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Mamoulakis C, Tsarouhas K, Fragkiadoulaki I, Heretis I, Wilks MF, Spandidos DA, Tsitsimpikou C, Tsatsakis A. Contrast-induced nephropathy: Basic concepts, pathophysiological implications and prevention strategies. Pharmacol Ther 2017. [PMID: 28642116 DOI: 10.1016/j.pharmthera.2017.06.009] [Citation(s) in RCA: 109] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Contrast-induced nephropathy (CIN) is reversible acute renal failure observed following administration of iodinated contrast media (CM) during angiographic or other medical procedures such as urography. There are various mechanisms through which CM develop their nephrotoxic effects, including oxidative stress and apoptosis. CIN is a real-life, albeit not very rare, entity. Exact pathophysiology remains obscure and no standard diagnostic criteria apply. The Acute Kidney Injury Network criteria was recently employed but its incidence/clinical significance warrants further clarification based on recent methodological advancements, because most published studies to date were contaminated by bias. The current study is a comprehensive review conducted to provide an overview of the basic concepts of CIN and summarize recent knowledge on its pathophysiology and the evidence supporting potential prevention strategies. CIN is expected to increase morbidity, hospital stay and mortality, while all patients scheduled to receive CM should undergo risk assessment for CIN and high-risk patients may be considered candidates for prevention strategies. The value of using compounds with antioxidant properties other than sodium bicarbonate, remains controversial, warranting further clinical investigation.
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Affiliation(s)
- Charalampos Mamoulakis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece.
| | | | - Irini Fragkiadoulaki
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
| | - Ioannis Heretis
- Department of Urology, University General Hospital of Heraklion, University of Crete, Medical School, Heraklion, Crete, Greece
| | - Martin F Wilks
- Swiss Centre for Applied Human Toxicology, University of Basel, CH-4055 Basel, Switzerland
| | - Demetrios A Spandidos
- Department of Virology, Medical School, University of Crete, Heraklion, Crete, Greece
| | - Christina Tsitsimpikou
- Department of Hazardous Substances, Mixtures and Articles, General Chemical State Laboratory of Greece, Ampelokipi, Athens, Greece
| | - Aristides Tsatsakis
- Department of Forensic Sciences and Toxicology, Faculty of Medicine, University of Crete, Heraklion 71003, Greece
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52
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Andreucci M, Faga T, Serra R, De Sarro G, Michael A. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf 2017; 9:25-37. [PMID: 28579836 PMCID: PMC5447694 DOI: 10.2147/dhps.s122207] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An important side effect of diagnostic contrast drugs is contrast-induced acute kidney injury (CI-AKI; a sudden decrease in renal function) occurring 48-72 hours after injection of a contrast drug that cannot be attributed to other causes. Its existence has recently been challenged, because of some retrospective studies in which the incidence of AKI was not different between subjects who received a contrast drug and those who did not, even using propensity score matching to prevent selection bias. For some authors, only patients with estimated glomerular filtration rate <30 mL/min/1.73 m2 are at significant risk of CI-AKI. Most agree that when renal function is normal, there is no CI-AKI risk. Many experimental studies, however, are in favor of the existence of CI-AKI. Contrast drugs have been shown to cause the following changes: renal vasoconstriction, resulting in a rise in intrarenal resistance (decrease in renal blood flow and glomerular filtration rate and medullary hypoxia); epithelial vacuolization and dilatation and necrosis of proximal tubules; potentiation of angiotensin II effects, reducing nitric oxide (NO) and causing direct constriction of descending vasa recta, leading to formation of reactive oxygen species in isolated descending vasa recta of rats microperfused with a solution of iodixanol; increasing active sodium reabsorption in the thick ascending limbs of Henle's loop (increasing O2 demand and consequently medullary hypoxia); direct cytotoxic effects on endothelial and tubular epithelial cells (decrease in release of NO in vasa recta); and reducing cell survival, due to decreased activation of Akt and ERK1/2, kinases involved in cell survival/proliferation. Prevention is mainly based on extracellular volume expansion, statins, and N-acetylcysteine; conflicting results have been obtained with nebivolol, furosemide, calcium-channel blockers, theophylline, and hemodialysis.
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Affiliation(s)
| | | | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Medical and Surgical Sciences
| | - Giovambattista De Sarro
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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Abstract
The German Society of Internal Medicine ("Deutsche Gesellschaft für Innere Medizin", DGIM) founded the Choosing wisely initiative in order to address diagnostic and therapeutic procedures that are frequently inappropriately applied, whether this be in terms of over-, under-, or misuse of health services. The German Society of Nephrology ("Deutsche Gesellschaft für Nephrologie," DGfN) strongly supports the initiative and has contributed five positive and five negative recommendations. These ten recommendations are discussed in the current publication. The positive recommendations reflect the importance of early recognition of renal disease via simple blood and urine tests, the use of radiocontrast media in cases of impaired renal function, as well as the problems associated with low vaccination rates. Three of the negative recommendations are focused on hydration and diuretics. The remaining two negative recommendations concern angioplasty in cases of renal artery stenosis and the unconsidered use of nonsteroidal anti-inflammatory drugs.
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Affiliation(s)
- J Galle
- Klinik für Nephrologie und Dialyseverfahren, Klinikum Lüdenscheid, Paulmannshöher Str. 14, 58515, Lüdenscheid, Deutschland.
| | - J Floege
- Klinik für Nieren- und Hochdruckkrankheiten, rheumatologische und immunologische Erkrankungen (Medizinische Klinik II), Universitätsklinikum Aachen, AöR, Aachen, Deutschland
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Tailored Duration of Contrast Material Injection in High-Pitch Computed Tomographic Aortography With a Double-Level Test Bolus Method. Invest Radiol 2017; 52:274-280. [DOI: 10.1097/rli.0000000000000340] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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55
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Arai Y, Takahashi D, Asano K, Tanaka M, Oda M, Ko SBH, Ko MSH, Mandai S, Nomura N, Rai T, Uchida S, Sohara E. Salt suppresses IFNγ inducible chemokines through the IFNγ-JAK1-STAT1 signaling pathway in proximal tubular cells. Sci Rep 2017; 7:46580. [PMID: 28425456 PMCID: PMC5397865 DOI: 10.1038/srep46580] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Accepted: 03/17/2017] [Indexed: 12/04/2022] Open
Abstract
The mechanisms of immunoactivation by salt are now becoming clearer. However, those of immunosuppression remain unknown. Since clinical evidence indicates that salt protects proximal tubules from injury, we investigated mechanisms responsible for salt causing immunosuppression in proximal tubules. We focused on cytokine-related gene expression profiles in kidneys of mice fed a high salt diet using microarray analysis and found that both an interferon gamma (IFNγ) inducible chemokine, chemokine (C-X-C motif) ligand 9 (CXCL9), and receptor, CXCR3, were suppressed. We further revealed that a high salt concentration suppressed IFNγ inducible chemokines in HK2 proximal tubular cells. Finally, we demonstrated that a high salt concentration decreased IFNGR1 expression in the basolateral membrane of HK2 cells, leading to decreased phosphorylation of activation sites of Janus kinase 1 (JAK1) and Signal Transducers and Activator of Transcription 1 (STAT1), activators of chemokines. JAK inhibitor canceled the effect of a high salt concentration on STAT1 and chemokines, indicating that the JAK1-STAT1 signaling pathway is essential for this mechanism. In conclusion, a high salt concentration suppresses IFNγ-JAK1-STAT1 signaling pathways and chemokine expressions in proximal tubules. This finding may explain how salt ameliorates proximal tubular injury and offer a new insight into the linkage between salt and immunity.
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Affiliation(s)
- Yohei Arai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Daiei Takahashi
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Kenichi Asano
- Laboratory of Immune regulation, School of Life Science, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Masato Tanaka
- Laboratory of Immune regulation, School of Life Science, Tokyo University of Pharmacy and Life Sciences, Tokyo, Japan
| | - Mayumi Oda
- Department of Systems Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shigeru B. H. Ko
- Department of Systems Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Minoru S. H. Ko
- Department of Systems Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Shintaro Mandai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Naohiro Nomura
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Tatemitsu Rai
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Shinichi Uchida
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
| | - Eisei Sohara
- Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University (TMDU), Tokyo, Japan
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Yeh BM, FitzGerald PF, Edic PM, Lambert JW, Colborn RE, Marino ME, Evans PM, Roberts JC, Wang ZJ, Wong MJ, Bonitatibus PJ. Opportunities for new CT contrast agents to maximize the diagnostic potential of emerging spectral CT technologies. Adv Drug Deliv Rev 2017; 113:201-222. [PMID: 27620496 PMCID: PMC5344792 DOI: 10.1016/j.addr.2016.09.001] [Citation(s) in RCA: 108] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 08/30/2016] [Accepted: 09/01/2016] [Indexed: 12/15/2022]
Abstract
The introduction of spectral CT imaging in the form of fast clinical dual-energy CT enabled contrast material to be differentiated from other radiodense materials, improved lesion detection in contrast-enhanced scans, and changed the way that existing iodine and barium contrast materials are used in clinical practice. More profoundly, spectral CT can differentiate between individual contrast materials that have different reporter elements such that high-resolution CT imaging of multiple contrast agents can be obtained in a single pass of the CT scanner. These spectral CT capabilities would be even more impactful with the development of contrast materials designed to complement the existing clinical iodine- and barium-based agents. New biocompatible high-atomic number contrast materials with different biodistribution and X-ray attenuation properties than existing agents will expand the diagnostic power of spectral CT imaging without penalties in radiation dose or scan time.
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Affiliation(s)
- Benjamin M Yeh
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States.
| | - Paul F FitzGerald
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Peter M Edic
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Jack W Lambert
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Robert E Colborn
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Michael E Marino
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Paul M Evans
- GE Healthcare Life Sciences, The Grove Centre, White Lion Road, Amersham, Buckinghamshire HP7 9LL, United Kingdom
| | - Jeannette C Roberts
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
| | - Zhen J Wang
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Margaret J Wong
- Department of Radiology and Biomedical Imaging, University of California San Francisco, 505 Parnassus Ave, San Francisco, CA 94143-0628, United States
| | - Peter J Bonitatibus
- General Electric Global Research, One Research Circle, Niskayuna, NY 12309, United States
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57
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The Evidence for and Against Corticosteroid Prophylaxis in At-Risk Patients. Radiol Clin North Am 2017; 55:413-421. [DOI: 10.1016/j.rcl.2016.10.012] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Harris MA, Snaith B, Clarke R. Strategies for assessing renal function prior to outpatient contrast-enhanced CT: a UK survey. Br J Radiol 2016; 89:20160077. [PMID: 27557630 DOI: 10.1259/bjr.20160077] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
OBJECTIVE To identify current UK screening practices prior to contrast-enhanced CT. To determine the patient management strategies to minimize the risk of contrast-induced acute kidney injury (CI-AKI) risk in outpatients. METHODS An invitation to complete an electronic survey was distributed to the CT managers of 174 UK adult National Health Service hospital trusts. The survey included questions related to local protocols and national guidance on which these are based. Details of the assessment of renal function prior to imaging and thresholds for contrast contraindication and patient management were also sought. RESULTS A response rate of 47.1% was received. Almost all sites had a policy in place for contrast administration (n = 80/82; 97.6%). The majority of sites require a blood test on outpatients undergoing a contrast-enhanced CT scan (n = 75/82; 91.5%); however, some (15/75; 20.0%) sites only check the result in patients at high risk and a small number (7/82; 8.5%) of sites indicated that it was a referrer responsibility. The estimated glomerular filtration rate (eGFR) or serum creatinine (SCr) result threshold at which i.v. contrast was contraindicated varied and 19 different threshold levels of eGFR or SCr were identified, each leading to different prophylactic strategies. Inconsistency was noted in the provision of follow-up blood tests after contrast administration. CONCLUSION The wide variation in practice reflects inconsistencies in published guidance. Evidence-based consensuses of which patients to test and subsequent risk thresholds will aid clinicians identify those patients in which the risk of CI-AKI is clinically significant but manageable. There is also a need to determine the value of the various prophylactic strategies, follow-up regimen and efficient service delivery pathways. Advances in knowledge: This survey has identified that further work is required to define which patients are high risk, confirm those which require renal function testing prior to contrast administration and how best to manage patients at risk of CI-AKI. The role of new technologies within this service delivery pathway requires further investigation.
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Affiliation(s)
| | - Beverly Snaith
- 1 Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
| | - Ruth Clarke
- 1 Radiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, UK
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59
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Higashigaito K, Schmid T, Puippe G, Morsbach F, Lachat M, Seifert B, Pfammatter T, Alkadhi H, Husarik DB. CT Angiography of the Aorta: Prospective Evaluation of Individualized Low-Volume Contrast Media Protocols. Radiology 2016; 280:960-8. [DOI: 10.1148/radiol.2016151982] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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60
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Pourmand A, Guida K, Abdallah A, Taheri MR, Shokoohi H. Gadolinium-based contrast agent anaphylaxis, a unique presentation of acute abdominal pain. Am J Emerg Med 2016; 34:1737.e1-2. [PMID: 26809660 DOI: 10.1016/j.ajem.2015.12.063] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 12/22/2015] [Indexed: 11/29/2022] Open
Affiliation(s)
- Ali Pourmand
- George Washington University, Emergency Medicine Department, Washington, DC.
| | - Kathryn Guida
- George Washington University, Emergency Medicine Department, Washington, DC
| | - Assya Abdallah
- George Washington University, Emergency Medicine Department, Washington, DC
| | - M Reza Taheri
- George Washington University, Radiology Department, Washington, DC
| | - Hamid Shokoohi
- George Washington University, Emergency Medicine Department, Washington, DC
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61
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Fukuda K, Higashimori A, Yokoi Y. Intravascular Ultrasound-Guided Mesenteric Stenting in Patients with Advanced Chronic Kidney Disease. Ann Vasc Surg 2016; 35:205.e5-8. [PMID: 27241868 DOI: 10.1016/j.avsg.2016.01.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2015] [Revised: 12/08/2015] [Accepted: 01/04/2016] [Indexed: 10/21/2022]
Abstract
Endovascular treatment of chronic mesenteric ischemia in patients with impaired renal function or allergy to contrast media is a challenging procedure because angiography requires iodinated contrast media for accurate diagnosis and interventional procedures. Superior mesenteric artery stenting without contrast angiography is described in an 81-year-old woman with cardiovascular disease and chronic kidney disease (CKD) stage 5. Balloon angioplasty and stent placement were performed successfully using intravascular ultrasound, pressure wire, surface ultrasound, and fluoroscopy. Intervention without contrast media has wide applicability to patients with advanced CKD and/or those with allergy to iodinated contrast media.
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Affiliation(s)
- Keisuke Fukuda
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan.
| | - Akihiro Higashimori
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
| | - Yoshiaki Yokoi
- Department of Cardiology, Kishiwada Tokushukai Hospital, Kishiwada City, Osaka, Japan
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62
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Mathur M, Weinreb JC. Imaging patients with renal impairment. Abdom Radiol (NY) 2016; 41:1108-21. [PMID: 27015867 DOI: 10.1007/s00261-016-0709-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Imaging with intravascular contrast media is generally considered safe, particularly in patients without renal failure. However, as renal function deteriorates, the potential risk of nonallergic-type adverse events increases. This presents a unique challenge, particularly when the use of intravenous contrast media is deemed essential for diagnostic purposes. Following a discussion regarding the definition and epidemiology of kidney injury, this review focuses on the evolving understanding of both contrast-induced nephropathy and nephrogenic systemic fibrosis and discusses preventative strategies aimed at minimizing the risk of developing these entities. Alternative non-contrast imaging techniques are also discussed.
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Affiliation(s)
- Mahan Mathur
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA.
| | - Jeffrey C Weinreb
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, 333 Cedar Street, Room TE-2, PO Box 208042, New Haven, CT, 06520, USA
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63
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Nyman U, Aspelin P, Jakobsen J, Björk J. Some Clarifying Points Regarding Controversies in Contrast Material–induced Acute Kidney Injury. Radiology 2016; 279:982-4. [DOI: 10.1148/radiol.2016152504] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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64
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Bannas P, François CJ, Reeder SB. Magnetic Resonance Angiography of the Upper Extremity. Magn Reson Imaging Clin N Am 2016. [PMID: 26216777 DOI: 10.1016/j.mric.2015.04.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The magnetic resonance angiography (MRA) toolbox includes a wide array of versatile methods for diagnosis and therapy planning in patients with a variety of upper extremity vascular pathologies. MRA can provide excellent image quality with high spatial and high temporal resolution without the disadvantages of ionizing radiation, iodinated contrast, and operator dependency. Contrast-enhanced techniques are preferred for their robustness, image quality, and shorter scan times. This article provides an overview of the available MRA techniques and a description of the clinical entities that are well suited for evaluation with contrast-enhanced MRA.
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Affiliation(s)
- Peter Bannas
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Radiology, University Hospital Hamburg-Eppendorf, Martinistrasse 52, Hamburg 20246, Germany.
| | - Christopher J François
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA
| | - Scott B Reeder
- Department of Radiology, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792-3252, USA; Department of Biomedical Engineering, University of Wisconsin-Madison, 1415 Engineering Drive, Madison, WI 53706, USA; Department of Medical Physics, University of Wisconsin-Madison, 1111 Highland Avenue, Madison, WI 53705-2275, USA; Department of Medicine, University of Wisconsin-Madison, 1685 Highland Avenue, Madison, WI 53705-2281, USA; Department of Emergency Medicine, University of Wisconsin-Madison, 600 Highland Avenue, Madison, WI 53792, USA
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65
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Nyman U, Aspelin P, Jakobsen J, Björk J. Controversies in Contrast Material-induced Acute Kidney Injury: Propensity Score Matching of Patients with Different Dose/Absolute Glomerular Filtration Rate Ratios. Radiology 2016; 277:633-7. [PMID: 26599923 DOI: 10.1148/radiol.2015151341] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ulf Nyman
- From the Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Lund University, Malmö, Sweden (U.N.); Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm 14186, Sweden (P.A.); Department of Radiology and Nuclear Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway (J.J.); Research and Development Centre Skåne, Skåne University Hospital, Lund, Sweden (J.B.); and Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden (J.B.)
| | - Peter Aspelin
- From the Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Lund University, Malmö, Sweden (U.N.); Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm 14186, Sweden (P.A.); Department of Radiology and Nuclear Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway (J.J.); Research and Development Centre Skåne, Skåne University Hospital, Lund, Sweden (J.B.); and Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden (J.B.)
| | - Jarl Jakobsen
- From the Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Lund University, Malmö, Sweden (U.N.); Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm 14186, Sweden (P.A.); Department of Radiology and Nuclear Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway (J.J.); Research and Development Centre Skåne, Skåne University Hospital, Lund, Sweden (J.B.); and Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden (J.B.)
| | - Jonas Björk
- From the Department of Translational Medicine, Division of Medical Radiology, Skåne University Hospital, Lund University, Malmö, Sweden (U.N.); Division of Medical Imaging and Technology, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Karolinska University Hospital, Stockholm 14186, Sweden (P.A.); Department of Radiology and Nuclear Medicine, Oslo University Hospital, Faculty of Medicine, University of Oslo, Oslo, Norway (J.J.); Research and Development Centre Skåne, Skåne University Hospital, Lund, Sweden (J.B.); and Department of Occupational and Environmental Medicine, Lund University, Lund, Sweden (J.B.)
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66
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Goldin JG, Beckett K. Risks of thoracic CT. IMAGING 2016. [DOI: 10.1183/2312508x.10001915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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McDonald RJ, McDonald JS, Newhouse JH, Davenport MS. Controversies in Contrast Material–induced Acute Kidney Injury: Closing in on the Truth? Radiology 2015; 277:627-32. [PMID: 26599922 DOI: 10.1148/radiol.2015151486] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Robert J McDonald
- From the Departments of Radiology of Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (R.J.M., J.S.M.); Columbia University Medical Center, New York, NY (J.H.N.); and University of Michigan Health System, Ann Arbor, Mich (M.S.D.)
| | - Jennifer S McDonald
- From the Departments of Radiology of Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (R.J.M., J.S.M.); Columbia University Medical Center, New York, NY (J.H.N.); and University of Michigan Health System, Ann Arbor, Mich (M.S.D.)
| | - Jeffrey H Newhouse
- From the Departments of Radiology of Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (R.J.M., J.S.M.); Columbia University Medical Center, New York, NY (J.H.N.); and University of Michigan Health System, Ann Arbor, Mich (M.S.D.)
| | - Matthew S Davenport
- From the Departments of Radiology of Mayo Clinic, 200 1st St SW, Rochester, MN 55905 (R.J.M., J.S.M.); Columbia University Medical Center, New York, NY (J.H.N.); and University of Michigan Health System, Ann Arbor, Mich (M.S.D.)
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Taslakian B, Sebaaly MG, Al-Kutoubi A. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 2: Patient Preparation and Medications). Cardiovasc Intervent Radiol 2015; 39:489-99. [PMID: 26606917 DOI: 10.1007/s00270-015-1239-4] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 11/04/2015] [Indexed: 01/17/2023]
Abstract
Performing an interventional procedure imposes a commitment on interventional radiologists to conduct the initial patient assessment, determine the best course of therapy, and provide long-term care. Patient care before and after an interventional procedure, identification, and management of early and delayed complications of various procedures are equal in importance to the procedure itself. In this second part, we complete the comprehensive, methodical review of pre-procedural care and patient preparation before vascular and interventional radiology procedures.
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Affiliation(s)
- Bedros Taslakian
- Department of Radiology, NYU Langone Medical Center, 660 First Avenue, New York, NY, 10016, USA.
| | - Mikhael Georges Sebaaly
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, PO Box: 11-0236, Lebanon.
| | - Aghiad Al-Kutoubi
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Riad El-Solh, Beirut, 1107 2020, PO Box: 11-0236, Lebanon.
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Davenport MS, Mervak BM, Ellis JH, Dillman JR, Dunnick NR, Cohan RH. Indirect Cost and Harm Attributable to Oral 13-Hour Inpatient Corticosteroid Prophylaxis before Contrast-enhanced CT. Radiology 2015; 279:492-501. [PMID: 26536404 DOI: 10.1148/radiol.2015151143] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE To estimate the effect of an oral 13-hour inpatient corticosteroid premedication regimen on length of stay, hospital cost, and hospital-acquired infections (HAIs) by using a combination of real and hypothetical study populations. MATERIALS AND METHODS Institutional review board approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Inpatients who received an oral 13-hour corticosteroid premedication regimen before contrast material-enhanced CT (n = 1424) from 2008 to 2013 were matched by age, sex, and year when CT was performed to a control cohort (n = 1425) of patients who underwent contrast-enhanced CT without premedication and who had similar rates of 13 comorbid diseases. Length of stay in the hospital and time from admission to CT were compared by using the Mann-Whitney U test. Rates of prospectively reported HAIs were compared by using χ(2) tests. The indirect cost and risk of HAI with premedication were estimated by using published data. RESULTS Premedicated inpatients had a significantly longer median length of stay (+25 hours; 158 vs 133 hours, P < .001), a significantly longer median time to CT (+25 hours, 42 vs 17 hours, respectively; P < .001), and a significantly greater risk of HAI (5.1% [72 of 1424] vs 3.1% [44 of 1424], respectively; P = .008) compared with nonpremedicated control subjects. On the basis of these data and existing references, the prolonged length of stay was estimated to result in 0.04 HAI-related deaths and a cost of $159 131 (in U.S. dollars) for each prevented reaction of any severity and 32 HAI-related deaths and a cost of $131 211 400 for each prevented reaction-related death. CONCLUSION Oral 13-hour inpatient corticosteroid prophylaxis is associated with substantial cost relative to its modest benefit, and may cause more indirect harm than the direct harm that it prevents.
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Affiliation(s)
- Matthew S Davenport
- From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108
| | - Benjamin M Mervak
- From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108
| | - James H Ellis
- From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108
| | - Jonathan R Dillman
- From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108
| | - N Reed Dunnick
- From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108
| | - Richard H Cohan
- From the Department of Radiology (M.S.D., B.M.M., .H.E., J.R.D., N.R.D., R.H.C.), Division of Abdominal Imaging (M.S.D., J.H.E., N.R.D., R.H.C.); Section of Pediatric Imaging (J.R.D.), and Michigan Radiology Quality Collaborative (M.S.D.), University of Michigan Health System, 1500 E Medical Center Dr, Ann Arbor, MI 48108
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Taslakian B, Sebaaly MG, Al-Kutoubi A. Patient Evaluation and Preparation in Vascular and Interventional Radiology: What Every Interventional Radiologist Should Know (Part 1: Patient Assessment and Laboratory Tests). Cardiovasc Intervent Radiol 2015; 39:325-33. [DOI: 10.1007/s00270-015-1228-7] [Citation(s) in RCA: 96] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/11/2015] [Indexed: 11/30/2022]
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Beckett KR, Moriarity AK, Langer JM. Safe Use of Contrast Media: What the Radiologist Needs to Know. Radiographics 2015; 35:1738-50. [DOI: 10.1148/rg.2015150033] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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