCR-ABL tyrosine kinase inhibitor imatinib is highly effective for chronic myeloid leukemia (CML. However, some patients gradually develop resistance to imatinib, resulting in therapeutic failure. Metabonomic and genomic profiling of patients' responses to drug interventions can provide novel information about the in vivo metabolism of low-molecular-weight compounds and extend our insight into the mechanism of drug resistance. Based on a multi-platform of high-throughput metabonomics, SNP array analysis, karyotype and mutation, the metabolic phenotypes and genomic polymorphisms of CML patients and their diverse responses to imatinib were characterized. The untreated CML patients (UCML showed different metabolic patterns from those of healthy controls, and the discriminatory metabolites suggested the perturbed metabolism of the urea cycle, tricarboxylic acid cycle, lipid metabolism, and amino acid turnover in UCML. After imatinib treatment, patients sensitive to imatinib (SCML and patients resistant to imatinib (RCML had similar metabolic phenotypes to those of healthy controls and UCML, respectively. SCML showed a significant metabolic response to imatinib, with marked restoration of the perturbed metabolism. Most of the metabolites characterizing CML were adjusted to normal levels, including the intermediates of the urea cycle and tricarboxylic acid cycle (TCA. In contrast, neither cytogenetic nor metabonomic analysis indicated any positive response to imatinib in RCML. We report for the first time the associated genetic and metabonomic responses of CML patients to imatinib and show that the perturbed in vivo metabolism of UCML is independent of imatinib treatment in resistant patients. Thus, metabonomics can potentially characterize patients' sensitivity or resistance to drug intervention.

  8. Accuracy of pre-contrast imaging in abdominal magnetic resonance imaging of pediatric oncology patients

    International Nuclear Information System (INIS)

    Mohd Zaki, Faizah; Moineddin, Rahim; Grant, Ronald; Chavhan, Govind B.

    2016-01-01

    Safety concerns are increasingly raised regarding the use of gadolinium-based contrast media for MR imaging. To determine the accuracy of pre-contrast abdominal MR imaging for lesion detection and characterization in pediatric oncology patients. We included 120 children (37 boys and 83 girls; mean age 8.94 years) referred by oncology services. Twenty-five had MRI for the first time and 95 were follow-up scans. Two authors independently reviewed pre-contrast MR images to note the following information about the lesions: location, number, solid vs. cystic and likely nature. Pre- and post-contrast imaging reviewed together served as the reference standard. The overall sensitivity was 88% for the first reader and 90% for the second; specificity was 94% and 91%; positive predictive value was 96% and 94%; negative predictive value was 82% and 84%; accuracy of pre-contrast imaging for lesion detection as compared to the reference standard was 90% for both readers. The difference between mean number of lesions detected on pre-contrast imaging and reference standard was not significant for either reader (reader 1, P = 0.072; reader 2, P = 0.071). There was substantial agreement (kappa values of 0.76 and 0.72 for readers 1 and 2) between pre-contrast imaging and reference standard for determining solid vs. cystic lesion and likely nature of the lesion. The addition of post-contrast imaging increased confidence of both readers significantly (P < 0.0001), but the interobserver agreement for the change in confidence was poor (kappa 0.12). Pre-contrast abdominal MR imaging has high accuracy in lesion detection in pediatric oncology patients and shows substantial agreement with the reference standard for characterization of lesions. Gadolinium-based contrast media administration cannot be completely eliminated but can be avoided in many cases, with the decision made on a case-by-case basis, taking into consideration location and type of tumor. (orig.)

  9. Accuracy of pre-contrast imaging in abdominal magnetic resonance imaging of pediatric oncology patients

    Energy Technology Data Exchange (ETDEWEB)

    Mohd Zaki, Faizah [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, Toronto, ON (Canada); Universiti Kebangsaan Malaysia Medical Center, Department of Radiology, Kuala Lumpur (Malaysia); Moineddin, Rahim [University of Toronto, Department of Family and Community Medicine, Toronto, ON (Canada); Grant, Ronald [University of Toronto, Department of Hematology and Oncology, The Hospital for Sick Children and Medical Imaging, Toronto, ON (Canada); Chavhan, Govind B. [University of Toronto, Department of Diagnostic Imaging, The Hospital for Sick Children and Medical Imaging, Toronto, ON (Canada)

    2016-11-15

    Safety concerns are increasingly raised regarding the use of gadolinium-based contrast media for MR imaging. To determine the accuracy of pre-contrast abdominal MR imaging for lesion detection and characterization in pediatric oncology patients. We included 120 children (37 boys and 83 girls; mean age 8.94 years) referred by oncology services. Twenty-five had MRI for the first time and 95 were follow-up scans. Two authors independently reviewed pre-contrast MR images to note the following information about the lesions: location, number, solid vs. cystic and likely nature. Pre- and post-contrast imaging reviewed together served as the reference standard. The overall sensitivity was 88% for the first reader and 90% for the second; specificity was 94% and 91%; positive predictive value was 96% and 94%; negative predictive value was 82% and 84%; accuracy of pre-contrast imaging for lesion detection as compared to the reference standard was 90% for both readers. The difference between mean number of lesions detected on pre-contrast imaging and reference standard was not significant for either reader (reader 1, P = 0.072; reader 2, P = 0.071). There was substantial agreement (kappa values of 0.76 and 0.72 for readers 1 and 2) between pre-contrast imaging and reference standard for determining solid vs. cystic lesion and likely nature of the lesion. The addition of post-contrast imaging increased confidence of both readers significantly (P < 0.0001), but the interobserver agreement for the change in confidence was poor (kappa 0.12). Pre-contrast abdominal MR imaging has high accuracy in lesion detection in pediatric oncology patients and shows substantial agreement with the reference standard for characterization of lesions. Gadolinium-based contrast media administration cannot be completely eliminated but can be avoided in many cases, with the decision made on a case-by-case basis, taking into consideration location and type of tumor. (orig.)

  10. The relationship between contrast enhancement on CT and cerebral vasospasm in patient with subarachnoid hemorrhage

    International Nuclear Information System (INIS)

    Tazawa, Toshiaki; Mizukami, Masahiro; Kawase, Takeshi; Usami, Takashi; Togashi, Osamu

    1982-01-01

    Sixty patients with a single rupture of an aneurysm were subjected to study. Contrast enhanced CT (CECT) was performed by intravenous infusion of 100 ml of 60% meglumine iothalamate in 10 minutes. Post-contrast CT scans were repeated serially just after infusion, 15 minutes and 30 minutes later. Prominent increase in density in the region of the circle of Willis and its branches 30 minutes after infusion was considered as remarkable enhancement. In 17 (46%) out of 37 patients who underwent CECT within day 3, the contrast enhancement was remarkable. Transient or permanent symptomatic vasospasm occurred in 13 (76.5%) out of these 17 patients and the remaining 4 patients who underwent the operation with successful removal of subarachnoid clot within day 3 did not develop symptomatic vasospasm. Eight (67%) out of 12 patients operated within day 3, in whom post-operative CT showed incomplete removal of subarachnoid clot, developed transient or permanent symptomatic vasospasm. In only one (5%) out of 20 patients without remarkable enhancement, transient symptomatic vasospasm occurred. The abnormal contrast enhancement in the region of the circle of Willis and its branches within day 3 was closely related to the subsequent occurrence of vasospasm. Contrast enhanced CT was performed in 41 patients after day 3. There was no patient with remarkable enhancement on CECT. There was no relationship between the findings on CECT after day 3 and the occurrence of vasospasm. CECT within day 3 allows prediction of that patient destined for vasospasm and early removal of subarachnoid clot within day 3 may minimize the future development of vasospasm.(J.P.N.)

  11. Patient safety and adverse events in contrast medium examinations

    International Nuclear Information System (INIS)

    Enge, I.; Edgren, J.

    1989-01-01

    This volume contains six contributions dealing with the properties, safety and economic aspects (lower risks but higher costs of new low-osmonality contrast media compared to the older high-osmonality, ionic ones) of contrast media used in radiology, and risks involved in procedures for administering of radiologic contrast media. (H.W.). refs.; figs.; tabs

  12. Use of cystatin C and serum creatinine for the diagnosis of contrast-induced nephropathy in patients undergoing contrast-enhanced computed tomography at an oncology centre.

    Directory of Open Access Journals (Sweden)

    Joao Italo Fortalesa Melo

    Full Text Available Our aim was to assess renal function using as laboratory measurements serum creatinine and cystatin C concentrations before and after administration of low-osmolarity (nonionic iodinated contrast medium in patients with cancer undergoing computed tomography (CT.This prospective study included 400 oncologic outpatients. Serum creatinine and cystatin C concentrations were measured before and 72 h after contrast administration. Glomerular filtration rates (GFRs were estimated using serum creatinine-based [Modification of Diet in Renal Disease (MDRD and Cockroft-Gault and cystatin C based (Larsson equations. Exploratory data analysis was performed. The nonparametric Wilcoxon test was used to compare pre and post contrast of test results and estimated clearance. The confidence interval used in the analysis was 95%.Compared with the pre-contrast values, the mean serum creatinine concentration was significantly higher and average GFRs estimated using MDRD and Cockcroft-Gault equations were significantly lower after the administration of contrast (p <0.001. It was also observed a significant increase after contrast in the concentration of Cystatin C (p = 0.015. In addition, a decrease in GFR estimated using the average Larsson (p = 0.021 was observed between time points. However, none of the patients presented clinically significant nephropathy.Assessment using serum creatinine and cystatin C concentrations showed changes in renal function among patients with cancer undergoing contrast-enhanced CT examination in this study. No significant renal damage related to the use of low-osmolarity iodinated contrast medium of the type and dosage employed in this study was observed. This contrast medium is thus safe for use in patients with cancer.

  13. Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

    International Nuclear Information System (INIS)

    Murakami, Ryusuke; Kumita, Shin-ichiro; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

    2013-01-01

    Purpose: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methods: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72 h after contrast administration. Results: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P = .027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P = .046). Conclusions: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT

  14. Anemia and the risk of contrast-induced nephropathy in patients with renal insufficiency undergoing contrast-enhanced MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Murakami, Ryusuke, E-mail: rywakana@nms.ac.jp; Kumita, Shin-ichiro; Hayashi, Hiromitsu; Sugizaki, Ken-ichi; Okazaki, Emi; Kiriyama, Tomonari; Hakozaki, Kenta; Tani, Hitomi; Miki, Izumi; Takeda, Minako

    2013-10-01

    Purpose: The purpose of this study was to assess the effect of anemia on the incidence of contrast-induced nephropathy (CIN) in patients with renal impairment undergoing MDCT. Materials and methods: Institutional review board approval was waived for this retrospective review of 843 patients with stable renal insufficiency (eGFR between 15 and 60 mL/min) who had undergone contrast-enhanced MDCT. Baseline hematocrit and hemoglobin values were measured. Serum creatinine (SCr) was assessed at the baseline and at 48–72 h after contrast administration. Results: The overall incidence of CIN in the patient population with renal insufficiency was 6.9%. CIN developed in 7.8% (54 of 695) of anemic patients, and in 2.8% (4 of 148) of non-anemic patients (P = .027). After adjustment for confounders, low hemoglobin and low hematocrit values remained independent predictors of CIN (odds ratio 4.6, 95% CI 1.0–20.5, P = .046). Conclusions: Anemia is associated with a higher incidence of CIN in patients with renal insufficiency. Anemia is a potentially modifiable risk factor for CIN, and has an unfavorable impact on prognosis in patients with renal insufficiency undergoing contrast-enhanced MDCT.

  15. Correlation between contrast sensitivity and visual acuity in retinitis pigmentosa patients.

    Science.gov (United States)

    Akeo, Kiyoshi; Hiida, Yoshiki; Saga, Masamichi; Inoue, Rikako; Oguchi, Yoshihisa

    2002-01-01

    High-contrast figures such as Landolt rings are insufficient to evaluate the function of the foveal cones of retinitis pigmentosa (RP) patients. We investigated the correlation between visual function as determined with Landolt rings and with the Vistech Contrast Sensitivity Function Test (VCTS) at various spatial frequencies, in addition to the Cambridge Low Contrast Grating (CLCG). The study included 30 retinitis pigmentosa patients (53 eyes). All patients were assessed with Landolt rings, the Vistech method, and the CLCG. We estimated the relative contribution of contrast sensitivity to visual acuity by VCTS at each spatial frequency and by CLCG by simple linear regression analysis. The results of the regression analysis of VCTS at 1.5, 3.0, and 6.0 cycles/degree showed a significant correlation between Landolt rings and VCTS and between CLCG and VCTS that was strongest at 6.0 cycles/degree. There was no significant correlation between Landolt rings and VCTS or between CLCG and VCTS at 12.0 and 18.0 cycles/degree. Patients with a visual acuity of 20/25 and CLCG greater than 100 were divided into two groups according to their contrast sensitivity at 18.0 cycles/degree on VCTS. The VCTS at the highest frequency was useful for evaluating the foveal visual function in RP patients having good visual acuity with the Landolt rings. Thus, contrast sensitivity should be useful in detecting minute impairment or improvement of visual function in RP. Copyright 2002 S. Karger AG, Basel

  16. A prospective study on the risk of contrast induced nephropathy in the patients who underwent contrast-enhanced CT examination

    International Nuclear Information System (INIS)

    Zhang Baocui; Zhang Yudong; Zhao Kai; Wang Xiaoying; Jiang Xuexiang

    2013-01-01

    Objective: To investigate the incidence of contrast induced nephropathy (CIN) among different patient groups after contrast agent injection. Methods: A total of 1243 patients were included in this study (male = 694, female = 549). The SCr level one week before and 72 hours after the CT examination and the incidence of CIN were recorded and comparison was made among groups according to sex, age, body mass index (BMI), the history of high blood pressure (HBP), diabetes mellitus (DM), chronic kidney disease (CKD), chronic heart failure (CHF), tumor, nephrotoxicity drug (NTD) usage. The frequency, type, dose and injection velocity of the contrast media (CM) were also recorded. Multivariate predictors of CIN were identified by Logistic regression using step-wise selection with entry and exit criteria of P 1). Conclusion: Women, age ≥ 75 years, LOCM, NTD, tumor, and the frequency of using CM more than once per month were more likely to develop CIN. (authors)

  17. Effect on renal function of an iso-osmolar contrast agent in patients with monoclonal gammopathies

    International Nuclear Information System (INIS)

    Preda, Lorenzo; Agazzi, Alberto; Martinelli, Giovanni; Raimondi, Sara; Lanfranchi, Carla Federica; Passerini, Rita; Calvetta, Albania; Bellomi, Massimo

    2011-01-01

    To assess the safety of the non-ionic iso-osmolar contrast agent iodixanol on renal function in patients with monoclonal gammopathies undergoing CT. We explored the effect of iodixanol on renal function in 30 patients with monoclonal gammopathies and 20 oncological patients with a normal electrophoretic profile (control group). The parameters used to estimate renal function were: serum creatinine, eGFR (determined 24 h before and 48 h after the administration of iodixanol), and urinary excretion of Neutrophil Gelatinase-Associated Lipocalin (NGAL) determined 2 h and 24 h after. Serum creatinine was also determined 1 month after the administration of iodixanol. No significant increase in serum creatinine values were observed in the monoclonal gammopathies group and in 19/20 patients in the control group. Only 1 patient in the control group developed a transient contrast agent-induced nephropathy. We found no statistically significant difference between the two groups regarding the percentage variation from baseline values of serum creatinine, creatinine clearance, NGAL 2 h after, and eGFR. Whereas NGAL at 24 h showed a statistically significant increase in patients with Monoclonal gammopathies. The use of iodixanol appears to be safe in patients with monoclonal gammopathies and an eGFR ≥ 60 ml/min/1.73 mq. (orig.)

  18. Prognostic value of contrast-enhanced MR mammography in patients with breast cancer.

    Science.gov (United States)

    Fischer, U; Kopka, L; Brinck, U; Korabiowska, M; Schauer, A; Grabbe, E

    1997-01-01

    The objective of this study was to evaluate the prognostic value of contrast-enhanced MR mammography in patients with breast cancer. A total of 190 patients with breast cancer (37 noninvasive carcinomas, 153 invasive carcinomas) underwent dynamic contrast-enhanced MR mammography preoperatively. Using 1.5-T unit, T1-weighted sequences (2D FLASH) were obtained repeatedly one time before and five times after IV administration of 0.1 mmol gadopentetate-dimeglumine per kilogram body weight. The findings on MR imaging were correlated with histopathologically defined prognostic factors (histological type, tumor size, tumor grading, metastasis in lymph nodes). In addition, immunohistochemically defined prognostic factors (c-erbB-1, c-erbB-2, p53, Ki-67) were correlated with the signal increase on MR mammogram in 40 patients. There was no significant correlation between the findings on MR mammography and the histopathological type of carcinoma, the grading, and the lymphonodular status. Noninvasive carcinomas showed a higher rate of moderate (38 %) or low (27 %) enhancement on MR imaging than invasive carcinomas (6 and 3 %). The results on MR mammography and the results of immunohistochemical stainings did not correlate significantly. Noninvasive carcinomas showed significantly lower enhancement than invasive carcinomas. However, the signal behavior of contrast-enhanced MR mammography is not related to established histopathological prognostic parameters as subtyping, grading, nodal status, and the expression of certain oncogenes/tumor suppressor genes.

  19. Prognostic value of contrast-enhanced MR mammography in patients with breast cancer

    International Nuclear Information System (INIS)

    Fischer, U.; Kopka, L.; Brinck, U.; Korabiowska, M.; Schauer, A.; Grabbe, E.

    1997-01-01

    The objective of this study was to evaluate the prognostic value of contrast-enhanced MR mammography in patients with breast cancer. A total of 190 patients with breast cancer (37 noninvasive carcinomas, 153 invasive carcinomas) underwent dynamic contrast-enhanced MR mammography preoperatively. Using 1.5-T unit, T1-weighted sequences (2D FLASH) were obtained repeatedly one time before and five times after IV administration of 0.1 mmol gadopentetate-dimeglumine per kilogram body weight. The findings on MR imaging were correlated with histopathologically defined prognostic factors (histological type, tumor size, tumor grading, metastasis in lymph nodes). In addition, immunohistochemically defined prognostic factors (c-erbB-1,c-erbB-2, p53, Ki-67) were correlated with the signal increase on MR mammogram in 40 patients. There was no significant correlation between the findings on MR mammography and the histopathological type of carcinoma, the grading, and the lymphonodular status. Noninvasive carcinomas showed a higher rate of moderate (38 %) or low (27 %) enhancement on MR imaging than invasive carcinomas (6 and 3 %). The results on MR mammography and the results of immunohistochemical stainings did not correlate significantly. Noninvasive carcinomas showed significantly lower enhancement than invasive carcinomas. However, the signal behavior of contrast-enhanced MR mammography is not related to established histopathological prognostic parameters as subtyping, grading, nodal status, and the expression of certain oncogenes/tumor suppressor genes. (orig.). With 5 tabs

  20. Low incidence of nephropathy in surgical ICU patients receiving intravenous contrast : a retrospective analysis

    NARCIS (Netherlands)

    Haveman, Jan Willem; Gansevoort, Ron T.; Bongaerts, Alfons H. H.; Nijsten, Maarten W. N.

    Objective: Various studies have documented a markedly high incidence of contrast-induced nephropathy (CIN). Most of these studies were conducted in patients not in the ICU. In ICU patients intravenous contrast may be withheld for fear of CIN. We investigated the incidence of CIN in ICU patients.

  1. Postoperative lumbar MR imaging with contrast enhancement. Comparison between symptomatic and asymptomatic patients

    International Nuclear Information System (INIS)

    Grane, P.; Tullberg, T.; Rydberg, J.; Lindgren, L.

    1995-01-01

    Contrast-enhanced MR imaging of the spine after surgery for lumbar disk herniation almost always shows pathologic changes. To investigate to what extent these changes are correlated to patients' actual clinical symptoms, we compared the postoperative MR findings in 19 asymptomatic patients with 42 symptomatic patients (43 levels). The asymptomatic patients underwent MR examination one year after surgery. Twenty-six of the symptomatic patients underwent MR one year of less after surgery, and in 16 patients (17 levels) MR was performed more than one year after surgery. Sixteen percent of the asymptomatic and 42% of the symptomatic patients had disk herniation at the level of previous surgery. Most of the herniated disks were found in the symptomatic patients less than one year after surgery. The amount of epidural scar tissue, displacement and thickening of nerve roots, and compression of the dural sac were also studied. Disk herniation as a probable cause of recurrent sciatica was a common finding among symptomatic patients examined one year or less after surgery. In comparing asymptomatic patients and symptomatic patients with more than one year between surgery and MR examination, no significant radiologic differences, including disk herniation, were found. (orig.)

  2. Postoperative lumbar MR imaging with contrast enhancement. Comparison between symptomatic and asymptomatic patients

    Energy Technology Data Exchange (ETDEWEB)

    Grane, P. [Dept. of Neuroradiology, Karolinska Hospital, Stockholm (Sweden); Tullberg, T. [Dept. of Orthopaedics, St. Goeran`s Hospital, Stockholm (Sweden); Rydberg, J. [Dept. of Radiology, St. Goeran`s Hospital, Stockholm (Sweden); Lindgren, L. [Dept. of Neurosurgery, Karolinska Hospital, Stockholm (Sweden)

    1995-05-01

    Contrast-enhanced MR imaging of the spine after surgery for lumbar disk herniation almost always shows pathologic changes. To investigate to what extent these changes are correlated to patients` actual clinical symptoms, we compared the postoperative MR findings in 19 asymptomatic patients with 42 symptomatic patients (43 levels). The asymptomatic patients underwent MR examination one year after surgery. Twenty-six of the symptomatic patients underwent MR one year of less after surgery, and in 16 patients (17 levels) MR was performed more than one year after surgery. Sixteen percent of the asymptomatic and 42% of the symptomatic patients had disk herniation at the level of previous surgery. Most of the herniated disks were found in the symptomatic patients less than one year after surgery. The amount of epidural scar tissue, displacement and thickening of nerve roots, and compression of the dural sac were also studied. Disk herniation as a probable cause of recurrent sciatica was a common finding among symptomatic patients examined one year or less after surgery. In comparing asymptomatic patients and symptomatic patients with more than one year between surgery and MR examination, no significant radiologic differences, including disk herniation, were found. (orig.).

  3. Study of the safety of a new non-ionic contrast medium, iopromide 370 in patients with chronic renal failure

    International Nuclear Information System (INIS)

    Meyrier, A.; Fernet, M.; Rainfray, M.

    1989-01-01

    Intravenous injection of iodinated contrast media usually induces modifications of renal function. Adverse effects of contrast media on renal function may affect diuresis, blood flow or glomerular filtration rate. These modifications are mainly related to osmolality but also chemotoxicity. This open study showed that after i.v. injection of a bolus of iopromide 370, a new non-ionic contrast medium, there was no untoward effect on renal function in patients with renal insufficiency. This justifies comparative studies in patients with renal impairment including elderly subjects, to confirm the tolerance of this product in high risk groups [fr

  4. Contrast-enhanced fast fluid-attenuated inversion recovery MR imaging in patients with brain tumors

    International Nuclear Information System (INIS)

    Kim, Chan Kyo; Na, Dong Gyu; Ryoo, Wook Jae; Byun Hong Sik; Yoon, Hye Kyung; Kim, Jong hyun

    2000-01-01

    To assess the feasibility of contrast-enhanced fast fluid-attenuated inversion recovery (fast FLAIR) MR imaging in patients with brain tumors. This study involved 31 patients with pathologically proven brain tumors and nine with clinically diagnosed metastases. In all patients, T2-weighted, fast FLAIR, images were visual contrast-enhanced T1-weighted MR images were obtained. Contrast-enhanced fast FLAIR images were visually compared with other MR sequences in terms of tumor conspicuity. In order to distinguish tumor and surrounding edema, contrast-enhanced fast FLAIR images were compared with fast FLAIR and T2-weighted images. The tumor-to- white matter contrast-to-noise ratios (CNRs), as demonstrated by T2-weighted, fast FLAIR, contrast-enhanced fast FLAIR and contrast-enhanced T1-weighted imaging, were quantitatively assessed and compared. For the visual assessment of tumor conspicuity, contrast-enhanced fast FLAIR image imaging superior to fast FLAIR in 60% of cases (24/40), and superior to T2-weighted in 70% (28/40). Contrast-enhanced fast FLAIR imaging was inferior to contrast-enhanced T1-weighted in 58% of cases (23/40). For distinguishing between tumor and surrounding edema, contrast-enhanced fast FLAIR imaging was superior to fast FLAIR or T2-weighted in 22 of 27 tumors with peritumoral edema (81%). Quantitatively, CNR was the highest on contrast-enhanced fast FLAIR image and the lowest on fast FLAIR. For the detection of leptomeningeal metastases, contrast-enhanced fast FLAIR was partially superior to contrast-enhanced T1-weighted imaging in two of three high-grade gliomas. Although contrast-enhanced fast FLAIR imaging should not be seen as a replacement for conventional modalities, it provides additional informaton for assessment of the extent of glial cell tumors and leptomeningeal metastases in patients with brain tumors. (author)

  5. Dynamic contrast-enhanced MRI in patients with luminal Crohn's disease

    NARCIS (Netherlands)

    Ziech, M. L. W.; Lavini, C.; Caan, M. W. A.; Nio, C. Y.; Stokkers, P. C. F.; Bipat, S.; Ponsioen, C. Y.; Nederveen, A. J.; Stoker, J.

    2012-01-01

    Objectives: To prospectively assess dynamic contrast-enhanced (DCE-)MRI as compared to conventional sequences in patients with luminal Crohn's disease. Methods: Patients with Crohn's disease undergoing MRI and ileocolonoscopy within 1 month had DCE-MRI (3T) during intravenous contrast injection of

  6. Dose Tc-99m MIBI scintimammography provide more information additive to contrast enhanced MRI in highly suspected breast cancer patients?

    International Nuclear Information System (INIS)

    Kim, Seong Jang; Kim, In Ju; Kim, Yong Ki; Bae, Young Tae

    2000-01-01

    The aim of this study was to investigate whether Tc-99m MIBI scintimammography (SMM) provide more information than contrast enhanced MRI in highly suspected breast cancer patients. This study included 32 breast lesions of 29 highly suspected patients having breast cancer. All patients were performed SMM and contrast enhanced MRI. The SMMs and contrast enhanced MRI were correlated with histopathologic results. Thirty breast lesions were diagnosed malignant diseases and 2 were diagnosed benign diseases. SMM showed 29 true positives (TP), 1 true negative (TN), 1 false positive (FP), and 1 false negative (FN). The sensitivity was 96.6%. Contrast enhanced MRI revealed 24 TP, 0 TN, 1 FP, 3 FN and 4 indeterminate cases. The sensitivity was 88.8%. In the assessment of axillary lymph node metastasis, SMM showed 9 TP, 10 TN, 0 FP, and 3 FN. The sensitivity and specificity were 75% and 100%. Contrast enhanced MRI revealed 6 TP, 9 TN, 1 FP, and 6 FN. The sensitivity and specificity were 50% and 90%. Among 4 indeterminate cases with MRI findings, SMM correctly diagnosed malignant breast diseases in 3 lesions. However, SMM showed false positive in 1 lesion. SMM could correctly diagnosed malignant breast diseases more 5 lesions than contrast enhanced MRI. SMM revealed higher sensitivity in detection of primary breast cancer and axillary LN metastasis than contrast enhanced MRI. SMMs could correctly diagnosed malignant breast diseases even if the MRI showed indeterminate findings. In highly suspected patients having breast cancer, SMM may provide additive information in detection of breast cancer if contrast enhanced MRI showed indeterminate findings but this is to be determined later by large population based study

  7. Comparison of arterial input functions measured from ultra-fast dynamic contrast enhanced MRI and dynamic contrast enhanced computed tomography in prostate cancer patients

    Science.gov (United States)

    Wang, Shiyang; Lu, Zhengfeng; Fan, Xiaobing; Medved, Milica; Jiang, Xia; Sammet, Steffen; Yousuf, Ambereen; Pineda, Federico; Oto, Aytekin; Karczmar, Gregory S.

    2018-02-01

    The purpose of this study was to evaluate the accuracy of arterial input functions (AIFs) measured from dynamic contrast enhanced (DCE) MRI following a low dose of contrast media injection. The AIFs measured from DCE computed tomography (CT) were used as ‘gold standard’. A total of twenty patients received CT and MRI scans on the same day. Patients received 120 ml Iohexol in DCE-CT and a low dose of (0.015 mM kg-1) of gadobenate dimeglumine in DCE-MRI. The AIFs were measured in the iliac artery and normalized to the CT and MRI contrast agent doses. To correct for different temporal resolution and sampling periods of CT and MRI, an empirical mathematical model (EMM) was used to fit the AIFs first. Then numerical AIFs (AIFCT and AIFMRI) were calculated based on fitting parameters. The AIFMRI was convolved with a ‘contrast agent injection’ function (AIFMRICON ) to correct for the difference between MRI and CT contrast agent injection times (~1.5 s versus 30 s). The results show that the EMMs accurately fitted AIFs measured from CT and MRI. There was no significant difference (p  >  0.05) between the maximum peak amplitude of AIFs from CT (22.1  ±  4.1 mM/dose) and MRI after convolution (22.3  ±  5.2 mM/dose). The shapes of the AIFCT and AIFMRICON were very similar. Our results demonstrated that AIFs can be accurately measured by MRI following low dose contrast agent injection.

  8. The evidence-based evaluation of the safety of contrast media in patients with diabetes mellitus

    International Nuclear Information System (INIS)

    Li Jixia; Huang Baosheng

    2009-01-01

    Contrast-induced nephropathy (CIN) has now been the third most common cause of acquired renal failure. Diabetes mellitus (DM), the type of contrast agent used and the intra-arterial route of administration are three important risk factors inducing CIN. The incidence rate of CIN is very high in patients with DM or renal insufficiency after iodinated contrast was administered. Unfortunately, it has not yet attracted physicians'and radiologists'sufficient attention. This paper aims to make an evidence-based evaluation of the safety and rephrotoxicity of various contrast agents when they are used in patients with DM. Usually, intravenous administration of contrast media will not cause permanent damage to the kidney in highrisk patients. Low-osmolarity contrast media is relatively safe for patients with DM only, while it takes much risk of CIN when low-osmolarity contrast media is used in patients with diabetic nephropathy or in patients of DM accompanied with renal insufficiency, for such patients, the iso-osmolarity contrast media, iodixanol, can be used. (authors)

  9. Optimized contrast volume for dynamic CT angiography in renal transplant patients using a multiphase CT protocol

    International Nuclear Information System (INIS)

    Helck, A.; Bamberg, F.; Sommer, W.H.; Wessely, M.; Becker, C.; Clevert, D.A.; Notohamiprodjo, M.; Reiser, M.; Nikolaou, K.

    2011-01-01

    Objectives: To study the feasibility of an optimized multiphase renal-CT-angiography (MP-CTA) protocol in patients with history of renal transplantation compared with Doppler-ultrasound (DUS). Methods: 36 Patients underwent both DUS and time-resolved, MP-CTA (12 phases), with a mean contrast-volume of 34.4 ± 5.1 ml. Quality of MP-CTA was assessed quantitatively (vascular attenuation) and qualitatively (grades 1–4, 1 = best). For the assessment of clinical value of MP-CTA, cases were grouped into normal, macrovascular (arterial/venous) and microvascular complications (parenchymal perfusion defect). DUS served as the standard of reference. Results: Using the best of 12 phases in each patient, optimal attenuation was 353 ± 111 HU, 337 ± 98 HU and 164 ± 51 HU in the iliac arteries, renal arteries, and renal veins, respectively. Mean image quality was 1.1 ± 0.3 (n = 36) and 2.1 ± 0.6 (n = 30) for the transplant renal arteries and veins, respectively. Six renal veins were non-diagnostic in MP-CTA. In 36 patients, MP-CTA showed 13 vascular complications and 10 parenchymal perfusion defects. DUS was not assessable in eight patients. Overall, MP-CTA showed 15 cases with pathology (42%) not identifiable with DUS. The mean effective radiation dose of the MP-CTA protocol was 13.5 ± 5.2 mSv. Conclusion: MP-CTA can be sufficiently performed with reduced contrast volume at reasonable radiation dose in renal transplant patients, providing substantially higher diagnostic yield than DUS.

  10. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis

    NARCIS (Netherlands)

    Moos, Shira I.; van Vemde, David N. H.; Stoker, Jaap; Bipat, Shandra

    2013-01-01

    To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. This review is performed in accordance with the

  11. Value of contrast enhanced CT scanning in the non-trauma emergency room patient

    International Nuclear Information System (INIS)

    Wood, L.P.; Parisi, M.; Finch, I.J.

    1990-01-01

    To determine the value of performing contrast CT in addition to non-contrast CT in the evaluation of acute non-traumatic central nervous system disorders, we retrospectively reviewed 322 cases originating from the emergency room at our institution. The most common indication for scanning was seizure activity (34% of total), followed by headache (30%), focal neurological deficit (10%), and altered mental status (8%). 75% of the noncontrast scans were normal. The contrast enhanced scan revealed abnormalities not evident on the non-contrast scan in only three of these cases, and the information did not alter patient management. We conclude that in the acute setting, if a non-contrast CT is normal, a contrast study is usually unnecessary. Therefore, given the additional risks of contrast infusion, the contrast study, if needed, is generally best obtained at a later date, after more careful evaluation of the patient's history and medical records. If the non-contrast CT scan is abnormal, a contrast enhanced CT scan may be beneficial, but, again, is often not needed to direct acute patient management. (orig.)

  12. 99mTc-HM-PAO SPECT of epileptic patients showing focal paroxysm on electroencephalography

    International Nuclear Information System (INIS)

    Takaishi, Yasuko; Hashimoto, Kiyoshi; Fujino, Osamu; Kamayachi, Satoshi; Fujita, Takehisa; Enokido, Hisashi; Komatsuzaki, Hideki; Kawakami, Yasuhiko; Hirayama, Tsunenori

    1995-01-01

    The usefulness of 99m Tc-HM-PAO SPECT in diagnosing epilepsy was studied. The subjects were 33 epileptic patients, ranging in age from 5 years and 5 months to 28 years and 3 months, who showed focal paroxysm on electroencephalograms. Lowered accumulation site was found on SPECT in 19 patients. Four patients with abnormal findings on X-ray CT or MRI showed lowered accumulation and focal paroxysm at the same site. Of 29 patients with normal X-ray CT or MRI findings, 15 (52%) showed lowered accumulation. Five patients showed a focal paroxysm at the site of lowered accumulation. In 8 patients the focal paroxysm site was partly coincided with the accumulation site. In some patients the focal site predicted by the findings of clinical symptoms and the lowered accumulation site coincided. SPECT is therefore a useful method in diagnosing a focal site in epilepsy and considered to reflect the severity of disease. (Y.S.)

  13. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    Energy Technology Data Exchange (ETDEWEB)

    Andersen, Kjel [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: kjel_andersen@web.de; Hennersdorf, Marcus [Department of Cardiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: hennersdorf@med.uni-duesseldorf.de; Cohnen, Mathias [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: cohnen@med.uni-duesseldorf.de; Blondin, Dirk [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: blondin@med.uni-duesseldorf.de; Moedder, Ulrich [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: moedder@uni-duesseldorf.de; Poll, Ludger W. [Institute of Diagnostic Radiology, University Hospital Duesseldorf, Moorenstr. 5, 40225 Duesseldorf (Germany)], E-mail: poll@gmx.de

    2009-07-15

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  14. Myocardial delayed contrast enhancement in patients with arterial hypertension: Initial results of cardiac MRI

    International Nuclear Information System (INIS)

    Andersen, Kjel; Hennersdorf, Marcus; Cohnen, Mathias; Blondin, Dirk; Moedder, Ulrich; Poll, Ludger W.

    2009-01-01

    Purpose: In arterial hypertension left ventricular hypertrophy comprises myocyte hypertrophy, interstitial fibrosis and structural alterations of the coronary microcirculation. MRI enables the detection of myocardial fibrosis, infarction and scar tissue by delayed enhancement (DE) after contrast media application. Aim of this study was to investigate patients with arterial hypertension but without known coronary disease or previous myocardial infarction to detect areas of DE. Methods and material: Twenty patients with arterial hypertension with clinical symptoms of myocardial ischemia, but without history of myocardial infarction and normal coronary arteries during coronary angiography were investigated on a 1.0 T superconducting magnet (Gyroscan T10-NT, Intera Release 8.0, Philips). Fast gradient-echo cine sequences and T2-weighted STIR-sequences were acquired. Fifteen minutes after injection of Gadobenate dimeglumine inversion recovery gradient-echo sequences were performed for detection of myocardial DE. Presence or absence of DE on MRI was correlated with clinical data and the results of echocardiography and electrocardiography, respectively. Results: Nine of 20 patients showed DE in the interventricular septum and the anteroseptal left ventricular wall. In 6 patients, DE was localized intramurally and in 3 patients subendocardially. There was a significant correlation between myocardial DE and ST-segment depressions during exercise and between DE and left-ventricular enddiastolic pressure. Patients with intermittent atrial fibrillation showed a myocardial DE more often than patients without atrial fibrillation. Conclusion: In our series, 45% of patients with arterial hypertension showed DE on cardiac MRI. In this clinical setting, delayed enhancement may be due to coronary microangiopathy. The more intramurally localization of DE, however, rather indicates myocardial interstitial fibrosis.

  15. Contrast-induced nephropathy in patients with chronic kidney disease and peripheral arterial disease

    International Nuclear Information System (INIS)

    Kroneberger, Christian; Enzweiler, Christian N; Schmidt-Lucke, Andre; Rückert, Ralph-Ingo; Teichgräber, Ulf; Franiel, Tobias

    2015-01-01

    The risk for contrast-induced nephropathy (CIN) after intra-arterial application of an iodine-based contrast material is unknown for patients with chronic kidney disease (CKD) and peripheral arterial disease (PAD). To investigate the incidence of CIN in patients with CKD and PAD. This retrospective study was approved by the local ethics committee. One hundred and twenty patients with 128 procedures (73 with baseline eGFR in the range of 45–60 mL/min/1.73m 2 , 55 with eGFR < 45 mL/min/1.73m 2 ) were evaluated. All patients received intra-arterially an iodine-based low-osmolar contrast material (CM) after adequate intravenous hydration with isotonic NaCl 0.9% solution. CIN was defined as an increase in serum creatinine of more than 44 μmol/L within 4 days. The influence of patient-related risk factors (age, weight, body mass index, eGFR, serum creatinine, hypertension, diabetes mellitus, coronary heart disease, heart failure) and therapy-related risk factors (amount of CM, nephrotoxic drugs, number of CM applications) on CIN were examined. CIN developed in 0% (0/73) of procedures in patients with PAD and an eGFR in the range of 45–60 mL/min/1.73m 2 and in 10.9% (6/55) of procedures in patients with an eGFR <45 mL/min/1.73m 2 . No risk factor significantly influenced the development of CIN, although baseline serum creatinine (P = 0.06) and baseline eGFR (P = 0.10) showed a considerable dependency. Patients with an eGFR in the range of 45–60 mL/min/1.73m 2 and PAD seem not at risk for CIN after intra-arterial CM application and adequate hydration. Whereas, an eGFR < 45 mL/min/1.73m 2 correlated with a risk of 10.9% for a CIN

  16. Value of the Gd-DTPA contrast enhanced MR in patients with failed back surgery syndrome

    International Nuclear Information System (INIS)

    Paprzycki, W.; Gradzki, J.; Sosnowski, P.; Stajgis, M.

    1994-01-01

    Gd-DTPA contrast - enhanced MR enables differentiation between postoperative scar and recurrent prolapse of nucleus pulposus (RPNP). Pre- and post-contrast MR studies in 40 patients with failed back surgery syndrome, previously treated surgically on 54 intervertebral levels, were evaluated. Presence of RPNP was confirmed on 4, postoperative scars on 35 and both condition on 15 invertebral levels. Correct interpretation of pathologic changes on 15 invertebral levels (28%) was only possible after contrast enhancement. Contrast enhancement of scar excluded the diagnosis of coexistence of RPNP and scar, based on pre-contrast MR studies. MR with Gd-DTPA contrast enhancement is the best diagnostic method in patients with failed back surgery syndrome (author)

  17. Contrast nephropathy in high-risk patients undergoing coronary angiography and intervention

    International Nuclear Information System (INIS)

    Uddin, M.A.; Rabbani, M.A.; Jafary, F.H.; Bhatti, M.A.; Islam, M.

    2005-01-01

    Objective: To determine the incidence of contrast nephropathy in high-risk patients undergoing coronary angiography and percutaneous coronary intervention (PCI), and to define the characteristics of this cohort. Design: Descriptive study. Place and Duration of Study: The Aga Khan University Hospital, Karachi from January to December 2002. Patients and Methods: One hundred and fifteen patients with serum creatinine greater than 1.4mg/dl who underwent coronary angiography or PCI were included. All patients received non-ionic contrast dye. Acute contrast nephropathy was defined as rise in serum creatinine of >0.5mg/dl within 48 hours following the index procedure. Means and standard deviations were calculated for continuous variables and frequencies for categorical variables. Results: Mean age of patients was 62.3 year + 8.83. Mean pre-contrast creatinine was 1.9+0.9mg/dl. Eleven (9.65%) patients developed contrast nephropathy. 4.4% of patients with serum creatinine 4.0(p-value 0.001). 11.9% diabetic patients developed nephropathy compared to 6.3% of non-diabetics (p-value 0.355). 11.4% of hypertensive and 3.7% of non-hypertensive patients developed contrast-nephropathy (p-value 0.454). 12.9% of low dose group ( 100ml) developed nephropathy (p-value 0.188). Mean serum creatinine in low dose group was higher (3.0mg/dl vs. 1.7 mg/dl). Conclusion: The incidence of contrast nephropathy in this study was similar to that reported in literature. Risk of CIN was found to be significantly proportional to the severity of baseline renal disease. Trends towards higher risk of CIN were seen in patients with diabetes and hypertension. Higher incidence of CIN in patients receiving low-dose contrast was confounded by higher baseline serum creatinine in that group. (author)

  18. Measuring self-esteem in dieting disordered patients: the validity of the Rosenberg and Coopersmith contrasted.

    Science.gov (United States)

    Griffiths, R A; Beumont, P J; Giannakopoulos, E; Russell, J; Schotte, D; Thornton, C; Touyz, S W; Varano, P

    1999-03-01

    In order to ascertain the most appropriate measure of self-esteem for dieting disordered patients, this study contrasted the construct and convergent validities of two widely used measures. In addition, dieting disordered subgroups were compared on levels of self-esteem. One hundred and seventeen male and female patients diagnosed with anorexia nervosa, bulimia nervosa, or eating disorder not otherwise specified completed the Rosenberg Self-Esteem Scale (SES), the Coopersmith Self-Esteem Inventory (SEI), and measures of dieting disorder pathology and depression. No significant differences among the three dieting disorder subgroups were found. In determining convergent validity, regression analyses indicated that the SES was a significant predictor of dieting disorder psychopathology whereas the SEI was not. Of the two self-esteem measures, only the SES showed evidence of convergent validity. The results suggest that the SES has sounder construct and convergent validity than the SEI. Hence, the SES may be more appropriate for use with dieting disordered populations.

  19. Clinical characteristics in patients showing ischemic electrocardiographic changes during adenosine triphosphate loading single-photon emission computed tomography

    International Nuclear Information System (INIS)

    Ohtaki, Yuka; Chikamori, Taishiro; Hida, Satoshi; Tanaka, Hirokazu; Igarashi, Yuko; Hatano, Tsuguhisa; Usui, Yasuhiro; Miyagi, Manabu; Yamashina, Akira

    2010-01-01

    Although ischemic electrocardiographic (ECG) changes during dipyridamole or adenosine infusion have been reported as a marker for severe coronary artery disease (CAD), few studies have focused on ST-segment changes with adenosine triphosphate (ATP)-loading myocardial single-photon emission computed tomography (SPECT). Between January 2003 and August 2008, 4650 consecutive patients underwent ATP-loading SPECT. After 1412 patients with left bundle branch block, pacemaker rhythm, or previous coronary revascularization were excluded, 16 out of 3238 patients (0.5%) showed ischemic ST-segment depression during ATP-loading myocardial SPECT. They were aged 67±11 years; 10 were men and 6 women. Of these patients, 8 demonstrated perfusion abnormalities, whereas the remaining 8 showed normal myocardial perfusion imaging. In 6 of the 8 patients with abnormal SPECT, coronary angiography was performed, revealing left main trunk disease in 1 patient, 3-vessel disease in 4, 1-vessel disease with proximal left ascending artery occlusion in 1, and an insignificant lesion in 1. By contrast, no major cardiac event was observed in the 8 patients with normal SPECT during follow-up for an average of 2 years. The prevalence of ischemic ST-segment changes during ATP loading is very rare. However, this finding should be taken into account since almost half of the patients, particularly those with perfusion abnormalities, may have severe CAD which requires coronary revascularization. (author)

  20. Patient selection and preparation strategies for the use of contrast material in patients with chronic kidney disease

    DEFF Research Database (Denmark)

    Andersen, Poul Erik

    2012-01-01

    administration of iodinated contrast media can result in contrast-induced acute kidney injury and Gadolinium can induce nephrogenic systemic fibrosis (NSF). It is important to identify these high-risk patients by means of se-creatinine/e glomerular filtration rate. The indication for contrast examination should......The prevalence of chronic kidney disease and peripheral arterial disease is increasing. Thus, it is increasingly problematic to image these patients as the number of patients needing a vascular examination is increasing accordingly. In high-risk patients with impaired kidney function, intravascular...

  1. Acute renal failure following contrast injection for head computerized tomography in two patients with diabetic nephropathy

    International Nuclear Information System (INIS)

    Matsunaga, Hiroshi; Sando, Hiroyuki; Nunokawa, Tomoo; Murakami, Tooru; Miyakawa, Yuzo

    1981-01-01

    Two cases of diabetes mellitus with renal and retinal involvement developed acute renal failure after undergoing head computerized tomography. The first case was a 62-year-old male who had been diagnosed as having diabetes 25 years before. He had diabetic retinopathy of Scott IIIb. Before head computerized tomography, the serum BUN was 37 mg/dl, and creatinine was 4.1 mg/dl. Oliguria began immediately after the scanning and confinued for 48 hr. The serum levels of BUN and creatinine rose to 106 and 7.7 mg/dl, respectively. Case 2 was a 49-year-old male who had been diagnosed as having diabetes 15 years before. He showed Scott IIb and IV retinopathy. The BUN and creatinine levels in the serum were 32 and 2.3 mg/dl, respectively. After receiving head computerized tomography, he developed oliguria and remained oliguric for 48 hr. During that period, the serum levels of BUN and creatinin were elevated to 112 and 7.5 mg/dl, respectively. Fortunately, both of these patients recovered from the oliguria without resorting to hemodialysis. The iodine contrast medium routinely used for contrast enhancement in the head computerized tomography was implicated in the acute renal failure of these patients. Only elevn cases have so far been reported in the literature who developed acute renal failure following computerized tomography. In view of the three or four times greater dosis of iodine contrast medium employed in computerized tomography compared to intravenous pyelography, the acute incidence of such complications might be much higher. Among the thirteen cases including the two reported here, as many as eight were diabetic. It is well recongnized that the incidence of acute renal failure after intravenous pyelography is particularly high in cases of diabetic nephropathy. (author)

  2. Diazepam prophylaxis of contrast media-induced seizures during computed tomography of patients with brain metastases

    International Nuclear Information System (INIS)

    Pagani, J.J.; Hayman, L.A.; Bigelow, R.H.; Libshitz, H.I.; Lepke, R.A.; Wallace, S.

    1983-01-01

    The effect of 5 mg of intravenous diazepam (Valium) on contrast media-associated seizer incidence was studied in a randomized controlled trial involving 284 patients with known or suspected brain metastases undergoing cerebral computed tomography. Of these patients, 188 were found to have brain metastases, and it is estimated that for this subgroup prophylactic diazepam reduces the risk of contrast-assocated seizure by a factor of 0.26. Seizures occurred in three of 96 patients with metastases on diazepam and in 14 of 92 patients with metastases but without diazepam. Factors related to increased risk of contrast media-associated seizures are: (1) prior seizure history due to brain metatases and/or prior contrast, (2) progressive cerebral metastases, and (3) prior or concurrent brain antineoplastic therapy. Factors not related to an increased risk of these seizures are: (1) contrast media dosage, chemical composition, or osmolarity, (2) computed tomographic appearance of metastases, and (3) type of primary malignancy. Concomitant therapeutic levels of diphenylhydantoin (Dilantin) do not protect completely against contrast media-associated seizures. Pathophysiology of contrast media-associated seizures is discussed in view of the risk factors determined by this study

  3. Effects of iodinated contrast media on renal function in patients with multiple myeloma

    International Nuclear Information System (INIS)

    Jacob, H.M.

    1980-01-01

    Case histories of 89 patients with definite myoloma of the years 1959 to 1974 were investigated in a retrospective study. 41 intravenous urographies were carried out in 31 of these patients. There was no correlation between deterioration of the renal function and contrast medium application. Relevant literature on the subject has been compiled. By 1979, 19 case studies and 5 general studies had been published which have been summarized in tables in the present study. Analyses of these case histories have shown that acute renal failure was often due to other causes and not to contrast medium application. If these cases are left out of account 8 cases remain in which lethal renal failure occurred after intravenous urography of myeloma patients. The diiodinated contrast media formerly used was less well tolerated than the present triiodinated contrast media. Further risk factors were dehydratation and/or abdominal compression. Both measures are no longer employed in intravenous urography. (orig./MG) [de

  4. Follow Up for Emergency Department Patients After Intravenous Contrast and Risk of Nephropathy

    Directory of Open Access Journals (Sweden)

    Getaw Worku Hassen

    2014-05-01

    Full Text Available Introduction: Contrast-induced nephropathy (CIN, defined as an increase in serum creatinine (SCr greater than 25% or ≥0.5 mg/dL within 3 days of intravenous (IV contrast administration in the absence of an alternative cause, is the third most common cause of new acute renal failure in hospitalized patients. It is known to increase in-hospital mortality up to 27%. The purpose of this study was to investigate the rate of outpatient follow up and the occurrence of CIN in patients who presented to the emergency department (ED and were discharged home after computed tomography (CT of the abdomen and pelvis (AP with IV contrast. Methods: We conducted a single center retrospective review of charts for patients who required CT of AP with IV contrast and who were discharged home. Patients’ clinical data included the presence of diabetes mellitus, hypertension, chronic kidney disease (CKD and congestive heart failure (CHF. Results: Five hundred and thirty six patients underwent CT of AP with IV contrast in 2011 and were discharged home. Diabetes mellitus was documented in 96 patients (18%. Hypertension was present in 141 patients (26.3%, and 82 patients (15.3% were on angiotensin-converting-enzyme inhibitors (ACEI. Five patients (0.9% had documented CHF and all of them were taking furosemide. Seventy patients (13% had a baseline SCr >1.2 mg/dL. One hundred fifty patients (28% followed up in one of the clinics or the ED within one week after discharge, but only 40 patients (7.5% had laboratory workup. Out of 40 patients who followed up within 1 week after discharge, 9 patients (22.5% developed CIN. One hundred ninety patients (35.4% followed up in one of the clinics or the ED after 7 days and within 1 month after discharge, but only 71 patients (13.2% had laboratory workup completed. Out of 71 patients who followed up within 1 month, 11 patients (15% developed CIN. The overall incidence of CIN was 15.3% (17 out of 111 patients. Conclusion: There was a

  5. Efficacy of high iodine concentration contrast medium with saline pushing in hepatic CT in patients with chronic liver disease. Comparison of high doses-standard contrast medium concentration

    International Nuclear Information System (INIS)

    Matoba, Munetaka; Kondo, Tamaki; Nishikawa, Takahiro; Kuginuki, Yasuaki; Yokota, Hajime; Higashi, Kotaro; Tonami, Hisao

    2006-01-01

    The aim of this study was to compare the enhancement of liver parenchyama with high iodine concentration contrast medium with saline pushing to that with high doses standard iodine concentration in hepatic CT in patients with chronic liver disease. There was no statistically significant difference regarding to the enhancement of liver parenchyama between the 370 mgI/ml of contrast medium with saline pushing and high doses standard iodine concentration contrast medium. (author)

  6. Risk factors for delusion of theft in patients with Alzheimer's disease showing mild dementia in Japan.

    Science.gov (United States)

    Murayama, N; Iseki, E; Endo, T; Nagashima, K; Yamamoto, R; Ichimiya, Y; Arai, H; Sato, K

    2009-07-01

    The mechanism underlying delusion in Alzheimer's disease patients has not been fully clarified; however, the occurrence of delusion is a critical issue for dementia patients and their caregivers. In Japan, delusion of theft is the most frequent delusion in AD patients. We examined the risk factors for delusion of theft in AD patients showing mild dementia. Fifty-six AD patients were administered HDS-R, MMSE and COGNISTAT, including the 'speech sample', to assess their neuropsychological and social cognitive functions. The age, years of education, presence of cohabiting family members and premorbid personality traits were obtained from family members. About 25.0% of AD patients showed delusion of theft (D-group), and 75% did not (non-D-group). About 33.3% of female patients and 5.9% of male patients were included in the D-group (p theft in AD patients was related to female gender, absence of cohabiting family members, neurotic personality and retained social cognitive function.

  7. TIA Caused by Contrast Echocardiography in Patient with Platypnea-Orthodeoxia.

    Science.gov (United States)

    Loncar, Goran; Payot, Laurent; Dubois, Mathieu

    2015-10-01

    Platypnea-orthodeoxia syndrome (POS) is a rare clinical disorder characterized by dyspnea caused by the upright position and relieved at recumbent position. Few cases of POS and stroke were reported in literature, and the association between stroke and POS with evidence of patent foramen ovale (PFO) is rare. Stroke may occur in patients with cardiac shunt who undergo contrast echocardiography. We present a patient with POS who experienced transitory ischemic attack (TIA) most likely caused by injection of agitated saline microbubbles during screen for PFO. No case report of TIA/stroke during contrast echocardiography in patients with POS has previously been published. © 2015, Wiley Periodicals, Inc.

  8. Exploring the Interactions of the Dietary Plant Flavonoids Fisetin and Naringenin with G-Quadruplex and Duplex DNA, Showing Contrasting Binding Behavior: Spectroscopic and Molecular Modeling Approaches.

    Science.gov (United States)

    Bhattacharjee, Snehasish; Chakraborty, Sandipan; Sengupta, Pradeep K; Bhowmik, Sudipta

    2016-09-01

    Guanine-rich sequences have the propensity to fold into a four-stranded DNA structure known as a G-quadruplex (G4). G4 forming sequences are abundant in the promoter region of several oncogenes and become a key target for anticancer drug binding. Here we have studied the interactions of two structurally similar dietary plant flavonoids fisetin and naringenin with G4 as well as double stranded (duplex) DNA by using different spectroscopic and modeling techniques. Our study demonstrates the differential binding ability of the two flavonoids with G4 and duplex DNA. Fisetin more strongly interacts with parallel G4 structure than duplex DNA, whereas naringenin shows stronger binding affinity to duplex rather than G4 DNA. Molecular docking results also corroborate our spectroscopic results, and it was found that both of the ligands are stacked externally in the G4 DNA structure. C-ring planarity of the flavonoid structure appears to be a crucial factor for preferential G4 DNA recognition of flavonoids. The goal of this study is to explore the critical effects of small differences in the structure of closely similar chemical classes of such small molecules (flavonoids) which lead to the contrasting binding properties with the two different forms of DNA. The resulting insights may be expected to facilitate the designing of the highly selective G4 DNA binders based on flavonoid scaffolds.

  9. Prevention of Contrast-Induced Nephropathy in STEMI Patients Undergoing Primary Percutaneous Coronary Intervention

    DEFF Research Database (Denmark)

    Busch, Sarah Victoria Ekeløf; Jensen, Svend Eggert; Rosenberg, Jacob

    2012-01-01

    -acetylcysteine, one study of early and late hydration regimens, one study of recombinant human brain natriuretic peptide and one study comparing a low-osmolar contrast agent with an iso-osmolar contrast agent. Results: Recombinant human brain natriuretic peptide and the regimens of hydration significantly reduced...... the incidence of CIN and administration of N-acetylcysteine in one of the six studies significantly reduced the occurrence of CIN. The iso-osmolar contrast agent was not proven to be superior to the low-osmolar contrast agent in terms of preventing CIN. Conclusion: Preliminary studies are promising but further......Objective: To evaluate the current prophylactic strategies against CIN in patients with STEMI treated by primary percutaneous coronary intervention. Background: Contrast-induced nephropathy (CIN) is the third leading course of acute renal failure and a recognized complication to cardiac...

  10. PET/CT with intravenous contrast can be used for PET attenuation correction in cancer patients

    DEFF Research Database (Denmark)

    Berthelsen, A K; Holm, S; Loft, A

    2005-01-01

    PURPOSE: If the CT scan of a combined PET/CT study is performed as a full diagnostic quality CT scan including intravenous (IV) contrast agent, the quality of the joint PET/CT procedure is improved and a separate diagnostic CT scan can be avoided. CT with IV contrast can be used for PET attenuation...... correction, but this may result in a bias in the attenuation factors. The clinical significance of this bias has not been established. Our aim was to perform a prospective clinical study where each patient had CT performed with and without IV contrast agent to establish whether PET/CT with IV contrast can...... scans without, and then with contrast agent, followed by an 18F-fluorodeoxyglucose whole-body PET scan. The CT examinations were performed with identical parameters on a GE Discovery LS scanner. The PET data were reconstructed with attenuation correction based on the two CT data sets. A global...

  11. Is a Double Contrast Barium Enema Necessary in Patients who Undergo a CT Colonography as a Preoperative Work-up?

    International Nuclear Information System (INIS)

    Lee, Ji Won; Lee, Soon Jin; Choi, Dong Il; Kim, Hee Jung; Chun, Ho Kyung; Yun, Seong Hyeon; Jeon, Yong Hwan; Park, Seung Bae; Kim, Min Ju

    2009-01-01

    To determine the efficiency of CT colonography (CTC), as compared with the double contrast barium enema (DCBE) for the preoperative work-up of colorectal neoplasms. A total of 39 patients underwent both a CTC and DCBE before surgery. Three abdominal radiologists and three colorectal surgeons retrospectively reviewed virtual double contrast (VDC) and DCBE images, regarding each examination for localization, conspicuity, extent and morphology of neoplasms. We reviewed the radiological reports of the CTC and DCBE for the polyps. In the case of both VDC and DCBE, 40 cancers were detected in 39 patients. According to abdominal radiologists, VDC showed the same ability to identify DCBE for localization of neoplasms (p 0.05). The performance of the CTC is comparable to the DCBE for the localization of main mass and polyps in patients with colorectal neoplasm. Barium enema don't seem to be necessary for patients who undergo a CTC as preoperative work-up

  12. Retrospective Analysis of Patient Presentations at the Sydney (Australia) Royal Easter Show from 2012 to 2014.

    Science.gov (United States)

    Crabtree, Nathan; Mo, Shirley; Ong, Leon; Jegathees, Thuvarahan; Wei, Daniel; Fahey, David; Liu, Jia Jenny

    2017-04-01

    Introduction Comprehensive studies on the relationship between patient demographics and subsequent treatment and disposition at a single mass-gathering event are lacking. The Sydney Royal Easter Show (SRES; Sydney Olympic Park, New South Wales, Australia) is an annual, 14-day, agricultural mass-gathering event occurring around the Easter weekend, attracting more than 800,000 patrons per year. In this study, patient records from the SRES were analyzed to examine relationships between weather, crowd size, day of week, and demographics on treatment and disposition. This information would help to predict factors affecting patient treatment and disposition to guide ongoing training of first responders and to evaluate the appropriateness of staffing skills mix at future events. Hypothesis Patient demographics, environmental factors, and attendance would influence the nature and severity of presentations at the SRES, which would influence staffing requirements. A retrospective analysis of 4,141 patient record forms was performed for patients who presented to St John Ambulance (Australian Capital Territory, Australia) at the SRES between 2012 and 2014 inclusive. Presentation type was classified using a previously published minimum data set. Data on weather and crowd size were obtained from the Australian Bureau of Meteorology (Melbourne, Victoria, Australia) and the SRES, respectively. Statistical analyses were performed using SPSS v22 (IBM; Armonk, New York USA). Between 2012 to 2014, over 2.5 million people attended the SRES with 4,141 patients treated onsite. As expected, the majority of presentations were injuries (49%) and illnesses (46%). Although patient demographics and presentation types did not change over time, the duration of treatment increased. A higher proportion of patients were discharged to hospital or home compared to the proportion of patients discharged back to the event. Patients from rural/regional locations (accounting for 15% of all patients) were

  13. The influence of contrast media on kidney function in patients with stable coronary artery disease

    DEFF Research Database (Denmark)

    Reuter, Simon Bertram; Harutyunyan, Marina; Mygind, Naja Dam

    2014-01-01

    AIMS: To investigate the incidence of contrast media-induced nephropathy (CIN) in patients with stable coronary artery disease (CAD) referred for elective coronary intervention following hydration routines. The reversibility of CIN was followed in a 6 month-period. METHODS AND RESULTS: A total...... coronary interventions. Kidney function and the amount of contrast media used was not a predictor of CIN development. The induced CIN was not completely normalized in a 6-month follow-up period....

  14. Changes in risk of immediate adverse reactions to iodinated contrast media by repeated administrations in patients with hepatocellular carcinoma.

    Directory of Open Access Journals (Sweden)

    Naoto Fujiwara

    Full Text Available BACKGROUND: To elucidate whether repeated exposures to iodinated contrast media increase the risk of adverse reaction. MATERIALS AND METHODS: We retrospectively reviewed 1,861 patients with hepatocellular carcinoma who visited authors' institution, a tertiary referral center, between 2004 and 2008. We analyzed cumulative probability of adverse reactions and risk factors. We categorized all symptoms into hypersensitivity reactions, physiologic reactions, and other reactions, according to the American College of Radiology guidelines, and evaluated each category as an event. We estimated the association between hazard for adverse reactions and the number of cumulative exposures to contrast media. We also evaluated subsequent contrast media injections and adverse reactions. RESULTS: There were 23,684 contrast media injections in 1,729 patients. One hundred and thirty-two patients were excluded because they were given no contrast media during the study period. Adverse reactions occurred in 196 (0.83% patients. The cumulative incidence at 10(th, 20(th, and 30(th examination was 7.9%, 15.2%, and 24.1%, respectively. Presence of renal impairment was found to be one of risk factors for adverse reactions. The estimated hazard of overall adverse reaction gradually decreased until around 10(th exposure and rose with subsequent exposures. The estimated hazard of hypersensitivity showed V-shaped change with cumulative number of exposures. The estimated hazard of physiologic reaction had a tendency toward decreasing and that of other reaction had a tendency toward increasing. Second adverse reaction was more severe than the initial in only one among 130 patients receiving subsequent injections. CONCLUSION: Repeated exposures to iodinated contrast media increase the risk of adverse reaction.

  15. Changes in risk of immediate adverse reactions to iodinated contrast media by repeated administrations in patients with hepatocellular carcinoma.

    Science.gov (United States)

    Fujiwara, Naoto; Tateishi, Ryosuke; Akahane, Masaaki; Taguri, Masataka; Minami, Tatsuya; Mikami, Shintaro; Sato, Masaya; Uchino, Koji; Uchino, Kouji; Enooku, Kenichiro; Kondo, Yuji; Asaoka, Yoshinari; Yamashiki, Noriyo; Goto, Tadashi; Shiina, Shuichiro; Yoshida, Haruhiko; Ohtomo, Kuni; Koike, Kazuhiko

    2013-01-01

    To elucidate whether repeated exposures to iodinated contrast media increase the risk of adverse reaction. We retrospectively reviewed 1,861 patients with hepatocellular carcinoma who visited authors' institution, a tertiary referral center, between 2004 and 2008. We analyzed cumulative probability of adverse reactions and risk factors. We categorized all symptoms into hypersensitivity reactions, physiologic reactions, and other reactions, according to the American College of Radiology guidelines, and evaluated each category as an event. We estimated the association between hazard for adverse reactions and the number of cumulative exposures to contrast media. We also evaluated subsequent contrast media injections and adverse reactions. There were 23,684 contrast media injections in 1,729 patients. One hundred and thirty-two patients were excluded because they were given no contrast media during the study period. Adverse reactions occurred in 196 (0.83%) patients. The cumulative incidence at 10(th), 20(th), and 30(th) examination was 7.9%, 15.2%, and 24.1%, respectively. Presence of renal impairment was found to be one of risk factors for adverse reactions. The estimated hazard of overall adverse reaction gradually decreased until around 10(th) exposure and rose with subsequent exposures. The estimated hazard of hypersensitivity showed V-shaped change with cumulative number of exposures. The estimated hazard of physiologic reaction had a tendency toward decreasing and that of other reaction had a tendency toward increasing. Second adverse reaction was more severe than the initial in only one among 130 patients receiving subsequent injections. Repeated exposures to iodinated contrast media increase the risk of adverse reaction.

  16. Informed consent for the administration of an intravenous contrast agent: importance and determinants of patient refusal

    International Nuclear Information System (INIS)

    Martel, J.; Garcia-Diaz, J. D.

    1999-01-01

    We proposed to determine the proportion of patients who refuse to undergo intravenous contrast administration and the factors that influence their refusal. Our series consisted of 442 patients who were supposed to undergo imaging studies involving the intravenous injection of an iodine contrast. In a personal interview, the patients were issued a questionnaire specifically designed for this study. The following parameters were recorded: sex, age, inpatient or outpatient status, medical history available, person who informed them about the procedure, person signing the informed consent (patient or other) , highest academic degree, attitude toward receiving the information and degree of concern after reading and signing the consent form. In our series 8.6% of the patients (95% confidence interval: 6-11.2) refused to sign the informed consent form. In addition, there were a number of patients who delayed the procedure or hindered the daily work schedule by some other means. When the relationship between each of the variables studied and refusal to sign the consent form was assessed, significant associations were observed between the latter and the academic level of the patient, his or her degree of concern and having received the information from a trained person. There was also a nearly significant trend toward the association between refusal and the patient's background. Relatively few patients refuse to sign the informed consent to receive intravenous contrast administration but this negative decision interferes with the health care practice. It is possible to identify certain correctable factors that influence the patient in this respect. (Author) 13 refs

  17. Utility of intravenous nonionic contrast media for abdominal CT in patients with renal dysfunction

    International Nuclear Information System (INIS)

    Craig, B.M.; Alpern, M.B.; Sandler, M.A.; Pearlberg, J.L.; Swanson, D.P.

    1987-01-01

    The safety and efficacy of a nonionic contrast medium (NICM) for CT enhancements in patients with renal dysfunction were evaluated. Thirty consecutive patients referred for abdominal CT with a serum creatinine (SCr) level over 5 mg/dL or a SCr level of 2-5 mg/dL and another risk factor (e.g., diabetes, single kidney) received NICM. Each was matched with a control who received the same 150-mL bolus of a conventional medium. No adverse reactions or significant alterations in SCr values were found in the NICM patients. No significant differences between the patient groups were found in blinded subjective image quality ratings or measured attenuation values of a parenchymal organs and vascular structures (with the exception of less renal enhancement in the NICM patients, reflecting their renal dysfunction). Use of an NICM is a safe and effective method for contrast medium-enhanced CT in patients with renal dysfunction

  18. The cortisol awakening response in caregivers of schizophrenic offspring shows sensitivity to patient status.

    Science.gov (United States)

    Gonzalez-Bono, Esperanza; De Andres-Garcia, Sara; Moya-Albiol, Luis

    2011-01-01

    Taking care of offspring during a prolonged period of time is probably one of the most stressful life experiences for parents. The present study compares the cortisol awakening response (CAR) in 38 long-term caregivers (mothers and fathers of schizophrenic relatives) with a control group of 32 non-caregivers. Factors such as general stress, caregiver burden, patient severity, and institutionalization were studied. Although a blunted CAR was observed in caregivers in comparison with controls, this difference was not significant. Among caregivers, the absence of institutionalization for the patient is associated with a lack of CAR in caregivers in comparison with caregivers of institutionally supported patients. General stress, caregiver burden, and patient severity themselves did not favor significant changes in CAR. CAR shows greater sensitivity to institutional support than patient severity and perceived stress. Further research is needed to explain the impact of these factors on health and the psychological factors involved.

  19. Contrast-induced enphropathy in patients undergoing intravenous contrast-enhanced computed tomography in Korea; A multi-institutional study in 101487 patients

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Joong Yub [Medical Research Collaborating Center, Seoul National University Hospital, Seoul National University College of Medicine, Seoul (Korea, Republic of); Cho, Jeong Yeon [Dept. of Radiology, Seoul National University College of Medicine, Seoul (Korea, Republic of); Jeong, Yong Yeon [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University Medical School, Hwasun (Korea, Republic of); and others

    2014-08-15

    To evaluate the prevalence of known risk factors for contrast-induced nephropathy (CIN) and their association with the actual occurrence of CIN in patients undergoing intravenous contrast-enhanced computed tomography (CECT) in Korea. Patients who underwent CECT in 2008 were identified in the electronic medical records of 16 tertiary hospitals of Korea. Data on demographics, comorbidities, prescriptions and laboratory test results of patients were collected following a standard data extraction protocol. The baseline renal function was assessed using the estimated glomerular filtration rate (eGFR). We identified the prevalence of risk factors along the eGFR strata and evaluated their influence on the incidence of CIN, defined as a 0.5 mg/dL or 25% increase in serum creatinine after CECT. Of 432425 CECT examinations in 272136 patients, 140838 examinations in 101487 patients met the eligibility criteria for analysis. The mean age of the participants was 57.9 ± 15.5 years; 25.1% of the patients were older than 70 years. The prevalence of diabetes mellitus was 11.9%, of hypertension 13.7%, of gout 0.55% and of heart failure was 1.7%. Preventive measures were used in 40238 CECT examinations (28.6%). The prevalence of risk factors and use of preventive measures increased as the renal function became worse. A CIN was occurred after 3103 (2.2%) CECT examinations, revealing a significant association with decreased eGFR, diabetes mellitus, and congestive heart failure after adjustment. Risk factors for CIN are prevalent among the patients undergoing CECT. Preventive measures were seemingly underutilized and a system is needed to improve preventive care.

  20. Gastric cancers of Western European and African patients show different patterns of genomic instability

    Directory of Open Access Journals (Sweden)

    Mulder Chris JJ

    2011-01-01

    Full Text Available Abstract Background Infection with H. pylori is important in the etiology of gastric cancer. Gastric cancer is infrequent in Africa, despite high frequencies of H. pylori infection, referred to as the African enigma. Variation in environmental and host factors influencing gastric cancer risk between different populations have been reported but little is known about the biological differences between gastric cancers from different geographic locations. We aim to study genomic instability patterns of gastric cancers obtained from patients from United Kingdom (UK and South Africa (SA, in an attempt to support the African enigma hypothesis at the biological level. Methods DNA was isolated from 67 gastric adenocarcinomas, 33 UK patients, 9 Caucasian SA patients and 25 native SA patients. Microsatellite instability and chromosomal instability were analyzed by PCR and microarray comparative genomic hybridization, respectively. Data was analyzed by supervised univariate and multivariate analyses as well as unsupervised hierarchical cluster analysis. Results Tumors from Caucasian and native SA patients showed significantly more microsatellite instable tumors (p Conclusions Gastric cancers from SA and UK patients show differences in genetic instability patterns, indicating possible different biological mechanisms in patients from different geographical origin. This is of future clinical relevance for stratification of gastric cancer therapy.

  1. Iodinated Contrast Media-Induced Thyroid Dysfunction in Euthyroid Nodular Goiter Patients.

    Science.gov (United States)

    Kornelius, Edy; Chiou, Jeng-Yuan; Yang, Yi-Sun; Lo, Shih-Chang; Peng, Chiung-Huei; Lai, Yung-Rung; Huang, Chien-Ning

    2016-08-01

    The risks of thyroid dysfunction after iodinated contrast media exposure in patients with euthyroid nodular goiter are largely unknown. This observational, retrospective cohort study included a random selection of one million people in Taiwan. All patients with iodinated contrast media exposure during this study period were selected. Patients with euthyroid nodular goiter were identified as cases, while patients without thyroid nodule were selected as controls. We followed these patients until the first event of thyroid dysfunction including hyperthyroidism or hypothyroidism after iodinated contrast media exposure. A total of 334 cases and 2672 matched controls were selected in this study. The mean age of cases and controls were 58.6 and 58.4 years old, and mean follow-up durations were 2.1 and 2 years respectively. After adjustment, patients with euthyroid nodular goiter had a higher risk of thyroid dysfunction (hazard ratio 5.43, [confidence interval (CI) 3.01-9.80]) compared with controls after iodinated contrast media exposure. In the subgroup analysis, the risks of hyperthyroidism and hypothyroidism in cases compared with controls were 5.77 [CI 2.64-12.62] and 4.95 [CI 2.15-11.40] respectively. Half of the euthyroid nodular goiter cases developed thyroid dysfunction within one year after iodinated contrast media exposure. Interestingly, all thyroid-related comorbidities and drug prescriptions did not increase the risk of thyroid dysfunction. Presence of euthyroid nodular goiter was associated with higher risk of thyroid dysfunction including hyperthyroidism and hypothyroidism after iodinated contrast media exposure.

  2. Contrast Materials

    Science.gov (United States)

    ... is mixed with water before administration liquid paste tablet When iodine-based and barium-sulfate contrast materials ... for patients with kidney failure or allergies to MRI and/or computed tomography (CT) contrast material. Microbubble ...

  3. Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis

    Directory of Open Access Journals (Sweden)

    Marcelo Adriano da Cunha Silva Vieira

    2015-04-01

    Full Text Available Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001. The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.

  4. TKA patients with unsatisfying knee function show changes in neuromotor synergy pattern but not joint biomechanics.

    Science.gov (United States)

    Ardestani, Marzieh M; Malloy, Philip; Nam, Denis; Rosenberg, Aaron G; Wimmer, Markus A

    2017-12-01

    Nearly 20% of patients who have undergone total knee arthroplasty (TKA) report persistent poor knee function. This study explores the idea that, despite similar knee joint biomechanics, the neuro-motor synergies may be different between high-functional and low-functional TKA patients. We hypothesized that (1) high-functional TKA recruit a more complex neuro-motor synergy pattern compared to low-functional TKA and (2) high-functional TKA patients demonstrate more stride-to-stride variability (flexibility) in their synergies. Gait and electromyography (EMG) data were collected during level walking for three groups of participants: (i) high-functional TKA patients (n=13); (ii) low-functional TKA patients (n=13) and (iii) non-operative controls (n=18). Synergies were extracted from EMG data using non-negative matrix factorization. Analysis of variance and Spearman correlation analyses were used to investigate between-group differences in gait and neuro-motor synergies. Results showed that synergy patterns were different among the three groups. Control subjects used 5-6 independent neural commands to execute a gait cycle. High functional TKA patients used 4-5 independent neural commands while low-functional TKA patients relied on only 2-3 independent neural commands to execute a gait cycle. Furthermore, stride-to-stride variability of muscles' response to the neural commands was reduced up to 15% in low-functional TKAs compared to the other two groups. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Retinal fluorescein contrast arrival time of young patients with the hepatosplenic form of the Schistosomiasis mansoni

    Directory of Open Access Journals (Sweden)

    Ana Catarina Delgado de Souza

    2002-10-01

    Full Text Available Schistosoma mansoni is responsible for lesions that can alter the hemodinamic of the portal venous circulation, lung arterial and venous sistemic systems. Therefore, hemodinamic changes in the ocular circulation of mansonic schistosomotic patients with portal hypertension and hepatofugal venous blood flow is also probable. The purpose of this study was to determine the fluorescein contrast arrival time at the retina of young patients with the hepatosplenic form of schistosomiasis, clinically and surgically treated. The control group included 36 non schistosomotic patients, mean age of 17.3 years, and the case group was represented by 25 schistosomotic patients, mean age of 18.2 years, who were cared for at The University Hospital (Federal University of Pernambuco, Brazil, from 1990 to 2001. They underwent digital angiofluoresceinography and were evaluated for the contrast arrival time at the early retinal venous phase of the exam. Both groups were ophthalmologically examined at the same hospital (Altino Ventura Foundation, Recife, Brazil, using the same technique. There was retardation of the retinal contrast arrival time equal or more than 70 sec in the eyes of three schistosomotic patients (12% and in none of the control group, however, the mean contrast arrival time between the two groups were not statistically different. These findings lend support to the hypothesis that there could be a delay of the eye venous blood flow drainage.

  6. In which patients should serum creatinine be measured before iodinated contrast medium administration?

    International Nuclear Information System (INIS)

    Thomsen, Henrik S.

    2005-01-01

    Routine measurement of serum creatinine before injection of intravascular iodinated contrast material in all patients would be cumbersome and have an associated cost. There is doubt about whether serum creatinine should be measured routinely in all patients or selectively. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and draw up guidelines on this important practical issue. A literature search was carried out and summarized in a report. Based on the available information and discussions amongst the members of the Committee, guidelines were produced. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela, Spain. The practice for identifying patients at risk of contrast medium induced nephropathy varies considerably from one institution to another. Patients at risk constitute only a small percentage of all cases referred for contrast enhanced imaging examination. However, it is important to identify them and take the necessary precautions. Recent serum creatinine level should be available in patients with an increased probability of a raised serum creatinine level (renal disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout, current intake of nephrotoxic drugs). A simple guideline has been produced. (orig.)

  7. In which patients should serum creatinine be measured before iodinated contrast medium administration?

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, Henrik S. [Copenhagen University Hospital, Herlev (Denmark). Department of Diagnostic Radiology; Morcos, Sameh K. [Northern General Hospital, Department of Diagnostic Imaging, Sheffield Teaching Hospitals NHS Trust, Sheffield (United Kingdom)

    2005-04-01

    Routine measurement of serum creatinine before injection of intravascular iodinated contrast material in all patients would be cumbersome and have an associated cost. There is doubt about whether serum creatinine should be measured routinely in all patients or selectively. The Contrast Media Safety Committee of the European Society of Urogenital Radiology decided to review the literature and draw up guidelines on this important practical issue. A literature search was carried out and summarized in a report. Based on the available information and discussions amongst the members of the Committee, guidelines were produced. The report and guidelines were discussed at the 11th European Symposium on Urogenital Radiology in Santiago de Compostela, Spain. The practice for identifying patients at risk of contrast medium induced nephropathy varies considerably from one institution to another. Patients at risk constitute only a small percentage of all cases referred for contrast enhanced imaging examination. However, it is important to identify them and take the necessary precautions. Recent serum creatinine level should be available in patients with an increased probability of a raised serum creatinine level (renal disease, renal surgery, proteinuria, diabetes mellitus, hypertension, gout, current intake of nephrotoxic drugs). A simple guideline has been produced. (orig.)

  8. Clinical courses and CT findings in the patients with contrast media-associated seizures

    International Nuclear Information System (INIS)

    Onda, Kiyoshi; Takeda, Norio; Tanaka, Ryuichi

    1987-01-01

    From February 1976 through March 1985, 12,479 patients underwent cranial computed tomography (CT) examinations with 65 % Angiografin (100 ml/kg for adults and 2 ml/kg for children). Among them, five patients experienced contrast media-associated seizures. The present study analyzed (1) the time of occurrence of seizures, (2) CT appearances at the time of seizures, (3) epileptogenecity, and (4) clinical features of seizures. Two patients had malignant gliomas, 2 metastatic brain tumors, and one hemangioendothelioma. Seizures occurred at CT examinations performed after the initial treatment, such as radiation or surgery, with the incidence for each patient varing from 2 to 5. There were lesions near the motor cortex on CT scans, and enhancement was observed in most cases. Three patients had experienced epilepsy attacks due to their underlying diseases. In the other two, contrast media-associated seizures preceded the occasional onset of epilepsy attacks. This strongly suggested the influence of their underlying diseases in the occurrence of contrast media-associated seizures. A careful use of contrast media for cranial CT examination is emphasized. (Namekawa, K.)

  9. Changes in Renal Function in Elderly Patients Following Intravenous Iodinated Contrast Administration: A Retrospective Study

    International Nuclear Information System (INIS)

    Alsafi, A.; Alsafi, Z.; Lakhani, A.; Strickland, N.H.

    2014-01-01

    Contrast-induced nephropathy (CIN) is a recognised complication of intravascular administration of iodinated contrast media (ICM). Previous studies suggest a higher incidence in the elderly, but no large study has assessed this to date. We set out to assess changes in creatinine in elderly inpatients following computed tomography (CT) examination and compare those who received intravenous contrast to those who did not. Methods. Using the Radiology Information System in two teaching hospitals, inpatients over the age of seventy who had a CT examination and a baseline creatinine were identified and their follow-up creatinine levels were analysed. Elderly inpatients who underwent a non contrast CT over the same period were used as controls. Results. 677 elderly inpatients who received ICM were compared with 487 controls. 9.2% of patients who received ICM developed acute kidney injury (AKI) compared to 3.5% of inpatient controls (Ρ<0.0001). Patients with higher baseline eGFR had a higher incidence of post-CT AKI. Conclusions. The incidence of post-CT AKI is higher in patients who received IV ICM compared to those who did not; the difference may be partly attributable to contrast-induced nephropathy. This suggests that the incidence of CIN in the elderly may not be as high as previously thought.

  10. Anti-Jo-1 antibody-positive patients show a characteristic necrotizing perifascicular myositis.

    Science.gov (United States)

    Mescam-Mancini, Lénaig; Allenbach, Yves; Hervier, Baptiste; Devilliers, Hervé; Mariampillay, Kuberaka; Dubourg, Odile; Maisonobe, Thierry; Gherardi, Romain; Mezin, Paulette; Preusse, Corinna; Stenzel, Werner; Benveniste, Olivier

    2015-09-01

    Idiopathic inflammatory myopathies can be classified as polymyositis, dermatomyositis, immune-mediated necrotizing myopathy, sporadic inclusion body myositis or non-specific myositis. Anti-Jo-1 antibody-positive patients are assigned to either polymyositis or dermatomyositis suggesting overlapping pathological features. We aimed to determine if anti-Jo-1 antibody-positive myopathy has a specific morphological phenotype. In a series of 53 muscle biopsies of anti-Jo-1 antibody-positive patients, relevant descriptive criteria defining a characteristic morphological pattern were identified. They were tested in a second series of anti-Jo-1 antibody-positive patients and compared to 63 biopsies from patients suffering from other idiopathic inflammatory myopathies. In anti-Jo-1 antibody-positive patients, necrotic fibres, which strongly clustered in perifascicular regions, were frequently observed. Sarcolemmal complement deposition was detected specifically in perifascicular areas. Inflammation was mainly located in the perimysium and around vessels in 90.6%. Perimysial fragmentation was observed in 90% of cases. Major histocompatibility complex class I staining was diffusely positive, with a perifascicular reinforcement. Multivariate analysis showed that criteria defining perifascicular pathology: perifascicular necrosis, atrophy, and perimysial fragmentation allow the distinction of anti-Jo-1 antibody-positive patients, among patients suffering from other idiopathic inflammatory myopathies. Anti-Jo-1 antibody-positive patients displayed perifascicular necrosis, whereas dermatomyositis patients exhibited perifascicular atrophy. © The Author (2015). Published by Oxford University Press on behalf of the Guarantors of Brain. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  11. Contrasting patterns of comprehension for superordinate, basic-level, and subordinate names in semantic dementia and aphasic stroke patients.

    Science.gov (United States)

    Crutch, Sebastian J; Warrington, Elizabeth K

    2008-06-01

    It is well established that patients with semantic memory impairment show a relative sparing of general superordinate information as compared with more detailed item-specific information. The objective of the current study was to examine whether or not this superordinate superiority effect is also reliably observed in individuals with stroke. The participants were 3 patients with a diagnosis of semantic dementia (SD) and 4 left middle cerebral artery stroke patients. In the first experiment, participants were administered a series of spoken-word-picture matching tasks, in which picture identity was probed under two conditions: item name (e.g., goose, beetle, shark, hedgehog) and superordinate name (e.g., bird, insect, fish, mammal). The SD patients showed the predicted pattern of performance, identifying stimuli significantly more accurately by their superordinate term than by their specific name. By contrast, the stroke patients showed the reverse pattern of inferior performance in the superordinate condition in all versions of the experimental task. In a second experiment comparing comprehension ofbasic-level names (e.g., dog, bird, fish) and subordinate-level names (e.g., Dalmatian, sparrow, trout), stroke patients also showed a reversal of the normal basic-level effect, showing less accurate comprehension of basic-level names. The pattern of results documented among the stroke patients cannot be accommodated obviously or readily by existing models of conceptual knowledge. These contrasting abilities of SD patients, stroke patients, and normal healthy participants to process subordinate, basic-level, and superordinate names are considered in relation to disorders of executive processing and taxonomic categorization.

  12. Incidence of contrast-induced nephropathy in hospitalised patients with cancer

    Energy Technology Data Exchange (ETDEWEB)

    Cicin, Irfan; Erdogan, Bulent; Gulsen, Emrah; Uzunoglu, Sernaz; Kodaz, Hilmi [Trakya University, Department of Medical Oncology, Faculty of Medicine, Edirne (Turkey); Sut, Necdet [Trakya University, Department of Biostatistics, Faculty of Medicine, Edirne (Turkey); Turkmen, Esma [Trakya University, Department of Medical Oncology, Faculty of Medicine, Edirne (Turkey); Trakya Ueniversitesi Hastanesi Medikal Onkoloji Bilim Dali, Edirne (Turkey); Ustundag, Sedat [Trakya University, Department of Nephrology, Faculty of Medicine, Edirne (Turkey)

    2014-01-15

    To determine the frequency of and possible factors related to contrast-induced nephropathy (CIN) in hospitalised patients with cancer. Ninety adult patients were enrolled. Patients with risk factors for acute renal failure were excluded. Blood samples were examined the day before contrast-enhanced computed tomography (CT) and serially for 3 days thereafter. CIN was defined as an increase in serum creatinine (Cr) of 0.5 mg/dl or more, or elevation of Cr to 25 % over baseline. Relationships between CIN and possible risk factors were investigated. CIN was detected in 18/90 (20 %) patients. CIN developed in 25.5 % patients who underwent chemotherapy and in 11 % patients who did not (P = 0.1). CIN more frequently developed in patients who had undergone CT within 45 days after the last chemotherapy (P = 0.005); it was also an independent risk factor (P = 0.017). CIN was significantly more after treatment with bevacizumab/irinotecan (P = 0.021) and in patients with hypertension (P = 0.044). The incidence of CIN after CT in hospitalised oncological patients was 20 %. CIN developed 4.5-times more frequently in patients with cancer who had undergone recent chemotherapy. Hypertension and the combination of bevacizumab/irinotecan may be additional risk factors for CIN development. (orig.)

  13. The influence of contrast media on kidney function in patients with stable coronary artery disease.

    Science.gov (United States)

    Reuter, Simon Bertram; Harutyunyan, Marina; Mygind, Naja Dam; Jørgensen, Erik; Kastrup, Jens

    2014-08-01

    To investigate the incidence of contrast media-induced nephropathy (CIN) in patients with stable coronary artery disease (CAD) referred for elective coronary intervention following hydration routines. The reversibility of CIN was followed in a 6 month-period. A total of 447 patients referred for elective coronary intervention due to suspected CAD were included. Blood samples were collected before and 24 h after intervention and medical records were obtained. Patients had no drinking fluid restrictions and were routinely treated with a 1000 ml saline infusion. All patients were invited to a 6-month examination and collection of blood samples. A total of 19 patients (4.3%) developed CIN. CIN patients had a pre-investigation higher estimated glomerular filtration rate (eGRF), lower level of kidney failure and lower creatinine level than non-CIN patients. Kidney function was not normalized in CIN patients 6 months after the intervention. Two patients still met the definition of CIN. With no restriction in fluid intake and supplementary infusion of saline, only a few patients with stable CAD developed early indications of CIN during elective coronary interventions. Kidney function and the amount of contrast media used was not a predictor of CIN development. The induced CIN was not completely normalized in a 6-month follow-up period.

  14. Contrast-enhanced swallow study sensitivity for anastomotic leak detection in post-esophagectomy patients.

    Science.gov (United States)

    Mejía-Rivera, S; Pérez-Marroquín, S A; Cortés-González, R; Medina-Franco, H

    2018-03-07

    Esophagectomy is a highly invasive surgery and one of its postoperative complications is anastomotic leakage, occurring in 53% of cases. The aim of the present study was to determine the sensitivity of the contrast-enhanced swallow study as a method for diagnosing anastomotic leak in patients that underwent esophagectomy. The present retrospective study included the case records of patients that underwent esophagectomy with reconstruction and cervical anastomosis at the Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán within the time frame of January 1, 2000 and May 31, 2006. Demographic, clinical, and laboratory data emphasizing clinical and radiographic anastomotic leak detection were identified. Descriptive statistics were carried out and contrast-enhanced swallow study sensitivity for diagnosing leakage was calculated. Seventy patients were included in the analysis. The mean age of the patients was 50.6 years, 51 of the patients were men (72.86%), and 19 were women (27.14%). Indications for surgery were benign lesion in 29 patients (41.4%) and malignant lesion in 41 (58.6%). A total of 44.3% of the patients presented with a comorbidity, with diabetes mellitus and high blood pressure standing out. Thirty patients (42.85%) presented with anastomotic leak. Contrast-enhanced swallow study sensitivity for leak detection was 43.33%. The diagnostic sensitivity of the contrast-enhanced swallow study was very low. Therefore, we recommend the discontinuation of its routine use as a method for diagnosing anastomotic leaks. Copyright © 2018 Asociación Mexicana de Gastroenterología. Publicado por Masson Doyma México S.A. All rights reserved.

  15. Contrast-Induced Nephropathy Is Less Common in Patients with Good Coronary Collateral Circulation.

    Science.gov (United States)

    Avci, Eyup; Yildirim, Tarik; Kadi, Hasan

    2017-10-01

    Contrast-induced nephropathy (CIN) is a typically reversible type of acute renal failure that develops after exposure to contrast agents; underlying endothelial dysfunction is thought to be an important risk factor for CIN. Although the mechanism of coronary collateral circulation (CCC) is not fully understood, a pivotal role of the endothelium has been reported in many studies. The aim of this study was to investigate whether there is a relationship between CCC and CIN. Patients with at least one occluded major coronary artery and blood creatinine analyses performed before and on the second day after angiography were included in the study. CIN was defined as a 25% or greater elevation of creatinine on the second day after exposure to the contrast agent. Collateral grading was performed according to the Rentrop classification. Patients were grouped according to whether they developed CIN or not, i.e., CIN(-) and CIN(+) group. A total of 214 patients who met the inclusion criteria were included in the study. CIN was diagnosed in 43 patients (20.1%) in the study population. Good CCC was identified in 112 patients (65.5%) in the CIN(-) group, whereas it was identified in 13 patients (30.2%) in the CIN(+) group. In the CIN(-) group, good CCC was significantly more frequent ( p Good collateral circulation was associated with a lower frequency of CIN, and poor collateral circulation was an independent predictor of CIN.

  16. Modified double contrast-enhanced examination of the stomach of adipose patients after vertical gastroplasty

    International Nuclear Information System (INIS)

    Raissaki, M.T.; Prassopoulos, P.; Hatjidakis, A.A.; Christodoulakis, M.; Melissas, J.; Gourtsoyiannis, N.C.

    1995-01-01

    The study reported covers 28 patients who were examined once by radiology before surgery, and twice after surgery. The first post-surgery examination was done on days 5-7, the second during the 4th until 6th month after surgery. For the first examination, water-soluble contrast agent was initially applied, then barium containing contrast agent. The second examination was done by modified double contrast technique. The most frequent, pre-surgery findings revealed gastro-esophageal reflux in 13 patients. The first post-surgery control detected a somastenosis in 2 patients, while the second control examination detected complications of various nature in 11 patients and gastro-esophageal reflux in 5 patients. In 6 patients, discrepancy between clinical and radiological findings was stated. The pouch size did not correlate with the frequency of complications, or with the body-to-mass index decrease. The examination method proposed in this article yields pre-surgery information on the anatomy of the stomach, more accurate dewscription of post-surgery complications, and better evaluation of the antireflux effect of the vertical gastroplasty. (orig.) [de

  17. Diabetes patients show different time-course of myocardial perfusion improvement after coronary artery bypass grafting

    International Nuclear Information System (INIS)

    Lee, J. J.; Seok, J. W.; Eo, J. S.

    2005-01-01

    Diabetes mellitus is an independent risk factor of cardiovascular disease. Diabetes is known to cause microangiopathy. The microangiopathy is hardly detectable on the coronary angiography. Myocardial perfusion imaging shows the resultant perfusion status which reflects the microangiopathy. For patients who underwent revascularization, the microangiopathy could affect the myocardial perfusion improvement. Diabetes patients probably experience the different myocardial perfusion improvement as compared to the non-diabetes patients although they have similar angiographic findings. The aim of this study is to find out whether there is a time-course difference of perfusion improvement between the diabetes and non diabetes patients who showed patent angiographic findings after coronary artery grafting surgery (CABG). A total of 129 patients who underwent coronary artery bypass grafting surgery were enrolled in this study. Myocardial SPECTs performed at previous, short-term (3 month), and mid-term (1 year) to CABG. One-year follow up angiography was done 411±121 days after surgery. Graft patency was determined according to the FitzGibbon et al. Segments were assigned to vascular territories using a 20 segment model. The segments of excellent patency were included in this study. Time course differences of concerned segments were analyzed using RMANOVA. The number of segments enrolled was 764 of diabetes and 1083 of non-diabetes. At short-term follow up, reversibility score was 2.8±8.1% in diabetes and 0.3±7.5% in non-diabetes. At long-term follow up, reversibility score was 1.8±8.0% in diabetes and 0.1±7.3% in non-diabetes. The time-course of reversibility score was significantly different between the diabetes and non diabetes (p<0.001) Diabetic segments showed high residual reversibility score than non-diabetic segments after CABG although the angiographic finding was patent in both groups. This result is maybe attributable to microangiopathy induced by diabetes

  18. Prostate cancer patient subsets showing improved bNED control with adjuvant androgen deprivation

    International Nuclear Information System (INIS)

    Anderson, Penny R.; Hanlon, Alexandra L.; Movsas, Benjamin; Hanks, Gerald E.

    1997-01-01

    Purpose: Cooperative groups have investigated the outcome of androgen deprivation therapy combined with radiation therapy in prostate cancer patients with variable pretreatment prognostic indicators. This report describes an objective means of selecting patients for adjuvant hormonal therapy by a retrospective matched case/control comparison of outcome between patients with specific pretreatment characteristics who receive adjuvant hormones (RT + H) vs. patients with identical pretreatment characteristics treated with radiation therapy alone (RT). In addition, this report shows the 5-year bNED control for patients selected by this method for RT + H vs. RT alone. Methods and Materials: From (10(88)) to (12(93)), 517 T1-T3 NXM0 patients with known pretreatment PSA level were treated at Fox Chase Cancer Center. Four hundred fifty-nine of those patients were treated with RT alone while 58 were treated with RT + H. The patients were categorized according to putative prognostic factors indicative of bNED control, which include the palpation stage, Gleason score, and pretreatment PSA. We compared actuarial bNED control rates according to treatment group within each of the prognostic groups. In addition, we devised a retrospective matched case/control selection of RT patients for comparison with the RT + H group. Five-year bNED control was compared for the two treatment groups, excluding the best prognosis group, using 56 RT + H patients and 56 matched (by stage, grade, and pretreatment PSA level) controls randomly selected from the RT alone group. bNED control for the entire group of 517 patients was then analyzed multivariately using step-wise Cox regression to determine independent predictors of outcome. Covariates considered for entry into the model included stage (T1/T2AB vs. T2C/T3), grade (2-6 vs. 7-10), pretreatment PSA (0-15 vs. > 15), treatment (RT vs. RT + H), and center of prostate dose. bNED failure is defined as PSA ≥1.5 ngm/ml and rising on two consecutive

  19. Patients at high risk of adverse events from intravenous contrast media after computed tomography examination

    Energy Technology Data Exchange (ETDEWEB)

    Reddan, Donal [University College Galway Hospitals, Unit 7, Merlin Park Hospital, Galway (Ireland)]. E-mail: donal.reddan@mailn.hse.ie

    2007-05-15

    Adverse reactions to iodinated contrast media (CM) may occur and require prompt recognition and treatment. Although adverse reactions to radiocontrast agents cannot be eliminated, an important first step toward reducing their incidence is to identify patients at greatest risk. Prior to examinations using CM, patients should be adequately assessed by obtaining thorough medical histories and using simple screening tests. Studies have demonstrated that patients with a history of asthma, allergy, hyperthyroidism, and previous reaction to CM are at risk for severe reactions to iodinated CM. Renal adverse reactions reportedly occur more frequently in patients with pre-existing chronic kidney disease, especially those with diabetic nephropathy. Patients with congestive heart failure, dehydration, older age, and those who use nephrotoxic medications are also at risk for developing contrast-associated nephropathy. The occurrence of adverse events may be further increased in patients with multiple risk factors. As the number of patients undergoing computed tomography procedures continues to increase, it is essential for physicians to be able to identify patients at risk for adverse events of CM. Patient-related risk factors are discussed and simple tools for risk stratification presented.

  20. Provider portrayals and patient-provider communication in drama and reality medical entertainment television shows.

    Science.gov (United States)

    Jain, Parul; Slater, Michael D

    2013-01-01

    Portrayals of physicians on medical dramas have been the subject of research attention. However, such research has not examined portrayals of interactions between physicians and patients, has not compared physician portrayals on medical dramas versus on medical reality programs, and has not fully examined portrayals of physicians who are members of minority groups or who received their education internationally. This study content-analyzes 101 episodes (85 hours) of such programs broadcast during the 2006-2007 viewing season. Findings indicate that women are underrepresented as physicians on reality shows, though they are no longer underrepresented as physicians on dramas. However, they are not as actively portrayed in patient-care interactions as are male physicians on medical dramas. Asians and international medical graduates are underrepresented relative to their proportion in the U.S. physician population, the latter by almost a factor of 5. Many (but certainly not all) aspects of patient-centered communication are modeled, more so on reality programs than on medical dramas. Differences in patient-provider communication portrayals by minority status and gender are reported. Implications for public perception of physicians and expectations regarding provider-patient interaction are discussed.

  1. Nephrogenic systemic fibrosis versus contrast-induced nephropathy: risks and benefits of contrast-enhanced MR and CT in renally impaired patients

    DEFF Research Database (Denmark)

    Martin, Diego R; Semelka, Richard C; Chapman, Arlene

    2009-01-01

    -sectional imaging modality. Factors to consider include the relative risks of the contrast agent. Other factors include the relative procedural risks, including radiation risks and the relative expected diagnostic yield of the examination technique (12). In this review we describe both nephrogenic systemic fibrosis...... and contrast-induced nephropathy to compare the implications with regard to relative risks and benefits of contrast-enhanced MRI or CT in patients with impaired renal function. J. Magn. Reson. Imaging 2009;30:1350-1356. (c) 2009 Wiley-Liss, Inc....

  2. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: A meta-analysis

    Energy Technology Data Exchange (ETDEWEB)

    Moos, Shira I., E-mail: s.i.moos@amc.uva.nl; Vemde, David N.H. van; Stoker, Jaap; Bipat, Shandra

    2013-09-15

    Purpose: To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. Methods: This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I{sup 2} index. Results: 42 articles with 18,790 patients (mean age 61.5 years (range: 38–83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR) < 60 mL/min, 55.2% had hypertension; 20.2% had diabetes mellitus (DM) and 6.5% had congestive heart failure (CHF). The overall pooled CIN incidence, defined as a SCr increase of ≥25% or ≥0.5 mg/dL, was 4.96% (95%CI: 3.79–6.47). Data analysis showed associations between CIN and the presence of renal insufficiency, DM, malignancy, age > 65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06–2.82), 1.87 (95%CI: 1.55–2.26), 1.79 (95%CI: 1.03–3.11), 1.95 (95%CI: 1.02–3.70) and 2.32 (95%CI: 1.04–5.19), respectively while hypertension, anaemia and CFH were not associated (p = 0.13, p = 0.38, p = 0.40). Conclusion: The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use.

  3. Contrast-enhanced sonography for quantitative assessment of portal hypertension in patients with liver cirrhosis.

    Science.gov (United States)

    Qu, En-Ze; Zhang, Ying-Cai; Li, Zhi-Yan; Liu, Yang; Wang, Jin-Rui

    2014-11-01

    The clinical utility of contrast-enhanced sonography in portal hypertension remains unclear. We explored the feasibility of using contrast-enhanced sonography for noninvasive assessment of portal venous pressure. Twenty healthy individuals (control group; 9 men; mean age, 46.4 years) and 18 patients with portal hypertension (15 men; mean age, 46.2 years) were enrolled in this study. The portal hypertension group included patients who underwent splenectomy and pericardial blood vessel disarticulation at our hospital from October 2010 to March 2011. One week before surgery, patients with portal hypertension underwent preoperative liver contrast-enhanced sonography. Two-dimensional, Doppler, and contrast-enhanced sonographic parameters were compared between the groups. Portal venous pressure was measured intraoperatively by portal vein puncture in the portal hypertension group, and its relationship with the other parameters was analyzed. The 2-dimensional, Doppler, and contrast-enhanced sonographic parameters differed between the groups (P Portal venous pressure was inversely correlated with the area under the portal vein/hepatic artery time-intensity curve ratio (Qp/Qa), portal vein/hepatic artery strength ratio (Ip/Ia), and portal vein/hepatic artery wash-in perfusion slope ratio (βp/βa), with correlation coefficients of -0.701, -0.625, and -0.494, respectively. Measurement of the liver contrast-enhanced sonographic parameters Qp/Qa, Ip/Ia, and βp/βa could be used as a new quantitative method for noninvasively assessing portal venous pressure. © 2014 by the American Institute of Ultrasound in Medicine.

  4. Iodinated contrast media and patients with high-risk kidneys. Aiming at rational prevention

    International Nuclear Information System (INIS)

    Fontaine, B.; Frouge, C.; Gagey, N.

    1994-01-01

    Acute renal failure induced by iodinated contrast media (CM) accounts for about 10% of all hospital cases of renal failure, especially in azotemic patients. The specific anatomy and physiology of the inner medulla renalis render it particularly sensitive to even a moderate reduction in blood supply. Renal function will be estimated by measuring serum creatinine levels, before and within 72 hours after administration of the iodinated contrast medium. Hypovolaemia, diabetes mellitus-induced microangiopathy, nephrotoxic drugs and especially dehydratation may provoke renal accidents. Proper hydration, choosing a low osmolality medium and adequately spacing exposures to CM are elementary measures to be adopted to prevent renal failure. (authors)

  5. Monocytes of patients with familial hypercholesterolemia show alterations in cholesterol metabolism

    Directory of Open Access Journals (Sweden)

    Soufi Muhidien

    2008-11-01

    Full Text Available Abstract Background Elevated plasma cholesterol promotes the formation of atherosclerotic lesions in which monocyte-derived lipid-laden macrophages are frequently found. To analyze, if circulating monocytes already show increased lipid content and differences in lipoprotein metabolism, we compared monocytes from patients with Familial Hypercholesterolemia (FH with those from healthy individuals. Methods Cholesterol and oxidized cholesterol metabolite serum levels of FH and of healthy, gender/age matched control subjects were measured by combined gas chromatography – mass spectroscopy. Monocytes from patients with FH and from healthy subjects were isolated by antibody-assisted density centrifugation. Gene expression profiles of isolated monocytes were measured using Affymetrix HG-U 133 Plus 2.0 microarrays. We compared monocyte gene expression profiles from FH patients with healthy controls using a Welch T-test with correction for multiple testing (p Results Using microarray analysis we found in FH patients a significant up-regulation of 1,617 genes and a down-regulation of 701 genes compared to monocytes from healthy individuals. These include genes of proteins that are involved in the uptake, biosynthesis, disposition, and cellular efflux of cholesterol. In addition, plasma from FH patients contains elevated amounts of sterols and oxysterols. An increased uptake of oxidized as well as of native LDL by FH monocytes combined with a down-regulation of NPC1 and ABCA1 explains the lipid accumulation observed in these cells. Conclusion Our data demonstrate that circulating FH monocytes show differences in cell physiology that may contribute to the early onset of atherosclerosis in this disease.

  6. Contrast-Enhanced MR Imaging of Lymph Nodes in Cancer Patients

    International Nuclear Information System (INIS)

    Choi, Seung Hong; Moon, Woo Kyung

    2010-01-01

    The accurate identification and characterization of lymph nodes by modern imaging modalities has important therapeutic and prognostic significance for patients with newly diagnosed cancers. The presence of nodal metastases limits the therapeutic options, and it generally indicates a worse prognosis for the patients with nodal metastases. Yet anatomic imaging (CT and MR imaging) is of limited value for depicting small metastatic deposits in normal-sized nodes, and nodal size is a poor criterion when there is no extracapsular extension or focal nodal necrosis to rely on for diagnosing nodal metastases. Thus, there is a need for functional methods that can be reliably used to identify small metastases. Contrast-enhanced MR imaging of lymph nodes is a non-invasive method for the analysis of the lymphatic system after the interstitial or intravenous administration of contrast media. Moreover, some lymphotrophic contrast media have been developed and used for detecting lymph node metastases, and this detection is independent of the nodal size. This article will review the basic principles, the imaging protocols, the interpretation and the accuracies of contrast-enhanced MR imaging of lymph nodes in patients with malignancies, and we also focus on the recent issues cited in the literature. In addition, we discuss the results of several pre-clinical studies and animal studies that were conducted in our institution

  7. Positive Contrast MRI Techniques for Visualization of Iron-Loaded Hernia Mesh Implants in Patients.

    Directory of Open Access Journals (Sweden)

    Alexander Ciritsis

    Full Text Available In MRI, implants and devices can be delineated via susceptibility artefacts. To discriminate susceptibility voids from proton-free structures, different positive contrast techniques were implemented. The purpose of this study was to evaluate a pulse sequence-based positive contrast technique (PCSI and a post-processing susceptibility gradient mapping algorithm (SGM for visualization of iron loaded mesh implants in patients.Five patients with iron-loaded MR-visible inguinal hernia mesh implants were examined at 1.5 Tesla. A gradient echo sequence (GRE; parameters: TR: 8.3ms; TE: 4.3ms; NSA:2; FA:20°; FOV:350mm² and a PCSI sequence (parameters: TR: 25ms; TE: 4.6ms; NSA:4; FA:20°; FOV:350mm² with on-resonant proton suppression were performed. SGM maps were calculated using two algorithms. Image quality and mesh delineation were independently evaluated by three radiologists.On GRE, the iron-loaded meshes generated distinct susceptibility-induced signal voids. PCSI exhibited susceptibility differences including the meshes as hyperintense signals. SGM exhibited susceptibility differences with positive contrast. Visually, the different algorithms presented no significant differences. Overall, the diagnostic value was rated best in GRE whereas PCSI and SGM were barely "sufficient".Both "positive contrast" techniques depicted implanted meshes with hyperintense signal. SGM comes without additional acquisition time and can therefore be utilized in every patient.

  8. Intravenous contrast medium application in elderly patients - evaluation of Iopentol (Imagopaque trademark 300); Intravenoese Kontrastmittel-Applikation bei aelteren Patienten - Anwendungsbeobachtung von Iopentol (Imagopaque trademark 300)

    Energy Technology Data Exchange (ETDEWEB)

    Rathsmann, P.; Jacobs, G.F.; Mueller, R.D. [Zentrum fuer Klinische Radiologie, Kliniken Essen-Sued (Germany)

    2004-12-01

    Purpose: We examined the subjective compatibility of elderly patients who received the intravenous contrast medium Iopentol (Imagopaque trademark 300). In addition, objective data were acquired to show possible interactions between contrast media and organ systems in old patients. Methods and materials: A CT scan with intravenous application of contrast media was performed on 132 patients ranging in age from 75 to 96 years. The patients were questioned about their individual sensations. In addition, blood pressure, creatinine and CT-densitometry were acquired as objective date. Results: The patients' individual sensations and clinical data show a very low rate of complications. Mild allergic reactions were noticed in two patients. No severe anaphylactic reactions were encountered. Statistically significant changes in blood pressure before and after administration of the contrast medium were not observed. The serum creatinine concentration was unchanged after application of contrast media. For CT-densitometry, the patients were divided into two groups, one group with patients 75-84 years and the other group with patients 85-96 years of age. CT-densitometry showed no age-related differences. The protocol of contrast administration resulted in excellent opacification of the examined regions, only the liver did not enhance in some cases before the opacification of the portal vein. Conclusion: It is shown that old age alone is no reason to withhold contrast media containing iodine when performing CT. For the evaluation of the liver, however, the peculiarities of old age have to be taken into account and the interval between injection of the contrast medium and beginning of the spiral-CT has to be extended. (orig.)

  9. Pupil cycle time and contrast sensitivity in type II diabetes mellitus patients: A pilot study

    Directory of Open Access Journals (Sweden)

    Hoyoung Lee

    2011-01-01

    Full Text Available Context: Pupil cycle time (PCT has been widely used for examination of ocular diabetic autonomic neuropathy (DAN. Aims: The primary aim of this study was to evaluate the difference of contrast sensitivity according to PCT results, and the secondary aim was to determine the factors associated with PCT difference for type II diabetes patients. Settings and Design: A clinical pilot study that included a total of 60 eyes of 60 type II diabetes patients. Materials and Methods: We divided all patients into three groups according to PCT results. Group A and Group C were composed of patients who had upper one third PCT and lower one third PCT, respectively. We analyzed difference of age, diabetes duration, hypertension duration, mean best corrected visual acuity (BCVA, mean spherical equivalent (SE, HbA1C, glomerular filtration rate (GFR, stage of diabetic retinopathy, and Cardiac Autonomic Function Score (CAFS. Contrast sensitivity and decrease of visual acuity by glare were also estimated and analyzed for 28 eyes of 28 non-proliferative diabetic retinopathy (NPDR patients. Group [NPDR] A and Group [NPDR] C were defined as those who had lower one third PCT and upper one third PCT, respectively. Statistical Analysis: Statistical analysis was done using SPSS 17.0 software. Results and Conclusions: Each group contained 20 eyes. Significant differences between Group A and Group C were observed in duration of diabetes and CAFS (P ≤ 0.001 and P < 0.001, respectively. Contrast sensitivity in Group [NPDR] A was significantly more than in Group [NPDR] C at all cpds (all P ≤ 0.001. We found that PCT can influence contrast sensitivity or glare in diabetes patients and also confirmed a significant correlation of PCT with CAFS and duration of diabetes.

  10. Coronary collateralization shows sex and racial-ethnic differences in obstructive artery disease patients.

    Directory of Open Access Journals (Sweden)

    Zhi Liu

    Full Text Available Coronary collateral circulation protects cardiac tissues from myocardial infarction damage and decreases sudden cardiac death. So far, it is unclear how coronary collateralization varies by race-ethnicity groups and by sex.We assessed 868 patients with obstructive CAD. Patients were assessed for collateral grades based on Rentrop grading system, as well as other covariates. DNA samples were genotyped using the Affymetrix 6.0 genotyping array. To evaluate genetic contributions to collaterals, we performed admixture mapping using logistic regression with estimated local and global ancestry.Overall, 53% of participants had collaterals. We found difference between sex and racial-ethnic groups. Men had higher rates of collaterals than women (P-value = 0.000175. White Hispanics/Latinos showed overall higher rates of collaterals than African Americans and non-Hispanic Whites (59%, 50% and 48%, respectively, P-value = 0.017, and especially higher rates in grade 1 and grade 3 collateralization than the other two populations (P-value = 0.0257. Admixture mapping showed Native American ancestry was associated with the presence of collaterals at a region on chromosome 17 (chr17:35,243,142-41,251,931, β = 0.55, P-value = 0.000127. African ancestry also showed association with collaterals at a different region on chromosome 17 (chr17: 32,266,966-34,463,323, β = 0.38, P-value = 0.00072.In our study, collateralization showed sex and racial-ethnic differences in obstructive CAD patients. We identified two regions on chromosome 17 that were likely to harbor genetic variations that influenced collateralization.

  11. Is hypoalbuminemia a prognostic risk factor for contrast-induced nephropathy in peritoneal dialysis patients?

    Directory of Open Access Journals (Sweden)

    Hassan K

    2014-10-01

    Full Text Available Kamal Hassan,1,2 Hassan Fadi3 1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 2Peritoneal Dialysis Unit, Galilee Medical Center, Nahariya, Israel; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Objective: Residual renal function (RRF is an important predictor of outcome in peritoneal dialysis (PD patients. Hypoalbuminemia was found to be an independent risk factor for the development of acute kidney injury. We investigated the possibility of an association between serum albumin levels and the development of iodine contrast media-induced nephropathy (CIN in PD patients.Methods: A total of 103 PD patients who underwent invasive angiographies with exposure to iodine contrast media (ICM were reviewed retrospectively. All patients received 0.9% saline intravenously at a rate of 75 mL per hour for 12 hours prior, during, and 12 hours after exposure to ICM. Acetylcysteine was given orally at a dose of 600 mg twice daily, on the day before and on the day of exposure to ICM. The nonionic, low-osmolar contrast agent iopromide was used at a mean dose of 75.0±15.2 mL. The changes in RRF from baseline to 1 week and 4 weeks after exposure to ICM were recorded. Outcomes of patients with serum albumin levels <3.8 g/dL and those with serum albumin levels ≥3.8 g/dL were compared. A reduction >30% in RRF at 7 days after exposure to ICM was considered CIN.Results: CIN developed in 27.2% (28/103 of patients. Of the 103 patients, 59.2% (61 had serum albumin levels <3.8 g/dL. Of those, 37.7% (23/61 developed CIN, compared with 11.9% (5/42 of those with serum albumin levels ≥3.8 g/dL (P=0.004. After adjustment for all tested variables in a logistic regression with a stepwise selection model, serum albumin level at exposure to ICM was found to be the most powerful predictor of the development of CIN (odds ratio =4.5; confidence interval =1.5–13.0; P=0.006.Conclusion: PD patients with serum albumin levels <3.8 g

  12. Patients with bulimia nervosa do not show typical neurodevelopment of cognitive control under emotional influences.

    Science.gov (United States)

    Dreyfuss, Michael F W; Riegel, Melissa L; Pedersen, Gloria A; Cohen, Alexandra O; Silverman, Melanie R; Dyke, Jonathan P; Mayer, Laurel E S; Walsh, B Timothy; Casey, B J; Broft, Allegra I

    2017-08-30

    Bulimia nervosa (BN) emerges in the late teen years and is characterized by binge eating and related compensatory behaviors. These behaviors often co-occur with periods of negative affect suggesting an association between emotions and control over eating behavior. In the current study, we examined how cognitive control and neural processes change under emotional states of arousal in 46 participants with (n=19) and without (n=27) BN from the ages of 18-33 years. Participants performed a go/nogo task consisting of brief negative, positive and neutral emotional cues and sustained negative, positive and neutral emotional states of arousal during functional magnetic resonance imaging (fMRI). Overall task performance improved with age for healthy participants, but not for patients with BN. These age-dependent behavioral effects were paralleled by diminished recruitment of prefrontal control circuitry in patients with BN with age. Although patients with BN showed no difference in performance on the experimental manipulations of negative emotions, sustained positive emotions related to improved performance among patients with BN. Together the findings highlight a neurodevelopmental approach towards understanding markers of psychopathology and suggest that sustained positive affect may have potential therapeutic effects on maintaining behavioral control in BN. Copyright © 2017 Elsevier Ireland Ltd. All rights reserved.

  13. Adverse effects to iodinated contrast media in interleukin-2 treated patients; Reacciones adversas a los medio de contraste yodados en pacientes tratados con interleuquina 2

    Energy Technology Data Exchange (ETDEWEB)

    Vias, I.; Nicolas, A. I.; Lopez Picazo, J. M.; Elduayen, B.; Delgado, C.; Ano, M.; Fernande-villa, T.; Garcia del Barrio, L.; Velazquez, P.; Bilbao, J. I. [Universidad de Navarra. Pamplona (Spain)

    2000-07-01

    Interleukin-2 (IL-2) is a potent modulator of immune response that provokes tumor regression in cancer patients. IL-2 may induce sensitization to radiological iodinated contrast media (ICM) and this phenomenon has been rarely reported in literature. We report the increased incidence of adverse reactions to ICM patients treated with systemic IL-2, discuss the possible mechanisms of action, and propose patient management strategies. Retrospective study was conducted in 168 patients treated with subcutaneous IL-2 and 544 patients who did not.CT scans were performed with intravenous administration of 80-160 ml of nonionic ICM with a power injector. The incidence of adverse reactions to ICM among our patients was 7.14%. It differs significantly (p<0.001) from that in the control group (1.28%). Thus, patients treated with IL-2 have a relative risk of 5,6 times (CI 95%; 2.2-13.9). The adverse reactions in IL-2 patients were mild and resolved promptly without treatment in 11 patients. In one patient hypotension required intravenous forced hydration. Patients on IL-2 treatment may be at risk of experiencing contrast induced adverse reactions. Potent of the immune system by IL-2 may increase the potential risk for hypersensitivity or other adverse reactions to ICM. Knowledge of this fact may be valuable in clinical decision making and patient follow-up strategies. (Author) 18 refs.

  14. Brain MRI screening showing evidences of early central nervous system involvement in patients with systemic sclerosis.

    Science.gov (United States)

    Mohammed, Reem Hamdy A; Sabry, Yousriah Y; Nasef, Amr A

    2011-05-01

    Systemic sclerosis is a multisystem autoimmune collagen disease where structural and functional abnormalities of small blood vessels prevail. Transient ischemic attacks, ischemic stroke, and hemorrhage have been reported as primary consequence of vascular central nervous system affection in systemic sclerosis. Magnetic resonance imaging is considered to be the most sensitive diagnostic technique for detecting symptomatic and asymptomatic lesions in the brain in cases of multifocal diseases. The objective of this study is to detect subclinical as well as clinically manifest cerebral vasculopathy in patients with systemic sclerosis using magnetic resonance imaging. As much as 30 female patients with systemic sclerosis aged 27-61 years old, with disease duration of 1-9 years and with no history of other systemic disease or cerebrovascular accidents, were enrolled. Age-matched female control group of 30 clinically normal subjects, underwent brain magnetic resonance examination. Central nervous system (CNS) involvement in the form of white matter hyperintense foci of variable sizes were found in significantly abundant forms in systemic sclerosis patients on magnetic resonance evaluation than in age-related control group, signifying a form of CNS vasculopathy. Such foci showed significant correlation to clinical features of organic CNS lesion including headaches, fainting attacks and organic depression as well as to the severity of peripheral vascular disease with insignificant correlation with disease duration. In conclusion, subclinical as well as clinically manifest CNS ischemic vasculopathy is not uncommon in systemic sclerosis patients and magnetic resonance imaging is considered a sensitive noninvasive screening tool for early detection of CNS involvement in patients with systemic sclerosis.

  15. Clinical significance of intraluminal contrast enhancement in patients with spontaneous cervical artery dissection. A black-blood MRI study

    Energy Technology Data Exchange (ETDEWEB)

    Coppenrath, Eva; Lenz, Olga; Sommer, Nora; Treitl, Karla; Reiser, Maximilian [Munich Univ. (Germany). Inst. of Clinical Radiology; Lummel, Nina [Univ. Hospital Klinikum rechts der Isar Munich, Munich (Germany). Inst. of Neuroradiology and Interventional Neuroradiology; Linn, Jennifer [Univ. Hospital Dresden (Germany). Inst. of Neuroradiology; Bamberg, Fabian [Tuebingen Univ. (Germany). Diagnostical and Interventional Radiology; Pfefferkorn, Thomas [Munich Univ. (Germany). Interdisciplinary Stroke Center Munich; Saam, Tobias [Radiology Center Rosenheim (Germany)

    2017-07-15

    Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2{sup *}w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0. iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD.

  16. Clinical significance of intraluminal contrast enhancement in patients with spontaneous cervical artery dissection. A black-blood MRI study

    International Nuclear Information System (INIS)

    Coppenrath, Eva; Lenz, Olga; Sommer, Nora; Treitl, Karla; Reiser, Maximilian

    2017-01-01

    Recent studies have suggested that intraluminal thrombi show contrast enhancement on carotid black-blood T1w MRI. The aim of this study was to evaluate the significance of intraluminal contrast enhancement (iCE) regarding symptom status in patients with spontaneous cervical artery dissection (sCAD). 33 consecutive patients (19 men) with sCAD received a brain MRI (DIFF, T2w, T2"*w, FLAIR) and a multi-sequence 3T-MRI with fat-saturated high-resolution black-blood T1w-sequences pre- and post-contrast, contrast-enhanced MR angiography and TOF images of carotid and vertebral arteries. Presence/absence of iCE, vessel occlusion and vessel wall hematoma (hyperintense in T1w pre-contrast) were analysed by two radiologists in consensus decision. 44 of 132 analysed vessels had a vessel wall hematoma, consistent with sCAD. In 17 of 44 dissected vessels an acute ischemic stroke was found. 16 of 17 (94.1 %) vessels ipsilateral to ischemic stroke demonstrated iCE, compared to 9 of 44 (20.4 %) dissected vessels without stroke (P< 0.001). The presence/absence of iCE resulted in a sensitivity, specificity, positive and negative predictive value and accuracy for ischemic stroke of 0.94, 0.67, 0.64, 0.95, and 0.77, respectively, and an odds ratio of 32.0. iCE, which is suggestive of intraluminal thrombus formation, is strongly correlated with ischemic symptoms in patients with sCAD.

  17. Stratified premedication strategy for the prevention of contrast media hypersensitivity in high-risk patients.

    Science.gov (United States)

    Lee, Suh-Young; Yang, Min Suk; Choi, Young-Hoon; Park, Chang Min; Park, Heung-Woo; Cho, Sang Heon; Kang, Hye-Ryun

    2017-03-01

    Although the severity of hypersensitivity reactions to iodinated contrast media varies, it is well correlated with the severity of recurrent reactions; however, prophylaxis protocols are not severity-stratified. To assess the outcomes of tailored prophylaxis according to the severity of hypersensitivity reactions to iodinated contrast media. Our premedication protocols were stratified based on the severity of previous reactions: (1) 4 mg of chlorpheniramine for mild reactions, (2) adding 40 mg of methylprednisolone for moderate reactions, and (3) adding multiple doses of 40 mg of methylprednisolone for severe index reactions. Cases of reexposure in patients with a history of hypersensitivity reactions were routinely monitored and mandatorily recorded. Among a total of 850 patients who underwent enhanced computed tomography after severity-tailored prophylaxis, breakthrough reactions occurred in 17.1%, but most breakthrough reactions (89.0%) were mild and did not require medical treatment. Additional corticosteroid use did not reduce the breakthrough reaction rate in cases with a mild index reaction (16.8% vs 17.2%, P = .70). However, underpremedication with a single dose of corticosteroid revealed significantly higher rates of breakthrough reaction than did double doses of corticosteroid in cases with a severe index reaction (55.6% vs 17.4%, P = .02). Changing the iodinated contrast media resulted in an additional reduction of the breakthrough reaction rate overall (14.9% vs 32.1%, P = .001). In a total severity-based stratified prophylaxis regimens and changing iodinated contrast media can be considered in patients with a history of previous hypersensitivity reaction to iodinated contrast media to reduce the risk of breakthrough reactions. Copyright © 2016 American College of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

  18. Multiple renal aspergillus abscesses in an AIDS patient: contrast-enhanced helical CT and MRI findings

    International Nuclear Information System (INIS)

    Heussel, C.P.; Kauczor, H.U.; Thelen, M.; Heussel, G.; Jahn, B.

    1999-01-01

    Renal insufficiency or allergic reactions for X-ray contrast agents are frequent limitations in immunocompromised hosts such as neutropenic or AIDS patients. Due to a better tolerance of contrast agents in MRI, this technique is well suited for investigation of parenchymal organs. We demonstrate an allergic AIDS patient who presented with fever and flank pain. At sonography, anechoic renal lesions were supposed to be non-complicated cysts; however, on T2-weighted MRI, the center was of high signal. Dynamic contrast-enhanced MRI of the kidneys demonstrated an enhancing rim with ill-defined margins. The lesions were supposed to be multiple bilateral abscesses. Due to the multiple dynamic contrast series, a delayed enhancement of renal parenchyma was detectable adjacent to the lesion. This was suggested as accompanying local pyelonephritis and an infectious etiology became more reliable. Aspergillus fumigatus was identified by CT-guided biopsy as the underlying microorganism. The MR appearance of this manifestation has not been described previously. (orig.)

  19. Diagnostic accuracy and tolerability of contrast enhanced CT colonoscopy in symptomatic patients with increased risk for colorectal cancer

    International Nuclear Information System (INIS)

    Ozsunar, Yelda; Coskun, Guelten; Delibas, Naciye; Uz, Burcin; Yuekselen, Vahit

    2009-01-01

    Objective: We compared the accuracy and tolerability of intravenous contrast enhanced spiral computed tomography colonography (CTC) and optical colonoscopy (OC) for the detection of colorectal neoplasia in symptomatic patients for colorectal neoplasia. Methods: A prospective study was performed in 48 patients with symptomatic patients with increased risk for colorectal cancer. Spiral CTC was performed in supine and prone positions after colonic cleansing. The axial, 2D MPR and virtual endoluminal views were analyzed. Results of spiral CTC were compared with OC which was done within 15 days. The psychometric tolerance test was asked to be performed for both CTC and colonoscopy after the procedure. Results: Ten lesions in 9 of 48 patients were found in CTC and confirmed with OC. Two masses and eight polyps, consisted of 1 tubulovillous, 1 tubular, 2 villous adenoma, 4 adenomatous polyp, 4 adenocarcinoma, were identified. Lesion prevalence was 21%. Sensitivity, specificity, accuracy, positive and negative predictive values were found 100%, 87%, 89%, 67% and 100%, respectively. Psychometric tolerance test showed that CTC significantly more comfortable comparing with OC (p = 0.00). CTC was the preferred method in 37% while OC was preferred in 6% of patients. In both techniques, the most unpleasant part was bowel cleansing. Conclusion: Contrast enhanced CTC is a highly accurate method in detecting colorectal lesions. Since the technique was found to be more comfortable and less time consuming compare to OE, it may be preferable in management of symptomatic patients with increased risk for colorectal cancer.

  20. Sepsis patients' renal manifestation on contrast-enhanced CT

    International Nuclear Information System (INIS)

    Sasaguri, K.; Yamaguchi, K.; Nakazono, T.; Mizuguchi, M.; Irie, H.

    2016-01-01

    Aim: To evaluate renal volume and attenuation changes in patients with sepsis on contrast-enhanced computed tomography (CT) with respect to the severity of sepsis. Materials and methods: Forty-four patients with sepsis who underwent CT before and after the onset of sepsis were retrospectively analysed. Renal volume and CT attenuation value of the renal cortex on contrast-enhanced CT were measured for each patient and changes in renal volume and CT attenuation value from before to after the onset of sepsis were calculated. The changes were correlated with the severity of sepsis (Sepsis-related Organ Failure Assessment [SOFA] score). The time course of the renal volume and CT attenuation changes were also evaluated. Results: Renal volume increased by 17.6% and CT attenuation value decreased by 19% after the onset of sepsis with statistically significant differences (p<0.001 for both renal volume and CT attenuation changes). The renal volume and CT attenuation changes had significant correlations with the SOFA score (r=0.36, p=0.018 and −0.43, p=0.005, respectively). The time course of the renal volume and CT attenuation changes seemed to be gradual compared to that of the SOFA score and to lag behind the peak of the SOFA score. Conclusion: In patients with sepsis, the renal volume increases and the CT attenuation value decreases in proportion to the severity of sepsis. The changes may lag behind the peak of severity of sepsis and can be observed for a relatively long time after a patient's recovery from sepsis. - Highlights: • The renal volume increases and the renal enhancement on contrast-enhanced CT decreases in patients with sepsis. • The degrees of these changes are correlated with severity of sepsis. • These changes may lag behind the peak of severity of sepsis and last for a long time after a patient's recovery from sepsis.

  1. Gadolinium Use in Spine Pain Management Procedures for Patients with Contrast Allergies: Results in 527 Procedures

    International Nuclear Information System (INIS)

    Safriel, Yair; Ang, Roberto; Ali, Muhammed

    2008-01-01

    Introduction. To review the safety and efficacy of gadolinium in spine pain management procedures in patients at high risk for a contrast reaction and who are not suitable candidates for the use of standard non-ionic contrast. Methods. We reviewed records over a 61-month period of all image-guided spinal pain management procedures where patients had allergies making them unsuitable candidates for standard non-ionic contrast and where gadolinium was used to confirm needle tip placement prior to injection of medication. Results. Three hundred and four outpatients underwent 527 procedures. A spinal needle was used in all but 41 procedures. Gadolinium was visualized using portable C-arm fluoroscopy in vivo allowing for confirmation of needle tip location. The gadolinium dose ranged from 0.2 to 10 ml per level. The highest dose received by one patient was 15.83 ml intradiscally during a three-level discogram. Three hundred and one patients were discharged without complication or known delayed complications. One patient had documented intrathecal injection but without sequelae and 2 patients who underwent cervical procedures experienced seizures requiring admission to the intensive care unit. Both the latter patients were discharged without any further complications. Conclusion. Based on our experience we recommend using gadolinium judiciously for needle tip confirmation. We feel more confident using gadolinium in the lumbar spine and in cervical nerve blocks. Gadolinium should probably not be used as an injectate volume expander. The indications for gadolinium use in cervical needle-guided spine procedures are less clear and use of a blunt-tipped needle should be considered

  2. Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction

    International Nuclear Information System (INIS)

    Shetty, Sanjay K.; Nelson, Erik N.; Lawrimore, Tara M.; Palmer, William E.

    2007-01-01

    When performing epidural steroid injections for the management of chronic back pain, imaging guidance and a limited epidurogram improve accuracy of needle placement and ensure appropriate delivery of the injectate into the epidural space. We describe our experience using a gadolinium chelate as an alternative contrast agent for limited epidurography in patients with a history of an iodinated contrast reaction. Thirty-eight of 2,067 (1.8%) epidural steroid injections performed in our department over a 25-month period (December 2003-January 2006) employed gadolinium. All injections were performed in the lumbar spine employing a paramedian interlaminar approach. Procedural notes and patient charts were reviewed to evaluate for immediate or delayed complications related to incorrect intrathecal or intravascular needle placement. A retrospective analysis of selected fluoroscopic spot images was performed to evaluate confidence of epidural needle placement; this analysis compared these spot images against those obtained from age- and gender-matched control patients in whom iodinated contrast was used to confirm needle placement. Real-time fluoroscopic guidance permitted confident visualization of an epidurogram at the time of procedure in all 38 cases as documented in the procedural report, and no procedure resulted in a complication due to incorrect needle placement. Retrospective review of fluoroscopic spot images revealed at least moderate confidence of epidural needle placement by both readers in 29/38 cases (76.3%). Fluoroscopic spot images obtained using gadolinium yielded significantly less confidence than images obtained in control patients whose procedures were performed using iodinated contrast (P < 0.01). However, operators were sufficiently confident in needle placement based on real-time fluoroscopic images (not available in our subsequent review) to inject anesthestic in all 38 cases, despite the immediate consequences that could result from intrathecal

  3. Use of gadolinium chelate to confirm epidural needle placement in patients with an iodinated contrast reaction

    Energy Technology Data Exchange (ETDEWEB)

    Shetty, Sanjay K. [Massachusetts General Hospital, Harvard Medical School, Division of Musculoskeletal Radiology, Department of Radiology, Boston, MA (United States); Beth Israel Deaconess Medical Center, Harvard Medical School, Department of Radiology, Boston, MA (United States); Nelson, Erik N.; Lawrimore, Tara M.; Palmer, William E. [Massachusetts General Hospital, Harvard Medical School, Division of Musculoskeletal Radiology, Department of Radiology, Boston, MA (United States)

    2007-04-15

    When performing epidural steroid injections for the management of chronic back pain, imaging guidance and a limited epidurogram improve accuracy of needle placement and ensure appropriate delivery of the injectate into the epidural space. We describe our experience using a gadolinium chelate as an alternative contrast agent for limited epidurography in patients with a history of an iodinated contrast reaction. Thirty-eight of 2,067 (1.8%) epidural steroid injections performed in our department over a 25-month period (December 2003-January 2006) employed gadolinium. All injections were performed in the lumbar spine employing a paramedian interlaminar approach. Procedural notes and patient charts were reviewed to evaluate for immediate or delayed complications related to incorrect intrathecal or intravascular needle placement. A retrospective analysis of selected fluoroscopic spot images was performed to evaluate confidence of epidural needle placement; this analysis compared these spot images against those obtained from age- and gender-matched control patients in whom iodinated contrast was used to confirm needle placement. Real-time fluoroscopic guidance permitted confident visualization of an epidurogram at the time of procedure in all 38 cases as documented in the procedural report, and no procedure resulted in a complication due to incorrect needle placement. Retrospective review of fluoroscopic spot images revealed at least moderate confidence of epidural needle placement by both readers in 29/38 cases (76.3%). Fluoroscopic spot images obtained using gadolinium yielded significantly less confidence than images obtained in control patients whose procedures were performed using iodinated contrast (P < 0.01). However, operators were sufficiently confident in needle placement based on real-time fluoroscopic images (not available in our subsequent review) to inject anesthestic in all 38 cases, despite the immediate consequences that could result from intrathecal

  4. Reducing the oral contrast dose in CT colonography: evaluation of faecal tagging quality and patient acceptance

    International Nuclear Information System (INIS)

    Liedenbaum, M.H.; Denters, M.J.; Zijta, F.M.; Ravesteijn, V.F. van; Bipat, S.; Vos, F.M.; Dekker, E.; Stoker, J.

    2011-01-01

    Aim: To evaluate the minimal iodine contrast medium load necessary for an optimal computed tomography colonography tagging quality. Materials and Methods: Faecal occult blood test positive patients were randomly selected for one of three iodine bowel preparations: (1) 3 x 50 ml meglumine ioxithalamate (45 g iodine), (2) 4 x 25 ml meglumine ioxithalamate (30 g iodine); or (3) 3 x 25 ml (22.5 g iodine) meglumine ioxithalamate. Two experienced readers assessed the tagging quality per colonic segment on a five-point scale and the presence of adherent stool. Also semi-automatic homogeneity measurements were performed. Patient acceptance was assessed with questionnaires. Results: Of 70 eligible patients, 45 patients participated (25 males, mean age 62 years). Each preparation group contained 15 patients. The quality of tagging was insufficient (score 1-2) in 0% of segments in group 1; 4% in group 2 (p < 0.01 versus group 1); and 5% in group 3 (p = 0.06 versus group 1). In group 1 in 11% of the segments adherent stool was present compared with 49% in group 2 and 41% in group 3 (p < 0.01, group 2 and 3 versus group 1). Homogeneity was 85, 102 (p < 0.01), and 91 SD HU (p = 0.26) in groups 1, 2, and 3, respectively. In group 1 two patients experienced no burden after contrast agent ingestion compared to one patient in group 2 and nine patients in group 3 (p = 0.017). Conclusion: A dose of 3 x 50 ml meglumine ioxithalamate is advisable for an optimal tagging quality despite beneficial effects on the patient acceptance in patients receiving a lower dose.

  5. Contrast-enhanced CMR in patients after percutaneous closure of the left atrial appendage: A pilot study

    Directory of Open Access Journals (Sweden)

    Petersen Steffen E

    2011-07-01

    Full Text Available Abstract Background To evaluate the feasibility and value of first-pass contrast-enhanced dynamic and post-contrast 3D CMR in patients after transcatheter occlusion of left atrial appendage (LAA to identify incorrect placement and persistent leaks. Methods 7 patients with different occluder systems (n = 4 PLAATO; n = 2 Watchman; n = 1 ACP underwent 2 contrast-enhanced (Gd-DOTA CMR sequences (2D TrueFISP first-pass perfusion and 3D-TurboFLASH to assess localization, artifact size and potential leaks of the devices. Perfusion CMR was analyzed visually and semi-quantitatively to identify potential leaks. Results All occluders were positioned within the LAA. The ACP occluder presented the most extensive artifact size. Visual assessment revealed a residual perfusion of the LAA apex in 4 cases using first-pass perfusion and 3D-TurboFLASH indicating a suboptimal LAA occlusion. By assessing signal-to-time-curves the cases with a visually detected leak showed a 9-fold higher signal-peak in the LAA apex (567 ± 120% increase from baseline signal than those without a leak (61 ± 22%; p Conclusion This CMR pilot study provides valuable non-invasive information in patients after transcatheter occlusion of the LAA to identify correct placement and potential leaks. We recommend incorporating CMR in future clinical studies to evaluate new device types.

  6. Contrast-enhanced MR imaging of the breast in patients with breast implants after cancer surgery

    International Nuclear Information System (INIS)

    Bone, B.; Aspelin, P.; Isberg, B.; Perbeck, L.; Veress, B.

    1995-01-01

    The purpose of the study was to determine the value of contrast-enhanced MR imaging in the assessment of local recurrence in breast cancer patients who underwent mastectomy and breast reconstruction with an implant. Eighty-three patients have been evaluated by semidynamic contrast-enhanced MR imaging. The T1-weighted FLASH 3-D sequence was repeated twice postcontrast for evaluation of the entire breast bilaterally. The findings were compared to physical examination, mammography and histopathology. Recurrence verified by histopathology occurred in 14 of 83 patients (17%). Contrast-enhanced MR imaging was superior to palpation and mammography in revealing recurrences, especially when these were located close to the chest wall. MR was also more sensitive in detecting multiple foci of cancers. Our study revealed that MR imaging was influenced by size, type and composition of the tumor, as illustrated by the false-negative results. Therefore, the use of all 3 investigation methods is necessary for detecting recurrence at an early stage during the postoperative follow-up. (orig.)

  7. Patient radiation doses in upper GI examinations: a comparison between conventional and double-contrast techniques.

    Science.gov (United States)

    Bankvall, G; Owman, T

    1982-01-01

    A total of 60 patients, divided into 3 groups with 20 patients in each, were examined with 3 different techniques: group 1 -- conventional technique, exposure at 120 kV; group 2 -- double-contrast technique (hypotonic gastrography, HG), exposure at 80 kW; group 3 -- HG, exposure at 120 kV. All examinations were performed in the same examination room and by the same radiologist. Absorbed doses to skin, thyroid, breasts, and gonads as well as energy imparted were measured. The only significant dose enhancements found when using double-contrast instead of conventional technique were in the female breasts and then only if the voltage was in the lower range. With exposure at 120 kV there was little difference in absorbed dose, but a significant advantage with respect to energy was imparted when using a double-contrast technique instead of a conventional technique. The testes doses were very low in all 3 types of examinations, and it seems that use of a testes shield is hardly motivated. With regard to both diagnostic accuracy and patient radiation dose, there can be no reason to use a conventional technique for upper GI examinations.

  8. Coronary artery calcification scores improve contrast-induced nephropathy risk assessment in chronic kidney disease patients.

    Science.gov (United States)

    Osugi, Naohiro; Suzuki, Susumu; Shibata, Yohei; Tatami, Yosuke; Harata, Shingo; Ota, Tomoyuki; Hayashi, Mutsuharu; Yasuda, Yoshinari; Ishii, Hideki; Shimizu, Atsuya; Murohara, Toyoaki

    2017-06-01

    Coronary artery calcification (CAC) is an independent predictor of cardiovascular morbidity and mortality in chronic kidney disease (CKD) patients. The aim of the present study was to evaluate the predictive value of CAC scores for the incidence of contrast-induced nephropathy (CIN) after cardiac catheterization in non-dialyzed CKD patients. The present study evaluated a total of 140 CKD patients who underwent cardiac catheterization. Patients were stratified into two groups based on the optimal cut-off value of the CAC score, which was graded by a non-triggered, routine diagnostic chest computed tomography scan: CAC score ≥8 (high CAC group); and CAC score 10 % in the baseline serum cystatin C level at 24 h after contrast administration. The mean estimated glomerular filtration rate levels were 41.1 mL/min/1.73 m 2 , and the mean contrast dose administered was 37.5 mL. Patients with high CAC scores exhibited a higher incidence of CIN than patients with low CAC scores (25.5 vs. 3.2 %, p < 0.001). After multivariate adjustment for confounders, the CAC score predicted CIN (odds ratio 1.68, 95 % confidence interval 1.28-2.21, p < 0.001). Moreover, the C-index for CIN prediction significantly increased when the CAC scores were added to the Mehran risk score (0.855 vs. 0.760, p = 0.023). CAC scores, as evaluated using semi-quantitative methods, are a simple and powerful predictor of CIN. Incorporating the CAC score in the Mehran risk score significantly improved the predictive ability to predict CIN incidence.

  9. Relationship between contrast sensitivity test and disease severity in multiple sclerosis patients.

    Science.gov (United States)

    Soler García, A; González Gómez, A; Figueroa-Ortiz, L C; García-Ben, A; García-Campos, J

    2014-09-01

    To assess the importance of the Pelli-Robson contrast sensitivity test in multiple sclerosis patients according to the Expanded Disability Status Scale (EDSS). A total of 62 patients with multiple sclerosis were included in a retrospective study. Patients were enrolled from the Neurology Department to Neuroophthalmology at Virgen de la Victoria Hospital. Patients were classified into 3 groups according to EDSS: group A) lower than 1.5, group B) between 1.5 and 3.5 and group C) greater than 3.5. Visual acuity and monocular and binocular contrast sensitivity were performed with Snellen and Pelli-Robson tests respectively. Twelve disease-free control participants were also recruited. Correlations between parameter changes were analyzed. The mean duration of the disease was 81.54±35.32 months. Monocular and binocular Pelli-Robson mean values in the control group were 1.82±0.10 and 1.93±0.43 respectively, and 1.61±0.29 and 1.83±0.19 in multiple sclerosis patients. There were statistically significant differences in the monocular analysis for a level of significance P<.05. Mean monocular and binocular Pelli-Robson values in relation to gravity level were, in group A: 1.66±0.24 and 1.90±0.98, group B: 1.64±0.21 and 1.82±0.16, and group C: 1.47±0.45 and 1.73±0.32 respectively. Group differences were statistically significant in both tests: P=.05 and P=.027. Monocular and binocular contrast discrimination analyzed using the Pelli-Robson test was found to be significantly lower when the severity level, according EDSS, increases in multiple sclerosis patients. Copyright © 2013 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  10. Evaluation of the single radiosensitivity in patients subjected to medical exposure that show severe skin reactions

    International Nuclear Information System (INIS)

    Di Giorgio, M.; Vallerga, M.B.; Portas, M.; Perez, M.R.

    2006-01-01

    signs after 5 months. So much the micronucleus frequency like the comet essay showed compatible values with a normal radiosensitivity. In the case 2 it was observed a partial answer, with resistant pain to the analgesic ones and sharpen again crisis. In this case, both essays indicated hypersensitivity to the lR in the lymphocytes of the patient's outlying blood. It was concludes that the bio indicators of individual radiosensitivity can be of utility for the radioleisures prevention, by means of the personalized adaptation of therapeutic outlines that imply the use of IR. Also, in situations of accidental overexposure to IR, these indicators would have predict value, contributing to the design of therapeutic strategies. (Author)

  11. Factors affecting the incidence of contrast-induced nephropathy in patients undergoing computed tomography.

    Science.gov (United States)

    Heras Benito, M; Garrido Blázquez, M; Gómez Sanz, Y; Bernardez Mardomingo, M; Ruiz Cacho, J; Rodríguez Recio, F J; Fernández-Reyes Luis, M J

    2018-05-17

    To analyze the incidence of contrast-induced nephropathy in a cohort of patients undergoing computed tomography (CT) with intravenous iodinated contrast material. To evaluate the efficacy of N-acetylcysteine in preventing contrast-induced nephropathy. This prospective observational study was carried out in the months comprising March 2016 through July 2016. We selected the first five patients scheduled to undergo CT examination each day who agreed to participate and signed the informed consent form. We recorded patients' cardiovascular histories, chronic treatments, and indications for the CT examination. We measured blood levels of creatinine and urea before and after the CT examination. We used the Modification of Diet in Renal Disease (MDRD-4) equation to estimate the glomerular filtration rate. We analyzed the type and dose of contrast material. We recorded whether N-acetylcysteine was administered before the CT examination. We used SPSS 15.0 ® to compare means and proportions. Statistical significance was set at p < 0.05. No incidents of contrast-induced nephropathy were detected in any of the 202 patients included [mean age, 63.92 ± 12 years (range 22-87); 57.4% male; 21.8% diabetic; 39.6% hypertensive; 87.1% had MDRD4 ≥ 60 ml/min/1.73 m 2 (89.45 ± 14, range 62.36-134.14) and 12.9% had MDRD4 < 60 ml/min/1.73 m 2 (45.38 ± 11, range 9.16-58.90)]. The most common indication for CT examinations was oncologic (81.2%). The only contrast agent administered was iopamidol; the mean dose was 107.83 ± 11 ml (range 70-140). The mean interval between pre-CT and post-CT laboratory tests was 4.06 ± 1 days. Only 13 patients received N-acetylcysteine; 9 of these had MDRD < 60 ml/min/1.73 m 2 and 4 had MDRD4 ≥ 60 ml/min/1.73 m 2 (p = 0.000). The incidence of contrast-induced nephropathy was not significant in patients with glomerular filtration rates greater than 30 ml/min/1.73 m 2 : these favorable results might be due to

  12. Endolympathic hydrops in patients with vestibular schwannoma: visualization by non-contrast-enhanced 3D FLAIR

    International Nuclear Information System (INIS)

    Naganawa, Shinji; Kawai, Hisashi; Sone, Michihiko; Nakashima, Tsutomu; Ikeda, Mitsuru

    2011-01-01

    Signal intensity of ipsilateral labyrinthine lymph fluid has been reported to increase in most cases with vestibular schwannoma (VS) on 3D fluid attenuated inversion recovery (FLAIR). The purpose of this study was twofold, (1) to evaluate if endolymphatic space can be recognized in the patients with VS on non-contrast-enhanced 3D-FLAIR images and (2) to know if the vertigo in the patients with VS correlates to vestibular endolymphatic hydrops. From the introduction of 32-channel head coil at 3 T in May 2008 to June 2010, 15 cases with unilateral VS were identified in the radiology report database. The two cases without a significant signal increase on 3D FLAIR were excluded. Resting 13 cases were retrospectively analyzed in regard to the recognition of endolymphatic hydrops in the cochlea and vestibule and to the correlation between the patients' symptoms and endolymphatic hydrops. In all cases, vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. Cochlear endolymphatic space can be identified only in one case with significant hydrops. Vestibular hydrops was identified in four cases. Among these four cases, three had vertigo, and one had no vertigo. In those nine cases without hydrops, two had vertigo, and seven did not have vertigo. No significant correlation between vertigo and vestibular hydrops was found. Vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. In some patients with VS, vestibular hydrops is seen; however, endolymphatic hydrops in the vestibule might not be the only responsible cause of vertigo in the patients with VS. (orig.)

  13. Endolympathic hydrops in patients with vestibular schwannoma: visualization by non-contrast-enhanced 3D FLAIR

    Energy Technology Data Exchange (ETDEWEB)

    Naganawa, Shinji; Kawai, Hisashi [Nagoya University Graduate School of Medicine, Department of Radiology, Nagoya (Japan); Sone, Michihiko; Nakashima, Tsutomu [Nagoya University Graduate School of Medicine, Department of Otorhinolaryngology, Nagoya (Japan); Ikeda, Mitsuru [Nagoya University School of Health Sciences, Department of Radiological Technology, Nagoya (Japan)

    2011-12-15

    Signal intensity of ipsilateral labyrinthine lymph fluid has been reported to increase in most cases with vestibular schwannoma (VS) on 3D fluid attenuated inversion recovery (FLAIR). The purpose of this study was twofold, (1) to evaluate if endolymphatic space can be recognized in the patients with VS on non-contrast-enhanced 3D-FLAIR images and (2) to know if the vertigo in the patients with VS correlates to vestibular endolymphatic hydrops. From the introduction of 32-channel head coil at 3 T in May 2008 to June 2010, 15 cases with unilateral VS were identified in the radiology report database. The two cases without a significant signal increase on 3D FLAIR were excluded. Resting 13 cases were retrospectively analyzed in regard to the recognition of endolymphatic hydrops in the cochlea and vestibule and to the correlation between the patients' symptoms and endolymphatic hydrops. In all cases, vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. Cochlear endolymphatic space can be identified only in one case with significant hydrops. Vestibular hydrops was identified in four cases. Among these four cases, three had vertigo, and one had no vertigo. In those nine cases without hydrops, two had vertigo, and seven did not have vertigo. No significant correlation between vertigo and vestibular hydrops was found. Vestibular endolymphatic space can be recognized on non-contrast-enhanced 3D FLAIR. In some patients with VS, vestibular hydrops is seen; however, endolymphatic hydrops in the vestibule might not be the only responsible cause of vertigo in the patients with VS. (orig.)

  14. Numerical deconvolution to enhance sharpness and contrast of portal images for radiotherapy patient positioning verification

    International Nuclear Information System (INIS)

    Looe, H.K.; Uphoff, Y.; Poppe, B.; Carl von Ossietzky Univ., Oldenburg; Harder, D.; Willborn, K.C.

    2012-01-01

    The quality of megavoltage clinical portal images is impaired by physical and geometrical effects. This image blurring can be corrected by a fast numerical two-dimensional (2D) deconvolution algorithm implemented in the electronic portal image device. We present some clinical examples of deconvolved portal images and evaluate the clinical advantages achieved by the improved sharpness and contrast. The principle of numerical 2D image deconvolution and the enhancement of sharpness and contrast thereby achieved are shortly explained. The key concept is the convolution kernel K(x,y), the mathematical equivalent of the smearing or blurring of a picture, and the computer-based elimination of this influence. Enhancements of sharpness and contrast were observed in all clinical portal images investigated. The images of fine bone structures were restored. The identification of organ boundaries and anatomical landmarks was improved, thereby permitting a more accurate comparison with the x-ray simulator radiographs. The visibility of prostate gold markers is also shown to be enhanced by deconvolution. The blurring effects of clinical portal images were eliminated by a numerical deconvolution algorithm that leads to better image sharpness and contrast. The fast algorithm permits the image blurring correction to be performed in real time, so that patient positioning verification with increased accuracy can be achieved in clinical practice. (orig.)

  15. Numerical deconvolution to enhance sharpness and contrast of portal images for radiotherapy patient positioning verification

    Energy Technology Data Exchange (ETDEWEB)

    Looe, H.K.; Uphoff, Y.; Poppe, B. [Pius Hospital, Oldenburg (Germany). Clinic for Radiation Therapy; Carl von Ossietzky Univ., Oldenburg (Germany). WG Medical Radiation Physics; Harder, D. [Georg August Univ., Goettingen (Germany). Medical Physics and Biophysics; Willborn, K.C. [Pius Hospital, Oldenburg (Germany). Clinic for Radiation Therapy

    2012-02-15

    The quality of megavoltage clinical portal images is impaired by physical and geometrical effects. This image blurring can be corrected by a fast numerical two-dimensional (2D) deconvolution algorithm implemented in the electronic portal image device. We present some clinical examples of deconvolved portal images and evaluate the clinical advantages achieved by the improved sharpness and contrast. The principle of numerical 2D image deconvolution and the enhancement of sharpness and contrast thereby achieved are shortly explained. The key concept is the convolution kernel K(x,y), the mathematical equivalent of the smearing or blurring of a picture, and the computer-based elimination of this influence. Enhancements of sharpness and contrast were observed in all clinical portal images investigated. The images of fine bone structures were restored. The identification of organ boundaries and anatomical landmarks was improved, thereby permitting a more accurate comparison with the x-ray simulator radiographs. The visibility of prostate gold markers is also shown to be enhanced by deconvolution. The blurring effects of clinical portal images were eliminated by a numerical deconvolution algorithm that leads to better image sharpness and contrast. The fast algorithm permits the image blurring correction to be performed in real time, so that patient positioning verification with increased accuracy can be achieved in clinical practice. (orig.)

  16. Delayed contrast-enhanced computed tomography in patients with known or suspected cardiac sarcoidosis: A feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Aikawa, Tadao; Naya, Masanao; Obara, Masahiko [Hokkaido University Graduate School of Medicine, Sapporo (Japan); Oyama-Manabe, Noriko; Kudo, Kohsuke [Hokkaido University Hospital, Department of Diagnostic and Interventional Radiology, Sapporo (Japan); Ohira, Hiroshi; Sugimoto, Ayako; Tsujino, Ichizo [Hokkaido University Graduate School of Medicine, First Department of Medicine, Sapporo (Japan); Manabe, Osamu; Tamaki, Nagara [Hokkaido University Graduate School of Medicine, Department of Nuclear Medicine, Sapporo (Japan); Tsutsui, Hiroyuki [Kyushu University, Department of Cardiovascular Medicine, Fukuoka (Japan)

    2017-10-15

    To evaluate the diagnostic value of delayed contrast-enhanced computed tomography (DE-CT) for cardiac sarcoidosis (CS) in patients with or without implantable devices, including a quantitative comparison with late gadolinium enhancement cardiac magnetic resonance (LGE-CMR). Twenty-four patients (mean age, 64 ± 9 years; 17 women) with known or suspected CS underwent retrospective electrocardiogram-gated DE-CT at 80 kV with knowledge-based iterative model reconstruction. Fourteen patients without implantable devices also underwent LGE-CMR, while ten with pacemakers or implantable cardioverter-defibrillators did not. The presence of hyperenhanced myocardium was assessed visually and quantitatively using a 5-standard deviation threshold above the mean of remote myocardium. Inter-observer agreement for visual detection of hyperenhanced segments on DE-CT was excellent in patients with implantable devices and in those without (κ = 0.91 and κ = 0.94, respectively). Comparisons of the percent area of hyperenhanced myocardium between DE-CT and LGE-CMR on both per-patient and per-segment analyses showed good correlations (r = 0.96 and r = 0.83, respectively; p < 0.001). The sensitivity and specificity of DE-CT for the diagnosis of CS were 94% and 33%. The extent of hyperenhanced lesion with DE-CT showed good agreement with LGE-CMR results. DE-CT showed high sensitivity for detecting CS and may be useful particularly in patients with contraindications to CMR. (orig.)

  17. Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study.

    Science.gov (United States)

    Tepetam, Fatma Merve; Çiftaslan, Nezihe; Oruç, Özlem; Duman, Dildar; Ağca, Meltem; Bulut, İsmet; Çolakoğlu, Bahattin

    2016-08-01

    Previous hypersensitivity reactions to contrast media (CM), atopy, atopic disease, drug allergy, and age (20-29 or >55) are risk factors for CM hypersensitivity reactions. Our aim was to evaluate whether these risk factors should prompt skin testing for diagnosing CM allergy. The study was conducted among patients referred for allergy testing with CM. Skin tests were performed with non ionic or gadolinium CM, recommended by a radiologist. After completion of tests patients were telephonically queried on their symptoms of reactions. 151 risk patients (53 men, 98 women; mean age 55.2) were included in the study. Only 13 (9 %) had a history of hypersensitivity reaction to CM. Compared with the other patients, atopy was significantly more common in patients with a history of CM hypersensitivity reactions. Female gender and mean age were also higher, but not significant. All of the tests with CMs were negative. Only one patient reported urticaria within 1-2 min after administration of CM (telephonically). Atopy can increase the risk of CM allergy. However, skin tests with CMs may be inefficient, unnecessary, and time-consuming, except in cases with a history of CM allergy. Premedication protocols appear to be beneficial in patients with a history of CM allergy and cannot be recommended for patients with well-controlled asthma, rhinitis, atopic dermatitis or history of drug allergy.

  18. Prevalence and characteristics of intravertebral enhancement on contrast-enhanced CT scans in cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Rasselet, Benjamin [Medical Imaging Department and Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5 (France); Larbi, Ahmed; Viala, Pierre [Medical Imaging Department, Nimes University Hospital, 4 rue du Professeur Robert Debré, 30029 Nîmes (France); Molinari, Nicolas [Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5 (France); Tetreau, Raphael [Medical Imaging Department, Montpellier Cancer Institute (ICM), 208 Avenue des Apothicaires, 34298 Montpellier Cedex 5 (France); Faruch-Bilfeld, Marie [Medical Imaging Department, Toulouse University Hospital, Place du Docteur Baylac, 31059 Toulouse Cedex 9 (France); Taourel, Patrice [Medical Imaging Department and Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5 (France); Cyteval, Catherine, E-mail: c-cyteval@chu-montpellier.fr [Medical Imaging Department and Biostatistics Department, Montpellier University Hospital, 191 Avenue du Doyen Gaston Giraud, 34 295 Montpellier Cedex 5 (France)

    2017-01-15

    Highlights: • 2.8% of collateral venous circulation seen on CT scan in a cancer population. • 37% of intravertebral enhancement in this population with collateral venous circulation. • 80.8% of intravertebral enhancements are located between C6 and. • 73% of intravertebral enhancements are located ipsilateral to the injection side. -  Abstract: Study design: This was a single center, retrospective observational study. Objective: to investigate—in a cancer population—the prevalence and hallmarks of intravertebral enhancement (IVE) detected on contrast-enhanced CT. Summary of background data: Intravertebral enhancements secondary to iodinated contrast stagnation have been described. Cancer patients have an increased risk of perivertebral venous thrombosis or stenosis secondary to several risk factors (cancer or drug induced hypercoagulability, deterioration of venous flow linked to catheter insertion, prolonged immobilization). In case of a high density lesion identified on CT, the diagnostic choice between metastasis and contrast media within bone marrow vessels may be an issue, especially as oncologic follow-up CT scans are usually performed with contrast medium injection. Methods: 2572 contrast-enhanced body CT scans performed in cancer patients over 3 months in the medical imaging department of a university hospital were retrospectively reviewed. IVE was sought when paravertebral venous collateral circulation was detected and bone metastasis ruled out and classified as linear or nodular. Their locations within vertebra, their relation to the injection side and the predominant collateral venous network side were evaluated. Results: Sixty-seven (2.8%) patients had a collateral paravertebral venous system and among them 21 had IVE (37%). There were 208 IVE locations involving 75 vertebrae. 199 IVE were linear-shaped (95.7%) and 9 nodular-shaped (4.3%). 80.8% were located between C6 and T4. 88.9% were localized in the vertebral body. 73.1% were located

  19. Prevalence and characteristics of intravertebral enhancement on contrast-enhanced CT scans in cancer patients

    International Nuclear Information System (INIS)

    Rasselet, Benjamin; Larbi, Ahmed; Viala, Pierre; Molinari, Nicolas; Tetreau, Raphael; Faruch-Bilfeld, Marie; Taourel, Patrice; Cyteval, Catherine

    2017-01-01

    Highlights: • 2.8% of collateral venous circulation seen on CT scan in a cancer population. • 37% of intravertebral enhancement in this population with collateral venous circulation. • 80.8% of intravertebral enhancements are located between C6 and. • 73% of intravertebral enhancements are located ipsilateral to the injection side. -  Abstract: Study design: This was a single center, retrospective observational study. Objective: to investigate—in a cancer population—the prevalence and hallmarks of intravertebral enhancement (IVE) detected on contrast-enhanced CT. Summary of background data: Intravertebral enhancements secondary to iodinated contrast stagnation have been described. Cancer patients have an increased risk of perivertebral venous thrombosis or stenosis secondary to several risk factors (cancer or drug induced hypercoagulability, deterioration of venous flow linked to catheter insertion, prolonged immobilization). In case of a high density lesion identified on CT, the diagnostic choice between metastasis and contrast media within bone marrow vessels may be an issue, especially as oncologic follow-up CT scans are usually performed with contrast medium injection. Methods: 2572 contrast-enhanced body CT scans performed in cancer patients over 3 months in the medical imaging department of a university hospital were retrospectively reviewed. IVE was sought when paravertebral venous collateral circulation was detected and bone metastasis ruled out and classified as linear or nodular. Their locations within vertebra, their relation to the injection side and the predominant collateral venous network side were evaluated. Results: Sixty-seven (2.8%) patients had a collateral paravertebral venous system and among them 21 had IVE (37%). There were 208 IVE locations involving 75 vertebrae. 199 IVE were linear-shaped (95.7%) and 9 nodular-shaped (4.3%). 80.8% were located between C6 and T4. 88.9% were localized in the vertebral body. 73.1% were located

  20. A comparison of definitions of contrast-induced nephropathy in patients with normal serum creatinine

    Directory of Open Access Journals (Sweden)

    Mohammad Reza Khatami

    2016-01-01

    Full Text Available Contrast-induced nephropathy (CIN is the third leading cause of acute kidney injury in hospitalized patients. The prevalence of CIN is reported to range from 0% to 50%, depending not only on patient condition and the procedure used but also the definition of CIN applied. We aimed to determine the best diagnostic indicator of CIN in patients with normal serum creatinine. This study included 206 patients with normal serum creatinine who underwent coronary angiography/angioplasty. Serum creatinine level and glomerular filtration rate (GFR were measured before and on the second and fifth days after contrast administration. The incidence of CIN based on a 25% increase in serum creatinine was calculated and compared with the incidence based on a 25% decrease in GFR or an increase of at least 0.5 mg/dL in serum creatinine. Of 206 patients, 127 were male (61.7% and 79 were female (38.3%; the mean age was 59.56 ± 10.3 years. The prevalence of CIN was 30% based on a 25% increase in serum creatinine, 23% based on a 25% decrease in GFR (P <0.012 and 3.8% based on a serum creatinine increase of at least 0.5 mg/dL (P <0.0001. The serum creatinine levels remained within the normal range in the majority of patients with CIN based on the different definitions. In patients with normal serum creatinine, the absolute increase in serum creatinine may describe the prevalence of CIN more accurately than the relative increase in serum creatinine or relative decrease in GFR.

  1. MR imaging of hepatic metastasis in patients with malignant melanoma: Evaluation of suspected lesions screened at contrast-enhanced CT

    International Nuclear Information System (INIS)

    Sofue, Keitaro; Tateishi, Ukihide; Tsurusaki, Masakatsu; Arai, Yasuaki; Yamazaki, Naoya; Sugimura, Kazuro

    2012-01-01

    Purpose: To evaluate the magnetic resonance (MR) imaging feature of suspected hepatic metastasis in patients with malignant melanoma which showed intermediate findings on screened contrast-enhanced computed tomography (CECT). Materials and methods: MR imaging was performed in 38 patients (22 men, 16 women; mean age, 58 years) whose CECT findings were intermediate. Hepatic metastases had been diagnosed on MR imaging in 23 of the 38 patients. Verification of hepatic metastasis was made by histological examination: ultrasonographic-guided needle biopsy (n = 3), autopsy (n = 3), and surgical resection (n = 1), or by an obvious progression in number and/or size of the lesions on follow-up MR imaging (n = 24). Two diagnostic radiologists reviewed MR images by consensus. The median follow-up duration was 14.2 months. Results: Abnormal findings were detected in 31 patients on MR images, and undetected in the remaining seven patients resulting in false-positive on CECT. The mean size of the lesion was 11.0 mm. False-positive results were obtained in two lesions which disappeared on follow-up MR imaging. In six patients, lesions were considered as hepatic cysts on MR images. As a result, a total of 35 hepatic metastases were detected on MR images. Of these, 18 patients demonstrated typical melanotic appearance on MR images which showed shortened T1 and T2 relaxation times, and five patients demonstrated atypical melanotic appearance. In 16 patients, extra-hepatic metastases were also developed. Conclusion: MR imaging could rule out hepatic metastasis in patients with malignant melanoma which showed intermediate findings on screened CECT, and could detect additional extra-hepatic metastases.

  2. Contrast enema findings in patients presenting with poor functional outcome after primary repair for Hirschsprung disease.

    Science.gov (United States)

    Garrett, Kevin M; Levitt, Marc A; Peña, Alberto; Kraus, Steven J

    2012-09-01

    The radiologic evaluation of Hirschsprung disease is well described in the literature. However, there is a paucity of literature describing the appearance of the neo-rectum and colon after repair, specifically describing findings in patients with poor functional outcome, which would suggest the need for reoperation. We describe findings on contrast enema and correlate them with surgical findings at reoperation in children with poor functional outcome after primary repair for Hirschsprung disease who suffer from bowel dysfunction that can manifest with either soiling or obstructive symptoms such as enterocolitis. Children were identified from our colorectal surgery database. At the time of abstract submission, 35 children had contrast enemas prior to reoperation. Additional children continue to present for evaluation. The majority of children included in the study had their primary repair performed elsewhere. The initial procedures included: Duhamel (n = 11), Soave (n = 20) or Swenson (n = 3). One child had undergone a primary Soave repair and subsequently had a Swenson-type reoperation but continued to have a poor outcome. One child's initial surgical repair could not be determined. Images were reviewed by a staff pediatric radiologist and a pediatric radiology fellow. Findings encountered on contrast enema in these children include a distal narrowed segment due to stricture or aganglionic/transitional zone segment (8), dilated/hypomotile distal segment (7), thickened presacral space due to compressing Soave cuff (11), dilated Duhamel pouch (8), active enterocolitis (3) and partially obstructing twist of the pull-through segment (1). Multiple anatomical and pathological complications exist that can lead to bowel dysfunction in children after repair of Hirschsprung disease. Little recent literature exists regarding the radiographic findings in children. We had the opportunity to review a substantial series of these children, describe the contrast enema

  3. Evaluation of contrast wash-in and peak enhancement in adenosine first pass perfusion CMR in patients post bypass surgery

    Directory of Open Access Journals (Sweden)

    Schnackenburg Bernhard

    2010-05-01

    Full Text Available Abstract Background Adenosine first pass perfusion cardiovascular magnetic resonance (CMR yields excellent results for the detection of significant coronary artery disease (CAD. In patients with coronary artery bypass grafts (CABG the kinetics of a contrast bolus may by altered only due to different distances through the bypass grafts compared to native vessels, thereby possibly imitating a perfusion defect. The aim of the study was to evaluate semiquantitative perfusion parameters in order to assess possible differences in epicardial contrast kinetics in areas supplied by native coronaries and CABG, both without significant stenosis. Methods Twenty patients with invasive exclusion of significant CAD (control group and 38 patients with CABG without angiographically significant (≥50% stenosis in unbypassed coronaries or grafts were retrospectively included in the study. They underwent adenosine first pass (0.05 mmol/kg Gd-DTPA perfusion (3 short axis views/heart beat and late gadolinium enhancement (LGE imaging 1 day before invasive coronary angiography. Areas perfused by native coronaries and/or the different bypasses were identified in X-ray angiography using the 16 segment model. In each of these areas upslope and maximal signal intensity (SImax relative to the left ventricular parameters, time to 50% maximal signal intensity (TSI50%max and time to maximal signal intensity (TSImax were calculated. Results In areas perfused by coronary arteries with bypasses compared to native coronaries relative upslope and relative SImax did not show a significant difference. TSI50%max and TSImax in native coronaries and bypasses were 7.2s ± 1.9s vs. 7.5s ± 1.9s (p max resulted in a significant (p Conclusion Adenosine perfusion CMR in patients post CABG may be associated with a short delay in contrast arrival. However, once the contrast is in the myocardium there is similar wash-in kinetics and peak enhancement. Therefore, since the delay is only short

  4. Assessing Tumor Response to Treatment in Patients with Lung Cancer Using Dynamic Contrast-Enhanced CT

    DEFF Research Database (Denmark)

    Strauch, Louise S; Eriksen, Rie Ø; Sandgaard, Michael

    2016-01-01

    Reviews and Meta-Analyses (PRISMA) guidelines. Only original research articles concerning treatment response in patients with lung cancer assessed with DCE-CT were included. To assess the validity of each study we implemented Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). The initial search......The aim of this study was to provide an overview of the literature available on dynamic contrast-enhanced computed tomography (DCE-CT) as a tool to evaluate treatment response in patients with lung cancer. This systematic review was compiled according to Preferred Reporting Items for Systematic...... yielded 651 publications, and 16 articles were included in this study. The articles were divided into groups of treatment. In studies where patients were treated with systemic chemotherapy with or without anti-angiogenic drugs, four out of the seven studies found a significant decrease in permeability...

  5. Impact of minimum contrast media volumes during elective percutaneous coronary intervention for prevention of contrast-induced nephropathy in patients with stable coronary artery disease.

    Science.gov (United States)

    Ebisawa, Soichiro; Kurita, Tairo; Tanaka, Nobuyoshi; Nasu, Kenya; Kimura, Masashi; Ito, Tatsuya; Kinoshita, Yoshihisa; Tsuchikane, Etsuo; Terashima, Mitsuyasu; Suzuki, Takahiko

    2016-01-01

    Contrast-induced nephropathy (CIN) is an important complication following percutaneous coronary intervention (PCI). The clinical importance of a minimum contrast media volume (CMV) for PCI to prevent CIN has not been well evaluated. The purpose of this study was to evaluate the impact of minimum CMV to prevent CIN after PCI. In this study, 2052 consecutive patients who underwent elective PCI in our institute were analyzed. We divided patients into two groups according to CMV: a minimum CMV PCI group [CMV ≤50 ml (n = 94)] and a non-minimum CMV PCI group [CMV >50 ml (n = 1958)]. CIN occurred in 160 (7.8 %) patients. The incidence of CIN was significantly lower in the minimum CMV PCI group than in the non-minimum CMV PCI group (2.1 vs. 8.1 %; P = 0.03). According to multivariate analysis, elderly patients and diabetes mellitus patients were at high risk of developing CIN in this study population. When analyzing only high-risk patients, the incidence of CIN was also significantly lower in the minimum CMV group than in the non-minimum CMV group (2.6 vs. 10.3 %; P = 0.03). Minimum CMV PCI could reduce the incidence of CIN, particularly in high-risk patients; as such, defining the minimum CMV clinical cut-off values may be useful for the prevention of CIN.

  6. Dynamic contrast-enhanced MRI in patients with luminal Crohn's disease

    International Nuclear Information System (INIS)

    Ziech, M.L.W.; Lavini, C.; Caan, M.W.A.; Nio, C.Y.; Stokkers, P.C.F.; Bipat, S.; Ponsioen, C.Y.; Nederveen, A.J.; Stoker, J.

    2012-01-01

    Objectives: To prospectively assess dynamic contrast-enhanced (DCE-)MRI as compared to conventional sequences in patients with luminal Crohn's disease. Methods: Patients with Crohn's disease undergoing MRI and ileocolonoscopy within 1 month had DCE-MRI (3T) during intravenous contrast injection of gadobutrol, single shot fast spin echo sequence and 3D T1-weighted spoiled gradient echo sequence, a dynamic coronal 3D T1-weighted fast spoiled gradient were performed before and after gadobutrol. Maximum enhancement (ME) and initial slope of increase (ISI) were calculated for four colon segments (ascending colon + coecum, transverse colon, descending colon + sigmoid, rectum) and (neo)terminal ileum. C-reactive protein (CRP), Crohn's disease activity index (CDAI), per patient and per segment Crohn's disease endoscopic index of severity (CDEIS) and disease duration were determined. Mean values of the (DCE-)MRI parameters in each segment from each patient were compared between four disease activity groups (normal mucosa, non-ulcerative lesions, mild ulcerative and severe ulcerative disease) with Mann–Whitney test with Bonferroni adjustment. Spearman correlation coefficients were calculated for continuous variables. Results: Thirty-three patients were included (mean age 37 years; 23 females, median CDEIS 4.4). ME and ISI correlated weakly with segmental CDEIS (r = 0.485 and r = 0.206) and ME per patient correlated moderately with CDEIS (r = 0.551). ME was significantly higher in segments with mild (0.378) or severe (0.388) ulcerative disease compared to normal mucosa (0.304) (p < 0.001). No ulcerations were identified at conventional sequences. ME correlated with disease duration in diseased segments (r = 0.492), not with CDAI and CRP. Conclusions: DCE-MRI can be used as a method for detecting Crohn's disease ulcerative lesions.

  7. Dynamic contrast-enhanced MRI in patients with luminal Crohn's disease

    Energy Technology Data Exchange (ETDEWEB)

    Ziech, M.L.W., E-mail: m.l.ziech@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Lavini, C., E-mail: c.lavini@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Caan, M.W.A., E-mail: m.w.a.caan@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Nio, C.Y., E-mail: C.Y.Nio@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Stokkers, P.C.F., E-mail: p.stokkers@slaz.nl [Academic Medical Center, Department of Gastroenterology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Sint Lucas Andreas Ziekenhuis, Department of Gastroenterology, Jan Tooropstraat 164, 1061 AE, Amsterdam (Netherlands); Bipat, S., E-mail: S.Bipat@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Ponsioen, C.Y., E-mail: c.y.ponsioen@amc.uva.nl [Academic Medical Center, Department of Gastroenterology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Nederveen, A.J., E-mail: a.j.nederveen@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands); Stoker, J., E-mail: j.stoker@amc.uva.nl [Academic Medical Center, Department of Radiology, Meibergdreef 9, 1105 AZ, Amsterdam (Netherlands)

    2012-11-15

    Objectives: To prospectively assess dynamic contrast-enhanced (DCE-)MRI as compared to conventional sequences in patients with luminal Crohn's disease. Methods: Patients with Crohn's disease undergoing MRI and ileocolonoscopy within 1 month had DCE-MRI (3T) during intravenous contrast injection of gadobutrol, single shot fast spin echo sequence and 3D T1-weighted spoiled gradient echo sequence, a dynamic coronal 3D T1-weighted fast spoiled gradient were performed before and after gadobutrol. Maximum enhancement (ME) and initial slope of increase (ISI) were calculated for four colon segments (ascending colon + coecum, transverse colon, descending colon + sigmoid, rectum) and (neo)terminal ileum. C-reactive protein (CRP), Crohn's disease activity index (CDAI), per patient and per segment Crohn's disease endoscopic index of severity (CDEIS) and disease duration were determined. Mean values of the (DCE-)MRI parameters in each segment from each patient were compared between four disease activity groups (normal mucosa, non-ulcerative lesions, mild ulcerative and severe ulcerative disease) with Mann-Whitney test with Bonferroni adjustment. Spearman correlation coefficients were calculated for continuous variables. Results: Thirty-three patients were included (mean age 37 years; 23 females, median CDEIS 4.4). ME and ISI correlated weakly with segmental CDEIS (r = 0.485 and r = 0.206) and ME per patient correlated moderately with CDEIS (r = 0.551). ME was significantly higher in segments with mild (0.378) or severe (0.388) ulcerative disease compared to normal mucosa (0.304) (p < 0.001). No ulcerations were identified at conventional sequences. ME correlated with disease duration in diseased segments (r = 0.492), not with CDAI and CRP. Conclusions: DCE-MRI can be used as a method for detecting Crohn's disease ulcerative lesions.

  8. Radioresistant DNA synthesis in cells of patients showing increased chromosomal sensitivity to ionizing radiation

    International Nuclear Information System (INIS)

    Barenfeld, L.S.; Pleskach, N.M.; Bildin, V.N.; Prokofjeva, V.V.; Mikhelson, V.M.

    1986-01-01

    The rate of DNA synthesis after γ-irradiation was studied either by analysis of the steady-state distribution of daughter [ 3 H]DNA in alkaline sucrose gradients or by direct assay of the amount of [ 3 H]thymidine incorporated into DNA of fibroblasts derived from a normal donor (LCH882) and from Down's syndrome (LCH944), Werner's syndrome (WS1LE) and xeroderma pigmentosum (XP2LE) patients with chromosomal sensitivity to ionizing radiation. Doses of γ-irradiation that markedly inhibited the rate of DNA synthesis in normal human cells caused almost no inhibition of DNA synthesis in the cells from the affected individuals. The radioresistant DNA synthesis in Down's syndrome cells was mainly due to a much lower inhibition of replicon initiation than that in normal cells; these cells were also more resistant to damage that inhibited replicon elongation. Our data suggest that radioresistant DNA synthesis may be an intrinsic feature of all genetic disorders showing increased radiosensitivity in terms of chromosome aberrations. (orig.)

  9. Reduced iodinated contrast media for abdominal imaging by dual-layer spectral detector computed tomography for patients with kidney disease

    Directory of Open Access Journals (Sweden)

    Hirokazu Saito, MD

    2018-04-01

    Full Text Available Contrast-enhanced computed tomography using iodinated contrast media is useful for diagnosis of gastrointestinal diseases. However, contrast-induced nephropathy remains problematic for kidney diseases patients. Although current guidelines recommended the use of a minimal dose of contrast media necessary to obtain adequate images for diagnosis, obtaining adequate images with sufficient contrast enhancement is difficult with conventional computed tomography using reduced contrast media. Dual-layer spectral detector computed tomography enables the simultaneous acquisition of low- and high-energy data and the reconstruction of virtual monochromatic images ranging from 40 to 200 keV, retrospectively. Low-energy virtual monochromatic images can enhance the contrast of images, thereby facilitating reduced contrast media. In case 1, abdominal computed tomography angiography at 50 keV using 40% of the conventional dose of contrast media revealed the artery that was the source of diverticular bleeding in the ascending colon. In case 2, ischemia of the transverse colon was diagnosed by contrast-enhanced computed tomography and iodine-selective imaging using 40% of the conventional dose of contrast media. In case 3, advanced esophagogastric junctional cancer was staged and preoperative abdominal computed tomography angiography could be obtained with 30% of the conventional dose of contrast media. However, the texture of virtual monochromatic images may be a limitation at low energy. Keywords: Virtual monochromatic images, Contrast-induced nephropathy

  10. Sodium Bicarbonate Versus Sodium Chloride for Preventing Contrast-Associated Acute Kidney Injury in Critically Ill Patients: A Randomized Controlled Trial.

    Science.gov (United States)

    Valette, Xavier; Desmeulles, Isabelle; Savary, Benoit; Masson, Romain; Seguin, Amélie; Sauneuf, Bertrand; Brunet, Jennifer; Verrier, Pierre; Pottier, Véronique; Orabona, Marie; Samba, Désiré; Viquesnel, Gérald; Lermuzeaux, Mathilde; Hazera, Pascal; Dutheil, Jean-Jacques; Hanouz, Jean-Luc; Parienti, Jean-Jacques; du Cheyron, Damien

    2017-04-01

    To test whether hydration with bicarbonate rather than isotonic sodium chloride reduces the risk of contrast-associated acute kidney injury in critically ill patients. Prospective, double-blind, multicenter, randomized controlled study. Three French ICUs. Critically ill patients with stable renal function (n = 307) who received intravascular contrast media. Hydration with 0.9% sodium chloride or 1.4% sodium bicarbonate administered with the same infusion protocol: 3 mL/kg during 1 hour before and 1 mL/kg/hr during 6 hours after contrast medium exposure. The primary endpoint was the development of contrast-associated acute kidney injury, as defined by the Acute Kidney Injury Network criteria, 72 hours after contrast exposure. Patients randomized to the bicarbonate group (n = 151) showed a higher urinary pH at the end of the infusion than patients randomized to the saline group (n = 156) (6.7 ± 2.1 vs 6.2 ± 1.8, respectively; p 0.99) were also similar between the saline and bicarbonate groups, respectively. Except for urinary pH, none of the outcomes differed between the two groups. Among ICU patients with stable renal function, the benefit of using sodium bicarbonate rather than isotonic sodium chloride for preventing contrast-associated acute kidney injury is marginal, if any.

  11. Association of dynamic susceptibility contrast enhanced MR Perfusion parameters with prognosis in elderly patients with glioblastomas

    Energy Technology Data Exchange (ETDEWEB)

    Jabehdar Maralani, Pejman [University of Toronto, Department of Medical Imaging, Sunnybrook Health Sciences Center, Toronto, ON (Canada); Melhem, Elias R.; Herskovits, Edward H. [University of Maryland Medical Center, Department of Radiology, Baltimore, MD (United States); Wang, Sumei; Voluck, Matthew R.; Learned, Kim O.; Mohan, Suyash [Perelman School of Medicine at University of Pennsylvania, Department of Radiology, Division of Neuroradiology, Philadelphia, PA (United States); Kim, Sang Joon [University of Ulsan Asan Medical Center, Department of Radiology, Songpa-gu, Seoul (Korea, Republic of); O' Rourke, Donald M. [Perelman School of Medicine at University of Pennsylvania, Department of Surgery, Division of Neurosurgery, Philadelphia, PA (United States)

    2015-09-15

    We aimed to evaluate the prognostic value of dynamic susceptibility contrast (DSC) MR perfusion in elderly patients with glioblastomas (GBM). Thirty five patients aged ≥65 and 35 aged <65 years old, (referred to as elderly and younger, respectively) were included in this retrospective study. The median relative cerebral volume (rCBV) from the enhancing region (rCBV{sub ER-Med}) and immediate peritumoral region (rCBV{sub IPR-Med}) and maximum rCBV from the enhancing region of the tumor (rCBV{sub ER-Max}) were compared and correlated with survival data. Analysis was repeated after rCBVs were dichotomized into high and low values and after excluding elderly patients who did not receive postoperative chemoradiation (34.3 %). Kaplan-Meyer survival curves and parametric and semi-parametric regression tests were used for analysis. All rCBV parameters were higher in elderly compared to younger patients (p < 0.05). After adjustment for age, none were independently associated with shorter survival (p > 0.05). After rCBV dichotomization into high and low values, high rCBV in elderly was independently associated with shorter survival compared to low rCBV in elderly, or any rCBV in younger patients (p < 0.05). rCBV can be an imaging biomarker to identify a subgroup of GBM patients in the elderly with worse prognosis compared to others. (orig.)

  12. Analysis of allergen immunotherapy studies shows increased clinical efficacy in highly symptomatic patients

    DEFF Research Database (Denmark)

    Howarth, P; Malling, Hans-Jørgen; Molimard, M

    2011-01-01

    them. Thus, clinical studies of AIT can neither establish baseline symptom levels nor limit the enrolment of patients to those with the most severe symptoms. Allergen immunotherapy treatment effects are therefore diluted by patients with low symptoms for a particular pollen season. The objective...... tertiles). The difference observed in the average score in each tertile in active vs placebo-treated patients was assessed. This allowed an estimation of the efficacy that could be achieved in patients from sites where symptoms were high during the pollen season. Results:  An increased treatment effect...... of this analysis was to assess the effect possible to achieve with AIT in the groups of patients presenting the most severe allergic symptoms. Methods:  Study centres were grouped into tertiles categorized according to symptom severity scores observed in the placebo patients in each centre (low, middle and high...

  13. Patients with eating disorders showed no signs of coeliac disease before and after nutritional intervention.

    Science.gov (United States)

    Kaltsa, Maria; Garoufi, Anastasia; Tsitsika, Artemis; Tsirogianni, Alexandra; Papasteriades, Chryssa; Kossiva, Lydia

    2015-07-01

    This study assessed the presence of specific antibodies for coeliac disease in outpatients suffering from eating disorders before and after nutritional intervention. We also evaluated whether those patients should undergo regular screening for coeliac disease. The sample consisted of 154 patients with a mean age of 16.7 years - ranging from one to 19 years of age - suffering from eating disorders. Serology screening for coeliac disease and total immunoglobulin A (IgA) levels was evaluated in the 154 children before the nutritional intervention and in 104 patients after the intervention. The patients consumed an adequate amount of gluten in both phases. Postintervention evaluation revealed that 92 patients (88.5%) achieved a normal body weight, while the remaining 12 (11.5%) became obese. Postprandial abdominal discomfort and pain were resolved. The serology tests were negative in all patients, before and after intervention. None displayed IgA deficiency. To the best of our knowledge, this was the first prospective study where patients underwent a screening serology for coeliac disease before and after nutritional intervention. No indication of the coexistence of eating disorders and coeliac disease was documented, and the patients in our study were unlikely to require regular screening for coeliac disease. ©2015 Foundation Acta Paediatrica. Published by John Wiley & Sons Ltd.

  14. CONTRAST STUDY ON CT AND BA IN DIAGNOSIS OF PATIENTS WITH ATHEROTHROMBOTIC BRAIN INFARCTION

    Institute of Scientific and Technical Information of China (English)

    Mingshun Liu; Haixiang Gao; Xiaomei Fu; Po Ma

    2007-01-01

    Objectives: To explore applied value on CT and BA in diagnosis of patients with atherothrombotic brain infarction. Methods:CT and BA were examined in 246 patients with atherothrombotic brain infarction. Results:The different change of CT and BA were showed in 246 patients with atherothrombotic brain infarction. Conclusions: There were separately different advantage and shortcoming in CT and BA in diagnosis of atherothrombotic brain infarction. The value of clinical application of BA was important in diagnosis of atherothrombotic brain infarction.

  15. Prospective comparison of air-contrast barium enema and colonoscopy in patients with fecal occult blood: a pilot study.

    Science.gov (United States)

    Rockey, Don C; Koch, Johannes; Yee, Judy; McQuaid, Kenneth R; Halvorsen, Robert A

    2004-12-01

    The utility of air-contrast barium enema and colonoscopy for evaluation of the colon has been debated. Air-contrast barium enema is less expensive and invasive than colonoscopy, but it also is less sensitive and specific. Further, although air-contrast barium enema may be less painful than colonoscopy, it often is poorly tolerated by patients. Thus, this study compared the sensitivity and the specificity of air-contrast barium enema and colonoscopy for detection of colonic lesions in patients with fecal occult blood. Over a 30-month period, patients with fecal occult blood were recruited. Patients underwent standard air-contrast barium enema, followed by colonoscopy 7 to 14 days later. Colonoscopists were blinded to the results of air-contrast barium enema until the colonoscopy was completed, after which the results were disclosed. If the findings were discrepant, colonoscopy was repeated. A total of 100 patients were evaluated. Nine air-contrast barium enemas were reported to be inadequate, and the cecum was not intubated at colonoscopy in two patients. In the remaining patients, 5 cancers were identified (1 each cecum, transverse colon, descending colon, sigmoid colon, and rectum) by both studies. Sixty-six polypoid lesions were identified in 30 patients. Diverticula were identified in 42 patients by air-contrast barium enema and in 18 patients by colonoscopy. Air-contrast barium enema detected 3 of 36 polypoid lesions 5 mm or less in diameter, 5 of 15 adenomas 6 to 9 mm in size, and 4 of 15 adenomas 10 mm or greater in diameter (sensitivity 8%, 33%, and 27%, respectively). After excluding patients with diverticula, air-contrast barium enema detected 3 of 7 adenomas 10 mm or greater in size. Overall, 12 polypoid lesions or filling defects were identified by air-contrast barium enema that could not be verified by colonoscopy. The specificity of air-contrast barium enema for lesions 1.0 cm or greater in size was 100%; for those 6 mm or greater, it was 97%. Air-contrast

  16. Are referring clinicians aware of patients at risk from intravenous injection of iodinated contrast media?

    International Nuclear Information System (INIS)

    Konen, Eli; Konen, Osnat; Katz, Miriam; Levy, Yair; Rozenman, Judith; Hertz, Marjorie

    2002-01-01

    AIM: The purpose of our study was to assess the level of awareness of referring clinicians to populations at risk for complications of intravascular administration of iodinated contrast media. SUBJECTS AND METHODS: Two hundred and three physicians from three university hospitals completed an anonymous questionnaire regarding risk factors and contraindications to the intravenous administration of iodinated contrast media. The questionnaire included medical conditions with increased risk for anaphylactoid reaction (asthma, hay fever and food allergy) as well as chemotoxic (ischaemic heart disease, phaeochromocytoma and myasthenia gravis) adverse reactions, some with dependence on renal function (metformin treatment, diabetes mellitus and multiple myeloma). Two additional multiple-choice questions addressed pre-medication protocols and risk of nephrotoxicity in diabetic patients. RESULTS: Asthma, food allergy and hay fever were recognized as risk factors by 81·3%, 77·8% and 61·6% of respondents respectively, while ischaemic heart disease, phaeochromocytoma and myasthenia gravis were defined as such only by 9·8%, 30·0% and 28·6% respectively. Metformin treatment, diabetes mellitus and multiple myeloma, in the presence of normal renal function, were considered as risk factors by 46·3%, 38·9% and 58·1% of respondents respectively. One of the generally accepted pre-medication protocols was selected by 89·8%. The risk of nephrotoxicity in a diabetic patient was correctly assessed by 63·5% of respondents. CONCLUSION: We found a relatively high awareness among referring clinicians of a potential anaphylactoid reaction and nephrotoxicity due to iodinated contrast media. However, additional chemotoxic adverse reactions are less well known. Future efforts to improve communication between clinicians and radiologists should be focused in this direction. Konen, E. et al. (2002)

  17. Are referring clinicians aware of patients at risk from intravenous injection of iodinated contrast media?

    Energy Technology Data Exchange (ETDEWEB)

    Konen, Eli; Konen, Osnat; Katz, Miriam; Levy, Yair; Rozenman, Judith; Hertz, Marjorie

    2002-02-01

    AIM: The purpose of our study was to assess the level of awareness of referring clinicians to populations at risk for complications of intravascular administration of iodinated contrast media. SUBJECTS AND METHODS: Two hundred and three physicians from three university hospitals completed an anonymous questionnaire regarding risk factors and contraindications to the intravenous administration of iodinated contrast media. The questionnaire included medical conditions with increased risk for anaphylactoid reaction (asthma, hay fever and food allergy) as well as chemotoxic (ischaemic heart disease, phaeochromocytoma and myasthenia gravis) adverse reactions, some with dependence on renal function (metformin treatment, diabetes mellitus and multiple myeloma). Two additional multiple-choice questions addressed pre-medication protocols and risk of nephrotoxicity in diabetic patients. RESULTS: Asthma, food allergy and hay fever were recognized as risk factors by 81{center_dot}3%, 77{center_dot}8% and 61{center_dot}6% of respondents respectively, while ischaemic heart disease, phaeochromocytoma and myasthenia gravis were defined as such only by 9{center_dot}8%, 30{center_dot}0% and 28{center_dot}6% respectively. Metformin treatment, diabetes mellitus and multiple myeloma, in the presence of normal renal function, were considered as risk factors by 46{center_dot}3%, 38{center_dot}9% and 58{center_dot}1% of respondents respectively. One of the generally accepted pre-medication protocols was selected by 89{center_dot}8%. The risk of nephrotoxicity in a diabetic patient was correctly assessed by 63{center_dot}5% of respondents. CONCLUSION: We found a relatively high awareness among referring clinicians of a potential anaphylactoid reaction and nephrotoxicity due to iodinated contrast media. However, additional chemotoxic adverse reactions are less well known. Future efforts to improve communication between clinicians and radiologists should be focused in this direction. Konen

  18. Effect of different ultrasound contrast materials and temperatures on patient comfort during intrauterine and tubal assessment for infertility

    International Nuclear Information System (INIS)

    Fenzl, Vanja

    2012-01-01

    Hysterosalpingo-contrast sonography (HyCoSy) is safe and easy to perform outpatient method in the evaluation of female infertility. During this procedure a certain level of discomfort and pain are experienced by patients. On the basis of reducing avoidable pain inductors the aim of this study was to compare pain sensation due to different warmth of applied contrasts (sterile saline and Echovist ® ). Prospective and randomized study was performed on patients requiring tubal and uterine assessment during standard infertility work up. One group of patients was examined using both contrasts at room temperature and the other group using preheated contrasts at body temperature. Pain experience of the procedure was rated by patients for each contrast by numerical scale (0–10) immediately after the procedure. There was significant statistical difference between pain scores during application of two contrasts in each group; Echovist induces significantly less pain in comparison to sterile saline at the same temperature (P = 0.002, 0.001). Between two groups there is also statistically significant difference in pain during introduction of the same contrast at different temperature (P < 0.001). The most tolerable for the patient is body temperature of the applied contrasts although their structure and concentrations can be another factor associated with tolerability of the procedure.

  19. Effect of different ultrasound contrast materials and temperatures on patient comfort during intrauterine and tubal assessment for infertility

    Energy Technology Data Exchange (ETDEWEB)

    Fenzl, Vanja, E-mail: vanja.radic@inet.hr [Department of Gynecology and Obstetrics, University Hospital “Merkur”, Zajčeva 19 (Croatia); University of Applied Health Studies, Mlinarska Cesta 38, 10000 Zagreb (Croatia)

    2012-12-15

    Hysterosalpingo-contrast sonography (HyCoSy) is safe and easy to perform outpatient method in the evaluation of female infertility. During this procedure a certain level of discomfort and pain are experienced by patients. On the basis of reducing avoidable pain inductors the aim of this study was to compare pain sensation due to different warmth of applied contrasts (sterile saline and Echovist{sup ®}). Prospective and randomized study was performed on patients requiring tubal and uterine assessment during standard infertility work up. One group of patients was examined using both contrasts at room temperature and the other group using preheated contrasts at body temperature. Pain experience of the procedure was rated by patients for each contrast by numerical scale (0–10) immediately after the procedure. There was significant statistical difference between pain scores during application of two contrasts in each group; Echovist induces significantly less pain in comparison to sterile saline at the same temperature (P = 0.002, 0.001). Between two groups there is also statistically significant difference in pain during introduction of the same contrast at different temperature (P < 0.001). The most tolerable for the patient is body temperature of the applied contrasts although their structure and concentrations can be another factor associated with tolerability of the procedure.

  20. Primary and secondary patient data in contrast: the use of observational studies like RABBIT.

    Science.gov (United States)

    Richter, Adrian; Meißner, Yvette; Strangfeld, Anja; Zink, Angela

    2016-01-01

    The study of secondary patient data, particularly represented by claims data, has increased in recent years. The strength of this approach involves easy access to data that have been generated for administrative purposes. By contrast, collection of primary data for research is time-consuming and may therefore appear outdated. Both administrative data and data collected prospectively in clinical care can address similar research questions concerning effectiveness and safety of treatments. Therefore, why should we invest the precious time of rheumatologists to generate primary patient data? This article will outline some features of primary patient data collection illustrated by the German biologics register RABBIT (Rheumatoid arthritis: observation of biologic therapy). RABBIT is a long-term observational cohort study that was initiated more than 15 years ago. We will discuss as quality indicators: (i) study design, (ii) type of documentation, standardisation of (iii) clinical and (iv) safety data, (v) monitoring of the longitudinal follow-up, (vi) losses to follow-up as well as (vii) the possibilities to link the data base. The impact of these features on interpretation and validity of results is illustrated using recent publications. We conclude that high quality and completeness of data prospectively-collected offers many advantages over large quantities of non-standardised data collected in an unsupervised manner. We expect the enthusiasm about the use of secondary patient data to decline with more awareness of their methodological limitations while studies with primary patient data like RABBIT will maintain and broaden their impact on daily clinical practice.

  1. Patients with severe acquired brain injury show increased arousal in tilt-table training

    DEFF Research Database (Denmark)

    Riberholt, Christian G; Thorlund, Jonas Bloch; Mehlsen, Jesper

    2013-01-01

    Patients with severe acquired brain injury (ABI) are often mobilised using a tilt-table. Complications such as orthostatic intolerance have been reported. The primary objective of this study was to investigate if using a tilt-table was feasible for mobilising patients with severe ABI admitted...... for sub-acute rehabilitation. We also investigated change in arousal, treatment duration before termination due to orthostatic reactions and change in muscle tone....

  2. Non-ionic iodinated contrast media related immediate reactions: A mechanism study of 27 patients.

    Science.gov (United States)

    Zhai, Liqin; Guo, Xiangjie; Zhang, Haoyue; Jin, Qianqian; Zeng, Qiang; Tang, Xiaoxian; Gao, Cairong

    2017-01-01

    The underlying mechanism of non-ionic iodinated contrast media-related immediate reactions was evaluated in this study. Patients presenting at least grade II immediate reactions after non-ionic iodinated contrast media injection were enrolled. Basophil activation was evaluated by flow cytometry. The plasma concentration of human terminal complement complex SC5b-9, as well as concentrations of serum chymase, tryptase, human mast cell carboxypeptidase A3, human prostaglandin D2, and total IgE were measured by enzyme-linked immunosorbent assay. The basophil activation percentage was significantly higher in the study group than in the control group (17.94±21.06% vs 3.45±1.49%). The plasma concentration of human terminal complement complex SC5b-9 and concentrations of serum chymase, human mast cell carboxypeptidase A3, prostaglandin D2, tryptase, and total IgE were also significantly increased (236.99±318.21 vs 49.70±30.41ng/mL, 0.41±0.49 vs 0.09±0.06ng/mL, 1.17±0.67 vs 0.30±0.17ng/mL, 203.52±137.27 vs 102.28±48.72pg/mL, 3.81±0.22 vs 2.70±0.16ng/mL, 102.00±51.84 vs 19.97±2.75ng/mL, respectively). Both mast cells and basophils were activated in non-ionic iodinated contrast media to mediate immediate hypersensitivity, and mast cells may be involved. Different mechanisms, including IgE-dependent, complement-dependent, and direct membrane effects, contributed to mast cell and basophil activation. Individual patients may use a single or combined mechanism involving single or combined mast cells and basophils. Immediate reactions following non-ionic iodinated contrast media injection may be a mechanically heterogenous disease. Copyright © 2016. Published by Elsevier B.V.

  3. Physical Stress Echocardiography: Prediction of Mortality and Cardiac Events in Patients with Exercise Test showing Ischemia

    Directory of Open Access Journals (Sweden)

    Ana Carla Pereira de Araujo

    2014-11-01

    Full Text Available Background: Studies have demonstrated the diagnostic accuracy and prognostic value of physical stress echocardiography in coronary artery disease. However, the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia is limited. Objective: To evaluate the effectiveness of physical stress echocardiography in the prediction of mortality and major cardiac events in patients with exercise test positive for myocardial ischemia. Methods: This is a retrospective cohort in which 866 consecutive patients with exercise test positive for myocardial ischemia, and who underwent physical stress echocardiography were studied. Patients were divided into two groups: with physical stress echocardiography negative (G1 or positive (G2 for myocardial ischemia. The endpoints analyzed were all-cause mortality and major cardiac events, defined as cardiac death and non-fatal acute myocardial infarction. Results: G2 comprised 205 patients (23.7%. During the mean 85.6 ± 15.0-month follow-up, there were 26 deaths, of which six were cardiac deaths, and 25 non-fatal myocardial infarction cases. The independent predictors of mortality were: age, diabetes mellitus, and positive physical stress echocardiography (hazard ratio: 2.69; 95% confidence interval: 1.20 - 6.01; p = 0.016. The independent predictors of major cardiac events were: age, previous coronary artery disease, positive physical stress echocardiography (hazard ratio: 2.75; 95% confidence interval: 1.15 - 6.53; p = 0.022 and absence of a 10% increase in ejection fraction. All-cause mortality and the incidence of major cardiac events were significantly higher in G2 (p < 0. 001 and p = 0.001, respectively. Conclusion: Physical stress echocardiography provides additional prognostic information in patients with exercise test positive for myocardial ischemia.

  4. Cytokine profiles show heterogeneity of interferon-β response in multiple sclerosis patients

    DEFF Research Database (Denmark)

    Hegen, Harald; Adrianto, Indra; Lessard, Christopher J

    2016-01-01

    OBJECTIVE: To evaluate serum cytokine profiles for their utility to determine the heterogeneous responses to interferon (IFN)-β treatment in patients with multiple sclerosis (MS). METHODS: Patients with relapsing-remitting MS (RRMS) or clinically isolated syndrome receiving de novo IFN-β treatment...... were included in this prospective, observational study. Number of relapses and changes in disability were assessed 2 years prior to and 2 years after initiation of treatment. Sera were collected at baseline and after 3 months on therapy. Cytokine levels in sera were assessed by Luminex multiplex assays...

  5. Lead Time to Appointment and No-Show Rates for New and Follow-up Patients in an Ambulatory Clinic.

    Science.gov (United States)

    Drewek, Rupali; Mirea, Lucia; Adelson, P David

    High rates of no-shows in outpatient clinics are problematic for revenue and for quality of patient care. Longer lead time to appointment has variably been implicated as a risk factor for no-shows, but the evidence within pediatric clinics is inconclusive. The goal of this study was to estimate no-show rates and test for association between appointment lead time and no-show rates for new and follow-up patients. Analyses included 534 new and 1920 follow-up patients from pulmonology and gastroenterology clinics at a freestanding children's hospital. The overall rate of no-shows was lower for visits scheduled within 0 to 30 days compared with 30 days or more (23% compared with 47%, P < .0001). Patient type significantly modified the association of appointment lead time; the rate of no-shows was higher (30%) among new patients compared with (21%) follow-up patients with appointments scheduled within 30 days (P = .004). For appointments scheduled 30 or more days' lead time, no-show rates were statistically similar for new patients (46%) and follow-up patients (0.48%). Time to appointment is a risk factor associated with no-shows, and further study is needed to identify and implement effective approaches to reduce appointment lead time, especially for new patients in pediatric subspecialties.

  6. Direct observation during surgery shows preservation of cerebral microcirculation in patients with traumatic brain injury

    NARCIS (Netherlands)

    Pérez-Bárcena, Jon; Romay, Eduardo; Llompart-Pou, Juan Antonio; Ibáñez, Javier; Brell, Marta; Llinás, Pedro; González, Elsa; Merenda, Amedeo; Ince, Can; Bullock, Ross

    2015-01-01

    To describe the alterations of the cortical microcirculation of the brain (blood flow and vessel density) in TBI patients who and compare them with a control group. Prospective and observational study in a third-level university hospital. Cortical microcirculation in the brain was directly observed

  7. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    NARCIS (Netherlands)

    Bouwense, S.A.; Olesen, S.S.; Drewes, A.M.; Goor, H. van; Wilder-Smith, O.H.G.

    2015-01-01

    BACKGROUND: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs

  8. Differentiation between early rheumatoid arthritis patients and healthy persons by conventional and dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Axelsen, Mette Bjørndal; Ejbjerg, B J; Hetland, M L

    2014-01-01

    OBJECTIVES: To identify the magnetic resonance imaging (MRI) parameter that best differentiates healthy persons and patients with early rheumatoid arthritis (RA), and to investigated responsiveness to treatment of various MRI parameters. METHOD: Conventional MRI and dynamic contrast-enhanced (DCE...

  9. Preliminary Investigations Showing Venous Thromboembolism Recurrence in Patients with Residual Venous Obstruction in Singaporean Population.

    Science.gov (United States)

    Sule, Ashish Anil; Er, Chaozer; Chong, Claudia Y X; Chin, Han Xin; Chin, Tay Jam

    2017-12-01

    This study aims to determine the association of residual venous obstruction (RVO) with recurrent venous thromboembolism (VTE). A retrospective cohort study was conducted determining if RVO on ultrasonography is associated with recurrent VTE in a Singaporean population. The subjects were identified from the Vascular Diagnostic Laboratory patients' record of Tan Tock Seng Hospital (TTSH), Singapore between 2008 and 2013. All the patients included had RVO after 3 months of anticoagulation. Data such as age, gender, race, thrombus location, etiology, history of malignancy, thrombophilia screen, treatment duration, and follow-up were recorded for analysis. Statistical analysis was performed using Stata/SE 13.1 (StataCorp LLC). The study was approved by the National Healthcare Group Domain Specific Review Board (DSRB), Singapore. Out of the 34 patients who had RVO, 6 (17.6%) developed VTE recurrence. Patients were treated with anticoagulation for a mean time of 24.5 months. The mean follow-up time for VTE recurrence was 25.4 months. Out of the six patients who had VTE recurrence, one had common iliac vein involvement, four had superficial femoral vein and common femoral vein involvement, zero had popliteal vein involvement, and one had calf veins involvement. There was a significant association between thrombophilia ( p  = 0.0195) and malignancy ( p  = 0.020) at inclusion with the risk of recurrent VTE. The presence of RVO after 3 months of anticoagulation is likely to increase the risk of VTE recurrence. Larger studies with RVO are needed to evaluate if there is an increased risk of VTE recurrence in the Asian population.

  10. Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy.

    NARCIS (Netherlands)

    Schilp, J.; Blok, C. de; Langelaan, M.; Spreeuwenberg, P.; Wagner, C.

    2014-01-01

    Background: Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch

  11. Guideline adherence for identification and hydration of high-risk hospital patients for contrast-induced nephropathy

    NARCIS (Netherlands)

    Schilp, J.; de Blok, C.; Langelaan, M.; Spreeuwenberg, P.; Wagner, C.

    2014-01-01

    Background: Contrast-induced nephropathy (CIN) is a common cause of acute renal failure in hospital patients. To prevent CIN, identification and hydration of high-risk patients is important. Prevention of CIN by hydration of high-risk patients was one of the themes to be implemented in the Dutch

  12. Contrast-enhanced ultrasound vs multidetector-computed tomography for detecting liver metastases in colorectal cancer: a prospective, blinded, patient-by-patient analysis

    DEFF Research Database (Denmark)

    Rafaelsen, S R; Jakobsen, A

    2011-01-01

    This study compared the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer.......This study compared the sensitivity and specificity of contrast-enhanced ultrasound (CEUS) and multidetector-computed tomography (MDCT) in the detection of liver metastases in patients with colorectal cancer....

  13. Handgrip strength shows no improvements in geriatric patients with persistent inflammation during hospitalization

    DEFF Research Database (Denmark)

    Norheim, Kristoffer Larsen; Bautmans, Ivan; Kjaer, Michael

    2017-01-01

    PURPOSE: Hospital-associated deconditioning due to a combination of illness and inactivity is a serious problem for elderly adults. Here we investigate whether persistence in inflammatory status affects changes in physical function during short-term hospitalization. METHODS: This was a prospective...... observational study in elderly medical patients at a geriatric department. Measurements were obtained at admission and one week after admission and included de Morton Mobility Index (DEMMI) test, 30-second chair stand test (30-s CST), 4-m gait speed (4-m GST) test, handgrip strength, activity levels determined...... with ActivPALs, and concentrations of circulating C-reactive protein (CRP) from blood samples. Only patients with inflammation (C-reactive protein levels ≥10mg·L(-1)) at admission were included in this study. They were divided into those with continued inflammation (CI: CRP remained ≥10mg·L(-1)) and those...

  14. A patient with coexisting narcolepsy and morbid jealousy showing favourable response to fluoxetine.

    Science.gov (United States)

    Wing, Y. K.; Lee, S.; Chiu, H. F.; Ho, C. K.; Chen, C. N.

    1994-01-01

    A 37 year old Chinese man suffered from coexisting narcolepsy and morbid jealousy which were precipitated by head injury 5 years previously. Fluoxetine 20 mg/day reduced his narcoleptic symptoms and morbid jealousy but not his sleepiness. On defaulting treatment, the patient's symptoms and marital problem recurred. A common central serotonin disturbance might be involved in mediating the sleep disorder and associated psychopathology. PMID:8140016

  15. Affect School for chronic benign pain patients showed improved alexithymia assessments with TAS-20

    Directory of Open Access Journals (Sweden)

    Thulesius Hans O

    2010-06-01

    Full Text Available Abstract Background Alexithymia is a disturbance associated with psychosomatic disorders, pain syndromes, and a variety of psychiatric disorders. The Affect School (AS based on Tomkins Affect Theory is a therapy focusing on innate affects and their physiological expressions, feelings, emotions and scripts. In this pilot study we tried the AS-intervention method in patients with chronic benign pain. Methods The AS-intervention, with 8 weekly group sessions and 10 individual sessions, was offered to 59 patients with chronic non-malignant pain at a pain rehabilitation clinic in Sweden 2004-2005. Pre and post intervention assessments were done with the Hospital Anxiety and Depression scale (HAD, the Toronto Alexithymia Scale-20 (TAS-20, the Visual Analogue Scale for pain assessment (VAS-pain, the European Quality of Life health barometer (EQoL and the Stress and Crisis Inventory-93 (SCI-93. After the group sessions we used Bergdahl's Questionnaire for assessing changes in interpersonal relations, general well-being and evaluation of AS. Results The AS intervention was completed by 54 out of 59 (92% patients. Significant reductions in total TAS-20 post-test scores (p = 0.0006 as well as TAS-20 DIF and DDF factors (Difficulties Identifying Feelings, and Difficulties Describing Feelings were seen (p = 0.0001, and p = 0.0008 while the EOT factor (Externally Oriented Thinking did not change. Improvements of HAD-depression scores (p = 0.04, EQoL (p = 0.02 and self-assessed changes in relations to others (p Conclusions This pilot study involving 59 patients with chronic benign pain indicates that the alexithymia DIF and DDF, as well as depression, social relations and quality of life may be improved by the Affect School therapeutic intervention.

  16. Akinetic-rigid and tremor-dominant Parkinson's disease patients show different patterns of intrinsic brain activity.

    Science.gov (United States)

    Zhang, Jiuquan; Wei, Luqing; Hu, Xiaofei; Xie, Bing; Zhang, Yanling; Wu, Guo-Rong; Wang, Jian

    2015-01-01

    Parkinson's disease (PD) is a surprisingly heterogeneous neurodegenerative disorder. It is well established that different subtypes of PD present with different clinical courses and prognoses. However, the neural mechanism underlying these disparate presentations is uncertain. Here we used resting-state fMRI (rs-fMRI) and the regional homogeneity (ReHo) method to determine neural activity patterns in the two main clinical subgroups of PD (akinetic-rigid and tremor-dominant). Compared with healthy controls, akinetic-rigid (AR) subjects had increased ReHo mainly in right amygdala, left putamen, bilateral angular gyrus, bilateral medial prefrontal cortex (MPFC), and decreased ReHo in left post cingulate gyrus/precuneus (PCC/PCu) and bilateral thalamus. In contrast, tremor-dominant (TD) patients showed higher ReHo mostly in bilateral angular gyrus, left PCC, cerebellum_crus1, and cerebellum_6, while ReHo was decreased in right putamen, primary sensory cortex (S1), vermis_3, and cerebellum_4_5. These results indicate that AR and TD subgroups both represent altered spontaneous neural activity in default-mode regions and striatum, and AR subjects exhibit more changed neural activity in the mesolimbic cortex (amygdala) but TD in the cerebellar regions. Of note, direct comparison of the two subgroups revealed a distinct ReHo pattern primarily located in the striatal-thalamo-cortical (STC) and cerebello-thalamo-cortical (CTC) loops. Overall, our findings highlight the involvement of default mode network (DMN) and STC circuit both in AR and TD subtypes, but also underscore the importance of integrating mesolimbic-striatal and CTC loops in understanding neural systems of akinesia and rigidity, as well as resting tremor in PD. This study provides improved understanding of the pathophysiological models of different subtypes of PD. Copyright © 2014 Elsevier Ltd. All rights reserved.

  17. Visualization of Chronic Myocardial Infarction Using the Intravascular Contrast Agent MS-325 (Gadofosveset in Patients

    Directory of Open Access Journals (Sweden)

    Thomas Thouet

    2012-01-01

    Full Text Available Aims. The aim of this study was to evaluate the potential of visualizing chronic myocardial infarction in patients using the intravascular CA MS-325 (gadofosveset, EPIX Pharmaceuticals, Mass, USA. Methods. Nine patients were enrolled in a clinical phase II multicenter trial for MRCA and perfusion imaging using MS-325. They had objective evidence of chronic myocardial infarction as visualized by previously performed late gadolinium (Gd enhancement imaging (LGE with a conventional extracellular Gd-DTPA CA (Magnevist, Bayer Healthcare, Germany, 0.2 mmol/kg/body weight serving as reference standard. A prepulse-optimized LGE study was performed immediately and at several time points after injection of MS-325 (0.05 mmol/kg/body weight. The number and localization of segments demonstrating LGE with MS-325 as well as signal intensities were compared with the reference standard (Gd-DTPA. Results. Using MS-325, LGE could be detected at every time point in all 9 patients. The accuracy of LGE with MS-325 as compared to LGE with Gd-DTPA was highest 54±4 minutes after contrast injection, resulting in a sensitivity of 84% with a specificity of 98%. Conclusion. The intravascular CA MS-325 has the potential to visualize chronic myocardial infarction. However, in comparison with Gd-DTPA, the transmural extent and the number of segments are smaller.

  18. Intra-individual, randomised comparison of the MRI contrast agents gadobutrol versus gadoteridol in patients with primary and secondary brain tumours, evaluated in a blinded read

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, M. [Klinikum Luenen St. Marien-Hospital, Department of Diagnostic and Interventional Radiology and Neuroradiology, Luenen (Germany); Schulte-Altedorneburg, G. [Staedtisches Klinikum Muenchen Harlaching, Department of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Muenchen (Germany); Piontek, M.; Heuser, L. [Universitaetsklinikum Knappschaftskrankenhaus GmbH, Department of Diagnostic and Interventional Radiology, Neuroradiology and Nuclear Medicine, Bochum (Germany); Hentsch, A. [Radiologisches Institut Hohenzollernstrasse, Koblenz (Germany); Spangenberg, P. [Universitaetsklinikum Knappschaftskrankenhaus GmbH, Department of Neurosurgery, Bochum (Germany); Schwenke, C. [SCO:SSiS, Berlin (Germany); Harders, A. [Universitaetsklinikum Knappschaftskrankenhaus GmbH, Department of Neurosurgery Knappschaftskrankenhaus, Bochum (Germany)

    2013-12-15

    To prove that 1.0 M gadobutrol provides superior contrast enhancement and MRI image characteristics of primary and secondary brain tumours compared with 0.5 M gadoteridol, thereby providing superior diagnostic information. Brain MRI was performed in two separate examinations in patients scheduled for neurosurgery. Independent injections of 1.0 M gadobutrol and 0.5 M gadoteridol at doses of 0.1 mmol Gd/kg body weight were administered per patient in randomised order. Evaluation was performed in an off-site blinded read. Fifty-one patients in the full analysis set (FAS) were eligible for efficacy analysis and 44 for the per-protocol analysis. For the primary efficacy variable ''preference in contrast enhancement for one contrast agent or the other'', the rate of ''gadobutrol preferred'' was estimated at 0.73 (95 % confidence interval 0.61; 0.83), showing significant superiority of gadobutrol over gadoteridol. Calculated lesion-to-brain contrast and the results of all qualitative secondary efficacy variables were also in favour of gadobutrol. Keeping a sufficient time delay after contrast application proved to be essential to get optimal image quality. Compared with 0.5 M gadoteridol, 1.0 M gadobutrol was proven to have significantly superior contrast enhancement characteristics in a routine MRI protocol of primary and secondary brain tumours. (orig.)

  19. Intra-individual, randomised comparison of the MRI contrast agents gadobutrol versus gadoteridol in patients with primary and secondary brain tumours, evaluated in a blinded read

    International Nuclear Information System (INIS)

    Koenig, M.; Schulte-Altedorneburg, G.; Piontek, M.; Heuser, L.; Hentsch, A.; Spangenberg, P.; Schwenke, C.; Harders, A.

    2013-01-01

    To prove that 1.0 M gadobutrol provides superior contrast enhancement and MRI image characteristics of primary and secondary brain tumours compared with 0.5 M gadoteridol, thereby providing superior diagnostic information. Brain MRI was performed in two separate examinations in patients scheduled for neurosurgery. Independent injections of 1.0 M gadobutrol and 0.5 M gadoteridol at doses of 0.1 mmol Gd/kg body weight were administered per patient in randomised order. Evaluation was performed in an off-site blinded read. Fifty-one patients in the full analysis set (FAS) were eligible for efficacy analysis and 44 for the per-protocol analysis. For the primary efficacy variable ''preference in contrast enhancement for one contrast agent or the other'', the rate of ''gadobutrol preferred'' was estimated at 0.73 (95 % confidence interval 0.61; 0.83), showing significant superiority of gadobutrol over gadoteridol. Calculated lesion-to-brain contrast and the results of all qualitative secondary efficacy variables were also in favour of gadobutrol. Keeping a sufficient time delay after contrast application proved to be essential to get optimal image quality. Compared with 0.5 M gadoteridol, 1.0 M gadobutrol was proven to have significantly superior contrast enhancement characteristics in a routine MRI protocol of primary and secondary brain tumours. (orig.)

  20. Pregabalin and placebo responders show different effects on central pain processing in chronic pancreatitis patients

    Directory of Open Access Journals (Sweden)

    Bouwense SA

    2015-07-01

    Full Text Available Stefan AW Bouwense,1 Søren S Olesen,2 Asbjørn M Drewes,2 Harry van Goor,1 Oliver HG Wilder-Smith31Pain and Nociception Neuroscience Research Group, Department of Surgery, Radboud university medical center, Nijmegen, The Netherlands; 2Mech-Sense, Department of Gastroenterology and Hepatology, Aalborg University Hospital, Aalborg, Denmark; 3Pain and Nociception Neuroscience Research Group, Department of Anaesthesiology, Pain and Palliative Medicine, Radboud university medical center, Nijmegen, The NetherlandsBackground: Pain control in chronic pancreatitis is a major challenge; the mechanisms behind analgesic treatment are poorly understood. This study aims to investigate the differences in pain sensitivity and modulation in chronic pancreatitis patients, based on their clinical response (responders vs nonresponders to placebo or pregabalin treatment. Methods: This study was part of a randomized, double-blind, placebo-controlled trial evaluating the analgesic effects of pregabalin and placebo in chronic pancreatitis. Post hoc, patients were assigned to one of four groups, ie, responders and nonresponders to pregabalin (n=16; n=15 or placebo (n=12; n=17 treatment. Responders were defined as patients with >30% pain reduction after 3 weeks of treatment. We measured change in pain sensitivity before and after the treatment using electric pain detection thresholds (ePDT in dermatomes C5 (generalized effects and Ventral T10 (segmental effects. Descending endogenous pain modulation was quantified via conditioned pain modulation (CPM paradigm. Results: Sixty patients were analyzed in a per-protocol analysis. ePDT change in C5 was significant vs baseline and greater in pregabalin (1.3 mA vs placebo responders (−0.1 mA; P=0.015. This was not so for ePDT in Ventral T10. CPM increased more in pregabalin (9% vs placebo responders (−17%; P<0.001. CPM changed significantly vs baseline only for pregabalin responders (P=0.006. Conclusion: This hypothesis

  1. Real-time phase contrast magnetic resonance imaging for assessment of haemodynamics: from phantom to patients

    Energy Technology Data Exchange (ETDEWEB)

    Traber, Julius; Wurche, Lennart; Dieringer, Matthias A.; Utz, Wolfgang; Knobelsdorff-Brenkenhoff, Florian von; Schulz-Menger, Jeanette [Max-Delbrueck-Centrum and Charite -Medical University Berlin and HELIOS Klinikum Berlin-Buch, Department of Cardiology and Nephrology, Working Group on Cardiovascular Magnetic Resonance Imaging, Experimental and Clinical Research Center, Berlin (Germany); Greiser, Andreas [Siemens AG Healthcare Sector, Erlangen (Germany); Jin, Ning [Siemens Medical Solutions USA, Inc., Columbus, OH (United States)

    2016-04-15

    Assessment of haemodynamics is crucial in many cardiac diseases. Phase contrast MRI (PC-MRI) can accurately access it. Arrhythmia is a major limitation in conventional segmented PC-MRI (SEG). A real-time PC-MRI sequence (RT) could overcome this. We validated RT by comparing to SEG. A prototype RT using shared velocity encoding was tested against SEG at 1.5 T in a flow phantom and consecutively included patients with (n = 55) or without (n = 59) aortic valve disease. In patients with atrial fibrillation (Afib, n = 15), only RT was applied. Phantom: PC images were acquired in front of and behind an interchangeable aortic-stenosis-like inlay. Mean velocity and flow were quantified. Patients: PC images were acquired in the ascending aorta, pulmonary trunk and superior caval vein. Peak velocity, stroke volume and regurgitant fraction were quantified. Phantom: Mean velocities (11 ± 1 to 207 ± 10 cm/s) and flow correlated closely between SEG and RT (r ≥ 0.99, ICC ≥ 0.98, p < 0.0005). Patients without AVD or with aortic regurgitation: Concordance of SEG and RT was excellent regarding peak velocities, stroke volumes (r ≥ 0.91, ICC ≥ 0.94, p < 0.0005) and regurgitant fractions (r = 0.95, ICC = 0.95, p < 0.0005). RT was feasible in all patients with Afib. The real-time sequence is accurate compared to conventional segmented PC-MRI. Its applicability in Afib was shown. Real-time PC-MRI might become a valuable tool in arrhythmia. (orig.)

  2. Contrast induced nephropathy in patients undergoing intravenous (IV) contrast enhanced computed tomography (CECT) and the relationship with risk factors: a meta-analysis.

    Science.gov (United States)

    Moos, Shira I; van Vemde, David N H; Stoker, Jaap; Bipat, Shandra

    2013-09-01

    To summarize the incidence of contrast-induced nephropathy (CIN) and associations between CIN incidence and risk factors in patients undergoing intravenous contrast-enhanced computed tomography (CECT) with low- or iso-osmolar iodinated contrast medium. This review is performed in accordance with the preferred reporting items in systematic reviews and meta-analysis (PRISMA) guidelines. We searched the MEDLINE, EMBASE and Cochrane databases from 2002 till November 2012. Two reviewers included papers and extracted data. The pooled data were analysed by either fixed or random-effects approach depending on heterogeneity defined as the I(2) index. 42 articles with 18,790 patients (mean age 61.5 years (range: 38-83 years)) were included. The mean baseline eGFR was 59.8 mL/min and ranged from 4 to 256 mL/min. Of all patients 45.0% had an estimated glomerular filtration rate (eGFR)65 years and use of non-steroidal anti-inflammatory drugs (NSAID's) with odds ratios of 1.73 (95%CI: 1.06-2.82), 1.87 (95%CI: 1.55-2.26), 1.79 (95%CI: 1.03-3.11), 1.95 (95%CI: 1.02-3.70) and 2.32 (95%CI: 1.04-5.19), respectively while hypertension, anaemia and CFH were not associated (p=0.13, p=0.38, p=0.40). The mean incidence of CIN after intravenous iodinated CECT was low and associated with renal insufficiency, diabetes, presence of malignancy, old age and NSAID's use. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

  3. PCSK9 Inhibitors Show Value for Patients and the US Health Care System.

    Science.gov (United States)

    Cheng, Wei-Han; Gaudette, Étienne; Goldman, Dana P

    2017-12-01

    Proprotein convertase subtilisin/kexin type 9 (PCSK9) inhibitors were approved by the US Food and Drug Administration (FDA) as cholesterol-lowering therapies for patients with familial hypercholesterolemia or atherosclerotic cardiovascular disease. To estimate the long-term health and economic value of PCSK9 inhibitors for Americans (51 years and older). We conducted simulations using the Future Elderly Model, an established dynamic microsimulation model to project the lifetime outcomes for the US population aged 51 years and older. Health effects estimates and confidence intervals from published meta-analysis studies were used to project changes in life expectancy, quality-adjusted life-years, and lifetime medical spending resulting from the use of PCSK9 inhibitors. We considered two treatment scenarios: 1) current FDA eligibility and 2) an extended eligibility scenario that includes patients with no pre-existing cardiovascular disease but at high risk. We assumed that the price of PCSK9 inhibitors was discounted by 35% in the first 12 years and by 57% thereafter, with gradual uptake of the drug in eligible populations. Use of PCSK9 inhibitors by individuals covered by current FDA approval would extend life expectancy at the age of 51 years by an estimated 1.1 years and would yield a lifetime net value of $5800 per person. If use was extended to those at high risk for cardiovascular disease, PCSK9 inhibitors would generate a lifetime net benefit of $14,100 per person. Expanded access to PCSK9 inhibitors would offer positive long-term net value for patients and the US health care system at the current discounted prices. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

  4. ELECTROENCEPHALOGRAPHY SHOWING DYING BRAIN IN A PATIENT WITH ACUTE BACLOFEN POISONING

    Directory of Open Access Journals (Sweden)

    A. Y. Mikhaylov

    2017-01-01

    Full Text Available We report a case of acute baclofen poisoning in a 23-year-old female patient, who committed suicide, which led to the development of a deep coma. The electroencephalogram on the first day recorded the phenomenon of “burst suppression”, which was seen as a sign of a dying brain. Subsequent studies have shown positive changes of the electroencephalogram and regression of neurological symptoms. Thus, the phenomenon of “burst suppression” in the depression of consciousness to deep coma and given adequate treatment, can be reversible.

  5. MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis

    Energy Technology Data Exchange (ETDEWEB)

    Jans, L., E-mail: lennartjans@hotmail.com [Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium); Van Praet, L.; Elewaut, D.; Van den Bosch, F.; Carron, P. [Department of Rheumatology, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium); Jaremko, J.L. [Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta (Canada); Behaeghe, M.; Denis, A.; Huysse, W.; Lambrecht, V.; Verstraete, K. [Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium)

    2014-01-15

    Purpose: To determine the prevalence of clinically relevant non-inflammatory disease on MRI of the sacroiliac (SI) joints in patients suspected of sacroiliitis. To assess the added value of axial imaging of the pelvis in these patients. Methods: In a retrospective study of 691 patients undergoing MRI of the SI joints from January 2006 to December 2012 for inflammatory back pain the prevalence of sacroiliitis and non-inflammatory disease was recorded. Results: In 285 (41%) patients MRI did not show any abnormal findings. In 36% of patients MRI features of sacroiliitis were present. Spinal degenerative changes were the most common non-inflammatory finding in 305 patients (44.1%) and consisted of disc degeneration in 222 (32%) patients, facet joint arthrosis in 58 (8.4%) patients and disc herniation in 25 (3.6%) patients. Hip joint disease in 44 (6.4%) patients, lumbosacral transitional anomaly in 41 (5.9%) patients, SI joint degenerative changes in 25 (3.6%) patients and diffuse idiopathic skeletal hyperostosis in 24 (3.5%) patients were also common. Osteitis condensans ilii in 17 (2.5%) patients, tumour in 11 (1.6%) patients, fracture in 8 (1.2%) patients, infection in 4 (0.6%) patients and acute spondylolysis in 2 patients (0.3%) were less frequently seen. Conclusion: Our study shows that non-inflammatory disease is more common than true sacroiliitis on MRI of the SI joints in patients with inflammatory type back pain. Axial pulse sequences may demonstrate unexpected findings that remain undetected if only coronal images are obtained. Clinical relevance statement:, MRI of the SI joints may demonstrate conditions that clinically mimic sacroiliitis. Axial imaging of the pelvis may help detect these unexpected findings.

  6. MRI of the SI joints commonly shows non-inflammatory disease in patients clinically suspected of sacroiliitis

    International Nuclear Information System (INIS)

    Jans, L.; Van Praet, L.; Elewaut, D.; Van den Bosch, F.; Carron, P.; Jaremko, J.L.; Behaeghe, M.; Denis, A.; Huysse, W.; Lambrecht, V.; Verstraete, K.

    2014-01-01

    Purpose: To determine the prevalence of clinically relevant non-inflammatory disease on MRI of the sacroiliac (SI) joints in patients suspected of sacroiliitis. To assess the added value of axial imaging of the pelvis in these patients. Methods: In a retrospective study of 691 patients undergoing MRI of the SI joints from January 2006 to December 2012 for inflammatory back pain the prevalence of sacroiliitis and non-inflammatory disease was recorded. Results: In 285 (41%) patients MRI did not show any abnormal findings. In 36% of patients MRI features of sacroiliitis were present. Spinal degenerative changes were the most common non-inflammatory finding in 305 patients (44.1%) and consisted of disc degeneration in 222 (32%) patients, facet joint arthrosis in 58 (8.4%) patients and disc herniation in 25 (3.6%) patients. Hip joint disease in 44 (6.4%) patients, lumbosacral transitional anomaly in 41 (5.9%) patients, SI joint degenerative changes in 25 (3.6%) patients and diffuse idiopathic skeletal hyperostosis in 24 (3.5%) patients were also common. Osteitis condensans ilii in 17 (2.5%) patients, tumour in 11 (1.6%) patients, fracture in 8 (1.2%) patients, infection in 4 (0.6%) patients and acute spondylolysis in 2 patients (0.3%) were less frequently seen. Conclusion: Our study shows that non-inflammatory disease is more common than true sacroiliitis on MRI of the SI joints in patients with inflammatory type back pain. Axial pulse sequences may demonstrate unexpected findings that remain undetected if only coronal images are obtained. Clinical relevance statement:, MRI of the SI joints may demonstrate conditions that clinically mimic sacroiliitis. Axial imaging of the pelvis may help detect these unexpected findings

  7. Effect of sodium bicarbonate on the prevention of contrast induced nephropathy in patients undergoing coronary angiography

    International Nuclear Information System (INIS)

    Isono, Tsuyoshi; Kamihata, Hiroshi; Seno, Takeshi; Manabe, Kenichi; Moriguchi, Akira; Yurugi, Takatomi; Iwasaka, Toshiji; Motohiro, Masayuki

    2007-01-01

    Contrast induced nephropathy (CIN) remains a common complication of coronary angiography (CAG) and is associated with significant morbidity and mortality. Although a previous study reported pretreatment with sodium bicarbonate is more effective than sodium chloride for prophylaxis of CIN, this has not been a universal finding and the long-term effects of sodium bicarbonate on CIN have not been studied before. We performed a prospective, single-center, randomized trial to investigate whether CIN can be avoided by sodium bicarbonate in patients with chronic renal failure. Eighty patients with chronic renal failure (defined as serum creatinine concentration (SCr), >1.1 mg per deciliter), who were undergoing CAG, were enrolled in this study. We assigned them to either sodium chloride plus sodium bicarbonate (Group B: n=35) or sodium chloride alone (Group C: n=45). In all patients, an infusion of sodium chloride of 1 ml/kg per hour was given between 12 hours before and after the procedure. In Group B, sodium bicarbonate infusion of 1 ml/kg per hour continued from 3 hours before procedure to 6 hours after procedure, changing from sodium chloride at 1 ml/kg per hour. SCr was measured at baseline, day 1, day 2 and 1 month after the procedure. CIN was defined as a 25% increase in SCr from baseline value, or an absolute increase of at least 0.5 mg/dl, which appears within 2 days after CAG. No differences in age, sex and contrast volume were observed between the two groups. SCr at baseline was not significantly different in the two groups (Group B: 1.41±0.32 versus Group C: 1.50±0.38 mg/dl). SCr at day 2 was significantly lower in Group B than Group C (1.44±0.38 versus 1.60±0.5 mg/dl, p<0.05) and 1 month (1.28±0.27 versus 1.49±0.55 mg/dl, p<0.05). CIN occurred in 9 patients (20%) in Group C but in only 2 (6%) in Group B (p=0.03). Sodium chloride plus sodium bicarbonate is more effective than sodium chloride alone for prophylaxis of CIN and can help retain long

  8. Feasibility of measuring renal blood flow by phase-contrast magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease.

    Science.gov (United States)

    Spithoven, E M; Meijer, E; Borns, C; Boertien, W E; Gaillard, C A J M; Kappert, P; Greuter, M J W; van der Jagt, E; Vart, P; de Jong, P E; Gansevoort, R T

    2016-03-01

    Renal blood flow (RBF) has been shown to predict disease progression in autosomal dominant polycystic kidney disease (ADPKD). We investigated the feasibility and accuracy of phase-contrast RBF by MRI (RBFMRI) in ADPKD patients with a wide range of estimated glomerular filtration rate (eGFR) values. First, we validated RBFMRI measurement using phantoms simulating renal artery hemodynamics. Thereafter, we investigated in a test-set of 21 patients intra- and inter-observer coefficient of variation of RBFMRI. After validation, we measured RBFMRI in a cohort of 91 patients and compared the variability explained by characteristics indicative for disease severity for RBFMRI and RBF measured by continuous hippuran infusion. The correlation in flow measurement using phantoms by phase-contrast MRI was high and fluid collection was high (CCC=0.969). Technical problems that precluded RBFMRI measurement occurred predominantly in patients with a lower eGFR (34% vs. 16%). In subjects with higher eGFRs, variability in RBF explained by disease characteristics was similar for RBFMRI compared to RBFHip, whereas in subjects with lower eGFRs, this was significantly less for RBFMRI. Our study shows that RBF can be measured accurately in ADPKD patients by phase-contrast, but this technique may be less feasible in subjects with a lower eGFR. Renal blood flow (RBF) can be accurately measured by phase-contrast MRI in ADPKD patients. RBF measured by phase-contrast is associated with ADPKD disease severity. RBF measurement by phase-contrast MRI may be less feasible in patients with an impaired eGFR.

  9. Baseline Hemodynamics and Response to Contrast Media During Diagnostic Cardiac Catheterization Predict Adverse Events in Heart Failure Patients.

    Science.gov (United States)

    Denardo, Scott J; Vock, David M; Schmalfuss, Carsten M; Young, Gregory D; Tcheng, James E; O'Connor, Christopher M

    2016-07-01

    Contrast media administered during cardiac catheterization can affect hemodynamic variables. However, little is documented about the effects of contrast on hemodynamics in heart failure patients or the prognostic value of baseline and changes in hemodynamics for predicting subsequent adverse events. In this prospective study of 150 heart failure patients, we measured hemodynamics at baseline and after administration of iodixanol or iopamidol contrast. One-year Kaplan-Meier estimates of adverse event-free survival (death, heart failure hospitalization, and rehospitalization) were generated, grouping patients by baseline measures of pulmonary capillary wedge pressure (PCWP) and cardiac index (CI), and by changes in those measures after contrast administration. We used Cox proportional hazards modeling to assess sequentially adding baseline PCWP and change in CI to 5 validated risk models (Seattle Heart Failure Score, ESCAPE [Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness], CHARM [Candesartan in Heart Failure: Assessment of Reduction in Mortality and Morbidity], CORONA [Controlled Rosuvastatin Multinational Trial in Heart Failure], and MAGGIC [Meta-Analysis Global Group in Chronic Heart Failure]). Median contrast volume was 109 mL. Both contrast media caused similarly small but statistically significant changes in most hemodynamic variables. There were 39 adverse events (26.0%). Adverse event rates increased using the composite metric of baseline PCWP and change in CI (Pcontrast correlated with the poorest prognosis. Adding both baseline PCWP and change in CI to the 5 risk models universally improved their predictive value (P≤0.02). In heart failure patients, the administration of contrast causes small but significant changes in hemodynamics. Calculating baseline PCWP with change in CI after contrast predicts adverse events and increases the predictive value of existing models. Patients with elevated baseline PCWP and

  10. Avaliação da sensibilidade ao contraste e da estereopsia em pacientes com lente intra-ocular multifocal Contrast sensitivity and stereopsis in pseudophakic patients with multifocal intraocular lens

    Directory of Open Access Journals (Sweden)

    Filipe de Oliveira

    2005-08-01

    binocular contrast sensitivity test demonstrated that 6 patients (30% presented 1.80 log units, 13 (65% 1.65 and in only 1 (5% the sensitivity was 1.50 log units. By the other hand, the monocular test in right eye showed 17 patients (85% with 1.65 log units and 3 (15% with 1.50. In the left eye, the test presented 16 patients (80% with 1.65 log units and 4 (20% with 1.50 log units. The average and the standard deviation of the contrast sensitivity were 1.63 (±0.05 for right eye, 1.62 (±0.06 for left eye and 1.69 (±0.08 for binocular test. Stereopsis test disclosed 12 patients (60% presenting 40", 6 (30% 50" and only 2 (10% 60" (average: 45" and standard deviation: 6.88". CONCLUSIONS:The Acrysof Restor® intraocular lens provided results of contrast sensitivity and stereopsis in accordance with the criteria of normality established previously in other studies for phakic and pseudophakic patients. Therefore, this intraocular lens does not decrease visual functionality.

  11. Multiphase contrast-enhanced magnetic resonance imaging features of Bacillus Calmette-Guerin-induced granulomatous prostatitis in five patients

    Energy Technology Data Exchange (ETDEWEB)

    Kawada, Hiroshi; Kanematsu, Masayuki; Goshima, Satoshi; Kondo, Hiroshi; Watanabe, Haruo; Noda, Yoshifumi; Tanahashi, Yukichi; Kawai, Nobuyuki; Hoshi, Hiroaki [Gifu University Hospital, Gifu (Japan)

    2015-04-15

    To evaluate the multiphase contrast-enhanced magnetic resonance (MR) imaging features of Bacillus Calmette-Guerin (BCG)-induced granulomatous prostatitis (GP). Magnetic resonance images obtained from five patients with histopathologically proven BCG-induced GP were retrospectively analyzed for tumor location, size, signal intensity on T2-weighted images (T2WI) and diffusion-weighted images (DWI), apparent diffusion coefficient (ADC) value, and appearance on gadolinium-enhanced multiphase images. MR imaging findings were compared with histopathological findings. Bacillus Calmette-Guerin-induced GP (size range, 9-40 mm; mean, 21.2 mm) were identified in the peripheral zone in all patients. The T2WI showed lower signal intensity compared with the normal peripheral zone. The DWIs demonstrated high signal intensity and low ADC values (range, 0.44-0.68 x 10(-3) mm2/sec; mean, 0.56 x 10(-3) mm2/sec), which corresponded to GP. Gadolinium-enhanced multiphase MR imaging performed in five patients showed early and prolonged ring enhancement in all cases of GP. Granulomatous tissues with central caseation necrosis were identified histologically, which corresponded to ring enhancement and a central low intensity area on gadolinium-enhanced MR imaging. The findings on T2WI, DWI, and gadolinium-enhanced images became gradually obscured with time. Bacillus Calmette-Guerin-induced GP demonstrates early and prolonged ring enhancement on gadolinium-enhanced MR imaging which might be a key finding to differentiate it from prostate cancer.

  12. Short term high dose atorvastatin for the prevention of contrast-induced nephropathy in patients undergoing computed tomography angiography

    Directory of Open Access Journals (Sweden)

    Hamid Sanei

    2014-09-01

    Full Text Available BACKGROUND: Statins are shown effective by some studies in preventing contrast-induced nephropathy (CIN. We evaluated the effectiveness of atorvastatin in the prevention of CIN in computed tomography angiography (CTA candidates. METHODS: This study was conducted on patients referring for elective CTA with normal renal function. Patients received atorvastatin (80 mg/day or placebo from 24 h before to 48 h after administration of the contrast material. Serum creatinine was measured before and 48 h after contrast material injection. CIN was defined as an increase in serum creatinine level of ≥ 0.5 mg/dl or ≥ 25% of the baseline creatinine. RESULTS: A total of 236 patients completed the study; 115 atorvastatin, 121 placebo, mean age = 58.40 ± 9.80 year, 68.6% male. Serum creatinine increased after contrast material injection in both the atorvastatin (1.00 ± 0.16-1.02 ± 0.15 mg/dl, P = 0.017 and placebo groups (1.03 ± 0.17-1.08 ± 0.18 mg/dl, P < 0.001. Controlling for age, gender, comorbidities, drug history, and baseline serum creatinine level, patients who received atorvastatin experienced less increase in serum creatinine after contrast material injection (beta = 0.127, P = 0.034. However, there was no difference between the atorvastatin and placebo groups in the incidence of CIN (4.3 vs. 5.0%, P = 0.535. CONCLUSION: In patients undergoing CTA, a short-term treatment with high dose atorvastatin is effective in preventing contrast-induced renal dysfunction, in terms of less increase in serum creatinine level after contrast material injection. Further trials including larger sample of patients and longer follow-ups are warranted.   Keywords: Kidney Diseases, Multidetector Computed Tomography, Contrast Media, Hydroxymethylglutaryl-CoA Reductase Inhibitors, Atorvastatin 

  13. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    International Nuclear Information System (INIS)

    Tehranzadeh, Jamshid; Ashikyan, Oganes; Anavim, Arash; Shin, John

    2008-01-01

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The ''rheumatoid'' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with PsA of

  14. Detailed analysis of contrast-enhanced MRI of hands and wrists in patients with psoriatic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Tehranzadeh, Jamshid [University of California, Department of Radiological Sciences, Irvine (United States); University of California Medical Center, Department of Radiological Sciences R-140, Orange, CA (United States); Ashikyan, Oganes; Anavim, Arash; Shin, John [University of California, Department of Radiological Sciences, Irvine (United States)

    2008-05-15

    The objective was to perform detailed analysis of the involved soft tissues, tendons, joints, and bones in the hands and wrists of patients with psoriatic arthritis (PsA). We reviewed 23 contrast-enhanced MR imaging studies (13 hands and 10 wrists) in 10 patients with the clinical diagnosis of PsA. We obtained clinical information from medical records and evaluated images for the presence of erosions, bone marrow edema, joint synovitis, tenosynovitis, carpal tunnel, and soft tissue involvement. Two board-certified musculoskeletal radiologists reviewed all images independently. Differences were resolved during a subsequent joint session. The average duration of disease was 71.3 months, ranging from 1 month to 25 years. Eight of the 10 wrists (80%) and 6 of the 13 hands demonstrated bone erosions. Bone marrow abnormalities were shown in 5 of the 10 wrists (50%) and 4 of the 14 hands (31%). Triangular fibrocartilage tears were seen in 6 of the 10 wrists (60%). Wrist and hand joint synovitis were present in all studies (67 wrist joints and 101 hand joints). Wrist soft tissue involvement was detected in 9 of the 10 wrists (90%) and hand soft tissue involvement was present in 12 of the 13 wrists (92%). Findings adjacent to the region of soft tissue involvement included synovitis (4 wrists) and tenosynovitis (3 wrists). Bone marrow edema adjacent to the region of soft tissue involvement was seen in one wrist. Bulge of the flexor retinaculum was seen in 4 of the 10 wrists (40%) and median nerve enhancement was seen in 8 of the 10 wrists (80%). Tenosynovitis was seen in all studies (all 10 of the hands and all 13 of the wrists). The 'rheumatoid' type of distribution of bony lesions was common in our study. Interobserver agreement for various findings ranged from 83% to 100%. Contrast-enhanced MRI unequivocally demonstrated bone marrow edema, erosions, tendon and soft-tissue disease, and median nerve involvement, with good interobserver reliability in patients with

  15. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

    Energy Technology Data Exchange (ETDEWEB)

    Lobbes, Marc B.I.; Wildberger, Joachim E. [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands); Lalji, Ulrich; Houwers, Janneke; Nijssen, Estelle C. [Maastricht University Medical Center, Department of Radiology, Maastricht (Netherlands); Nelemans, Patty J. [Maastricht University, Department of Epidemiology, Maastricht (Netherlands); Roozendaal, Lori van; Heuts, Esther [Maastricht University Medical Center, Department of Surgical Oncology, Maastricht (Netherlands); Smidt, Marjolein L. [Maastricht University Medical Center, Department of Surgical Oncology, Maastricht (Netherlands); GROW School for Oncology and Developmental Biology, Maastricht (Netherlands)

    2014-07-15

    Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM. During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities. Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0 % (+3.1 %), specificity to 87.7 % (+45.7 %), PPV to 76.2 % (+36.5 %) and NPV to 100.0 % (+2.9 %) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p < 0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p < 0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed. CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening. (orig.)

  16. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme.

    Science.gov (United States)

    Lobbes, Marc B I; Lalji, Ulrich; Houwers, Janneke; Nijssen, Estelle C; Nelemans, Patty J; van Roozendaal, Lori; Smidt, Marjolein L; Heuts, Esther; Wildberger, Joachim E

    2014-07-01

    Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM. During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities. Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0% (+3.1%), specificity to 87.7% (+45.7%), PPV to 76.2% (+36.5%) and NPV to 100.0% (+2.9%) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p mammography, even in lower prevalence patient populations such as referrals from breast cancer screening. • CESM is feasible in the workflow of referrals from routine breast screening. • CESM is superior to mammography, even in low disease prevalence populations. • CESM has an extremely high negative predictive value for breast cancer. • CESM is comparable to MRI in assessment of breast cancer extent. • CESM is comparable to histopathology in assessment of breast cancer extent.

  17. Contrast-enhanced spectral mammography in patients referred from the breast cancer screening programme

    International Nuclear Information System (INIS)

    Lobbes, Marc B.I.; Wildberger, Joachim E.; Lalji, Ulrich; Houwers, Janneke; Nijssen, Estelle C.; Nelemans, Patty J.; Roozendaal, Lori van; Heuts, Esther; Smidt, Marjolein L.

    2014-01-01

    Feasibility studies have shown that contrast-enhanced spectral mammography (CESM) increases diagnostic accuracy of mammography. We studied diagnostic accuracy of CESM in patients referred from the breast cancer screening programme, who have a lower disease prevalence than previously published papers on CESM. During 6 months, all women referred to our hospital were eligible for CESM. Two radiologists blinded to the final diagnosis provided BI-RADS classifications for conventional mammography and CESM. Statistical significance of differences between mammography and CESM was calculated using McNemar's test. Receiver operating characteristic (ROC) curves were constructed for both imaging modalities. Of the 116 eligible women, 113 underwent CESM. CESM increased sensitivity to 100.0 % (+3.1 %), specificity to 87.7 % (+45.7 %), PPV to 76.2 % (+36.5 %) and NPV to 100.0 % (+2.9 %) as compared to mammography. Differences between conventional mammography and CESM were statistically significant (p < 0.0001). A similar trend was observed in the ROC curve. For conventional mammography, AUC was 0.779. With CESM, AUC increased to 0.976 (p < 0.0001). In addition, good agreement between tumour diameters measured using CESM, breast MRI and histopathology was observed. CESM increases diagnostic performance of conventional mammography, even in lower prevalence patient populations such as referrals from breast cancer screening. (orig.)

  18. {sup 18}F-FDG PET/contrast enhanced CT in the standard surveillance of high risk colorectal cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Jiménez Londoño, Germán Andrés, E-mail: gjimenez91@yahoo.com [Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); García Vicente, Ana María [Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Sánchez Pérez, Victoria [Department of Oncology, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Jiménez Aragón, Fátima [Department of Radiology, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); León Martin, Alberto [Investigation Unit, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Cano Cano, Juana María [Department of Oncology, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Domínguez Ferreras, Esther [Department of Radiology, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Gómez López, Ober Van [Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Espinosa Arranz, Javier [Department of Oncology, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain); Soriano Castrejón, Ángel María [Department of Nuclear Medicine, Hospital General Universitario de Ciudad Real, Ciudad Real (Spain)

    2014-12-15

    Highlights: • We assessed the accuracy of FDG-PET/contrast enhanced CT (FDG-PET/ceCT) in the detection of unsuspected recurrence of colorectal cancer. In regard to our knowledge, no previous experience has been reported about the combined acquisition and interpretation of a FDG-PET/ceCT in the surveillance of colorectal cancer. • We designed a prospective study and performed an individual and combined assessment of both techniques (PET and ceCT), in a patient-based analysis and a lesion-based analysis. • The value of PET and ceCT was found to be similar in the detection of unsuspected recurrence of CRC in a patient-based analysis. The most interesting of our result, is that the combined assessment of PET/ceCT improves the accuracy in the lesion-based analysis. - Abstract: Objective: To assess the accuracy of FDG-PET/contrast enhanced CT (FDG-PET/ceCT) in the detection of unsuspected recurrence of colorectal cancer (CRC) in patients with high risk of relapse. Methods: Thirty-three patients (14 females and 19 males, mean age: 62, range: 41–78), with CRC in complete remission, were prospectively included. All patients underwent FDG-PET/ceCT (58 studies). FDG-PET/ceCT was requested in the surveillance setting, and performed following a standardized protocol. A portal venous phase CT scan was performed after the injection of iodinated contrast agent. An individual and combined assessment of both techniques (PET and ceCT) was performed. Concordant and discordant findings of PET, ceCT and FDG-PET/ceCT were compared in a patient-based and a lesion-based analysis. The final diagnosis, recurrence or disease free status (DFS), were established by histopathology or clinical/radiological follow-up of at least 6 months. Results: Seven out of 33 patients had a confirmed recurrence and the rest of patients had a DFS. In a patient-based analysis the sensitivity and specificity of PET, ceCT and PET/ceCT was of 86% and 88%, 86% and 92%, 86% and 85%, respectively. Attending to

  19. Showing the Unsayable: Participatory Visual Approaches and the Constitution of 'Patient Experience' in Healthcare Quality Improvement.

    Science.gov (United States)

    Papoulias, Constantina

    2018-06-01

    This article considers the strengths and potential contributions of participatory visual methods for healthcare quality improvement research. It argues that such approaches may enable us to expand our understanding of 'patient experience' and of its potential for generating new knowledge for health systems. In particular, they may open up dimensions of people's engagement with services and treatments which exceed both the declarative nature of responses to questionnaires and the narrative sequencing of self reports gathered through qualitative interviewing. I will suggest that working with such methods may necessitate a more reflexive approach to the constitution of evidence in quality improvement work. To this end, the article will first consider the emerging rationale for the use of visual participatory methods in improvement before outlining the implications of two related approaches-photo-elicitation and PhotoVoice-for the constitution of 'experience'. It will then move to a participatory model for healthcare improvement work, Experience Based Co-Design (EBCD). It will argue that EBCD exemplifies both the strengths and the limitations of adequating visual participatory approaches to quality improvement ends. The article will conclude with a critical reflection on a small photographic study, in which the author participated, and which sought to harness service user perspectives for the design of psychiatric facilities, as a way of considering the potential contribution of visual participatory methods for quality improvement.

  20. Role of diffusion weighted imaging and dynamic contrast enhanced MR mammography to detect recurrence in breast cancer patients after sur

    Directory of Open Access Journals (Sweden)

    Safaa Ibrahim Saif El-nasr

    2016-09-01

    Conclusion: Our study showed better diagnostic performance for DCE-MRI compared to DWI in post operative breast assessment. However, DWI can provide an alternative diagnostic tool to contrast administration “if interpreted in association with conventional MR sequences” thus can be used when contrast media is contraindicated.

  1. Rivastigmine in Wernicke-Korsakoff's syndrome: five patients with rivastigmine showed no more improvement than five patients without rivastigmine.

    NARCIS (Netherlands)

    Luykx, H.J.; Dorresteijn, L.D.A.; Haffmans, P.M.; Bonebakker, A.; Kerkmeer, M.; Hendriks, V.M.

    2008-01-01

    AIMS: To evaluate whether rivastigmine, an achetylcholinesterase inhibitor (AChEl), may be effective in restoring memory in Wernicke-Korsakoff's syndrome (WKS). METHODS: Five patients treated with rivastigmine for a period of 6 months were compared with five matched control patients, who received 6

  2. Gadolinium Deposition in Human Brain Tissues after Contrast-enhanced MR Imaging in Adult Patients without Intracranial Abnormalities.

    Science.gov (United States)

    McDonald, Robert J; McDonald, Jennifer S; Kallmes, David F; Jentoft, Mark E; Paolini, Michael A; Murray, David L; Williamson, Eric E; Eckel, Laurence J

    2017-11-01

    Purpose To determine whether gadolinium deposits in neural tissues of patients with intracranial abnormalities following intravenous gadolinium-based contrast agent (GBCA) exposure might be related to blood-brain barrier integrity by studying adult patients with normal brain pathologic characteristics. Materials and Methods After obtaining antemortem consent and institutional review board approval, the authors compared postmortem neuronal tissue samples from five patients who had undergone four to 18 gadolinium-enhanced magnetic resonance (MR) examinations between 2005 and 2014 (contrast group) with samples from 10 gadolinium-naive patients who had undergone at least one MR examination during their lifetime (control group). All patients in the contrast group had received gadodiamide. Neuronal tissues from the dentate nuclei, pons, globus pallidus, and thalamus were harvested and analyzed with inductively coupled plasma mass spectrometry (ICP-MS), transmission electron microscopy with energy-dispersive x-ray spectroscopy, and light microscopy to quantify, localize, and assess the effects of gadolinium deposition. Results Tissues from the four neuroanatomic regions of gadodiamide-exposed patients contained 0.1-19.4 μg of gadolinium per gram of tissue in a statistically significant dose-dependent relationship (globus pallidus: ρ = 0.90, P = .04). In contradistinction, patients in the control group had undetectable levels of gadolinium with ICP-MS. All patients had normal brain pathologic characteristics at autopsy. Three patients in the contrast group had borderline renal function (estimated glomerular filtration rate the contrast group was localized to the capillary endothelium and neuronal interstitium and, in two cases, within the nucleus of the cell. Conclusion Gadolinium deposition in neural tissues after GBCA administration occurs in the absence of intracranial abnormalities that might affect the permeability of the blood-brain barrier. These findings

  3. Prediction of wall motion improvement after coronary revascularization in patients with postmyocardial infarction. Diagnostic value of dobutamine stress echocardiography and myocardial contrast echocardiography

    International Nuclear Information System (INIS)

    Waku, Sachiko; Ohkubo, Tomoyuki; Takada, Kiyoshi; Ishihara, Tadashi; Ohsawa, Nakaaki; Adachi, Itaru; Narabayashi, Isamu

    1997-01-01

    The diagnostic value of dobutamine stress echocardiography, myocardial contrast echocardiography and dipyridamole stress thallium-201 single photon emission computed tomography (SPECT) for predicting recovery of wall motion abnormality after revascularization was evaluated in 13 patients with postmyocardial infarction. Seventeen segments showed severe wall motion abnormalities before revascularization. Nine segments which had relatively good Tl uptake on delayed SPECT images despite severely abnormal wall motion were opacified during myocardial contrast echocardiography, and showed improved wall motion after revascularization. In contrast, three segments which had poor Tl uptake and severely abnormal wall motion were not opacified during myocardial contrast echocardiography, and showed no improvement in wall motion during dobutamine stress echocardiography and after revascularization. The following three findings were assumed to be signs of myocardial viability: good Tl uptake on delayed SPECT images, improved wall motion by dobutamine stress echocardiography, and positive opacification of the myocardium by myocardiai contrast echocardiography. Myocardial contrast echocardiography had the highest sensitivity (100%) and negative predictive value (100%). Delayed SPECT images had the highest specificity (100%) and positive predictive value (100%). Dobutamine stress echocardiography had a sensitivity of 83.0%, specificity of 80.0%, positive predictive value of 90.9%, and negative predictive value of 66.7%, respectively. Myocardial contrast echocardiography showed the lowest specificity (60.0%). The techniques of dobutamine stress echocardiography and SPECT, though noninvasive, may underestimate wall motion improvement after revascularization. Further examination by myocardial contrast echocardiography is recommended to assess myocardial viability for determining the indications for coronary revascularization in spite of its invasiveness. (author)

  4. Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment

    Energy Technology Data Exchange (ETDEWEB)

    Payabvash, Seyedmehdi [Zeenat Qureshi Stroke Institute, Minneapolis, MN (United States); University of Minnesota, Department of Radiology, Minneapolis, MN (United States); Qureshi, Mushtaq H.; Khan, Shayaan M.; Khan, Mahnoor; Majidi, Shahram; Pawar, Swaroop; Qureshi, Adnan I. [Zeenat Qureshi Stroke Institute, Minneapolis, MN (United States)

    2014-09-15

    This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment. We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure. Of the 135 patients studied, 74 (55 %) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p = 0.001). An average attenuation of <50 Hounsfield units (HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56 % sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85 %) patients with contrast extravasation versus 9/20 (45 %) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p < 0.001). An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment. (orig.)

  5. Differentiating intraparenchymal hemorrhage from contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients undergoing endovascular treatment

    International Nuclear Information System (INIS)

    Payabvash, Seyedmehdi; Qureshi, Mushtaq H.; Khan, Shayaan M.; Khan, Mahnoor; Majidi, Shahram; Pawar, Swaroop; Qureshi, Adnan I.

    2014-01-01

    This study aimed to identify the imaging characteristics that can help differentiate intraparenchymal hemorrhage from benign contrast extravasation on post-procedural noncontrast CT scan in acute ischemic stroke patients after endovascular treatment. We reviewed the clinical and imaging records of all acute ischemic stroke patients who underwent endovascular treatment in two hospitals over a 3.5-year period. The immediate post-procedural CT scan was evaluated for the presence of hyperdense lesion(s). The average attenuation of the lesion(s) was measured. Intraparenchymal hemorrhage was defined as a persistent hyperdensity visualized on follow-up CT scan, 24 h or greater after the procedure. Of the 135 patients studied, 74 (55 %) patients had hyperdense lesion(s) on immediate post-procedural CT scan. Follow-up scans confirmed the diagnosis of intraparenchymal hemorrhage in 20 of these 74 patients. A receiver operating characteristic analysis showed that the average attenuation of the most hyperdense lesion can differentiate intraparenchymal hemorrhage from contrast extravasation with an area under the curve of 0.78 (p = 0.001). An average attenuation of <50 Hounsfield units (HU) in the most visually hyperattenuating hyperdense lesion had 100 % specificity and 56 % sensitivity for identification of contrast extravasations. Petechial hyperdensity was seen in 46/54 (85 %) patients with contrast extravasation versus 9/20 (45 %) patients with intraparenchymal hemorrhage on the immediate post-procedural CT scan (p < 0.001). An average attenuation <50 HU of the most hyperattenuating hyperdense parenchymal lesion on immediate post-procedural CT scan was very specific for differentiating contrast extravasation from intraparenchymal hemorrhage in acute ischemic stroke patients after endovascular treatment. (orig.)

  6. Evaluation of heart perfusion in patients with acute myocardial infarction using dynamic contrast-enhanced magnetic resonance imaging

    DEFF Research Database (Denmark)

    Nielsen, Gitte; Fritz-Hansen, Thomas; Dirks, Christina G

    2004-01-01

    with acute transmural myocardial infarction were studied using a Turbo-fast low angle shot (FLASH) MRI sequence to monitor the first pass of an extravascular contrast agent (CA), gadolinium diethylene triamine pentaacetic acid (Gd-DTPA). Quantitation of perfusion, expressed as Ki (mL/100 g/minute), in five......PURPOSE: To investigate the diagnostic ability of quantitative magnetic resonance imaging (MRI) heart perfusion in acute heart patients, a fast, multislice dynamic contrast-enhanced MRI sequence was applied to patients with acute myocardial infarction. MATERIALS AND METHODS: Seven patients...

  7. Usefulness and biological background of dynamic contrast-enhanced MR images in patients with primary breast cancer

    International Nuclear Information System (INIS)

    Yamamoto, Yutaka; Kurebayashi, Junichi; Sonoo, Hiroshi

    2002-01-01

    Dynamic contrast-enhanced MR images were obtained between September 1998 and May 2000 from 44 primary breast cancer patients who were scheduled to undergo breast-conserving surgery. The MR images and clinico-pathological findings were analyzed to investigate the risk factors for histologically positive margins and histologically positive lymph node metastases. We elucidated the relationship between MR images and the biological background of breast cancer. The following interesting findings were made from these analyses. An irregular shape and unclear border of the tumor mass and the coexistence of daughter nodule(s) were significant risk factors for positive-surgical margins; an irregularly shaped tumor mass and spiculated tumor mass were significant risk factors for positive lymph node metastases; breast tumors with a strand-like appearance had a significantly lower histological grade; breast tumors with high contrast enhancement ratios had a significantly higher nuclear grade and progesterone receptor negativity; and breast tumors showing a ring-like enhancement expressed a low level of VEGF. These findings suggest that preoperative MR images of primary breast cancer provide not only useful information on the extent of breast tumors and the possibility of lymph node metastasis but also on the malignant potency and hormone responsiveness of breast tumors. (author)

  8. Edge Contrast of the FLAIR Hyperintense Region Predicts Survival in Patients with High-Grade Gliomas following Treatment with Bevacizumab.

    Science.gov (United States)

    Bahrami, N; Piccioni, D; Karunamuni, R; Chang, Y-H; White, N; Delfanti, R; Seibert, T M; Hattangadi-Gluth, J A; Dale, A; Farid, N; McDonald, C R

    2018-04-05

    Treatment with bevacizumab is standard of care for recurrent high-grade gliomas; however, monitoring response to treatment following bevacizumab remains a challenge. The purpose of this study was to determine whether quantifying the sharpness of the fluid-attenuated inversion recovery hyperintense border using a measure derived from texture analysis-edge contrast-improves the evaluation of response to bevacizumab in patients with high-grade gliomas. MRIs were evaluated in 33 patients with high-grade gliomas before and after the initiation of bevacizumab. Volumes of interest within the FLAIR hyperintense region were segmented. Edge contrast magnitude for each VOI was extracted using gradients of the 3D FLAIR images. Cox proportional hazards models were generated to determine the relationship between edge contrast and progression-free survival/overall survival using age and the extent of surgical resection as covariates. After bevacizumab, lower edge contrast of the FLAIR hyperintense region was associated with poorer progression-free survival ( P = .009) and overall survival ( P = .022) among patients with high-grade gliomas. Kaplan-Meier curves revealed that edge contrast cutoff significantly stratified patients for both progression-free survival (log-rank χ 2 = 8.3, P = .003) and overall survival (log-rank χ 2 = 5.5, P = .019). Texture analysis using edge contrast of the FLAIR hyperintense region may be an important predictive indicator in patients with high-grade gliomas following treatment with bevacizumab. Specifically, low FLAIR edge contrast may partially reflect areas of early tumor infiltration. This study adds to a growing body of literature proposing that quantifying features may be important for determining outcomes in patients with high-grade gliomas. © 2018 by American Journal of Neuroradiology.

  9. Dynamic contrast-enhanced MRI and sonography in patients receiving primary chemotherapy for breast cancer

    International Nuclear Information System (INIS)

    Montemurro, Filippo; Aglietta, Massimo; Martincich, Laura; Rosa, Giovanni De; Cirillo, Stefano; Marra, Vincenzo; Regge, Daniele; Biglia, Nicoletta; Sismondi, Piero; Gatti, Marco

    2005-01-01

    We compared dynamic contrast-enhanced MRI (DCE-MRI) and sonography (US) for monitoring tumour size in 21 patients with breast cancer undergoing primary chemotherapy (PCT) followed by surgery. The correlation between DCE-MRI and US measurements of tumour size, defined as the product of the two major diameters, was 0.555 (P=0.009), 0.782 (P 2 , P 2 , P=0.009). After PCT, the median tumour size measured by the two techniques was similar (256 vs 289 mm 2 for DCE-MRI and US, respectively, P=0.859). The correlation with the histopathological major tumour diameter was 0.824 (P<0.001) and 0.705 (P<0.001) for post-treatment DCE-MRI and US, respectively. Measurements of the final major tumour diameter by DCE-MRI tended to be more precise, including cases achieving a pathological complete response. Randomized trials are warranted to establish the clinical impact of the initial discrepancy in tumour size estimates between DCE-MRI and US, and the trend towards a better definition of the final tumour size provided by DCE-MRI in this clinical setting. (orig.)

  10. Repeatability and correlations of dynamic contrast enhanced and T2* MRI in patients with advanced pancreatic ductal adenocarcinoma.

    Science.gov (United States)

    Klaassen, Remy; Gurney-Champion, Oliver J; Wilmink, Johanna W; Besselink, Marc G; Engelbrecht, Marc R W; Stoker, Jaap; Nederveen, Aart J; van Laarhoven, Hanneke W M

    2018-07-01

    In current oncological practice of pancreatic ductal adenocarcinoma (PDAC), there is a great demand for response predictors and markers for early treatment evaluation. In this study, we investigated the repeatability and the interaction of dynamic contrast enhanced (DCE) and T2* MRI in patients with advanced PDAC to enable for such evaluation using these techniques. 15 PDAC patients underwent two DCE, T2* and anatomical 3 T MRI sessions before start of treatment. Parametric maps were calculated for the transfer constant (K trans ), rate constant (k ep ), extracellular extravascular space (v e ) and perfusion fraction (v p ). Quantitative R2* (1/T2*) maps were obtained from the multi-echo T2* images. Differences between normal and cancerous pancreas were determined using a Wilcoxon matched pairs test. Repeatability was obtained using Bland-Altman analysis and relations between DCE and T2*/R2* were observed by Spearman correlation and voxel-wise binned plots of tumor voxels. PDAC K trans (p = 0.007), k ep (p T2*. Voxel wise analysis showed a steep increase in R2* for tumor voxels with lower K trans and v e . We showed good repeatability of DCE and T2* related MRI parameters in advanced PDAC patients. Furthermore, we have illustrated the relation of DCE K trans and v e with tissue T2* and R2* indicating substantial value of these parameters for detecting tumor hypoxia in future studies. The results from our study pave the way for further response evaluation studies and patient selection based on DCE and T2* parameters. Copyright © 2018 Elsevier Inc. All rights reserved.

  11. Antisocial alcoholic patients show as much improvement at 14-month follow-up as non-antisocial alcoholic patients

    NARCIS (Netherlands)

    Verheul, R.; van den Brink, W.; Koeter, M. W.; Hartgers, C.

    1999-01-01

    The authors investigated the impact of DSM-III-R adult criteria for antisocial personality disorder (and co-occurrence of childhood conduct or mood disorder) on one-year changes of multi-domain problem severity in 309 alcoholic patients. Adult antisocial traits were associated with more drug, legal,

  12. Multiple Determinations of Sperm DNA Fragmentation Show That Varicocelectomy Is Not Indicated for Infertile Patients with Subclinical Varicocele

    Directory of Open Access Journals (Sweden)

    Agustín García-Peiró

    2014-01-01

    Full Text Available Varicocele is one of the most common causes of low semen quality, which is reflected in high percentages of sperm cells with fragmented DNA. While varicocelectomy is usually performed to ameliorate a patient’s fertility, its impact on sperm DNA integrity in the case of subclinical varicocele is poorly documented. In this study, multiple DNA fragmentation analyses (TUNEL, SCD, and SCSA were performed on semen samples from sixty infertile patients with varicocele (15 clinical varicoceles, 19 clinical varicoceles after surgical treatment, 16 subclinical varicoceles, and 10 subclinical varicoceles after surgical treatment. TUNEL, SCD, and SCSA assays all showed substantial sperm DNA fragmentation levels that were comparable between subclinical and clinical varicocele patients. Importantly, varicocelectomy did improve sperm quality in patients with clinical varicocele; however, this was not the case in patients with subclinical varicocele. In summary, although infertile patients with clinical and subclinical varicocele have similar sperm DNA quality, varicocelectomy should only be advised for patients with clinical varicocele.

  13. Patients' oral hydration levels and incidence of immediate to short-term mild side-effects in contrast agent enhanced MRI diagnostics

    International Nuclear Information System (INIS)

    Jonker, Leon; Fallahi, Farshid

    2015-01-01

    Aim: Gadolinium-based contrast agents for radiodiagnostic purposes can lead to side effects, including nephrotoxicity in patients with renal insufficiency. This study evaluated whether the occurrence of mild side effects from gadolinium-based contrast enhanced magnetic resonance imaging (MRI) correlates to patients' oral hydration levels. Methods: Oral fluid intake levels 24 h pre- and 24 h post-MRI, as well as incidence of mild side-effects experienced 30 min and 24 h post-MRI were recorded by using a patient self-reporting questionnaire. Results: A total of 174 patients, 29 controls, 98 administered Prohance and 47 receiving Dotarem, were enrolled. Overall, the most frequently reported side-effect was headache; nausea only occurred in patients receiving contrast agent. One or more side-effects experienced 24 h following the MRI scan were reported by 10% (controls), 24% (Prohance) and 22% (Dotarem) of patients, respectively. Multivariate ordinal regression analysis showed that only male gender (OR 0.24, 95% CI 0.11–0.53) was statistically significantly associated with a decreased incidence of side-effects 30 min after MRI. At 24-h post MRI, a lack of contrast agent (OR 0.40, 95% CI 0.09–1.74) and male gender (OR 0.46, 95% CI 0.19–1.09) were associated with fewer side-effects. Conclusions: The level oral fluid intake before and after undergoing gadolinium-based contrast-enhanced MRI does not appear to markedly affect the incidence of common undesirable mild symptoms experienced shortly after the procedure. Confounding differences between patients in reporting side-effects may contribute to these findings. - Highlights: • We assess the incidence of patient-reported side-effects after contrast-enhanced MRI. • We examine the potential impact of oral hydration levels on side-effects. • Patient reported side-effects are high compared to those reported by clinicians. • Female gender and contrast agent itself are associated with increased side

  14. Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Zandrino, F.; Benzi, L.; Ferretti, M.L.; Ferrando, R.; Reggiani, G.; Musante, F. [Department of Radiology, Azienda Ospedaliera ' ' SS Antonio e Biagio e C. Arrigo' ' , Alessandria (Italy)

    2002-05-01

    Our objective was to describe our technique for multislice CT cholangiography without cholangiographic contrast agent, and to present our preliminary clinical results. Thirty-seven patients with suspected biliary obstruction were studied. A multislice CT unit was used with the following technical parameters: 2.5-mm collimation; 7.5-mm/s table speed; pitch 6; 0.8-s rotation time; 300 mA; 120 kVp; 18- to 24-s scan time; scan volume ranging from the hepatic dome to below the pancreatic head; 70-s delay after injection of 150 ml of iodinated contrast agent at 4 ml/s. No biliary contrast material was given; oral iodinated contrast agent was administered to opacify bowel loops. Axial, multiplanar reformatted, and minimum intensity projection images were evaluated. The CT findings were compared with the gold standard techniques: endoscopic retrograde cholangiography (ERCP) in 30 patients, percutaneous transhepatic cholangiography in 5, and intraoperative cholangiography in 2. In 5 patients with ampullary lesions biopsy was made during ERCP, 9 underwent surgery, and 11 US-guided fine-needle aspiration. Bile ducts appeared hypodense within the surrounding enhanced structures. Regarding the site of obstruction, agreement between multislice CT and conventional cholangiography was observed in all cases. One patient presented negative findings on both CT and ERCP. In 31 of 36 (86%) patients, multislice CT cholangiography without cholangiographic contrast agent correctly assessed the cause of bile duct obstruction. Multislice CT cholangiography without cholangiographic contrast agent seems to be a promising diagnostic tool in the assessment of patients with bile duct obstruction. (orig.)

  15. Multislice CT cholangiography without biliary contrast agent: technique and initial clinical results in the assessment of patients with biliary obstruction

    International Nuclear Information System (INIS)

    Zandrino, F.; Benzi, L.; Ferretti, M.L.; Ferrando, R.; Reggiani, G.; Musante, F.

    2002-01-01

    Our objective was to describe our technique for multislice CT cholangiography without cholangiographic contrast agent, and to present our preliminary clinical results. Thirty-seven patients with suspected biliary obstruction were studied. A multislice CT unit was used with the following technical parameters: 2.5-mm collimation; 7.5-mm/s table speed; pitch 6; 0.8-s rotation time; 300 mA; 120 kVp; 18- to 24-s scan time; scan volume ranging from the hepatic dome to below the pancreatic head; 70-s delay after injection of 150 ml of iodinated contrast agent at 4 ml/s. No biliary contrast material was given; oral iodinated contrast agent was administered to opacify bowel loops. Axial, multiplanar reformatted, and minimum intensity projection images were evaluated. The CT findings were compared with the gold standard techniques: endoscopic retrograde cholangiography (ERCP) in 30 patients, percutaneous transhepatic cholangiography in 5, and intraoperative cholangiography in 2. In 5 patients with ampullary lesions biopsy was made during ERCP, 9 underwent surgery, and 11 US-guided fine-needle aspiration. Bile ducts appeared hypodense within the surrounding enhanced structures. Regarding the site of obstruction, agreement between multislice CT and conventional cholangiography was observed in all cases. One patient presented negative findings on both CT and ERCP. In 31 of 36 (86%) patients, multislice CT cholangiography without cholangiographic contrast agent correctly assessed the cause of bile duct obstruction. Multislice CT cholangiography without cholangiographic contrast agent seems to be a promising diagnostic tool in the assessment of patients with bile duct obstruction. (orig.)

  16. Transvaginal sonography combined with saline contrast sonohysterography in evaluating the uterine cavity in premenopausal patients with abnormal uterine bleeding

    DEFF Research Database (Denmark)

    Dueholm, M; Forman, A; Jensen, ML

    2001-01-01

    OBJECTIVES: To evaluate whether saline contrast sonohysterography (SCSH) adds additional information to that obtained by transvaginal sonography (TVS) for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS: This was a two......-center prospective study at a university clinic and a central hospital in Denmark. The uterine cavity was evaluated with TVS and SCSH in 470 premenopausal patients with abnormal uterine bleeding. One hundred and eighty-nine of the patients had operative hysteroscopy or hysterectomy within 4 months which provided...... uterine bleeding. All abnormalities except one were found at SCSH, while TVS alone missed polyps and had almost one in four equivocal findings. The use of TVS, without saline contrast, left one in five of the polyps undiagnosed in referred patients with abnormal bleeding....

  17. Diagnosis of portal vein thrombosis discontinued with liver tumors in patients with liver cirrhosis and tumors by contrast-enhanced US: A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Song Zezhou; Huang Min [Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province (China); Jiang Tianan, E-mail: tiananjiang@hzcnc.co [Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province (China); Zhao Qiyu [Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou (China); Yao Lei; Mou Yun; Zhao Junkang; Ao Jianyang [Department of Ultrasound, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province (China); Chen Fen [Department of Hepatobiliary Pancreatic Surgery, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou (China); Chen Yan [Department of Ultrasound, First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, Zhejiang Province (China)

    2010-08-15

    Aims: We assessed the role of contrast-enhanced ultrasound (CEUS) in the differential diagnosis between benign and malignant portal vein thrombosis (PVT) in patients who had liver tumors. Methods: Seventeen consecutive patients who had cirrhosis, liver tumors, and PVT were prospectively studied with CEUS. CEUS was performed at low mechanical index after intravenous administration of a second-generation contrast agent (SonoVue, Bracco, Milan, Italy). Presence or absence of thrombus enhancement on CEUS were considered diagnostic for malignant or benign PVT. Five patients also underwent percutaneous portal vein fine-needle biopsy under US guidance. All patients were followed-up. Shrinkage of the thrombus and/or recanalization of the vessels on CDUS during follow-up were considered definitive evidence of the benign nature of the thrombosis, whereas the enlargement of the thrombus, disruption of the vessel wall, and parenchymal infiltration over follow-up were considered consistent with malignancy. Results: Follow-up showed signs of malignant thrombosis in 14 of 17 patients. CEUS showed early arterial enhancement of the PVT in 14 patients of 14 malignant PVT, 1 patient of 3 benign PVT and the absence of thrombus enhancement in 2 patients of 3 benign PVT. FNB confirmed the results for malignant PVT in four of five patients, for benign granulomatous inflammation PVT in one of five patients in which CEUS showed early arterial enhancement of the PVT. The sensitivity, specificity and accuracy is 100%, 66.7% and 93.3% at diagnosis of malignant PVT using CEUS. In one patient with intrahepatic bile duct stone, CEUS were positive for malignant PVT, whereas FNB was negative (benign granulomatous inflammation PVT); follow-up examination confirmed benign PVT. Conclusion: CEUS seems to be the pretty sensitive and specific test for diagnosing malignant portal vein thrombosis in patients with cirrhosis and tumors.

  18. Contrast-enhanced computed tomographic colonography in the follow-up of colorectal cancer patients: a feasibility study

    International Nuclear Information System (INIS)

    Laghi, Andrea; Iannaccone, Riccardo; Carbone, Iacopo; Piacentini, Francesca; Passariello, Roberto; Bria, Emilio; Trasatti, Luciana; Lauro, Salvatore; Vecchione, Aldo

    2003-01-01

    The aim of our study was to assess whether contrast-enhanced CT colonography is a feasible alternative to both conventional colonoscopy and liver ultrasonography in the follow-up program of colorectal cancer patients. Thirty-five patients, surgically treated for colorectal cancer, underwent a follow-up program that included physical examination, carcinoembryonic antigen serum assay, conventional colonoscopy, liver ultrasonography, and chest X-ray. For these patients, we added a yearly contrast-enhanced CT colonography. All CT examinations were performed with a high-resolution protocol using a multidetector spiral CT scanner (Siemens, Erlangen, Germany) prior to and after the administration of 130 ml of i.v. contrast material. Images were directly analyzed on a dedicated workstation by two radiologists to determine colonic evaluation, visualization of colonic anastomosis, presence of polyps, and extra-colonic findings. Colonic evaluation was judged as optimal in 91.7% of all colonic segments. All mechanical surgical anastomoses were visualized with CT colonography. There was no evidence of anastomotic recurrence. Seven polyps were detected in five different patients with CT colonography, with two false-positive and no false-negative examinations. Three liver metastases and two basal pulmonary nodules were also identified. Contrast-enhanced CT colonography is a feasible alternative to both conventional colonoscopy and liver ultrasonography in the follow-up of patients operated on for colorectal cancer. (orig.)

  19. The Effect of Hyperuricemia on the Rate of Contrast-Induced Nephropathy in Patients with Coronary Angiography

    Directory of Open Access Journals (Sweden)

    Hossein Vakili

    2016-10-01

    Full Text Available Introduction: There is little information about the relationship between hyperuricemia and contrast induced nephropathy. The present study aimed to evaluate the relationship between hyperuricemia and contrast induced nephropathy among patients, who had undergone coronary angiography.Methods: In the current study, 200 consecutive patients with coronary artery disease, who underwent coronary angiography in Modarres hospital, were enrolled. According to the available data, the upper limit normal level of uric acid was defined as 7 mg/dl in males and 6.5 mg/dl in females. By increasing level of serum creatinine to 0.5 mg/dl (or 25% enhancement from basic level of creatinine during 48 hours of introduction of contrast agent, diagnosis of Contrast Induced Nephropathy (CIN was established. The relationship between hyperuricemia and CIN was then assessed.Results: There is a significant difference between normouricemic patients and hyperuricemic patients, in aspect of weight (P = 0.011 and uric acid (P = 0.001; however, other quantitative and qualitative variables including age, volume of contract agent, creatinine level after angiography, hemoglobin level, gender, arterial access type, number of involved vessels, were insignificant between the two groups (P > 0.05. Moreover, as an essential finding, CIN was shown in 9% of normouricemic patients and 10% of hyperuricemic  patients with no significant difference between the two groups (P = 0.6.Conclusions: Our study suggests that hyperuricemia may not significantly increase the rate of the contrast-induced nephropathy in patients, who had undergone angiography

  20. Study of Coronary Flow Reserve with Intravenous Use of Microbubbles (Contrast Echocardiography and Adenosine: Protocol for Clinical Application in Patients Suspected of Having Coronary Heart Disease

    Directory of Open Access Journals (Sweden)

    Morcerf Fernando

    2002-01-01

    Full Text Available OBJECTIVE: To test the feasibility, safety and accuracy of the adenosine protocol in the study of myocardial perfusion with microbubbles contrast echocardiography. METHODS: 81 pts (64 male, 60+11 years were submitted to contrast echocardiography with PESDA (sonicated solution of albumin 20%-1ml, dextrose 5%-12ml and deca-fluorobutane gas-8ml to study the myocardial perfusion at rest and after bolus injection of adenosine (6 to 18mg and to coronary angiography within 1 month each other. For each patient 3 left ventricle perfusion beds were considered (total of 243 territories. 208 territories were analyzed and 35 territories were excluded. PESDA was continuously infused (1-2ml/min, titrated for best myocardial contrast. Triggered (1:1 second harmonic imaging was used. RESULTS: Coronary angiography showed 70 flow limiting (> 75% lesions and 138 no flow limiting lesions. At rest an obvious myocardium contrast enhancement was seen in at least 1 segment of a territory in all patients. After adenosine injection an unquestionable further increase in myocardial contrast was observed in 136 territories (99% related to no flow limiting lesions, lasting < 10 s, and a myocardial perfusion defect was detected in 68 territories (97% related to flow limiting lesions. It was observed only 4 false results. There were no serious complications. CONCLUSION: Myocardial perfusion study with PESDA and adenosine protocol is a practical, safe and accurate method to analyze the coronary flow reserve.

  1. Prediction of liver-related events using fibroscan in chronic hepatitis B patients showing advanced liver fibrosis.

    Directory of Open Access Journals (Sweden)

    Seung Up Kim

    Full Text Available Liver stiffness measurement (LSM using transient elastography (FibroScan® can assess liver fibrosis noninvasively. This study investigated whether LSM can predict the development of liver-related events (LREs in chronic hepatitis B (CHB patients showing histologically advanced liver fibrosis.Between March 2006 and April 2010, 128 CHB patients with who underwent LSM and liver biopsy (LB before starting nucleot(side analogues and showed histologically advanced fibrosis (≥F3 with a high viral loads [HBV DNA ≥2,000 IU/mL] were enrolled. All patients were followed regularly to detect LRE development, including hepatic decompensation (variceal bleeding, ascites, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatocellular carcinoma (HCC.The mean age of the patient (72 men, 56 women was 52.2 years. During the median follow-up period [median 27.8 (12.6-61.6 months], LREs developed in 19 (14.8% patients (five with hepatic decompensation, 13 with HCC, one with both. Together with age, multivariate analysis identified LSM as an independent predictor of LRE development [P19 kPa were at significantly greater risk than those with LSM≤19 kPa for LRE development (HR, 7.176; 95% CI, 2.257-22.812; P = 0.001.LSM can be a useful predictor of LRE development in CHB patients showing histologically advanced liver fibrosis.

  2. Long-term monitoring shows hepatitis B virus resistance to entecavir in nucleoside-naïve patients is rare through 5 years of therapy.

    Science.gov (United States)

    Tenney, Daniel J; Rose, Ronald E; Baldick, Carl J; Pokornowski, Kevin A; Eggers, Betsy J; Fang, Jie; Wichroski, Michael J; Xu, Dong; Yang, Joanna; Wilber, Richard B; Colonno, Richard J

    2009-05-01

    Patients with chronic hepatitis B virus (HBV) infection who develop antiviral resistance lose benefits of therapy and may be predisposed to further resistance. Entecavir (ETV) resistance (ETVr) results from HBV reverse transcriptase substitutions at positions T184, S202, or M250, which emerge in the presence of lamivudine (LVD) resistance substitutions M204I/V +/- L180M. Here, we summarize results from comprehensive resistance monitoring of patients with HBV who were continuously treated with ETV for up to 5 years. Monitoring included genotypic analysis of isolates from all patients at baseline and when HBV DNA was detectable by polymerase chain reaction (> or = 300 copies/mL) from Years 1 through 5. In addition, genotyping was performed on isolates from patients experiencing virologic breakthrough (> or = 1 log(10) rise in HBV DNA). In vitro phenotypic ETV susceptibility was determined for virologic breakthrough isolates, and for HBV containing novel substitutions emerging during treatment. The results over 5 years of therapy showed that in nucleoside-naïve patients, the cumulative probability of genotypic ETVr and genotypic ETVr associated with virologic breakthrough was 1.2% and 0.8%, respectively. In contrast, a reduced barrier to resistance was observed in LVD-refractory patients, as the LVD resistance substitutions, a partial requirement for ETVr, preexist, resulting in a 5-year cumulative probability of genotypic ETVr and genotypic ETVr associated with breakthrough of 51% and 43%, respectively. Importantly, only four patients who achieved < 300 copies/mL HBV DNA subsequently developed ETVr. Long-term monitoring showed low rates of resistance in nucleoside-naïve patients during 5 years of ETV therapy, corresponding with potent viral suppression and a high genetic barrier to resistance. These findings support ETV as a primary therapy that enables prolonged treatment with potent viral suppression and minimal resistance.

  3. 18F-FDG PET/contrast enhanced CT in the standard follow-up of patients with lymphoma.

    Science.gov (United States)

    García Vicente, A M; Talavera Rubio, M P; Dominguez Ferreras, E; Calle Primo, C; Amo-Salas, M; Tello Galán, M J; Jiménez Londoño, G A; Jiménez Aragón, F; Hernández Ruiz, B; Soriano Castrejón, Á

    To assess the diagnostic accuracy of 18 F-FDG PET/contrast enhanced computed tomography (ceCT) in the detection of asymptomatic recurrences in patients with lymphoma. Patients with lymphoma and clinical complete remission underwent 18 F-FDG PET/ceCT for standard follow-up. 18 F-FDG PET and ceCT were evaluated blindly by two independent observers, and classified as positive or negative for recurrence. Additionally a combined evaluation of both techniques was performed. The final diagnosis was established by histopathological analysis or a clinical follow-up longer than 6 months. Statistical diagnostic parameters and concordance levels between both diagnostic techniques were calculated. A total of 114 explorations on 90 patients were analyzed. Only 4 patients were diagnosed as asymptomatic recurrence during the follow-up. 18 F-FDG PET/ceCT, 18 F-FDG PET and ceCT showed an association with the final diagnosis (p=0.002 and χ 2 =11.96; p<0.001 and χ 2 =15.60; p=0.001 and χ 2 =11.96, respectively). The concordance between 18 F-FDG PET and ceCT was moderate/high and significant (kappa=0.672; p<0.001). A sensitivity and specificity of 50% and 88% was obtained for the 18 F-FDG PET/ceCT civ, 50% and 93% for the 18 F-FDG PET, and 50% and 91% for the ceCT. The combined use of 18 F-FDG PET/ceCT did not offer any advantage compared to any isolated diagnostic technique in the detection of asymptomatic lymphoma recurrence. Copyright © 2017 Elsevier España, S.L.U. y SEMNIM. All rights reserved.

  4. Application of 3DAC (3D anisotropy contrast) imaging to predict motor function outcome of patients with cerebral infarction

    International Nuclear Information System (INIS)

    Igase, Keiji; Matsubara, Ichiro; Arai, Masamori; Goishi, Jyunji; Sadamoto, Kazuhiko

    2009-01-01

    ThreeDAC (3D anisotropy contrast) image can depict neuronal fibers in 3 dimensions and the way those anatomical structures exist. However, despite its sophistication, quantitative analysis of 3DAC image has been performed poorly, probably, due to difficulties collecting numerical factors, thus we have tried to evaluate a feasible quantitative 3DAC image technique to predict motor function outcome in patients with cerebral infarction. Twenty-five patients with a acute cerebral infarctions, who underwent 3DAC procedure with 3 tesla MRI within 1 week after the onset, were enrolled in this study. To assess motor function, we applied manual muscle testing (MMT) score, which was modified by designating from 1 to 13 points corresponding to MMT, during both the onset and 3 months later. 3DAC image was created through the procedure assigning each direction to red, green and blue (RGB) colors after obtaining rare 3DAC images. On the slice showing the maximally injured region, Injured Fiber Ratio (IFR), defined as the ratio of injured area on horizontal fibers shown as blue area to the area of whole horizontal fibers in a healthy side, was calculated and compared with MMT score. Although MMT score at the onset did not correlate significantly with IFR, each MMT score of the arm and leg 3 months later revealed a significant correlation with IFR(R 2 =0.47 and R 2 =0.67, respectively). Given these results, by exploiting the IFR obtained from 3DAC image a motor function outcome in patients with cerebral infarction might be predicted even in a very acute stage and 3DAC image could be a feasible modality for analyzing a neuronal injury in cerebral infarction patients. (author)

  5. Cerebral Hemodynamics in Patients with Hemolytic Uremic Syndrome Assessed by Susceptibility Weighted Imaging and Four-Dimensional Non-Contrast MR Angiography.

    Directory of Open Access Journals (Sweden)

    Ulrike Löbel

    .41 and 2.05, respectively; P = 0.04. In patients with abnormal conventional MRI, mean TTP (7.45, mean hemoglobin (7.65, and mean hematocrit (22.0 were lower compared to patients with normal conventional MRI scans (mean TTP = 8.28, mean hemoglobin = 8.63, mean hematocrit = 25.23.In contrast to conventional MRI, almost all patients showed pathological changes in cerebral hemodynamics assessed by SWI and 4D MRA. Loss of venous contrast on SWI is most likely the result of an increase in CBF and may be related to the acute onset of anemia. Future studies will be needed to assess a possible therapeutic effect of blood transfusions in patients with HUS and neurological symptoms.

  6. Contrast enhanced CT of spinal cord angioma

    International Nuclear Information System (INIS)

    Nakamura, Takahiko; Ebitani, Tsutomu; Honma, Takao; Sofue, Muroto; Nakamura, Shigeru

    1982-01-01

    Contrast enhanced CT on 6 patients with spinal cord angioma showed enhancement in 2 of them. The conditions to produce contrast enhancement were the window width of 100 - 200, and the window level of 0 - 50. In spinal cord angioma, contrast enhanced CT is presently only an adjunct to angiography and myelography. Nevertheless, contrast enhanced CT is useful in the screening test for spinal cord angioma, in the patients who are nonindicated to angiography, and in the postoperative follow-up. (Ueda, J.)

  7. Modeling Patient No-Show History and Predicting Future Outpatient Appointment Behavior in the Veterans Health Administration.

    Science.gov (United States)

    Goffman, Rachel M; Harris, Shannon L; May, Jerrold H; Milicevic, Aleksandra S; Monte, Robert J; Myaskovsky, Larissa; Rodriguez, Keri L; Tjader, Youxu C; Vargas, Dominic L

    2017-05-01

    Missed appointments reduce the efficiency of the health care system and negatively impact access to care for all patients. Identifying patients at risk for missing an appointment could help health care systems and providers better target interventions to reduce patient no-shows. Our aim was to develop and test a predictive model that identifies patients that have a high probability of missing their outpatient appointments. Demographic information, appointment characteristics, and attendance history were drawn from the existing data sets from four Veterans Affairs health care facilities within six separate service areas. Past attendance behavior was modeled using an empirical Markov model based on up to 10 previous appointments. Using logistic regression, we developed 24 unique predictive models. We implemented the models and tested an intervention strategy using live reminder calls placed 24, 48, and 72 hours ahead of time. The pilot study targeted 1,754 high-risk patients, whose probability of missing an appointment was predicted to be at least 0.2. Our results indicate that three variables were consistently related to a patient's no-show probability in all 24 models: past attendance behavior, the age of the appointment, and having multiple appointments scheduled on that day. After the intervention was implemented, the no-show rate in the pilot group was reduced from the expected value of 35% to 12.16% (p value < 0.0001). The predictive model accurately identified patients who were more likely to miss their appointments. Applying the model in practice enables clinics to apply more intensive intervention measures to high-risk patients. Reprint & Copyright © 2017 Association of Military Surgeons of the U.S.

  8. The strategy of performing non-prophylactic hemodialysis therapy after administration of contrast media in renal insufficiency patients

    International Nuclear Information System (INIS)

    Hokama, Sanehiro; Oda, Masami; Kadekawa, Katsumi

    2007-01-01

    Acute renal failure induced by contrast media is an important problem in renal insufficiency patients. Prophylactic hemodialysis is usually undertaken after the administration of radiocontrast media. However, we decided to cease giving prophylactic hemodialysis from February, 2002 in line with the guidelines regarding dialysis and contrast media administration provided by the European Society of Urogenital Radiology. We reported our policy at the doctor's meeting of hemodialysis therapy and at the meeting of clinical engineering technologists which were held in Okinawa. After the presentation, a questionnaire survey in 28 hospitals was undertaken by telephone. In all the hospitals, prophylactic hemodialysis after the administration of radiocontrast media was still being continued, with the exception of one hospital. We need to enlighten medical staff that the strategy of performing hemodialysis immediately after the administration of contrast media in patients with reduced renal function does not diminish the rate of radiocontrast media-induced nephropathy. (author)

  9. Repeatability and correlations of dynamic contrast enhanced and T2* MRI in patients with advanced pancreatic ductal adenocarcinoma

    NARCIS (Netherlands)

    Klaassen, Remy; Gurney-Champion, Oliver J.; Wilmink, Johanna W.; Besselink, Marc G.; Engelbrecht, Marc R. W.; Stoker, Jaap; Nederveen, Aart J.; van Laarhoven, Hanneke W. M.

    2018-01-01

    In current oncological practice of pancreatic ductal adenocarcinoma (PDAC), there is a great demand for response predictors and markers for early treatment evaluation. In this study, we investigated the repeatability and the interaction of dynamic contrast enhanced (DCE) and T2* MRI in patients with

  10. Evaluation of the acute adverse reaction of contrast medium with high and moderate iodine concentration in patients undergoing computed tomography

    International Nuclear Information System (INIS)

    Nagamoto, Masashi; Gomi, Tatsuya; Terada, Hitoshi; Terada, Shigehiko; Kohda, Eiichi

    2006-01-01

    The aim of this prospective study was to evaluate and compare acute adverse reactions between contrast medium containing moderate and high concentrations of iodine in patients undergoing computed tomography (CT). A total of 945 patients undergoing enhanced CT were randomly assigned to receive one of two doses of contrast medium. We then prospectively investigated the incidence of adverse reactions. Iopamidol was used as the contrast medium, with a high concentration of 370 mgI/ml and a moderate concentration of 300 mgI/ml. The frequency of adverse reactions, such as pain at the injection site and heat sensation, were determined. Acute adverse reactions were observed in 2.4% (11/458) of the moderate-concentration group compared to 3.11% (15/482) of the high-concentration group; there was no significant difference in incidence between the two groups. Most adverse reactions were mild, and there was no significant difference in severity. One patient in the high-concentration group was seen to have a moderate adverse reaction. No correlation existed between the incidence of adverse reactions and patient characteristics such as sex, age, weight, flow amount, and flow rate. The incidence of pain was not significantly different between the two groups. In contrast, the incidence of heat sensation was significantly higher in the high-concentration group. The incidence and severity of acute adverse reactions were not significantly different between the two groups, and there were no severe adverse reactions in either group. (author)

  11. Myocardial enhancement pattern in patients with acute myocardial infarction on two-phase contrast-enhanced Ecg-gated multidetector-row computed tomography

    International Nuclear Information System (INIS)

    Ko, S.M.; Seo, J.B.; Hong, M.K.; Do, K.H.; Lee, S.H.; Lee, J.S.; Song, J.W.; Park, S.J.; Park, S.W.; Lim, T.H.

    2006-01-01

    Aim: To evaluate the myocardial enhancement pattern of the left ventricle on two-phase contrast-enhanced electrocardiogram (ECG)-gated multidetector computed tomography (MDCT) images in patients with acute myocardial infarction (AMI). METHODS: Two-phase contrast-enhanced ECG-gated MDCT examinations were performed in 16 patients with AMI. The presence, location and pattern of myocardial enhancement were evaluated. MDCT findings were compared with the catheter angiographic results. RESULTS: Subendocardial (n=9) or transmural (n=6) area of early perfusion defects of the myocardium was detected in 15 of 16 patients (94%) on early-phase CT images. Variable delayed myocardial enhancement patterns on late-phase CT images were observed in 12 patients (75%): (1) subendocardial residual perfusion defect and subepicardial late enhancement (n=6); (2) transmural late enhancement (n=1); (3) isolated subendocardial late enhancement (n=1); and (4) isolated subendocardial residual perfusion defect (n=2). On catheter angiography, 14 of 15 corresponding coronary arteries showed significant stenosis. CONCLUSION: Variable abnormal myocardial enhancement pattern was seen on two-phase, contrast-enhanced ECG-gated MDCT in patients with AMI. Assessment of myocardial attenuation on CT angiography gives additional information of the location and extent of infarction

  12. Feasibility of measuring renal blood flow by phase-contrast magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease

    Energy Technology Data Exchange (ETDEWEB)

    Spithoven, E.M.; Meijer, E.; Boertien, W.E.; Gaillard, C.A.J.M.; Jong, P.E. de; Gansevoort, R.T. [University of Groningen, Department of Nephrology, Community and Occupational Medicine, University Medical Center Groningen, PO Box 30.001, RB Groningen (Netherlands); Borns, C.; Kappert, P.; Greuter, M.J.W.; Jagt, E. van der [University of Groningen, Department of Radiology, Community and Occupational Medicine, University Medical Center Groningen, Groningen (Netherlands); Vart, P. [University of Groningen, Department of Health Sciences, Community and Occupational Medicine, University Medical Center Groningen, Groningen (Netherlands)

    2016-03-15

    Renal blood flow (RBF) has been shown to predict disease progression in autosomal dominant polycystic kidney disease (ADPKD). We investigated the feasibility and accuracy of phase-contrast RBF by MRI (RBF{sub MRI}) in ADPKD patients with a wide range of estimated glomerular filtration rate (eGFR) values. First, we validated RBF{sub MRI} measurement using phantoms simulating renal artery hemodynamics. Thereafter, we investigated in a test-set of 21 patients intra- and inter-observer coefficient of variation of RBF{sub MRI}. After validation, we measured RBF{sub MRI} in a cohort of 91 patients and compared the variability explained by characteristics indicative for disease severity for RBF{sub MRI} and RBF measured by continuous hippuran infusion. The correlation in flow measurement using phantoms by phase-contrast MRI was high and fluid collection was high (CCC=0.969). Technical problems that precluded RBF{sub MRI} measurement occurred predominantly in patients with a lower eGFR (34% vs. 16%). In subjects with higher eGFRs, variability in RBF explained by disease characteristics was similar for RBF{sub MRI} compared to RBF{sub Hip,} whereas in subjects with lower eGFRs, this was significantly less for RBF{sub MRI}. Our study shows that RBF can be measured accurately in ADPKD patients by phase-contrast, but this technique may be less feasible in subjects with a lower eGFR. (orig.)

  13. The value of ultrasound contrast for assessing cancer cell proliferation and invasion function as well as angiogenesis in lesions of in patients with gastric cancer

    Directory of Open Access Journals (Sweden)

    Qin Yang

    2017-06-01

    Full Text Available Objective: To study the value of ultrasound contrast for assessing cancer cell proliferation and invasion as well as angiogenesis in lesions of in patients with gastric cancer. Methods: A total of 39 patients with gastric cancer and 48 patients with gastric ulcer who were treated in our hospital between August 2012 and May 2016 were included in gastric cancer group and gastric ulcer group respectively, and 50 healthy subjects who accepted gastroscopy in our hospital during the same period were included in normal control group. The day after admission, color Doppler diasonograph was used to test the gastric ultrasound contrast parameters; fluorescence quantitative PCR method was used to detect the proliferation and invasion gene mRNA expression in stomach tissue; enzyme-linked immunosorbent assay (ELISA was used to detect the serum angiogenesis index levels. Results: Ultrasound contrast parameters ET and TTP levels of gastric cancer group and gastric ulcer group were significantly lower than those of normal control group, and ultrasound contrast parameters ET and TTP levels of gastric cancer group were significantly lower than those of gastric ulcer group; Stat3, Survivin, Bcl-2, 毬-catenin, eIF4E, CD44, UHRF1 and c-met mRNA expression in tissue as well as VEGF, EGFR, HIF-毩 and Ang-2 levels in serum of gastric cancer group were higher than those of gastric ulcer group and normal control group while E-cadherin mRNA expression in tissue was lower than those of gastric ulcer group and normal control group; Spearman correlation analysis showed that ultrasound contrast parameters ET and TTP levels were correlated with the cancer cell proliferation and invasion function as well as angiogenesis indexes in lesions. Conclusion: Ultrasound contrast parameters can accurately assess the malignant degree of gastric cancer, and is expected to become the reliable means for early diagnosis and treatment guidance of gastric cancer in the future.

  14. Economic impact of an ultrasonographic contrast agent on the diagnosis and initial management of patients with suspected renal artery stenosis

    International Nuclear Information System (INIS)

    Levesque, J.; Lacourciere, Y.; Onrot, J.M.

    2002-01-01

    To determine resource use in the diagnosis and management of Canadian hypertensive patients with suspected renal artery stenosis and to estimate the impact of diagnosis with contrast-enhanced duplex Doppler ultrasonography (US) on resource use. Seventy-eight patients with suspected renal artery stenosis underwent usual diagnostic tests (captopril-enhanced renal scintigraphy or duplex Doppler US) and contrast-enhanced US. A management pathway ('planned') describing the medical resources required for further patient care was outlined on the basis of results from each test (separately), and a modified management pathway ('recommended'), which considered data from both diagnostic methods, was also outlined. Medical resources and productivity losses were assessed prospectively for a 3-month period after patients underwent both tests ('actual' management pathway). With usual diagnostic methods, 14 (18%) of the tests were inconclusive, whereas only 1 (1%) of the enhanced US examinations was inconclusive; the cost-efficacy ratio was $422 and $343 per successful diagnosis, respectively. Further management costs for patients with an inconclusive diagnosis were estimated at $6370 after the usual diagnostic tests, but only $1278 with enhanced US. Although the costs of the planned and recommended management pathways were similar ($227 and $294 per patient respectively), the proportion of patients requiring further resources was lower with enhanced US (56% v. 46%). Three-month actual management costs ranged from $121 to $1605 per patient (mean $360). Diagnostic tests and surgical procedures were the major cost drivers in all pathways, and costs wore highest for patients in whom stenosis was diagnosed. For patients with suspected renal artery stenosis, contrast-enhanced US had a higher diagnostic success rate than usual diagnostic methods and afforded savings through lower administrative costs and lower medical resource consumption for patients whose diagnosis was unclear after

  15. A patient with Graves’ disease showing only psychiatric symptoms and negativity for both TSH receptor autoantibody and thyroid stimulating antibody

    Directory of Open Access Journals (Sweden)

    Hamasaki Hidetaka

    2012-12-01

    Full Text Available Abstract Background Both thyroid stimulating hormone (TSH and thyroid stimulating antibody (TSAb negative Graves’s disease (GD is extremely rare. Here we present such a patient. Case presentation The patient was a 76-year-old woman who was diagnosed as having schizophrenia forty years ago. She did not show characteristic symptoms for hyperthyroidism, such as swelling of thyroid, exophthalmos, tachycardia and tremor, however, she showed only psychomotor agitation. Serum free triiodothyronine and free thyroxine levels were elevated and TSH level was suppressed, suggesting the existence of hyperthyroidism. However, both the first generation TSH receptor autoantibody (TRAb1 and the thyroid stimulating autoantibody (TSAb were negative. Slightly increased blood flow and swelling was detected by thyroid echography. Thyroid scintigraphy demonstrated diffuse and remarkably elevated uptake of 123I uptake. Finally, we diagnosed her as having GD. She was treated by using methimazole, and hyperthyroidism and her psychiatric symptoms were promptly ameliorated. Discussion We experienced a patient with GD who did not show characteristic symptoms except for psychiatric symptoms, and also showed negativity for both TRAb1 and TSAb. Thyroid autoantibody-negative GD is extremely rare. Thyroid scintigraphy was useful to diagnose such a patient.

  16. Estimation of pulmonary vascular resistance in patients with pulmonary fibrosis by phase-contrast magnetic resonance imaging

    International Nuclear Information System (INIS)

    Ayukawa, Yuichiro; Murayama, Sadayuki; Tsuchiya, Nanae; Yara, Satomi; Fujita, Jiro

    2011-01-01

    The aim of this study was to assess pulmonary vascular resistance (PVR) in patients with pulmonary fibrosis (PF) by phase-contrast magnetic resonance imaging (MRI). Subjects were 11 healthy volunteers and 11 patients with PF. Using phase-contrast MRI, we measured pulmonary arterial blood flow and calculated the parameters of PVR. Parameters were compared between volunteers and patients using unpaired t-tests. The diagnostic capability of the parameters was evaluated by receiver operating characteristic (ROC) curve analysis. Patients underwent respiratory function tests (RFTs) and chest computed tomography (CT), and they were correlated with MRI parameters. Most MRI parameters were significantly different between volunteers and patients (t-test P values were <0.05 in 9 of 10 parameters). Regarding the RFT and CT visual score, only the %DLco/VA and acceleration time and the CT visual score and average flow volume had significant correlation [r=-0.667 (P=0.024) and r=-0.6 (P=0.031)], respectively. Our findings suggest that PVR derived from phase-contrast MRI is significantly higher in patients with PF than in volunteers. However, all but two of these parameters may not correlate with the severity of PF. (author)

  17. Mesenchymal stromal cells of osteosarcoma patients do not show evidence of neoplastic changes during long-term culture.

    Science.gov (United States)

    Buddingh, Emilie P; Ruslan, S Eriaty N; Reijnders, Christianne M A; Szuhai, Karoly; Kuijjer, Marieke L; Roelofs, Helene; Hogendoorn, Pancras C W; Maarten Egeler, R; Cleton-Jansen, Anne-Marie; Lankester, Arjan C

    2015-01-01

    In vitro expanded mesenchymal stromal cells (MSCs) are increasingly used as experimental cellular therapy. However, there have been concerns regarding the safety of their use, particularly with regard to possible oncogenic transformation. MSCs are the hypothesized precursor cells of high-grade osteosarcoma, a tumor with often complex karyotypes occurring mainly in adolescents and young adults. To determine if MSCs from osteosarcoma patients could be predisposed to malignant transformation we cultured MSCs of nine osteosarcoma patients and five healthy donors for an average of 649 days (range 601-679 days). Also, we compared MSCs derived from osteosarcoma patients at diagnosis and from healthy donors using genome wide gene expression profiling. Upon increasing passage, increasing frequencies of binucleate cells were detected, but no increase in proliferation suggestive of malignant transformation occurred in MSCs from either patients or donors. Hematopoietic cell specific Lyn substrate 1 (HLCS1) was differentially expressed (fold change 0.25, P value 0.0005) between MSCs of osteosarcoma patients (n = 14) and healthy donors (n = 9). This study shows that although HCLS1 expression was downregulated in MSCs of osteosarcoma patients and binucleate cells were present in both patient and donor derived MSCs, there was no evidence of neoplastic changes to occur during long-term culture.

  18. TRANSVAGINAL SONOGRAPHY COMBINED WITH SALINE CONTRAST SONOHYSTEROGRAPHY IN EVALUATING THE UTERINE CAVITY IN PREMENOPAUSAL PATIENTS WITH ABNORMAL UTERINE BLEEDING

    Directory of Open Access Journals (Sweden)

    K. G. M. Premleel

    2016-06-01

    Full Text Available OBJECTIVES To evaluate whether saline contrast sonohysterography (SCSH improved the diagnostic accuracy of transvaginal sonography (TVS for predicting endometrial abnormality in premenopausal patients with abnormal uterine bleeding. PATIENTS AND METHODS The uterine cavity was evaluated with TVS and SCSH in 60 premenopausal patients with abnormal uterine bleeding. All 58 patients underwent operative hysteroscopy or hysterectomy within 4 months which provided a detailed description of the uterine cavity and was used as the true value for exclusion of polyps and submucous myomas. RESULT Out of 60 patients, 45 had uterine abnormalities on TVS and SCSH and rest of the patients who appeared normal but had other abnormalities such as ovarian haemorrhagic cyst. Out of the 45 patients, 9 patients had submucous myomas and 9 were diagnosed as endometrial polyp. The findings were confirmed using hysterectomy/hysteroscopy/endometrial sampling. CONCLUSION The use of TVS without saline contrast left nine submucosal fibroids and five in nine of the polyps undiagnosed in referred patients with complaints of abnormal bleeding. It also helps in reducing the rate of more invasive procedures such as hysteroscopy. However, studies carried out for longer duration and large study population are required to validate our findings

  19. Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents.

    Science.gov (United States)

    Hoppe, Hanno; Spagnuolo, Sara; Froehlich, Johannes M; Nievergelt, Helga; Dinkel, Hans-Peter; Gretener, Silvia; Thoeny, Harriet C

    2010-03-01

    The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors. This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated. Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 +/- 15.5 ml (range 15-60 ml) or 0.24 + 0.12 mmol/kg (range 0.1-0.53 mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60 ml/min/1.73 m(2)). Mean eGFR pre-angiography was 26 ml/min/1.73 m(2) and 33 ml/min/1.73 m(2) post-angiography. The mean follow-up period covers 28 months, range 1-84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF. Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO(2) angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients.

  20. Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents

    International Nuclear Information System (INIS)

    Hoppe, Hanno; Spagnuolo, Sara; Froehlich, Johannes M.; Thoeny, Harriet C.; Nievergelt, Helga; Dinkel, Hans-Peter; Gretener, Silvia

    2010-01-01

    The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors. This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated. Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 ± 15.5 ml (range 15-60 ml) or 0.24 + 0.12 mmol/kg (range 0.1-0.53 mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR 2 ). Mean eGFR pre-angiography was 26 ml/min/1.73 m 2 and 33 ml/min/1.73 m 2 post-angiography. The mean follow-up period covers 28 months, range 1-84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF. Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO 2 angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients. (orig.)

  1. Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents

    Energy Technology Data Exchange (ETDEWEB)

    Hoppe, Hanno; Spagnuolo, Sara; Froehlich, Johannes M.; Thoeny, Harriet C. [University Hospital Bern, Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, Bern (Switzerland); Nievergelt, Helga [University Hospital Bern, Clinic of Dermatology, Bern (Switzerland); Dinkel, Hans-Peter [Hospital Landshut, Institute of Diagnostic and Interventional Radiology, Landshut (Germany); Gretener, Silvia [University Hospital of Bern, Division of Vascular Medicine, Swiss Cardiovascular Center, Bern (Switzerland)

    2010-03-15

    The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors. This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated. Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 {+-} 15.5 ml (range 15-60 ml) or 0.24 + 0.12 mmol/kg (range 0.1-0.53 mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60 ml/min/1.73 m{sup 2}). Mean eGFR pre-angiography was 26 ml/min/1.73 m{sup 2} and 33 ml/min/1.73 m{sup 2} post-angiography. The mean follow-up period covers 28 months, range 1-84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF. Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO{sub 2} angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients. (orig.)

  2. Refractive Outcomes, Contrast Sensitivity, HOAs, and Patient Satisfaction in Moderate Myopia: Wavefront-Optimized Versus Tissue-Saving PRK.

    Science.gov (United States)

    Nassiri, Nader; Sheibani, Kourosh; Azimi, Abbas; Khosravi, Farinaz Mahmoodi; Heravian, Javad; Yekta, Abasali; Moghaddam, Hadi Ostadi; Nassiri, Saman; Yasseri, Mehdi; Nassiri, Nariman

    2015-10-01

    To compare refractive outcomes, contrast sensitivity, higher-order aberrations (HOAs), and patient satisfaction after photorefractive keratectomy for correction of moderate myopia with two methods: tissue saving versus wavefront optimized. In this prospective, comparative study, 152 eyes (80 patients) with moderate myopia with and without astigmatism were randomly divided into two groups: the tissue-saving group (Technolas 217z Zyoptix laser; Bausch & Lomb, Rochester, NY) (76 eyes of 39 patients) or the wavefront-optimized group (WaveLight Allegretto Wave Eye-Q laser; Alcon Laboratories, Inc., Fort Worth, TX) (76 eyes of 41 patients). Preoperative and 3-month postoperative refractive outcomes, contrast sensitivity, HOAs, and patient satisfaction were compared between the two groups. The mean spherical equivalent was -4.50 ± 1.02 diopters. No statistically significant differences were detected between the groups in terms of uncorrected and corrected distance visual acuity and spherical equivalent preoperatively and 3 months postoperatively. No statistically significant differences were seen in the amount of preoperative to postoperative contrast sensitivity changes between the two groups in photopic and mesopic conditions. HOAs and Q factor increased in both groups postoperatively (P = .001), with the tissue-saving method causing more increases in HOAs (P = .007) and Q factor (P = .039). Patient satisfaction was comparable between both groups. Both platforms were effective in correcting moderate myopia with or without astigmatism. No difference in refractive outcome, contrast sensitivity changes, and patient satisfaction between the groups was observed. Postoperatively, the tissue-saving method caused a higher increase in HOAs and Q factor compared to the wavefront-optimized method, which could be due to larger optical zone sizes in the tissue-saving group. Copyright 2015, SLACK Incorporated.

  3. MR of the small bowel with a biphasic oral contrast agent (polyethylene glycol): technical aspects and findings in patients affected by Crohn's disease.

    Science.gov (United States)

    Laghi, Andrea; Paolantonio, Pasquale; Iafrate, Franco; Borrelli, Osvaldo; Dito, Lucia; Tomei, Ernesto; Cucchiara, Salvatore; Passariello, Roberto

    2003-01-01

    To report our experience using MR of the small bowel with polyethylene glycol (PEG) solution as an oral contrast agent in a population of adults and children with known Crohn's disease. 40 patients (29 males; 11 females), 15 adults (age range 24-52 years) and 25 children (age range 5-17 years), with known Crohn's disease, underwent MR of the small bowel using a supeconductive 1.5 T magnet, and polyethylene glycol solution as an oral contrast agent. The fixed amount of contrast agent was 750-1000 ml for adults and 10 ml/kg of body weight for children. The Crohn's Disease Activity Index (CDAI) was available in all patients. Our study protocol included the acquisition of T2-weighted half-Fourier single-shot turbo spin-echo (HASTE) sequences and true fast imaging in the steady-state precession (true-FISP) sequences, followed by the acquisition of "spoiled" 2D gradient echo T1-weighted sequences with fat suppression (FLASH, fast low-angle shot) or alternatively "spoiled" 3D (VIBE, volume interpolated breath-hold examination), acquired 70 seconds after intravenous administration of gadopentetate dimeglumine (Gd-DTPA) (0,1 mmol/kg). A specific MR score was created and calculated for each patient and was compared by means of the Spearman rank with CDAI. In all patients no significant side effects were observed and the MR examination was well tolerated even by paediatric patients. In all cases MR showed a small bowel wall thickening (> 4 mm) in the terminal ileum, with lumen stenosis in 26 patients. In 3 cases pathological segments proximal to the terminal ileum were observed and in another 3 cases caecal involvement was visible. The MR examination was able to show abnormalities of perivisceral fat tissue in 15 patients, mesenteric lymphadenopathy in 1 patient and abdominal abscess in 1 case. The Spearman rank showed a statistically significant correlation between CDAI and the MR score (r = 0.91, P = 0,0001). MR using PEG as an oral contrast agent could be considered a test

  4. Duplex-assisted carotid artery stenting without administration of contrast medium for patients with chronic kidney disease or allergic reaction.

    Science.gov (United States)

    Mizowaki, Takashi; Fujita, Atsushi; Imahori, Taichiro; Uyama, Atsushi; Inoue, Satoshi; Kohta, Masaaki; Hamaguchi, Hirotoshi; Sasayama, Takashi; Hosoda, Kohkichi; Kohmura, Eiji

    2016-07-01

    We aimed to investigate the safety and feasibility of duplex-assisted carotid artery stenting (CAS) without administration of contrast medium for the prevention of adverse reactions. Fifteen patients (9 % of all CASs) with severe carotid stenosis (≥70 %) associated with chronic kidney disease (CKD) (stage ≥3) or allergy to contrast medium underwent duplex-assisted CAS without administration of contrast medium over 4 years. The procedural success rate and perioperative complication rates were compared between the duplex-assisted CAS (n = 15) and conventional CAS (n = 153) groups. The technical success rate was 100 % in both groups. Combined stroke or death rates during the post-procedural period did not differ significantly between the duplex-assisted CAS group (0/15, 0 %) and conventional CAS group (4/153, 2.6 %). None of the 14 patients with CKD in the duplex-assisted CAS group experienced further deterioration of renal function. The mean surface radiation dose of participants in the duplex-assisted CAS group (n = 13, 312 ± 131 mGy) was significantly lower than that of the conventional CAS group (n = 31, 1036 ± 571 mGy) (p duplex-assisted CAS group (156 ± 39.7 min) and the conventional CAS group (156 ± 37.4 min). Duplex-assisted CAS without administration of contrast medium could be an alternative option in selected patients deemed to be at high risk for renal failure from nephrotoxic contrast medium or who have an allergy to contrast medium.

  5. Characterization of socioeconomic status of Japanese patients with atopic dermatitis showing poor medical adherence and reasons for drug discontinuation.

    Science.gov (United States)

    Murota, Hiroyuki; Takeuchi, Satoshi; Sugaya, Makoto; Tanioka, Miki; Onozuka, Daisuke; Hagihara, Akihito; Saeki, Hidehisa; Imafuku, Shinichi; Abe, Masatoshi; Shintani, Yoichi; Kaneko, Sakae; Masuda, Koji; Hiragun, Takaaki; Inomata, Naoko; Kitami, Yuki; Tsunemi, Yuichiro; Abe, Shinya; Kobayashi, Miwa; Morisky, Donald E; Furue, Masutaka; Katoh, Norihito

    2015-09-01

    Patients' high adherence to medication is indispensable for the management of skin diseases including atopic dermatitis. We previously showed poor medication adherence in Japanese dermatological patients. This study was conducted to determine the level of adherence to oral or topical medication in Japanese patients with atopic dermatitis, attempting to characterize the socioeconomic status of those patients with poor adherence. A web questionnaire survey on demographic data as well as adherence level was conducted on patients registered in the monitoring system. Adherence level was assessed with Morisky Medication Adherence Scale-8 (MMAS-8). Among a total of 3096 respondents with dermatological disorders, data of 1327 subjects with atopic dermatitis were extracted and analyzed. More than 80% of subjects felt that both oral and topical medications were safe and efficacious, while less than 60% of them were satisfied with their treatment. Levels of adherence to oral and topical treatments were evaluated with MMAS-8, giving scores of 4.6 and 4.2, respectively. Demographic factors such as gender, marital status, state of employment, alcohol consumption, frequency of hospital visits, and experience of drug effectiveness had a significant impact on the degree of adherence to treatment. Medication adherence level in Japanese subjects with atopic dermatitis was relatively low compared with that of other chronic diseases. Our survey has characterized patients with poor adherence, who are good targets for interventions to maximize potentially limited healthcare resources. Copyright © 2015 Z. Published by Elsevier Ireland Ltd.. All rights reserved.

  6. Malignant focal hepatic lesions complicating underlying liver disease: dual-phase contrast-enhanced spiral CT sensitivity and specificity in orthotopic liver transplant patients

    International Nuclear Information System (INIS)

    Mortele, K.J.; De Keukeleire, K.; Praet, M.; Van Vlierberghe, H.; Hemptinne, B. de; Ros, P.R.

    2001-01-01

    The aim of this study was to determine the accuracy of contrast-enhanced biphasic spiral CT as a screening tool in the preoperative evaluation of orthotopic liver transplant (OLT) patients. Spiral-CT examinations were performed before liver transplantation in 53 patients. Scans were retrospectively reviewed and compared with pathologic findings in fresh-sectioned livers. When findings between spiral CT and pathology were discordant, formalized livers were reexamined with lesion-by lesion evaluation. Fresh pathologic evaluation revealed 23 liver lesions (16 HCC, 7 macro-regenerative nodules). Malignancy was identified in 13 of 53 patients (24.5%). Pre-transplantation spiral CT depicted 27 liver lesions (23 HCC, 4 macro-regenerative nodules). Malignancy was suspected in 14 patients (26.4%). In 10 of 53 (18.9%), spiral CT and pathologic evaluation were discordant. Subsequent retrospective pathologic evaluation showed malignancy in 4 additional patients. Spiral CT compared with the retrospective pathologic findings revealed 36 real-negative, 14 real-positive, 0 false-positive, and 3 false-negative patients with malignancy. Sensitivity and specificity of spiral CT in detection of malignancy was 82 and 100%, respectively. Contrast-enhanced biphasic spiral CT is an accurate technique in the evaluation of patients preceding OLT. Routine fresh-sectioned liver pathologic findings are not as sensitive as previously estimated. (orig.)

  7. Bupropion Shows Different Effects on Brain Functional Connectivity in Patients With Internet-Based Gambling Disorder and Internet Gaming Disorder.

    Science.gov (United States)

    Bae, Sujin; Hong, Ji Sun; Kim, Sun Mi; Han, Doug Hyun

    2018-01-01

    Internet gaming disorder (IGD) and gambling disorder (GD) share similar clinical characteristics but show different brain functional connectivity patterns. Bupropion is known to be effective for the treatment of patients with IGD and GD. We hypothesized that bupropion may be effective for the treatment of Internet-based gambling disorder (ibGD) and IGD and that the connections between the default mode network (DMN) and cognitive control network (CCN) would be different between ibGD and IGD patients after 12 weeks of bupropion treatment. 16 patients with IGD, 15 patients with ibGD, and 15 healthy subjects were recruited in this study. At baseline and after 12 weeks of bupropion treatment, the clinical symptoms of patients with IGD or ibGD were assessed, and brain activity was evaluated using resting state functional magnetic resonance imaging. After the 12-week bupropion treatment, clinical symptoms, including the severity of IGD or GD, depressive symptoms, attention, and impulsivity improved in both groups. In the IGD group, the functional connectivity (FC) within the posterior DMN as well as the FC between the DMN and the CCN decreased following treatment. Moreover, the FC within the DMN in the IGD group was positively correlated with changes in Young Internet Addiction Scale scores after the bupropion treatment period. In the ibGD group, the FC within the posterior DMN decreased while the FC within the CCN increased after the bupropion treatment period. Moreover, the FC within the CCN in the ibGD group was significantly greater than that in the IGD group. Bupropion was effective in improving clinical symptoms in patients with IGD and ibGD. However, there were differences in the pharmacodynamics between the two groups. After 12 weeks of bupropion treatment, the FC within the DMN as well as between the DMN and CCN decreased in patients with IGD, whereas the FC within the CCN increased in patients with ibGD.

  8. Contrast-enhanced spectral mammography (CESM) versus MRI in the high-risk screening setting: patient preferences and attitudes.

    Science.gov (United States)

    Phillips, Jordana; Miller, Matthew M; Mehta, Tejas S; Fein-Zachary, Valerie; Nathanson, Audrey; Hori, Wendy; Monahan-Earley, Rita; Slanetz, Priscilla J

    Our study evaluates patient preferences toward screening CESM versus MRI. As part of a prospective study, high-risk patients had breast MRI and CESM. Patients completed an anonymous survey to evaluate preferences regarding the two modalities. 88% of participants completed the survey. 79% preferred CESM over MRI if the exams had equal sensitivity. 89% would be comfortable receiving contrast as part of an annual screening test. High-risk populations may accept CESM as a screening exam and may prefer it over screening MRI if ongoing trials demonstrate screening CESM to be clinically non-inferior MRI. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Light localization with low-contrast targets in a patient implanted with a suprachoroidal-transretinal stimulation retinal prosthesis.

    Science.gov (United States)

    Endo, Takao; Fujikado, Takashi; Hirota, Masakazu; Kanda, Hiroyuki; Morimoto, Takeshi; Nishida, Kohji

    2018-04-20

    To evaluate the improvement in targeted reaching movements toward targets of various contrasts in a patient implanted with a suprachoroidal-transretinal stimulation (STS) retinal prosthesis. An STS retinal prosthesis was implanted in the right eye of a 42-year-old man with advanced Stargardt disease (visual acuity: right eye, light perception; left eye, hand motion). In localization tests during the 1-year follow-up period, the patient attempted to touch the center of a white square target (visual angle, 10°; contrast, 96, 85, or 74%) displayed at a random position on a monitor. The distance between the touched point and the center of the target (the absolute deviation) was averaged over 20 trials with the STS system on or off. With the left eye occluded, the absolute deviation was not consistently lower with the system on than off for high-contrast (96%) targets, but was consistently lower with the system on for low-contrast (74%) targets. With both eyes open, the absolute deviation was consistently lower with the system on than off for 85%-contrast targets. With the system on and 96%-contrast targets, we detected a shorter response time while covering the right eye, which was being implanted with the STS, compared to covering the left eye (2.41 ± 2.52 vs 8.45 ± 3.78 s, p trial: Feb. 20, 2014 Date of registration: Jan. 4, 2014 Trial registration number: UMIN000012754 Registration site: UMIN Clinical Trials Registry (UMIN-CTR) http://www.umin.ac.jp/ctr/index.htm.

  10. Case report of a young stroke patient showing interim normalization of the MRI diffusion-weighted imaging lesion

    International Nuclear Information System (INIS)

    Ostwaldt, Ann-Christin; Usnich, Tatiana; Nolte, Christian H.; Villringer, Kersten; Fiebach, Jochen B.

    2015-01-01

    In acute ischemic stroke, diffusion weighted imaging (DWI) shows hyperintensities and is considered to indicate irreversibly damaged tissue. We present the case of a young stroke patient with unusual variability in the development of signal intensities within the same vessel territory. A 35-year-old patient presented with symptoms of global aphasia and hypesthesia of the left hand. MRI demonstrated a scattered lesion in the MCA territory. After rtPA therapy the patient received further MRI examination, three times on day 1, and once on day 2, 3, 5 and 43. The posterior part of the lesion showed the usual pattern with increasing DWI hyperintensity and decreased ADC, as well as delayed FLAIR positivity. However, the anterior part of the lesion, which was clearly visible in the first examination completely normalized on the first day and only reappeared on day 2. This was accompanied by a normalization of the ADC as well as an even further delayed FLAIR positivity. We showed that interim normalization of DWI and ADC in the acute phase can not only be found in rodent models of stroke, but also in humans. We propose that DWI lesion development might be more variable during the first 24 h after stroke than previously assumed

  11. Re-exposure to low osmolar iodinated contrast media in patients with prior moderate-to-severe hypersensitivity reactions: A multicentre retrospective cohort study.

    Science.gov (United States)

    Park, Hye Jung; Park, Jung-Won; Yang, Min-Suk; Kim, Mi-Yeong; Kim, Sae-Hoon; Jang, Gwang Cheon; Nam, Young-Hee; Kim, Gun-Woo; Kim, Sujeong; Park, Hye-Kyung; Jung, Jae-Woo; Park, Jong-Sook; Kang, Hye-Ryun

    2017-07-01

    To evaluate the outcomes of re-exposure to low-osmolar iodinated contrast medium (LOCM) in patients with a history of moderate-to-severe hypersensitivity reaction (HSR). We retrospectively evaluated a cohort comprising all subjects satisfying the following conditions at 11 centres: (1) experienced a moderate-to-severe HSR to LOCM by December 2014, and (2) underwent contrast-enhanced computed tomography after the initial HSR between January 2014 and December 2014. A total of 150 patients with 328 instances of re-exposure were included; the recurrence rate of HSR was 19.5%. Patients with severe initial HSR exhibited a higher recurrence rate of severe HSR compared to patients with moderate initial HSR, despite more intensive premedication. In the multivariate analysis, the independent risk factors for recurrence of HSR were diabetes, chronic urticaria, drug allergy other than to iodinated contrast media (ICM) and severe initial HSR. The risk of recurrent HSR was 67.1% lower in cases where the implicated ICM was changed to another one (odds ratio: 0.329; P = 0.001). However, steroid premedication did not show protective effects against recurrent HSR. In high-risk patients who have previously experienced a moderate-to-severe initial HSR to LOCM, we should consider changing the implicated ICM to reduce recurrence risk. • In patients with moderate-to-severe HSR, steroid premedication only shows limited effectiveness. • Changing the implicated ICM can reduce the recurrence of HSR to ICM. • Diabetes, chronic urticaria and drug allergies increase the risk of ICM HSR.

  12. Impact of iso-osmolar versus low-osmolar contrast agents on contrast-induced nephropathy and tissue reperfusion in unselected patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention (from the Contrast Media and Nephrotoxicity Following Primary Angioplasty for Acute Myocardial Infarction [CONTRAST-AMI] Trial).

    Science.gov (United States)

    Bolognese, Leonardo; Falsini, Giovanni; Schwenke, Carsten; Grotti, Simone; Limbruno, Ugo; Liistro, Francesco; Carrera, Arcangelo; Angioli, Paolo; Picchi, Andrea; Ducci, Kenneth; Pierli, Carlo

    2012-01-01

    Conflicting data have been reported on the effects of low-osmolar and iso-osmolar contrast media on contrast-induced acute kidney injury (CI-AKI). In particular, no clinical trial has yet focused on the effect of contemporary contrast media on CI-AKI, epicardial flow, and microcirculatory function in patients with ST-segment elevation acute myocardial infarction who undergo primary percutaneous coronary intervention. The Contrast Media and Nephrotoxicity Following Coronary Revascularization by Angioplasty for Acute Myocardial Infarction (CONTRAST-AMI) trial is a prospective, randomized, single-blind, parallel-group, noninferiority study aiming to evaluate the effects of the low-osmolar contrast medium iopromide compared to the iso-osmolar agent iodixanol on CI-AKI and tissue-level perfusion in patients with ST-segment elevation acute myocardial infarction. Four hundred seventy-five consecutive, unselected patients who underwent primary percutaneous coronary intervention were randomized to iopromide (n = 239) or iodixanol (n = 236). All patients received high-dose N-acetylcysteine and hydration. The primary end point was the proportion of patients with serum creatinine (sCr) increases ≥25% from baseline to 72 hours. Secondary end points were Thrombolysis In Myocardial Infarction (TIMI) myocardial perfusion grade, increase in sCr ≥50%, increase in sCr ≥0.5 or ≥1 mg/dl, and 1-month major adverse cardiac events. The primary end point occurred in 10% of the iopromide group and in 13% of the iodixanol group (95% confidence interval -9% to 3%, p for noninferiority = 0.0002). A TIMI myocardial perfusion grade of 0 or 1 was present in 14% of patients in the 2 groups. No differences between the 2 groups were found in any of the secondary analyses of sCr increase. No significant difference in 1-month major adverse cardiac events was found (8% vs 6%, p = 0.37). In conclusion, in a population of unselected patients with ST-segment elevation acute myocardial infarction

  13. Cost-effectiveness of positive contrast and nuclear arthrography in patients who underwent total hip arthroplasty

    International Nuclear Information System (INIS)

    Swan, J.S.; Braunstein, E.M.; Capello, W.; Wellman, H.

    1989-01-01

    The authors have compared the cost effectiveness of contrast arthrography (CA) and nuclear arthrography (NA), in which In-111 chloride is injected with the contrast material, of total hip arthroplasties. Their series included 48 cases of surgically proved loose femoral components. The cost per true-positive result was obtained by taking the total cost of the examinations in surgically proved cases and dividing by the number of true-position cases. The cost of CA was $297 and the cost of NA was $335. For CA, the cost per true positive was $1,018, and for the NA the cost per true positive was $946. In spite of higher initial cost, NA is more cost effective than CA on a cost per true-positive case basis. NA is cost effective in evaluating hip arthroplasties in which there is suspicion of a loose femoral component

  14. Budesonide/formoterol and formoterol provide similar rapid relief in patients with acute asthma showing refractoriness to salbutamol

    Directory of Open Access Journals (Sweden)

    Lombardi DM

    2006-01-01

    Full Text Available Abstract Background To compare the efficacy and safety of budesonide/formoterol (Symbicort® with formoterol (Oxis® in the treatment of patients with acute asthma who showed evidence of refractoriness to short-acting β2-agonist therapy. Methods In a 3 hour, randomized, double-blind study, a total of 115 patients with acute asthma (mean FEV1 40% of predicted normal and a refractory response to salbutamol (mean reversibility 2% of predicted normal after inhalation of 400 μg, were randomized to receive either budesonide/formoterol (320/9 μg, 2 inhalations at t = -5 minutes and 2 inhalations at 0 minutes [total dose 1280/36 μg] or formoterol (9 μg, 2 inhalations at t = -5 minutes and 2 inhalations at 0 minutes [total dose 36 μg]. The primary efficacy variable was the average FEV1 from the first intake of study medication to the measurement at 90 minutes. Secondary endpoints included changes in FEV1 at other timepoints and change in respiratory rate at 180 minutes. Treatment success, treatment failure and patient assessment of the effectiveness of the study medication were also measured. Results FEV1 increased after administration of the study medication in both treatment groups. No statistically significant difference between the treatment groups was apparent for the primary outcome variable, or for any of the other efficacy endpoints. There were no statistically significant between-group differences for treatment success, treatment failure or patient assessment of medication effectiveness. Both treatments were well tolerated. Conclusion Budesonide/formoterol and formoterol provided similarly rapid relief of acute bronchoconstriction in patients with asthma who showed evidence of refractoriness to a short-acting β2-agonist.

  15. Contrast-enhanced MRI of subchondral cysts in patients with or at risk for knee osteoarthritis: The MOST study

    International Nuclear Information System (INIS)

    Crema, M.D.; Roemer, F.W.; Marra, M.D.; Niu, J.; Lynch, J.A.; Felson, D.T.; Guermazi, A.

    2010-01-01

    Objective: The aim of the study was (1) to evaluate contrast enhancement patterns of subchondral cysts on magnetic resonance imaging and (2) to discuss possible radiological explanations of cyst enhancement based on existing theories of subchondral cyst formation in osteoarthritis. Materials and methods: The Multicenter Osteoarthritis Study (MOST) is a NIH-funded longitudinal observational study for individuals who have or are at high risk for knee osteoarthritis. All subjects with available non-enhanced and contrast-enhanced MRI were included. The tibiofemoral and patellofemoral joints were divided in 14 subregions. The presence and size of subchondral cysts and bone marrow edema-like lesions (BMLs) were scored semiquantitatively in each subregion on non-contrast-enhanced MRI from 0 to 3. Enhancement of subchondral cysts was evaluated on contrast-enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). The adjacent articular cartilage was scored in each subregion on non-enhanced MRI as grade 0 (intact), grade 1 (partial thickness loss), or grade 2 (full thickness loss). Results: Four hundred knees were included (1 knee per person, 5600 subregions). Subchondral cysts were detected in 260 subregions (4.6%). After intravenous contrast administration, 245 cysts (94.2%) showed full enhancement, 12 (4.6%) showed partial enhancement and 3 (1.2%) showed no enhancement. Enhancing BMLs were found in 237 (91.2%) subregions containing cysts, which were located adjacent or in the middle of BMLs. In 121 subregions (46.5%) having cysts, no adjacent full thickness cartilage loss was detected. Conclusion: Most subchondral cysts demonstrated full or partial contrast enhancement, and were located adjacent or in the midst of enhancing BMLs. As pure cystic lesions are not expected to enhance on MRI, the term 'subchondral cyst-like bone marrow lesion' might be appropriate to describe these lesions.

  16. Contrast-enhanced MRI of subchondral cysts in patients with or at risk for knee osteoarthritis: The MOST study

    Energy Technology Data Exchange (ETDEWEB)

    Crema, M.D., E-mail: michelcrema@gmail.co [Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Roemer, F.W., E-mail: frank.roemer@klinikum-augsburg.d [Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Department of Radiology, Klinikum Augsburg, Stenglinstrasse 2, Augsburg 86156 (Germany); Marra, M.D., E-mail: monicadiasmarra@gmail.co [Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (United States); Niu, J., E-mail: niujp@bu.ed [Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, X Building, Suite 200, Boston, MA 02118 (United States); Lynch, J.A., E-mail: jlynch@psg.ucsf.ed [Department of Epidemiology and Biostatistics, University of California at San Francisco, 185 Berry Street, Lobby 5, Suite 5700, San Francisco, CA 94107 (United States); Felson, D.T., E-mail: dfelson@bu.ed [Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, X Building, Suite 200, Boston, MA 02118 (United States); Guermazi, A., E-mail: ali.guermazi@bmc.or [Department of Radiology, Boston University School of Medicine, 820 Harrison Ave, FGH Building, 3rd Floor, Boston, MA 02118 (United States)

    2010-07-15

    Objective: The aim of the study was (1) to evaluate contrast enhancement patterns of subchondral cysts on magnetic resonance imaging and (2) to discuss possible radiological explanations of cyst enhancement based on existing theories of subchondral cyst formation in osteoarthritis. Materials and methods: The Multicenter Osteoarthritis Study (MOST) is a NIH-funded longitudinal observational study for individuals who have or are at high risk for knee osteoarthritis. All subjects with available non-enhanced and contrast-enhanced MRI were included. The tibiofemoral and patellofemoral joints were divided in 14 subregions. The presence and size of subchondral cysts and bone marrow edema-like lesions (BMLs) were scored semiquantitatively in each subregion on non-contrast-enhanced MRI from 0 to 3. Enhancement of subchondral cysts was evaluated on contrast-enhanced MRI as grade 0 (absent), grade 1 (partial enhancement), or grade 2 (full enhancement). The adjacent articular cartilage was scored in each subregion on non-enhanced MRI as grade 0 (intact), grade 1 (partial thickness loss), or grade 2 (full thickness loss). Results: Four hundred knees were included (1 knee per person, 5600 subregions). Subchondral cysts were detected in 260 subregions (4.6%). After intravenous contrast administration, 245 cysts (94.2%) showed full enhancement, 12 (4.6%) showed partial enhancement and 3 (1.2%) showed no enhancement. Enhancing BMLs were found in 237 (91.2%) subregions containing cysts, which were located adjacent or in the middle of BMLs. In 121 subregions (46.5%) having cysts, no adjacent full thickness cartilage loss was detected. Conclusion: Most subchondral cysts demonstrated full or partial contrast enhancement, and were located adjacent or in the midst of enhancing BMLs. As pure cystic lesions are not expected to enhance on MRI, the term 'subchondral cyst-like bone marrow lesion' might be appropriate to describe these lesions.

  17. Surface plasmon resonance analysis shows an IgG-isotype-specific defect in ABO blood group antibody formation in patients with common variable immunodeficiency

    Directory of Open Access Journals (Sweden)

    Michael Bernhard Fischer

    2015-05-01

    Full Text Available Background: Common variable immunodeficiency (CVID is the most common clinically severe primary immunodeficiency and comprises a heterogeneous group of patients with recurrent severe bacterial infections due to the failure to produce IgG antibodies after exposure to infectious agents and immunization. Diagnostic recommendations for antibody failure include assessment of isoagglutinins. We have readdressed this four decades old but still accepted recommendation with up to date methodology.Methods: Anti-A/B IgM- and IgG-antibodies were measured by Diamed-ID Micro Typing, surface plasmon resonance (SPR using the Biacore® device and flow cytometry.Results: When Diamed-ID Micro Typing was used, CVID patients (n=34 showed IgG- and IgM-isoagglutinins that were comparable to healthy volunteers (n=28, while all XLA patients (n=8 had none. Anti-A/B IgM-antibodies were present in more than 2/3 of the CVID patients and showed binding kinetics comparable to anti-A/B IgM-antibodies from healthy individuals. A correlation could be found in CVID patients between levels of anti-A/B IgM-antibodies and levels of serum IgM and PnP-IgM-antibodies. In contrast in CVID patients as a group ABO antibodies were significantly decreased when assessed by SPR, which correlated with levels of switched memory, non-switched memory and naïve B cells, but all CVID patients had low/undetectable anti-A/B IgG-antibodies.Conclusion: These results indicate that conventional isoagglutinin assessment and assessment of anti-A/B IgM antibodies are not suited for the diagnosis of impaired antibody production in CVID. Examination of anti-A/B IgG antibodies by SPR provides a useful method for the diagnosis of IgG antibody failure in all CVID patients studied, thus indicating an important additional rationale to start immunoglobulin replacement therapy early in these patients, before post-infectious sequelae develop.

  18. Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT--a pooled analysis of two randomized trials

    DEFF Research Database (Denmark)

    Thomsen, Henrik S; Morcos, Sameh K

    2009-01-01

    of the LOCM were also observed in patients with GFR contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM......The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients...... with glomerular filtration rate (GFR) contrast-enhanced MDCT examinations and to compare the rates of CIN following the IV administration of low-osmolar contrast media (LOCM, iopamidol and iomeprol) and an iso-osmolar contrast medium (IOCM, iodixanol). A total of 301 adult patients...

  19. Panel-based whole exome sequencing identifies novel mutations in microphthalmia and anophthalmia patients showing complex Mendelian inheritance patterns.

    Science.gov (United States)

    Riera, Marina; Wert, Ana; Nieto, Isabel; Pomares, Esther

    2017-11-01

    Microphthalmia and anophthalmia (MA) are congenital eye abnormalities that show an extremely high clinical and genetic complexity. In this study, we evaluated the implementation of whole exome sequencing (WES) for the genetic analysis of MA patients. This approach was used to investigate three unrelated families in which previous single-gene analyses failed to identify the molecular cause. A total of 47 genes previously associated with nonsyndromic MA were included in our panel. WES was performed in one affected patient from each family using the AmpliSeq TM Exome technology and the Ion Proton TM platform. A novel heterozygous OTX2 missense mutation was identified in a patient showing bilateral anophthalmia who inherited the variant from a parent who was a carrier, but showed no sign of the condition. We also describe a new PAX6 missense variant in an autosomal-dominant pedigree affected by mild bilateral microphthalmia showing high intrafamiliar variability, with germline mosaicism determined to be the most plausible molecular cause of the disease. Finally, a heterozygous missense mutation in RBP4 was found to be responsible in an isolated case of bilateral complex microphthalmia. This study highlights that panel-based WES is a reliable and effective strategy for the genetic diagnosis of MA. Furthermore, using this technique, the mutational spectrum of these diseases was broadened, with novel variants identified in each of the OTX2, PAX6, and RBP4 genes. Moreover, we report new cases of reduced penetrance, mosaicism, and variable phenotypic expressivity associated with MA, further demonstrating the heterogeneity of such disorders. © 2017 The Authors. Molecular Genetics & Genomic Medicine published by Wiley Periodicals, Inc.

  20. Differences in aortic vortex flow pattern between normal and patients with stroke: qualitative and quantitative assessment using transesophageal contrast echocardiography.

    Science.gov (United States)

    Son, Jang-Won; Hong, Geu-Ru; Hong, Woosol; Kim, Minji; Houle, Helene; Vannan, Mani A; Pedrizzetti, Gianni; Chung, Namsik

    2016-06-01

    The flow in the aorta forms a vortex, which is a critical determinant of the flow dynamics in the aorta. Arteriosclerosis can alter the blood flow pattern of the aorta and cause characteristic alterations of the vortex. However, this change in aortic vortex has not yet been studied. This study aimed to characterize aortic vortex flow pattern using transesophageal contrast echocardiography in normal and stroke patients. A total of 85 patients who diagnosed with ischemic stroke and 16 normal controls were recruited for this study. The 16 normal control subjects were designated as the control group, and the 85 ischemic stroke patients were designated as the stroke group. All subjects underwent contrast transesophageal echocardiography (TEE), and particle image velocimetry was used to assess aortic vortex flow. Qualitative and quantitative analyses of vortex flow morphology, location, phasic variation, and pulsatility were undertaken and compared between the groups. In the control group, multiple irregularly-shaped vortices were observed in a peripheral location in the descending thoracic aorta. In contrast, the stroke group had a single, round, merged, and more centrally located aortic vortex flow. In the quantitative analysis of vortex, vortex depth, which represents the location of the major vortex in the aorta, was significantly higher in the control group than in the stroke group (0.599 ± 0.159 vs. 0.522 ± 0.101, respectively, P = 0.013). Vortex relative strength, which is the pulsatility parameter of the vortex itself, was significantly higher in the stroke group than in the control group (0.367 ± 0.148 vs. 0.304 ± 0.087, respectively, P = 0.025). It was feasible to visualize and quantify the characteristic morphology and pulsatility of the aortic vortex flow using contrast TEE, and aortic vortex pattern significantly differed between normal and stroke patients.

  1. Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT

    Energy Technology Data Exchange (ETDEWEB)

    Utsunomiya, Daisuke; Yanaga, Yumi; Oda, Seitaro; Namimoto, Tomohiro; Yamashita, Yasuyuki (Dept. of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto Univ., Kumamoto (Japan)), email: utsunomi@kumamoto-u.ac.jp; Awai, Kazuo (Dept. of Diagnostic Radiology, Graduate School of Biomedical Sciences, Hiroshima Univ., Hiroshima (Japan)); Funama, Yoshinori (Dept. of Medical Physics, Faculty of Life Sciences, Kumamoto Univ., Kumamoto (Japan))

    2011-06-15

    Background Although pre-existing renal insufficiency (RI) is the most important risk factor for contrast-induced nephropathy (CIN), the background distribution of baseline renal function has not been investigated thoroughly in patients scheduled for contrast-enhanced CT. Purpose To investigate the incidence and severity of baseline RI evaluated by estimated glomerular filtration rates (eGFR) in patients who underwent contrast-enhanced CT at an academic center. Material and Methods A total of 6586 patients (3630 men and 2956 women; mean age 57.0 +- 11.9 years) who underwent contrast-enhanced CT between January and December 2008 were retrospectively studied. Of these, 829 had cardiovascular diseases (CVD), 5116 had oncologic diseases, 178 had diabetes mellitus (DM), and 1572 had chronic liver disease (CLD). The eGFR (mL/min/1.73 m2) was calculated from their serum creatinine level. Mild, moderate-a, moderate-b, and severe RI were recorded at 60 < =eGFR < 90, 45 < =eGFR < 60, 30 < =eGFR < 45 and eGFR < 30, respectively. Results Of the 6586 patients, 1.6%, 3.7%, 13.7%, and 54.2% were judged to present with severe, moderate-b, moderate-a, and mild RI, respectively. While moderate-b-to-severe RI was recorded in 133 (3.2%) of 4161 patients aged 70 years or less, it was observed in 218 (9.0%) of the 2425 patients who were 71 years or older. Among the 829 CVD patients, 9.9% manifested moderate-b-to-severe- and 73.0% mild-to-moderate-a RI. The corresponding rates were 4.4% and 68.9% for oncologic disease, 16.9% and 61.2% for DM, and 4.8% and 71.5% for CLD patients. By univariate analysis, there was a significant association between moderate-b-to-severe RI and the advanced age, CVD, DM, and non-oncologic disease. Multivariate analysis showed that the advanced age, DM, and non-oncologic disease were statistically associated with moderate-b-to-severe RI. Conclusion The incidence of RI of eGFR < 45mL/min/1.73 m2 at baseline was high in patients with advanced age, CVD and DM and

  2. Bupropion Shows Different Effects on Brain Functional Connectivity in Patients With Internet-Based Gambling Disorder and Internet Gaming Disorder

    Directory of Open Access Journals (Sweden)

    Sujin Bae

    2018-04-01

    Full Text Available IntroductionInternet gaming disorder (IGD and gambling disorder (GD share similar clinical characteristics but show different brain functional connectivity patterns. Bupropion is known to be effective for the treatment of patients with IGD and GD. We hypothesized that bupropion may be effective for the treatment of Internet-based gambling disorder (ibGD and IGD and that the connections between the default mode network (DMN and cognitive control network (CCN would be different between ibGD and IGD patients after 12 weeks of bupropion treatment.Methods16 patients with IGD, 15 patients with ibGD, and 15 healthy subjects were recruited in this study. At baseline and after 12 weeks of bupropion treatment, the clinical symptoms of patients with IGD or ibGD were assessed, and brain activity was evaluated using resting state functional magnetic resonance imaging.ResultsAfter the 12-week bupropion treatment, clinical symptoms, including the severity of IGD or GD, depressive symptoms, attention, and impulsivity improved in both groups. In the IGD group, the functional connectivity (FC within the posterior DMN as well as the FC between the DMN and the CCN decreased following treatment. Moreover, the FC within the DMN in the IGD group was positively correlated with changes in Young Internet Addiction Scale scores after the bupropion treatment period. In the ibGD group, the FC within the posterior DMN decreased while the FC within the CCN increased after the bupropion treatment period. Moreover, the FC within the CCN in the ibGD group was significantly greater than that in the IGD group.ConclusionBupropion was effective in improving clinical symptoms in patients with IGD and ibGD. However, there were differences in the pharmacodynamics between the two groups. After 12 weeks of bupropion treatment, the FC within the DMN as well as between the DMN and CCN decreased in patients with IGD, whereas the FC within the CCN increased in patients with ibGD.

  3. Serial contrast-enhanced magnetic resonance and magnetization transfer in the study of patients with multiple sclerosis

    International Nuclear Information System (INIS)

    Rovira, A.; Alonso, J.; Cucurella, G.; Nos, C.; Tintore, M.; Pedraza, S.; Rio, J.; Montalban, X.

    1997-01-01

    To demonstrate the changes in the magnetization transfer ratio (MTR) of different demyelinating plaques, correlating them with the baseline values in T1-weighted contrast-enhanced magnetic resonance (MR) sequences in order to relate them more closely to the underlying disease. The study was based on 33 demyelinating plaques obtained from six patients clinically diagnosed as having remitting-recurring multiple sclerosis (MS). All the patients underwent two MR studies at a 3 to 5-month interval, including contrast-enhanced T1 and T2- weighted sequences and magnetization transfer images. The latter were used to calculate the MTR for each of the demyelinating plaques included in the study. The statistical analysis of the results obtained revealed statistically significant between initial MTR values and those of subsequent T1-weighted sequences. The MTR demonstrate significant differences between plaques according to contrast-enhanced T1-weigh tes sequences, probably indicating variable degrees of edema, demyelination and tissue destruction. These differences should be taken into account to enable the use of T1-weighted sequences to quantify the lesion load in MS patients. (Author) 35 refs

  4. Brain natriuretic peptide is a potent vasodilator in aged human microcirculation and shows a blunted response in heart failure patients

    DEFF Research Database (Denmark)

    Edvinsson, Marie-Louise; Uddman, Erik; Edvinsson, Lars

    2014-01-01

    in the forearm was measured by laser Doppler Flowmetry. Local heating (+44°C, 10 min) was used to evoke a maximum local dilator response. RESULTS: Non-invasive iontophoretic administration of either BNP or acetylcholine (ACh), a known endothelium-dependent dilator, elicited an increase in local flow. The nitric......, the vasodilator responses to ACh and to local heating were only somewhat attenuated in CHF patients. Thus, dilator capacity and nitric oxide signalling were not affected to the same extent as BNP-mediated dilation, indicating a specific downregulation of the latter response. CONCLUSIONS: The findings show...... for the first time that microvascular responses to BNP are markedly reduced in CHF patients. This is consistent with the hypothesis of BNP receptor function is downregulated in CHF....

  5. The clinical value of bilateral breast MR imaging: is it worth performing on patients showing suspicious microcalcifications on mammography?

    Energy Technology Data Exchange (ETDEWEB)

    Akita, Ayano; Tanimoto, Akihiro; Kuribayashi, Sachio [Keio University, Department of Diagnostic Radiology, School of Medicine, Tokyo (Japan); Jinno, Hiromitsu [Keio University, Department of Surgery, School of Medicine, Tokyo (Japan); Kameyama, Kaori [Keio University, Division of Diagnostic Pathology, School of Medicine, Tokyo (Japan)

    2009-09-15

    The purpose of this study was to evaluate the clinical value of bilateral breast magnetic resonance (MR) imaging (MRI) in patients showing suspicious microcalcifications on mammography and negative ultrasound findings. Fifty patients underwent MRI before stereotactic vacuum-assisted breast biopsy (SVAB). MR findings were classified into five types for interpretation, and types 4 and 5 were considered malignant. SVAB revealed 13 carcinomas and 37 benign lesions. Malignant lesions were more frequently found in cases of positive MRI diagnoses than in negative MRI diagnoses (P < 0.001). Mammography had a sensitivity of 100%, a specificity of 24% and an accuracy of 44%, whereas mammography plus MRI had a sensitivity of 85%, a specificity of 100% and an accuracy of 96%. In the evaluation of mammographically detected microcalcifications, bilateral breast MRI is of good diagnostic value and may alter the indications for SVAB. (orig.)

  6. Survey of effective doses to patients undergoing contrast-based X-ray fluoroscopy procedures in Tanzania

    International Nuclear Information System (INIS)

    Ngaile, J.E.; Msaki, P.K.; Kazema, R.R.

    2017-01-01

    The aim of this study was to assess the radiation burden imparted to patients from contrast-based X-ray fluoroscopy procedures in Tanzania. The effective doses (EDs) to patients from five contrast-based fluoroscopy procedures were obtained from four hospitals. The ED was estimated using the knowledge of the patient characteristics, patient-related exposure parameters, measurements of air kerma area product and PCXCM software. The median EDs for the barium swallow (BS), barium meal (BM), barium enema (BE), hysterosalpingography (HSG) and retrograde urethrography (RUG) were 0.50, 1.43, 2.83, 0.65 and 0.59 mSv, respectively. The median ED per hospital for the BS and BM procedures varied by factors of up to 9.9 and 4.2, respectively, while for the BE, HSG and RUG varied by factors of up to 2.3, 2.4 and 4.3, respectively. The overall differences between individual EDs across the four hospitals varied by factors of up to 53, 58.9 and 11.4 for the BS, BM and BE, respectively, while for the HSG and RUG differed by factors of up to 22 and 46.7, respectively. The mean EDs in this study were mostly lower than reported values from Spain, the UK, Ghana and Greece, while slightly higher than those reported from India. The observed wide variations of procedural protocols and patient doses within and across the hospitals; and the observed high patient doses in this study relative to those from the literature call for the need to standardize procedural protocols and optimize contrast-based fluoroscopy procedures. (authors)

  7. High-resolution motion compensated MRA in patients with congenital heart disease using extracellular contrast agent at 3 Tesla

    Directory of Open Access Journals (Sweden)

    Dabir Darius

    2012-10-01

    Full Text Available Abstract Background Using first-pass MRA (FP-MRA spatial resolution is limited by breath-hold duration. In addition, image quality may be hampered by respiratory and cardiac motion artefacts. In order to overcome these limitations an ECG- and navigator-gated high-resolution-MRA sequence (HR-MRA with slow infusion of extracellular contrast agent was implemented at 3 Tesla for the assessment of congenital heart disease and compared to standard first-pass-MRA (FP-MRA. Methods 34 patients (median age: 13 years with congenital heart disease (CHD were prospectively examined on a 3 Tesla system. The CMR-protocol comprised functional imaging, FP- and HR-MRA, and viability imaging. After the acquisition of the FP-MRA sequence using a single dose of extracellular contrast agent the motion compensated HR-MRA sequence with isotropic resolution was acquired while injecting the second single dose, utilizing the timeframe before viability imaging. Qualitative scores for image quality (two independent reviewers as well as quantitative measurements of vessel sharpness and relative contrast were compared using the Wilcoxon signed-rank test. Quantitative measurements of vessel diameters were compared using the Bland-Altman test. Results The mean image quality score revealed significantly better image quality of the HR-MRA sequence compared to the FP-MRA sequence in all vessels of interest (ascending aorta (AA, left pulmonary artery (LPA, left superior pulmonary vein (LSPV, coronary sinus (CS, and coronary ostia (CO; all p  Conclusions An ECG- and navigator-gated HR-MRA-protocol with infusion of extracellular contrast agent at 3 Tesla is feasible. HR-MRA delivers significantly better image quality and vessel sharpness compared to FP-MRA. It may be integrated into a standard CMR-protocol for patients with CHD without the need for additional contrast agent injection and without any additional examination time.

  8. Limitations of combined flexible sigmoidoscopy and double contrast barium enema in patients with rectal bleeding

    International Nuclear Information System (INIS)

    Hixson, L.J.; Sampliner, R.E.; Chernin, M.; Amberg, J.; Kogan, F.; Veterans Administration Medical Center, Tucson, AZ

    1989-01-01

    Eighty-seven outpatients with non-massive rectal bleeding or asymptomatic positive fecal occult blood were evaluated with 35 cm flexible sigmoidoscopy, double contrast barium enema (DBCE) and colonoscopy. 82% had hemorrhoids and 35% harbored colorectal neoplasia. The combination of flexible sigmoidoscopy and DCBE missed none of 7 malignant lesions. However, 35% of benign polyps ≥ 1 cm and 60.5% of those < 1 cm were not detected by this combination. The presence of hemorrhoids should not prevent a search for colon neoplasia and colonoscopy is the preferred method. (orig.)

  9. Assessment of resectability of pancreatic cancer with dynamic contrast-enhanced MR imaging: technique, surgical correlation and patient outcome

    International Nuclear Information System (INIS)

    Spencer, J.A.; Ward, J.; Guthrie, J.A.; Robinson, P.J.A.; Guillou, P.J.

    1998-01-01

    The aim of our work was to investigate the use of a dynamic contrast-enhanced MR (DCEMR) technique for staging apparently localised pancreatic cancer, and to determine the patterns of tumour and vascular enhancement with this technique. Thirty-five consecutive patients were examined. The MR findings were correlated with surgical findings in 13 patients and with clinical outcome in 22 patients. Breath-hold gradient-echo fast low angle shot (TR = 100, TE = 4, flip angle 80 ) acquisitions were obtained at 10 and 40 s (right anterior coronal oblique plane) and at 90 s (axial plane) following intravenous gadolinium. Mean contrast-to-noise ratio was higher on the first than the second acquisition (p < 0.001) and higher on the second acquisition than the third (p < 0.005). Tumour conspicuity was greatest and arterial anatomy was best demonstrated on the first acquisition and the portal venous anatomy on the second. Small tumours were isointense by the third acquisition. Maximal intensity projections were helpful. The MR findings correctly predicted the surgical findings in 11 of 13 cases (85 %) and the clinical course in the other 22 patients. The DCEMR imaging technique is valuable in the staging of patients with pancreatic cancer. Capillary and portal venous phase images are both required for complete local staging. (orig.)

  10. Contrast media use in patients with chronic kidney disease undergoing coronary angiography: A systematic review and meta-analysis of randomized trials.

    Science.gov (United States)

    Pandya, Bhavi; Chalhoub, Jean M; Parikh, Valay; Gaddam, Sainath; Spagnola, Jonathan; El-Sayegh, Suzanne; Bogin, Marc; Kandov, Ruben; Lafferty, James; Bangalore, Sripal

    2017-02-01

    Patients with chronic kidney disease (CKD) undergoing coronary angiography (CA), adequate hydration and minimizing volume of contrast media (CM) are class 1b recommendations for preventing contrast induced nephropathy (CIN). Current data are insufficient to justify specific recommendations about isoosmolar vs. low-osmolar contrast media by the ACCF/AHA/SCAI guidelines. Randomized trials comparing IOCM to LOCM in CKD stage 3 and above patients undergoing CA, and reporting incidence of CIN (defined by a rise in creatinine of 25% from baseline) were included in the analysis. The secondary outcome of the study was the incidence of serum creatinine increase by >1mg/dl. A total of 2839 patients were included in 10 trials, in which 1430 patients received IOCM and 1393 received LOCM. When compared to LOCM, IOCM was not associated with significant benefit in preventing CIN (OR=0.72, [CI: 0.50-1.04], P=0.08, I2=59%). Subgroup analysis revealed non-significant difference in incidence of CIN based on baseline use of N-acetylcystine (NAC), diabetes status, ejection fraction, and whether percutaneous coronary intervention vs coronary angiography alone was performed. The difference between IOCM and LOCM was further attenuated when restricted to studies with larger sample size (>250 patients) (OR=0.93; [CI: 0.66-1.30]) or when compared with non-ionic LOCM (OR=0.79, [CI: 0.52-1.21]). In patients with CKD stage 3 and above undergoing coronary angiography, use of IOCM showed overall non-significant difference in incidence of CIN compared to LOCM. The difference was further attenuated when IOCM was compared with non-ionic LOCM. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  11. Repeat survey of current practice regarding corticosteroid prophylaxis for patients at increased risk of adverse reaction to intravascular contrast agents

    Energy Technology Data Exchange (ETDEWEB)

    Radhakrishnan, S. [Department of Radiology, Wishaw General Hospital, Lanarkshire Acute Hospitals NHS Trust, 50, Netherton Street, Wishaw, Lanarkshire ML2 0DP (United Kingdom)]. E-mail: sureshradhakrish@hotmail.com; Manoharan, S. [Department of Radiology, Wishaw General Hospital, Lanarkshire Acute Hospitals NHS Trust, 50, Netherton Street, Wishaw, Lanarkshire ML2 0DP (United Kingdom); Fleet, M. [Department of Radiology, Wishaw General Hospital, Lanarkshire Acute Hospitals NHS Trust, 50, Netherton Street, Wishaw, Lanarkshire ML2 0DP (United Kingdom)

    2005-01-01

    AIM: To compare the findings of a survey undertaken by us in 2002 regarding steroid premedication given in radiology departments to reduce the risk of adverse reactions in patients at increased risk of intravascular contrast media reactions with a similar survey published in 1994 by R. Seymour et al. The high risk patients considered in our survey were patients with history of asthma, drug allergies, hay fever and eczema. MATERIALS AND METHODS: A total of 225 questionnaires were sent to the consultant in charge for audit for radiology departments from the list given by the Royal College of Radiologists. 175 of the 225 questionnaires were returned (response rate 77.8%) and of these 172 were analysed with respect to the type, dose and duration of steroids. RESULTS: Compared to the survey in 1994, it was found that the number of departments who use steroid cover for all category of risk factors had increased compared to previous survey (73.8% in 2002 versus 55.3% in 1994 (p=0.001). There is now almost universal use of non-ionic contrast 98.8% versus 82.4% in 1994 (p=0.001). There is no agreed policy among radiology departments for the need or the dose or duration of steroid cover. CONCLUSION: Despite the more widespread use of non-ionic contrast media, the use of steroid premedication has increased which is contrary to what is expected as the incidence of adverse reaction to non ionic media is less than ionic contrast media.

  12. Combined diffusion-weighted and dynamic contrast-enhanced imaging of patients with acute osteoporotic vertebral fractures

    International Nuclear Information System (INIS)

    Biffar, Andreas; Sourbron, Steven; Dietrich, Olaf; Schmidt, Gerwin; Ingrisch, Michael; Reiser, Maximilian F.; Baur-Melnyk, Andrea

    2010-01-01

    Objectives: To evaluate the potential and to analyze parameter correlations of combined quantitative diffusion-weighted MRI (DWI) and high-temporal-resolution dynamic contrast-enhanced MRI (DCE-MRI) in vertebral bone marrow (vBM) of patients with osteoporosis and acute vertebral compression fractures, providing additional information for a better understanding of the physiological background of parameter changes. Materials and methods: 20 patients with acute osteoporotic fractures were examined with DWI and DCE-MRI at 1.5 T. DCE-MRI was performed with a 2D saturation-recovery turbo-FLASH sequence, acquiring 300 dynamics with a temporal resolution of 1 s. For DWI measurements, a DW HASTE sequence with b-values from 100 to 600 s/mm 2 was applied. In each patient, ROIs were drawn manually in the fractures and in normal appearing vertebrae. For DCE-MRI, the concentration-time curves of these ROIs were analyzed using a two-compartment tracer-kinetic model in the lesions, providing separate estimates of perfusion and permeability, and a one-compartment model in normal vBM, providing only a mixed representation of perfusion and permeability in terms of a mixed flow parameter K trans and the extracellular volume (ECV). In the case of DWI, attenuation curves were fitted to a monoexponential decay model to determine the apparent diffusion coefficient (ADC). Results: Mean perfusion parameters and ADCs were significantly (p trans : 7.81 mL/100 mL/min vs. 14.61 mL/100 mL/min, ECV: 52.84 mL/100 mL vs. 4.61 mL/100 mL, ADC: 1.71 x 10 -3 mm 2 /s vs. 0.57 x 10 -3 mm 2 /s). ADCs showed a significant correlation with the ECV. Conclusion: The quantitative analysis of DWI and DCE-MRI could distinguish osteoporotic fractures from normal appearing vertebrae. A significant correlation found between ECV and ADCs might be able to explain the cause for the increased diffusivity in osteoporotic fractures. Since the other perfusion parameters do not correlate with the ADC, they provide

  13. Risk factors for contrast-induced nephropathy and their association with mortality in patients with blunt splenic injuries.

    Science.gov (United States)

    Hsieh, Ting-Min; Tsai, Tzu-Hsien; Liu, Yueh-Wei; Hsieh, Ching-Hua

    2016-11-01

    Although angioembolization increases the success rate of non-operative management in patients with blunt splenic injuries (BSI), the issue of contrast-induced nephropathy (CIN) due to serial administration of contrast medium remains unclear. We aimed to examine the risk factors of CIN and their clinical effect on mortality in patients with BSI. We retrospectively studied the complete data on 377 trauma patients with BSI who survived more than 48 h between July 2003 and June 2015. CIN was defined as the relative (≥25%) or absolute (≥0.5 mg/dL) increase in serum creatinine within 48 h after contrast administration. A multivariate logistic regression analysis was conducted to identify the independent predictors of CIN and mortality. CIN was independently associated with body mass index (BMI) ≥ 30 kg/m 2 (odds ratio [OR]: 3.25, 95% confidence interval [CI]: 1.20-8.76), injury severity score (ISS) ≥ 25 (OR: 6.08, 95% CI: 2.76-13.53), and 24-h hemoglobin (Hb) < 10 g/dL (OR: 3.16, 95% CI: 1.46-6.81). CIN (OR: 19.04, 95% CI: 6.15-58.94) and diabetes (OR: 3.43, 95% CI: 1.04-11.26) were also identified as independent predictors for mortality. In this study, we found that BMI ≥ 30 kg/m 2 , ISS ≥ 25, and 24-h Hb < 10 g/dL were independent risk factors for the occurrence of CIN in patients with BSI. However, angioembolization was not identified to be an independent risk factor for CIN. In addition, CIN and diabetes mellitus were identified as independent risk factors for mortality in patients with BSI. Copyright © 2016 IJS Publishing Group Ltd. Published by Elsevier Ltd. All rights reserved.

  14. The use of nitrates in the prevention of contrast-induced nephropathy in patients hospitalized after undergoing percutaneous coronary intervention.

    Science.gov (United States)

    Peguero, Julio G; Cornielle, Vertilio; Gomez, Sabas I; Issa, Omar M; Heimowitz, Todd B; Santana, Orlando; Goldszer, Robert C; Lamas, Gervasio A

    2014-05-01

    Contrast-induced nephropathy (CIN) is a significant cause of morbidity and mortality and effective strategies for its prevention are greatly needed. The purpose of this retrospective, single-center study was to investigate whether nitrate use during percutaneous coronary artery intervention reduces the incidence of CIN. Chart review of all individuals who underwent percutaneous coronary intervention (PCI) from April 2010 to March 2011 was done. Included in the study were patients who were admitted to the hospital after percutaneous coronary artery intervention and had baseline and follow-up creatinine measured. Patients with end-stage renal disease requiring dialysis and those patients with insufficient information to calculate Mehran score were excluded. There were 199 patients who met the eligibility criteria for inclusion in this study. In the identified population, postprocedure renal function was compared between 112 patients who received nitrates prior to coronary intervention and 87 who did not. Baseline characteristics were similar between the 2 groups. Contrast-induced nephropathy was defined as either a 25% or a 0.5 mg/dL, or greater, increase in serum creatinine during the first 48 to 72 hours after contrast exposure. Overall, 43 (21.6%) patients developed CIN post-PCI. Of the patients who received nitrates, 15.2% developed renal impairment when compared to 29.9% in those who did not (odds ratio [OR] = 0.42, 95% confidence interval [CI] 0.21-0.84, P = .014). Multivariate logistic regression analysis demonstrated that nitrate use was independently correlated with a reduction in the development of contrast nephropathy (OR = 0.334, 95% CI 0.157-0.709, P = .004). Additionally, of the various methods of nitrate administration, intravenous infusion was shown to be the most efficacious route in preventing renal impairment (OR = 0.42, 95% CI 0.20-0.90, P = .03). In conclusion, the use of nitrates prior to PCI, particularly intravenous nitroglycerin infusion, may

  15. Minimizing Contrast Medium Doses to Diagnose Pulmonary Embolism with 80-kVp Multidetector Computed Tomography in Azotemic Patients

    Energy Technology Data Exchange (ETDEWEB)

    Holmquist, F. (Dept. of Diagnostic Radiology, Malmoe Univ. Hospital, Univ. of Lund, Malmoe (Sweden)); Hansson, K.; Pasquariello, F. (Dept. of Internal Medicine, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden)); Bjoerk, J. (Competence Center for Clinical Research, Univ. Hospital, Univ. of Lund, Lund (Sweden)); Nyman, U. (Dept. of Radiology, Lasarettet Trelleborg, Univ. of Lund, Trelleborg (Sweden))

    2009-02-15

    Background: In diagnosing acute pulmonary embolism (PE) in azotemic patients, scintigraphy and magnetic resonance imaging are frequently inconclusive or not available in many hospitals. Computed tomography is readily available, but relatively high doses (30-50 g I) of potentially nephrotoxic iodine contrast media (CM) are used. Purpose: To report on the diagnostic quality and possible contrast-induced nephropathy (CIN) after substantially reduced CM doses to diagnose PE in azotemic patients using 80-peak kilovoltage (kVp) 16-row multidetector computed tomography (MDCT) combined with CM doses tailored to body weight, fixed injection duration adapted to scan time, automatic bolus tracking, and saline chaser. Material and Methods: Patients with estimated glomerular filtration rate (eGFR) <50 ml/min were scheduled to undergo 80-kVp MDCT using 200 mg I/kg, and those with eGFR =50 ml/min, 120-kVp MDCT with 320 mg I/kg. Both protocols used an 80-kg maximum dose weight and a fixed 15-s injection time. Pulmonary artery density and contrast-to-noise ratio were measured assuming 70 Hounsfield units (HU) for a fresh clot. CIN was defined as a plasma creatinine rise >44.2 mumol/l from baseline. Results: 89/148 patients (63/68 females) underwent 80-/120-kVp protocols, respectively, with 95% of the examinations being subjectively excellent or adequate. Mean values in the 80-/120-kVp cohorts regarding age were 82/65 years, body weight 66/78 kg, effective mAs 277/117, CM dose 13/23 g I, pulmonary artery density 359/345 HU, image noise (1 standard deviation) 24/21 HU, contrast-to-noise ratio 13/13, and dose-length product 173/258 mGycm. Only 1/65 and 2/119 patients in the 80- and 120-kVp cohorts, respectively, with negative CT and no anticoagulation suffered non-fatal thromboembolism during 3-month follow-up. No patient developed CIN. Conclusion: 80-kVp 16-row MDCT with optimization of injection parameters may be performed with preserved diagnostic quality, using markedly reduced CM

  16. Monitoring of tumor microcirculation during fractionated radiotherapy in patients with rectal carcinomas: a clinical study using contrast enhanced MR imaging

    International Nuclear Information System (INIS)

    Vries, A. de; Judmaier, W.; Griebel, J.; Kremser, Ch.; Gneiting, T.; Peer, S.; Aichner, F.; Lukas, P.

    1996-01-01

    Purpose/Objective: Combined radio chemotherapy is a frequently used treatment scheme for malignant neoplasms. The purpose of using chemotherapeutics such as 5-FU during radiotherapy is to enhance the effectiveness of radiation. The effectiveness of this approach depends on the accumulation of the drugs within the tumor, which is governed by micro circulatory parameters. However, to date scheduling of chemotherapy application is based on empirical data. There is no clinical study available monitoring tumor microcirculation during fractionated radiotherapy. Contrast enhanced MR imaging in tumors provides not only a better understanding of tumor micro vascularity but is also a method to characterize the substance accumulation within the tumor matrix during radiotherapy. This could help to optimize the scheduling of chemotherapy application. Materials and Methods: Patients with clinical and histological proven rectal carcinoma underwent a preoperative combined radio chemotherapy up to a total dose of 39,4Gy, hyperfractionated with b.i.d., single dose 1,1Gy. The fields in box-technique included the rectal canal and adjacent lymph nodes. 5-FU (300mg/m 2 per treatment day) was given continuously parallel to irradiation. To evaluate the Gd-DTPA (Magnevist, Schering, Germany) concentration time curve after i.v. constant rate infusion (0,05 mmol/kg Gd-DTPA) we used an ultrafast T1-mapping sequence on a 1,5-T whole body imager (Magneton Vision, Siemens, Germany). The transaxial slice (thickness 5 mm) was chosen so that both tumor and arterial vessels could be clearly identified. Before, during and after the infusion 53 T1 maps were obtained within 40 min in intervals of 14s (35 scans) and 120s (15 scans). Assuming a linear relation between relaxation rate, R1=1/T1, and Gd-DTPA concentration, concentration time curves were evaluated for arterial blood and tumor. The patients underwent MR imaging before and in constant intervals during fractionated radiotherapy. As a first

  17. MRI before and after external beam intensity-modulated radiotherapy of patients with prostate cancer: The feasibility of monitoring of radiation-induced tissue changes using a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence

    International Nuclear Information System (INIS)

    Franiel, Tobias; Luedemann, Lutz; Taupitz, Matthias; Boehmer, Dirk; Beyersdorff, Dirk

    2009-01-01

    Purpose: To identify and quantify suitable pharmacokinetic MRI parameters for monitoring tissue changes after external beam intensity-modulated radiotherapy of prostate cancer. Material and methods: Six patients with biopsy-proven prostate cancer (initial PSA, 6.0-81.4 ng/ml) underwent MRI at 1.5 T using a combined endorectal/body phased-array coil and a dynamic contrast-enhanced inversion-prepared dual-contrast gradient echo sequence (T1/T2*w; 1.65 s temporal resolution). MRI was performed before and immediately after radiotherapy, at 3 months and at 1 year. Perfusion, blood volume, mean transit time, delay, dispersion, interstitial volume, and extraction coefficient were calculated in prostate cancer and normal prostate for all four time points using a sequential 3-compartment model. Results: Prostate cancer and normal prostate tissue showed a statistically significant decrease in perfusion (p = 0.006, p = 0.001) and increase in extraction coefficient (p = 0.004, p 3 min, p = 0.028) and a smaller extraction coefficient (0.42 vs. 0.64, p = 0.028). Conclusions: Two pharmacokinetic parameters, perfusion and extraction coefficient, appear to be suitable candidates for monitoring the response to percutaneous intensity-modulated radiotherapy of prostate cancer.

  18. Extravasation of the contrast media during voiding cystourethrography in a long-term spinal cord injury patient.

    Science.gov (United States)

    Kovindha, A; Sivasomboon, C; Ovatakanont, P

    2005-07-01

    To present complications and pitfalls in voiding cystourethrography (VCUG) and introduce a guideline for performing VCUG in a long-term spinal cord injury (SCI) patient with neurogenic bladder dysfunction (NBD) and contracted bladder. A case report. Maharaj Nakorn Chiang Mai Hospital, Chiang Mai, Thailand. We describe a chronic C(5) tetraplegic man with NBD and contracted bladder, who developed autonomic dysreflexia (AD), gross hematuria and extravasation of contrast median during VCUG. A foley catheter was retained after VCUG. AD was resolved and urine cleared after a week of continuous bladder irrigation. VCUG should be performed with caution in a long-term SCI patient with NBD and contracted bladder. Forceful pushing of the contrast media by the hand-injection method caused abrupt distention of the contracted bladder, damaged bladder mucosa and aggrevated AD. We suggest a guideline as follows: report bladder capacity and AD, if present, in an X-ray requisition form; use the gravity-drip method, stop the drip and drain the contrast media if a sudden headache and rising of blood pressure (BP) develop; observe urine colour, and report if bleeding or AD occurs.

  19. Elevated serum BAFF levels in patients with localized scleroderma in contrast to other organ-specific autoimmune diseases.

    Science.gov (United States)

    Matsushita, Takashi; Hasegawa, Minoru; Matsushita, Yukiyo; Echigo, Takeshi; Wayaku, Takamasa; Horikawa, Mayuka; Ogawa, Fumihide; Takehara, Kazuhiko; Sato, Shinichi

    2007-02-01

    Serum levels of B-cell activating factor belonging to the tumor necrosis factor family (BAFF), a potent B-cell survival factor, are elevated in patients with systemic autoimmune diseases, such as systemic lupus erythematosus (SLE), rheumatoid arthritis and systemic sclerosis (SSc). The objective of this study was to determine serum BAFF levels and relate the results to the clinical features in patients with organ-specific autoimmune diseases of the skin, such as localized scleroderma and autoimmune bullous diseases. Serum BAFF levels were examined by enzyme-linked immunosorbent assay in 44 patients with localized scleroderma, 20 with pemphigus vulgaris/pemphigus foliaceus, 20 with bullous pemphigoid and 30 healthy controls. Twenty patients with SSc and 20 with SLE were also examined as disease controls. Serum BAFF levels were elevated in localized scleroderma patients compared with healthy controls. Concerning localized scleroderma subgroups, patients with generalized morphea, the severest form of localized scleroderma, had higher serum BAFF levels than linear scleroderma or morphea patients. The BAFF levels of generalized morphea were comparable with those of SSc or SLE. Furthermore, serum BAFF levels correlated positively with antihistone antibody levels and the severity of skin lesion as well as the number of skin lesions. By contrast, serum BAFF levels were not significantly elevated in patients with pemphigus or pemphigoid. These results suggest that BAFF may be contributing to autoimmunity and disease development in localized scleroderma.

  20. Sodium Bicarbonate-Ascorbic Acid Combination for Prevention of Contrast-Induced Nephropathy in Chronic Kidney Disease Patients Undergoing Catheterization.

    Science.gov (United States)

    Komiyama, Kota; Ashikaga, Takashi; Inagaki, Dai; Miyabe, Tomonori; Arai, Marina; Yoshida, Kiyotaka; Miyazawa, Satoshi; Nakada, Akihiro; Kawamura, Iwanari; Masuda, Shinichiro; Nagamine, Sho; Hojo, Rintaro; Aoyama, Yuya; Tsuchiyama, Takaaki; Fukamizu, Seiji; Shibui, Takashi; Sakurada, Harumizu

    2017-01-25

    Sodium bicarbonate and ascorbic acid have been proposed to prevent contrast-induced nephropathy (CIN). The present study evaluated the effect of their combined use on CIN incidence.Methods and Results:We prospectively enrolled 429 patients with chronic kidney disease (CKD: baseline estimated glomerular filtration rate <60 mL/min/1.73 m 2 ) prior to elective coronary catheterization. CIN was defined as absolute (≥0.5 mg/dL) or relative (≥25%) increase in serum creatinine within 72 h. In the saline hydration (n=218) and combined sodium bicarbonate+ascorbic acid (n=211) groups, a total of 1,500-2,500 mL 0.9% saline was given before and after the procedure. In addition, the combination group received 20 mEq sodium bicarbonate and 3 g ascorbic acid i.v. before the procedure, followed by 2 g ascorbic acid after the procedure and a further 2 g after 12 h. There were no significant differences between the basic characteristics and contrast volume in the 2 groups. CIN occurred in 19 patients (8.7%) in the saline group, and in 6 patients (2.8%) in the combined treatment group (P=0.008). Combined sodium bicarbonate and ascorbic acid could prevent CIN following catheterization in CKD patients.

  1. Usefulness of Sodium Bicarbonate for the Prevention of Contrast-Induced Nephropathy in Patients Undergoing Cardiac Resynchronization Therapy.

    Science.gov (United States)

    Alonso, Pau; Sanz, Jorge; García-Orts, Ana; Reina, Samuel; Jiménez, Sonia; Osca, Joaquín; Cano, Oscar; Andrés, Ana; Sancho-Tello, María José; Martínez, Luis

    2017-11-01

    The use of contrast media during cardiac resynchronization therapy (CRT) devices implantation is associated with the risk of contrast-induced nephropathy (CIN). The aim of this study was to evaluate the possible beneficial role of periprocedural intravenous volume expansion with isotonic saline and sodium bicarbonate solution in patients who undergo CRT implantation. Eligible patients were randomly assigned in a 1:1 ratio to receive hydration plus one-sixth molar sodium bicarbonate (study group) or not (control group). Primary end point was CIN incidence. Secondary end points were (1) a combined end point of death, heart transplantation, or hospitalization for heart failure at 12 months, (2) incidence of death, and (3) the need for renal replacement therapy at 12 months. Final analysis was performed with 93 patients. In the hydration group CIN incidence was significantly reduced related to control group (0% vs 11%, p = 0.02). There was a trend to reduce the combined end point in hydration group (12.5% vs 22%, p = 0.14). Finally, CIN incidence was related to a higher 12 months mortality (25% vs 7%, p = 0.03). In conclusion, CIN incidence was 11% in a nonselected population of patients receiving a CRT device. CIN appearance could be reduced by using a hydration protocol based on sodium bicarbonate and isotonic saline. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. [Contrast-induced nephropathy in patients at risk of renal failure undergoing computed tomography: systematic review and meta-analysis of randomized controlled trials].

    Science.gov (United States)

    Arana, Estanislao; Catalá-López, Ferrán

    2010-09-11

    We evaluated and quantified by meta-analysis techniques the incidence of contrast-induced nephropathy (CIN) in patients at risk undergoing computed tomography (CT). We conducted a systematic review of randomized controlled clinical trials designated to evaluate the nephrotoxicity related to iso-osmolar contrast media (IOCM) compared to low-osmolar contrast media (LOCM). Main electronic databases searched included PubMed/MEDLINE, EMBASE, ISI Web of Knowledge and Virtual Health Library (BVS-BIREME), as well as abstracts presented at related scientific societies meetings. Prior to data extraction, definitions of nephrotoxicity and risk population were established. Besides meta-analysis, the global agreement between CIN definitions was evaluated with Mantel-Haenszel stratified test. Five studies were included with 716 randomized patients. When CIN was defined as increased serum creatinine (SCr)>or=25%, the relative risk (RR) was 0.71 (CI95%: 0.40-1.26)-in favor of IOCM-and when it was defined as SCr>or=0.5mg/dL it showed a RR 1.48 (CI95%: 0.37-5.87)-favoring LOCM-in the four studies used this criterion. Mantel-Haenszel stratified test was chi2=2.51 (p=0.8). In patients with renal failure undergoing CT there is a similar risk of CIN with the administration of any contrast media studied. CIN incidence depends on the chosen criteria and is lower with the definition of SCr>or=0.5mg/dL at 24-72h. No agreement was found between CIN definitions were adopted. Copyright © 2009 Elsevier España, S.L. All rights reserved.

  3. Comparison between CT Colonography and Double-Contrast Barium Enema for Colonic Evaluation in Patients with Renal Insufficiency

    International Nuclear Information System (INIS)

    Chung, Sun Young; Park, Seong Ho; Lee, Seung Soo; Lee, Ju Hee; Kim, Ah Young; Park, Su Ki; Han, Duck Jong; Ha, Hyun Kwon

    2012-01-01

    To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean ± SD in age, 51 ± 6.4 years) and CTC (n = 176; 50 ± 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of ≥ 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p 0.046). Electrolyte changes were similar in the two groups. In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

  4. Comparison between CT colonography and double-contrast barium enema for colonic evaluation in patients with renal insufficiency.

    Science.gov (United States)

    Chung, Sun-Young; Park, Seong Ho; Lee, Seung Soo; Lee, Ju Hee; Kim, Ah Young; Park, Su-Kil; Han, Duck Jong; Ha, Hyun Kwon

    2012-01-01

    To compare the CT colonography (CTC) and double-contrast barium enema (DCBE) for colonic evaluation in patients with renal insufficiency. Two sequential groups of consecutive patients with renal insufficiency who had a similar risk for colorectal cancer, were examined by DCBE (n = 182; mean ± SD in age, 51 ± 6.4 years) and CTC (n = 176; 50 ± 6.7 years), respectively. CTC was performed after colon cleansing with 250-mL magnesium citrate (n = 87) or 4-L polyethylene glycol (n = 89) and fecal tagging. DCBE was performed after preparation with 250-mL magnesium citrate. Patients with colonic polyps/masses of ≥ 6 mm were subsequently recommended to undergo a colonoscopy. Diagnostic yield and positive predictive value (PPV) for colonic polyps/masses, examination quality, and examination-related serum electrolyte change were retrospectively compared between the two groups. Both the CTC and DCBE were positive for colonic polyps/masses in 28 (16%) of 176 and 11 (6%) of 182 patients, respectively (p = 0.004). Among patients with positive findings, 17 CTC and six DCBE patients subsequently underwent a colonoscopy and yielded a PPV of 88% (15 of 17 patients) and 50% (3 of 6 patients), respectively (p = 0.089). Thirteen patients with adenomatous lesions were detected in the CTC group (adenocarcinoma [n = 1], advanced adenoma [n = 6], and non-advanced adenoma [n = 6]), as compared with two patients (each with adenocarcinoma and advanced adenoma) in the DCBE group (p = 0.003). Six (3%) of 176 CTC and 16 (9%) of 182 DCBE examinations deemed to be inadequate (p = 0.046). Electrolyte changes were similar in the two groups. In patients with renal insufficiency, CTC has a higher diagnostic yield and a marginally higher PPV for detecting colorectal neoplasia, despite a similar diagnostic yield for adenocarcinoma, and a lower rate of inadequate examinations as compared with DCBE.

  5. Distribution of estimated glomerular filtration rate (eGFR) values in patients receiving contrast-enhanced magnetic resonance imaging

    International Nuclear Information System (INIS)

    Shimoji, Keigo; Aoki, Shigeki; Nakanishi, Atsushi

    2012-01-01

    The aim of this study was to elucidate the distribution of estimated glomerular filtration rate (eGFR) values in patients who underwent gadolinium-based contrast agent (GBCA)-enhanced magnetic resonance imaging (MRI) at different types of hospitals. We retrospectively studied 2,550 patients who underwent MRI at five institutions. We recorded the date and value of each patient's eGFR test. The distribution of eGFR values was compared with that in the general Japanese population. A total of 84.3% of patients had their eGFRs evaluated before GBCA-enhanced MRI. Of these, 84.7% were evaluated within 3 months before the GBCA-enhanced MRI, and 1.3% were evaluated on the day of the GBCA-enhanced MRI. A total of 87.2% of patients tested had an eGFR of ≥60 ml/min/1.73 m 2 ; 12.8% had an eGFR of 2 , and no patients had an eGFR of 2 . The rate of renal function evaluation differed among hospitals. The prevalence of low eGFR values was greater in Juntendo Tokyo Koto Geriatric Medical Center than in the other hospitals, and the prevalence of low eGFR values was greater in patients who underwent GBCA-enhanced MRI than in the general Japanese population. (author)

  6. SU-F-J-103: Assessment of Liver Tumor Contrast for Radiation Therapy: Inter-Patient and Inter-Sequence Variability

    Energy Technology Data Exchange (ETDEWEB)

    Moore, B [Duke University Medical Physics Graduate Program, Durham, NC (United States); Yin, F; Cai, J [Duke University Medical Physics Graduate Program, Durham, NC (United States); Duke University Medical Center, Radiation Oncology, Durham, NC (United States); Czito, B; Palta, M [Duke University Medical Center, Radiation Oncology, Durham, NC (United States)

    2016-06-15

    Purpose: To determine the variation in tumor contrast between different MRI sequences and between patients for the purpose of MRI-based treatment planning. Methods: Multiple MRI scans of 11 patients with cancer(s) in the liver were included in this IRB-approved study. Imaging sequences consisted of T1W MRI, Contrast-Enhanced T1W MRI, T2W MRI, and T2*/T1W MRI. MRI images were acquired on a 1.5T GE Signa scanner with a four-channel torso coil. We calculated the tumor-to-tissue contrast to noise ratio (CNR) for each MR sequence by contouring the tumor and a region of interest (ROI) in a homogeneous region of the liver using the Eclipse treatment planning software. CNR was calculated (I-Tum-I-ROI)/SD-ROI, where I-Tum and I-ROI are the mean values of the tumor and the ROI respectively, and SD-ROI is the standard deviation of the ROI. The same tumor and ROI structures were used in all measurements for different MR sequences. Inter-patient Coefficient of variation (CV), and inter-sequence CV was determined. In addition, mean and standard deviation of CNR were calculated and compared between different MR sequences. Results: Our preliminary results showed large inter-patient CV (range: 37.7% to 88%) and inter-sequence CV (range 5.3% to 104.9%) of liver tumor CNR, indicating great variations in tumor CNR between MR sequences and between patients. Tumor CNR was found to be largest in CE-T1W (8.5±7.5), followed by T2W (4.2±2.4), T1W (3.4±2.2), and T2*/T1W (1.7±0.6) MR scans. The inter-patient CV of tumor CNR was also the largest in CE-T1W (88%), followed by T1W (64.3%), T1W (56.2%), and T2*/T1W (37.7) MR scans. Conclusion: Large inter-sequence and inter-patient variations were observed in liver tumor CNR. CE-T1W MR images on average provided the best tumor CNR. Efforts are needed to optimize tumor contrast and its consistency for MRI-based treatment planning of cancer in the liver. This project is supported by NIH grant: 1R21CA165384.

  7. SU-F-J-103: Assessment of Liver Tumor Contrast for Radiation Therapy: Inter-Patient and Inter-Sequence Variability

    International Nuclear Information System (INIS)

    Moore, B; Yin, F; Cai, J; Czito, B; Palta, M

    2016-01-01

    Purpose: To determine the variation in tumor contrast between different MRI sequences and between patients for the purpose of MRI-based treatment planning. Methods: Multiple MRI scans of 11 patients with cancer(s) in the liver were included in this IRB-approved study. Imaging sequences consisted of T1W MRI, Contrast-Enhanced T1W MRI, T2W MRI, and T2*/T1W MRI. MRI images were acquired on a 1.5T GE Signa scanner with a four-channel torso coil. We calculated the tumor-to-tissue contrast to noise ratio (CNR) for each MR sequence by contouring the tumor and a region of interest (ROI) in a homogeneous region of the liver using the Eclipse treatment planning software. CNR was calculated (I_Tum-I_ROI)/SD_ROI, where I_Tum and I_ROI are the mean values of the tumor and the ROI respectively, and SD_ROI is the standard deviation of the ROI. The same tumor and ROI structures were used in all measurements for different MR sequences. Inter-patient Coefficient of variation (CV), and inter-sequence CV was determined. In addition, mean and standard deviation of CNR were calculated and compared between different MR sequences. Results: Our preliminary results showed large inter-patient CV (range: 37.7% to 88%) and inter-sequence CV (range 5.3% to 104.9%) of liver tumor CNR, indicating great variations in tumor CNR between MR sequences and between patients. Tumor CNR was found to be largest in CE-T1W (8.5±7.5), followed by T2W (4.2±2.4), T1W (3.4±2.2), and T2*/T1W (1.7±0.6) MR scans. The inter-patient CV of tumor CNR was also the largest in CE-T1W (88%), followed by T1W (64.3%), T1W (56.2%), and T2*/T1W (37.7) MR scans. Conclusion: Large inter-sequence and inter-patient variations were observed in liver tumor CNR. CE-T1W MR images on average provided the best tumor CNR. Efforts are needed to optimize tumor contrast and its consistency for MRI-based treatment planning of cancer in the liver. This project is supported by NIH grant: 1R21CA165384

  8. Pretreatment Evaluation of Microcirculation by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Predicts Survival in Primary Rectal Cancer Patients

    Energy Technology Data Exchange (ETDEWEB)

    DeVries, Alexander Friedrich [Department of Radio-Oncology, Academic Teaching Hospital Feldkirch, Feldkirch (Austria); Piringer, Gudrun, E-mail: gudrun.piringer@hotmail.com [Department of Oncology, Wels-Grieskirchen Medical Hospital, Wels (Austria); Kremser, Christian; Judmaier, Werner [Department of Radiology, Innsbruck Medical University, Innsbruck (Austria); Saely, Christoph Hubert [Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Feldkirch (Austria); Lukas, Peter [Department of Radio-Oncology, Innsbruck Medical University, Innsbruck (Austria); Öfner, Dietmar [Department of Surgery, Paracelsus Medical University, Salzburg (Austria)

    2014-12-01

    Purpose: To investigate the prognostic value of the perfusion index (PI), a microcirculatory parameter estimated from dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI), which integrates information on both flow and permeability, to predict overall survival and disease-free survival in patients with primary rectal cancer. Methods and Materials: A total of 83 patients with stage cT3 rectal cancer requiring neoadjuvant chemoradiation were investigated with DCE-MRI before start of therapy. Contrast-enhanced dynamic T{sub 1} mapping was obtained, and a simple data analysis strategy based on the calculation of the maximum slope of the tissue concentration–time curve divided by the maximum of the arterial input function was used as a measure of tumor microcirculation (PI), which integrates information on both flow and permeability. Results: In 39 patients (47.0%), T downstaging (ypT0-2) was observed. During a mean (±SD) follow-up period of 71 ± 29 months, 58 patients (69.9%) survived, and disease-free survival was achieved in 45 patients (54.2%). The mean PI (PImean) averaged over the group of nonresponders was significantly higher than for responders. Additionally, higher PImean in age- and gender-adjusted analyses was strongly predictive of therapy nonresponse. Most importantly, PImean strongly and significantly predicted disease-free survival (unadjusted hazard ratio [HR], 1.85 [ 95% confidence interval, 1.35-2.54; P<.001)]; HR adjusted for age and sex, 1.81 [1.30-2.51]; P<.001) as well as overall survival (unadjusted HR 1.42 [1.02-1.99], P=.040; HR adjusted for age and sex, 1.43 [1.03-1.98]; P=.034). Conclusions: This analysis identifies PImean as a novel biomarker that is predictive for therapy response, disease-free survival, and overall survival in patients with primary locally advanced rectal cancer.

  9. Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function

    Directory of Open Access Journals (Sweden)

    Anju Ranga

    2017-01-01

    Full Text Available Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.

  10. Contrast-enhanced magnetic resonance imaging for the detection of ruptured coronary plaques in patients with acute myocardial infarction.

    Directory of Open Access Journals (Sweden)

    Christian H P Jansen

    Full Text Available X-ray coronary angiography (XCA is the current gold standard for the assessment of lumen encroaching coronary stenosis but XCA does not allow for early detection of rupture-prone vulnerable plaques, which are thought to be the precursor lesions of most acute myocardial infarctions (AMI and sudden death. The aim of this study was to investigate the potential of delayed contrast-enhanced magnetic resonance coronary vessel wall imaging (CE-MRCVI for the detection of culprit lesions in the coronary arteries.16 patients (13 male, age 61.9±8.6 years presenting with sub-acute MI underwent CE-MRCVI within 24-72h prior to invasive XCA. CE-MRCVI was performed using a T1-weighted 3D gradient echo inversion recovery sequence (3D IR TFE 40±4 minutes following the administration of 0.2 mmol/kg gadolinium-diethylenetriamine-pentaacetic acid (DTPA on a 3T MRI scanner equipped with a 32-channel cardiac coil.14 patients were found to have culprit lesions (7x LAD, 1xLCX, 6xRCA as identified by XCA. Quantitative CE-MRCVI correctly identified the culprit lesion location with a sensitivity of 79% and excluded culprit lesion formation with a specificity of 99%. The contrast to noise ratio (CNR of culprit lesions (9.7±4.1 significantly exceeded CNR values of segments without culprit lesions (2.9±1.9, p<0.001.CE-MRCVI allows the selective visualization of culprit lesions in patients immediately after myocardial infarction (MI. The pronounced contrast uptake in ruptured plaques may represent a surrogate biomarker of plaque activity and/or vulnerability.

  11. The role of routine preoperative EUS when performed after contrast enhanced CT in the diagnostic work-up in patients suspected of pancreatic or periampullary cancer.

    Science.gov (United States)

    Cieslak, Kasia P; van Santvoort, Hjalmar C; Vleggaar, Frank P; van Leeuwen, Maarten S; ten Kate, Fibo J; Besselink, Marc G; Molenaar, I Quintus

    2014-01-01

    In patients suspected of pancreatic or periampullary cancer, abdominal contrast-enhanced computed tomography (CT) is the standard diagnostic modality. A supplementary endoscopic ultrasonography (EUS) is often performed, although there is only limited evidence of its additional diagnostic value. The aim of the study is to evaluate the additional diagnostic value of EUS over CT in deciding on exploratory laparotomy in patients suspected of pancreatic or periampullary cancer. We retrospectively analyzed 86 consecutive patients who routinely underwent CT and EUS before exploratory laparotomy with or without pancreatoduodenectomy for suspected pancreatic or periampullary carcinoma between 2007 and 2010. Primary outcomes were visibility of a mass, resectability on CT/EUS and resection with curative intent. A mass was visible on CT in 72/86 (84%) patients. In these 72 patients, EUS demonstrated a mass in 64/72 (89%) patients. Resectability was accurately predicted by CT in 65/72 (90%) and by EUS in 58/72 (81%) patients. In 14/86 (16%) patients no mass was seen on CT. EUS showed a mass in 12/14 (86%) of these patients. A malignant lesion was histological proven in 11/12 (92%) of these patients. Overall, resectability was accurately predicted by CT and EUS in 90% (77/86) and 84% (72/86), respectively. In patients with a visible mass on CT, suspected for pancreatic or periampullary cancer, EUS has no additional diagnostic value, does not influence the decision to perform laparotomy and should therefore not be performed routinely. In patients without a visible mass on CT, EUS is useful to confirm the presence of a tumor. Copyright © 2014 IAP and EPC. Published by Elsevier B.V. All rights reserved.

  12. Is hypoalbuminemia a prognostic risk factor for contrast-induced nephropathy in peritoneal dialysis patients?

    OpenAIRE

    Hassan, Kamal; Fadi,Hassan

    2014-01-01

    Kamal Hassan,1,2 Hassan Fadi3 1Faculty of Medicine in the Galilee, Bar-Ilan University, Safed, Israel; 2Peritoneal Dialysis Unit, Galilee Medical Center, Nahariya, Israel; 3Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel Objective: Residual renal function (RRF) is an important predictor of outcome in peritoneal dialysis (PD) patients. Hypoalbuminemia was found to be an independent risk factor for the development of acute kidney injury. We investigated the possibility of a...

  13. Contrast-Enhanced Proton Radiography for Patient Set-up by Using X-Ray CT Prior Knowledge

    Energy Technology Data Exchange (ETDEWEB)

    Spadea, Maria Francesca, E-mail: mfspadea@unicz.it [Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro (Italy); Fassi, Aurora [Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano (Italy); Zaffino, Paolo [Department of Experimental and Clinical Medicine, Magna Graecia University, Catanzaro (Italy); Riboldi, Marco; Baroni, Guido [Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano (Italy); Bioengineering Unit—CNAO Foundation, Pavia (Italy); Depauw, Nicolas [Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong (Australia); Seco, Joao [Department of Radiation Oncology, Harvard Medical School and Massachusetts General Hospital, Boston, Massachusetts (United States)

    2014-11-01

    Purpose: To obtain a contrasted image of the tumor region during the setup for proton therapy in lung patients, by using proton radiography and x-ray computed tomography (CT) prior knowledge. Methods and Materials: Six lung cancer patients' CT scans were preprocessed by masking out the gross tumor volume (GTV), and digitally reconstructed radiographs along the planned beam's eye view (BEV) were generated, for a total of 27 projections. Proton radiographies (PR) were also computed for the same BEV through Monte Carlo simulations. The digitally reconstructed radiograph was subtracted from the corresponding proton image, resulting in a contrast-enhanced proton radiography (CEPR). Michelson contrast analysis was performed both on PR and CEPR. The tumor region was then automatically segmented on CEPR and compared to the ground truth (GT) provided by physicians in terms of Dice coefficient, accuracy, precision, sensitivity, and specificity. Results: Contrast on CEPR was, on average, 4 times better than on PR. For 10 lateral projections (±45° off of 90° or 270°), although it was not possible to distinguish the tumor region in the PR, CEPR offers excellent GTV visibility. The median ± quartile values of Dice, precision, and accuracy indexes were 0.86 ± 0.03, 0.86 ± 0.06, and 0.88 ± 0.02, respectively, thus confirming the reliability of the method in highlighting tumor boundaries. Sensitivity and specificity analysis demonstrated that there is no systematic over- or underestimation of the tumor region. Identification of the tumor boundaries using CEPR resulted in a more accurate and precise definition of GTV compared to that obtained from pretreatment CT. Conclusions: In most proton centers, the current clinical protocol is to align the patient using kV imaging with bony anatomy as a reference. We demonstrated that CEPR can significantly improve tumor visualization, allowing better patient set-up and permitting image guided proton therapy (IGPT)

  14. How invasive is TMJ double-contrast arthrography in combination with cinematography? Patient discomfort versus known diagnostic gain.

    Science.gov (United States)

    Engelke, W; Mommaerts, M

    1990-04-01

    There is no doubt that double-contrast TMJ fluoroscopic tomography enables a differential diagnosis and treatment in internal derangement pathosis. Its indication is, apart from the expected diagnostic gain, also determined by the degree of its invasiveness, and other alternative diagnostics being available (nuclear magnetic resonance). Data on patient discomfort and complications were gathered in 63 arthrotomographies; pain sensations and mandibular mobility, during and after the procedure in particular, were studied. We consider, along with Westesson, the procedure to be less invasive than commonly considered, once the surgeon-radiologist has gained enough experience.

  15. Preventive effect of pretreatment with intravenous nicorandil on contrast-induced nephropathy in patients with renal dysfunction undergoing coronary angiography (PRINCIPLE Study).

    Science.gov (United States)

    Ko, Young-Guk; Lee, Byoung-Kwon; Kang, Woong Chol; Moon, Jae-Youn; Cho, Yun Hyeong; Choi, Seong Hun; Hong, Myeong-Ki; Jang, Yangsoo; Kim, Jong-Youn; Min, Pil-Ki; Kwon, Hyuck-Moon

    2013-07-01

    To investigate the effect of pretreatment with intravenous nicorandil on the incidence of contrast-induced nephropathy (CIN) in patients with renal dysfunction undergoing coronary angiography. This randomized controlled multicenter study enrolled a total of 166 patients (nicorandil n=81; control n=85) with an estimated glomerular filtration rate 0.5 mg/dL increase or >25% rise in serum creatinine (SCr) concentration within 48 hours of contrast exposure compared to baseline. The final analysis included 149 patients (nicorandil n=73; control n=76). The baseline characteristics and the total volume of the used contrast (Iodixanol, 125.6±69.1 mL vs. 126.9±74.6 mL, p=0.916) were similar between the two groups. The incidence of CIN also did not differ between the nicorandil and control groups (6.8% vs. 6.6%, p=0.794). There was no difference between the two groups in the relative change in SCr from baseline to peak level within 48 hours after coronary angiography (-1.58±24.07% vs. 0.96±17.49%, p=0.464), although the nicorandil group showed less absolute change in SCr than the control group (-0.01±0.43 mg/mL vs. 0.02±0.31 mg/mL, p=0.005). Prophylactic intravenous infusion of nicorandil did not decrease the incidence of CIN in patients with renal dysfunction undergoing coronary angiography.

  16. Evaluation of possible factors affecting contrast sensitivity function in patients with primary Sjögren’s syndrome

    Directory of Open Access Journals (Sweden)

    Sedat Arikan

    2015-06-01

    Full Text Available ABSTRACT Purpose: The contrast sensitivity (CS function in patients with primary Sjögren’s syndrome (pSS may be impaired either frequently as a result of dry eye diseases or rarely as a result of optic neuropathy. In this study, we aimed to evaluate the CS function in pSS patients as well as to assess corneal aberrations and thickness of the peripapillary retinal nerve fiber layer (pRNFL. Methods: Fourteen eyes of 14 pSS patients (pSS group and 14 eyes of 14 healthy participants (control group were subjected to assessment of CS at the spatial frequencies of 1.5, 3.0, 6.0, 12, and 18 cycles/degree (cpd using a functional visual acuity contrast test (FACT; measurement of corneal high-order aberrations (HOAs in terms of coma-like, spherical-like, and total HOAs using Scheimpflug corneal topography; and measurement of the thickness of both the macular ganglion cell-inner plexiform layer (mGCIPL and pRNFL in all quadrants using optical coherence tomography. None of the participants were under treatment with artificial tears. Results: The results of the CS test did not differ between the 2 groups at all spatial frequencies (p>0.05. In addition, there were no statistically significant differences between the 2 groups in terms of corneal HOAs (p>0.05 and thickness of mGCIPL (p>0.05. However, among all quadrants, only the inferior quadrant of pRNFL in pSS patients was statistically significantly thinner than that in the healthy participants (p=0.04. Conclusions: The CS function in pSS patients can be maintained with normal thickness of both pRNFL and mGCIPL and with lack of increased corneal HOAs, which may be present even in the absence of artificial tear usage.

  17. Prediction of presence of kidney disease in a general patient population undergoing intravenous iodinated contrast enhanced computed tomography.

    Science.gov (United States)

    Moos, Shira I; Stoker, Jaap; Nagan, Gajenthiran; de Weijert, Roderick S; van Vemde, David N H; Bipat, Shandra

    2014-06-01

    To assess which risk factors can be used to reduce superfluous estimated glomerular filtration rate (eGFR) measurements before intravenous contrast medium administration. In consecutive patients, all decreased eGFR risk factors were assessed: diabetes mellitus (DM), history of urologic/nephrologic disease (HUND), nephrotoxic medication, cardiovascular disease, hypertension, age > 60 years, anaemia, malignancy and multiple myeloma/M. Waldenström. We studied four models: (1) all risk factors, (2) DM, HUND, hypertension, age > 60 years; (3) DM, HUND, cardiovascular disease, hypertension; (4) DM, HUND, age > 75 years and congestive heart failure. For each model, association with eGFR < 60 ml/min/1.73 m(2) or eGFR < 45 ml/min/1.73 m(2) was studied. A total of 998 patients, mean age 59.94 years were included; 112 with eGFR < 60 ml/min/1.73 m(2) and 30 with eGFR < 45 ml/min/1.73 m(2). Model 1 detected 816 patients: 108 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Model 2 detected 745 patients: 108 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Model 3 detected 622 patients: 100 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Model 4 detected 440 patients: 86 with eGFR < 60 ml/min/1.73 m(2) and all 30 with eGFR < 45 ml/min/1.73 m(2). Associations were significant (p < 0.001). Model 4 is most effective, resulting in the lowest proportion of superfluous eGFR measurements while detecting all patients with eGFR < 45 ml/min/1.73 m(2) and most with eGFR < 60 ml/min/1.73 m(2). A major risk factor for contrast-induced nephropathy (CIN) is kidney disease. Risk factors are used to identify patients with pre-existent kidney disease. Evidence for risk factors to identify patients with kidney disease is limited. The number of eGFR measurements to detect kidney disease can be reduced.

  18. Effects of computed tomography contrast medium factors on contrast enhancement

    International Nuclear Information System (INIS)

    Terasawa, Kazuaki; Hatcho, Atsushi; Okuda, Itsuko

    2011-01-01

    The various nonionic iodinated contrast media used in contrast computed tomography (CT) studies differ in terms of their composition, characteristics, and iodine concentration (mgI/ml), as well as the volume injected (ml). Compared with ionic iodinated contrast media, nonionic iodinated contrast media are low-osmolar agents, with different agents having different osmotic pressures. Using a custom-made phantom incorporating a semipermeable membrane, the osmotic flow rate (hounsfield unit (HU)/s) could easily be measured based on the observed increase in CT numbers, and the relationship between the osmotic pressure and the osmotic flow rate could be obtained (r 2 =0.84). In addition, taking the effects of patient size into consideration, the levels of contrast enhancement in the abdominal aorta (AA) and inferior vena cava (IVC) were compared among four types of CT contrast medium. The results showed differences in contrast enhancement in the IVC during the equilibrium phase depending on the type of contrast medium used. It was found that the factors responsible for the differences observed in enhancement in the IVC were the osmotic flow rate and the volume of the blood flow pathways in the circulatory system. It is therefore considered that the reproducibility of contrast enhancement is likely to be reduced in the examination of parenchymal organs, in which scanning must be performed during the equilibrium phase, even if the amount of iodine injected per unit body weight (mgI/kg) is maintained at a specified level. (author)

  19. Intrahepatic Vγ9Vδ2 T-cells from HCV-infected patients show an exhausted phenotype but can inhibit HCV replication.

    Science.gov (United States)

    Cimini, E; Bordoni, V; Sacchi, A; Visco-Comandini, U; Montalbano, M; Taibi, C; Casetti, R; Lalle, E; D'Offizi, G; Capobianchi, M R; Agrati, C

    2018-01-02

    Hepatitis C virus (HCV) persistence results from inefficiencies of both innate and adaptive immune responses to eradicate the infection. A functional impairment of circulating Vγ9Vδ2 T-cells was described but few data are available on Vγ9Vδ2 T-cells in the liver that, however, represents the battlefield in the HCV/host interaction. Aim of this work was to compare circulating and intrahepatic Vγ9Vδ2 T-cells in chronic HCV-infected patients (HCV pos ) and in HCV-negative (HCV neg ) subjects. Phenotypic and functional analysis was performed by flow cytometry. Anti-HCV activity was analyzed by using an in vitro autologous liver culture system. Independently from HCV infection, the liver was enriched of Vγ9Vδ2 T-cells expressing an effector/activated phenotype. In contrast, an enrichment of PD-1 expressing Vγ9Vδ2 T-cells was observed both in the peripheral blood and in the liver of HCV pos patients, probably due to a persistent antigenic stimulation. Moreover, a lower frequency of IFN-γ producing Vγ9Vδ2 T-cells was observed in the liver of HCV pos patients, suggesting a functional impairment in the cytokine production in HCV pos liver. Despite this hypo-responsiveness, intrahepatic Vγ9Vδ2 T-cells are able to exert an anti-HCV activity after specific stimulation. Altogether, our data show that HCV infection induced a dysregulation of intrahepatic Vγ9Vδ2 T cells that maintain their anti-HCV activity after specific stimulation. A study aimed to evaluate the mechanisms of the antiviral activity may be useful to identify new pathways able to improve Vγ9Vδ2 T-cells intrahepatic function during HCV infection. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Three-dimensional black-blood contrast-enhanced MRI improves detection of intraluminal thrombi in patients with acute ischaemic stroke.

    Science.gov (United States)

    Jang, Won; Kwak, Hyo Sung; Chung, Gyung Ho; Hwang, Seung Bae

    2018-03-19

    This study evaluated the utility of three-dimensional (3D), black-blood (BB), contrast-enhanced, magnetic resonance imaging (MRI) for the detection of intraluminal thrombi in acute stroke patients. Forty-seven patients with acute stroke involving the anterior circulation underwent MRI examination within 6 h of clinical onset. Cerebral angiography was used as the reference standard. In a blinded manner, two neuroradiologists interpreted the following three data sets: (1) diffusion-weighted imaging (DWI) + 3D BB contrast-enhanced MRI; (2) DWI + susceptibility weighted imaging (SWI); (3) DWI + 3D BB contrast-enhanced MRI + SWI. Of these patients, 47 had clots in the middle cerebral artery and four had clots in the anterior cerebral artery. For both observers, the area under the curve (Az) for data sets 1 and 3, which included 3D BB contrast-enhanced MRI, was significantly greater than it was for data set 2, which did not include 3D BB contrast-enhanced MR imaging (observer 1, 0.988 vs 0.904, p = 0.001; observer 2, 0.988 vs 0.894, p = 0.000). Three-dimensional BB contrast-enhanced MRI improves detection of intraluminal thrombi compared to conventional MRI methods in patients with acute ischaemic stroke. • BB contrast-enhanced MRI helps clinicians to assess the intraluminal clot • BB contrast-enhanced MRI improves detection of intraluminal thrombi • BB contrast-enhanced MRI for clot detection has a higher sensitivity.

  1. Dual-energy CT for detection of contrast enhancement or leakage within high-density haematomas in patients with intracranial haemorrhage

    Energy Technology Data Exchange (ETDEWEB)

    Watanabe, Yoshiyuki; Tsukabe, Akio; Kunitomi, Yuki; Nishizawa, Mitsuo; Arisawa, Atsuko; Tanaka, Hisashi; Tomiyama, Noriyuki [Osaka University Graduate School of Medicine, Department of Diagnostic and Interventional Radiology, Suita, Osaka (Japan); Yoshiya, Kazuhisa; Shimazu, Takeshi [Osaka University Graduate School of Medicine, Department of Traumatology and Acute Critical Medicine, Osaka (Japan)

    2014-04-15

    Our study aimed to elucidate the diagnostic performance of dual-energy CT (DECT) in the detection of contrast enhancement in intracranial haematomas (ICrH) with early phase dual-energy computed tomography angiography (CTA) and compare the results with those obtained by delayed CT enhancement. Thirty-six patients with ICrH were retrospectively included in this study. All patients had undergone single-energy non-contrast CT and contrast-enhanced dual-source DECT. DECT images were post-processed with commercial software, followed by obtaining iodine images and virtual non-contrast images and generating combined images that created the impression of 120-kVp images. Two neuroradiologists, blinded to the patients' data, reviewed two reading sessions: session A (non-contrast CT and combined CT) and session B (non-contrast CT, combined CT, and iodine images) for detection of contrast enhancement in the haematomas. Contrast leakage or enhancement was detected in 23 (57.5 %) out of 40 haemorrhagic lesions in 36 patients on delayed CT. Three enhanced lesions were depicted only in the DECT iodine images. The sensitivity, specificity, positive predictive value, and negative predictive value of session A were 82.6, 94.1, 95.0, and 80.0 %, respectively, and those of session B were 95.7, 94.1, 95.7, and 94.1 %, respectively. DECT emphasised the iodine enhancement and facilitated the detection of contrast enhancement or leakage. (orig.)

  2. Dual-energy CT for detection of contrast enhancement or leakage within high-density haematomas in patients with intracranial haemorrhage.

    Science.gov (United States)

    Watanabe, Yoshiyuki; Tsukabe, Akio; Kunitomi, Yuki; Nishizawa, Mitsuo; Arisawa, Atsuko; Tanaka, Hisashi; Yoshiya, Kazuhisa; Shimazu, Takeshi; Tomiyama, Noriyuki

    2014-04-01

    Our study aimed to elucidate the diagnostic performance of dual-energy CT (DECT) in the detection of contrast enhancement in intracranial haematomas (ICrH) with early phase dual-energy computed tomography angiography (CTA) and compare the results with those obtained by delayed CT enhancement. Thirty-six patients with ICrH were retrospectively included in this study. All patients had undergone single-energy non-contrast CT and contrast-enhanced dual-source DECT. DECT images were post-processed with commercial software, followed by obtaining iodine images and virtual non-contrast images and generating combined images that created the impression of 120-kVp images. Two neuroradiologists, blinded to the patients' data, reviewed two reading sessions: session A (non-contrast CT and combined CT) and session B (non-contrast CT, combined CT, and iodine images) for detection of contrast enhancement in the haematomas. Contrast leakage or enhancement was detected in 23 (57.5 %) out of 40 haemorrhagic lesions in 36 patients on delayed CT. Three enhanced lesions were depicted only in the DECT iodine images. The sensitivity, specificity, positive predictive value, and negative predictive value of session A were 82.6, 94.1, 95.0, and 80.0 %, respectively, and those of session B were 95.7, 94.1, 95.7, and 94.1 %, respectively. DECT emphasised the iodine enhancement and facilitated the detection of contrast enhancement or leakage.

  3. Dual-energy CT for detection of contrast enhancement or leakage within high-density haematomas in patients with intracranial haemorrhage

    International Nuclear Information System (INIS)

    Watanabe, Yoshiyuki; Tsukabe, Akio; Kunitomi, Yuki; Nishizawa, Mitsuo; Arisawa, Atsuko; Tanaka, Hisashi; Tomiyama, Noriyuki; Yoshiya, Kazuhisa; Shimazu, Takeshi

    2014-01-01

    Our study aimed to elucidate the diagnostic performance of dual-energy CT (DECT) in the detection of contrast enhancement in intracranial haematomas (ICrH) with early phase dual-energy computed tomography angiography (CTA) and compare the results with those obtained by delayed CT enhancement. Thirty-six patients with ICrH were retrospectively included in this study. All patients had undergone single-energy non-contrast CT and contrast-enhanced dual-source DECT. DECT images were post-processed with commercial software, followed by obtaining iodine images and virtual non-contrast images and generating combined images that created the impression of 120-kVp images. Two neuroradiologists, blinded to the patients' data, reviewed two reading sessions: session A (non-contrast CT and combined CT) and session B (non-contrast CT, combined CT, and iodine images) for detection of contrast enhancement in the haematomas. Contrast leakage or enhancement was detected in 23 (57.5 %) out of 40 haemorrhagic lesions in 36 patients on delayed CT. Three enhanced lesions were depicted only in the DECT iodine images. The sensitivity, specificity, positive predictive value, and negative predictive value of session A were 82.6, 94.1, 95.0, and 80.0 %, respectively, and those of session B were 95.7, 94.1, 95.7, and 94.1 %, respectively. DECT emphasised the iodine enhancement and facilitated the detection of contrast enhancement or leakage. (orig.)

  4. 3D non-contrast-enhanced ECG-gated MR angiography of the lower extremities with dual-source radiofrequency transmission at 3.0 T: Intraindividual comparison with contrast-enhanced MR angiography in PAOD patients.

    Science.gov (United States)

    Rasper, Michael; Wildgruber, Moritz; Settles, Marcus; Eckstein, Hans-Henning; Zimmermann, Alexander; Reeps, Christian; Rummeny, Ernst J; Huber, Armin M

    2016-09-01

    To compare prospectively image quality and diagnostic confidence of flow-sensitive 3D turbo spin echo (TSE)-based non-contrast-enhanced MR angiography (NE-MRA) at 3.0 T using dual-source radiofrequency (RF) transmission with contrast-enhanced MRA (CE-MRA) in patients with peripheral arterial occlusive disease (PAOD). After consent was obtained, 35 patients (mean age 69.1 ± 10.6 years) with PAOD stage II-IV underwent NE-MRA followed by CE-MRA. Signal-to-noise ratio and contrast-to-noise ratio were calculated. Subjective image quality was independently assessed by two radiologists and stenosis scoring was performed in 875 arterial segments. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for stenosis classification were calculated using CE-MRA as a reference method. Diagnostic agreement with CE-MRA was evaluated with Cohen's kappa statistics. NE-MRA provided high objective and subjective image quality at all levels of the arterial tree. Sensitivity and specificity for the detection of relevant stenosis was 91 % and 89 %, respectively; the NPV was 96 % and the PPV 78 %. There was good concordance between CE-MRA and NE-MRA in stenosis scoring. 3D electrocardiography (ECG)-gated TSE NE-MRA with patient-adaptive dual-source RF transmission at 3.0 T is a promising alternative for PAOD patients with contraindications for gadolinium-based contrast agents. It offers high sensitivity and NPV values in the detection of clinically relevant arterial stenosis. • Flow-sensitive TSE NE-MRA is a promising technique for PAOD evaluation. • Diagnostic accuracy is comparable to contrast-enhanced MRA. • NE-MRA eliminates the risk of NSF in patients with renal insufficiency. • Costs arising from the use of contrast agents can be avoided.

  5. Arthritis patients show long-term benefits from 3 weeks intensive exercise training directly following hospital discharge

    NARCIS (Netherlands)

    Bulthuis, Y.; Drossaers-Bakker, K.W.; Drossaers-Bakker, K.W.; Taal, Erik; Rasker, Johannes J.; Oostveen, J.; van 't Pad Bosch, P.; Oosterveld, F.; van de Laar, Mart A F J

    2007-01-01

    Objective: To examine the efficacy of short-term intensive exercise training (IET) directly following hospital discharge. - Methods: In the Disabled Arthritis Patients Post-hospitalization Intensive Exercise Rehabilitation (DAPPER) study, patients with rheumatoid arthritis or osteoarthritis were

  6. Contrast-enhanced magnetic resonance venography in pediatric patients with chronic kidney disease: initial experience with ferumoxytol

    International Nuclear Information System (INIS)

    Luhar, Aarti; Khan, Sarah; Ghahremani, Shahnaz; Griggs, Rachel; Hall, Theodore R.; Finn, J.P.; Zaritsky, Joshua; Salusky, Isidro

    2016-01-01

    Ferumoxytol is an ultra-small superparamagnetic iron oxide (USPIO) particle that is FDA-approved for parenteral treatment of iron deficiency anemia in adults with chronic kidney disease. Because of the association between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with severe chronic kidney disease, we sought to evaluate the diagnostic role of ferumoxytol-enhanced MR venography in children with chronic kidney disease. Twenty children underwent 22 high-resolution ferumoxytol-enhanced MR venography examinations at 3.0 T. High-resolution 3-D contrast-enhanced imaging was performed at a minimum of 3 time points following injection of ferumoxytol at a total dose of 4 mg/kg. Two blinded pediatric radiologists independently scored six named veins on ferumoxytol-enhanced MR venography examinations according to a three-point subjective score, where a score ≥2 was considered diagnostic. Additionally, all relevant venous structures in the included field of view were analyzed for occlusive or non-occlusive thrombosis, compression and presence of collaterals. All patients underwent ferumoxytol-enhanced MR venography successfully and without adverse event. The overall scores of the reviewing radiologists for all venous structures were 2.7-2.9. In all cases, the reviewers were confident basing their diagnoses on the ferumoxytol-enhanced MR venography findings. In 12 of 22 examinations, findings on follow-up imaging or invasive procedures were available to correlate with the findings on ferumoxytol-enhanced MR venography. There was complete concordance between the findings from follow-up imaging and invasive procedures with findings from ferumoxytol-enhanced MR venography. Ferumoxytol holds promise as a powerful alternative to gadolinium-based contrast agents for reliable, high-resolution MR venography in children with chronic kidney disease. (orig.)

  7. Intracranial contrast transit times on digital subtraction angiography decrease more in patients with delayed intraparenchymal hemorrhage after Pipeline.

    Science.gov (United States)

    Brunozzi, Denise; Shakur, Sophia F; Charbel, Fady T; Alaraj, Ali

    2018-04-01

    Background Pipeline embolization devices (PEDs) are used for endovascular treatment of cerebral aneurysms but can be associated with delayed ipsilateral intraparenchymal hemorrhage (DIPH). Changes in intracranial hemodynamics after PED are poorly understood. Objective Here, we assess hemodynamic changes after PED in patients and compare these changes in patients with and without DIPH (DIPH+ and DIPH-). Methods Records of patients with distal internal carotid artery (ICA) aneurysms treated with PED at our institution between 2012 and 2017 were retrospectively reviewed. Regions of interest were selected proximally to PED over the cavernous ICA and distally over the middle cerebral artery (MCA), and then transit times were determined using syngo iFlow software (Siemens). Ratio of MCA to ICA transit time was compared before, after treatment, and at follow-up. Ratios were also compared between DIPH+ and DIPH- subgroups. Correlations between aneurysm size, age, and ratios were investigated. Results Fifty-three patients were included. The ratio of MCA to ICA transit time decreased significantly after PED deployment (1.13 vs. 1.22, p transit time decreases following PED treatment and decreases more in patients with DIPH. These contrast transit time changes can be detected in real time immediately after PED deployment.

  8. Non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in the patients with refractory renal colic

    International Nuclear Information System (INIS)

    Kravchick, Sergey; Stepnov, Eugeny; Lebedev, Valery; Linov, Lina; Leibovici, Octavian; Ben-Horin, Clara L. Dosoretz; Trejo, Leonardo; Peled, Ronit; Cytron, Shmuel

    2006-01-01

    Objectives: To assess the importance of combined use of non-contrast computerized tomography (NCCT) and dynamic renal scintigraphy (DRS) in evaluation of patients with refractory flank pain in the emergency department. Methods: The study involved 64 consecutive patients with refractory renal colic. All patients were evaluated with plain abdominal films kidneys, ureters and bladder (KUB), NCCT and DRS. We assessed the accuracy of different diagnostic procedures and their combinations; in addition, we determined their importance for different steps of evaluation. Results: Urololithiasis was diagnosed in 76.6% (n = 49) of the patients. Twenty-nine percent of calculi were >4 mm. Surgical intervention were performed in 20 patients (40.8%). A combination of NCCT plus DRS yielded the greatest sensitivity (96%) in establishing final diagnosis, however clinical, laboratory and KUB data in combination with DRS, yielded greater specificity (93%) and PPV (97%). Sex (male), WBC (mean 10.2 x 10 3 ± 3.1) and KUB (calculus > 4 mm) were chosen in the three-step multi-variant analysis, while only male sex was found to be the strongest predictor (p 3 and calculi > 4 mm on the KUB

  9. Prevention of contrast-induced nephropathy with single bolus erythropoietin in patients with diabetic kidney disease: A randomized controlled trial.

    Science.gov (United States)

    Shema-Didi, Lilach; Kristal, Batya; Eizenberg, Sarit; Marzuq, Nabil; Sussan, Majdy; Feldman-Idov, Yulie; Ofir, Pnina; Atar, Shaul

    2016-04-01

    Contrast-induced-nephropathy (CIN) is associated with poor outcomes, thus prevention of CIN may be of clinical value. Erythropoietin (EPO) has been shown to elicit tissue-protective effects in experimental models and in clinical studies of acute kidney injury. We therefore evaluated its effectiveness for prevention of CIN after coronary angiography (CA) ± percutaneous coronary intervention (PCI) in diabetic patients with chronic kidney disease. A prospective, randomized, controlled trial was carried out in 138 diabetic patients with eGFR <60 mL/min who underwent non-urgent CA ± PCI. Patients received normal saline and n-acetyl cysteine before CA, with or without 50,000 U of EPO administered 30 min prior to CA. CIN was defined as an increase in serum creatinine of at least 0.5 mg/dL during the first 2 days after exposure to contrast media. Primary outcome was the incidence of CIN. Secondary outcomes were the sensitivity and positive predictive value (PPV) of Cystatin C (CC) and Neutrophil-gelatinase-associated-lipocalin (NGAL) for diagnosis of CIN. The observed incidence of CIN was 8.7%, significantly lower than the expected for such high-risk population. The administration of EPO prior to CA did not reduce the incidence of CIN (9.7% vs. 7.6%, P = 0.65). CC and NGAL demonstrated a low sensitivity (16.6%) and low PPV (6.7 and 33.3%, respectively) for detecting CIN. The administration of EPO prior to CA did not reduce the incidence of CIN. Additional prospective research with a larger sample size and in other patient categories is essential to further define the potential protective effect of EPO on prevention of CIN. © 2015 Asian Pacific Society of Nephrology.

  10. Urinary ET-1 excretion after exposure to radio-contrast media in diabetic patients and patients with preexisting mild impaired renal function.

    Science.gov (United States)

    Heunisch, Fabian; von Einem, Gina; Alter, Markus; Weist, Andreas; Dschietzig, Thomas; Kretschmer, Axel; Hocher, Berthold

    2014-11-24

    Contrast media-induced nephropathy (CIN) is associated with increased morbidity and mortality. The renal endothelin system has been associated with disease progression of various acute and chronic renal diseases. However, robust data coming from adequately powered prospective clinical studies analyzing the short and long-term impacts of the renal ET system in patients with CIN are missing so far. We thus performed a prospective study addressing this topic. We included 327 patients with diabetes or renal impairment undergoing coronary angiography. Blood and spot urine were collected before and 24 h after contrast media (CM) application. Patients were followed for 90 days for major clinical events like need for dialysis, unplanned rehospitalization or death. The concentration of ET-1 and the urinary ET-1/creatinine ratio decreased in spot urine after CM application (ET-1 concentration: 0.91±1.23 pg/ml versus 0.63±1.03 pg/ml, pET-1/creatinine ratio: 0.14±0.23 versus 0.09±0.19, pET-1 concentrations in patients with CIN decreased significantly more than in patients without CIN (-0.26±1.42 pg/ml vs. -0.79±1.69 pg/ml, p=0.041), whereas the decrease of the urinary ET-1/creatinine ratio was not significantly different (non-CIN patients: -0.05±0.30; CIN patients: -0.11±0.21, p=0.223). Urinary ET-1 concentrations as well as the urinary ET-1/creatinine ratio were not associated with clinical events (need for dialysis, rehospitalization or death) during the 90 day follow-up after contrast media exposure. However, the urinary ET-1 concentration and the urinary ET-1/creatinine ratio after CM application were higher in those patients who had a decrease of GFR of at least 25% after 90 days of follow-up. In general the ET-1 system in the kidney seems to be down-regulated after contrast media application in patients with moderate CIN risk. Major long-term complications of CIN (need for dialysis, rehospitalization or death) are not associated with the renal ET system

  11. Happy employees lead to loyal patients. Survey of nurses and patients shows a strong link between employee satisfaction and patient loyalty.

    Science.gov (United States)

    Atkins, P M; Marshall, B S; Javalgi, R G

    1996-01-01

    A strong relationship exists between employee satisfaction and patients' perceptions of the quality of their care, measured in terms of their intent to return and to recommend the hospital to others. Employee dissatisfaction can negatively affect quality of care and have an adverse effect on patient loyalty and, thus hospital profitability. Therefore, health care marketers should regularly measure employee satisfaction as one way to monitor service quality. Health care marketers must work more closely with their human-resource departments to understand and influence employees' work environment and maintain a high level of job satisfaction. Marketers also should place an increased emphasis on both employee and patient perceptions of satisfaction when developing internal and external strategic marketing plans and formulating future research.

  12. Contrasting features of urea cycle disorders in human patients and knockout mouse models.

    Science.gov (United States)

    Deignan, Joshua L; Cederbaum, Stephen D; Grody, Wayne W

    2008-01-01

    The urea cycle exists for the removal of excess nitrogen from the body. Six separate enzymes comprise the urea cycle, and a deficiency in any one of them causes a urea cycle disorder (UCD) in humans. Arginase is the only urea cycle enzyme with an alternate isoform, though no known human disorder currently exists due to a deficiency in the second isoform. While all of the UCDs usually present with hyperammonemia in the first few days to months of life, most disorders are distinguished by a characteristic profile of plasma amino acid alterations that can be utilized for diagnosis. While enzyme assay is possible, an analysis of the underlying mutation is preferable for an accurate diagnosis. Mouse models for each of the urea cycle disorders exist (with the exception of NAGS deficiency), and for almost all of them, their clinical and biochemical phenotypes rather closely resemble the phenotypes seen in human patients. Consequently, all of the current mouse models are highly useful for future research into novel pharmacological and dietary treatments and gene therapy protocols for the management of urea cycle disorders.

  13. Prevalence of NSF following intravenous gadolinium-contrast media administration in dialysis patients with endstage renal disease

    Energy Technology Data Exchange (ETDEWEB)

    Heinz-Peer, Gertraud, E-mail: gertraud.heinz@meduniwien.ac.a [Department of Radiology, Medical University of Vienna (Austria); Neruda, Anita [Department of Radiology, Medical University of Vienna (Austria); Watschinger, Bruno; Vychytil, Andreas [Department of Nephrology, Medical University of Vienna (Austria); Geusau, Alexandra [Department of Dermatology, Medical University of Vienna (Austria); Haumer, Markus [Department of Internal Medicine II, Medical University of Vienna (Austria); Weber, Michael [Department of Radiology, Medical University of Vienna (Austria)

    2010-10-15

    Purpose: To evaluate the prevalence of nephrogenic systemic fibrosis (NSF) in a patient population being at highest risk for developing this disease and to evaluate possible risk factors. Materials and methods: The radiological records of 552 patients with ESRD being on hemodialysis (HD) or peritoneal dialysis (PD) were retrospectively reviewed to identify whether the patients underwent MR-examinations with or without intravenous administration of GBCA. In case of exposure to GBCA, the number of contrast injections, the benchmark and the cumulative doses of GBCA, and possible cofactors regarding pathogenesis of NSF were recorded. Diagnosis of NSF was confirmed either by deep skin biopsy or by review of medical and histopathological records. Data of NSF patients were compared with data of dialysis patients who did not develop NSF after MR-examinations. Results: 146 dialysis patients underwent MRI without i.v.-administration of GBCA. No case of NSF was observed in this patient population. 195/552 patients proved to have a total number of 325 well-documented exposures to GBCA. Seven different types of GBCA were used during these MR-examinations. NSF prevalence rate was 1.6%. One patient died of NSF. Three different types of GBCA were involved in 6 NSF cases. 4/6 proved to be confounded cases. The cumulative dose of GBCA, history of thrombosis, recent surgery, and the combination of HD and PD proved to be significant cofactors for the development of NSF (p < .05). No significant difference regarding residual renal clearance (p = .898) and residual urine volume (p = .083) was found between NSF and non-NSF patients. Conclusion: The prevalence of NSF proved to be much lower in this high risk patient group being exposed to GBCA compared to the literature. NSF was not observed in ESRD patients undergoing MRI without administration of GBCA. Our data support a positive association between cumulative dose of GBCA and development of NSF. No positive association was found

  14. Leaving out control groups: an internal contrast analysis of gene expression profiles in atrial fibrillation patients--a systems biology approach to clinical categorization.

    Science.gov (United States)

    Vanhoutte, Kurt; de Asmundis, Carlo; Francesconi, Anna; Figysl, Jurgen; Steurs, Griet; Boussy, Tim; Roos, Markus; Mueller, Andreas; Massimo, Lucio; Paparella, Gaetano; Van Caelenberg, Kristien; Chierchia, Gian Battista; Sarkozy, Andrea; Terradellas, Pedro Brugada Y; Zizi, Martin

    2009-01-01

    Atrial fibrillation (AF) is a frequent chronic dysrythmia with an incidence that increases with age (>40). Because of its medical and socio-economic impacts it is expected to become an increasing burden on most health care systems. AF is a multi-factorial disease for which the identification of subtypes is warranted. Novel approaches based on the broad concepts of systems biology may overcome the blurred notion of normal and pathological phenotype, which is inherent to high throughput molecular arrays analysis. Here we apply an internal contrast algorithm on AF patient data with an analytical focus on potential entry pathways into the disease. We used a RMA (Robust Multichip Average) normalized Affymetrix micro-array data set from 10 AF patients (geo_accession #GSE2240). Four series of probes were selected based on physiopathogenic links with AF entryways: apoptosis (remodeling), MAP kinase (cell remodeling), OXPHOS (ability to sustain hemodynamic workload) and glycolysis (ischemia). Annotated probe lists were polled with Bioconductor packages in R (version 2.7.1). Genetic profile contrasts were analysed with hierarchical clustering and principal component analysis. The analysis revealed distinct patient groups for all probe sets. A substantial part (54% till 67%) of the variance is explained in the first 2 principal components. Genes in PC1/2 with high discriminatory value were selected and analyzed in detail. We aim for reliable molecular stratification of AF. We show that stratification is possible based on physiologically relevant gene sets. Genes with high contrast value are likely to give pathophysiological insight into permanent AF subtypes.

  15. Prevalence and signal characteristics of late gadolinium enhancement on contrast-enhanced magnetic resonance imaging in patients with takotsubo cardiomyopathy

    International Nuclear Information System (INIS)

    Nakamori, Shiro; Matsuoka, Koji; Onishi, Katsuya

    2012-01-01

    The background of this study was to determine the prevalence and signal intensity (SI) characteristics of late gadolinium enhancement (LGE) on magnetic resonance imaging (MRI) in takotsubo cardiomyopathy (TC). Cine, black-blood T2-weighted and LGE MR images were acquired in 23 patients with TC within 72h of onset. Wall motion abnormality (WMA), edema and LGE were evaluated with a 16-segment model. The SI characteristics of LGE were analyzed using SI distribution in remote normal segments as reference. Follow-up MRI was performed 3 months later. Retrospective analysis of LGE MRI was also performed in 10 patients with acute myocardial infarction (AMI) to compare the SI characteristics between TC and AMI. In acute phase, WMA and edema were observed in 236 (64%) and 205 (56%) of 368 segments. LGE was observed in 10 (2.7%) of 368 segments and in 5 (22%) of 23 patients. All LGE lesions in TC exhibited transmural enhancement. The contrast-to-noise ratio (CNR) in TC was significantly lower than that of AMI (3.1±0.3 standard deviations (SD) vs. 6.1±1.2 SD, P<0.01), and CNR value of 4 was useful for distinguishing TC from AMI. Both LGE and WMA disappeared within 12 months. Grey myocardial signal on LGE MRI may be observed in patients with TC. However, the extent of LGE is substantially less than that of WMA and edema, and disappears within 12 months. (author)

  16. The Fate of High-Density Lesions on the Non-contrast CT Obtained Immediately After Intra-arterial Thrombolysis in Ischemic Stroke Patients

    International Nuclear Information System (INIS)

    Jang, Yu Mi; Lee, Deok Hee; Kim, Ho Sung; Ryu, Chang Woo; Lee, Jeong Hyun; Choi, Choong Gon; Kim, Sang Joon; Suh, Dae Chul

    2006-01-01

    Hyperdense lesions can frequently be observed on the CT obtained immediately after intra-arterial (IA) thrombolysis, and it is sometimes difficult to differentiate contrast extravasation from the hemorrhagic lesions. The purposes of this study are to classify the hyperdense lesions according to their morphologic features and to track the outcome of those lesions. Among the 94 patients who suffered with anterior circulation ischemic stroke and who were treated with IA thrombolysis, 31 patients revealed hyperdense lesions on the CT obtained immediately after the procedure. The lesions were categorized into four types according to their volume, shape, location and density: cortical high density (HD), soft HD, metallic HD and diffuse HD. The follow-up images were obtained 3 5 days later in order to visualize the morphologic changes and hemorrhagic transformation of the lesions. Among the 31 patients with HD lesions, 18 (58%) showed hemorrhagic transformation of their lesion, and six of them were significant. All the cortical HD lesions (n = 4) revealed spontaneous resolution. Seven of the soft HD lesions (n = 13) showed spontaneous resolution, while the rest of the group showed hemorrhagic transformation. Among them the hemorrhage was significant in only two patients (2/6) who did not achieve successful recanalization. All the metallic HD lesions (n = 10) resulted in hemorrhagic transformation; among them, three cases (30%) with a maximum CT value more than 150 HU (Hounsfield unit) subsequently showed significant hemorrhagic transformation on the follow-up CT. There were four diffuse HD lesions, and two of them showed hemorrhagic transformation. The parenchymal hyperdense lesions observed on the CT obtained immediately after IA thrombolysis in ischemic stroke patients exhibited varying features and they were not always hemorrhagic. Most of the soft HD lesions were benign, and although all of the metallic HD lesions were hemorrhagic, some of them were ultimately found

  17. Sex on show. Issues of privacy and dignity in a Forensic mental health hospital: Nurse and patient views.

    Science.gov (United States)

    Quinn, Chris; Happell, Brenda

    2015-08-01

    To explore perceptions of privacy and dignity for sexual relationships in a Forensic mental health hospital. The role of nurses in forensic mental health hospitals is frequently complicated by opposing expectations of therapeutic relationships and maintaining security. What can result is an over-emphasis on risk reduction by controlling patient behaviour, which can extend to patient intimacy and sexual relationships. An exploratory, qualitative approach. Individual interviews were conducted with 12 nurses and 10 patients in a forensic mental health hospital. Thematic data analysis was undertaken to identify the main themes. The need for a private and dignified place for patient intimacy was one major theme to emerge from this research from both nurse and patient participants and is the focus of this article. A disparity is reported between the level of support reported by nurse participants with the experience of the patient participants. Sexual intimacy and sexual relationships are important components of normal human behaviour. Institutional rules and rule adherence create barriers for patients, forcing their intimacy and sexual relationships into secrecy. There is a need for further research to consider the benefits and risks of patient intimacy and sexual relationships for long-term patients in forensic mental health settings. Patients in forensic hospitals are sexually active and seek support from nurses. Nurses are in an ideal role to recognise the important part they can play in supporting the intimacy and sexual relationship needs of patients. Strategies to assist in developing confidence in responding to normal human behaviour is a matter of priority. © 2015 John Wiley & Sons Ltd.

  18. Informed consent for the administration of an intravenous contrast agent: importance and determinants of patient refusal; Consentimiento informado para la administracion de contraste intravenoso. Importancia y factores determinantes del rechazo por los pacientes

    Energy Technology Data Exchange (ETDEWEB)

    Martel, J. [Fundacion Hospital Alcorcon. Madrid (Spain); Garcia-Diaz, J. D. [Hospital Universitario Principe de Asturias. Alcala de Henares. Madrid (Spain)

    1999-07-01

    We proposed to determine the proportion of patients who refuse to undergo intravenous contrast administration and the factors that influence their refusal. Our series consisted of 442 patients who were supposed to undergo imaging studies involving the intravenous injection of an iodine contrast. In a personal interview, the patients were issued a questionnaire specifically designed for this study. The following parameters were recorded: sex, age, inpatient or outpatient status, medical history available, person who informed them about the procedure, person signing the informed consent (patient or other) , highest academic degree, attitude toward receiving the information and degree of concern after reading and signing the consent form. In our series 8.6% of the patients (95% confidence interval: 6-11.2) refused to sign the informed consent form. In addition, there were a number of patients who delayed the procedure or hindered the daily work schedule by some other means. When the relationship between each of the variables studied and refusal to sign the consent form was assessed, significant associations were observed between the latter and the academic level of the patient, his or her degree of concern and having received the information from a trained person. There was also a nearly significant trend toward the association between refusal and the patient's background. Relatively few patients refuse to sign the informed consent to receive intravenous contrast administration but this negative decision interferes with the health care practice. It is possible to identify certain correctable factors that influence the patient in this respect. (Author) 13 refs.

  19. MRI of the fingers in patients with systemic scleroderma. Early results of contrast-enhanced examinations on a dedicated MRI system

    International Nuclear Information System (INIS)

    Bonel, H.; Seemann, M.; Reiser, M.; Messer, G.; Walchner, M.; Roecken, M.

    1997-01-01

    Purpose. To estimate disease activity in patients with systemic sclerosis using contrast-enhanced MRI of the skin. Material and Methods. In a pre-study, sequences of a low-field (0.2 T) scanner (Artoscan, Esaote, Genova, Italy) were optimized for detection of intravenous contrast (0.1 mmol/l Gd-DTPA) in six patients with the autoimmune disease systemic scleroderma. Based on the results of the pre-study, 17 patients with scleroderma (7 sclerotic/10 active inflammatory disease) were scanned using gradient-spoiled 3D GRE sequences (FA 90 , TR 100 ms, TE 18 ms), which had been established as most sensitive for intravenous contrast. Contrast enhancement of the skin was determined quantitatively by contrast-to-noise ratios (CNR), comparing post- to pre-contrast and dynamic scans (for 6 min, 1 acquisition/min). Patients in the chronic state with sclerodactylia and active inflammation of the hands were considered separately and compared to a control group (n=10) matched according to age. Results. CNR increase after intravenous contrast was significantly higher in patients with active disease (86±16% increase) than sclerosing disease (29±3%, p [de

  20. Can Dynamic Susceptibility Contrast Magnetic Resonance Imaging Replace Single-Photon Emission Computed Tomography in the Diagnosis of Patients with Alzheimer's Disease? A Pilot Study

    International Nuclear Information System (INIS)

    Cavallin, L.; Danielsson, R.; Oeksengard, A.R.; Wahlund, L.O.; Julin, P.; Frank, A.; Engman, E.L.; Svensson, L.; Kristoffersen Wiberg, M.

    2006-01-01

    Purpose: To compare single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) in a cohort of patients examined for suspected dementia, including patients with no objective cognitive impairment (control group), mild cognitive impairment (MCI), and Alzheimer's disease (AD). Material and Methods: Twenty-four patients, eight with AD, 10 with MCI, and six controls were investigated with SPECT using 99m Tc-hexamethylpropyleneamine oxime (HMPAO) and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) with gadobutrol. Three observers performed a visual interpretation of the SPECT and MR images using a four-point visual scale. Results: SPECT was superior to DSC-MRI in differentiating normal from pathological. All three observers showed statistically significant results in discriminating between the control group, AD, and MCI by SPECT, with a P value of 0.0006, 0.04, and 0.01 for each observer. The statistical results were not significant for MR (P values 0.8, 0.1, and 0.2, respectively). Conclusion: DSC-MRI could not replace SPECT in the diagnosis of patients with Alzheimer's disease. Several patient- and method-related improvements should be made before this method can be recommended for clinical practice

  1. Can Dynamic Susceptibility Contrast Magnetic Resonance Imaging Replace Single-Photon Emission Computed Tomography in the Diagnosis of Patients with Alzheimer's Disease? A Pilot Study

    Energy Technology Data Exchange (ETDEWEB)

    Cavallin, L.; Danielsson, R.; Oeksengard, A.R.; Wahlund, L.O.; Julin, P.; Frank, A.; Engman, E.L.; Svensson, L.; Kristoffersen Wiberg, M. [Karolinska Univ. Hospital, Stockholm (Sweden). Div. of Radiology

    2006-11-15

    Purpose: To compare single-photon emission computed tomography (SPECT) and magnetic resonance imaging (MRI) in a cohort of patients examined for suspected dementia, including patients with no objective cognitive impairment (control group), mild cognitive impairment (MCI), and Alzheimer's disease (AD). Material and Methods: Twenty-four patients, eight with AD, 10 with MCI, and six controls were investigated with SPECT using {sup 99m}Tc-hexamethylpropyleneamine oxime (HMPAO) and dynamic susceptibility contrast magnetic resonance imaging (DSC-MRI) with gadobutrol. Three observers performed a visual interpretation of the SPECT and MR images using a four-point visual scale. Results: SPECT was superior to DSC-MRI in differentiating normal from pathological. All three observers showed statistically significant results in discriminating between the control group, AD, and MCI by SPECT, with a P value of 0.0006, 0.04, and 0.01 for each observer. The statistical results were not significant for MR (P values 0.8, 0.1, and 0.2, respectively). Conclusion: DSC-MRI could not replace SPECT in the diagnosis of patients with Alzheimer's disease. Several patient- and method-related improvements should be made before this method can be recommended for clinical practice.

  2. Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

    Science.gov (United States)

    Gardner, Kristin OʼMara

    2015-01-01

    The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families.

  3. Intraoperative laser speckle contrast imaging for monitoring cerebral blood flow: results from a 10-patient pilot study

    Science.gov (United States)

    Richards, Lisa M.; Weber, Erica L.; Parthasarathy, Ashwin B.; Kappeler, Kaelyn L.; Fox, Douglas J.; Dunn, Andrew K.

    2012-02-01

    Monitoring cerebral blood flow (CBF) during neurosurgery can provide important physiological information for a variety of surgical procedures. Although multiple intraoperative vascular monitoring technologies are currently available, a quantitative method that allows for continuous monitoring is still needed. Laser speckle contrast imaging (LSCI) is an optical imaging method with high spatial and temporal resolution that has been widely used to image CBF in animal models in vivo. In this pilot clinical study, we adapted a Zeiss OPMI Pentero neurosurgical microscope to obtain LSCI images by attaching a camera and a laser diode. This LSCI adapted instrument has been used to acquire full field flow images from 10 patients during tumor resection procedures. The patient's ECG was recorded during acquisition and image registration was performed in post-processing to account for pulsatile motion artifacts. Digital photographs confirmed alignment of vasculature and flow images in four cases, and a relative change in blood flow was observed in two patients after bipolar cautery. The LSCI adapted instrument has the capability to produce real-time, full field CBF image maps with excellent spatial resolution and minimal intervention to the surgical procedure. Results from this study demonstrate the feasibility of using LSCI to monitor blood flow during neurosurgery.

  4. Prognostic value of preoperative dynamic contrast-enhanced MRI perfusion parameters for high-grade glioma patients

    Energy Technology Data Exchange (ETDEWEB)

    Ulyte, Agne [Vilnius University, Faculty of Medicine, Vilnius (Lithuania); Katsaros, Vasileios K. [General Anticancer and Oncological Hospital ' ' St. Savvas' ' , Department of Advanced Imaging Modalities - CT and MRI, Athens (Greece); University of Athens, Department of Neurosurgery, Evangelismos Hospital, Athens (Greece); Liouta, Evangelia; Stranjalis, Georgios [University of Athens, Department of Neurosurgery, Evangelismos Hospital, Athens (Greece); Boskos, Christos [University of Athens, Department of Neurosurgery, Evangelismos Hospital, Athens (Greece); General Anticancer and Oncological Hospital ' ' St. Savvas' ' , Department of Radiation Oncology, Athens (Greece); Papanikolaou, Nickolas [Champalimaud Foundation, Department of Radiology, Centre for the Unknown, Lisbon (Portugal); Usinskiene, Jurgita [National Cancer Institute, Vilnius (Lithuania); Affidea Lietuva, Vilnius (Lithuania); Bisdas, Sotirios [University College London Hospitals, Department of Neuroradiology, The National Hospital for Neurology and Neurosurgery, London (United Kingdom)

    2016-12-15

    The prognostic value of the dynamic contrast-enhanced (DCE) MRI perfusion and its histogram analysis-derived metrics is not well established for high-grade glioma (HGG) patients. The aim of this prospective study was to investigate DCE perfusion transfer coefficient (K{sup trans}), vascular plasma volume fraction (v{sub p}), extracellular volume fraction (v{sub e}), reverse transfer constant (k{sub ep}), and initial area under gadolinium concentration time curve (IAUGC) as predictors of progression-free (PFS) and overall survival (OS) in HGG patients. Sixty-nine patients with suspected anaplastic astrocytoma or glioblastoma underwent preoperative DCE-MRI scans. DCE perfusion whole tumor region histogram parameters, clinical details, and PFS and OS data were obtained. Univariate, multivariate, and Kaplan-Meier survival analyses were conducted. Receiver operating characteristic (ROC) curve analysis was employed to identify perfusion parameters with the best differentiation performance. On univariate analysis, v{sub e} and skewness of v{sub p} had significant negative impacts, while k{sub ep} had significant positive impact on OS (P < 0.05). v{sub e} was also a negative predictor of PFS (P < 0.05). Patients with lower v{sub e} and IAUGC had longer median PFS and OS on Kaplan-Meier analysis (P < 0.05). K{sup trans} and v{sub e} could also differentiate grade III from IV gliomas (area under the curve 0.819 and 0.791, respectively). High v{sub e} is a consistent predictor of worse PFS and OS in HGG glioma patients. v{sub p} skewness and k{sub ep} are also predictive for OS. K{sup trans} and v{sub e} demonstrated the best diagnostic performance for differentiating grade III from IV gliomas. (orig.)

  5. Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

    International Nuclear Information System (INIS)

    Zha, Yunfei; Li, Maojin; Yang, Jianyong

    2010-01-01

    To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies. Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (E max ), enhancement slope (ES), and time to peak (TTP) were determined from a time intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow. Differences in E max , ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p max , ES, and TTP values were significantly different between bone marrow infiltration groups Grade 1 and Grade 2 (Z = -2.72, -2.24 and -2.89 respectively, p max , ES and TTP values were not significantly different between bone marrow infiltration groups Grade 2 and Grade 3 (Z = -1.57, -1.82 and -1.58 respectively, p > 0.05). A positive correlation was found between E max , ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p max and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t = -7.92, -4.55, and 5.12, respectively, p max , ES, and TTP can reflect the malignancies' histological grade

  6. Contrast Media Use in Radiation Oncology: A Prospective, Controlled Educational Intervention Study with Retrospective Analysis of Patient Outcomes

    Science.gov (United States)

    Barker, Christopher A.; Mutter, Robert W.; Shapiro, Lauren Q.; Zhang, Zhigang; Wolden, Suzanne L.; Yahalom, Joachim

    2016-01-01

    Purpose Intravenous contrast media (ICM) administration is recommended as part of radiation therapy (RT) simulation in a variety of clinical scenarios, but can cause adverse events. We sought to assess radiation oncology resident knowledge about ICM, and to determine if an educational intervention (EI) could improve this level of knowledge. In conjunction, we retrospectively analyzed risk factors and adverse events related to ICM use before and after the EI to determine whether any improvements in patient outcomes could be realized. Methods Over 2 years, 21 residents in radiation oncology at Memorial Sloan-Kettering Cancer Center (MSKCC) participated in a pretest-EI-posttest study based on the ACR’s Manual on Contrast Media. Medical and RT records were reviewed, and ICM use, risk factors and adverse events were recorded. Results There was no significant difference in resident understanding of ICM use in residents of different years of training (p=0.85). Understanding of ICM use increased in residents that attended the EI (p<0.05), but this was not sustained 1 year after the EI (p=0.48). Of the 6852 RT simulations that were performed at MSKCC, 1350 (19.7%) involved ICM. Mild adverse events occurred in a few patients (<5%) simulated with ICM, but there was no difference in the number of risk factors or adverse events before and after the EI. Conclusions The EI effectively improved short-term understanding of ICM use. However, the effect was not sustained. The frequency of adverse events related to ICM use was small and not significantly impacted by the EI. PMID:21129689

  7. Prediction of presence of kidney disease in patients undergoing intravenous iodinated contrast enhanced computed tomography: a validation study

    Energy Technology Data Exchange (ETDEWEB)

    Schreuder, Sanne M.; Stoker, Jaap; Bipat, Shandra [University of Amsterdam, Department of Radiology, Academic Medical Centre, G1-212, Amsterdam (Netherlands)

    2017-04-15

    To validate two previously presented models containing risk factors to identify patients with estimated glomerular filtration rate (eGFR) <60 ml/min/1.73 m{sup 2} or eGFR <45 ml/min/1.73 m{sup 2}. In random patients undergoing intravenous contrast-enhanced computed tomography (CECT) the following risk factors were assessed: history of urological/nephrological disease, hypertension, diabetes mellitus, anaemia, congestive heart failure, other cardiovascular disease or multiple myeloma or Waldenstroem disease. Data on kidney function, age, gender and type and indication of CECT were also registered. We studied two models: model A - diabetes mellitus, history of urological/nephrological disease, cardiovascular disease, hypertension; model B - diabetes mellitus, history of urological/nephrological disease, age >75 years and congestive heart failure. For each model, associations with eGFR <60 ml/min/1.73 m{sup 2} or eGFR <45 ml/min/1.73 m{sup 2} was studied. A total of 1,001 patients, mean age 60.36 years were included. In total, 92 (9.2 %) patients had an eGFR <60 ml/min/1.73 m{sup 2} and 11 (1.1 %) patients an eGFR <45 ml/min/1.73 m{sup 2}. Model A detected 543 patients: 81 with eGFR <60 ml/min/1.73 m{sup 2} (missing 11) and all 11 with eGFR <45 ml/min/1.73 m{sup 2}. Model B detected 420 patients: 70 (missing 22) with eGFR <60 ml/min/1.73 m{sup 2} and all 11 with eGFR <45 ml/min/1.73 m{sup 2}. Associations were significant (p < 0.05). Model B resulted in the lowest superfluous eGFR measurements while detecting all patients with eGFR <45 ml/min/1.73 m{sup 2} and nearly all with eGFR <60 ml/min/1.73 m{sup 2}. (orig.)

  8. 4-step 4-h carboplatin desensitization protocol for patients with gynecological malignancies showing platinum hypersensitivity: a retrospective study.

    Science.gov (United States)

    Takase, Naoto; Matsumoto, Koji; Onoe, Takuma; Kitao, Akihito; Tanioka, Maki; Kikukawa, Yoshitaka; Yamaguchi, Satoshi; Fujiwara, Kiyoshi; Negoro, Shunichi

    2015-06-01

    Platinum agents are essential for treating gynecological malignancies, particularly ovarian cancer. However, multiple carboplatin doses may cause hypersensitivity reactions (HSRs). Carboplatin desensitization prevents life-threatening HSRs and promotes the successful completion of planned chemotherapy. Since January 2010, carboplatin desensitization was performed at our institution. Solutions with 1/1000, 1/100, and 1/10 dilutions of carboplatin and an undiluted solution were prepared in 250 mL of 5% glucose. Each solution was administered as a 1-h intravenous infusion (4-step 4-h protocol). This retrospective analysis was approved by the institutional review board. From January 2010 to December 2013, 20 patients with gynecological malignancies (median age 62 years, range 43-74 years) received desensitization treatment. The International Federation of Gynecology and Obstetrics stages at presentation were I, II, III, and IV in 1, 1, 15, 13 patients, respectively. During first-line and second-line treatments, 3 and 17 patients, respectively, experienced carboplatin-induced HSRs. The median carboplatin cycle number was 11 (range 2-16). In the first desensitization cycle, 17 (85%) patients completed treatment without adverse events, 2 experienced Grade 1 HSRs but completed treatment, and 1 experienced Grade 3 HSR and discontinued treatment. The first desensitization cycle completion rate was 95%. Of 83 desensitization cycles administered, 79 (95.2%) were completed. No treatment-related deaths occurred. Most patients completed the planned chemotherapy. Our protocol could be conducted safely with shorter duration and simpler procedures than previous protocols. Carboplatin desensitization seems beneficial for patients with a history of carboplatin-induced HSRs; however, the risk of HSR recurrence still remains. Desensitization should therefore be performed only by well-trained staff.

  9. Secukinumab shows significant efficacy in two patients with difficult-to-treat areas of psoriasis: a Greek experience.

    Science.gov (United States)

    Platsidaki, Eftychia; Kostopoulos, Nikolaos; Marnelakis, Ioannis; Panagakis, Pantelis

    2018-03-15

    Psoriasis is one of the most frequently occurring chronic inflammatory skin diseases. There are some specialized regions of the body that are considered difficult to treat. Secukinumab is a human monoclonal immunoglobulin G antibody that blocks the interleukin 17A ligand and has been shown to be highly efficacious in treating moderate-to-severe psoriasis. We studied two Greek patients, one with scalp psoriasis and the other with palmoplantar psoriasis, both resistant to treatment. Patients were treated with secukinumab and efficacy and safety were recorded. The patient with severe, refractory palmoplantar psoriasis achieved complete clearance at the end of the 4-week treatment period with secukinumab. The patient with moderate to severe, chronic scalp psoriasis was successfully treated with secukinumab, obtaining complete clearance of symptoms and remission of disease after approximately 16 weeks. In both cases clinical response was maintained through week 52. Secukinumab has been shown to be highly efficacious in the treatment of psoriasis of specific anatomical sites with an acceptable safety profile.

  10. Data showing levels of interleukin-1β and nitric oxide in the plasma of uropathogenic E. coli infected UTI patients.

    Science.gov (United States)

    Verma, Vivek; Arora, Renu; Dhanda, Rakesh Singh; Gaind, Rajni; Yadav, Manisha

    2018-08-01

    Urinary tract infections (UTI) are a major cause of morbidity, affecting at least four million women worldwide, 65-75% of these infections are caused by Uropathogenic Escherichia coli (UPEC) (Foxman, 2010) [1]. Repertoire of virulence factors carried by UPEC provides the ability to precede urinary tract and additionally they provoke pro-inflammatory responses (Cirl et al., 2008; Verma et al., 2016) [2], [3]. In context to UPEC infected UTI patients, the levels of pro-inflammatory cytokine IL-1β and enzymatic antioxidant nitric oxide (NO) have not been reported worldwide till date, including India. In this data article, we report for the first time the levels of IL-1β and nitric oxide in the plasma of UPEC infected UTI patients. Data includes a profile of pro-inflammatory cytokine IL-1β and NO in the plasma of the confirmed UPEC infected UTI patients ( N  = 30) versus healthy controls ( N  = 40) from the present pilot study. The levels of IL-1β in plasma were significantly higher ( p  UTI patients (60.29 ± 1.1 μM) as compared to healthy controls (106.3 ± 8.75 μM).

  11. Prediction of presence of kidney disease in a general patient population undergoing intravenous iodinated contrast enhanced computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Moos, Shira I.; Stoker, Jaap; Nagan, Gajenthiran; Weijert, Roderick S. de; Vemde, David N.H. van; Bipat, Shandra [Academic Medical Center, University of Amsterdam, Department of Radiology, G1-215, Amsterdam (Netherlands)

    2014-06-15

    To assess which risk factors can be used to reduce superfluous estimated glomerular filtration rate (eGFR) measurements before intravenous contrast medium administration. In consecutive patients, all decreased eGFR risk factors were assessed: diabetes mellitus (DM), history of urologic/nephrologic disease (HUND), nephrotoxic medication, cardiovascular disease, hypertension, age > 60 years, anaemia, malignancy and multiple myeloma/M. Waldenstroem. We studied four models: (1) all risk factors, (2) DM, HUND, hypertension, age > 60 years; (3) DM, HUND, cardiovascular disease, hypertension; (4) DM, HUND, age > 75 years and congestive heart failure. For each model, association with eGFR < 60 ml/min/1.73 m{sup 2} or eGFR < 45 ml/min/1.73 m{sup 2} was studied. A total of 998 patients, mean age 59.94 years were included; 112 with eGFR < 60 ml/min/1.73 m{sup 2} and 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 1 detected 816 patients: 108 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 2 detected 745 patients: 108 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 3 detected 622 patients: 100 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Model 4 detected 440 patients: 86 with eGFR < 60 ml/min/1.73 m{sup 2} and all 30 with eGFR < 45 ml/min/1.73 m{sup 2}. Associations were significant (p < 0.001). Model 4 is most effective, resulting in the lowest proportion of superfluous eGFR measurements while detecting all patients with eGFR < 45 ml/min/1.73 m{sup 2} and most with eGFR < 60 ml/min/1.73 m{sup 2}. (orig.)

  12. Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT - A pooled analysis of two randomized trials

    Energy Technology Data Exchange (ETDEWEB)

    Thomsen, Henrik S. [University of Copenhagen, Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, and Department of Diagnostic Sciences, Faculty of Health Sciences, Herlev (Denmark); Morcos, Sameh K. [University of Sheffield, Department of Diagnostic Imaging, Northern General Hospital, Sheffield (United Kingdom)

    2009-04-15

    The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients with glomerular filtration rate (GFR) <60 ml/min undergoing contrast-enhanced MDCT examinations and to compare the rates of CIN following the IV administration of low-osmolar contrast media (LOCM, iopamidol and iomeprol) and an iso-osmolar contrast medium (IOCM, iodixanol). A total of 301 adult patients with moderate-to-severe renal failure received a similar IV contrast dose (40 gI). Serum creatinine (SCr) was measured at screening, baseline and 48-72 {+-} 6 h after the MDCT examination. Primary CIN outcome was an increase in SCr {>=}0.5 mg/dl ({>=}44.2 {mu}mol/l) from baseline. The CIN rates were 2.3% in the total population, 0.6% when GFR >40 ml/min, 4.6% when GFR <40 ml/min and 7.8% in patients with GFR <30 ml/min. The incidence of CIN was significantly higher after iodixanol than after LOCM (seven patients, 4.7% following IOCM, no CIN cases following the LOCM; p = 0.007). Significant differences in favor of the LOCM were also observed in patients with GFR <40 ml/min and GFR <30 ml/min. Following the IV administration of nonionic contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM iopamidol and iomeprol, especially in high-risk patients. Differences in osmolality between these LOCM and iodixanol do not play a role in the genesis of CIN. (orig.)

  13. Contrast induced nephropathy

    DEFF Research Database (Denmark)

    Stacul, Fulvio; van der Molen, Aart J; Reimer, Peter

    2011-01-01

    PURPOSE: The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN). AREAS COVERED: Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic me....../min/1.73 m (2) is CIN risk threshold for intravenous contrast medium. • Hydration with either saline or sodium bicarbonate reduces CIN incidence. • Patients with eGFR = 60 ml/min/1.73 m (2) receiving contrast medium can continue metformin normally....

  14. Diagnostic importance of contrast enhanced 18F-fluorodeoxyglucose positron emission computed tomography in patients with tumor induced osteomalacia: Our experience

    International Nuclear Information System (INIS)

    Jain, Avani S.; Shelley, Simon; Muthukrishnan, Indirani; Kalal, Shilpa; Amalachandran, Jaykanth; Chandran, Sureshkumar

    2016-01-01

    To assess the diagnostic utility of contrast-enhanced 18 F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET-ceCT) in localization of tumors in patients with clinical diagnosis of tumor-induced osteomalacia (TIO), in correlation with histopathological results. Eight patients (five male and three female) aged 24–60 (mean 42) years with a clinical diagnosis of TIO were included in this prospective study. They underwent whole body (head to toe) FDG PET-ceCT following a standard protocol on Philips GEMINI TF PET-CT scanner. The FDG PET-ceCT results were correlated with postoperative histology findings and clinical follow-up. All the patients had an abnormal PET-ceCT study. The sensitivity of PET-ceCT was 87.5%, and positive predictive value was 100%. The tumor was located in the craniofacial region in 6/8 patients and in bone in 2/8 patients. Hemangiopericytoma was the most common reported histology. All patients underwent surgery, following which they demonstrated clinical improvement. However, one patient with atypical findings on histology did not show any clinical improvement, hence, underwent 68 Gallium-DOTANOC PET-ceCT scan for relocalization of the site of the tumor. The tumors causing TIO are small in size and usually located in obscure sites in the body. Hence, head to toe protocol should be followed for FDG PET-ceCT scans with the inclusion of upper limbs. Once the tumor is localized, regional magnetic resonance imaging can be performed for better characterization of soft tissue lesion. Imaging with FDG PET-ceCT plays an important role in detecting the site of the tumor and thereby facilitating timely management

  15. Mutation analysis in Duchenne and Becker muscular dystrophy patients from Bulgaria shows a peculiar distribution of breakpoints by intron

    Energy Technology Data Exchange (ETDEWEB)

    Todorova, A.; Bronzova, J.; Kremensky, I. [Univ. Hospital of Obstetrics and Gynecology, Sofia (Bulgaria)] [and others

    1996-10-02

    For the first time in Bulgaria, a deletion/duplication screening was performed on a group of 84 unrelated Duchenne/Becker muscular dystrophy patients, and the breakpoint distribution in the dystrophin gene was analyzed. Intragenic deletions were detected in 67.8% of patients, and intragenic duplications in 2.4%. A peculiar distribution of deletion breakpoints was found. Only 13.2% of the deletion breakpoints fell in the {open_quotes}classical{close_quotes} hot spot in intron 44, whereas the majority (> 54%) were located within the segment encompassing introns 45-51, which includes intron 50, the richest in breakpoints (16%) in the Bulgarian sample. Comparison with data from Greece and Turkey points at the probable existence of a deletion hot spot within intron 50, which might be a characteristic of populations of the Balkan region. 17 refs., 2 figs.

  16. Efficacy of muscle exercise in patients with muscular dystrophy: a systematic review showing a missed opportunity to improve outcomes.

    Directory of Open Access Journals (Sweden)

    Silvia Gianola

    Full Text Available BACKGROUND: Although muscular dystrophy causes muscle weakness and muscle loss, the role of exercise in the management of this disease remains controversial. OBJECTIVE: The purpose of this systematic review is to evaluate the role of exercise interventions on muscle strength in patients with muscular dystrophy. METHODS: We performed systematic electronic searches in Medline, Embase, Web of Science, Scopus and Pedro as well as a list of reference literature. We included trials assessing muscle exercise in patients with muscular dystrophy. Two reviewers independently abstracted data and appraised risk of bias. RESULTS: We identified five small (two controlled and three randomized clinical trials comprising 242 patients and two ongoing randomized controlled trials. We were able to perform two meta-analyses. We found an absence of evidence for a difference in muscle strength (MD 4.18, 95% CIs - 2.03 to 10.39; p = 0.91 and in endurance (MD -0.53, 95% CIs -1.11 to 0.05; p = 0.26. In both, the direction of effects favored muscle exercise. CONCLUSIONS: The first included trial about the efficacy of muscular exercise was published in 1978. Even though some benefits of muscle exercise were consistently reported across studies, the benefits might be due to the small size of studies and other biases. Detrimental effects are still possible. After several decades of research, doctors cannot give advice and patients are, thus, denied basic information. A multi-center randomized trial investigating the strength of muscles, fatigue, and functional limitations is needed.

  17. A simple spatial working memory and attention test on paired symbols shows developmental deficits in schizophrenia patients.

    Science.gov (United States)

    Song, Wei; Zhang, Kai; Sun, Jinhua; Ma, Lina; Jesse, Forrest Fabian; Teng, Xiaochun; Zhou, Ying; Bao, Hechen; Chen, Shiqing; Wang, Shuai; Yang, Beimeng; Chu, Xixia; Ding, Wenhua; Du, Yasong; Cheng, Zaohuo; Wu, Bin; Chen, Shanguang; He, Guang; He, Lin; Chen, Xiaoping; Li, Weidong

    2013-01-01

    People with neuropsychiatric disorders such as schizophrenia often display deficits in spatial working memory and attention. Evaluating working memory and attention in schizophrenia patients is usually based on traditional tasks and the interviewer's judgment. We developed a simple Spatial Working Memory and Attention Test on Paired Symbols (SWAPS). It takes only several minutes to complete, comprising 101 trials for each subject. In this study, we tested 72 schizophrenia patients and 188 healthy volunteers in China. In a healthy control group with ages ranging from 12 to 60, the efficiency score (accuracy divided by reaction time) reached a peak in the 20-27 age range and then declined with increasing age. Importantly, schizophrenia patients failed to display this developmental trend in the same age range and adults had significant deficits compared to the control group. Our data suggests that this simple Spatial Working Memory and Attention Test on Paired Symbols can be a useful tool for studies of spatial working memory and attention in neuropsychiatric disorders.

  18. [A case of a geriatric patient with stage IV anal canal cancer showing complete response to chemoradiation therapy].

    Science.gov (United States)

    Kuroda, Masatoshi; Hirai, Ryuji; Ikeda, Eiji; Tsuji, Hisashi; Takagi, Shoji; Yamano, Toshihisa; Yoshitomi, Seiji

    2012-11-01

    We present a case in which chemoradiation therapy was effective in a geriatric patient with Stage IV anal canal cancer. The patient is an 81-year-old woman who complained of proctorrhagia and anal pain. She was referred to us by her family doctor who suspected rectal cancer. Tumors as large as 6.5 cm in diameter mainly on the right side of the rectum as well as 2 palpable enlarged lymph nodes on the right inguinal area, were found during the initial physical examination. Squamous cell carcinoma was elevated to 16 ng/mL. A CT scan revealed that irregularly shaped masses as large as 7 cm in diameter were externally exposed on the right side of the rectum along with enlarged lymph nodes on the right inguinal area and metastasis at S7 lesion in the liver. Squamous cell carcinoma was diagnosed from biopsy results. Due to her age, the chemotherapy regimen was S-1+CDDP with radiation therapy and 4-port irradiation (50.4 Gy) of the primary tumor, interior of the pelvis, and inguinal lymph nodes. Partial response was observed upon completion of treatment, and complete response was obtained after 6 months. She is currently an outpatient taking S-1: 60 mg/day orally. There is no indication of cancer recurrence after 1 year and 3 months, and she continues to visit an outpatient clinic for regular follow-ups. These results demonstrate the effectiveness of chemoradiation therapy for geriatric patients with Stage IV anal canal cancer.

  19. A Simple Spatial Working Memory and Attention Test on Paired Symbols Shows Developmental Deficits in Schizophrenia Patients

    Directory of Open Access Journals (Sweden)

    Wei Song

    2013-01-01

    Full Text Available People with neuropsychiatric disorders such as schizophrenia often display deficits in spatial working memory and attention. Evaluating working memory and attention in schizophrenia patients is usually based on traditional tasks and the interviewer’s judgment. We developed a simple Spatial Working Memory and Attention Test on Paired Symbols (SWAPS. It takes only several minutes to complete, comprising 101 trials for each subject. In this study, we tested 72 schizophrenia patients and 188 healthy volunteers in China. In a healthy control group with ages ranging from 12 to 60, the efficiency score (accuracy divided by reaction time reached a peak in the 20–27 age range and then declined with increasing age. Importantly, schizophrenia patients failed to display this developmental trend in the same age range and adults had significant deficits compared to the control group. Our data suggests that this simple Spatial Working Memory and Attention Test on Paired Symbols can be a useful tool for studies of spatial working memory and attention in neuropsychiatric disorders.

  20. Effect of duration of contrast material injection on peak enhancement times and values of the aorta, main portal vein, and liver at dynamic MDCT with the dose of contrast medium tailored to patient weight

    International Nuclear Information System (INIS)

    Erturk, S.M.; Ichikawa, T.; Sou, H.; Tsukamoto, T.; Motosugi, U.; Araki, T.

    2008-01-01

    Aim: To investigate the effects of contrast material injection duration on peak enhancement times and attenuation values of the aorta, main portal vein, and liver at MDCT when the dose of contrast material is adjusted to patient weight. Material and methods: Seventy-five patients were randomly assigned to one of five groups, with durations of injection of 25, 30, 35, 40, or 45 s. All patients were injected with 2 ml/kg iodine (300 mg/ml). Attenuation values and peak enhancement times for the aorta, main portal vein, and liver were determined. The relationship between patient weight and enhancement times and values, the differences regarding peak enhancement times, and the relationship between injection duration and enhancement values were investigated using Pearson correlation, analysis of variance (ANOVA), and Spearman rank correlation, respectively. Results: No significant correlations were seen between patient weight and peak enhancement times or values. Mean peak enhancement times for the aorta, main portal vein, and liver were 9-11 s, 18-22 s, and 30-34 s, respectively (p > 0.05). The correlations between injection duration and peak enhancement values were significant and negative. Conclusions: Regardless of patient weight and injection duration, peak enhancement times of aorta, main portal vein and liver were approximately 10, 20, and 30 s, respectively. The enhancement values tended to be higher for shorter injection durations

  1. Characterization of the enhancing lesions on dynamic contrast enhanced magnetic resonance imaging in patients with interstitial mammoplasty

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Tae Yun [Department of Radiology, Seoul St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Kim, Sung Hun, E-mail: rad-ksh@catholic.ac.kr [Department of Radiology, Seoul St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Kang, Bong Joo [Department of Radiology, Seoul St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Kim, Hyeon Sook [Department of Radiology, St. Paul Hospital, The Catholic University of Korea (Korea, Republic of); Cha, Eun Suk [Department of Radiology, Ewha Womans University, School of Medicine, Mokdong Hospital (Korea, Republic of); Kim, Ji Youn [Department of Radiology, Yeouido St. Mary' s Hospital, The Catholic University of Korea (Korea, Republic of); Song, Byung Joo [Department of Surgery, Seoul St. Mary' s Hospital, The Catholic University of Korea, Seoul (Korea, Republic of)

    2013-12-01

    Purpose: The purpose of this study was to categorize the morphologic and kinetic features of enhancing lesions in breasts with interstitial mammoplasty using dynamic contrast-enhanced magnetic resonance imaging and to assess factors predictive of breast cancer. Materials and methods: We retrospectively reviewed the clinical and radiological data of 21 enhancing lesions in 19 patients with interstitial mammoplasty, who underwent breast magnetic resonance imaging and biopsy or an operation in our hospital from September 2008 to July 2012. These lesions were sorted by morphological and kinetic features and final assessment category according to the BI-RADS lexicon. Results: Nine cases were confirmed to be ductal carcinoma in situ (n = 2) and invasive ductal carcinoma (n = 7), and the remaining 12 cases were fibrocystic disease (n = 2), fibroadenoma (n = 2), fat necrosis (n = 1), foreign body granuloma (n = 3) and silicone mastitis (n = 1). Common features of malignancy included irregular shape (50.0%), spiculated margins (75.0%), heterogeneous enhancement (50.0%) and type III kinetic pattern (87.5%). The correlations of margins and kinetic curve pattern with benignity and malignancy approached statistical significance (p = 0.02, respectively). We found no correlation for shape (p = 0.33) or internal enhancement (p = 0.42) between lesion types. The malignancy rate of enhancing lesions was 42.8% (9/21). The sensitivity and specificity of dynamic contrast-enhanced magnetic resonance imaging were 100% and 16.67%, respectively. The positive predictive value, negative predictive value and accuracy of magnetic resonance imaging were 47.38%, 100% and 52.38%. Overall inter-observer agreement for the kinetic curve pattern was good (κ = 0.67). Moderate agreement was seen in describing the shape, margin, enhancement and assessing the final category (κ = 0.59, 0.46, 0.58 and 0.49, respectively). Conclusion: Dynamic contrast-enhanced magnetic resonance imaging had a high

  2. Characterization of the enhancing lesions on dynamic contrast enhanced magnetic resonance imaging in patients with interstitial mammoplasty

    International Nuclear Information System (INIS)

    Kim, Tae Yun; Kim, Sung Hun; Kang, Bong Joo; Kim, Hyeon Sook; Cha, Eun Suk; Kim, Ji Youn; Song, Byung Joo

    2013-01-01

    Purpose: The purpose of this study was to categorize the morphologic and kinetic features of enhancing lesions in breasts with interstitial mammoplasty using dynamic contrast-enhanced magnetic resonance imaging and to assess factors predictive of breast cancer. Materials and methods: We retrospectively reviewed the clinical and radiological data of 21 enhancing lesions in 19 patients with interstitial mammoplasty, who underwent breast magnetic resonance imaging and biopsy or an operation in our hospital from September 2008 to July 2012. These lesions were sorted by morphological and kinetic features and final assessment category according to the BI-RADS lexicon. Results: Nine cases were confirmed to be ductal carcinoma in situ (n = 2) and invasive ductal carcinoma (n = 7), and the remaining 12 cases were fibrocystic disease (n = 2), fibroadenoma (n = 2), fat necrosis (n = 1), foreign body granuloma (n = 3) and silicone mastitis (n = 1). Common features of malignancy included irregular shape (50.0%), spiculated margins (75.0%), heterogeneous enhancement (50.0%) and type III kinetic pattern (87.5%). The correlations of margins and kinetic curve pattern with benignity and malignancy approached statistical significance (p = 0.02, respectively). We found no correlation for shape (p = 0.33) or internal enhancement (p = 0.42) between lesion types. The malignancy rate of enhancing lesions was 42.8% (9/21). The sensitivity and specificity of dynamic contrast-enhanced magnetic resonance imaging were 100% and 16.67%, respectively. The positive predictive value, negative predictive value and accuracy of magnetic resonance imaging were 47.38%, 100% and 52.38%. Overall inter-observer agreement for the kinetic curve pattern was good (κ = 0.67). Moderate agreement was seen in describing the shape, margin, enhancement and assessing the final category (κ = 0.59, 0.46, 0.58 and 0.49, respectively). Conclusion: Dynamic contrast-enhanced magnetic resonance imaging had a high

  3. Preoperative evaluation of neurovascular relationship by using contrast-enhanced and unenhanced 3D time-of-flight MR angiography in patients with trigeminal neuralgia

    International Nuclear Information System (INIS)

    Qin, Zhou; Zhiling, Liu; Chuanfu, Li; Qingshi Zeng; Chuncheng, Qu; Shilei, Ni

    2011-01-01

    Background Microvascular decompression is an etiological strategy for the therapy of trigeminal neuralgia (TN). Preoperative identification of neurovascular compression, therefore, could have an impact on the determination of appropriate treatment for TN. Purpose To evaluate the value of contrast-enhanced and unenhanced three-dimensional (3D) time-of-flight (TOF) MR angiography in the visualization of neurovascular relationship in patients with TN. Material and Methods Thirty-seven patients with unilateral TN underwent unenhanced and contrast-enhanced 3D TOF MR angiography with a 3.0-T MR system. Images were reviewed by a radiologist blinded to clinical details. Vascular contact with the trigeminal nerve was identified, and the nature of the involved vessels (artery or vein) was determined. All patients underwent microvascular decompression. Results In 37 patients with TN, contrast-enhanced 3D TOF MR angiography identified surgically verified neurovascular contact in 35 of 36 symptomatic nerves, and there was no false-positive. Based on surgical findings, the sensitivity of MR imaging was 97.2% and specificity 100%. The nature of the offending vessel was correctly identified in 94.4% of the patients by using the combination of contrast-enhanced and unenhanced MR angiography. Conclusion Contrast-enhanced 3D TOF MR angiography is useful in the detection of vascular contact with the trigeminal nerve in patients with TN, and this MR imaging in combination with unenhanced MR angiography could help in the identification of the nature of the responsible vessels

  4. Excess of Radiation Burden for Young Testicular Cancer Patients using Automatic Exposure Control and Contrast Agent on Whole-body Computed Tomography Imaging.

    Science.gov (United States)

    Niiniviita, Hannele; Kulmala, Jarmo; Pölönen, Tuukka; Määttänen, Heli; Järvinen, Hannu; Salminen, Eeva

    2017-06-01

    The aim of the study was to assess patient dose from whole-body computed tomography (CT) in association with patient size, automatic exposure control (AEC) and intravenous (IV) contrast agent. Sixty-five testicular cancer patients (mean age 28 years) underwent altogether 279 whole-body CT scans from April 2000 to April 2011. The mean number of repeated examinations was 4.3. The GE LightSpeed 16 equipped with AEC and the Siemens Plus 4 CT scanners were used for imaging. Whole-body scans were performed with (216) and without (63) IV contrast. The ImPACT software was used to determine the effective and organ doses. Patient doses were independent (p < 0.41) of patient size when the Plus 4 device (mean 7.4 mSv, SD 1.7 mSv) was used, but with the LightSpeed 16 AEC device, the dose (mean 14 mSv, SD 4.6 mSv) increased significantly (p < 0.001) with waist cirfumference. Imaging with the IV contrast agent caused significantly higher (13% Plus 4, 35% LightSpeed 16) exposure than non-contrast imaging (p < 0.001). Great caution on the use of IV contrast agent and careful set-up of the AEC modulation parameters is recommended to avoid excessive radiation exposure on the whole-body CT imaging of young patients.

  5. Serial contrast-enhanced magnetic resonance and magnetization transfer in the study of patients with multiple sclerosis; Resonancia magnetica con contraste y transferencia de magnetizacion en el estudio seriado de pacientes con esclerosis multiple

    Energy Technology Data Exchange (ETDEWEB)

    Rovira, A; Alonso, J; Cucurella, G; Nos, C; Tintore, M; Pedraza, S; Rio, J; Montalban, X [Hospital General i Universitari Vall d` Hebron. Barcelona (Spain)

    1998-12-31

    To demonstrate the changes in the magnetization transfer ratio (MTR) of different demyelinating plaques, correlating them with the baseline values in T1-weighted contrast-enhanced magnetic resonance (MR) sequences in order to relate them more closely to the underlying disease. The study was based on 33 demyelinating plaques obtained from six patients clinically diagnosed as having remitting-recurring multiple sclerosis (MS). All the patients underwent two MR studies at a 3 to 5-month interval, including contrast-enhanced T1 and T2- weighted sequences and magnetization transfer images. The latter were used to calculate the MTR for each of the demyelinating plaques included in the study. The statistical analysis of the results obtained revealed statistically significant between initial MTR values and those of subsequent T1-weighted sequences. The MTR demonstrate significant differences between plaques according to contrast-enhanced T1-weigh tes sequences, probably indicating variable degrees of edema, demyelination and tissue destruction. These differences should be taken into account to enable the use of T1-weighted sequences to quantify the lesion load in MS patients. (Author) 35 refs.

  6. Comparison of the Mammography, Contrast-Enhanced Spectral Mammography and Ultrasonography in a Group of 116 patients.

    Science.gov (United States)

    Luczyńska, Elzbieta; Heinze, Sylwia; Adamczyk, Agnieszka; Rys, Janusz; Mitus, Jerzy W; Hendrick, Edward

    2016-08-01

    Mammography (MG) is the gold-standard in breast cancer detection - the only method documented to reduce breast cancer mortality. Breast ultrasound (US) has been shown to increase sensitivity to breast cancers in screening women with dense breasts. Contrast-enhanced spectral mammography (CESM) is a novel technique intensively developed in the last few years. The goal of this study was to compare the sensitivity, specificity and accuracy of MG, US and CESM in detecting malignant breast lesions. The study included 116 patients. All patients were symptomatic and underwent MG, US and CESM. A radiologist with 20 years of experience in US and MG breast imaging and 1 year of experience in CESM reviewed images acquired in each of the three modalities separately, within an interval of 14-30 days. All identified lesions were confirmed at core biopsy. BI-RADS classifications on US, MG and CESM were compared to histopathology. MG, CESM and US were compared among 116 patients with 137 lesions encountered. Sensitivity of CESM was 100%, significantly higher than that of MG (90%, p<0.004) or US (92%, p<0.01). CESM accuracy was 78%, also higher than MG (69%, p<0.004) and US (70%, p=0.03). There was no statistically significant difference between AUCs for CESM and US (both 0.83). The AUCs of both US and CESM, however, were significantly larger than that of MG (p<0.0004 for each). CESM permitted better detection of malignant lesions than both MG and US, read individually. CESM found lesion enhancement in some benign lesions, as well, yielding a rate of false-positive diagnoses similar to that of MG and US. Copyright© 2016 International Institute of Anticancer Research (Dr. John G. Delinassios), All rights reserved.

  7. Positive enteric contrast material for abdominal and pelvic CT with automatic exposure control: What is the effect on patient radiation exposure?

    Energy Technology Data Exchange (ETDEWEB)

    Wang, Zhen J., E-mail: jane.wang@radiology.ucsf.edu [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States); Chen, Katherine S.; Gould, Robert; Coakley, Fergus V.; Fu Yanjun; Yeh, Benjamin M. [Department of Radiology, University of California San Francisco, 505 Parnassus Avenue, San Francisco, CA 94143-0628 (United States)

    2011-08-15

    Objective: To assess the effect of positive enteric contrast administration on automatic exposure control (AEC) CT radiation exposure in (1) a CT phantom, and (2) a retrospective review of patients. Materials and methods: We scanned a CT phantom containing simulated bowel that was sequentially filled with water and positive enteric contrast, and recorded the mean volume CT dose index (CTDIvol). We also identified 17 patients who had undergone 2 technically comparable CT scans of the abdomen and pelvis, one with positive enteric contrast and the other with oral water. Paired Student's t-tests were used to compare the mean CTDIvol between scans performed with and without positive enteric contrast. Both the phantom and patient CT scans were performed using AEC with a fixed noise index. Results: The mean CTDIvol for the phantom with simulated bowel containing water and positive enteric contrast were 8.2 {+-} 0.2 mGy, and 8.7 {+-} 0.1 mGy (6.1% higher than water, p = 0.02), respectively. The mean CTDIvol for patients scanned with oral water and with positive enteric contrast were 11.8 mGy and 13.1 mGy, respectively (p = 0.003). This corresponded to a mean CTDIvol which was 11.0% higher (range: 0.0-20.7% higher) in scans with positive enteric contrast than those with oral water in patients. Conclusions: When automatic exposure control is utilized for abdominopelvic CT, the radiation exposure, as measured by CTDIvol, is higher for scans performed with positive enteric contrast than those with oral water.

  8. The impact of reliable prebolus T 1 measurements or a fixed T 1 value in the assessment of glioma patients with dynamic contrast enhancing MRI.

    Science.gov (United States)

    Tietze, Anna; Mouridsen, Kim; Mikkelsen, Irene Klærke

    2015-06-01

    Accurate quantification of hemodynamic parameters using dynamic contrast enhanced (DCE) MRI requires a measurement of tissue T 1 prior to contrast injection (T 1). We evaluate (i) T 1 estimation using the variable flip angle (VFA) and the saturation recovery (SR) techniques and (ii) investigate if accurate estimation of DCE parameters outperform a time-saving approach with a predefined T 1 value when differentiating high- from low-grade gliomas. The accuracy and precision of T 1 measurements, acquired by VFA and SR, were investigated by computer simulations and in glioma patients using an equivalence test (p > 0.05 showing significant difference). The permeability measure, K trans, cerebral blood flow (CBF), and - volume, V p, were calculated in 42 glioma patients, using fixed T 1 of 1500 ms or an individual T 1 measurement, using SR. The areas under the receiver operating characteristic curves (AUCs) were used as measures for accuracy to differentiate tumor grade. The T 1 values obtained by VFA showed larger variation compared to those obtained using SR both in the digital phantom and the human data (p > 0.05). Although a fixed T 1 introduced a bias into the DCE calculation, this had only minor impact on the accuracy differentiating high-grade from low-grade gliomas, (AUCfix = 0.906 and AUCind = 0.884 for K trans; AUCfix = 0.863 and AUCind = 0.856 for V p; p for AUC comparison > 0.05). T 1 measurements by VFA were less precise, and the SR method is preferable, when accurate parameter estimation is required. Semiquantitative DCE values, based on predefined T 1 values, were sufficient to perform tumor grading in our study.

  9. Individual patient data meta-analysis shows no association between the SNP rs1800469 in TGFB and late radiotherapy toxicity

    International Nuclear Information System (INIS)

    Barnett, Gillian C.; Elliott, Rebecca M.; Alsner, Jan; Andreassen, Christian N.; Abdelhay, Osama; Burnet, Neil G.; Chang-Claude, Jenny; Coles, Charlotte E.; Gutiérrez-Enríquez, Sara; Fuentes-Raspall, Maria J.; Alonso-Muñoz, Maria C.; Kerns, Sarah; Raabe, Annette; Symonds, R. Paul; Seibold, Petra; Talbot, Chris J.; Wenz, Frederik; Wilkinson, Jennifer; Yarnold, John; Dunning, Alison M.

    2012-01-01

    Background and purpose: Reported associations between risk of radiation-induced normal tissue injury and single nucleotide polymorphisms (SNPs) in TGFB1, encoding the pro-fibrotic cytokine transforming growth factor-beta 1 (TGF-β1), remain controversial. To overcome publication bias, the international Radiogenomics Consortium collected and analysed individual patient level data from both published and unpublished studies. Materials and methods: TGFB1 SNP rs1800469 c.-1347T>C (previously known as C-509T) genotype, treatment-related data, and clinically-assessed fibrosis (measured at least 2 years after therapy) were available in 2782 participants from 11 cohorts. All received adjuvant breast radiotherapy. Associations between late fibrosis or overall toxicity, reported by STAT (Standardised Total Average Toxicity) score, and rs1800469 genotype were assessed. Results: No statistically significant associations between either fibrosis or overall toxicity and rs1800469 genotype were observed with univariate or multivariate regression analysis. The multivariate odds ratio (OR), obtained from meta-analysis, for an increase in late fibrosis grade with each additional rare allele of rs1800469 was 0.98 (95% Confidence Interval (CI) 0.85–1.11). This CI is sufficiently narrow to rule out any clinically relevant effect on toxicity risk in carriers vs. non-carriers with a high probability. Conclusion: This meta-analysis has not confirmed previous reports of association between fibrosis or overall toxicity and rs1800469 genotype in breast cancer patients. It has demonstrated successful collaboration within the Radiogenomics Consortium.

  10. The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

    Energy Technology Data Exchange (ETDEWEB)

    Ogul, Hayri, E-mail: drhogul@gmail.com [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Guzel, Yunus [Department of Orthopaedics and Traumatology, Medical Faculty, Ordu University, Ordu (Turkey); Pirimoglu, Berhan [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey); Tuncer, Kutsi [Department of Orthopedic, Medical Faculty, Ataturk University, Erzurum (Turkey); Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit [Department of Radiology, Medical Faculty, Ataturk University, Erzurum (Turkey)

    2016-10-15

    Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

  11. Model-based, semiquantitative and time intensity curve shape analysis of dynamic contrast-enhanced MRI: a comparison in patients undergoing antiangiogenic treatment for recurrent glioma

    NARCIS (Netherlands)

    Lavini, Cristina; Verhoeff, Joost J. C.; Majoie, Charles B.; Stalpers, Lukas J. A.; Richel, Dick J.; Maas, Mario

    2011-01-01

    To compare time intensity curve (TIC)-shape analysis of dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) data with model-based analysis and semiquantitative analysis in patients with high-grade glioma treated with the antiangiogenic drug bevacizumab. Fifteen patients had a pretreatment

  12. High prevalence of nephrogenic systemic fibrosis in chronic renal failure patients exposed to gadodiamide, a gadolinium-containing magnetic resonance contrast agent

    DEFF Research Database (Denmark)

    Rydahl, Casper; Thomsen, Henrik S; Marckmann, Peter

    2008-01-01

    OBJECTIVE: Nephrogenic systemic fibrosis (NSF) is a serious disease affecting renal failure patients. It may be caused by some gadolinium (Gd)-containing contrast agents, including gadodiamide. The study aimed at estimating the prevalence of NSF after gadodiamide exposure for patients with chronic...

  13. Comparison of contrast enhanced MR-angiography-MRI and digital subtraction angiography in the evaluation of pancreas and/or kidney transplantation patients : initial experience

    NARCIS (Netherlands)

    Boeve, WJ; Kok, T; Tegzess, Adam; van Son, WJ; Ploeg, RJ; Sluiter, WJ; Kamman, RL

    To evaluate whether combined contrast enhanced MRA and MRI (ce-MRA-MRI) has the potential to replace intra-arterial DSA (i.a.DSA) in patients with impaired graft function or suspected of vascular complications after pancreas and/or kidney transplantation. 7 patients after combined pancreas-kidney

  14. The clinical and radiological importance of extraarticular contrast material leakage into adjacent synovial compartments on ankle MR arthrography in patients with OCD and anterolateral impingement

    International Nuclear Information System (INIS)

    Ogul, Hayri; Guzel, Yunus; Pirimoglu, Berhan; Tuncer, Kutsi; Polat, Gokhan; Ergun, Fatih; Sade, Recep; Bayraktutan, Ummugulsum; Yuce, Ihsan; Kantarci, Mecit

    2016-01-01

    Purpose: To evaluate the tibiotalar joint capacity and the localisation, frequency and amount of extravasation in patients with extraarticular contrast material leakage into adjacent synovial compartments on ankle magnetic resonance (MR) arthrography. Materials and methods: Sites of extravasation were determined in the ankle MR arthrograms of 69 patients. Thirty-four patients without extraarticular contrast material leakage into locations unrelated to the injection path were included as a control group. Volumetric measurements of extraarticular contrast material leakage and the tibiotalar joint capacity were performed on a three dimensional (3D) volume measurement workstation. Results: Extravasation of contrast material occurred through the anterior, posterior, and anterolateral recesses of the tibiotalar joint. The most common site of extravasation was along the flexor hallucis longus tendon synovium (24.6%). The amount of extravasation was significantly higher in patients with ankle osteochondritis dissecans (OCD) than in patients with a different diagnosis (p = 0.039). Loose bodies were detected in all OCD’s patients with insufficient tibiotalar joint distention. Conclusions: Connections between the ankle joint and neighboring synovial compartments can decrease the diagnostic value of ankle MR arthrography examinations due to inadequate joint distention. Large injection volumes should be used for ankle MR arthrography of patients with OCD (especially OCD’s patients with loose body) and impingement syndrome.

  15. Dynamic Contrast Enhanced Magnetic Resonance Imaging of Diffuse Spinal Bone Marrow Infiltration in Patients with Hematological Malignancies

    Energy Technology Data Exchange (ETDEWEB)

    Zha, Yunfei; Li, Maojin [Renmin Hospital of Wuhan University, Wuhan (China); Yang, Jianyong [the First Affiliated Hospital, Sun Yat-Sen University, Guangzhou (China)

    2010-04-15

    To investigate the significance of the dynamic contrast enhanced magnetic resonance imaging (DCE-MRI) parameters of diffuse spinal bone marrow infiltration in patients with hematological malignancies. Dynamic gadolinium-enhanced MR imaging of the lumbar spine was performed in 26 patients with histologically proven diffuse bone marrow infiltration, including multiple myeloma (n = 6), acute lymphoblastic leukemia (n = 6), acute myeloid leukemia (n = 5), chronic myeloid leukemia (n = 7), and non-Hodgkin lymphoma (n = 2). Twenty subjects whose spinal MRI was normal, made up the control group. Peak enhancement percentage (E{sub max}), enhancement slope (ES), and time to peak (TTP) were determined from a time intensity curve (TIC) of lumbar vertebral bone marrow. A comparison between baseline and follow-up MR images and its histological correlation were evaluated in 10 patients. The infiltration grade of hematopoietic marrow with plasma cells was evaluated by a histological assessment of bone marrow. Differences in E{sub max}, ES, and TTP values between the control group and the patients with diffuse bone marrow infiltration were significant (t = -11.51, -9.81 and 3.91, respectively, p < 0.01). E{sub max}, ES, and TTP values were significantly different between bone marrow infiltration groups Grade 1 and Grade 2 (Z = -2.72, -2.24 and -2.89 respectively, p < 0.05). E{sub max}, ES and TTP values were not significantly different between bone marrow infiltration groups Grade 2 and Grade 3 (Z = -1.57, -1.82 and -1.58 respectively, p > 0.05). A positive correlation was found between E{sub max}, ES values and the histological grade of bone marrow infiltration (r = 0.86 and 0.84 respectively, p < 0.01). A negative correlation was found between the TTP values and bone marrow infiltration histological grade (r = -0.54, p < 0.01). A decrease in the E{sub max} and ES values was observed with increased TTP values after treatment in all of the 10 patients who responded to treatment (t

  16. Biologic and Conventional Systemic Therapies Show Similar Safety and Efficacy in Elderly and Adult Patients With Moderate to Severe Psoriasis.

    Science.gov (United States)

    Garber, Caren; Plotnikova, Natalia; Au, Shiu-chung; Sorensen, Eric P; Gottlieb, Alice

    2015-08-01

    Despite the aging population, few studies have documented the treatment of geriatric psoriasis. The purpose of this study is to compare the efficacy, safety, and prescribing patterns of biologics and conventional systemic medications in elderly versus adult psoriasis. All patient visits coded for psoriasis or psoriatic arthritis (ICD-9 696.1 or 696.0) at the Tufts Medical Center General Dermatology Clinic from January 1, 2008, to March 1, 2015 were included in this retrospective cohort study. The outcome measure used was the validated simple-measure for assessing psoriasis activity (S-MAPA), the product of the physician's global assessment and the body surface area. 194 patients who underwent 278 treatment courses were included in the study. 48 patients were included in the elderly cohort (≥ 65 years old) and 146 in the adult cohort (18-64 years old). There was no significant difference in S-MAPA improvement at 12 weeks between the two cohorts when treated with biologics (42.92% improvement in adults, 48.77% in elderly; P=0.498) or conventional systemics (43.96% and 51.82%, respectively; P=0.448). Within the elderly cohort, there was no significant difference in efficacy of biologics versus conventional systemics at any time point. Topical prescription rates were significantly higher in the elderly cohort ( P=0.004) while biologic prescription rates were significantly lower ( P=0.014) despite the same baseline S-MAPA in both age groups. For both biologics and conventional systemics, there was no statistically significant intergroup difference in the rate of adverse events ( P=0.322 for biologics; P=0.581 for conventional systemics) or infection ( P=0.753 for biologics; P=0.828 for conventional systemics). Within the elderly cohort, there was a higher rate of adverse events with conventional systemic treatment than with biologic treatment ( P=0.033). This study provides preliminary evidence to suggest that biologic and conventional systemic therapies are similarly

  17. Evaluation on changes of early renal function in patients with diabetic nephropathy with contrast-enhanced ultrasound and its clinical significance

    International Nuclear Information System (INIS)

    Guo Xinmin; Jin Hong; Pan Liwen; Chen Hui; Liu Wei; Quan Xianyue

    2013-01-01

    Objective: To quantitatively assess the parameter alteration of renal blood flow in patients with diabetic nephropathy (DN) with the contrast-enhanced ultrasound (CEUS), and to evaluate value of the technique in diagnosis of early renal function changes of DN patients. Methods: 40 diabetic patients were equally divided into two group according to Mogensen's staging criteria: normal albuminuria group (group Ⅰ) and early DN group (group Ⅱ); and 15 cases of healthy volunteers were used as control group (N group) (n=15). All subjects were performed renal CEUS perfusion imaging, and QontraXt image analysis software was applied to select the region of interest (ROI) in the renal cortex. Then the time intensity curve (TIC) and kidney blood perfusion parameters were collected. Results: The renal blood perfusion was clearly shown in real time CEUS; compared with N group, the time to peak (TTP), regional blood volume (RBV), and mean transit time (MTT) of the patients in group Ⅰ were increased, there were significant differences (P<0.05); but there were no significant differences of derived peak intensity (DPI) and regional blood flow (RBF) between two groups (P>0.05). Compared with group Ⅰ and N group, the RBV, TTP and MTT of the patients were increased, the DPI and RBF were reduced in group Ⅱ, there were significant differences (P<0.05). Conclusion: The CEUS technical analysis can be used in evaluating renal abnormality of the DN patients in early period by showing the changes of renal perfusion parameters. (authors)

  18. Comparison of neutral oral contrast versus positive oral contrast medium in abdominal multidetector CT

    International Nuclear Information System (INIS)

    Berther, Ralph; Eckhardt, Boris; Zollikofer, Christoph L.; Patak, Michael A.; Erturk, Sukru M.

    2008-01-01

    To determine whether neutral contrast agents with water-equivalent intraluminal attenuation can improve delineation of the bowel wall and increase overall image quality for a non-selected patient population, a neutral oral contrast agent (3% mannitol) was administered to 100 patients referred for abdominal multidetector row computed tomography (MDCT). Their results were compared with those of 100 patients given a positive oral contrast agent. Qualitative and quantitative measurements were done on different levels of the gastrointestinal tract by three experienced readers. Patients given the neutral oral contrast agent showed significant better qualitative results for bowel distension (P<0.001), homogeneity of the luminal content (P<0.001), delineation of the bowel-wall to the lumen (P<0.001) and to the mesentery (P<0.001) and artifacts (P<0.001), leading to a significant better overall image quality (P<0.001) than patients receiving positive oral contrast medium. The quantitative measurements revealed significant better distension (P<0.001) and wall to lumen delineation (P<0.001) for the patients receiving neutral oral contrast medium. The present results show that the neutral oral contrast agent (mannitol) produced better distension, better homogeneity and better delineation of the bowel wall leading to a higher overall image quality than the positive oral contrast medium in a non-selected patient population. (orig.)

  19. Serum killing of Ureaplasma parvum shows serovar-determined susceptibility for normal individuals and common variable immuno-deficiency patients.

    Science.gov (United States)

    Beeton, Michael L; Daha, Mohamed R; El-Shanawany, Tariq; Jolles, Stephen R; Kotecha, Sailesh; Spiller, O Brad

    2012-02-01

    Many Gram-negative bacteria, unlike Gram-positive, are directly lysed by complement. Ureaplasma can cause septic arthritis and meningitis in immunocompromised individuals and induce premature birth. Ureaplasma has no cell wall, cannot be Gram-stain classified and its serum susceptibility is unknown. Survival of Ureaplasma serovars (SV) 1, 3, 6 and 14 (collectively Ureaplasma parvum) were measured following incubation with normal or immunoglobulin-deficient patient serum (relative to heat-inactivated controls). Blocking monoclonal anti-C1q antibody and depletion of calcium, immunoglobulins, or lectins were used to determine the complement pathway responsible for killing. Eighty-three percent of normal sera killed SV1, 67% killed SV6 and 25% killed SV14; greater killing correlating to strong immunoblot identification of anti-Ureaplasma antibodies; killing was abrogated following ProteinA removal of IgG1. All normal sera killed SV3 in a C1q-dependent fashion, irrespective of immunoblot identification of anti-Ureaplasma antibodies; SV3 killing was unaffected by total IgG removal by ProteinG, where complement activity was retained. Only one of four common variable immunodeficient (CVID) patient sera failed to kill SV3, despite profound IgM and IgG deficiency for all; however, killing of SV3 and SV1 was restored with therapeutic intravenous immunoglobulin therapy. Only the classical complement pathway mediated Ureaplasma-cidal activity, sometimes in the absence of observable immunoblot reactive bands. Copyright © 2011 Elsevier GmbH. All rights reserved.

  20. Feasibility of power contrast injections and bolus triggering during CT scans in oncologic patients with totally implantable venous access ports of the forearm

    International Nuclear Information System (INIS)

    Goltz, Jan Peter; Machann, Wolfram; Noack, Claudia; Hahn, Dietbert; Kickuth, Ralph

    2011-01-01

    Background: Conventional totally implantable venous access ports (TIVAPs) are not approved for power contrast injections but often remain the only venous access site in oncologic patients. Therefore, these devices can play an important role if patients with a TIVAP are scheduled for a contrast-enhanced computed tomography (ceCT) as vascular access may become more difficult during the course of chemotherapy. Purpose: To evaluate the feasibility and safety of power injections in conventional TIVAPs in the forearm and to analyze the feasibility of bolus triggering during CT scans. Material and Methods: In this retrospective study we analyzed 177 power injections in 141 patients with TIVAPs in the forearm. Between October 2008 and March 2010 all patients underwent power injections (1.5 mL/s, 150 psi) via the TIVAP for ceCT because conventional vascular access via a peripheral vein had failed. Adequate functioning and catheter's tip location after injection were evaluated. Peak injection pressure and attenuation levels of aorta, liver and spleen were analyzed and compared with results of 50 patients who were injected via classical peripheral cannulas (3 mL/s, 300 psi). Feasibility of automatic scan initiation was evaluated. In vitro the port was stressed with 5 mL/s (300 psi). Results: One TIVAP showed tip dislocation with catheter rupture. Three (2.1%) devices were explanted owing to assumed infection within 4 weeks after the injection. Mean injection pressure was 121.9 ±24.1 psi. Triggering with automatic scan initiation succeeded in 13/44 (29.6%) scans. Injection via classical cannulas resulted in significantly higher enhancement (p < 0.05). In vitro the port system tolerated flow rates of up to 5 mL/s, injection pressures of up to 338 psi. Conclusion: Power injection is a safe alternative for patients with TIVAPs in the forearm if classic vascular access ultimately fails. Triggering was successful in one-third of the attempts. Image quality in the arterial phase

  1. Pediatric Patients Demonstrate Progressive T1-Weighted Hyperintensity in the Dentate Nucleus following Multiple Doses of Gadolinium-Based Contrast Agent.

    Science.gov (United States)

    Roberts, D R; Chatterjee, A R; Yazdani, M; Marebwa, B; Brown, T; Collins, H; Bolles, G; Jenrette, J M; Nietert, P J; Zhu, X

    2016-12-01

    While there have been recent reports of brain retention of gadolinium following gadolinium-based contrast agent administration in adults, a retrospective series of pediatric patients has not previously been reported, to our knowledge. We investigated the relationship between the number of prior gadolinium-based contrast agent doses and increasing T1 signal in the dentate nucleus on unenhanced T1-weighted MR imaging. We hypothesized that despite differences in pediatric physiology and the smaller gadolinium-based contrast agent doses that pediatric patients are typically administered based on weighted-adjusted dosing, the pediatric brain would also demonstrate dose-dependent increasing T1 signal in the dentate nucleus. We included children with multiple gadolinium-based contrast agent administrations at our institution. A blinded reader placed ROIs within the dentate nucleus and adjacent cerebellar white matter. To eliminate reader bias, we also performed automated ROI delineation of the dentate nucleus, cerebellar white matter, and pons. Dentate-to-cerebellar white matter and dentate-to pons ratios were compared with the number of gadolinium-based contrast agent administrations. During 20 years at our institution, 280 patients received at least 5 gadolinium-based contrast agent doses, with 1 patient receiving 38 doses. Sixteen patients met the inclusion/exclusion criteria for ROI analysis. Blinded reader dentate-to-cerebellar white matter ratios were significantly associated with gadolinium-based contrast agent doses (r s = 0.77, P = .001). The dentate-to-pons ratio and dentate-to-cerebellar white matter ratios based on automated ROI placement were also significantly correlated with gadolinium-based contrast agent doses (t = 4.98, P contrast agent doses is significantly correlated with progressive T1-weighted dentate hyperintensity. Definitive confirmation of gadolinium deposition requires tissue analysis. Any potential clinical sequelae of gadolinium retention in

  2. Application of Optical Coherence Tomography and Contrast Sensitivity Test for Observing Fundus Changes of Patients With Pregnancy-Induced Hypertension Syndrome.

    Science.gov (United States)

    Wang, Zhixue; Zou, Yuanyuan; Li, Wenying; Wang, Xueyan; Zhang, Min; Wang, Wenying

    2015-11-01

    This study was aimed to investigate the fundus changes of patients with pregnancy-induced hypertension syndrome (PIHS) using optical coherence tomography (OCT) technology and contrast sensitivity (CS) tests.Ninety-eight patients with PIHS underwent routine eye examinations including vision correction, fundus examination, OCT, and CS tests. The CS test was performed at low, medium, and high frequency, respectively. Moreover, the difference in CS tests between 2 groups was analyzed by independent-samples T test. The Kruskal-Wallis rank sum test and linear regression model were used to detect the correlation of OCT with CS, respectively. Meanwhile Satterthwaite approximate T test was adopted for pairwise comparisons after nonparametric analysis of variance.The OCT test revealed that 56.76% of the examined eyes showed shallow retinal detachment in the macula lutea and around the optic disk. The differences in CS at each spatial frequency between the case and control group were statistically significant (P tests might be valuable methods in observing fundus changes for PIHS patients.

  3. Three-dimensional anisotropy contrast MRI and functional MRI of the human brain. Clinical application to assess pyramidal tract in patients with brain tumor and infarction

    International Nuclear Information System (INIS)

    Morikawa, Minoru; Kaminogo, Makio; Ishimaru, Hideki; Nakashima, Kazuaki; Kitagawa, Naoki; Ochi, Makoto; Hayashi, Kuniaki; Shibata, Shobu; Kabasawa, Hiroyuki

    2001-01-01

    We describe and evaluate the findings of three-dimensional anisotropy contrast MR axonography (3DAC MRX) and functional MRI (fMRI) in brain tumor and infarction. We obtained diffusion-weighted images (DWI) in 28 patients including 23 brain tumors and 15 acute infarctions located in or near pyramidal tract. Three anisotropic DWIs were transformed into graduations color-coded as red, green and blue, and then composed to form a combined color 3DAC MRX. We also performed functional MRI in 7 of the 28 patients and compared with cortical mapping of 3DAC MRX. 3DAC MRX with 23 brain tumors showed that the ipsilateral pyramidal tract was either discontinuous due to impaired anisotropy (n=8) or compressed due to mass effect (n=15). In 10 patients of acute infarction with motor impairment, pyramidal tract involvement was visually more conspicuous on 3DAC MRX compared to standard DWI. On functional MRI, hand motor activation was observed between blue vertical directional colors of pre- and post central gyrus. In conclusion, 3DAC MRX is a new noninvasive approach for visualization of the white matter neuronal tract and provides the information concerning pyramidal tract involvement. (author)

  4. Contrast-enhanced CT in determining resectability in patients with pancreatic carcinoma: a meta-analysis of the positive predictive values of CT

    Energy Technology Data Exchange (ETDEWEB)

    Somers, Inne; Bipat, Shandra [University of Amsterdam, Department of Radiology, Academic Medical Centre, Amsterdam (Netherlands)

    2017-08-15

    To obtain a summary positive predictive value (sPPV) of contrast-enhanced CT in determining resectability. The MEDLINE and EMBASE databases from JAN2005 to DEC2015 were searched and checked for inclusion criteria. Data on study design, patient characteristics, imaging techniques, image evaluation, reference standard, time interval between CT and reference standard, and data on resectability/unresectablity were extracted by two reviewers. We used a fixed-effects or random-effects approach to obtain sPPV for resectability. Several subgroups were defined: 1) bolus-triggering versus fixed-timing; 2) pancreatic and portal phases versus portal phase alone; 3) all criteria (liver metastases/lymphnode involvement/local advanced/vascular invasion) versus only vascular invasion as criteria for unresectability. Twenty-nine articles were included (2171 patients). Most studies were performed in multicentre settings, initiated by the department of radiology and retrospectively performed. The I{sup 2}-value was 68%, indicating heterogeneity of data. The sPPV was 81% (95%CI: 75-86%). False positives were mostly liver, peritoneal, or lymphnode metastases. Bolus-triggering had a slightly higher sPPV compared to fixed-timing, 87% (95%CI: 81-91%) versus 78% (95%CI: 66-86%) (p = 0.077). No differences were observed in other subgroups. This meta-analysis showed a sPPV of 81% for predicting resectability by CT, meaning that 19% of patients falsely undergo surgical exploration. (orig.)

  5. Contrast volume reduction using third generation dual source computed tomography for the evaluation of patients prior to transcatheter aortic valve implantation

    Energy Technology Data Exchange (ETDEWEB)

    Bittner, Daniel O. [University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Department of Internal Medicine 2 (Cardiology), Erlangen (Germany); Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States); Arnold, Martin; Klinghammer, Lutz; Schuhbaeck, Annika; Hell, Michaela M.; Muschiol, Gerd; Gauss, Soeren; Achenbach, Stephan; Marwan, Mohamed [University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Department of Internal Medicine 2 (Cardiology), Erlangen (Germany); Lell, Michael; Uder, Michael [University Hospital Erlangen, Friedrich-Alexander University Erlangen-Nuernberg (FAU), Department of Radiology, Erlangen (Germany); Hoffmann, Udo [Harvard Medical School, Cardiac MR PET CT Program, Massachusetts General Hospital, Boston, MA (United States)

    2016-12-15

    Chronic renal failure is common in patients referred for transcatheter aortic valve implantation (TAVI). CT angiography is recommended and provides crucial information prior to TAVI. We evaluated the feasibility of a reduced contrast volume protocol for pre-procedural CT imaging. Forty consecutive patients were examined with prospectively ECG-triggered high-pitch spiral acquisition using a novel third-generation dual-source CT system; 38 ml contrast agent was used. Image quality was graded on a visual scale (1-4). Contrast attenuation was measured at the level of the aortic root and at the iliac bifurcation. Mean patient age was 82 ± 6 years (23 males; 58 %). Mean attenuation/average image quality was 285 ± 60 HU/1.5 at the aortic annulus compared to 289 ± 74 HU/1.8 at the iliac bifurcation (p = 0.77/p = 0.29). Mean estimated effective radiation dose was 2.9 ± 0.3 mSv. A repeat acquisition was necessary in one patient due to image quality. Out of the 35 patients who underwent TAVI, 31 (89 %) patients had no or mild aortic regurgitation. Thirty-two (91 %) patients were discharged successfully. Pre-procedural CTA with a total of 38 ml contrast volume is feasible and clinically useful, using third-generation dual-source CT, allowing comprehensive imaging for procedural success. (orig.)

  6. Intra-Arterial Treatment in Patients with Acute Massive Gastrointestinal Bleeding after Endoscopic Failure: Comparisons between Positive versus Negative Contrast Extravasation Groups

    International Nuclear Information System (INIS)

    Chang, Wei Chou; Liu, Chang Hsien; Hsu, Hsian He; Huang, Guo Shu; Hsieh, Tasi Yuan; Tsai, Shin Hung; Hsieh, Chung Bao; Yu, Chin Yung; Tung, Ho Jui

    2011-01-01

    To determine whether treatment outcome is associated with visualization of contrast extravasation in patients with acute massive gastrointestinal bleeding after endoscopic failure. From January 2007 to December 2009, patients that experienced a first attack of acute gastrointestinal bleeding after failure of initial endoscopy were referred to our interventional department for intra-arterial treatment. We enrolled 79 patients and divided them into two groups: positive and negative extravasation. For positive extravasation, patients were treated by coil embolization; and in negative extravasation, patients were treated with intra-arterial vasopressin infusion. The two groups were compared for clinical parameters, hemodynamics, laboratory findings, endoscopic characteristics, and mortality rates. Forty-eight patients had detectable contrast extravasation (positive extravasation), while 31 patients did not (negative extravasation). Fifty-six patients survived from this bleeding episode (overall clinical success rate, 71%). An elevation of hemoglobin level was observed in the both two groups; significantly greater in the positive extravasation group compared to the negative extravasation group. Although these patients were all at high risk of dying, the 90-day mortality rate was significantly lower in the positive extravasation than in the negative extravasation (20% versus 42%, p < 0.05). A multivariate analysis suggested that successful hemo stasis (odds ratio [OR] = 28.66) is the most important predictor affecting the mortality in the two groups of patients. Visualization of contrast extravasation on angiography usually can target the bleeding artery directly, resulting in a higher success rate to control of hemorrhage.

  7. Assessment of hemodynamic changes in patients with renal artery stenosis by means of the cine MR phase-contrast technique

    International Nuclear Information System (INIS)

    Schoenberg, S.O.; Knopp, M.V.; Bock, M.; Essig, M.; Hawighorst, H.; Zuna, I.; Schad, L.; Kaick, G. van; Kallinowski, F.; Allenberg, J.R.; Just, A.

    1997-01-01

    Purpose: To evaluate the use of high-temporal resolution cine MR phase-contrast flow measurements for assessment of flow dynamics in renal artery stenosis (RAS). Material and methods: In a dog model, cine MR flow measurements were validated by comparing the MR flow data to an invasive transit-time ultrasound reference technique for different degrees of RAS. Cardiac-gated MR flow curves were recorded in 56 renal arteries of 28 patients with a temporal resolution of at least 32 ms. In all cases RAS was confirmed by digital subtraction angiography (DSA). Abnormalities of flow dynamics were assessed in the calculated flow curves using the MR parameters mean flow, maximum velocity, and time to systolic maximum. Results: By means of the MR blood flow paremeters high-grade stenoses (>50%, n=23) were detected with sensitivity of 100% and specificity of 94% with reference to DSA. The overall differentiation between stenoses (n=37) and non-stenosed vessels (n=19) revealed a sensitivity of 87% and a specificity of 100%. Conclusion: Analysis of cardiac-gated MR flow curves provides a non-invasive method to assess the hemodynamic significance of RAS and thus allows a functional evaluation in relation to the morphologic characteristics of the stenosis. (orig.) [de

  8. Comparison of particle image velocimetry and phase contrast MRI in a patient-specific extracardiac total cavopulmonary connection.

    Science.gov (United States)

    Kitajima, Hiroumi D; Sundareswaran, Kartik S; Teisseyre, Thomas Z; Astary, Garrett W; Parks, W James; Skrinjar, Oskar; Oshinski, John N; Yoganathan, Ajit P

    2008-08-01

    Particle image velocimetry (PIV) and phase contrast magnetic resonance imaging (PC-MRI) have not been compared in complex biofluid environments. Such analysis is particularly useful to investigate flow structures in the correction of single ventricle congenital heart defects, where fluid dynamic efficiency is essential. A stereolithographic replica of an extracardiac total cavopulmonary connection (TCPC) is studied using PIV and PC-MRI in a steady flow loop. Volumetric two-component PIV is compared to volumetric three-component PC-MRI at various flow conditions. Similar flow structures are observed in both PIV and PC-MRI, where smooth flow dominates the extracardiac TCPC, and superior vena cava flow is preferential to the right pulmonary artery, while inferior vena cava flow is preferential to the left pulmonary artery. Where three-component velocity is available in PC-MRI studies, some helical flow in the extracardiac TCPC is observed. Vessel cross sections provide an effective means of validation for both experiments, and velocity magnitudes are of the same order. The results highlight similarities to validate flow in a complex patient-specific extracardiac TCPC. Additional information obtained by velocity in three components further describes the complexity of the flow in anatomic structures.

  9. Quantitative contrast-enhanced ultrasound evaluation of pathological complete response in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy.

    Science.gov (United States)

    Wan, Cai-Feng; Liu, Xue-Song; Wang, Lin; Zhang, Jie; Lu, Jin-Song; Li, Feng-Hua

    2018-06-01

    To clarify whether the quantitative parameters of contrast-enhanced ultrasound (CEUS) can be used to predict pathological complete response (pCR) in patients with locally advanced breast cancer receiving neoadjuvant chemotherapy (NAC). Fifty-one patients with histologically proved locally advanced breast cancer scheduled for NAC were enrolled. The quantitative data for CEUS and the tumor diameter were collected at baseline and before surgery, and compared with the pathological response. Multiple logistic regression analysis was performed to examine quantitative parameters at CEUS and the tumor diameter to predict the pCR, and receiver operating characteristic (ROC) curve analysis was used as a summary statistic. Multiple logistic regression analysis revealed that PEAK (the maximum intensity of the time-intensity curve during bolus transit), PEAK%, TTP% (time to peak), and diameter% were significant independent predictors of pCR, and the area under the ROC curve was 0.932(Az 1 ), and the sensitivity and specificity to predict pCR were 93.7% and 80.0%. The area under the ROC curve for the quantitative parameters was 0.927(Az 2 ), and the sensitivity and specificity to predict pCR were 81.2% and 94.3%. For diameter%, the area under the ROC curve was 0.786 (Az 3 ), and the sensitivity and specificity to predict pCR were 93.8% and 54.3%. The values of Az 1 and Az 2 were significantly higher than that of Az 3 (P = 0.027 and P = 0.034, respectively). However, there was no significant difference between the values of Az 1 and Az 2 (P = 0.825). Quantitative analysis of tumor blood perfusion with CEUS is superior to diameter% to predict pCR, and can be used as a functional technique to evaluate tumor response to NAC. Copyright © 2018. Published by Elsevier B.V.

  10. Characterization of fibromyalgia symptoms in patients 55-95 years old: a longitudinal study showing symptom persistence with suboptimal treatment.

    Science.gov (United States)

    Jacobson, Sandra A; Simpson, Rachel G; Lubahn, Cheri; Hu, Chengcheng; Belden, Christine M; Davis, Kathryn J; Nicholson, Lisa R; Long, Kathy E; Osredkar, Tracy; Lorton, Dianne

    2015-02-01

    Fibromyalgia (FM) has been understudied in the elderly population, a group with particular vulnerabilities to pain, reduced mobility, and sleep disruption. To characterize FM symptoms and treatments in a cohort of older subjects examined over time to determine the extent to which current, community-based treatment for older FM patients is in accord with published guidelines, and effective in reducing symptoms. A longitudinal, observational study of 51 subjects with FM (range 55-95 years) and 81 control subjects (58-95 years) performed at Banner Sun Health Research Institute in Sun City, AZ, USA. Serial history and examination data were obtained over a 6-year period. FM data included medical history, medications, physical examination, tender point examination, neuropsychological testing, sleep and pain ratings, the Physical Function Subscale of the Fibromyalgia Impact Questionnaire, and other standardized scales to evaluate depression and other psychiatric symptoms, and cognitive and functional impairment. Pain and stiffness that interfered with physical activity, sleep, and mood were reported by 80 % or more of subjects. Over time, pain involved an increasing number of body areas. Over half of subjects were treated with NSAIDs, one-quarter with opioids, and one-quarter with estrogen. Few were treated with dual-acting antidepressants or pregabalin. In this cohort of elders with suboptimally treated FM, substantial persistence of symptoms was seen over time. In general, recommended treatments were either not used or not tolerated. Age-appropriate treatments as well as education of primary care providers are needed to improve treatment of FM in the older population.

  11. Cerebral Hemodynamics in Patients with Hemolytic Uremic Syndrome Assessed by Susceptibility Weighted Imaging and Four-Dimensional Non-Contrast MR Angiography.

    Science.gov (United States)

    Löbel, Ulrike; Forkert, Nils Daniel; Schmitt, Peter; Dohrmann, Thorsten; Schroeder, Maria; Magnus, Tim; Kluge, Stefan; Weiler-Normann, Christina; Bi, Xiaoming; Fiehler, Jens; Sedlacik, Jan

    2016-01-01

    Conventional magnetic resonance imaging (MRI) of patients with hemolytic uremic syndrome (HUS) and neurological symptoms performed during an epidemic outbreak of Escherichia coli O104:H4 in Northern Europe has previously shown pathological changes in only approximately 50% of patients. In contrast, susceptibility-weighted imaging (SWI) revealed a loss of venous contrast in a large number of patients. We hypothesized that this observation may be due to an increase in cerebral blood flow (CBF) and aimed to identify a plausible cause. Baseline 1.5T MRI scans of 36 patients (female, 26; male, 10; mean age, 38.2±19.3 years) were evaluated. Venous contrast was rated on standard SWI minimum intensity projections. A prototype four-dimensional (time resolved) magnetic resonance angiography (4D MRA) assessed cerebral hemodynamics by global time-to-peak (TTP), as a surrogate marker for CBF. Clinical parameters studied were hemoglobin, hematocrit, creatinine, urea levels, blood pressure, heart rate, and end-tidal CO2. SWI venous contrast was abnormally low in 33 of 36 patients. TTP ranged from 3.7 to 10.2 frames (mean, 7.9 ± 1.4). Hemoglobin at the time of MRI (n = 35) was decreased in all patients (range, 5.0 to 12.6 g/dL; mean, 8.2 ± 1.4); hematocrit (n = 33) was abnormally low in all but a single patient (range, 14.3 to 37.2%; mean, 23.7 ± 4.2). Creatinine was abnormally high in 30 of 36 patients (83%) (range, 0.8 to 9.7; mean, 3.7 ± 2.2). SWI venous contrast correlated significantly with hemoglobin (r = 0.52, P = 0.0015), hematocrit (r = 0.65, P effect of blood transfusions in patients with HUS and neurological symptoms.

  12. Measurement of cerebral blood flow with two-dimensional cine phase-contrast MR imaging. Evaluation of normal subjects and patients with vertigo

    International Nuclear Information System (INIS)

    Kashimada, Akio; Machida, Kikuo; Honda, Norinari; Mamiya, Toshio; Takahashi, Taku; Kamano, Tsuyoshi; Osada, Hisato

    1995-01-01

    The purpose of this study was to determine whether or not the vertebral flow of patients with vertigo and normal brain magnetic resonance (MR) images was decreased in comparison with normal controls. Cerebral blood flow (CBF) was quantitatively measured by a two-dimensional phase contrast cine MR imaging technique in 24 normal controls (mean age, 38.6 years; range, 12-70) and 23 patients (mean age, 53.7 years; range, 19-76) with a 1.5 Tesla MR imaging unit. Inter-and intraobserver variation in blood flow measurements was small (r=0.970, standard error of the estimate [SEE]=2.9 ml, n=80; r=0.963, SEE=4.6 ml, n=40, respectively), In the normal group, mean summed vertebral flow (171 ml/min, SD=40.6) was significantly less than mean summed carotid flow (523 ml/min, SD=111). Right vertebral flow (80.2 ml/min, SD=30.5) was less than left vertebral flow (91.2 ml/min, SD=38.2), but the difference was not statistically significant (p<0.05), In the 23 patients, although the summed vertebral flows of two patients (63.3, 88.8 ml/min) were significantly less than that of the normal group, mean summed vertebral flow (165 ml/min, SD=59.1) showed no significant difference from that of the normal group (p<0.05). In this study, the majority of patients had normal CBF. This method is clinically useful for estimating CBF. (author)

  13. Measurement of cerebral blood flow with two-dimensional cine phase-contrast MR imaging. Evaluation of normal subjects and patients with vertigo

    Energy Technology Data Exchange (ETDEWEB)

    Kashimada, Akio; Machida, Kikuo; Honda, Norinari; Mamiya, Toshio; Takahashi, Taku; Kamano, Tsuyoshi; Osada, Hisato [Saitama Medical School, Kawagoe (Japan). Saitama Medical Center

    1995-03-01

    The purpose of this study was to determine whether or not the vertebral flow of patients with vertigo and normal brain magnetic resonance (MR) images was decreased in comparison with normal controls. Cerebral blood flow (CBF) was quantitatively measured by a two-dimensional phase contrast cine MR imaging technique in 24 normal controls (mean age, 38.6 years; range, 12-70) and 23 patients (mean age, 53.7 years; range, 19-76) with a 1.5 Tesla MR imaging unit. Inter-and intraobserver variation in blood flow measurements was small (r=0.970, standard error of the estimate [SEE]=2.9 ml, n=80; r=0.963, SEE=4.6 ml, n=40, respectively), In the normal group, mean summed vertebral flow (171 ml/min, SD=40.6) was significantly less than mean summed carotid flow (523 ml/min, SD=111). Right vertebral flow (80.2 ml/min, SD=30.5) was less than left vertebral flow (91.2 ml/min, SD=38.2), but the difference was not statistically significant (p<0.05), In the 23 patients, although the summed vertebral flows of two patients (63.3, 88.8 ml/min) were significantly less than that of the normal group, mean summed vertebral flow (165 ml/min, SD=59.1) showed no significant difference from that of the normal group (p<0.05). In this study, the majority of patients had normal CBF. This method is clinically useful for estimating CBF. (author).

  14. Pulmonary 64-MDCT angiography with 50 mL of iodinated contrast material in an unselected patient population: a feasible protocol

    Energy Technology Data Exchange (ETDEWEB)

    Trad, Henrique Simao; Boasquevisque, Gustavo Santos; Giacometti, Tiago Rangon; Trad, Catherine Yang; Zoghbi Neto, Orlando Salomao; Trad, Clovis Simao, E-mail: hsimtrad@gmail.com [Central de Diagnostico Ribeirao Preto (CEDIRP), Ribeirao Preto, SP (Brazil)

    2016-03-15

    Objective: To propose a protocol for pulmonary angiography using 64-slice multidetector computed tomography (64-MDCT) with 50 mL of iodinated contrast material, in an unselected patient population, as well as to evaluate vascular enhancement and image quality. Materials and methods: We evaluated 29 patients (22-86 years of age). The body mass index ranged from 19.0 kg/m{sup 2} to 41.8 kg/m{sup 2}. Patients underwent pulmonary CT angiography in a 64-MDCT scanner, receiving 50 mL of iodinated contrast material via venous access at a rate of 4.5 mL/s. Bolus tracking was applied in the superior vena cava. Two experienced radiologists assessed image quality and vascular enhancement. Results: The mean density was 382 Hounsfield units (HU) for the pulmonary trunk; 379 and 377 HU for the right and left main pulmonary arteries, respectively; and 346 and 364 HU for the right and left inferior pulmonary arteries, respectively. In all patients, subsegmental arteries were analyzed. There were streak artifacts from contrast material in the superior vena cava in all patients. However, those artifacts did not impair the image analysis. Conclusion: Our findings suggest that pulmonary angiography using 64-MDCT with 50 mL of iodinated contrast can produce high quality images in unselected patient populations. (author)

  15. High incidence of nephropathy in neurosurgical patients after intra-arterial administration of low-osmolar and iso-osmolar contrast media.

    Science.gov (United States)

    Serafin, Zbigniew; Karolkiewicz, Maciej; Gruszka, Marzena; Strózecki, Pawel; Lasek, Wladyslaw; Odrowaz-Sypniewska, Grazyna; Manitius, Jacek; Beuth, Wojciech

    2011-05-01

    Percutaneous endovascular examinations and interventions require significant amounts of iodinated contrast media (CM) and have been reported to be complicated by an increased incidence of post-contrast nephropathy. To evaluate renal function, the incidence of post-contrast nephropathy, and risk factors after interventional procedures in neurosurgical patients after intra-arterial administration of a low-osmolar contrast medium (LOCM) versus an iso-osmolar contrast medium (IOCM). This single-center, prospective, randomized, double-blinded study included 92 patients in its final analysis (mean age 49.6 ± 12.6 years, 29.3% men, mean eGFR 97.8 ± 26.3 mL/min/1.73 m(2)). LOCM was used in 48 patients (52.2%) and IOCM in 44 patients (47.8%). The patients were given an average of 151.2 ± 52.1 mL of contrast medium intra-arterially. Serum creatinine (SCr), urinary N-acetyl-β-glucosaminidase (NAG) excretion, and creatinine clearance (CCr) were measured at baseline, and on days 1 and 3 after the procedure. Baseline risk factors, renal functional parameters, and average CM doses were not statistically different between the two groups. SCr, NAG, and CCr values did not differ significantly between the LOCM and IOCM groups on days 1 and 3 after CM administration. Nephropathy developed in 21 cases (22.8%): 13 (27.1%) after LOCM use and 8 (18.2%) after IOCM; (P = NS). The only significant risk factors of CIN were the diabetes (P = 0.0466) and atherosclerosis (P = 0.0498). We found a high incidence of nephropathy in neurosurgical patients after intra-arterial CM administration. The renal function values and incidence of nephropathy following LOCM administration were not statistically different from those following IOCM administration.

  16. Clinical impact of EUS elastography followed by contrast-enhanced EUS in patients with focal pancreatic masses and negative EUS-guided FNA

    DEFF Research Database (Denmark)

    Iordache, Sevastiţa; Costache, Mădălin Ionuţ; Popescu, Carmen Florina

    2016-01-01

    and negative cytopathology after EUS-FNA, based on previously published results and cut-offs of real-time elastographic (RTE) EUS and contrast-enhanced harmonic (CEH) EUS. MATERIAL AND METHODS: We included in the study a subgroup of 50 consecutive patients with focal pancreatic masses which underwent EUS...... malignancy, the sensitivity, specificity and accuracy of RTE-EUS were: 97.7%, 77.4%, and 84% respectively. CEH-EUS had similar results: 89.5%, 80.7%, and 84%, respectively. In 25 patients with soft/mixed appearance during elastography,sequential assessment using contrast-enhanced EUSwas performed...

  17. Aspiration of Barium Contrast

    OpenAIRE

    Fuentes Santos, Cristina; Steen, Bárbara

    2014-01-01

    The aspiration of barium contrast is a rare complication that may occur during studies of the digestive tract. Barium is an inert material that can cause anywhere from an asymptomatic mechanical obstruction to serious symptoms of respiratory distress that can result in patient death. We present the case of a 79-year-old male patient in whom we observed the presence of contrast medium residue in the lung parenchyma as an incidental finding during hospitalization. When the patient’s medical fil...

  18. Prevalence of latent and manifest hyperthyroidism in an iodine-deficient area: non-selected patient population admitted for CT studies with iodine-containing contrast agents

    International Nuclear Information System (INIS)

    Saam, T.; Hess, T.; Kasperk, C.; Kauffmann, G.W.; Duex, M.

    2005-01-01

    Purpose: to evaluate the prevalence of latent and manifest hyperthyroidism in a non-selected group of patients admitted for contrast enhanced CT studies blood samples were tested for the levels of thyroid-stimulating hormone (TSH). Material and methods: TSH blood levels were obtained in 548 consecutive patients who were scheduled for contrast-enhanced (Iopromide; 300 mg iodine/ml) CT scanning. In case of TSH levels registered (sodium perchlorate) was commenced before scanning. In case of TSH levels < 0.1 mU/l, CT scanning was not performed but further evaluation of the thyroid function was initiated. Results: TSH blood levels ranged from 0.4 to 7.5 mU/l in 512 patients, and 36 patients (6.6%) had TSH blood levels < 0.4 mU/l and 9 patients blood levels < 0.1 mU/l, with 32 of those patients (5.8%) having regular T3 and T4 blood levels consistent with latent hyperthyroidism. In 4 patients (0.8%), T3 or T4 blood levels were increased consistent with manifest hyperthyroidism. Conclusion: in South Germany, the prevalence of latent or manifest hyperthyroidism in a non-selected patient group is high. Therefore TSH blood levels should be obtained prior to contrast-enhanced CT studies. (orig.)

  19. Oral contrast for CT in patients with acute non-traumatic abdominal and pelvic pain: what should be its current role?

    Science.gov (United States)

    Kielar, Ania Z; Patlas, Michael N; Katz, Douglas S

    2016-10-01

    Positive oral contrast agents, including barium suspensions and water-soluble iodinated solutions, have traditionally been used in conjunction with the CT evaluation of patients with abdominal and pelvic pain. Due to continued advancements in CT technology, and due to increasing obesity and correspondingly a general increase in the intra-abdominal and intra-pelvic fat separating bowel loops in North American patients and in patients in other parts of the world over the past few decades, the ability of radiologists to accurately evaluate the cause of acute symptoms has substantially improved. Recent research and evolving imaging society guidelines/systematic reviews increasingly support performing CT scans of the abdomen and pelvis without the need for positive oral contrast in these types of adult patient populations, in most clinical situations. Increased patient throughput, patient preference, patient safety, and most importantly, retention of high diagnostic accuracy, are reasons for this recent change in practice to routinely omit the use of enteric contrast agents for the majority of patients presenting with acute abdominal and pelvic pain whom are undergoing emergency CT.

  20. Dialysis and contrast media

    International Nuclear Information System (INIS)

    Morcos, Sameh K.; Thomsen, Henrik S.; Webb, Judith A.W.

    2002-01-01

    In a previous survey we revealed uncertainty among responders about (a) whether or not to perform hemodialysis in patients with severely reduced renal function who had received contrast medium; and (b) when to perform hemodialysis in patients on regular treatment with hemodialysis or continuous ambulatory dialysis who received contrast medium. Therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and to issue guidelines. The committee performed a Medline search. Based on this, a report and guidelines were prepared. The report was discussed at the Ninth European Symposium on Urogenital Radiology in Genoa, Italy. Hemodialysis and peritoneal dialysis safely remove both iodinated and gadolinium-based contrast media. The effectiveness of hemodialysis depends on many factors including blood and dialysate flow rate, permeability of dialysis membrane, duration of hemodialysis and molecular size, protein binding, hydrophilicity, and electrical charge of the contrast medium. Generally, several hemodialysis sessions are needed to removal all contrast medium, whereas it takes 3 weeks for continuous ambulatory dialysis to remove the agent completely. There is no need to schedule the dialysis in relation to the injection of iodinated or MR contrast media or the injection of contrast agent in relation to the dialysis program. Hemodialysis does not protect poorly functioning kidneys against contrast-medium-induced nephrotoxicity. Simple guidelines are given. (orig.)

  1. Using 80 kVp on a 320-row scanner for hepatic multiphasic CT reduces the contrast dose by 50 % in patients at risk for contrast-induced nephropathy

    Energy Technology Data Exchange (ETDEWEB)

    Taguchi, Narumi; Oda, Seitaro; Utsunomiya, Daisuke; Nakaura, Takeshi; Imuta, Masanori; Yamamura, Sadahiro; Yuki, Hideaki; Kidoh, Masafumi; Hirata, Kenichiro; Namimoto, Tomohiro; Yamashita, Yasuyuki [Kumamoto University, Department of Diagnostic Radiology, Faculty of Life Sciences, Kumamoto (Japan); Funama, Yoshinori [Kumamoto University, Department of Medical Physics, Faculty of Life Sciences, Kumamoto (Japan); Hatemura, Masahiro; Kai, Noriyuki [Kumamoto University Hospital, Department of Central Radiology, Kumamoto (Japan)

    2017-02-15

    We evaluated the effects of a low contrast material (CM) dose protocol using 80-kVp on the image quality of hepatic multiphasic CT scans acquired on a 320-row CT scanner. We scanned 30 patients with renal insufficiency (eGFR < 45 mL/min/1.73 m{sup 2}) using 80-kVp and a CM dose of 300mgI/kg. Another 30 patients without renal insufficiency (eGFR > 60 mL/min/1.73 m{sup 2}) were scanned with the conventional 120-kVp protocol and the standard CM dose of 600mgI/kg. Quantitative image quality parameters, i.e. CT attenuation, image noise, and the contrast-to-noise ratio (CNR) were compared and the visual image quality was scored on a four-point scale. The volume CT dose index (CTDI{sub vol}) and the size-specific dose estimate (SSDE) recorded with the 80- and the 120-kVp protocols were also compared. Image noise and contrast enhancement were equivalent for the two protocols. There was no significant difference in the CNR of all anatomic sites and in the visual scores for overall image quality. The CTDI{sub vol} and SSDE were approximately 25-30 % lower under the 80-kVp protocol. Hepatic multiphase CT using 80-kVp on a 320-row CT scanner allowed for a decrease in the CM dose and a reduction in the radiation dose without image quality degradation in patients with renal insufficiency. (orig.)

  2. Contrast enhanced liver MRI in patients with primary sclerosing cholangitis: inverse appearance of focal confluent fibrosis on delayed phase MR images with hepatocyte specific versus extracellular gadolinium based contrast agents.

    Science.gov (United States)

    Husarik, Daniela B; Gupta, Rajan T; Ringe, Kristina I; Boll, Daniel T; Merkle, Elmar M

    2011-12-01

    To assess the enhancement pattern of focal confluent fibrosis (FCF) on contrast-enhanced hepatic magnetic resonance imaging (MRI) using hepatocyte-specific (Gd-EOB-DTPA) and extracellular (ECA) gadolinium-based contrast agents in patients with primary sclerosing cholangitis (PSC). After institutional review board approval, 10 patients with PSC (6 male, 4 female; 33-61 years) with 13 FCF were included in this retrospective study. All patients had a Gd-EOB-DTPA-enhanced liver MRI exam, and a comparison ECA-enhanced MRI. On each T1-weighted dynamic dataset, the signal intensity (SI) of FCF and the surrounding liver as well as the paraspinal muscle (M) were measured. In the Gd-EOB-DTPA group, hepatocyte phase images were also included. SI FCF/SI M, SI liver/SI M, and [(SI liver - SI FCF)/SI liver] were compared between the different contrast agents for each dynamic phase using the paired Student's t-test. There was no significant difference in SI FCF/SI M in all imaging phases. SI liver/SI M was significantly higher for the Gd-EOB-DTPA group in the delayed phase (P DTPA group, mean [(SI liver - SI FCF)/SI liver] were as follows (values for ECA group in parentheses): unenhanced phase: 0.26 (0.26); arterial phase: 0.01 (-0.31); portal venous phase (PVP): -0.05 (-0.26); delayed phase (DP): 0.14 (-0.54); and hepatocyte phase: 0.26. Differences were significant for the DP (P DTPA-enhanced images. Copyright © 2011 AUR. Published by Elsevier Inc. All rights reserved.

  3. The patient had a normal magnetic resonance imaging and temporal lobe epilepsy secondary to a porencephalic cyst but showed structural lesions (hippocampal sclerosis)☆

    Science.gov (United States)

    Matsubara, Teppei; Ayuzawa, Satoshi; Aoki, Tsukasa; Fujiomto, Ayataka; Osuka, Satoru; Matsumura, Akira

    2013-01-01

    Patients with a porencephalic cyst frequently develop intractable temporal lobe epilepsy (TLE). We report a surgically-treated male patient with intractable mesial TLE (mTLE) secondary to a porencephalic cyst. Although magnetic resonance imaging showed no hippocampal abnormalities, long-term video-electrocorticography revealed seizure onset discharges in the hippocampus. Temporal lobectomy brought an end to the patient's seizures. Hippocampal sclerosis was histopathologically confirmed (dual pathology). Careful evaluation of hippocampal epileptogenicity is required, and temporal lobectomy, which is less invasive than hemispherectomy, can be a treatment of choice for patients with mTLE secondary to a porencephalic cyst. PMID:25667851

  4. Semiautomatic determination of arterial input functions for quantitative dynamic contrast-enhanced magnetic resonance imaging in non-small cell lung cancer patients.

    Science.gov (United States)

    Chung, Julius; Kim, Jae-Hun; Lee, Eun Ju; Kim, Yoo Na; Yi, Chin A

    2015-03-01

    The aim of this study was to validate a semiautomatic detection method for the arterial input functions (AIFs) using Kendall coefficient of concordance (KCC) for quantitative analysis of dynamic contrast-enhanced magnetic resonance imaging in non-small cell lung cancer patients. We prospectively enrolled 28 patients (17 men, 11 women; mean age, 62 years) who had biopsy-proven non-small cell lung cancer. All enrolled patients underwent dynamic contrast-enhanced magnetic resonance imaging of the entire thorax. For the quantitative measurement of pharmacokinetic parameters, K and ve, of the lung cancers, AIFs were determined in 2 different ways: a manual method that involved 3 independent thoracic radiologists selecting a region of interest (ROI) within the aortic arch in the 2D coronal plane and a semiautomatic method that used in-house software to establish a KCC score, which provided a measure of similarity to typical AIF pattern. Three independent readers selected voxel clusters with high KCC scores calculated 3-dimensionally across planes in the data set. K and ve were correlated using intraclass correlation coefficients (ICCs), and Bland-Altman plots were used to examine agreement across methods and reproducibility within a method. Arterial input functions were determined using the data from ROI volumes that were significantly larger in the semiautomatic method (mean ± SD, 3360 ± 768 mm) than in the manual method (677 ± 380 mm) (P < 0.001). K showed very strong agreement (ICC, 0.927) and ve showed moderately strong agreement (ICC, 0.718) between the semiautomatic and manual methods. The reproducibility for K (ICCmanual, 0.813 and ICCsemiautomatic, 0.998; P < 0.001) and ve (ICCmanual, 0.455 and ICCsemiautomatic, 0.985, P < 0.001) was significantly better with the semiautomatic method than the manual method. We found semiautomated detection using KCC to be a robust method for determining the AIF. This method allows for larger ROIs specified in 3D across planes

  5. Cardiac MRI. Estimation of changes in normalized myocardial gadolinium accumulation over time after contrast injection in patients with acute myocarditis and healthy volunteers

    International Nuclear Information System (INIS)

    Breuckmann, F.; Buhr, C.; Maderwald, S.; Bruder, O.; Schlosser, T.; Nassenstein, K.; Erbel, R.; Barkhausen, J.

    2011-01-01

    An increased normalized gadolinium accumulation (NGA) in the myocardium during early washout has been used for the diagnosis of acute myocarditis (AM). Due to the fact that the pharmacokinetics of contrast agents are complex, time-related changes in NGA after contrast injection are likely. Because knowledge about time-related changes of NGA may improve the diagnostic accuracy of MR, our study aimed to estimate the time course of NGA after contrast injection in patients as well as in healthy volunteers. An ECG-triggered inversion recovery SSFP sequence with incrementally increasing inversion times was repetitively acquired over the 15 minutes after injection of 0.2 Gd-DTPA per kg body weight in a 4-chamber view in 15 patients with AM and 20 volunteers. The T 1relaxation times and the longitudinal relaxation rates (R1) of the myocardium and skeletal musculature were calculated for each point in time after contrast injection. The time course of NGA was estimated based on the linear relationship between R 1 and tissue Gd concentration. NGA decreased over time in the form of a negative power function in patients with AM and in healthy controls. NGA in AM tended to be higher than in controls (p > 0.05). NGA rapidly changes after contrast injection, which must be considered when measuring NGA. Although we observed a trend towards higher NGA values in patients with AM with a maximum difference one minute after contrast injection, NGA did not allow us to differentiate patients with AM from healthy volunteers, because the observed differences did not reach a level of significance. (orig.)

  6. Baseline incidence and severity of renal insufficiency evaluated by estimated glomerular filtration rates in patients scheduled for contrast-enhanced CT

    International Nuclear Information System (INIS)

    Utsunomiya, Daisuke; Yanaga, Yumi; Oda, Seitaro; Namimoto, Tomohiro; Yamashita, Yasuyuki; Awai, Kazuo; Funama, Yoshinori

    2011-01-01

    Background Although pre-existing renal insufficiency (RI) is the most important risk factor for contrast-induced nephropathy (CIN), the background distribution of baseline renal function has not been investigated thoroughly in patients scheduled for contrast-enhanced CT. Purpose To investigate the incidence and severity of baseline RI evaluated by estimated glomerular filtration rates (eGFR) in patients who underwent contrast-enhanced CT at an academic center. Material and Methods A total of 6586 patients (3630 men and 2956 women; mean age 57.0 ± 11.9 years) who underwent contrast-enhanced CT between January and December 2008 were retrospectively studied. Of these, 829 had cardiovascular diseases (CVD), 5116 had oncologic diseases, 178 had diabetes mellitus (DM), and 1572 had chronic liver disease (CLD). The eGFR (mL/min/1.73 m 2 ) was calculated from their serum creatinine level. Mild, moderate-a, moderate-b, and severe RI were recorded at 60 2 at baseline was high in patients with advanced age, CVD and DM and in patients without oncologic disease

  7. Increased signal intensity of the cochlea on pre- and post-contrast enhanced 3D-FLAIR in patients with vestibular schwannoma

    Energy Technology Data Exchange (ETDEWEB)

    Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi [Nagoya University, Department of Radiology, Graduate School of Medicine, Nagoya (Japan); Fukatsu, Hiroshi [Aichi Medical University Hospital, Department of Medical Informatics, Nagakute (Japan); Nakashima, Tsutomu [Nagoya University, Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya (Japan)

    2009-12-15

    In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)

  8. Increased signal intensity of the cochlea on pre- and post-contrast enhanced 3D-FLAIR in patients with vestibular schwannoma

    International Nuclear Information System (INIS)

    Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi; Fukatsu, Hiroshi; Nakashima, Tsutomu

    2009-01-01

    In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)

  9. Time-Resolved Three-Dimensional Contrast-Enhanced Magnetic Resonance Angiography in Patients with Chronic Expanding and Stable Aortic Dissections

    Directory of Open Access Journals (Sweden)

    Michael Trojan

    2017-01-01

    Full Text Available Objective. To prospectively evaluate our hypothesis that three-dimensional time-resolved contrast-enhanced magnetic resonance angiography (TR-MRA is able to detect hemodynamic alterations in patients with chronic expanding aortic dissection compared to stable aortic dissections. Materials and Methods. 20 patients with chronic or residual aortic dissection in the descending aorta and patent false lumen underwent TR-MRA of the aorta at 1.5 T and repeated follow-up imaging (mean follow-up 5.4 years. 7 patients showed chronic aortic expansion and 13 patients had stable aortic diameters. Regions of interest were placed in the nondissected ascending aorta and the false lumen of the descending aorta at the level of the diaphragm (FL-diaphragm level resulting in respective time-intensity curves. Results. For the FL-diaphragm level, time-to-peak intensity and full width at half maximum were significantly shorter in the expansion group compared to the stable group (p=0.027 and p=0.003, and upward and downward slopes of time-intensity curves were significantly steeper (p=0.015 and p=0.005. The delay of peak intensity in the FL-diaphragm level compared to the nondissected ascending aorta was significantly shorter in the expansion group compared to the stable group (p=0.01. Conclusions. 3D TR-MRA detects significant alterations of hemodynamics within the patent false lumen of chronic expanding aortic dissections compared to stable aortic dissections.

  10. Accuracy of point-of-care serum creatinine devices for detecting patients at risk of contrast-induced nephropathy: a critical overview.

    Science.gov (United States)

    Martínez Lomakin, Felipe; Tobar, Catalina

    2014-12-01

    Contrast-induced nephropathy (CIN) is a common event in hospitals, with reported incidences ranging from 1 to 30%. Patients with underlying kidney disease have an increased risk of developing CIN. Point-of-care (POC) creatinine devices are handheld devices capable of providing quantitative data on a patient's kidney function that could be useful in stratifying preventive measures. This overview aims to synthesize the current evidence on diagnostic accuracy and clinical utility of POC creatinine devices in detecting patients at risk of CIN. Five databases were searched for diagnostic accuracy studies or clinical trials that evaluated the usefulness of POC devices in detecting patients at risk of CIN. Selected articles were critically appraised to assess their individual risk of bias by the use of standard criteria; 13 studies were found that addressed the diagnostic accuracy or clinical utility of POC creatinine devices. Most studies incurred a moderate to high risk of bias. Overall concordance between POC devices and reference standards (clinical laboratory procedures) was found to be moderate, with 95% limits of agreement often lying between -35.4 and +35.4 µmol/L (-0.4 and +0.4 mg/dL). Concordance was shown to decrease with worsening kidney function. Data on the clinical utility of these devices were limited, but a significant reduction in time to diagnosis was reported in two studies. Overall, POC creatinine devices showed a moderate concordance with standard clinical laboratory creatinine measurements. Several biases could have induced optimism in these estimations. Results obtained from these devices may be unreliable in cases of severe kidney failure. Randomized trials are needed to address the clinical utility of these devices.

  11. Comparison of FDG-PET/CT and contrast-enhanced CT for monitoring therapy response in patients with metastatic breast cancer

    Energy Technology Data Exchange (ETDEWEB)

    Riedl, Christopher C.; Ulaner, Gary A.; Jochelson, Maxine S.; Weber, Wolfgang A. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Weill Cornell Medical College, Department of Radiology, New York, NY (United States); Pinker, Katja [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); Ong, Leonard T. [Memorial Sloan Kettering Cancer Center, Department of Radiology, New York, NY (United States); Baltzer, Pascal [Medical University of Vienna, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria); McArthur, Heather L. [Cedars-Sinai Medical Center, Department of Medicine, Breast Oncology, Los Angeles, CA (United States); Goenen, Mithat [Memorial Sloan Kettering Cancer Center, Department of Epidemiology and Biostatistics, New York, NY (United States); Dickler, Maura [Memorial Sloan Kettering Cancer Center, Department of Medicine, New York, NY (United States)

    2017-08-15

    The aim of this study was to compare fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) and contrast-enhanced computed tomography (CE-CT) for the prediction of progression-free survival (PFS) and disease-specific survival (DSS) in patients with stage IV breast cancer undergoing systemic therapy. Sixty-five patients with metastatic breast cancer treated with first- or second-line systemic therapy in prospective clinical trials were included. Response to treatment was evaluated by Response Evaluation Criteria in Solid Tumors (RECIST) 1.1 for CE-CT and by PET Response Criteria in Solid Tumors (PERCIST), respectively. All responders by RECIST (n = 22) were also responders by PERCIST, but 40% (17/43) of non-responders by RECIST were responders by PERCIST. Responses according to RECIST and PERCIST both correlated with PFS, but PERCIST showed a significantly higher predictive accuracy (concordance index for PFS: 0.70 vs. 0.60). One-year PFS for responders vs. non-responders by RECIST was 59% vs. 27%, compared to 63% vs. 0% by PERCIST. Four-year DSS of responders and non-responders by RECIST was 50% and 38%, respectively (p = 0.2, concordance index: 0.55) as compared to 58% vs. 18% for PERCIST (p < 0.001, concordance index: 0.65). Response on PET/CT was also a significantly better predictor for DSS than disease control on CE-CT. In patients with metastatic breast cancer, tumor response on PET/CT appears to be a superior predictor of PFS and DSS than response on CE-CT. Monitoring tumor response by PET/CT may increase the power of clinical trials using tumor response as an endpoint, and may improve patient management in clinical routine. (orig.)

  12. Left ventricular mass in dialysis patients, determinants and relation with outcome. Results from the COnvective TRansport STudy (CONTRAST.

    Directory of Open Access Journals (Sweden)

    Ira M Mostovaya

    Full Text Available BACKGROUND AND OBJECTIVES: Left ventricular mass (LVM is known to be related to overall and cardiovascular mortality in end stage kidney disease (ESKD patients. The aims of the present study are 1 to determine whether LVM is associated with mortality and various cardiovascular events and 2 to identify determinants of LVM including biomarkers of inflammation and fibrosis. DESIGN SETTING PARTICIPANTS & MEASUREMENTS: Analysis was performed with data of 327 ESKD patients, a subset from the CONvective TRAnsport STudy (CONTRAST. Echocardiography was performed at baseline. Cox regression analysis was used to assess the relation of LVM tertiles with clinical events. Multivariable linear regression models were used to identify factors associated with LVM. RESULTS: Median age was 65 (IQR: 54-73 years, 203 (61% were male and median LVM was 227 (IQR: 183-279 grams. The risk of all-cause mortality (hazard ratio (HR = 1.73, 95% CI: 1.11-2.99, cardiovascular death (HR = 3.66, 95% CI: 1.35-10.05 and sudden death (HR = 13.06; 95% CI: 6.60-107 was increased in the highest tertile (>260 grams of LVM. In the multivariable analysis positive relations with LVM were found for male gender (B = 38.8±10.3, residual renal function (B = 17.9±8.0, phosphate binder therapy (B = 16.9±8.5, and an inverse relation for a previous kidney transplantation (B = -41.1±7.6 and albumin (B = -2.9±1.1. Interleukin-6 (Il-6, high-sensitivity C-reactive protein (hsCRP, hepcidin-25 and connective tissue growth factor (CTGF were not related to LVM. CONCLUSION: We confirm the relation between a high LVM and outcome and expand the evidence for increased risk of sudden death. No relationship was found between LVM and markers of inflammation and fibrosis. TRIAL REGISTRATION: Controlled-Trials.com ISRCTN38365125.

  13. Contrast sensitivity to spatial gratings in moderate and dim light conditions in patients with diabetes in the absence of diabetic retinopathy.

    Science.gov (United States)

    Safi, Sare; Rahimi, Anoushiravan; Raeesi, Afsaneh; Safi, Hamid; Aghazadeh Amiri, Mohammad; Malek, Mojtaba; Yaseri, Mehdi; Haeri, Mohammad; Middleton, Frank A; Solessio, Eduardo; Ahmadieh, Hamid

    2017-01-01

    To evaluate the ability of contrast sensitivity (CS) to discriminate loss of visual function in diabetic subjects with no clinical signs of retinopathy relative to that of normal subjects. In this prospective cross-sectional study, we measured CS in 46 diabetic subjects with a mean age of 48±6 years, a best-corrected visual acuity of 20/20 and no signs of diabetic retinopathy. The CS in these subjects was compared with CS measurements in 46 normal control subjects at four spatial frequencies (3, 6, 12, 18 cycles per degree) under moderate (500 lux) and dim (less than 2 lux) background light conditions. CS was approximately 0.16 log units lower in patients with diabetes relative to controls both in moderate and in dim background light conditions. Logistic regression classification and receiver operating characteristic curve analysis indicated that CS analysis using two light conditions was more accurate (0.78) overall compared with CS analysis using only a single illumination condition (accuracy values were 0.67 and 0.70 in moderate and dim light conditions, respectively). Our results showed that patients with diabetes without clinical signs of retinopathy exhibit a uniform loss in CS at all spatial frequencies tested. Measuring the loss in CS at two spatial frequencies (3 and 6 cycles per degree) and two light conditions (moderate and dim) is sufficiently robust to classify diabetic subjects with no retinopathy versus control subjects.

  14. Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography

    International Nuclear Information System (INIS)

    Veldhoen, Simon; Behzadi, Cyrus; Derlin, Thorsten; Henes, Frank Oliver; Adam, Gerhard; Bannas, Peter; Rybczinsky, Meike; Kodolitsch, Yskert von; Sheikhzadeh, Sara; Bley, Thorsten Alexander

    2015-01-01

    To assess whether ECG-gated non-contrast 2D steady-state free precession (SSFP) imaging allows for exact monitoring of aortic diameters in Marfan syndrome (MFS) patients using non-ECG-gated contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and echocardiography for intraindividual comparison. Non-ECG-gated CE-MRA and ECG-gated non-contrast SSFP at 1.5 T were prospectively performed in 50 patients. Two readers measured aortic diameters on para-sagittal images identically aligned with the aortic arch at the sinuses of Valsalva, sinotubular junction, ascending/descending aorta and aortic arch. Image quality was assessed on a three-point scale. Aortic root diameters acquired by echocardiography were used as reference. Intra- and interobserver variances were smaller for SSFP at the sinuses of Valsalva (p = 0.002; p = 0.002) and sinotubular junction (p = 0.014; p = 0.043). Image quality was better in SSFP than in CE-MRA at the sinuses of Valsalva (p < 0.0001), sinotubular junction (p < 0.0001) and ascending aorta (p = 0.02). CE-MRA yielded higher diameters than SSFP at the sinuses of Valsalva (mean bias, 2.5 mm; p < 0.0001), and comparison with echocardiography confirmed a higher bias for CE-MRA (7.2 ± 3.4 mm vs. SSFP, 4.7 ± 2.6 mm). ECG-gated non-contrast 2D SSFP imaging provides superior image quality with higher validity compared to non-ECG-gated contrast-enhanced 3D imaging. Since CE-MRA requires contrast agents with potential adverse effects, non-contrast SSFP imaging is an appropriate alternative for exact and riskless aortic monitoring of MFS patients. (orig.)

  15. Exact monitoring of aortic diameters in Marfan patients without gadolinium contrast: intraindividual comparison of 2D SSFP imaging with 3D CE-MRA and echocardiography

    Energy Technology Data Exchange (ETDEWEB)

    Veldhoen, Simon [University Medical Center Wuerzburg, Department of Diagnostic and Interventional Radiology, Bavaria (Germany); University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Behzadi, Cyrus; Derlin, Thorsten; Henes, Frank Oliver; Adam, Gerhard; Bannas, Peter [University Medical Center Hamburg-Eppendorf, Department of Diagnostic and Interventional Radiology, Hamburg (Germany); Rybczinsky, Meike; Kodolitsch, Yskert von; Sheikhzadeh, Sara [University Medical Center Hamburg-Eppendorf, Department of General and Interventional Cardiology, Hamburg (Germany); Bley, Thorsten Alexander [University Medical Center Wuerzburg, Department of Diagnostic and Interventional Radiology, Bavaria (Germany)

    2014-10-15

    To assess whether ECG-gated non-contrast 2D steady-state free precession (SSFP) imaging allows for exact monitoring of aortic diameters in Marfan syndrome (MFS) patients using non-ECG-gated contrast-enhanced 3D magnetic resonance angiography (CE-MRA) and echocardiography for intraindividual comparison. Non-ECG-gated CE-MRA and ECG-gated non-contrast SSFP at 1.5 T were prospectively performed in 50 patients. Two readers measured aortic diameters on para-sagittal images identically aligned with the aortic arch at the sinuses of Valsalva, sinotubular junction, ascending/descending aorta and aortic arch. Image quality was assessed on a three-point scale. Aortic root diameters acquired by echocardiography were used as reference. Intra- and interobserver variances were smaller for SSFP at the sinuses of Valsalva (p = 0.002; p = 0.002) and sinotubular junction (p = 0.014; p = 0.043). Image quality was better in SSFP than in CE-MRA at the sinuses of Valsalva (p < 0.0001), sinotubular junction (p < 0.0001) and ascending aorta (p = 0.02). CE-MRA yielded higher diameters than SSFP at the sinuses of Valsalva (mean bias, 2.5 mm; p < 0.0001), and comparison with echocardiography confirmed a higher bias for CE-MRA (7.2 ± 3.4 mm vs. SSFP, 4.7 ± 2.6 mm). ECG-gated non-contrast 2D SSFP imaging provides superior image quality with higher validity compared to non-ECG-gated contrast-enhanced 3D imaging. Since CE-MRA requires contrast agents with potential adverse effects, non-contrast SSFP imaging is an appropriate alternative for exact and riskless aortic monitoring of MFS patients. (orig.)

  16. Risk of contrast-medium-induced nephropathy in high-risk patients undergoing MDCT - A pooled analysis of two randomized trials

    International Nuclear Information System (INIS)

    Thomsen, Henrik S.; Morcos, Sameh K.

    2009-01-01

    The incidence of contrast-medium-induced nephropathy (CIN) following intravenous (IV) CM administration of contrast media to renally impaired patients undergoing multidetector computed tomography (MDCT) is not well characterized. Our objective was to investigate the incidence of CIN in patients with glomerular filtration rate (GFR) 40 ml/min, 4.6% when GFR <40 ml/min and 7.8% in patients with GFR <30 ml/min. The incidence of CIN was significantly higher after iodixanol than after LOCM (seven patients, 4.7% following IOCM, no CIN cases following the LOCM; p = 0.007). Significant differences in favor of the LOCM were also observed in patients with GFR <40 ml/min and GFR <30 ml/min. Following the IV administration of nonionic contrast agents in patients with moderate-to-severe renal insufficiency, the risk of significant CIN seems to be low. The IOCM iodixanol caused a higher rate of CIN than the LOCM iopamidol and iomeprol, especially in high-risk patients. Differences in osmolality between these LOCM and iodixanol do not play a role in the genesis of CIN. (orig.)

  17. Three-dimensional drip infusion CT cholangiography in patients with suspected obstructive biliary disease: a retrospective analysis of feasibility and adverse reaction to contrast material

    International Nuclear Information System (INIS)

    Persson, A; Dahlström, N; Smedby, Ö; Brismar, TB

    2006-01-01

    Computed Tomography Cholangiography (CTC) is a fast and widely available alternative technique to visualise hepatobiliary disease in patients with an inconclusive ultrasound when MRI cannot be performed. The method has previously been relatively unknown and sparsely used, due to concerns about adverse reactions and about image quality in patients with impaired hepatic function and thus reduced contrast excretion. In this retrospective study, the feasibility and the frequency of adverse reactions of CTC when using a drip infusion scheme based on bilirubin levels were evaluated. The medical records of patients who had undergone upper abdominal spiral CT with subsequent three-dimensional rendering of the biliary tract by means of CTC during seven years were retrospectively reviewed regarding serum bilirubin concentration, adverse reaction and presence of visible contrast media in the bile ducts at CT examination. In total, 153 consecutive examinations in 142 patients were reviewed. Contrast media was observed in the bile ducts at 144 examinations. In 110 examinations, the infusion time had been recorded in the medical records. Among these, 42 examinations had an elevated bilirubin value (>19 umol/L). There were nine patients without contrast excretion; 3 of which had a normal bilirubin value and 6 had an elevated value (25–133 umol/L). Two of the 153 examinations were inconclusive. One subject (0.7%) experienced a minor adverse reaction – a pricking sensation in the face. No other adverse effects were noted. We conclude that drip infusion CTC with an infusion rate of the biliary contrast agent iotroxate governed by the serum bilirubin value is a feasible and safe alternative to MRC in patients with and without impaired biliary excretion. In this retrospective study the feasibility and the frequency of adverse reactions when using a drip infusion scheme based on bilirubin levels has been evaluated

  18. Contrast media

    International Nuclear Information System (INIS)

    Decazes, Ph.

    2004-01-01

    The Guerbet firm, which holds 69% of the capital on the contrast media for medical imagery, could sale about 20% of this capital in order to accelerate its development in the United States, one of its next market with the Japan. (O.M.)

  19. Major depressive disorder and generalized anxiety disorder show different autonomic dysregulations revealed by heart-rate variability analysis in first-onset drug-naïve patients without comorbidity.

    Science.gov (United States)

    Shinba, Toshikazu

    2017-02-01

    The aim of the present study was to examine whether depression and anxiety disorder manifest different autonomic dysregulations using heart-rate variability (HRV) and heart rate (HR) measurements. HRV and HR were recorded both at rest and during task execution (random-number generation) in first-onset drug-naïve patients with major depressive disorder (MDD, n = 14) and generalized anxiety disorder (GAD, n = 11) as well as in healthy controls (n = 41). The patients showed no comorbidity of depression and anxiety disorder. GAD patients did not exhibit panic or phobic symptoms at the time of measurement. Following power spectrum analysis of HR trend, the high- (HF) and low-frequency (LF) components, the sum (LF + HF), and the LF/HF ratio were compared among the groups. In the MDD patients, as previously reported, HF was low and the LF/HF ratio was high during the initial-rest condition, and HF was less reactive to the task. In contrast, GAD patients showed significantly high HF, although autonomic reactivity was not impaired. The results indicate that baseline autonomic activity and its reactivity to behavioral changes are different between MDD and GAD in the early stage of illness. High parasympathetic tone in GAD may reflect responses of the parasympathetic system to anxiety. MDD is accompanied by an autonomic shift toward sympathetic activation and a reduced reactivity to task. © 2016 The Authors. Psychiatry and Clinical Neurosciences © 2016 Japanese Society of Psychiatry and Neurology.

  20. Contrasting patterns of deficits in visuospatial memory and executive function in patients with major depression with and without ECT referral.

    Science.gov (United States)

    Tsaltas, E; Kalogerakou, S; Papakosta, V-M; Kontis, D; Theochari, E; Koutroumpi, M; Anyfandi, E; Michopoulos, I; Poulopoulou, C; Papadimitriou, G; Oulis, P

    2011-05-01

    The pretreatment neuropsychological profile of drug-resistant patients with major depressive disorder (MDD) referred for electroconvulsive therapy (ECT) may differ from that of their drug-respondent MDD counterparts. Such differences could help in identifying distinct MDD subtypes, thus offering insights into the neuropathology underlying differential treatment responses. Depressed patients with ECT referral (ECTs), depressed patients with no ECT referral (NECTs) and non-psychiatric Controls (matched groups, n=15) were assessed with memory and executive function tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). ECTs scored significantly lower than NECTs in the Mini-Mental State Examination (MMSE; p=0.01). NECTs performed worse than Controls in the Paired Associates Learning (PAL) task (p<0.03; Control/NECT p<0.01) and the Spatial Recognition Memory (SRM) task (p<0.05; Controls/NECTs p<0.05); ECTs performed between Controls and NECTs, not differing from either. In the Intra/Extradimensional (IED) set-shifting task, ECTs performed worse that Controls and NECTS (IED: p<0.01; Controls/ECTs p<0.01), particularly in the shift phases, which suggests reduced attentional flexibility. In Stockings of Cambridge (SOC), ECTs abandoned the test early more often than Controls and NECTs (H=11, p<0.01) but ECTs who completed SOC performed comparably to the other two groups. A double dissociation emerged from the comparison of cognitive profiles of ECT and NECT patients. ECTs showed executive deficits, particularly in attentional flexibility, but mild deficits in tests of visuospatial memory. NECTs presented the opposite pattern. This suggests predominantly frontostriatal involvement in ECT versus temporal involvement in NECT depressives.

  1. Feasibility of measuring renal blood flow by phase-contrast magnetic resonance imaging in patients with autosomal dominant polycystic kidney disease

    NARCIS (Netherlands)

    Spithoven, E. M.; Meijer, E.; Borns, C.; Boertien, W. E.; Gaillard, C. A. J. M.; Kappert, P.; Greuter, M. J. W.; van der Jagt, E.; Vart, P.; de Jong, P. E.; Gansevoort, R. T.

    Renal blood flow (RBF) has been shown to predict disease progression in autosomal dominant polycystic kidney disease (ADPKD). We investigated the feasibility and accuracy of phase-contrast RBF by MRI (RBFMRI) in ADPKD patients with a wide range of estimated glomerular filtration rate (eGFR) values.

  2. A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging

    Energy Technology Data Exchange (ETDEWEB)

    Borges, J.P. [Laboratório de Atividade Física e Promoção è Saúde, Departamento de Desporto Coletivo, Instituto de Educação Física e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Lopes, G.O. [Laboratório de Atividade Física e Promoção è Saúde, Departamento de Desporto Coletivo, Instituto de Educação Física e Desportos, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, RJ (Brazil); Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Verri, V.; Coelho, M.P.; Nascimento, P.M.C.; Kopiler, D.A. [Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Tibirica, E. [Instituto Nacional de Cardiologia, Rio de Janeiro, RJ (Brazil); Laboratório de Investigação Cardiovascular, Departamento Osório de Almeida, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, RJ (Brazil)

    2016-09-01

    Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61) and healthy age-matched subjects (n=24). Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; P<0.01). With regard to post-occlusive reactive hyperemia-induced vasodilation, the patients also presented reduced responses compared to the controls (0.42±0.15 vs 0.50±0.13 APU/mmHg; P=0.04). In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men.

  3. A novel effective method for the assessment of microvascular function in male patients with coronary artery disease: a pilot study using laser speckle contrast imaging

    International Nuclear Information System (INIS)

    Borges, J.P.; Lopes, G.O.; Verri, V.; Coelho, M.P.; Nascimento, P.M.C.; Kopiler, D.A.; Tibirica, E.

    2016-01-01

    Evaluation of microvascular endothelial function is essential for investigating the pathophysiology and treatment of cardiovascular and metabolic diseases. Although laser speckle contrast imaging technology is well accepted as a noninvasive methodology for assessing microvascular endothelial function, it has never been used to compare male patients with coronary artery disease with male age-matched healthy controls. Thus, the aim of this study was to determine whether laser speckle contrast imaging could be used to detect differences in the systemic microvascular functions of patients with established cardiovascular disease (n=61) and healthy age-matched subjects (n=24). Cutaneous blood flow was assessed in the skin of the forearm using laser speckle contrast imaging coupled with the transdermal iontophoretic delivery of acetylcholine and post-occlusive reactive hyperemia. The maximum increase in skin blood flow induced by acetylcholine was significantly reduced in the cardiovascular disease patients compared with the control subjects (74 vs 116%; P<0.01). With regard to post-occlusive reactive hyperemia-induced vasodilation, the patients also presented reduced responses compared to the controls (0.42±0.15 vs 0.50±0.13 APU/mmHg; P=0.04). In conclusion, laser speckle contrast imaging can identify endothelial and microvascular dysfunctions in male individuals with cardiovascular disease. Thus, this technology appears to be an efficient non-invasive technique for evaluating systemic microvascular and endothelial functions, which could be valuable as a peripheral marker of atherothrombotic diseases in men

  4. Contrast-enhanced CT and diffusion-weighted MR imaging: Performance as a prognostic factor in patients with pancreatic ductal adenocarcinoma

    International Nuclear Information System (INIS)

    Fukukura, Yoshihiko; Takumi, Koji; Higashi, Michiyo; Shinchi, Hiroyuki; Kamimura, Kiyohisa; Yoneyama, Tomohide; Tateyama, Akihiro

    2014-01-01

    Objective: To determine whether contrast enhancement of CT and apparent diffusion coefficient on diffusion-weighted MR imaging are important parameters that can predict outcomes for patients with pancreatic ductal adenocarcinoma. Materials and methods: Ninety-two patients with histologically confirmed pancreatic ductal adenocarcinoma who underwent quadriphasic CT (including unenhanced, pancreatic parenchymal, portal venous and delayed phases) and fat-suppressed single-shot echo-planar diffusion-weighted MR imaging at 3.0 T were retrospectively analyzed to investigate prognostic factors. Overall survival curves were drawn using the Kaplan–Meier method. Effects on survival of variables including age, sex, tumor location, tumor size, TNM stage, carbohydrate antigen 19-9, carcinoembryonic antigen, treatment, tumor contrast enhancement and apparent diffusion coefficient values were analyzed in univariate analysis using the log-rank test. Variables were analyzed in multivariate analyses using the Cox proportional hazards regression model. Results: Median survival for the entire patient population was 18.2 months. Higher contrast enhancement during all phases was associated with significantly longer overall survival (P < 0.001 for all phases). The difference in overall survival between groups divided by median apparent diffusion coefficient value was not significant (P = 0.672). TNM stage (P = 0.026) and tumor contrast enhancement on CT (P = 0.027) were significantly related to survival in multivariate analysis. Conclusions: Poor enhancement of pancreatic adenocarcinomas on enhanced CT is associated with reduced patient survival

  5. Contrast-enhanced CT and diffusion-weighted MR imaging: Performance as a prognostic factor in patients with pancreatic ductal adenocarcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Fukukura, Yoshihiko, E-mail: fukukura@m.kufm.kagoshima-u.ac.jp [Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544 (Japan); Takumi, Koji [Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544 (Japan); Higashi, Michiyo [Department of Human Pathology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544 (Japan); Shinchi, Hiroyuki [Department of Surgical Oncology and Digestive Surgery, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544 (Japan); Kamimura, Kiyohisa; Yoneyama, Tomohide; Tateyama, Akihiro [Department of Radiology, Kagoshima University Graduate School of Medical and Dental Sciences, 8-35-1 Sakuragaoka, Kagoshima City 890-8544 (Japan)

    2014-04-15

    Objective: To determine whether contrast enhancement of CT and apparent diffusion coefficient on diffusion-weighted MR imaging are important parameters that can predict outcomes for patients with pancreatic ductal