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Yang K, Shang Y, Yang N, Pan S, Jin J, He Q. Application of nanoparticles in the diagnosis and treatment of chronic kidney disease. Front Med (Lausanne) 2023; 10:1132355. [PMID: 37138743 PMCID: PMC10149997 DOI: 10.3389/fmed.2023.1132355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 03/22/2023] [Indexed: 05/05/2023] Open
Abstract
With the development of nanotechnology, nanoparticles have been used in various industries. In medicine, nanoparticles have been used in the diagnosis and treatment of diseases. The kidney is an important organ for waste excretion and maintaining the balance of the internal environment; it filters various metabolic wastes. Kidney dysfunction may result in the accumulation of excess water and various toxins in the body without being discharged, leading to complications and life-threatening conditions. Based on their physical and chemical properties, nanoparticles can enter cells and cross biological barriers to reach the kidneys and therefore, can be used in the diagnosis and treatment of chronic kidney disease (CKD). In the first search, we used the English terms "Renal Insufficiency, Chronic" [Mesh] as the subject word and terms such as "Chronic Renal Insufficiencies," "Chronic Renal Insufficiency," "Chronic Kidney Diseases," "Kidney Disease, Chronic," "Renal Disease, Chronic" as free words. In the second search, we used "Nanoparticles" [Mesh] as the subject word and "Nanocrystalline Materials," "Materials, Nanocrystalline," "Nanocrystals," and others as free words. The relevant literature was searched and read. Moreover, we analyzed and summarized the application and mechanism of nanoparticles in the diagnosis of CKD, application of nanoparticles in the diagnosis and treatment of renal fibrosis and vascular calcification (VC), and their clinical application in patients undergoing dialysis. Specifically, we found that nanoparticles can detect CKD in the early stages in a variety of ways, such as via breath sensors that detect gases and biosensors that detect urine and can be used as a contrast agent to avoid kidney damage. In addition, nanoparticles can be used to treat and reverse renal fibrosis, as well as detect and treat VC in patients with early CKD. Simultaneously, nanoparticles can improve safety and convenience for patients undergoing dialysis. Finally, we summarize the current advantages and limitations of nanoparticles applied to CKD as well as their future prospects.
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Affiliation(s)
- Kaibi Yang
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Yiwei Shang
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Nan Yang
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Shujun Pan
- Urology and Nephrology Center, Department of Nephrology, Zhejiang Provincial People’s Hospital, Affiliated People’s Hospital, Hangzhou Medical College, Hangzhou, Zhejiang, China
| | - Juan Jin
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- *Correspondence: Juan Jin,
| | - Qiang He
- Department of Nephrology, the First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, Zhejiang, China
- Qiang He,
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Wu MC, Hsu MY, Shie RF, Cheng MH, Chu FI, Lin CY, Fan YP, Chu SY. Non-contrast-enhanced magnetic resonance angiography of facial arteries for pre-operative evaluation of vascularized submental lymph node flaps. BMC Med Imaging 2019; 19:68. [PMID: 31420022 PMCID: PMC6698015 DOI: 10.1186/s12880-019-0368-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2019] [Accepted: 08/06/2019] [Indexed: 12/15/2022] Open
Abstract
Background The aim of this study was to compare non-contrast-enhanced 3D phase contrast magnetic resonance angiography (3D PC-MRA) and conventional intravenous administration of contrast media, i.e., contrast-enhanced MRA (CE-MRA), to evaluate the courses of facial arteries for the preparation of vascularized submental lymph node flap (VSLN flap) transfer. Methods The head and neck regions of 20 patients with limb lymphedema were imaged using a 3 T MRI scanner. To improve the evaluation of facial artery courses, MRA was fused with anatomical structures generated by high-resolution T1-weighted imaging. The diagnostic and image qualities of facial arteries for VSLN flap planning were independently rated by two radiologists. Interobserver agreement was evaluated using Cohen’s kappa. Differences between 3D PC-MRA and CE-MRA in terms of the diagnostic quality of facial arteries were evaluated using McNemar’s test. Results Cohen’s kappa indicated fair to good interobserver agreement for the diagnostic and image qualities of the bilateral facial arteries. No significant difference in terms of the diagnostic quality of the left and right facial arteries between 3D PC-MRA and CE-MRA, respectively, was identified. Conclusions Non-contrast 3D PC-MRA is a reliable method for the evaluation of facial artery courses prior to VSLN flap transfer and could serve as an alternative to CE-MRA for patients with renal insufficiency or severe adverse reactions to contrast media.
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Affiliation(s)
- Ming-Chen Wu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; No. 5 Fuxing St., Guishan Dist, Taoyuan City, Taiwan
| | - Ming-Yi Hsu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; No. 5 Fuxing St., Guishan Dist, Taoyuan City, Taiwan
| | - Ren-Fu Shie
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; No. 5 Fuxing St., Guishan Dist, Taoyuan City, Taiwan
| | - Ming-Huei Cheng
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; No. 5 Fuxing St., Guishan Dist, Taoyuan City, Taiwan
| | - Fang-I Chu
- Department of Statistics and Applied Probability, University of California, Santa Barbara, CA, 93106-3110, USA.,Department of Radiation Oncology, University of California, 200 UCLA Medical Plaza, Suite B265, Los Angeles, CA, 90095-6951, USA
| | - Chien-Yuan Lin
- GE Healthcare, Taiwan; 6F, No.8, Min Sheng E. Rd., Sec. 3, Taipei, 10480, Taiwan
| | - Yui-Ping Fan
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; No. 5 Fuxing St., Guishan Dist, Taoyuan City, Taiwan
| | - Sung-Yu Chu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan; No. 5 Fuxing St., Guishan Dist, Taoyuan City, Taiwan.
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Updated Clinical Practice Guideline on Use of Gadolinium-Based Contrast Agents in Kidney Disease Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2019; 70:226-232. [DOI: 10.1016/j.carj.2019.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
In 2017, the Canadian Association of Radiologists issued a clinical practice guideline (CPG) regarding the use of gadolinium-based contrast agents (GBCAs) in patients with acute kidney injury (AKI), chronic kidney disease (CKD), or on dialysis due to mounting evidence indicating that nephrogenic systemic fibrosis (NSF) occurs with extreme rarity or not at all when using Group II GBCAs or the Group III GBCA gadoxetic acid (compared to first generation Group I linear GBCAs). One of the goals of the work group was to re-evaluate the CPG after 24 months to determine the effect of more liberal use of GBCA on reported cases of NSF in patients with AKI, CKD Stage 4 or 5 (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), or those that are dialysis-dependent. A comprehensive review of the literature was conducted by a subcommittee of the initial CPG panel between the dates of January 1, 2017-December 31, 2018 to identify new unconfounded cases of NSF linked to Group II or Group III GBCAs and an updated CPG developed. To our knowledge, when using a Group II or Group III GBCA between 2017-2018, only a single unconfounded case report of a fibrosing dermopathy has been reported in a patient who received gadobenate dimeglumine with Stage 2 CKD. No other unconfounded cases of NSF have been reported with Group II or III agents in during this timeframe. The subcommittee concluded that the main recommendations from the 2017 CPG should remain unaltered, but agreed that screening for renal disease in the outpatient setting is no longer justifiable, cost-effective or recommended. Patients on hemodialysis (HD) should, however, be identified prior to GBCA administration to arrange timely HD to optimize gadolinium clearance, although there remains no evidence that HD reduces the risk of NSF. When administering Group II or III GBCAs to patients with AKI, on dialysis or with severe CKD, informed consent relating to NSF is also no longer explicitly recommended.
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Targeted Imaging of Renal Fibrosis Using Antibody-Conjugated Gold Nanoparticles in Renal Artery Stenosis. Invest Radiol 2019; 53:623-628. [PMID: 29727402 DOI: 10.1097/rli.0000000000000476] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVES The ability to determine the severity of renal fibrosis, which is involved in most chronic kidney diseases, may be beneficial for monitoring disease progression and management. The aim of this study was to assess a new method involving gold nanoparticles conjugated to an anti-collagen-I antibody (Co-I-AuNPs) as a computed tomography (CT) imaging contrast for the evaluation of renal fibrosis in situ. MATERIALS AND METHODS Gold nanoparticles conjugated to an anti-collagen-I antibody were prepared using gold chloride reduction with sodium citrate and coated with polyethylene glycol (PEG), and their size was determined by electron microscopy and nanoparticle tracking analysis. Anti-collagen-I antibody was then conjugated to PEG-SH/COOH on the AuNP surface. The success of antibody conjugation was tested in vitro using collagen-coated plate and mouse stenotic kidney sections and in vivo using micro-CT and multidetector CT imaging. RESULTS Bare AuNPs were 18.7 ± 0.6 nm and PEG-coated AuNPs were 45.3 ± 0.1 nm in size. In vitro, Co-I-AuNPs specifically bound to both a collagen-coated plate and mouse fibrotic kidneys. Furthermore, the stenotic mouse kidney showed increased Co-I-AuNPs retention compared with the contralateral kidney (59.3 ± 5.1 vs 45.1 ± 1.7 HU, P = 0.05), which correlated with its collagen deposition. Micro-CT also detected gold signals in situ in the Co-I-AuNP-injected kidney, which colocalized with histological trichrome staining. CONCLUSION Gold nanoparticles conjugated to an anti-collagen-I antibody are able to visualize kidney fibrosis in vitro and in situ and may be useful for nondestructive quantification of tissue fibrosis.
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Janus N, Launay-Vacher V, Deray G. [Non-iodinated contrast media nephrotoxicity]. Nephrol Ther 2018; 14:484-490. [PMID: 30301611 DOI: 10.1016/j.nephro.2018.09.002] [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: 10/28/2022]
Abstract
The development of interventional radiology techniques regularly exposes patients to the potential renal toxocity of iodinated contrast media. Faced with this risk of nephrotoxicity, gadolinium-based contrast agents have long been considered as a safe alternative to iodinated contrast media, especially in sensitive or at risk patients. However, these gadolinium-based contrast agents are not devoid of nephrotoxicity and present another risk, a complication related to renal failure, the nephrogenic systemic fibrosis. European and US recommendations from health agencies have recently come closer, defining groups of patients at risk of nephrogenic systemic fibrosis according to their level of renal function and the type of gadolinium-based contrast agent used. What are the real renal risks for these products? How to evaluate the benefit-risk balance of the patient to choose a radiological examination in an informative, effective and safe way? This article focuses on the description of the risks of gadolinium-based contrast agents, reviews existing recommendations and best practices to guide the choice of clinicians.
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Affiliation(s)
- Nicolas Janus
- Service Icar, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Service de néphrologie, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France.
| | - Vincent Launay-Vacher
- Service Icar, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Service de néphrologie, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
| | - Gilbert Deray
- Service Icar, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France; Service de néphrologie, hôpital de la Pitié-Salpêtrière, 83, boulevard de l'Hôpital, 75013 Paris, France
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High-concentration iodinated contrast media for T1-weighted direct magnetic resonance arthrography. Clin Radiol 2018; 73:907.e1-907.e7. [DOI: 10.1016/j.crad.2018.07.100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Revised: 04/23/2018] [Accepted: 05/09/2018] [Indexed: 11/23/2022]
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol CB, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: A Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can J Kidney Health Dis 2018; 5:2054358118778573. [PMID: 29977584 PMCID: PMC6024496 DOI: 10.1177/2054358118778573] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/31/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE OF REVIEW Use of gadolinium-based contrast agents (GBCA) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCA are absolutely contraindicated in AKI, category G4 and G5 CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), and dialysis-dependent patients is outdated and may limit access to clinically necessary contrast-enhanced magnetic resonance imaging (MRI) examinations. This review and clinical practice guideline addresses the discrepancy between existing Canadian guidelines regarding use of GBCA in renal impairment and NSF. SOURCES OF INFORMATION Published literature (including clinical trials, retrospective cohort series, review articles, and case reports), online registries, and direct manufacturer databases were searched for reported cases of NSF by class and specific GBCA and exposed patient population. METHODS A comprehensive review was conducted identifying cases of NSF and their association to class of GBCA, specific GBCA used, patient, and dose (when this information was available). Based on the available literature, consensus guidelines were developed by an expert panel of radiologists and nephrologists. KEY FINDINGS In patients with category G2 or G3 CKD (eGFR ≥ 30 and < 60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with category G4 or G5 CKD (eGFR < 30 mL/min/1.73 m2) or on dialysis, administration of GBCA should be considered individually and alternative imaging modalities utilized whenever possible. If GBCA are necessary, newer GBCA may be administered with patient consent obtained by a physician (or their delegate) citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, those with category G4 or G5 CKD, or those on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCA. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCA is recommended. LIMITATIONS Limited available literature (number of injections and use in renal impairment) regarding the use of gadoxetate disodium. Limited, but growing and generally high-quality, number of clinical trials evaluating GBCA administration in renal impairment. Limited data regarding the topic of Gadolinium deposition in the brain, particularly as it related to patients with renal impairment. IMPLICATIONS In patients with AKI and category G4 and G5 CKD (eGFR < 30 mL/min/1.73 m2) and in dialysis-dependent patients who require GBCA-enhanced MRI, GBCA can be administered with exceedingly low risk of causing NSF when using macrocyclic agents and newer linear agents at routine doses.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Jason I. Blaichman
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Andreu F. Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
- Neuroradiology Section, MRI Modality Lead, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Québec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Clinical Epidemiology Program and the University of Ottawa, Ontario, Canada
| | | | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol C, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2018; 69:136-150. [PMID: 29706252 DOI: 10.1016/j.carj.2017.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023] Open
Abstract
Use of gadolinium-based contrast agents (GBCAs) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCAs are absolutely contraindicated in AKI, CKD stage 4 or 5 (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) and dialysis-dependent patients is outdated, and may limit access to clinically necessary contrast-enhanced MRI examinations. Following a comprehensive review of the literature and reported NSF cases to date, a committee of radiologists and nephrologists developed clinical practice guidelines to assist physicians in making decisions regarding GBCA administrations. In patients with mild-to-moderate CKD (eGFR ≥30 and <60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with severe CKD (eGFR <30 mL/min/1.73 m2), or on dialysis, administration of GBCAs should be considered individually and alternative imaging modalities utilized whenever possible. If GBCAs are necessary, newer GBCAs may be administered with patient consent obtained by a physician (or their delegate), citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, with stage 4 or 5 CKD, or on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCAs. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCAs is recommended.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jason I Blaichman
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian van der Pol
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Mayr A, Klug G, Reinstadler SJ, Feistritzer HJ, Reindl M, Kremser C, Kranewitter C, Bonaros N, Friedrich G, Feuchtner G, Metzler B. Is MRI equivalent to CT in the guidance of TAVR? A pilot study. Eur Radiol 2018; 28:4625-4634. [PMID: 29736853 DOI: 10.1007/s00330-018-5386-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 02/11/2018] [Accepted: 02/14/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES To compare a comprehensive cardiovascular magnetic resonance imaging (MRI) protocol with contrast-enhanced computed tomography angiography (CTA) for guidance in transcatheter aortic valve replacement (TAVR) evaluation. METHODS AND RESULTS Non-contrast three-dimensional (3D) 'whole heart' MRI imaging for aortic annulus sizing and measurements of coronary ostia heights, contrast-enhanced MRI angiography (MRA) for evaluation of transfemoral routes as well as aortoiliofemoral-CTA were performed in 16 patients referred for evaluation of TAVR. Aortic annulus measurements by MRI and CTA showed a very strong correlation (r=0.956, p<0.0001; effective annulus area for MRI 430±74 vs. 428±78 mm2 for CTA, p=0.629). Regarding decision for valve size there was complete consistency between MRI and CTA. Moreover, vessel luminal diameters and angulations of aortoiliofemoral access as measured by MRA and CTA showed overall very strong correlations (r= 0.819 to 0.996, all p<0.001), the agreement of minimal vessel diameter between the two modalities revealed a bias of 0.02 mm (upper and lower limit of agreement: 1.02 mm and -0.98 mm). CONCLUSIONS In patients referred for TAVR, MRI measurements of aortic annulus and minimal aortoiliofemoral diameters showed good to excellent agreement. Decisions based on MRI measurements regrading prosthesis sizing and transfemoral access would not have modified TAVR-strategy as compared to a CTA-based choice. KEY POINTS • 'Whole heart' MRI and CTA measurements of aortic annulus correlate very strongly. • MRI- and CTA-based prostheses sizing are in excellent agreement. • MRA and CTA equally guide TAVR access strategy.
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Affiliation(s)
- Agnes Mayr
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gert Klug
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Sebastian J Reinstadler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Hans-Josef Feistritzer
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Martin Reindl
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christian Kremser
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Christof Kranewitter
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Nikolaos Bonaros
- University Clinic of Cardiac Surgery, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Guy Friedrich
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Gudrun Feuchtner
- University Clinic of Radiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria
| | - Bernhard Metzler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Anichstraße 35, A-6020, Innsbruck, Austria.
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Martin DR, Kalb B, Mittal A, Salman K, Vedantham S, Mittal PK. No Incidence of Nephrogenic Systemic Fibrosis after Gadobenate Dimeglumine Administration in Patients Undergoing Dialysis or Those with Severe Chronic Kidney Disease. Radiology 2018; 286:113-119. [PMID: 28731375 DOI: 10.1148/radiol.2017170102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Diego R. Martin
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Bobby Kalb
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Ankush Mittal
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Khalil Salman
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Srinivasan Vedantham
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Pardeep K. Mittal
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
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12
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Incidence and Risk Factors for Gadolinium-Based Contrast Agent Immediate Reactions. Top Magn Reson Imaging 2017; 25:257-263. [PMID: 27748714 DOI: 10.1097/rmr.0000000000000109] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Since their clinical introduction in 1988, gadolinium-based contrast agents (GBCAs) have demonstrated an excellent safety profile with a reported acute adverse reaction rate ranging from 0.01% to 2%. By comparison, the acute adverse reaction rate of low osmolar nonionic computed tomography contrast agents (CTCs) ranges from 0.7% to 3.1%. Many of the risk factors associated with CTC reactions (drug allergies, asthma, atopy, prior contrast reaction) also point toward an increased incidence of acute adverse events to GBCAs. With CTCs, an increased adverse event rate was associated with ionic preparations and high osmolality. In response to concerns for nephrogenic systemic fibrosis, GBCAs are now selected for their augmented chemical stability. These agents possess some combination of macrocyclic chelates or ionic preparations. With their improved chemical stability, these agents also possess higher osmolality and the increased potential to elicit an acute adverse reaction. In light of these concerns, researchers are now focusing greater efforts on reexamining acute adverse reactions to GBCAs and whether there is an increased association with certain agents. In addition to hypersensitivity reactions, this article will also discuss contrast extravasations, safety of GBCAs for pregnant and nursing patients, and the potential nephrotoxic effects of GBCAs.
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13
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14
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Li L, Zhang Y, Chen Y, Zhu KS, Chen DJ, Zeng XQ, Wang XB. A multicentre retrospective study of transcatheter angiographic embolization in the treatment of delayed haemorrhage after percutaneous nephrolithotomy. Eur Radiol 2014; 25:1140-7. [PMID: 25537978 DOI: 10.1007/s00330-014-3491-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/08/2014] [Accepted: 11/05/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The objective is to determine the timing and indications of transcatheter angiographic embolization (TAE) for delayed haemorrhage after percutaneous nephrolithotomy (PCNL). METHODS The medical records of 144 patients who underwent arteriography and TAE for delayed post-PCNL haemorrhage at five university hospitals between January 2005 and December 2012 were reviewed retrospectively. RESULTS The mean time to the onset of post-PCNL haemorrhage was 10.5 days (2 - 30 days). Clinical presentation included sudden onset bleeding in 51 patients (35.4 %), intermittent bleeding in 67 patients (46. 5 %), and continuous slow bleeding in 26 patients (18.1 %). Hemodynamic instability occurred in 32 patients (22.2 %). The mean haemoglobin decrease from the first post-PCNL day to the day of TAE was 49.5 g/L (31.0 - 79.0 g/L). Renal arteriography showed pseudoaneurysms in 69 (47.9 %) patients, arteriovenous fistulas in 28 (19.4 %) patients, mixed arterial and arteriovenous lesions in 17 (11.8 %) patients, arterial lacerations in 23 (16.0 %) patients, and negative angiographic finding in seven (4.9 %) patients. TAE was successful in stopping bleeding in all 137 patients with vascular lesions. There were no major complications associated with TAE. CONCLUSIONS TAE should be the recommended treatment for delayed post-PCNL haemorrhage in patients with hemodynamic instability and/or corrected haemoglobin decrease >30 g/L following conservative management. KEY POINTS • Delayed haemorrhage after percutaneous nephrolithotomy occurs more than 24 hours postoperatively. • Angio-embolization is a safe and effective treatment for delayed post-PCNL haemorrhage. • Angio-embolization can treat hemodynamic instability and/or corrected haemoglobin decrease >30 g/L.
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Affiliation(s)
- Long Li
- The Division of Interventional Radiology, Department of Radiology, Guangdong Provincial Corps Hospital of Chinese People's Armed Police Forces, Guangzhou Medical University, 268 Yanling Road, Guangzhou City, Guangdong Province, 510507, China
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15
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Idée JM, Fretellier N, Robic C, Corot C. The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: A critical update. Crit Rev Toxicol 2014; 44:895-913. [PMID: 25257840 DOI: 10.3109/10408444.2014.955568] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Affiliation(s)
- Jean-Marc Idée
- Guerbet, Research & Innovation Division , Aulnay-sous-Bois , France
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16
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Abstract
Magnetic resonance (MR) imaging is a robust imaging modality for evaluation of vascular diseases. Technological advances have made MR imaging widely available for accurate and time-efficient vascular assessment. In this article the clinical usefulness of MR imaging techniques and their application are reviewed, using examples of vascular abnormalities commonly encountered in clinical practice, including abdominal, pelvic, and thoracic vessels. Common pitfalls and problem solving in interpretation of vascular findings in body MR imaging are also discussed.
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Affiliation(s)
- Wirana Angthong
- Department of Radiology, University of North Carolina Hospitals, UNC at Chapel Hill, CB 7510, 2001 Old Clinic Building, Chapel Hill, NC 27599-7510, USA; Department of Radiology, HRH Princess Maha Chakri Sirindhorn Medical Center, Srinakharinwirot University, 62 Moo 7, Khlong Sip, Ongkharak, Nakhon Nayok, Thailand
| | - Richard C Semelka
- Department of Radiology, University of North Carolina Hospitals, UNC at Chapel Hill, CB 7510, 2001 Old Clinic Building, Chapel Hill, NC 27599-7510, USA.
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17
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Winship B, Ramakrishnan S, Evans J, Lurie C, Martin D, Pearson T, Turgeon N. A single-center analysis of abdominal imaging in the evaluation of kidney transplant recipients. Clin Transplant 2013; 27:701-9. [DOI: 10.1111/ctr.12202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2013] [Indexed: 11/29/2022]
Affiliation(s)
| | | | - Jonathan Evans
- University of Birmingham College of Medical and Dental Sciences; Birmingham; UK
| | | | - Diego Martin
- Department of Radiology; University of Arizona College of Medicine; Tucson; AZ; USA
| | - Thomas Pearson
- Department of Surgery; Emory University; Atlanta; GA; USA
| | - Nicole Turgeon
- Department of Surgery; Emory University; Atlanta; GA; USA
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18
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Spencer J, Fitch E, Iaizzo PA. Anatomical reconstructions of the human cardiac venous system using contrast-computed tomography of perfusion-fixed specimens. J Vis Exp 2013. [PMID: 23629052 DOI: 10.3791/50258] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
A detailed understanding of the complexity and relative variability within the human cardiac venous system is crucial for the development of cardiac devices that require access to these vessels. For example, cardiac venous anatomy is known to be one of the key limitations for the proper delivery of cardiac resynchronization therapy (CRT)(1) Therefore, the development of a database of anatomical parameters for human cardiac venous systems can aid in the design of CRT delivery devices to overcome such a limitation. In this research project, the anatomical parameters were obtained from 3D reconstructions of the venous system using contrast-computed tomography (CT) imaging and modeling software (Materialise, Leuven, Belgium). The following parameters were assessed for each vein: arc length, tortuousity, branching angle, distance to the coronary sinus ostium, and vessel diameter. CRT is a potential treatment for patients with electromechanical dyssynchrony. Approximately 10-20% of heart failure patients may benefit from CRT(2). Electromechanical dyssynchrony implies that parts of the myocardium activate and contract earlier or later than the normal conduction pathway of the heart. In CRT, dyssynchronous areas of the myocardium are treated with electrical stimulation. CRT pacing typically involves pacing leads that stimulate the right atrium (RA), right ventricle (RV), and left ventricle (LV) to produce more resynchronized rhythms. The LV lead is typically implanted within a cardiac vein, with the aim to overlay it within the site of latest myocardial activation. We believe that the models obtained and the analyses thereof will promote the anatomical education for patients, students, clinicians, and medical device designers. The methodologies employed here can also be utilized to study other anatomical features of our human heart specimens, such as the coronary arteries. To further encourage the educational value of this research, we have shared the venous models on our free access website: www.vhlab.umn.edu/atlas.
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Merkx MAG, Bode AS, Huberts W, Oliván Bescós J, Tordoir JHM, Breeuwer M, van de Vosse FN, Bosboom EMH. Assisting vascular access surgery planning for hemodialysis by using MR, image segmentation techniques, and computer simulations. Med Biol Eng Comput 2013; 51:879-89. [PMID: 23526414 DOI: 10.1007/s11517-013-1060-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Accepted: 03/05/2013] [Indexed: 11/27/2022]
Affiliation(s)
- M A G Merkx
- Department of Biomedical Engineering, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands.
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Evaluation of renal blood flow using multi-phase echo-planar magnetic resonance imaging and signal targeting with alternating radiofrequency (EPISTAR) in 3-T magnetic resonance imaging. Radiol Phys Technol 2012; 6:86-91. [PMID: 22869501 DOI: 10.1007/s12194-012-0173-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Revised: 07/20/2012] [Accepted: 07/23/2012] [Indexed: 10/28/2022]
Abstract
Most arterial spin labeling techniques apply the constant post-labeling delay time after the blood-labeling time point on the target artery. As the hemodynamic status cannot be estimated in each patient, quantitative values of the blood flow may not be accurate. To overcome this problem, we performed renal perfusion imaging of human kidneys using multi-phase echo-planar magnetic resonance imaging and signal targeting with an alternating radiofrequency (EPISTAR) sequence at 3-T magnetic resonance imaging. Multi-phase EPISTAR obtained 17 phases every 100 ms between 250 and 1850 ms from the arterial-labeling time point. The highest signal-intensity image obtained using multi-phase images was applied to renal blood flow (RBF) calculations. In five healthy volunteers, the mean cortical RBF was 286.6 ± 48.7 mL/100 g/min. This value was not significantly different from those in four previous studies. This technique was more useful than previous studies, in that multi-phase images could confirm the hemodynamic status on RBF calculations.
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Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 2012; 23:307-18. [PMID: 22865271 DOI: 10.1007/s00330-012-2597-9] [Citation(s) in RCA: 292] [Impact Index Per Article: 24.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 06/17/2012] [Accepted: 06/21/2012] [Indexed: 01/03/2023]
Abstract
PURPOSE To update the guidelines of the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) on nephrogenic systemic fibrosis and gadolinium-based contrast media. AREAS COVERED Topics reviewed include the history, clinical features and prevalence of nephrogenic systemic fibrosis and the current understanding of its pathophysiology. The risk factors for NSF are discussed and prophylactic measures are recommended. The stability of the different gadolinium-based contrast media and the potential long-term effects of gadolinium in the body have also been reviewed.
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Casciani E, Polettini E, Masselli G, Stirati G, Gualdi G. Spontaneous renal artery dissection diagnosed by unenhanced magnetic resonance angiography: case report. Urol Int 2012; 89:486-8. [PMID: 22777312 DOI: 10.1159/000339751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2012] [Accepted: 05/20/2012] [Indexed: 12/31/2022]
Abstract
A 47-year-old patient is presented who was admitted to the emergency department with complaints of right-sided flank pain and hypertension. His creatinine and glomerular filtration rate were 2.5 mg/dl and 37 ml/min respectively, so that contrast media administration was contraindicated. The unenhanced magnetic resonance angiography image obtained with 3D in-flow inversion recovery sequence showed right renal artery dissection, without aortic dissection. Selective renal angiography confirmed the diagnosis and a stent was placed in the renal artery. The patient was free of pain after stenting, with normalized laboratory values and blood pressure.
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Affiliation(s)
- Emanuele Casciani
- Radiology, Emergency Department, University of Rome La Sapienza, Viale del Policlinico 155, Rome, Italy.
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23
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MR findings of lithium-related kidney disease: preliminary observations in four patients. ACTA ACUST UNITED AC 2012; 37:140-6. [PMID: 21717136 DOI: 10.1007/s00261-011-9745-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
PURPOSE To describe MR features of the kidney in patients on chronic lithium therapy and to correlate findings with the level of renal impairment. METHOD In this retrospective HIPPA compliant study, a search was performed in our institutional clinical and radiological computerized database for subjects with lithium-related kidney disease between August 1, 2009 and May 30, 2010. Four patients (2 male and 2 females, mean age 64.75 ± 3.5) with a total of eight kidneys fulfilled the search criteria. T2-weighted images were used to evaluate the presence, size, and distribution of renal cysts. T1-weighted images were used to evaluate kidney length, parenchymal thickness, and cortico-medullary differentiation (CMD). RESULTS All kidneys displayed multiple, very abundant, small size (1-2 mm) cysts. The distribution of the cysts was symmetric in renal cortex and medulla and the number of cysts was similar in both kidneys. Sparse, asymmetrical parenchymal renal cysts >3 mm in diameter were also observed. The size and parenchyma thickness of both kidneys was considered normal in all patients. The CMD differentiation was preserved only in patients with normal laboratory kidney findings (n = 2), but was lost in patients with chronic renal failure. CONCLUSIONS Multi-microcystic kidney disease secondary to long-term lithium therapy can be detected with MR imaging regardless of known renal impairment. Preservation of renal CMD was observed in both patients with normal kidney function. The results of our preliminary study suggest the possible role of MR imaging for the screening of early manifestations of nephropathy in patients undergoing chronic lithium therapy.
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Resta EC, Secchi F, Giardino A, Nardella VG, Di Leo G, Flor N, Sardanelli F. Non-contrast MR imaging for detecting endoleak after abdominal endovascular aortic repair. Int J Cardiovasc Imaging 2012; 29:229-35. [PMID: 22588711 DOI: 10.1007/s10554-012-0060-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 04/28/2012] [Indexed: 01/24/2023]
Abstract
Our aim was to investigate the possibility of ruling out endoleak after endovascular aortic repair (EVAR) of abdominal aortic aneurysm (AAA) using non-contrast MRI. Twenty-three patients (20 males, aged 73 ± 8 years) with an EVAR-treated AAA underwent 1.5-T MRI using axial, coronal and sagittal oblique true-FISP sequences. Two blinded and independent readers with 4 (R1) and 2 (R2) years of experience evaluated these images considering an area of even less than 5 mm in diameter with a signal intensity higher than that of normal muscles visible in the excluded aneurysmal sac as a sign of potential endoleak. The final assessment, mainly based on MR angiography and previous examinations, served as reference standard. Out of 23 patients, 13 (57%) were negative for endoleak at final assessment, while the remaining 10 (43%) were positive, with the following type distribution: Ia (n = 4), Ib (n = 2), II (n = 3), and III (n = 1). Sensitivity was 10/10 (100%; CI 95% 69-100%), specificity 7/13 (54%; 25-81%), accuracy 17/23 (74%; 52-90%), PPV 10/16 (63%; 35-85%) and NPV 7/7 (100%; 59-100%) for R1; 9/10 (90%; 56-100%), 8/13 (62%; 32-86%), 17/23 (74%; 52-90%), 9/14 (64%; 35-8%), and 8/9 (89%; 52-100%) for R2, respectively. Inter-reader Cohen κ was 0.810. A negative non-contrast true-FISP MR study can be used to rule out endoleak after EVAR of AAA. This hypothesis may contribute to the reduction of ionizing radiation exposure and contrast material administration for monitoring patients with an EVAR-treated AAA.
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Affiliation(s)
- Elda C Resta
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Via Festa del Perdono 7, 20122, Milan, Italy
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Zou Z, Zhang HL, Roditi GH, Leiner T, Kucharczyk W, Prince MR. Nephrogenic systemic fibrosis: review of 370 biopsy-confirmed cases. JACC Cardiovasc Imaging 2012; 4:1206-16. [PMID: 22093272 DOI: 10.1016/j.jcmg.2011.08.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 10/15/2022]
Abstract
Discovery of an association between gadolinium-based contrast agents (GBCAs) and nephrogenic systemic fibrosis (NSF) has led to less use of GBCA-enhanced magnetic resonance imaging in dialysis patients and patients with severe renal failure at risk of NSF, and the virtual elimination of new cases of NSF. But shifting patients with renal failure to alternative imaging methods may subject patients to other risks (e.g., ionizing radiation or iodinated contrast). This review paper examines 370 NSF cases reported in 98 articles to analyze NSF risk factors. Eliminating multiple risk factors by limiting GBCA dose to a maximum of 0.1 mmol/kg, dialyzing patients undergoing dialysis quickly following GBCA administration, delaying GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in patients with renal failure especially when there are proinflammatory conditions may substantially reduce the risk of NSF.
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Affiliation(s)
- Zhitong Zou
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
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Abstract
Cancer patients frequently undergo imaging examinations to diagnosis but also to evaluate their responses to treatment. These patients are also at high risk of kidney impairment before considering the possible nephrotoxicity of their chemotherapy. In this context, it is overriding to know contrast agents induced risks and what are the good practices to avoid them. Renal function evaluation takes a major part in there. The X-ray radiology using iodinated contrast agent (ICA) exposes patients to acute renal failure. This induced nephropathy is prevented by adequate hydration prior to injection when the glomerular filtration rate (GFR) of the patient is less than 60 ml/min/1.73 m(2). For hardly nephrotoxic, gadolinium-based contrast agents (GBCA) injected in magnetic resonance imaging, were considered for a long as a safe alternative to ICA. Yet they may induce nephrogenic systemic fibrosis (NSF). The recommendations of European and U.S. drugs safety agencies have recently converged defining groups at risk of NSF based on the level of patients GFR and the type of GBCA used. How to assess the risk-benefit balance of the cancer patient for whom you should choose an informative, effective and safe imaging examination?
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Abstract
Nephrogenic systemic fibrosis (NSF) has now been virtually eliminated by the discovery of its association with gadolinium-based contrast agents (GBCAs) and the consequent reduced use of GBCA-enhanced magnetic resonance imaging (MRI) in severe renal failure patients. This review of 408 biopsy-confirmed cases shows how to minimize NSF risk when performing GBCA-enhanced MRI or magnetic resonance angiography. The absence of any NSF cases in patients less than 8 years old or greater than 87 years old suggests that infants and elderly patients are already protected. Limiting GBCA dose to a maximum of 0.1 mMol/kg, dialyzing dialysis patients quickly following GBCA administration, delaying administration of GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in renal failure patients, especially when there are pro-inflammatory conditions, appear to have reduced NSF risk to the point where safe GBCA-enhanced MRI is possible in most patients.
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Affiliation(s)
- Zhitong Zou
- Department of Radiology, Weill Medical College of Cornell University, Ithaca, New York, USA; and Chinese Peoples' Liberation Army General Hospital, Beijing, China
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Incidence, Predictors and Associated Outcomes of Renal Cell Carcinoma in Long-term Dialysis Patients. Urology 2011; 77:1271-6. [DOI: 10.1016/j.urology.2011.01.007] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Revised: 12/30/2010] [Accepted: 01/04/2011] [Indexed: 12/31/2022]
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Saba L, Anzidei M, Lucatelli P, Mallarini G. The multidetector computed tomography angiography (MDCTA) in the diagnosis of splenic artery aneurysm and pseudoaneurysm. Acta Radiol 2011; 52:488-98. [PMID: 21498313 DOI: 10.1258/ar.2011.100283] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Splenic artery aneurysm is the most frequent visceral artery aneurysm and rupture of the aneurysm is associated with a high mortality rate. It is important to discriminate between a true aneurysm and a pseudoaneurysm that may be caused by pancreatitis, iatrogenic and postoperative causes, trauma and peptic ulcer disease. Multidetector-row CT angiography (MDCTA) allows detailed visualization of the vascular anatomy and may allow identification of aneurysms and pseudoaneurysms that affect the splenic artery. The objective of this article is to provide a review of the general characteristics of splenic artery aneurysms and pseudoaneurysms and to describe the findings of MDCTA.
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Affiliation(s)
- Luca Saba
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
| | - Michele Anzidei
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Pierleone Lucatelli
- Department of Radiological Sciences, University of Rome La Sapienza, Rome, Italy
| | - Giorgio Mallarini
- Department of Radiology, Azienda Ospedaliero Universitaria (AOU), Cagliari
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Abstract
CNS involvement in breast cancer modifies the prognosis and the treatment of the disease. Imaging plays a leading role for the diagnosis, the pretherapeutic assessment and the follow-up. MRI is the most sensitive modality for the detection of infraclinic lesions, reported in about 15% of metastatic breast cancers. In addition to conventional MR study, diffusion MR, perfusion MR and spectroscopy have a diagnostic value with specificity of more than 95%; 3D study is required if neurosurgical resection or stereotactic radiosurgery is contemplated. The use of new drugs in clinical trials needs a precise and accurate follow up to assess their usefulness; appreciation of the response is based on the precise measure of the number of targets and of their size; The WHO and recently the RECIST have established the guidelines for measurement of the tumoral targets and to assess the response to treatments. Brain modifications related to surgery or stereotactic radiosurgery are well studied by MRI.
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Abu-Alfa AK. Nephrogenic systemic fibrosis and gadolinium-based contrast agents. Adv Chronic Kidney Dis 2011; 18:188-98. [PMID: 21531325 DOI: 10.1053/j.ackd.2011.03.001] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 02/25/2011] [Accepted: 03/01/2011] [Indexed: 12/26/2022]
Abstract
The strong association between nephrogenic systemic fibrosis (NSF) and exposure to gadolinium-based contrast agents (GBCAs) has greatly affected the care of patients with kidney disease. NSF has been reported in patients with ESRD, CKD, and acute kidney injury (AKI). The majority of cases have occurred in patients with ESRD, but about 20% have been reported in patients with AKI or CKD stages 4 and 5. There is also a risk difference among GBCAs, with the Food and Drug Administration contraindicating 3 linear agents in patients at risk. Given the significant morbidity and mortality of NSF, it is imperative to identify individuals at risk. Although there are no data to support a role for hemodialysis (HD) in reducing the risk for NSF after administration of GBCAs, immediate HD is still recommended within 2 hours. Patients maintained on peritoneal dialysis seem to be at high risk and immediate HD is also recommended. However, this is not the current recommendation for CKD stages 4 and 5, especially with suspected lower risk of noncontraindicated agents. Individualized assessment is important and especially in those patients close to dialysis initiation. Instituting policies is important to address the imaging needs of patients with CKD and AKI while ensuring a balance between benefits and risks.
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Daccarett M, McGann CJ, Akoum NW, MacLeod RS, Marrouche NF. MRI of the left atrium: predicting clinical outcomes in patients with atrial fibrillation. Expert Rev Cardiovasc Ther 2011; 9:105-11. [PMID: 21166532 DOI: 10.1586/erc.10.177] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Atrial fibrillation is a significant public health burden, with clinically, epidemiologically and economically significant repercussions. In the last decade, catheter ablation has provided an improvement in morbidity and quality of life, significantly reducing long-term healthcare costs and avoiding recurrences compared with drug therapy. Despite recent progress in techniques, current catheter ablation success rates fall short of expectations. Late gadolinium-enhancement cardiovascular MRI is a well-established tool to image the myocardium and, most specifically, the left atrium. Unique imaging protocols allow for left atrial structural remodeling and fibrosis assessment, which has been demonstrated to correlate with clinical outcomes after catheter ablation, assessment of the individual's risks of thromboembolic events, and effective imaging of patients with left atrial appendage thrombus. Late gadolinium-enhancement MRI aids in the individualized treatment of atrial fibrillation, stratifying recurrence risk and guiding specific ablation strategies. Real-time MRI offers significant safety and effectiveness profiles that would optimize the invasive treatment of atrial fibrillation.
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Affiliation(s)
- Marcos Daccarett
- Division of Cardiology, University of Utah Health Sciences Center, 30 North 1900 East, Room 4A100, Salt Lake City, UT 84132, USA
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Martin DR. Nephrogenic Systemic Fibrosis and Gadolinium-Enhanced Magnetic Resonance Imaging: Does a US Food and Drug Administration Alert Influence Practice Patterns in CKD? Am J Kidney Dis 2010; 56:427-30. [DOI: 10.1053/j.ajkd.2010.07.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2010] [Accepted: 07/01/2010] [Indexed: 11/11/2022]
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Abstract
The increased use of abdominal imaging techniques for a variety of indications has contributed to more-frequent detection of renal cell carcinoma (RCC). Ultrasonography has been used to characterize the solid versus cystic nature of renal masses. This modality has limitations, however, in further characterization of solid tumors and in staging of malignancy, although contrast-enhanced ultrasonography has shown promise. Cross-sectional imaging with multiplanar reconstruction capability via CT or MRI has become the standard-bearer in the diagnosis, staging and surveillance of renal cancers. The use of specific protocols and the exploitation of different imaging characteristics of RCC subtypes, including variations in contrast agent timing, MRI weighting and digital subtraction, have contributed to this diagnostic capability. Cystic renal masses are a special case, evaluation of which can require multiple imaging modalities. Rigorous evaluation of these lesions can provide information that is crucial to prediction of the likelihood of malignancy. Such imaging is not without risk, however, as radiation from frequent CT imaging has been implicated in the development of secondary malignancies, and contrast agents for CT and MRI can pose risks, particularly in patients with compromised renal function.
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Leiner T, Kucharczyk W. Special issue: nephrogenic systemic fibrosis. J Magn Reson Imaging 2010; 30:1233-5. [PMID: 19938034 DOI: 10.1002/jmri.21985] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tim Leiner
- Liver Imaging Group, Department of Medicine, Division of Gastroenterology, University of California, San Diego, San Diego, California, USA
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