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Shin DJ, Choi YH, Lee SB, Cho YJ, Lee S, Cheon JE. Low-iodine-dose computed tomography coupled with an artificial intelligence-based contrast-boosting technique in children: a retrospective study on comparison with conventional-iodine-dose computed tomography. Pediatr Radiol 2024; 54:1315-1324. [PMID: 38839610 PMCID: PMC11254996 DOI: 10.1007/s00247-024-05953-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 06/07/2024]
Abstract
BACKGROUND Low-iodine-dose computed tomography (CT) protocols have emerged to mitigate the risks associated with contrast injection, often resulting in decreased image quality. OBJECTIVE To evaluate the image quality of low-iodine-dose CT combined with an artificial intelligence (AI)-based contrast-boosting technique in abdominal CT, compared to a standard-iodine-dose protocol in children. MATERIALS AND METHODS This single-center retrospective study included 35 pediatric patients (mean age 9.2 years, range 1-17 years) who underwent sequential abdominal CT scans-one with a standard-iodine-dose protocol (standard-dose group, Iobitridol 350 mgI/mL) and another with a low-iodine-dose protocol (low-dose group, Iohexol 240 mgI/mL)-within a 4-month interval from January 2022 to July 2022. The low-iodine CT protocol was reconstructed using an AI-based contrast-boosting technique (contrast-boosted group). Quantitative and qualitative parameters were measured in the three groups. For qualitative parameters, interobserver agreement was assessed using the intraclass correlation coefficient, and mean values were employed for subsequent analyses. For quantitative analysis of the three groups, repeated measures one-way analysis of variance with post hoc pairwise analysis was used. For qualitative analysis, the Friedman test followed by post hoc pairwise analysis was used. Paired t-tests were employed to compare radiation dose and iodine uptake between the standard- and low-dose groups. RESULTS The standard-dose group exhibited higher attenuation, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) of organs and vessels compared to the low-dose group (all P-values < 0.05 except for liver SNR, P = 0.12). However, noise levels did not differ between the standard- and low-dose groups (P = 0.86). The contrast-boosted group had increased attenuation, CNR, and SNR of organs and vessels, and reduced noise compared with the low-dose group (all P < 0.05). The contrast-boosted group showed no differences in attenuation, CNR, and SNR of organs and vessels (all P > 0.05), and lower noise (P = 0.002), than the standard-dose group. In qualitative analysis, the contrast-boosted group did not differ regarding vessel enhancement and lesion conspicuity (P > 0.05) but had lower noise (P < 0.05) and higher organ enhancement and artifacts (all P < 0.05) than the standard-dose group. While iodine uptake was significantly reduced in low-iodine-dose CT (P < 0.001), there was no difference in radiation dose between standard- and low-iodine-dose CT (all P > 0.05). CONCLUSION Low-iodine-dose abdominal CT, combined with an AI-based contrast-boosting technique exhibited comparable organ and vessel enhancement, as well as lesion conspicuity compared to standard-iodine-dose CT in children. Moreover, image noise decreased in the contrast-boosted group, albeit with an increase in artifacts.
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Affiliation(s)
- Dong-Joo Shin
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea.
- Department of Radiology, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea.
| | - Seul Bi Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea
| | - Yeon Jin Cho
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea
| | - Seunghyun Lee
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea
| | - Jung-Eun Cheon
- Department of Radiology, Seoul National University Hospital, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, Republic of Korea
- Department of Radiology, Seoul National University College of Medicine, Jongno-Gu, Seoul, Republic of Korea
- Institute of Radiation Medicine, Seoul National University Medical Research Center, Jongno-Gu, Seoul, Republic of Korea
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M’hango H, Kabengele C, Sukuntu V, Mwaba C. Burden and Risk Factors of Contrast-Associated Acute Kidney Injury in Hospitalized Zambian Children: A Prospective Cohort Study at the University Teaching Hospitals. Can J Kidney Health Dis 2023; 10:20543581231205156. [PMID: 37885671 PMCID: PMC10599111 DOI: 10.1177/20543581231205156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 08/09/2023] [Indexed: 10/28/2023] Open
Abstract
Background Contrast-associated acute kidney injury (CAAKI) is defined as acute kidney injury (AKI) occurring within 72 hours of administration of contrast media (CM) and is linked to adverse outcomes including longer hospital stay, increased hospital mortality, and a higher risk of chronic kidney disease in later life. Risk factors for the development of CAAKI in the Zambian pediatric population have not been well studied. Objectives The objective of this study was to assess the burden of CAAKI, ascertain its risk factors, and describe short-term outcomes in hospitalized children at the University Teaching Hospitals (UTH) undergoing contrast-enhanced radiological investigations. Methods This was a prospective observational study of in-patients undergoing contrast-enhanced radiological procedures, between September 2020 and September 2021. The participants were recruited from the Children's Hospital, the Cancer Diseases Hospital, and the Pediatric Surgical Ward at the University Teaching Hospital in Lusaka, Zambia. The primary outcome variable was occurrence of AKI at 48 hours post CM administration. We used 2 criteria to define CAAKI in our study-the European Society of Urogenital Radiology (ESUR) and the Kidney Disease Improving Global Outcomes (KDIGO) 2012 criteria. Multivariable logistic regression models were formulated to assess for risk factors of CAAKI. Results Of the 201 enrolled participants, 123 (61.2%) were male and the median age of the participants was 5 years (interquartile range [IQR] = 3-10). The mean hemoglobin was 103 g/L (standard deviation [SD] = 26), median creatinine was 30.9 µmol/l (IQR = 22.6-43), and the glomerular filtration rate (GFR) was 102.5 mL/min/1.73 m2 (IQR = 76.2-129.4). Forty-six (22.9%) developed CAAKI using the ESUR compared with 4.5% (9/201) using the KDIGO criteria. Independent risk factors of CAAKI were receiving a higher dose of CM (adjusted odds ratio [aOR] = 2.54; 95% confidence interval [CI] = [1.12-5.74]), prematurity (aOR = 4.6; 95% CI = [1.05-16.7]), and a higher eGFR (aOR= 1.01; 95% CI = [1.01-1.02]). Females had higher odds of CAAKI (aOR = 2.48; 95% CI = [1.18-5.18]) when compared with males. One CAAKI participant (2.2%) died; none of the participants who developed CAAKI and survived required dialysis and most of them (90%) were discharged before day 7. Day 7 eGFR results had returned to or near baseline values for those whose creatinine results were available. Conclusions Using the ESUR criteria, a significant proportion (22.9%) of children undergoing contrast-enhanced computed tomography (CT) scans at the UTH developed CAAKI. In contrast, using the KDIGO criteria only 4.5% had CAAKI. Being born as a preterm baby, being female, having a higher eGFR at baseline, and receiving a higher dose of CM were found to be independent risk factors for CAAKI development in Zambian children. Most of the cases of CAAKI in children were transient and of little clinical significance as only a minority of patients developing CAAKI required kidney replacement therapy and all resolved by day 7 post administration of CM.
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Affiliation(s)
- Hellen M’hango
- Department of Paediatrics, University Teaching Hospitals – Children’s Hospital, Lusaka, Zambia
| | | | - Veronica Sukuntu
- Department of Radiology, University Teaching Hospitals – Adult Hospital, Lusaka, Zambia
| | - Chisambo Mwaba
- Department of Paediatrics, University Teaching Hospitals – Children’s Hospital, Lusaka, Zambia
- Department of Paediatrics and Child Health, School of Medicine, University of Zambia, Lusaka, Zambia
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Lattanzio SM. Toxicity associated with gadolinium-based contrast-enhanced examinations. AIMS BIOPHYSICS 2021. [DOI: 10.3934/biophy.2021015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Hanson HR, Carlisle MA, Bensman RS, Byczkowski T, Depinet H, Terrell TC, Pitner H, Knox R, Goldstein SL, Basu RK. Early prediction of pediatric acute kidney injury from the emergency department: A pilot study. Am J Emerg Med 2020; 40:138-144. [PMID: 32024590 DOI: 10.1016/j.ajem.2020.01.046] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2019] [Revised: 01/15/2020] [Accepted: 01/26/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Identifying acute kidney injury (AKI) early can inform medical decisions key to mitigation of injury. An AKI risk stratification tool, the renal angina index (RAI), has proven better than creatinine changes alone at predicting AKI in critically ill children. OBJECTIVE To derive and test performance of an "acute" RAI (aRAI) in the Emergency Department (ED) for prediction of inpatient AKI and to evaluate the added yield of urinary AKI biomarkers. METHODS Study of pediatric ED patients with sepsis admitted and followed for 72 h. The primary outcome was inpatient AKI defined by a creatinine >1.5× baseline, 24-72 h after admission. Patients were denoted renal angina positive (RA+) for an aRAI score above a population derived cut-off. Test characteristics evaluated predictive performance of the aRAI compared to changes in creatinine and incorporation of 4 urinary biomarkers in the context of renal angina were assessed. RESULTS 118 eligible subjects were enrolled. Mean age was 7.8 ± 6.4 years, 16% required intensive care admission. In the ED, 27% had a +RAI (22% had a >50% creatinine increase). The aRAI had an AUC of 0.92 (0.86-0.98) for prediction of inpatient AKI. For AKI prediction, RA+ demonstrated a sensitivity of 94% (69-99) and a negative predictive value of 99% (92-100) (versus sensitivity 59% (33-82) and NPV 93% (89-96) for creatinine ≥2× baseline). Biomarker analysis revealed a higher AUC for aRAI alone than any individual biomarker. CONCLUSIONS This pilot study finds the aRAI to be a sensitive ED-based tool for ruling out the development of in-hospital AKI.
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Affiliation(s)
- Holly R Hanson
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH 45229, United States of America.
| | - Michael A Carlisle
- Department of General Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, United States of America.
| | - Rachel S Bensman
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH 45229, United States of America; Department of General Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, United States of America.
| | - Terri Byczkowski
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH 45229, United States of America.
| | - Holly Depinet
- Division of Pediatric Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH 45229, United States of America; Department of General Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, United States of America.
| | - Tara C Terrell
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Hilary Pitner
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, United States of America
| | - Ryan Knox
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Stuart L Goldstein
- Department of General Pediatrics, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, United States of America; Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, United States of America.
| | - Rajit K Basu
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, United States of America.
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You SK, Choi YH, Cheon JE, Kim WS, Kim IO, Lee SM, Cho HH. Effect of low tube voltage and low iodine concentration abdominal CT on image quality and radiation dose in children: preliminary study. Abdom Radiol (NY) 2019; 44:1928-1935. [PMID: 30683980 DOI: 10.1007/s00261-019-01896-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
PURPOSE To evaluate the image quality of a double-low protocol (low tube voltage and low iodine concentration) for abdominal CT in children. MATERIALS AND METHODS The double-low protocol was compared to the conventional protocol in pediatric patients weighing less than 40 kg from May 2016 to December 2016. Double-low protocol (Group A, n = 18): tube voltage, 70 kVp; and iodine concentration,: 250 mgI/mL versus Conventional protocol (Group B, n = 13): tube voltage, 80-100 kVp; and iodine concentration, 350 mgI/mL. Mean attenuation, noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were compared between the two groups. Image contrast, noise, beam-hardening artifacts, and overall image quality were subjectively scored. Reader performance for correctly differentiating two groups by visual assessment was evaluated. Radiation dose and total iodine load were recorded. RESULTS The mean attenuations of the portal vein and liver and the mean image noise in Group A were higher than in Group B (p = 0.04, 0.03, 0.004, respectively). The mean SNR and CNR of the main portal vein and liver were lower in Group A without any statistically significant difference. There were no statistically significant differences between the two groups in qualitative analysis (image contrast, image noise, and overall image quality) with substantial agreement between the reviewers (weighted kappa values; 0.59-0.76). Significantly diminished radiation dose and iodine load were observed in Group A compared with Group B (25.0%, 36.8% reduction; p = 0.007, 0.006, respectively). CONCLUSION The double-low protocol was feasible for pediatric abdominal CT and reduced both radiation dose and iodine load, while maintaining image quality.
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Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-Enhanced Ultrasound for identifying circulatory complications after liver transplants in children. Pediatr Transplant 2019; 23:e13327. [PMID: 30536767 DOI: 10.1111/petr.13327] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2018] [Accepted: 10/29/2018] [Indexed: 12/18/2022]
Abstract
Our main goal with this study was to share our off-label experience with CEUS for identifying circulatory complications after liver transplantation in children. A total of 74 CEUS examinations performed on 34 pediatric patients who underwent a liver transplant were retrospectively included. About 53% of the examinations were performed on children 2 years old or younger. About 82% of the examinations were performed within 30 days from the transplant. About 62% of patients were transplanted due to a cholestatic disease, 11% due to a metabolic disease, 8% were re-transplanted due to graft failure, and 19% was due to other conditions. BA was the most common reason for transplantation and represented 38% of patients. About 38% of the transplantations were performed with whole grafts from DD, 40% with split liver grafts, and 22% with left lateral segments from LD. For diagnosing arterial circulatory complications, the PPV was 80%. For diagnosing portal vein circulatory complications, the PPV was 66.7%. NPV was 100%. In 28% of the examinations, the examiner could not visualize the normal arterial blood flow without CEUS. CEUS is a non-invasive and safe imaging technique that seems valuable in these patients and further efforts are needed to license its use in the post-transplant setting.
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Affiliation(s)
- Alvaro Torres
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Huddinge, Sweden
| | - Seppo K Koskinen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Henrik Gjertsen
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.,Department of Pediatrics, Karolinska University Hospital, Huddinge, Sweden
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Hanson HR, Babcock L, Byczkowski T, Goldstein SL. Describing pediatric acute kidney injury in children admitted from the emergency department. Pediatr Nephrol 2018; 33:1243-1249. [PMID: 29549465 DOI: 10.1007/s00467-018-3909-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 12/06/2017] [Accepted: 02/02/2018] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To define those children who develop acute kidney injury (AKI) within 48 h of admission from the emergency department (ED) and ascertain patient-related factors in the ED associated with AKI. METHODS Retrospective, cohort study of children, birth to 19 years, admitted to a tertiary pediatric hospital from the ED between January 2010 and December 2013 who had serum creatinine (SCr) drawn as part of clinical care. AKI was defined as a 50% increase in SCr above baseline, as measured within 48 h of hospital presentation. Multivariable logistic regression was performed to determine factors associated with AKI by comparing those with and without kidney injury on hospital presentation. RESULTS Of all ED admissions, 13,827 subjects (27%) were included; 10% developed AKI. Of kids with AKI, 75% had a measured SCr consistent with AKI while in the ED, 36% were admitted to the intensive care unit, and 2% died (all significantly more than children without AKI). Young age, history of AKI or solid organ transplant, receipt of intravenous fluids or central venous access in the ED, and admission to intensive care were factors independently associated with AKI (AUC = 0.793, 95% CI 0.78-0.81). CONCLUSIONS One in 10 children who had SCr measured and were admitted to a tertiary pediatric hospital had AKI on or within 48 h of presentation. Inherent characteristics, identifiable in the ED, are associated with an increased risk of AKI. Future research should focus on improving AKI recognition in the ED by the development of a risk stratification tool.
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Affiliation(s)
- Holly R Hanson
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH, 45229, USA.
| | - Lynn Babcock
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH, 45229, USA
| | - Terri Byczkowski
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave, MLC 2008, Cincinnati, OH, 45229, USA
| | - Stuart L Goldstein
- Center for Acute Care Nephrology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Torres A, Koskinen SK, Gjertsen H, Fischler B. Contrast-enhanced ultrasound using sulfur hexafluoride is safe in the pediatric setting. Acta Radiol 2017; 58:1395-1399. [DOI: 10.1177/0284185117690423] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Background Contrast-enhanced ultrasound (CEUS) by using sulfur hexafluoride microbubbles is not licensed for use in children, but its off-label use is widespread. Purpose To outline our experience with the off-label use of CEUS in children, specifically with regards to safety. Material and Methods We retrieved all records of 10681 patients aged under 18 years who underwent abdominal ultrasound (US) January 2004 to December 2014. We then identified those who underwent an abdominal CEUS using sulfur hexafluoride microbubbles. Electronic patient charts were used to verify the indication for contrast agent, dose, possible adverse effects as well as information on patient height, weight, and age. Results We identified 173 patients (mean age, 11 years; range, 0.1–18 years) who underwent a total of 287 CEUS exams. Of all exams, 46% were performed on the native liver, 31% on a transplanted liver, and 23% on other organs. The indications were “circulatory status?” (40%), “characterization of lesion?” (40%), and miscellaneous (20%). Mean contrast dose was 2.3 mL (range, 0.1–8.1 mL). No immediate adverse effects were recorded. One patient experienced itching the day after, but this was considered to be a reaction to concomitantly administered fentanyl. Conclusion The use of intravenous ultrasound contrast seems safe in patients aged under 18 years and our results do not support the current practice to restrict the use of CEUS in children.
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Affiliation(s)
- Alvaro Torres
- Department of Radiology, Karolinska university hospital, Huddinge, Sweden
| | - Seppo K Koskinen
- Department of Radiology, Karolinska university hospital, Huddinge, Sweden
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
| | - Henrik Gjertsen
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, Sweden
| | - Björn Fischler
- Department of Clinical Science, Intervention, and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Pediatrics, Karolinska University Hospital
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Saul D, Mong A, Biko DM. Pediatric Considerations in Computed Tomographic Angiography. Radiol Clin North Am 2015; 54:163-76. [PMID: 26654398 DOI: 10.1016/j.rcl.2015.08.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Cardiovascular disease in children comprises a diverse collection of diseases involving multiple organ systems. Abnormality in children is predominately congenital but also may be acquired. Although noninvasive vascular imaging modalities such as magnetic resonance angiography and ultrasound lack ionizing radiation, with improving technology and an increased focus on radiation dose reduction, computed tomographic angiography (CTA) continues to have a role in evaluating cardiovascular disease in pediatric patients. This review focuses on specific considerations of CTA that the radiologist or ordering provider should consider when imaging the pediatric cardiovascular system.
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Affiliation(s)
- David Saul
- Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA
| | - Andrew Mong
- Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, The Children's Hospital of Philadelphia, 34th and Civic Center Boulevard, Philadelphia, PA 19104, USA; Department of Radiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
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Racadio JM, Kashinkunti SR, Nachabe RA, Racadio JM, Johnson ND, Kukreja KU, Patel MN, Privitera MB, Hales JE, Abruzzo TA. Clinically useful dilution factors for iodine and gadolinium contrast material: an animal model of pediatric digital subtraction angiography using state-of-the-art flat-panel detectors. Pediatr Radiol 2013; 43:1491-501. [PMID: 23736781 DOI: 10.1007/s00247-013-2723-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2013] [Revised: 04/01/2013] [Accepted: 04/19/2013] [Indexed: 11/24/2022]
Abstract
BACKGROUND Iodinated and gadolinium contrast agents pose some risk for certain pediatric patients, including allergic-like reactions, contrast-induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF). Digital flat-panel detectors enhance image quality during angiography and might allow use of more dilute contrast material to decrease risk of complications that might be dose-dependent, such as CIN and NSF. OBJECTIVE To assess the maximum dilution factors for iodine- and gadolinium-based contrast agents suitable for vascular imaging with fluoroscopy and digital subtraction angiography (DSA) on digital flat-panel detectors in an animal model. MATERIALS AND METHODS We performed selective catheterization of the abdominal aorta, renal artery and common carotid artery on a rabbit. In each vessel we performed fluoroscopy and DSA during contrast material injection using iodinated and gadolinium contrast material at 100%, 80%, 50%, 33% and 20% dilutions. An image quality score (0 to 3) was assigned by each of eight evaluators. Intracorrelation coefficient, paired t-test, one-way repeated analysis of variance, Spearman correlation and receiver operating characteristic curve analysis were applied to the data. RESULTS Overall the image quality scores correlated linearly with dilution levels. For iodinated contrast material, the optimum cut-off level for DSA when a score of at least 2 is acceptable is above 33%; it is above 50% when a score of 3 is necessary. For gadolinium contrast material, the optimum cut-off for DSA images is above 50% when a score of at least 2 is acceptable and above 80% when a score of 3 is necessary. CONCLUSION Knowledge of the relationship between image quality and contrast material dilution might allow a decrease in overall contrast load while maintaining appropriate image quality when using digital flat-panel detectors.
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Affiliation(s)
- John M Racadio
- Department of Radiology, Division of Pediatric Interventional Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., Cincinnati, OH, 45229-3030, USA,
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Abstract
Many assumptions are made when imaging children. In particular a judgement is made regarding how safe or unsafe each imaging modality is, using relatively arbitrary definitions and distinctions, due to the lack of robust scientific data. Here, the latest evidence is reviewed, particularly regarding the medical exposure to ionizing radiation (X-rays and CT) and MRI in childhood. The best evidence currently available suggests a small but convincing risk of cumulative low-dose ionizing radiation in children. Given our predictions for the children imaged today, it seems reasonable to pursue non-ionizing-based techniques wherever possible, although there is emerging evidence that MRI and ultrasound may have hitherto unknown effects. As our knowledge base expands, we must continually review our practice in light of the latest scientific data.
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Affiliation(s)
| | - Alvhild Alette Bj⊘rkum
- Departments of Biomedical Laboratory
Sciences and Chemical Engineering, Faculty of Engineering, Bergen University
College, Bergen, Norway
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Darge K, Papadopoulou F, Ntoulia A, Bulas DI, Coley BD, Fordham LA, Paltiel HJ, McCarville B, Volberg FM, Cosgrove DO, Goldberg BB, Wilson SR, Feinstein SB. Safety of contrast-enhanced ultrasound in children for non-cardiac applications: a review by the Society for Pediatric Radiology (SPR) and the International Contrast Ultrasound Society (ICUS). Pediatr Radiol 2013; 43:1063-73. [PMID: 23843130 DOI: 10.1007/s00247-013-2746-6] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2013] [Revised: 05/28/2013] [Accepted: 05/28/2013] [Indexed: 12/17/2022]
Abstract
The practice of contrast-enhanced ultrasound in children is in the setting of off-label use or research. The widespread practice of pediatric contrast-enhanced US is primarily in Europe. There is ongoing effort by the Society for Pediatric Radiology (SPR) and International Contrast Ultrasound Society (ICUS) to push for pediatric contrast-enhanced US in the United States. With this in mind, the main objective of this review is to describe the status of US contrast agent safety in non-cardiac applications in children. The five published studies using pediatric intravenous contrast-enhanced US comprise 110 children. There is no mention of adverse events in these studies. From a European survey 948 children can be added. In that survey six minor adverse events were reported in five children. The intravesical administration of US contrast agents for diagnosis of vesicoureteric reflux entails the use of a bladder catheter. Fifteen studies encompassing 2,951 children have evaluated the safety of intravesical US contrast agents in children. A European survey adds 4,131 children to this group. No adverse events could be attributed to the contrast agent. They were most likely related to the bladder catheterization. The existing data on US contrast agent safety in children are encouraging in promoting the widespread use of contrast-enhanced US.
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Affiliation(s)
- Kassa Darge
- Department of Radiology, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Arthurs OJ, Edwards A, Austin T, Graves MJ, Lomas DJ. The challenges of neonatal magnetic resonance imaging. Pediatr Radiol 2012; 42:1183-94. [PMID: 22886375 DOI: 10.1007/s00247-012-2430-2] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 04/27/2012] [Accepted: 05/06/2012] [Indexed: 12/29/2022]
Abstract
Improved neonatal survival rates and antenatal diagnostic imaging is generating a growing demand for postnatal MRI examinations. Neonatal brain MRI is now becoming standard clinical care in many settings, but with the exception of some research centres, the technique has not been optimised for imaging neonates and small children. Here, we review some of the challenges involved in neonatal MRI, including recent advances in overall MR practicality and nursing practice, to address some of the ways in which the MR experience could be made more neonate-friendly.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Hills Road, Cambridge, CB2 0QQ, UK.
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Sundgren PC, Leander P. Is administration of gadolinium-based contrast media to pregnant women and small children justified? J Magn Reson Imaging 2012; 34:750-7. [PMID: 21928308 DOI: 10.1002/jmri.22413] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
The use of gadolinium-based contrast media in pregnant or lactating women has been discouraged at many radiology departments due to the lack of knowledge of the risks for the fetus and the unwillingness to expose neonates to unnecessary drugs. In the present review the current literature and present guidelines regarding the use of gadolinium-based contrast media have been reviewed to validate the justification for their administration to pregnant or lactating women and small children.
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Affiliation(s)
- Pia C Sundgren
- Centre for Medical Imaging and Physiology, Skåne University Hospital, Lund University, Lund, Sweden.
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Trout AT, Dillman JR, Ellis JH, Cohan RH, Strouse PJ. Patterns of intravenous contrast material use and corticosteroid premedication in children--a survey of Society of Chairs of Radiology in Children's Hospitals (SCORCH) member institutions. Pediatr Radiol 2011; 41:1272-83. [PMID: 21594547 DOI: 10.1007/s00247-011-2112-5] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2011] [Revised: 03/20/2011] [Accepted: 03/25/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND There are few data available concerning the use of intravenous contrast materials in children. OBJECTIVE To assess patterns of intravenous iodinated/gadolinium-based contrast material (ICM/GBCM) use in children. MATERIALS AND METHODS Society of Chairs of Radiology in Children's Hospitals (SCORCH) members were invited to complete a Web-based survey regarding intravenous contrast material use at their institutions. RESULTS Sixty-six percent (42/64) of SCORCH member institutions responded, 76% of which are academic hospitals. Ioversol and gadopentetate dimeglumine are the most commonly used ICMs and GBCMs (52% and 81%, respectively). Premedication policies to mitigate risk of allergic-like contrast reactions are more common for ICMs than GBCMs (71% vs. 32%). For both ICMs and GBCMs, most institutions premedicate or avoid contrast material in the setting of a prior allergic-like contrast reaction of any severity. Policies regarding ICM and GBCM use in children with renal insufficiency are in place at 74% and 88% of institutions, respectively, but are variable. CONCLUSION Policies concerning premedication for prevention of allergic-like contrast agent reactions and administration of contrast materials in children with renal insufficiency are variable and not consistently present at all pediatric institutions. This highlights the need for standardization of practice patterns and pediatric-specific research on these topics.
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Affiliation(s)
- Andrew T Trout
- Department of Radiology, University of Michigan Health System, 1500 East Medical Center Drive, Ann Arbor, MI 48109-5030, USA.
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Arthurs OJ, Gallagher FA. Functional and molecular imaging with MRI: potential applications in paediatric radiology. Pediatr Radiol 2011; 41:185-98. [PMID: 20972674 DOI: 10.1007/s00247-010-1842-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Revised: 07/29/2010] [Accepted: 08/25/2010] [Indexed: 01/17/2023]
Abstract
MRI is a very versatile tool for noninvasive imaging and it is particularly attractive as an imaging technique in paediatric patients given the absence of ionizing radiation. Recent advances in the field of MRI have enabled tissue function to be probed noninvasively, and increasingly MRI is being used to assess cellular and molecular processes. For example, dynamic contrast-enhanced MRI has been used to assess tissue vascularity, diffusion-weighted imaging can quantify molecular movements of water in tissue compartments and MR spectroscopy provides a quantitative assessment of metabolite levels. A number of targeted contrast agents have been developed that bind specifically to receptors on the vascular endothelium or cell surface and there are several MR methods for labelling cells and tracking cellular movements. Hyperpolarization techniques have the capability of massively increasing the sensitivity of MRI and these have been used to image tissue pH, successful response to drug treatment as well as imaging the microstructure of the lungs. Although there are many challenges to be overcome before these techniques can be translated into routine paediatric imaging, they could potentially be used to aid diagnosis, predict disease outcome, target biopsies and determine treatment response noninvasively.
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Affiliation(s)
- Owen J Arthurs
- Department of Radiology, Addenbrooke's Hospital, Cambridge University Teaching Hospitals NHS Foundation Trust, University of Cambridge, Box 218, Level 5, Hills Road, Cambridge, CB2 0QQ, UK
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