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Wang H, Gao T, Zhang R, Hu J, Wang Y, Wei J, Zhou Y, Dong H. The intellectual base and global trends in contrast-induced acute kidney injury: a bibliometric analysis. Ren Fail 2023; 45:2188967. [PMID: 36929915 PMCID: PMC10026803 DOI: 10.1080/0886022x.2023.2188967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Contrast-induced acute kidney injury (CI-AKI) has become the third leading cause of hospital-acquired kidney injury. A comprehensive analysis of the current state of research in the field of CI-AKI will help to reveal trends and hot topics in the field. To date, there are no published bibliometric analyses related to CI-AKI studies. Here, we analyze the relevant literature since the emergence of the concept and provide valuable insights. The literature was collected from the Web of Science Core Collection. The data were analyzed visually using CiteSpace and VOSviewer software. We collected a total of 4775 papers, with the United States and Guangdong Acad Med Sci as the major publishing powers in terms of country/region and institution. J AM COLL CARDIOL was the journal with the most published and cocited articles. Cluster analysis showed that clinical trials are the current research hotspot. The areas of risk assessment, prevention strategies, risk factors, and vascular lesions have been popular in recent years. Research on the mechanism of injury in CI-AKI will be the focus of future research, which will be crucial to reduce the clinical incidence of CI-AKI. In summary, this study provides a comprehensive analysis of the development process in the field of CI-AKI and discusses future research directions based on the analysis of objective data from many studies on CI-AKI.
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Affiliation(s)
- Heng Wang
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Tingting Gao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Ruijing Zhang
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jie Hu
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Yuwen Wang
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Jianing Wei
- Key Laboratory of Cardiovascular Disease Diagnosis, Treatment and Clinical Pharmacology of Shanxi Province, The Second Hospital of Shanxi Medical University Cardiovascular Medicine, Taiyuan, China
| | - Yun Zhou
- Shanxi Province Integrated Traditional and Western Medicine Hospital, Taiyuan, China
| | - Honglin Dong
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, China
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Li B, Ni J, Chen F, Lu F, Zhang L, Wu W, Zhang Z. Evaluation of three-dimensional dual-energy CT cholangiopancreatography image quality in patients with pancreatobiliary dilatation: Comparison with conventional single-energy CT. Eur J Radiol Open 2023; 11:100537. [PMID: 37942123 PMCID: PMC10628547 DOI: 10.1016/j.ejro.2023.100537] [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: 07/14/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 11/10/2023] Open
Abstract
Objective This study aimed to evaluate three-dimensional (3D) negative-contrast CT cholangiopancreatography (nCTCP) image quality using dual-energy CT (DECT) with iterative reconstruction (IR) technique in patients with pancreatobiliary dilatation compared with single-energy CT (SECT). Methods Of the patients, 67 and 56 underwent conventional SECT (SECT set) and DECT with IR technique (DECT set), respectively. All patients were retrospectively analyzed during the portal phase to compare objective image quality and other data including patient demographics, hepatic and pancreatic parenchymal enhancement, noise, and attenuation difference (AD) between dilated ducts and enhanced hepatic parenchyma, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and CT volume dose index (CTDIvol). Two radiologists used the five-point Likert scale to evaluate the subjective image quality of 3D nCTCP regarding image noise, sharpness of dilated ducts, and overall image quality. Statistical analyses used the Mann-Whitney U test. Results No significant difference in patient demographics in either CT set was showed during objective evaluation (p > 0.05). However, higher hepatic and pancreatic parenchymal enhancement, AD, SNR, and CNR and lower hepatic and pancreatic noise (p < 0.005) as well as CTDIvol (p = 0.005) on DECT than on SECT were observed. Higher mean grades on DECT than on SECT were showed for image noise (4.65 vs 3.92), sharpness of dilated ducts (4.52 vs 3.94), and overall image quality (4.45 vs 3.91; p < 0.001), respectively during subjective evaluation. Conclusion A higher overall image quality and lower radiation dose on 3D nCTCP can be obtained by DECT with IR technique than with conventional SECT in patients with pancreatobiliary dilatation.
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Affiliation(s)
- Bin Li
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
| | - JianMing Ni
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
| | - FangMing Chen
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
| | - FengQi Lu
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
| | - Lei Zhang
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
| | - WenJuan Wu
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
| | - ZhuiYang Zhang
- Department of Radiology, Wuxi No.2 People’s Hospital, 68 Zhong shan Rd., Wuxi 214002, Jiangsu, PR China
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Wang H, Gao T, Zhang R, Hu J, Gao S, Wang Y, Qi X, Zhou Y, Zheng G, Dong H. Neutrophil Extracellular Traps Aggravate Contrast-Induced Acute Kidney Injury by Damaging Glomeruli and Peritubular Capillaries. J Inflamm Res 2023; 16:5629-5646. [PMID: 38046404 PMCID: PMC10693253 DOI: 10.2147/jir.s433110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 11/17/2023] [Indexed: 12/05/2023] Open
Abstract
Background Contrast-induced acute kidney injury (CI-AKI) is considered to be the third leading cause of hospital-acquired kidney injury. Current studies mostly suggest that contrast agents mainly harm renal tubular epithelial cells, but we hypothesized that the development of CI-AKI should be the result of the interaction of renal vascular and tubular injury. Methods First we constructed a CI-AKI mouse model and verified the success of the model by pathological injury and serum creatinine level. Immunohistochemistry, protein quantification and qRT-PCR were used to detect the location and level of expression of neutrophil extracellular traps (NETs) in the kidney. Then, we blocked the in vivo accumulation of NETs using GSK484 and DNase I and detected the expression of NETs and the damage of glomerular and peritubular capillaries. Results We first identified the presence of NETs in CI-AKI mice, and NETs were mainly accumulated in glomeruli and peritubular capillaries. The expression of NETs was positively correlated with the severity of CI-AKI kidney. After inhibition of NETs release or promotion of NETs degradation by drugs, renal vascular endothelial cell injury was reduced and renal pathological changes and creatinine levels were reversed in CI-AKI mice. In addition, inhibition of NETs reduced apoptosis and pyroptosis of renal cells and attenuated inflammation in vivo. Conclusion These findings suggest that NETs are involved in the development of CI-AKI by damaging glomerular and peritubular capillary endothelial cells. This study will provide a new strategy for clinical prevention and treatment of CI-AKI.
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Affiliation(s)
- Heng Wang
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Tingting Gao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Ruijing Zhang
- Department of Nephrology, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Jie Hu
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Siqi Gao
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yuwen Wang
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Xiaotong Qi
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
| | - Yun Zhou
- Shanxi Provincial Integrated TCM and WM Hospital, Taiyuan, People’s Republic of China
| | - Guoping Zheng
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
- Centre for Transplant and Renal Research, Westmead Institute for Medical Research, The University of Sydney, Sydney, NSW, Australia
| | - Honglin Dong
- Department of Vascular Surgery, The Second Hospital of Shanxi Medical University, Taiyuan, People’s Republic of China
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Dianatkhah M, Poursaeid S, Shirvani E, Badri S. Investigating the Prevalence of Contrast-associated Nephropathy and the Related Risk Factors in Patients Undergoing Elective Angioplasty. J Res Pharm Pract 2023; 12:64-67. [PMID: 38463185 PMCID: PMC10923199 DOI: 10.4103/jrpp.jrpp_1_24] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 03/08/2023] [Indexed: 03/12/2024] Open
Abstract
Objective Contrast-associated nephropathy (CAN) is a sudden decrease in kidney function following contrast media administration. Considering the importance of CAN in the patient's outcome and the high prevalence of this complication in cardiac catheterizing centers, this study was designed to investigate the prevalence and the related risk factors of CAN in patients undergoing angioplasty in Chamran Heart Hospital, Isfahan, Iran, from January 2022 to June 2022. Methods The inclusion criteria were adult patients above 18 admitted for elective percutaneous coronary intervention (PCI). Patient demographic information, underlying diseases and medications, dehydration state, type and amount of contrast media, and serum levels of blood urea nitrogen (BUN) and serum creatinine (SrCr) at 24 and 72 h after contrast injection were all recorded. Findings Out of 340, 128 patients developed CAN after PCI, giving an incidence of 37.64%. Adjusted analysis showed a significant relation between age over 65, the amount of contrast media administered, and the use of furosemide with the incidence of CAN. However, adjusted logistic regression analysis failed to show any significant relationship between the risk of CAN and the hydration status of the patients at 24 and 48 h after receiving contrast media as diagnosed by BUN/SrCr >20. Conclusion The prevalence of CAN in this study was higher than in other studies since this high-risk population was under risk factors such as arterial injection of contrast material and a higher amount of contrast material administration. In addition, advanced age, volume of contrast material, and previous or concurrent furosemide administration were associated with an increased risk of CAN.
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Affiliation(s)
- Mehrnoush Dianatkhah
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Samira Poursaeid
- Pharmacy Students’ Research Committee, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Ehsan Shirvani
- Interventional Cardiology Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Shirinsadat Badri
- Department of Clinical Pharmacy and Pharmacy Practice, Isfahan University of Medical Sciences, Isfahan, Iran
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Ratcovich H, Sadjadieh G, Linde JJ, Joshi FR, Kelbæk H, Kofoed KF, Køber L, Hansen PR, Torp-Pedersen C, Elming H, Gislason GH, Høfsten DE, Engstrøm T, Holmvang L. Coronary CT and timing of invasive coronary angiography in patients ≥75 years old with non-ST segment elevation acute coronary syndromes. Heart 2023; 109:457-463. [PMID: 36351794 DOI: 10.1136/heartjnl-2022-321640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Accepted: 10/25/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The ability of coronary CT angiography (cCTA) to rule out significant coronary artery disease (CAD) in older patients with non-ST segment elevation acute coronary syndromes (NSTEACS) is unclear since valid cCTA analysis may be limited by extensive coronary artery calcification. In addition, the effect of very early invasive coronary angiography (ICA) with possible revascularisation is debated. METHODS This is a posthoc analysis of patients ≥75 years included in the Very Early vs Standard Care Invasive Examination and Treatment of Patients with Non-ST-Segment Elevation Acute Coronary Syndrome Trial. cCTA was performed prior to the ICA. The diagnostic accuracy of cCTA was investigated. Presence of a coronary artery stenosis ≥50% by subsequent ICA was used as reference. Patients were randomised to a very early (within 12 hours of diagnosis) or a standard ICA (within 48-72 hours of diagnosis). The primary composite endpoint was 5-year all-cause mortality, non-fatal recurrent myocardial infarction or hospital admission for refractory myocardial ischaemia or heart failure. RESULTS Of 452 (21%) patients ≥75 years, 161 (35.6%) underwent cCTA. 19% of cCTAs excluded significant CAD. The negative predictive value (NPV) of cCTA was 94% (95% CI 79 to 99) and the sensitivity 98% (95% CI 94 to 100). No significant differences in the frequency of primary endpoints were seen in patients randomised to very early ICA (at 5-year follow-up, n=100 (46.9%) vs 122 (51.0%), log-rank p=0.357). CONCLUSION In patients ≥75 years with NSTEACS, cCTA before ICA showed a high NPV. A very early ICA <12 hours of diagnosis did not significantly improve long-term clinical outcomes.
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Affiliation(s)
- Hanna Ratcovich
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Golnaz Sadjadieh
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jesper J Linde
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Francis R Joshi
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henning Kelbæk
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | - Klaus F Kofoed
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Køber
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Peter Riis Hansen
- Department of Cardiology, Gentofte University Hospital, Hellerup, Denmark
| | - Christian Torp-Pedersen
- Department of Clinical Investigation and Cardiology, Nordsjællands Hospital, Hillerød, Denmark
| | - Hanne Elming
- Department of Cardiology, Zealand University Hospital Roskilde, Roskilde, Denmark
| | | | - Dan Eik Høfsten
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Thomas Engstrøm
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lene Holmvang
- Rigshospitalet, Department of Cardiology, Copenhagen University Hospital, Copenhagen, Denmark
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Kidney Function, Male Gender, and Aneurysm Diameter Are Predictors of Acute Kidney Injury in Patients with Abdominal Aortic Aneurysms Treated Endovascularly. Toxins (Basel) 2023; 15:toxins15020130. [PMID: 36828444 PMCID: PMC9966909 DOI: 10.3390/toxins15020130] [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: 12/30/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/09/2023] Open
Abstract
Abdominal aortic aneurysm (AAA) is a degenerative disease of the aortic wall with potentially fatal complications. The widespread adoption of endovascular aneurysm repair (EVAR), which is less invasive and equally (if not more) effective for abdominal aortic aneurysms (AAA), is due to the obvious advantages of the procedure compared to the traditional open repair. As the popularity of endovascular procedures grows, related complications become more evident, with kidney damage being one of them. Although acute kidney injury following EVAR is relatively common, its true incidence is still uncertain. The purpose of this study was to assess the incidence of acute kidney injury among patients treated with endovascular repair of ruptured AAA. In addition, we aimed to determine the predictors of PC-AKI in patients with abdominal aortic aneurysm treated with EVAR. PATIENTS AND METHODS We retrospectively analyzed a prospective registry of abdominal aortic aneurysm of 247 patients operated endovascularly at a single center between 2015 and 2021. Due to a lack of clinical data, data of 192 patients were reviewed for postcontrast acute kidney injury. Additional comorbidities were included in this study: hypertension, diabetes mellitus, atrial fibrillation, chronic coronary syndrome, COPD, and chronic kidney disease. Follow-up examinations were performed before the procedure and 48 h after contrast administration. RESULTS The group of 36 patients developed PC-AKI, which is 19% of the entire study population. Hypertension, diabetes, chronic kidney disease, male gender, and incidence of PC-AKI were more prevalent in patients with higher aortic aneurysm diameter ≥67 mm. In multiple regression analyses, independent predictors of PC-AKI were serum creatinine, chronic kidney disease, male gender, and aortic aneurysm diameter ≥67 mm. CONCLUSIONS One of the major complications after EVAR is acute kidney injury, which is linked to higher death and morbidity rates. Independent risk factors for postcontrast acute kidney injury were chronic kidney disease, male gender, and aortic diameter. Only aortic diameter could be modifiable risk factor, and earlier surgery could be considered to yield better outcomes. More research is critically needed to determine how AKI affects long-term outcomes and to look at preventive options.
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Yan SX, Gao M, Yang TH, Tian C, Jin S. The preventive effects of different doses of atorvastatin on contrast-induced acute kidney injury after CT perfusion. J Clin Lab Anal 2022; 36:e24386. [PMID: 35582743 PMCID: PMC9279945 DOI: 10.1002/jcla.24386] [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: 10/26/2020] [Revised: 03/17/2022] [Accepted: 03/19/2022] [Indexed: 11/20/2022] Open
Abstract
Background Contrast‐induced acute kidney injury (CI‐AKI) is a severe complication among patients receiving intravascular contrast media. The purpose of this study was to investigate the preventive effects of pretreatment of atorvastatin at intensive doses on CI‐AKI after computed tomography (CT) perfusion. Methods The levels of serum creatinine (SCR), blood urea nitrogen (BUN), Cystatin C (CysC), estimated glomerular filtration rate (eGFR), high‐sensitivity C‐reactive protein (hs‐CRP), and interleukin‐6 (IL‐6) in patients were compared between the observation group receiving 40 mg/kg atorvastatin and the control group receiving 20 mg/kg atorvastatin before and 72 h after CT examination. In addition, the incidence of CI‐AKI was recorded. Results Compared with the control group, the incidence of renal injury in the observation group was significantly reduced, from 8% to 2% (χ2 = 6.62, p = 0.010). In addition, there was no notable difference in the levels of Scr, BUN, CysC, hs‐CRP, and IL‐6 before CT examination between two groups (p > 0.05). The levels of SCR, BUN, CysC, hs‐CRP, and IL‐6 were increased, while the levels of eGFR were decreased in the control group at 72 h after CT examination (p < 0.05). At 72 h after CT enhancement, the levels of BUN, CysC, and hs‐CRP were prominently increased in the observation group (p < 0.05), while SCR, eGFR, and IL‐6 did not change (p > 0.05). Compared with the control group, the levels of SCR, BUN, CysC, eGFR, hs‐CRP, and IL‐6 in the observation group were significantly decreased at 72 h after CT examination (p < 0.05). Conclusion Intensive dose of atorvastatin pretreatment can prevent CI‐AKI undergoing CT perfusion through lowering inflammation as well as renal function indexes SCR, CysC, BUN, and eGFR.
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Affiliation(s)
- Shi-Xin Yan
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Man Gao
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Tian-Hao Yang
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Chao Tian
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
| | - Song Jin
- Imaging department of Tianjin Huanhu hospital, Tianjin, China
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Spiesecke P, Neumann K, Wakonig K, Lerchbaumer MH. Contrast-enhanced ultrasound (CEUS) in characterization of inconclusive cervical lymph nodes: a meta-analysis and systematic review. Sci Rep 2022; 12:7804. [PMID: 35551228 PMCID: PMC9098903 DOI: 10.1038/s41598-022-11542-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 04/25/2022] [Indexed: 01/02/2023] Open
Abstract
Lymph node metastases are common in malignant neoplasms of head and neck. Since cervical lymph nodes (cLN) are localized superficially, ultrasound (US) represents the primary imaging modality. The aim of the study is to report the value of US and contrast-enhanced ultrasound (CEUS) and their diagnostic confidence in the characterization of inconclusive cLN. A systematic review was performed using the literature data base PubMed. Results were filtered (published in a peer-reviewed journal, full-text available, published within the last ten years, species human, English or German full-text) and inclusion criteria were clearly defined (cohort with lymphadenopathy or malignancy in head and neck ≥ 50 patients, histological confirmation of malignant imaging findings, performance of CEUS as outcome variable). The results were quantified in a meta-analysis using a random-effects model. Overall, five studies were included in qualitative and quantitative analysis. The combination of non-enhanced US and CEUS enlarges the diagnostic confidence in the characterization of lymph nodes of unclear dignity. The pooled values for sensitivity and specificity in the characterization of a malignant cervical lymph node using US are 76% (95%-CI 66-83%, I2 = 63%, p < 0.01) and 80% (95%-CI 45-95%, I2 = 92%, p < 0.01), compared to 92% (95%-CI 89-95%, I2 = 0%, p = 0.65) and 91% (95%-CI 87-94%, I2 = 0%, p = 0.40) for the combination of US and CEUS, respectively. Consistent results of the included studies show improved diagnostic performance by additional CEUS. Nevertheless, more prospective studies are needed to implement CEUS in the diagnostic pathway of cLN.
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Affiliation(s)
- Paul Spiesecke
- Department of Radiology, Interdisciplinary Ultrasound Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité -Universitätsmedizin Berlin Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Konrad Neumann
- Institute of Biometry and Clinical Epidemiology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Katharina Wakonig
- Department of Otorhinolaryngology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Interdisciplinary Ultrasound Center, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, and Berlin Institute of Health, Charité -Universitätsmedizin Berlin Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Eskandari A, Narayanasamy S, Ward C, Priya S, Aggarwal T, Elam J, Nagpal P. Prevalence and significance of incidental findings on computed tomography pulmonary angiograms: A retrospective cohort study. Am J Emerg Med 2022; 54:232-237. [DOI: 10.1016/j.ajem.2022.01.064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/25/2022] [Accepted: 01/27/2022] [Indexed: 10/19/2022] Open
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El Hussein MT, Ha C. CHIPS: Prevention of contrast-induced nephropathy before and after cardiac catheterization. Nurse Pract 2021; 46:32-39. [PMID: 34808645 DOI: 10.1097/01.npr.0000804164.94431.fc] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT Contrast-induced nephropathy is the leading cause of acute kidney injury in hospital settings. Practitioners must have a comprehensive understanding of preventive interventions. This article provides a mnemonic NPs can use to prevent contrast-induced nephropathy. The mnemonic, CHIPS, addresses Contrast minimizations, Hemofiltration, Iso-osmolar/low osmolar contrast, Pharmacologic interventions, and Saline I.V. hydration.
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Sodagari F, Wood CG, Agrawal R, Yaghmai V. Feasibility of sub-second CT angiography of the abdomen and pelvis with very low volume of contrast media, low tube voltage, and high-pitch technique, on a third-generation dual-source CT scanner. Clin Imaging 2021; 82:15-20. [PMID: 34768221 DOI: 10.1016/j.clinimag.2021.10.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 10/04/2021] [Accepted: 10/21/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND Concerns about potential risks of using contrast media in patients with chronic renal insufficiency limit the utilization of CT angiography in this population. PURPOSE To evaluate the feasibility of abdominopelvic CTA with very low volumes of contrast media. MATERIAL AND METHODS In this retrospective study, 20 patients with chronic renal insufficiency underwent high-pitch abdominopelvic (AP) CTA on a third-generation dual-source CT scanner with 30 mL of nonionic iodinated contrast. The homogeneity of intravascular attenuation at the suprarenal aorta, infrarenal aorta, and the right common iliac artery was measured. Image noise, contrast-to-noise ratio (CNR), and signal-to-noise ratio (SNR) were used to assess objective image quality. Subjective image quality was evaluated on a 5-point scale (1 = unacceptable; 5 = excellent). RESULTS Twelve male and eight female patients underwent CTA of the abdomen and pelvis at 80 kVp. Five CTAs also included the chest (CAP). The mean scan duration was 0.78 ± 0.19 s for AP and 0.96 ± 0.06 s for CAP CTAs. The mean ± SD of attenuation at suprarenal aorta, infrarenal aorta, and right common iliac artery were 235.1 ± 68.0, 249.2 ± 61.3, and 254.4 ± 67.7 HU, respectively. The attenuation was homogeneous across vascular levels (P = 0.06). All scans had diagnostic subjective image quality with the median (IQR) of 3.5 (1.75). CNR and SNR were homogeneous across vascular levels (P = 0.08 and P = 0.14, respectively). CONCLUSION Sub-second, high-pitch abdominopelvic CTA with a low volume of contrast in patients with chronic renal insufficiency is technically and clinically feasible with good diagnostic image quality and homogenous attenuation across vascular levels.
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Affiliation(s)
- Faezeh Sodagari
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA; Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, CT, USA.
| | - Cecil G Wood
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA.
| | - Rishi Agrawal
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA.
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University-Feinberg School of Medicine, Chicago, IL, USA; Department of Radiological Sciences, University of California, Irvine School of Medicine, Orange, CA, USA.
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Post-Contrast Acute Kidney Injury in Patients with Various Stages of Chronic Kidney Disease-Is Fear Justified? Toxins (Basel) 2021; 13:toxins13060395. [PMID: 34206100 PMCID: PMC8226462 DOI: 10.3390/toxins13060395] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2021] [Revised: 05/24/2021] [Accepted: 05/27/2021] [Indexed: 01/21/2023] Open
Abstract
Post-contrast acute kidney injury (PC-AKI) is one of the side effects of iodinated contrast media, including those used in computed tomography. Its incidence seems exaggerated, and thus we decided to try estimate that number and investigate its significance in our clinical practice. We analyzed all computed tomographies performed in our clinic in 2019, including data about the patient and the procedure. In each case, we recorded the parameters of kidney function (serum creatinine concentration and eGFR) in four time intervals: before the test, immediately after the test, 14–28 days after the test, and over 28 days after the test. Patients who did not have a follow-up after computed tomography were excluded. After reviewing 706 CT scans performed in 2019, we included 284 patients undergoing contrast-enhanced CT and 67 non-enhanced CT in the final analysis. On this basis, we created two comparable groups in terms of age, gender, the severity of chronic kidney disease, and the number of comorbidities. We found that AKI was more common in the non-enhanced CT population (25.4% vs. 17.9%). In terms of our experience, it seems that PC-AKI is not a great risk for patients, even those with chronic kidney disease. Consequently, the fear of using contrast agents is not justified.
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Spiesecke P, Fischer T, Maxeiner A, Hamm B, Lerchbaumer MH. Contrast-enhanced ultrasound (CEUS) reliably rules out neoplasm in developmental renal pseudotumor. Acta Radiol 2021; 62:821-829. [PMID: 32631079 DOI: 10.1177/0284185120939291] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Renal pseudotumors appear as benign cortical hypertrophies and are typically assessed by contrast-enhanced computed tomography or magnetic resonance imaging to rule out malignancy. PURPOSE To investigate whether contrast-enhanced ultrasound (CEUS) can rule out renal neoplasm and thus potentially reduce cross-sectional imaging and further follow-up in these patients. MATERIAL AND METHODS Thirty-two patients with presumption of developmental renal pseudotumor on CEUS between June 2011 and July 2019 were retrospectively analyzed. All patients were examined with a standardized renal US protocol including B-mode, color-coded duplex sonography (CCDS), and CEUS by an experienced radiologist (EFSUMB level 3). Images were retrospectively interpreted in consensus by two highly experienced radiologists. Histopathological reports, cross-sectional imaging findings, and clinical course (treatment response, long-term imaging follow-up) were defined as standard of reference. RESULTS CEUS correctly identified 8/9 neoplastic lesions and missed one oncocytoma within the 32 included patients. Irregular vessel structure (88.9% vs. 13.0%, P = 0.007) and hyperenhancement (66.6% vs. 17.4%, P = 0.031) on CEUS were more common in neoplasm compared to developmental pseudotumors reaching statistical significance. Compared with the standard of reference, CEUS had 89% sensitivity (95% confidence interval [CI] 57-98), 96% specificity (95% CI 80-99), a positive predictive value of 89% (95% CI 57-98), and a negative predictive value of 96% (95% CI 79-99) for ruling out renal malignancy in developmental pseudotumors. CONCLUSION CEUS is a safe and fast method to rule out neoplasm in the diagnostic work-up of renal pseudotumors. In conjunction with B-mode and CCDS, CEUS has the potential to reduce further (invasive) diagnostic procedures.
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Affiliation(s)
- Paul Spiesecke
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Melatonin Alleviates Contrast-Induced Acute Kidney Injury by Activation of Sirt3. OXIDATIVE MEDICINE AND CELLULAR LONGEVITY 2021; 2021:6668887. [PMID: 34122726 PMCID: PMC8169261 DOI: 10.1155/2021/6668887] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/22/2021] [Indexed: 12/11/2022]
Abstract
Oxidative stress and apoptosis play a vital role in the pathogenesis of contrast-induced acute kidney injury (CI-AKI). The purpose of our study was to investigate the protective effects and mechanisms of melatonin against CI-AKI in a CI-AKI mouse model and NRK-52E cells. We established the CI-AKI model in mice, and the animals were pretreated with melatonin (20 mg/kg). Our results demonstrated that melatonin treatment exerted a renoprotective effect by decreasing the level of serum creatinine (SCr) and blood urea nitrogen (BUN), lessening the histological changes of renal tubular injuries, and reducing the expression of neutrophil gelatinase-associated lipid (NGAL), a marker of kidney injury. We also found that pretreatment with melatonin remarkably increased the expression of Sirt3 and decreased the ac-SOD2 K68 level. Consequently, melatonin treatment significantly decreased the oxidative stress by reducing the Nox4, ROS, and malondialdehyde (MDA) content and by increasing the superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) activity levels. The antiapoptotic effect of melatonin on CI-AKI was revealed by decreasing the ratio of Bax/Bcl2 and the cleaved caspase3 level and by reducing the number of apoptosis-positive tubular cells. In addition, melatonin treatment remarkably reduced the inflammatory cytokines of interleukin-1β (IL-1β), tumor necrosis factor α (TNFα), and transforming growth factor β (TGFβ) in vivo and in vitro. Sirt3 deletion and specific Sirt3 siRNA abolished the above renoprotective effects of melatonin in mice with iohexol-induced acute kidney injury and in NRK-52E cells. Thus, our results demonstrated that melatonin exhibited the renoprotective effects of antioxidative stress, antiapoptosis, and anti-inflammation by the activation of Sirt3 in the CI-AKI model in vivo and in vitro. Melatonin may be a potential drug to ameliorate CI-AKI in clinical practice.
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Wang J, Zhang C, Liu Z, Bai Y. Risk factors of contrast-induced nephropathy after percutaneous coronary intervention: a retrospective analysis. J Int Med Res 2021; 49:3000605211005972. [PMID: 33878914 PMCID: PMC8072857 DOI: 10.1177/03000605211005972] [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] [Indexed: 11/16/2022] Open
Abstract
Objective Contrast-induced nephropathy (CIN) is a serious complication in patients with acute coronary syndrome (ACS) and percutaneous coronary intervention (PCI). This study aimed to analyze the potential risk factors for CIN in patients undergoing PCI. Methods Patients with ACS who underwent PCI treatment from January 2017 to January 2020 were selected. The patients’ characteristics and medical information were collected and compared. Results A total of 1331 patients undergoing PCI were included. The incidence of CIN was 15.33%. Logistic regression analyses showed that a left ventricular ejection fraction ≤45% (odds ratio [OR] 4.18, 95% confidence interval [CI] 1.10–7.36), serum creatinine levels ≤60 μmol/L (OR 3.03, 95% CI 1.21–5.57), age ≥65 years (OR 2.75, 95% CI 1.32–4.60), log N-terminal pro-B-type natriuretic peptide levels ≥2.5 pg/mL (OR 2.31, 95% CI 1.18–5.13), uric acid levels ≥350 μmol/L (OR 2.29, 95% CI 1.04–5.30), emergency percutaneous intervention (OR 1.35, 95% CI 0.34–3.12), and triglyceride levels ≤1.30 mmol/L (OR 1.10, 95% CI 0.01–2.27) were independent risk factors for CIN in patients who underwent PCI. Conclusions Early prevention is required to reduce the occurrence of CIN in patients who undergo PCI and have risk factors for CIN.
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Affiliation(s)
- Jing Wang
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Chunyu Zhang
- Nursing Teaching and Research Department, First Affiliated Hospital, Heilongjiang University of Chinese Medicine, Yan'an, China
| | - Zhina Liu
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
| | - Yanping Bai
- Department of Cardiology, Yan'an University Affiliated Hospital, Yan'an, China
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Spiesecke P, Reinhold T, Wehrenberg Y, Werner S, Maxeiner A, Busch J, Fischer T, Hamm B, Lerchbaumer MH. Cost‐effectiveness analysis of multiple imaging modalities in diagnosis and follow‐up of intermediate complex cystic renal lesions. BJU Int 2021; 128:575-585. [DOI: 10.1111/bju.15353] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
| | - Thomas Reinhold
- Institute of Social Medicine, Epidemiology, and Health Economics
| | | | | | - Andreas Maxeiner
- Department of Urology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Jonas Busch
- Department of Urology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Spiesecke P, Münch F, Fischer T, Hamm B, Lerchbaumer MH. Multiparametric ultrasound findings in acute kidney failure due to rare renal cortical necrosis. Sci Rep 2021; 11:2060. [PMID: 33479443 PMCID: PMC7820240 DOI: 10.1038/s41598-021-81690-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2020] [Accepted: 01/06/2021] [Indexed: 02/06/2023] Open
Abstract
Renal cortical necrosis (RCN) is a rare cause of acute kidney failure and is usually diagnosed on the basis of characteristic enhancement patterns on cross-sectional imaging. Contrast-enhanced ultrasound (CEUS) offers benefits in patients with kidney failure in the clinical setting including the use of a nonnephrotoxic intravascular contrast agent and the fact that it can be performed at the bedside in critical cases. Therefore, the aim of this study is to investigate whether CEUS can reliably identify typical imaging features of RCN. We retrospectively analyzed 12 patients with RCN examined in our department and confirmation of the diagnosis by either histopathology, other contrast-enhanced cross-sectional imaging tests, and/or CEUS follow-up. Assessed parameters in conventional US were reduced echogenicity, loss of corticomedullary differentiation, length and width of kidney, hypoechoic rim, resistance index and in CEUS delayed wash-in of contrast agent (> 20 s), reverse rim sign, maximum nonenhancing rim and additional renal infarction. Furthermore, imaging features in RCN were compared with the findings in renal vein thrombosis (RVT), among them echogenicity, corticomedullar differentiation, hypoechoic rim, RI value, delayed cortical enhancement, total loss of cortical perfusion and enhancement of renal medulla. All 12 patients showed the reverse rim sign, while a hypoechogenic subcapsular rim was only visible in four patients on B-mode ultrasound. A resistance index (RI) was available in 10 cases and was always less than 1. RI was a strong differentiator in separating RVT from RCN (RI > 1 or not measurable due to hypoperfusion as differentiator, p = 0.001). CEUS showed total loss of medullary enhancement in all cases of RVT. With its higher temporal resolution, CEUS allows dynamic assessment of renal macro- and microcirculation and identification of the typical imaging findings of RCN with use of a nonnephrotoxic contrast agent.
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Affiliation(s)
- Paul Spiesecke
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Frédéric Münch
- Department of Nephrology and Intensive Care Medicine, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Berlin, Germany
| | - Thomas Fischer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany
| | - Markus H Lerchbaumer
- Department of Radiology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität Zu Berlin, Campus Charité Mitte, Charitéplatz 1, 10117, Berlin, Germany.
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Ma C, Chen T, Ti Y, Yang Y, Qi Y, Zhang C, Liu L, Bu P. Ranolazine alleviates contrast-associated acute kidney injury through modulation of calcium independent oxidative stress and apoptosis. Life Sci 2020; 267:118920. [PMID: 33352171 DOI: 10.1016/j.lfs.2020.118920] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 11/26/2020] [Accepted: 12/11/2020] [Indexed: 12/17/2022]
Abstract
This study investigates the role of ranolazine in contrast-associated acute kidney injury (CA-AKI) and potential mechanisms. For in vivo studies, mouse models of CA-AKI and control mice were treated with ranolazine or vehicle. Blood urea nitrogen (BUN) and serum creatinine were detected by spectrophotometry. Anti-T-cell immunoglobulin and mucin domain 1 (TIM 1) and anti-lipocalin 2 antibody (LCN2) were detected by immunofluorescence. Hemodynamic parameters were detected via invasive blood pressure measurement and renal artery color doppler ultrasound, capillary density was measured by CD31 immunofluorescence, vascular permeability assay was performed by Evans blue dye. The expressions of oxidative stress and apoptotic markers were measured and analyzed by immunofluorescence and western blotting. For in vitro studies, intracellular calcium concentration of HUVECs was measured with Fluo 3-AM under confocal microscopy. Results show that compared with control mice, serum BUN, creatinine, TIM 1 and LCN2 levels were elevated in CA-AKI mice, but this effect was alleviated by ranolazine-pretreatment. Safe doses of ranolazine (less than 64 mg/kg) had no significant effect on overall blood pressure, but substantially improved renal perfusion, reduced contrast-induced microcirculation disturbance, improved renal capillary density and attenuated renal vascular permeability in ranolazine-pretreated CA-AKI mice. Mechanistically, ranolazine markedly down-regulated oxidative stress and apoptosis markers compared to CA-AKI mice. Intracellularly, ranolazine attenuated calcium overload in HUVECs. These results indicate that ranolazine alleviates CA-AKI through modulation of calcium independent oxidative stress and apoptosis.
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Affiliation(s)
- Chang Ma
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Tongshuai Chen
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yun Ti
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yi Yang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Yan Qi
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Chunmei Zhang
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Lingxin Liu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Peili Bu
- The Key Laboratory of Cardiovascular Remodeling and Function Research, Chinese Ministry of Education, Chinese National Health Commission and Chinese Academy of Medical Sciences, The State and Shandong Province Joint Key Laboratory of Translational Cardiovascular Medicine, Department of Cardiology, Qilu Hospital, Cheeloo College of Medicine, Shandong University, Jinan, China.
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Minimal risk of contrast-induced kidney injury in a randomly selected cohort with mildly reduced GFR. Eur Radiol 2020; 31:3248-3257. [PMID: 33155105 PMCID: PMC8043936 DOI: 10.1007/s00330-020-07429-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Revised: 10/06/2020] [Accepted: 10/14/2020] [Indexed: 12/23/2022]
Abstract
OBJECTIVES Previous large studies of contrast-induced or post-contrast acute kidney injury (CI-AKI/PC-AKI) have been observational, and mostly retrospective, often with patients undergoing non-enhanced CT as controls. This carries risk of inclusion bias that makes the true incidence of PC-AKI hard to interpret. Our aim was to determine the incidence of PC-AKI in a large, randomly selected cohort, comparing the serum creatinine (Scr) changes after contrast medium exposure with the normal intraindividual fluctuation in Scr. METHODS In this prospective study of 1009 participants (age 50-65 years, 48% females) in the Swedish CArdioPulmonary bioImage Study (SCAPIS), with estimated glomerular filtration rate (eGFR) ≥ 50 mL/min, all received standard dose intravenous iohexol at coronary CT angiography (CCTA). Two separate pre-CCTA Scr samples and a follow-up sample 2-4 days post-CCTA were obtained. Change in Scr was statistically analyzed and stratification was used in the search of possible risk factors. RESULTS Median increase of Scr post-CCTA was 0-2 μmol/L. PC-AKI was observed in 12/1009 individuals (1.2%) according to the old ESUR criteria (> 25% or > 44 μmol/L Scr increase) and 2 individuals (0.2%) when using the updated ESUR criteria (≥ 50% or ≥ 27 μmol/L Scr increase). Possible risk factors (e.g., diabetes, age, eGFR, NSAID use) did not show increased risk of developing PC-AKI. The mean effect of contrast media on Scr did not exceed the intraindividual Scr fluctuation. CONCLUSIONS Iohexol administration to a randomly selected cohort with mildly reduced eGFR is safe, and PC-AKI is very rare, occurring in only 0.2% when applying the updated ESUR criteria. KEY POINTS • Iohexol administration to a randomly selected cohort, 50-65 years old with mildly reduced eGFR, is safe and PC-AKI is very rare. • Applying the updated ESUR PC-AKI criteria resulted in fewer cases, 0.2% compared to 1.2% using the old ESUR criteria in this cohort with predominantly mild reduction of renal function. • The mean effect of CM on Scr did not exceed the intraindividual background fluctuation of Scr, regardless of potential risk factors, such as diabetes or NSAID use in our cohort of 1009 individuals.
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Kelemen JA, Kaserer A, Jensen KO, Stein P, Seifert B, Simmen HP, Spahn DR, Pape HC, Neuhaus V. Prevalence and outcome of contrast-induced nephropathy in major trauma patients. Eur J Trauma Emerg Surg 2020; 48:907-913. [PMID: 32948886 PMCID: PMC7500990 DOI: 10.1007/s00068-020-01496-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/04/2020] [Indexed: 11/29/2022]
Abstract
Background Contrast-induced nephropathy (CIN) has been well investigated in patients undergoing coronary angiography, but not in trauma patients. The main aim of this study was to determine the prevalence and to investigate independent risk factors for the development of CIN. Methods Between 2008 and 2014, all pre-hospital intubated major trauma patients with documented serum creatinine levels (SCr) undergoing a contrast-enhanced whole-body CT at admission were retrospectively analyzed. CIN was defined as a relative increase in SCr > 25% over the baseline value or an absolute SCr increase of > 44 µmol/l within 72 h. Univariate and multivariable regression analyses were performed to identify significant risk factors. A p value of < 0.01 was considered statistically significant and a p value of 0.01–0.049 suggested evidence. Results Of 284 analyzed patients, 41 (14%) met the criteria for CIN. There is suggestive evidence that age and lactate level influenced the development of CIN. Six patients (15%) had hemodialysis in the CIN-group and eight (3.3%) in the group without CIN. Complication and mortality rate was higher in patients with CIN (71% vs. 56% and 32% vs. 23%, respectively). CIN was not an independent risk factor for complications or mortality while controlling for age, gender, injury severity score, and lactate level. The length of stay was not affected by CIN. Conclusion CIN occurs frequently in trauma patients, but is not an independent risk factor for complications or mortality. Therefore, contrast enhanced whole-body CT can safely be performed in trauma patients.
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Affiliation(s)
- Julian Alexander Kelemen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Alexander Kaserer
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Kai Oliver Jensen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Philipp Stein
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
- Institute of Anesthesiology, Cantonal Hospital Winterthur, Brauerstrasse 15, 8400 Winterthur, Switzerland
| | - Burkhardt Seifert
- Institute of Epidemiology, Biostatistics and Prevention, University of Zurich, Zurich, Switzerland
- Department of Biostatistics at Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland
| | - Hans-Peter Simmen
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Donat R. Spahn
- Institute of Anesthesiology, University and University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland
| | - Hans-Christoph Pape
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
| | - Valentin Neuhaus
- Division of Trauma Surgery, Department of Surgery, University Hospital Zurich, University of Zurich, Raemistrasse. 100, 8091 Zurich, Switzerland
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Kovac JD, Milovanovic T, Dugalic V, Dumic I. Pearls and pitfalls in magnetic resonance imaging of hepatocellular carcinoma. World J Gastroenterol 2020; 26:2012-2029. [PMID: 32536771 PMCID: PMC7267693 DOI: 10.3748/wjg.v26.i17.2012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 04/20/2020] [Accepted: 04/24/2020] [Indexed: 02/06/2023] Open
Abstract
Hepatocellular carcinoma (HCC) is the most common primary hepatic malignancy, which usually arises in cirrhotic liver. When the typical enhancement pattern, consisting of late arterial hyperenhancement followed by washout, is present in nodules larger than 1 cm, HCC can be confidently diagnosed without the need for tissue biopsy. Nevertheless, HCC can display an atypical enhancement pattern, either as iso or hypovascular lesion, or hypervascular lesion without washout. Not only the enhancement pattern of HCC could be atypical, but also a variety of histological types of HCC, such as steatotic, scirrhous, fibrolamellar, or combined hepatocellular-cholangiocellular carcinoma could raise diagnostic dilemmas. In addition, distinct morphological types of HCC or different growth pattern can occur. Awareness of these atypical and rare HCC presentations on magnetic resonance imaging is important for accurate differentiation from other focal liver lesions and timely diagnosis, which allows optimal treatment of patients.
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Affiliation(s)
- Jelena Djokic Kovac
- Departament of Radiology, Clinical Center Serbia, Belgrade 11000, Serbia
- School of Medicine, Belgrade University, Belgrade 11000, Serbia
| | - Tamara Milovanovic
- Departament of Hepatology, Clinical Center Serbia, Belgrade 11000, Serbia
- School of Medicine, Belgrade University, Belgrade 11000, Serbia
| | - Vladimir Dugalic
- Departament of Surgery, Clinical Center Serbia, Belgrade 11000, Serbia
- School of Medicine, Belgrade University, Belgrade 11000, Serbia
| | - Igor Dumic
- Divison of Hospital Medicine, Mayo Clinic College of Medicine and Sciences, Mayo Clinic Health System, New York, NY 10029, United States
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Lim E, Jang JH, Yoon D, Min YG, Kim HH. Does Exposure to Computed Tomography Contrast Media Increase Risk of End-Stage Renal Disease? Med Sci Monit 2020; 26:e921303. [PMID: 32203057 PMCID: PMC7111122 DOI: 10.12659/msm.921303] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
Background There are many studies on acute kidney injury (AKI) after exposure to contrast media in patients with chronic kidney disease (CKD). However, whether the risk of end-stage renal disease (ESRD) increases after exposure to contrast media in the long term, regardless of development of AKI after such exposure, has not been studied. Material/Methods The electronic health records of patients diagnosed with CKD and followed up from 2014 to 2018 at a tertiary university hospital were retrospectively collected. Patients were divided into patients who progressed to ESRD (ESRD group) and those who did not (non-ESRD group). Patients in the non-ESRD group were matched 1: 1 to those in the ESRD group by using disease risk score generation and matching. Multivariate logistic regression analysis was performed to assess the effect of contrast media exposure on progression to ESRD. Results In total, 179 patients were enrolled per group; 178 (99.4%) were in CKD stage 3 or above in both groups. Average serum creatinine was 4.31±3.02 mg/dl and 3.64±2.55 mg/dl in the ESRD and non-ESRD groups, respectively (p=0.242). Other baseline characteristics were not statistically significant, except for the number of times contrast-enhanced computed tomography (CECT) was performed (0.00 [Interquartile range (IQR) 0.00–2.00] in the ESRD group and 0.00 [IQR 0.00–1.00] in the non-ESRD group [p=0.006]); in multivariate logistic regression, this number (OR=1.24, 95% CI=1.08–1.47, p=0.006) was significantly related to progression to ESRD. Conclusions The use of CECT increased the risk of ESRD 1.2-fold in advanced and stable CKD outpatients after 5-year follow-up.
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Affiliation(s)
- Eunsoo Lim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Jong-Hwan Jang
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea
| | - Dukyong Yoon
- Department of Biomedical Informatics, Ajou University School of Medicine, Suwon, South Korea.,Department of Biomedical Sciences, Ajou University School of Medicine, Suwon, South Korea
| | - Young-Gi Min
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
| | - Hyuk-Hoon Kim
- Department of Emergency Medicine, Ajou University School of Medicine, Suwon, South Korea
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Post-contrast acute kidney injury in a hospitalized population: short-, mid-, and long-term outcome and risk factors for adverse events. Eur Radiol 2020; 30:3516-3527. [PMID: 32080754 PMCID: PMC7248019 DOI: 10.1007/s00330-020-06690-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 01/12/2020] [Accepted: 01/29/2020] [Indexed: 12/21/2022]
Abstract
Objectives To investigate the prognosis including major adverse kidney events within 30 days (MAKE30) and 90-day and 1-year adverse outcome in hospitalized patients with post-contrast acute kidney injury (PC-AKI) to identify high-risk factors. Methods This retrospective observational study included 288 PC-AKI patients selected from 277,898 patients admitted to hospitals from January 2015 to December 2015. PC-AKI was defined according to the 2018 guideline of European Society of Urogenital Radiology. Multivariable Cox regression and logistic regression analyses were used to analyze main outcome and risk factors. Results PC-AKI patients with AKI stage ≥ 2 had much higher incidence of MAKE30 than those with AKI stage 1 (RR = 7.027, 95% CI 4.918–10.039). Persistent renal dysfunction, heart failure, central nervous system failure, baseline eGFR < 60 mL/min/1.73 m2, oliguria or anuria, blood urea nitrogen ≥ 7.14 mmol/L, respiratory failure, and shock were independent risk factors of 90-day or 1-year adverse prognosis (p < 0.05). Compared with transient renal dysfunction, PC-AKI patients with persistent renal dysfunction had a higher all-cause mortality rate (RR = 3.768, 95% CI 1.612–8.810; RR = 4.106, 95% CI 1.765–9.551) as well as combined endpoints of death, chronic kidney disease, or end-stage renal disease (OR = 3.685, 95% CI 1.628–8.340; OR = 5.209, 95% CI 1.730–15.681) within 90 days or 1 year. Conclusions PC-AKI is not always a transient, benign creatininopathy, but can result in adverse outcome. AKI stage is independently correlated to MAKE30 and persistent renal dysfunction may exaggerate the risk of long-term adverse events. Key Points • PC-AKI can result in adverse outcome such as persistent renal dysfunction, dialysis, chronic kidney disease (CKD), end-stage renal disease (ESRD), or death. • AKI stage is independently correlated to MAKE30. • Persistent renal dysfunction may exaggerate the risk of long-term adverse events. Electronic supplementary material The online version of this article (10.1007/s00330-020-06690-3) contains supplementary material, which is available to authorized users.
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Bartolotta TV, Terranova MC, Gagliardo C, Taibbi A. CEUS LI-RADS: a pictorial review. Insights Imaging 2020; 11:9. [PMID: 32020352 PMCID: PMC7000618 DOI: 10.1186/s13244-019-0819-2] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2019] [Accepted: 11/21/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) greatly improved the diagnostic accuracy of US in the detection and characterization of focal liver lesions (FLLs), and it is suggested and often included in many international guidelines as an important diagnostic tool in the imaging work-up of cirrhotic patients at risk for developing hepatocellular carcinoma (HCC). In particular, CEUS Liver Imaging Reporting and Data System (LI-RADS) provides standardized terminology, interpretation, and reporting for the diagnosis of HCC. The aim of this pictorial essay is to illustrate CEUS features of nodules discovered at US in cirrhotic liver according to LI-RADS categorization.
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Affiliation(s)
- Tommaso Vincenzo Bartolotta
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy. .,Department of Radiology, Fondazione Istituto Giuseppe Giglio Ct.da Pietrapollastra, Via Pisciotto, 90015, Cefalù (Palermo), Italy.
| | - Maria Chiara Terranova
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| | - Cesare Gagliardo
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
| | - Adele Taibbi
- BiND Department: Biomedicine, Neuroscience and Advanced Diagnostic, University of Palermo, Via Del Vespro, 129 90127, Palermo, Italy
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Rajiah P, Ciancibello L, Novak R, Sposato J, Landeras L, Gilkeson R. Ultra-low dose contrast CT pulmonary angiography in oncology patients using a high-pitch helical dual-source technology. ACTA ACUST UNITED AC 2020; 25:195-203. [PMID: 31063136 DOI: 10.5152/dir.2019.17498] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
PURPOSE We aimed to determine if the image quality and vascular enhancement are preserved in computed tomography pulmonary angiography (CTPA) studies performed with ultra-low contrast and optimized radiation dose using high-pitch helical mode of a second generation dual source scanner. METHODS We retrospectively evaluated oncology patients who had CTPA on a 128-slice dual-source scanner, with a high-pitch helical mode (3.0), following injection of 30 mL of Ioversal at 4 mL/s with body mass index (BMI) dependent tube potential (80-120 kVp) and current (130-150 mAs). Attenuation, noise, and signal-to-noise ratio (SNR) were measured in multiple pulmonary arteries. Three independent readers graded the images on a 5-point Likert scale for central vascular enhancement (CVE), peripheral vascular enhancement (PVE), and overall quality. RESULTS There were 50 males and 101 females in our study. BMI ranged from 13 to 38 kg/m2 (22.8±4.4 kg/m2). Pulmonary embolism was present in 29 patients (18.9%). Contrast enhancement and SNR were excellent in all the pulmonary arteries (395.3±131.1 and 18.3±5.7, respectively). Image quality was considered excellent by all the readers, with average reader scores near the highest possible score of 5.0 (CVE, 4.83±0.48; PVE, 4.68±0.65; noise/quality, 4.78±0.47). The average radiation dose length product (DLP) was 161±60 mGy.cm. CONCLUSION Using a helical high-pitch acquisition technique, CTPA images of excellent diagnostic quality, including visualization of peripheral segmental/sub-segmental branches can be obtained using an ultra-low dose of iodinated contrast and low radiation dose.
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Affiliation(s)
- Prabhakar Rajiah
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Department of Radiology, Cardiothoracic Imaging, UT Southwestern Medical Center, Dallas, Texas, USA
| | - Leslie Ciancibello
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Ronald Novak
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Rebecca D. Considine Research Institute, Akron Children's Hospital, Akron, Ohio, USA
| | - Jennifer Sposato
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Luis Landeras
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA;Department of Radiology, University of Chicago, Chicago, Illinois, USA
| | - Robert Gilkeson
- Department of Radiology, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Mengna HMDP, Lei XMD, Tian’an JMDP. Time-intensity Curve Analysis of Hepatocellular Carcinoma using Two Contrast-enhanced Ultrasound Methods: Contrast Pulse Sequencing and Contrast Harmonic Imaging. ADVANCED ULTRASOUND IN DIAGNOSIS AND THERAPY 2020. [DOI: 10.37015/audt.2020.200007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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27
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Dietrich CF, Teufel A, Sirlin CB, Dong Y. Surveillance of hepatocellular carcinoma by medical imaging. Quant Imaging Med Surg 2019; 9:1904-1910. [PMID: 31867241 DOI: 10.21037/qims.2019.10.04] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Christoph F Dietrich
- Sino-German Tongji-Caritas Research Center of Ultrasound in Medicine, Department of Medical Ultrasound, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China.,Department of Internal Medicine II, Caritas-Krankenhaus Bad Mergentheim, Bad Mergentheim, Germany
| | - Andreas Teufel
- Division of Hepatology, Department of Medicine II, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, UC San Diego, San Diego, CA, USA
| | - Yi Dong
- Department of Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200433, China
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CT angiography for pulmonary embolism in the emergency department: investigation of a protocol by 20 ml of high-concentration contrast medium. Radiol Med 2019; 125:137-144. [PMID: 31659676 DOI: 10.1007/s11547-019-01098-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 10/15/2019] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To retrospectively compare semi-qualitative and quantitative CT pulmonary angiography (CTPAs) image metrics testing diagnostic performance between protocols performed by 20 or 40 ml of contrast medium (CM) in patients with suspected pulmonary embolism (PE). METHODS A total of 102 CTPAs performed by 20 ml (ultra-low volume: ULV) and 74 CTPAs performed by 40 ml (low volume: LV) protocol for the diagnosis of clinically suspected PE performed between October 2012 and September 2013 were retrieved. High-concentration CM (Iomeprol 400 mgI/ml) was injected at 3 ml/s (iodine delivery rate 1.2 mgI/s). Two radiologists (blinded and independent) semi-qualitatively scored vascular enhancement and image noise according to a five-point visual scoring system. Quantitative analysis was performed by regions of interest quantifying densitometric parameters, such as central and peripheral pulmonary arteries vascular contrast enhancement (CE, threshold for diagnostic CE ≥ 250 HU), and metrics for image noise. Continuous variables were compared by the Student's t test between groups if normally distributed while categorical variables were analyzed with the Chi-squared test. Interobserver agreement was calculated by the weighted kappa test; correlation coefficients were calculated using Pearson's correlation tests. RESULTS The semi-qualitative scores for central and peripheral pulmonary arteries vascular CE were sufficient by ULV, yet inferior than LV (p < 0.001). Semi-qualitative image noise was comparable between ULV and LV, and the interobserver agreement was only fair for quality of peripheral vessels. Agreement on nondiagnostic semi-qualitative parameters was seen in 9/102 (8.8%) ULV CTPAs, in particular associated with massive PE (2/9), pleuro-pulmonary abnormalities (5/9) or without major abnormalities (2/9). Quantitative analysis showed that mean CE was lower in ULV group (p < 0.001), though greater than the diagnostic threshold of 250 HU in both groups. CONCLUSIONS Diagnostic vascular CE (> 250 HU) was obtained in both 20 ml and 40 ml CTPAs. CTPA by 20 ml of CM rendered diagnostic CE for the assessment of pulmonary arteries in patients with clinical suspicion of acute PE. Decreased image quality was mostly associated with massive PE or concomitant pleuro-parenchymal abnormalities.
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Khaleel SA, Raslan NA, Alzokaky AA, Ewees MG, Ashour AA, Abdel-Hamied HE, Abd-Allah AR. Contrast media (meglumine diatrizoate) aggravates renal inflammation, oxidative DNA damage and apoptosis in diabetic rats which is restored by sulforaphane through Nrf2/HO-1 reactivation. Chem Biol Interact 2019; 309:108689. [PMID: 31173751 DOI: 10.1016/j.cbi.2019.06.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 05/24/2019] [Accepted: 06/03/2019] [Indexed: 02/01/2023]
Abstract
Diabetes mellitus is an independent risk factor for renal impairment in patients exposed to contrast media. It doubles the risk and decreases survival rate of contrast induced nephropathy (CIN). Sulforaphane has antioxidant properties via Nrf2 activation. The interaction of diabetes and/or sulforaphane with contrast media on Nrf2 regulation is not yet understood. Herein, diabetes was induced by a single intra-peritoneal injection of streptozotocin. Animals were then divided into five groups; control non-diabetic group; diabetic group; diabetic/sulforaphane group; diabetic/CIN group; diabetic/CIN/sulforaphane group. Animals were assessed 24 h after CIN induction. Sulforaphane improved the impaired nephrotoxicity parameters, histopathological features, and oxidative stress markers induced by contrast media (meglumine diatrizoate) in diabetic rats. Immunofluorescence detection revealed increased Nrf2 expression in kidney sections after sulforaphane pretreatment. Moreover, gene expression of Nrf2 and HO-1 were up-regulated, while IL-6 and caspase3 were down-regulated in kidney tissues of animals pretreated with sulforaphane. In NRK-52E cells, sulforaphane pretreatment significantly ameliorated the cytotoxicity of meglumine diatrizoate. However, silencing Nrf2 using small interfering RNA (siRNA) abolished the cytoprotective effects of sulforaphane. Collectively, the results of this study suggest that Nrf2/HO-1 pathway has a protective role against CIN and support the clinical implication of Nrf2 activators, such as sulforaphane, in CIN particularly in diabetic patients.
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Affiliation(s)
- Sahar A Khaleel
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt; Davis Heart and Lung Research Institute and Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA.
| | - Nahed A Raslan
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Amany A Alzokaky
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Mohamed G Ewees
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt; Davis Heart and Lung Research Institute and Division of Cardiovascular Medicine, College of Medicine, The Ohio State University, Columbus, OH, 43210, USA
| | - Ahmed A Ashour
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
| | - Hala E Abdel-Hamied
- Department of Pathology, College of Medicine, Al-Azhar University, Cairo, Egypt
| | - Adel R Abd-Allah
- Pharmacology and Toxicology Department, Faculty of Pharmacy, Al-Azhar University, Cairo, Egypt
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Rate and risk factors for AKI after CT scans in a cancer cohort
. Clin Nephrol 2019; 91:147-154. [PMID: 30415653 PMCID: PMC6727567 DOI: 10.5414/cn109591] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2019] [Indexed: 01/20/2023] Open
Abstract
Aims: The proinflammatory milieu in cancer patients may expose them to increased risk for acute kidney injury (AKI) after IV contrast (CON). The aims of this study were to determine: (1) the rates of AKI after CON and noncontrast (NC) CT scans in cancer inpatients, (2) if rates differed among cancer subtypes, and (3) whether recent chemotherapy, comorbid conditions, or nephrotoxins increase AKI after CON. Materials and methods: Retrospective data was collected on adults who had received a CON or NC CT from January 1, 2012 to December 30, 2014. AKI was defined as a > 1.5× increased baseline creatinine. Data was analyzed using Rao-Scott χ2-test, propensity score matching, and logistic regressions. Results: A total of 7,512 CT scans were performed in 4,456 patients (4,958 NC, 2,554 CON). The rate for AKI with CON was 7.3% and 11.4% (p < 0.001) with NC imaging. The risk of AKI increased with lower baseline eGFR: for eGFR ≤ 29 mL/min/1.73m2, OR = 1.83 (p = 0.0002); for eGFR 30 – 59 mL/min/1.73m2, OR = 1.5 compared to eGFR ≥ 60 mL/min/1.73m2 (p < 0.0001). AKI rates were higher when any chemotherapy was given within 60 days of CT (OR = 1.22, p < 0.02), with congestive heart failure (OR 1.51, p = 0.0006), and history of AKI (OR 3.89, p < 0.0001). In 1:1 propensity score matched samples, the OR for AKI after CON was 0.87 (p = 0.23) compared to NC. Conclusion: In cancer patients, eGFR below 59 mL/min/1.73m2 were associated with increased rate of AKI, independent of contrast exposure. Congestive heart failure and prior AKI were also associated with increased rates of AKI.
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Bartolotta TV, Taibbi A, Midiri M, Lagalla R. Contrast-enhanced ultrasound of hepatocellular carcinoma: where do we stand? Ultrasonography 2019; 38:200-214. [PMID: 31006227 PMCID: PMC6595127 DOI: 10.14366/usg.18060] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 02/25/2019] [Indexed: 12/12/2022] Open
Abstract
Contrast-enhanced ultrasound (CEUS) represents a significant breakthrough in ultrasonography (US), and it is being increasingly used for the evaluation of focal liver lesions (FLLs). CEUS is unique in that it allows non-invasive assessment of liver perfusion in real time throughout the vascular phase, which has led to dramatic improvements in the diagnostic accuracy of US in the detection and characterization of FLLs, the choice of therapeutic procedures, and the evaluation of response. Currently, CEUS is included as a part of the suggested diagnostic work-up of FLLs, including in cirrhotic patients with hepatocellular carcinoma, resulting in better patient management and cost-effective delivery of therapy.
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Affiliation(s)
| | - Adele Taibbi
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Massimo Midiri
- Department of Radiology, University of Palermo, Palermo, Italy
| | - Roberto Lagalla
- Department of Radiology, University of Palermo, Palermo, Italy
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32
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Wei LM, Zhu YQ, Zhang PL, Lu HT, Zhao JG. Evaluation of Quiescent-Interval Single-Shot Magnetic Resonance Angiography in Diabetic Patients With Critical Limb Ischemia Undergoing Digital Subtraction Angiography: Comparison With Contrast-Enhanced Magnetic Resonance Angiography With Calf Compression at 3.0 Tesla. J Endovasc Ther 2018; 26:44-53. [PMID: 30580695 DOI: 10.1177/1526602818817887] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
PURPOSE To assess the diagnostic performance of quiescent-interval single-shot magnetic resonance angiography (QISS-MRA) at 3 tesla in diabetic patients with critical limb ischemia (CLI) vs contrast-enhanced MR angiography (CE-MRA) using digital subtraction angiography (DSA) as the standard of reference. METHOD Thirty-seven consecutive diabetic patients (mean age 71.8±7.2 years; 30 men) with CLI (Fontaine stage III-IV) underwent QISS-MRA and CE-MRA with calf compression; DSA was the standard. Image quality (5-point Likert-type scale) and stenosis severity (5-point grading) for QISS-MRA and CE-MRA were evaluated by 2 blinded readers in 1147 and 654 vessel segments, respectively. Per-segment and per-region (pelvis, thigh, calf) sensitivity, specificity, positive predictive value, and negative predictive value were calculated. RESULTS Image quality of QISS-MRA was lower compared with CE-MRA in the pelvic region (p<0.001 in both readers) and thigh region (p=0.033 in reader 1 and p=0.018 in reader 2), whereas in the calf region, the image quality of QISS-MRA was better than CE-MRA (p=0.009 in reader 1 and p=0.001 in reader 2). In segment-based analyses, there was no difference between QISS-MRA and CE-MRA in sensitivity [89.5% vs 90.3% in reader 1 (p=0.774) and 87.6% vs 90.6% in reader 2 (p=0.266)] or specificity [94.2% vs 92.9% in reader 1 (p=0.513) and 92.9% vs 92.9% in reader 2 (p>0.999)]. In region-based analyses, QISS-MRA and CE-MRA yielded similar sensitivity and specificity in all areas but the pelvic region for reader 2 (specificity 95.5% vs 84.8%, p=0.041). CONCLUSION QISS-MRA performed very well in diabetic patients with CLI and was a good alternative for patients with contraindications to CE-MRA.
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Affiliation(s)
- Li-Ming Wei
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Yue-Qi Zhu
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Pei-Lei Zhang
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Hai-Tao Lu
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun-Gong Zhao
- 1 Department of Diagnostic and Interventional Radiology, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
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Nagayama Y, Nakaura T, Oda S, Taguchi N, Utsunomiya D, Funama Y, Kidoh M, Namimoto T, Sakabe D, Hatemura M, Yamashita Y. Dual-layer detector CT of chest, abdomen, and pelvis with a one-third iodine dose: image quality, radiation dose, and optimal monoenergetic settings. Clin Radiol 2018; 73:1058.e21-1058.e29. [DOI: 10.1016/j.crad.2018.08.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 08/24/2018] [Indexed: 12/12/2022]
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Cruz J, Figueiredo F, Matos AP, Duarte S, Guerra A, Ramalho M. Infectious and Inflammatory Diseases of the Urinary Tract: Role of MR Imaging. Magn Reson Imaging Clin N Am 2018; 27:59-75. [PMID: 30466913 DOI: 10.1016/j.mric.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Urinary tract infection (UTI) is among the most common of bacterial infections. Imaging studies are only required in cases of complicated UTIs. Ultrasound remains the first-line imaging method; however, CT is the gold standard for evaluation of UTIs. MR imaging's improved contrast resolution and absence of ionizing radiation may recommend its use for assessment of lower UTIs. Furthermore, MR imaging performs with diagnostic accuracy at least similar to CT in complicated UTIs, except for the identification of calculi and emphysematous pyelonephritis. In this article, the role of MR imaging for the evaluation of infectious and inflammatory disease processes of the urinary tract is reviewed.
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Affiliation(s)
- João Cruz
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal
| | - Filipa Figueiredo
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - Sérgio Duarte
- Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal
| | - Adalgisa Guerra
- Department of Radiology, Hospital da Luz, Avenida Lusíada, 100, Lisbon 1500-650, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal.
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Lau A, Chung H, Komada T, Platnich JM, Sandall CF, Choudhury SR, Chun J, Naumenko V, Surewaard BG, Nelson MC, Ulke-Lemée A, Beck PL, Benediktsson H, Jevnikar AM, Snelgrove SL, Hickey MJ, Senger DL, James MT, Macdonald JA, Kubes P, Jenne CN, Muruve DA. Renal immune surveillance and dipeptidase-1 contribute to contrast-induced acute kidney injury. J Clin Invest 2018; 128:2894-2913. [PMID: 29863495 DOI: 10.1172/jci96640] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 04/10/2018] [Indexed: 01/04/2023] Open
Abstract
Radiographic contrast agents cause acute kidney injury (AKI), yet the underlying pathogenesis is poorly understood. Nod-like receptor pyrin containing 3-deficient (Nlrp3-deficient) mice displayed reduced epithelial cell injury and inflammation in the kidney in a model of contrast-induced AKI (CI-AKI). Unexpectedly, contrast agents directly induced tubular epithelial cell death in vitro that was not dependent on Nlrp3. Rather, contrast agents activated the canonical Nlrp3 inflammasome in macrophages. Intravital microscopy revealed diatrizoate (DTA) uptake within minutes in perivascular CX3CR1+ resident phagocytes in the kidney. Following rapid filtration into the tubular luminal space, DTA was reabsorbed and concentrated in tubular epithelial cells via the brush border enzyme dipeptidase-1 in volume-depleted but not euvolemic mice. LysM-GFP+ macrophages recruited to the kidney interstitial space ingested contrast material transported from the urine via direct interactions with tubules. CI-AKI was dependent on resident renal phagocytes, IL-1, leukocyte recruitment, and dipeptidase-1. Levels of the inflammasome-related urinary biomarkers IL-18 and caspase-1 were increased immediately following contrast administration in patients undergoing coronary angiography, consistent with the acute renal effects observed in mice. Taken together, these data show that CI-AKI is a multistep process that involves immune surveillance by resident and infiltrating renal phagocytes, Nlrp3-dependent inflammation, and the tubular reabsorption of contrast via dipeptidase-1.
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Affiliation(s)
- Arthur Lau
- Department of Medicine.,Snyder Institute for Chronic Diseases
| | - Hyunjae Chung
- Department of Medicine.,Snyder Institute for Chronic Diseases
| | - Takanori Komada
- Department of Medicine.,Snyder Institute for Chronic Diseases
| | - Jaye M Platnich
- Department of Medicine.,Snyder Institute for Chronic Diseases
| | - Christina F Sandall
- Department of Biochemistry and Molecular Biology.,Libin Cardiovascular Institute of Alberta
| | | | - Justin Chun
- Department of Medicine.,Snyder Institute for Chronic Diseases
| | - Victor Naumenko
- Snyder Institute for Chronic Diseases.,Department of Microbiology, Immunology, and Infectious Diseases, and
| | - Bas Gj Surewaard
- Snyder Institute for Chronic Diseases.,Department of Microbiology, Immunology, and Infectious Diseases, and
| | | | - Annegret Ulke-Lemée
- Department of Biochemistry and Molecular Biology.,Libin Cardiovascular Institute of Alberta
| | - Paul L Beck
- Department of Medicine.,Snyder Institute for Chronic Diseases
| | - Hallgrimur Benediktsson
- Snyder Institute for Chronic Diseases.,Department of Pathology and Laboratory Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Anthony M Jevnikar
- Department of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Sarah L Snelgrove
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia
| | - Michael J Hickey
- Centre for Inflammatory Diseases, Monash University Department of Medicine, Monash Medical Centre, Clayton, Victoria, Australia
| | - Donna L Senger
- Department of Oncology.,Arnie Charbonneau Cancer Institute
| | - Matthew T James
- Department of Medicine.,Libin Cardiovascular Institute of Alberta
| | - Justin A Macdonald
- Department of Biochemistry and Molecular Biology.,Libin Cardiovascular Institute of Alberta
| | - Paul Kubes
- Snyder Institute for Chronic Diseases.,Department of Microbiology, Immunology, and Infectious Diseases, and
| | - Craig N Jenne
- Snyder Institute for Chronic Diseases.,Department of Microbiology, Immunology, and Infectious Diseases, and
| | - Daniel A Muruve
- Department of Medicine.,Snyder Institute for Chronic Diseases
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Ma X, Li X, Jiao Z, Zhang Y. Nicorandil for the prevention of contrast-induced nephropathy: A meta-analysis of randomized controlled trials. Cardiovasc Ther 2018; 36. [PMID: 29283501 DOI: 10.1111/1755-5922.12316] [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: 09/30/2017] [Revised: 12/10/2017] [Accepted: 12/20/2017] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Nicorandil has been suggested as a preventative strategy against the incidence of contrast-induced nephropathy (CIN). However, results of relevant randomized controlled trials (RCTs) were inconsistent. AIMS We performed a meta-analysis of RCTs to evaluate the preventive efficacy of periprocedural treatment of nicorandil against the incidence of CIN. METHODS Relevant RCTs were identified via search of PubMed, Embase, and Cochrane's Library databases. Results were pooled using a random-effect model. Subgroup analyses were performed to evaluate the potential influence of administering routes on the efficacy of nicorandil against CIN incidence. RESULTS Four RCTs with 709 patients were included. Treatment of nicorandil significantly reduced the incidence of CIN as compared with controls (risk ration [RR]: 0.38, 95% confidence interval [CI]: 0.19 ~ 0.74, P = .005) with moderate heterogeneity (I2 = 33%). Results of subsequent subgroup analysis showed that nicorandil significantly reduced the risk of CIN if orally administered (RR: 0.32, P < .001), but did not if intravenously administered (RR: 0.47, I2 = 68%). Moreover, treatment with nicorandil was associated with significantly less increment of SCr (weight mean difference [WMD]: -3.98%, P < .001) and a tendency of less increment of cystatin C (WMD: -3.86%, P = .08) after 48-hour contrast exposure as compared with controls. CONCLUSIONS Periprocedural treatment with nicorandil may be preventative against the incidence of CIN in patients undergoing contrast exposure. The influence of periprocedural nicorandil on clinical outcome in these patients deserves further investigation.
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Affiliation(s)
- Xiaofen Ma
- Department of nephrology, Affiliated Hospital of Jining Medical College, Jining, China
| | - Xiang Li
- Department of nephrology, Affiliated Hospital of Jining Medical College, Jining, China
| | - Zhanfeng Jiao
- Department of nephrology, Affiliated Hospital of Jining Medical College, Jining, China
| | - Yiming Zhang
- Department of nephrology, Affiliated Hospital of Jining Medical College, Jining, China
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Heimbach JK, Kulik LM, Finn RS, Sirlin CB, Abecassis MM, Roberts LR, Zhu AX, Murad MH, Marrero JA. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology 2018; 67:358-380. [PMID: 28130846 DOI: 10.1002/hep.29086] [Citation(s) in RCA: 2650] [Impact Index Per Article: 441.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 01/10/2017] [Indexed: 12/07/2022]
Affiliation(s)
- Julie K Heimbach
- Division of Transplant Surgery, William J. von Liebig Transplant Center, Mayo Clinic, Rochester, MN
| | - Laura M Kulik
- Department of Medicine, Division of Gastroenterology and Hepatology, Northwestern University, Chicago, IL
| | - Richard S Finn
- Department of Medicine, Division of Hematology and Oncology, David Geffen School of Medicine at the University of California, Los Angeles, Santa Monica Geffen School of Medicine at UCLA, Los Angeles, California
| | - Claude B Sirlin
- Liver Imaging Group, Department of Radiology, University of California, San Diego
| | | | - Lewis R Roberts
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Andrew X Zhu
- Massachusetts General Hospital Cancer Center, Harvard Medical School, Boston, MA
| | - M Hassan Murad
- Mayo Clinic Evidence-based Practice Center, Mayo Clinic, Rochester, MN
| | - Jorge A Marrero
- Digestive and Liver Diseases Division, Department of Internal Medicine, UT Southwestern Medical Center, Dallas, TX
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Boos J, Brook OR, Fang J, Temin N, Brook A, Raptopoulos V. What Is the Optimal Abdominal Aortic Aneurysm Sac Measurement on CT Images during Follow-up after Endovascular Repair? Radiology 2017; 285:1032-1041. [DOI: 10.1148/radiol.2017161424] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Johannes Boos
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Olga R. Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Jieming Fang
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Nathaniel Temin
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Alexander Brook
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
| | - Vasillios Raptopoulos
- From the Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave, Boston, MA 02215
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van der Pol LM, van der Hulle T, Cheung YW, Mairuhu ATA, Schaar CG, Faber LM, Ten Wolde M, Hofstee HMA, Hovens MMC, Nijkeuter M, van Klink RCJ, Kruip MJHA, Middeldorp S, Huisman MV, Klok FA. No added value of the age-adjusted D-dimer cut-off to the YEARS algorithm in patients with suspected pulmonary embolism. J Thromb Haemost 2017; 15:2317-2324. [PMID: 28941051 DOI: 10.1111/jth.13852] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Indexed: 11/29/2022]
Abstract
Essentials Imaging is warranted in the majority of patients to confirm or rule out pulmonary embolism (PE). The age-adjusted D-dimer (ADJUST) reduced the number of required imaging tests in patients ≥ 50 years. The YEARS algorithm was designed to improve the efficiency in patients with suspected PE. There was no added value of implementing ADJUST in the YEARS algorithm in our cohort. SUMMARY Background The YEARS algorithm was designed to simplify the diagnostic work-up of pulmonary embolism (PE) and to reduce the number of necessary computed tomography pulmonary angiography (CTPA) scans. An alternative strategy to reduce the number of CTPAs is the age-adjusted D-dimer cut-off (ADJUST) in patients aged 50 years or older. We aimed to investigate whether a combination of both diagnostic strategies might save additional CTPAs. Methods The YEARS algorithm consists of three items (clinical signs of deep venous thrombosis, hemoptysis, 'PE most likely diagnosis') with simultaneous D-dimer testing using a pre-test dependent threshold. We performed a post hoc analysis in 3465 patients managed according to YEARS to compare the number of patients managed without CTPA scans and associated diagnostic failures in hypothetical scenarios with different YEARS-ADJUST combinations. Results Following the YEARS algorithm, 1651 patients (48%) were managed without CTPA; PE was diagnosed in 456 (13%) patients at baseline and 18 patients with initial normal testing suffered venous thromboembolism (VTE) during 3-month follow-up (failure rate 0.61%; 95% confidence interval [CI], 0.36-0.96). If ADJUST had been fully integrated in YEARS, 1627 patients (47%) would have been managed without CTPA (absolute decrease of 0.69%; 95% CI -1.7 to 3.0), at cost of four additional missed PE diagnoses at baseline, for a projected 3-month VTE failure rate of 0.75% (95% CI, 0.49-1.13). None of the other studied scenarios showed relevant improvements in efficiency as well, but all led to more missed diagnoses. Conclusion In our cohort, there was no added value of implementing ADJUST in the YEARS algorithm.
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Affiliation(s)
- L M van der Pol
- Department Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
- Department of Medicine, Haga Teaching Hospital, The Hague, the Netherlands
| | - T van der Hulle
- Department Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - Y W Cheung
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - A T A Mairuhu
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - C G Schaar
- Department of Medicinee, Gelre Hospital, Apeldoorn, the Netherlands
| | - L M Faber
- Department of Medicine, Red Cross Hospital, Beverwijk, the Netherlands
| | - M Ten Wolde
- Department of Medicine, Flevo Hospital, Almere, the Netherlands
| | - H M A Hofstee
- Department of Internal Medicine, Haaglanden Medical Center, The Hague, the Netherlands
| | - M M C Hovens
- Department of Medicine, Rijnstate Hospital, Arnhem, the Netherlands
| | - M Nijkeuter
- Department of Medicine, University Medical Center Utrecht, Utrecht, the Netherlands
| | - R C J van Klink
- Department of Pulmonology, Alrijne Hospital, Leiden, the Netherlands
| | - M J H A Kruip
- Department of Hematology, Erasmus Medical Center, Rotterdam, the Netherlands
| | - S Middeldorp
- Department of Vascular Medicine, Academic Medical Center, Amsterdam, the Netherlands
| | - M V Huisman
- Department Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
| | - F A Klok
- Department Thrombosis and Hemostasis, Leiden University Medical Center, Leiden, the Netherlands
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Tao SM, Kong X, Schoepf UJ, Wichmann JL, Shuler DC, Zhou CS, Lu GM, Zhang LJ. Acute kidney injury in patients with nephrotic syndrome undergoing contrast-enhanced CT for suspected venous thromboembolism: a propensity score-matched retrospective cohort study. Eur Radiol 2017; 28:1585-1593. [PMID: 29098438 DOI: 10.1007/s00330-017-5109-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Revised: 09/10/2017] [Accepted: 09/29/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine whether intravenous iodinated contrast material administration increases the risk of acute kidney injury (AKI) in patients with nephrotic syndrome undergoing contrast-enhanced CT. METHODS Patients with nephrotic syndrome undergoing contrast-enhanced CT were retrospectively identified (n = 701). Control group consisted of patients with nephrotic syndrome receiving non-contrast CT (n = 1053). Two different 1:1 propensity score matching models using three or 10 variables were developed for each estimated glomerular filtration (eGFR) subgroup. Incidence of post-CT AKI for the two groups was assessed and compared by standard AKI criteria and Acute Kidney Injury Network (AKIN) criteria. RESULTS After matching with three variables, the AKI incidence in the contrast-enhanced CT and non-contrast CT groups was 2.7% vs 2.5% (standard AKI criteria) and 4.2% vs. 6.7% (AKIN criteria) (p = 1.00 and 0.05), respectively. After matching with 10 variables, AKI incidences were 3.1% vs. 2.6% (standard AKI criteria) and 4.1% vs. 7.4% (AKIN criteria) (p = 0.72 and 0.03), respectively. AKI incidences of each eGFR subgroup in the contrast-enhanced CT group were not higher than in the non-contrast CT group (lowest p = 0.46). CONCLUSION Intravenous contrast material administration during CT was not found to be a risk factor for AKI in this large cohort of patients with nephrotic syndrome. KEY POINTS • AKI incidence of contrast-enhanced CT and non-contrast CT had no difference. • AKI incidences of eGFR subgroup in contrast-enhanced CT were not increased. • Studies without a non-contrast CT control group may overestimate CIN incidence.
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Affiliation(s)
- Shu Min Tao
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Xiang Kong
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - U Joseph Schoepf
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29401, USA
| | - Julian L Wichmann
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29401, USA
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Frankfurt, Germany
| | - Darby C Shuler
- Division of Cardiovascular Imaging, Department of Radiology and Radiological Science, Medical University of South Carolina, Ashley River Tower, MSC 226, 25 Courtenay Dr, Charleston, SC, 29401, USA
| | - Chang Sheng Zhou
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Guang Ming Lu
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China
| | - Long Jiang Zhang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, Jiangsu, 210002, China.
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Aschoff AJ, Catalano C, Kirchin MA, Krix M, Albrecht T. Low radiation dose in computed tomography: the role of iodine. Br J Radiol 2017; 90:20170079. [PMID: 28471242 PMCID: PMC5603952 DOI: 10.1259/bjr.20170079] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Recent approaches to reducing radiation exposure during CT examinations typically utilize automated dose modulation strategies on the basis of lower tube voltage combined with iterative reconstruction and other dose-saving techniques. Less clearly appreciated is the potentially substantial role that iodinated contrast media (CM) can play in low-radiation-dose CT examinations. Herein we discuss the role of iodinated CM in low-radiation-dose examinations and describe approaches for the optimization of CM administration protocols to further reduce radiation dose and/or CM dose while maintaining image quality for accurate diagnosis. Similar to the higher iodine attenuation obtained at low-tube-voltage settings, high-iodine-signal protocols may permit radiation dose reduction by permitting a lowering of mAs while maintaining the signal-to-noise ratio. This is particularly feasible in first pass examinations where high iodine signal can be achieved by injecting iodine more rapidly. The combination of low kV and IR can also be used to reduce the iodine dose. Here, in optimum contrast injection protocols, the volume of CM administered rather than the iodine concentration should be reduced, since with high-iodine-concentration CM further reductions of iodine dose are achievable for modern first pass examinations. Moreover, higher concentrations of CM more readily allow reductions of both flow rate and volume, thereby improving the tolerability of contrast administration.
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Affiliation(s)
- Andrik J Aschoff
- 1 Department for Diagnostic and Interventional Radiology and Neuroradiology, Klinikum Kempten, Kempten, Germany
| | - Carlo Catalano
- 2 Department of Radiological Sciences, University of Rome "La Sapienza", Rome, Italy
| | - Miles A Kirchin
- 3 Bracco Imaging SpA, Global Medical & Regulatory Affairs, Milan, Italy
| | - Martin Krix
- 4 Bracco Imaging Germany, Global Medical & Regulatory Affairs, Konstanz, Germany
| | - Thomas Albrecht
- 5 Institut für Radiologie und Interventionelle Therapie, Vivantes-Klinikum Neukölln, Berlin, Germany
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Inoue A, Nitta N, Ohta S, Imoto K, Yamasaki M, Ikeda M, Murata K. StatSensor-i point-of-care creatinine analyzer may identify patients at high-risk of contrast-induced nephropathy. Exp Ther Med 2017; 13:3503-3508. [PMID: 28587433 DOI: 10.3892/etm.2017.4389] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Accepted: 03/03/2017] [Indexed: 11/05/2022] Open
Abstract
The current study assessed the accuracy of the StatSensor-i (STA) point-of-care creatinine analyzer prior to and following adjustment (offset correction) by linear regression scatter plots produced by the reference samples from patients and volunteers for detecting high risk of contrast-induced nephropathy in patients with an estimated glomerular filtration rate <45 ml/min/1.73 m2. Blood samples were obtained from 233 consecutive outpatients scheduled for contrast-enhanced CT studies. Of the 233 patients, 123 patient samples were evaluated prior to adjustment and the other 110 following adjustment. Serum creatinine levels and estimated glomerular filtration rate were measured using the analyzer and compared with the values returned by laboratory tests. Analysis was with the paired t-test, the Pearson correlation coefficient and Bland-Altman plotting. The sensitivity, specificity, positive and negative predictive values (PPV, NPV), and accuracy for detecting patients with an estimated glomerular filtration rate <45 ml/min/1.73 m2 were subsequently calculated. Mean serum creatinine levels measured with the analyzer were significantly higher than those returned by laboratory tests before (P<0.0001) and after adjustment (P<0.01). Following adjustment, the difference in serum creatinine values obtained with the STA analyzer and by laboratory methods did not exceed 0.3 mg/dl. Prior to adjustment, 9.7% of the samples were overdiagnosed as having an estimated glomerular filtration rate of <45 ml/min/1.73 m2; following adjustment, the overdiagnosis rate was 2.7%. The sensitivity, specificity, PPV, NPV and accuracy were 100, 89, 50, 100 and 90.2% before and 100, 96.3, 33.3, 100 and 96.4% after adjustment, respectively. With the adjusted point-of-care creatinine analyzer, estimated glomerular filtration rate may be reliably evaluated in the radiology suite.
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Affiliation(s)
- Akitoshi Inoue
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan.,Department of Radiology, Kohka Public Hospital, Koka, Shiga 528-0074, Japan
| | - Norihisa Nitta
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Shinichi Ohta
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
| | - Katsuji Imoto
- Department of Radiology, Kohka Public Hospital, Koka, Shiga 528-0074, Japan
| | - Michio Yamasaki
- Department of Radiology, Kohka Public Hospital, Koka, Shiga 528-0074, Japan
| | - Mitsuru Ikeda
- Division of Radiological Technology, School of Health Sciences Radiological Technology, Nagoya University, Higashi, Nagoya, Aichi 461-0047, Japan
| | - Kiyoshi Murata
- Department of Radiology, Shiga University of Medical Science, Seta-Tsukinowa-cho, Otsu, Shiga 520-2192, Japan
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Jiang J, Wang K, Xu Y, Liu J, Luo J, Tao X, Wang X. Preoperative Assessment of Hepatocellular Carcinoma with Split-Bolus Combined Phase Contrast-Enhanced Computed Tomography. Med Sci Monit 2017; 23:1834-1841. [PMID: 28412761 PMCID: PMC5402837 DOI: 10.12659/msm.904129] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background The aim of this study was to investigate the feasibility of a split-bolus combined phase contrast-enhanced computed tomography protocol in evaluation of liver vasculature in hepatocellular carcinoma (HCC) patients for the purpose of surgery guidance. Material/Methods Two groups of patients were recruited for the study: 24 consecutive cases of HCC who underwent multiphasic CT examination, and 22 consecutive cases who afterwards underwent split-bolus combined phase CT examination. The multiphasic protocol included an unenhanced scan and 3 image acquisitions after contrast injection. The injection of contrast medium was 440 mgI/kg in a single bolus. The split-bolus combined phase protocol included unenhanced scan and combined phase. The injection of contrast medium was 440 mgI/kg for the first bolus and 220 mgI/kg for the second bolus. The vascular delineation was evaluated with Likert scales. The CT values were measured, and the contrast-to-noise ratio (CNR) was calculated. We also compared the effective radiation dose (ED) of the 2 protocols. Results All mean CT values were significantly higher in the split-bolus protocol than in the multiphasic protocol (all P<.05), except for the hepatic vein (P>.05). The ED was significantly lower in the split-bolus protocol, corresponding to a dose reduction of 66% compared to the multiphasic protocol (P<.05). The scores of the branches of the hepatic vein in the split-bolus protocol were not lower than those in the multiphasic protocol. Conclusions For the preoperative HCC patients, the split-bolus combined phase CT examination meets the diagnostic requirement of surgical planning, with approximately 60% reduction in the radiation dose.
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Affiliation(s)
- Jian Jiang
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
| | - Ke Wang
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
| | - Yufeng Xu
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
| | - Jianxin Liu
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
| | - Jingjing Luo
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
| | - Xin Tao
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
| | - Xiaoying Wang
- Department of Radiology, Peking University First Hospital, Beijing, China (mainland)
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State-of-the-Art Pulmonary CT Angiography for Acute Pulmonary Embolism. AJR Am J Roentgenol 2016; 208:495-504. [PMID: 27897042 DOI: 10.2214/ajr.16.17202] [Citation(s) in RCA: 64] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Pulmonary CT angiography (CTA) is the imaging modality of choice in suspected acute pulmonary embolism (PE). Current pulmonary CTA techniques involve ever lower doses of contrast medium and radiation along with advanced postprocessing applications to enhance image quality, diagnostic accuracy, and provide added value in patient management. The objective of this article is to summarize these current developments and discuss the appropriate use of state-of-the-art pulmonary CTA. CONCLUSION Pulmonary CTA is well established as a fast and reliable means of excluding or diagnosing PE. Continued developments in CT system hardware and postprocessing techniques will allow incremental reductions in radiation and contrast material requirements while improving image quality. Advances in risk stratification and prognostication from pulmonary CTA examinations should further refine its clinical value while minimizing the potential harm from overutilization and overdiagnosis.
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Using 80 kVp on a 320-row scanner for hepatic multiphasic CT reduces the contrast dose by 50 % in patients at risk for contrast-induced nephropathy. Eur Radiol 2016; 27:812-820. [PMID: 27240454 DOI: 10.1007/s00330-016-4435-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Revised: 05/17/2016] [Accepted: 05/20/2016] [Indexed: 12/13/2022]
Abstract
OBJECTIVES We evaluated the effects of a low contrast material (CM) dose protocol using 80-kVp on the image quality of hepatic multiphasic CT scans acquired on a 320-row CT scanner. METHODS We scanned 30 patients with renal insufficiency (eGFR < 45 mL/min/1.73 m2) using 80-kVp and a CM dose of 300mgI/kg. Another 30 patients without renal insufficiency (eGFR > 60 mL/min/1.73 m2) were scanned with the conventional 120-kVp protocol and the standard CM dose of 600mgI/kg. Quantitative image quality parameters, i.e. CT attenuation, image noise, and the contrast-to-noise ratio (CNR) were compared and the visual image quality was scored on a four-point scale. The volume CT dose index (CTDIvol) and the size-specific dose estimate (SSDE) recorded with the 80- and the 120-kVp protocols were also compared. RESULTS Image noise and contrast enhancement were equivalent for the two protocols. There was no significant difference in the CNR of all anatomic sites and in the visual scores for overall image quality. The CTDIvol and SSDE were approximately 25-30 % lower under the 80-kVp protocol. CONCLUSION Hepatic multiphase CT using 80-kVp on a 320-row CT scanner allowed for a decrease in the CM dose and a reduction in the radiation dose without image quality degradation in patients with renal insufficiency. KEY POINTS • The 80-kVp CT protocol enabled reduction of contrast dose by 50 % • The 80-kVp CT protocol reduced the radiation dose by 25-33 % • There was no degradation in the image quality of the 80-kVp protocol.
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To Stent or Not to Stent? Update on Revascularization for Atherosclerotic Renovascular Disease. Curr Hypertens Rep 2016; 18:45. [PMID: 27130448 DOI: 10.1007/s11906-016-0655-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Renal artery stenosis (RAS) is increasingly encountered in clinical practice. The two most common etiologies are fibromuscular dysplasia (FMD) and atherosclerotic renal artery disease (ARAS), with the latter accounting for the vast majority of cases. Significant RAS activates the renin-angiotensin-aldosterone system and is associated with three major clinical syndromes: ischemic nephropathy, hypertension, and destabilizing cardiac syndromes. Over the past two decades, advancements in diagnostic and interventional techniques have led to improved detection and the widespread use of endovascular renal artery revascularization strategies in the management of ARAS. However, renal artery stenting for ARAS remains controversial. Although several studies have demonstrated some benefit with renal artery revascularization, this has not been to the extent anticipated or predicted. Moreover, these trials have significant flaws in their study design and are hampered with inherent bias which make their interpretation challenging. In this review, we evaluate the existing body of evidence and offer an approach to the management of patients with ARAS in light of the current literature. From the data provided, identification of subgroup of patients, namely, those with a hemodynamically significant RAS in the context of progressive renal insufficiency and/or deteriorating arterial hypertension, seems possible and may derive clinical benefit from ARAS stent revascularization. Appropriate patient selection is therefore the key and more robust studies are required.
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