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Trovarelli L, Mirarchi A, Arcuri C, Bruscoli S, Bereshchenko O, Febo M, Carniato F, Costantino F. Relaxometric properties and biocompatibility of a novel nanostructured fluorinated gadolinium metal-organic framework. Dalton Trans 2024; 53:15937-15945. [PMID: 39264337 DOI: 10.1039/d4dt02134g] [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: 09/13/2024]
Abstract
A novel Gd-MOF based on tetrafluoro-terephthalic acid has been synthesized and its structure has been solved using X-ray single crystal diffraction data. The compound, with the formula [Gd2(F4BDC)3·H2O]·DMF, is isostructural with other Ln-MOFs based on the same ligand and has been recently reported. Its crystals were also reduced to nanometer size by employing acetic acid or cetyltrimethylammonium bromide (CTAB) as a modulator. The relaxometric properties of the nanoparticles were evaluated in solution by measuring 1H T1 and T2 as a function of the applied magnetic field and temperature. The biocompatibility of Gd-MOFs was evaluated on murine microglial BV-2 and human glioblastoma U251 cell lines. In both cell lines, Gd-MOFs do not modify the cell cycle profile or the activation levels of ERK1/2 and Akt, which are protein-serine/threonine kinases that participate in many signal transduction pathways. These pathways are fundamental in the regulation of a large variety of processes such as cell migration, cell cycle progression, differentiation, cell survival, metabolism, transcription, tumour progression and others. These data indicate that Gd-MOF nanoparticles exhibit high biocompatibility, making them potentially valuable for diagnostic and biomedical applications.
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Affiliation(s)
- Letizia Trovarelli
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via Elce di Sotto n 8, 06123, Perugia, Italy.
| | - Alessandra Mirarchi
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Cataldo Arcuri
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Stefano Bruscoli
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Oxana Bereshchenko
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Marta Febo
- Department of Medicine and Surgery, University of Perugia, Piazza Lucio Severi 1, 06132, Perugia, Italy
| | - Fabio Carniato
- Department of Science and Technological Innovation, University of Eastern Piedmont "A. Avogadro", Viale Teresa Michel 11, 15121, Alessandria, Italy
| | - Ferdinando Costantino
- Department of Chemistry, Biology and Biotechnologies, University of Perugia, Via Elce di Sotto n 8, 06123, Perugia, Italy.
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2
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Patil NS, Huang RS, Caterine S, Yao J, Larocque N, van der Pol CB, Stubbs E. Artificial Intelligence Chatbots' Understanding of the Risks and Benefits of Computed Tomography and Magnetic Resonance Imaging Scenarios. Can Assoc Radiol J 2024; 75:518-524. [PMID: 38183235 DOI: 10.1177/08465371231220561] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
PURPOSE Patients may seek online information to better understand medical imaging procedures. The purpose of this study was to assess the accuracy of information provided by 2 popular artificial intelligence (AI) chatbots pertaining to common imaging scenarios' risks, benefits, and alternatives. METHODS Fourteen imaging-related scenarios pertaining to computed tomography (CT) or magnetic resonance imaging (MRI) were used. Factors including the use of intravenous contrast, the presence of renal disease, and whether the patient was pregnant were included in the analysis. For each scenario, 3 prompts for outlining the (1) risks, (2) benefits, and (3) alternative imaging choices or potential implications of not using contrast were inputted into ChatGPT and Bard. A grading rubric and a 5-point Likert scale was used by 2 independent reviewers to grade responses. Prompt variability and chatbot context dependency were also assessed. RESULTS ChatGPT's performance was superior to Bard's in accurately responding to prompts per Likert grading (4.36 ± 0.63 vs 3.25 ± 1.03 seconds, P < .0001). There was substantial agreement between independent reviewer grading for ChatGPT (κ = 0.621) and Bard (κ = 0.684). Response text length was not statistically different between ChatGPT and Bard (2087 ± 256 characters vs 2162 ± 369 characters, P = .24). Response time was longer for ChatGPT (34 ± 2 vs 8 ± 1 seconds, P < .0001). CONCLUSIONS ChatGPT performed superior to Bard at outlining risks, benefits, and alternatives to common imaging scenarios. Generally, context dependency and prompt variability did not change chatbot response content. Due to the lack of detailed scientific reasoning and inability to provide patient-specific information, both AI chatbots have limitations as a patient information resource.
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Affiliation(s)
- Nikhil S Patil
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, ON, Canada
| | - Ryan S Huang
- Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Scott Caterine
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Jason Yao
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | - Natasha Larocque
- Department of Radiology, McMaster University, Hamilton, ON, Canada
| | | | - Euan Stubbs
- Department of Radiology, McMaster University, Hamilton, ON, Canada
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3
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Kaster MA, Caldwell MA, Meade TJ. Development of Ln(III) Derivatives as 19F Parashift Probes. Inorg Chem 2024; 63:9877-9887. [PMID: 38748735 DOI: 10.1021/acs.inorgchem.4c00652] [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: 05/28/2024]
Abstract
19F parashift probes with paramagnetically shifted reporter nuclei provide attractive platforms to develop molecular imaging probes. These probes enable ratiometric detection of molecular disease markers using a direct detection technique. Here, we describe a series of trivalent lanthanide (Ln(III)) complexes that are structural analogues of the clinically approved MR contrast agent (CA) ProHance to obtain LnL 19F parashift probes. We evaluated trans-gadolinium paramagnetic lanthanides compared to diamagnetic YL for 19F chemical shift and relaxation rate enhancement. The paramagnetic contribution to chemical shift (δPCS) for paramagnetic LnL exhibited either shifts to lower frequency (δPCS < 0 for TbL, DyL, and HoL) or shifts to higher frequency (δPCS > 0 for ErL, TmL, and YbL) compared to YL 19F spectroscopic signal. Zero-echo time pulse sequences achieved 56-fold sensitivity enhancement for DyL over YL, while developing probe-specific pulse sequences with fast delay times and acquisition times achieved 0.6-fold enhancement in limit of detection for DyL. DyL provides an attractive platform to develop 19F parashift probes for ratiometric detection of enzymatic activity.
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Affiliation(s)
- Megan A Kaster
- Departments of Chemistry, Molecular Biosciences, Neurobiology and Radiology, Northwestern University, 2145 N. Sheridan Road, Evanston, Illinois 60208, United States
| | - Michael A Caldwell
- Departments of Chemistry, Molecular Biosciences, Neurobiology and Radiology, Northwestern University, 2145 N. Sheridan Road, Evanston, Illinois 60208, United States
| | - Thomas J Meade
- Departments of Chemistry, Molecular Biosciences, Neurobiology and Radiology, Northwestern University, 2145 N. Sheridan Road, Evanston, Illinois 60208, United States
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4
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Timms L, Zhou T, Qiao J, Gharagouzloo C, Mishra V, Lahoud RM, Chen JW, Harisinghani M, Sridhar S. Super High Contrast USPIO-Enhanced Cerebrovascular Angiography Using Ultrashort Time-to-Echo MRI. Int J Biomed Imaging 2024; 2024:9763364. [PMID: 38644981 PMCID: PMC11032209 DOI: 10.1155/2024/9763364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/07/2024] [Accepted: 03/12/2024] [Indexed: 04/23/2024] Open
Abstract
Background Ferumoxytol (Ferahame, AMAG Pharmaceuticals, Waltham, MA) is increasingly used off-label as an MR contrast agent due to its relaxivity and safety profiles. However, its potent T2∗ relaxivity limits achievable T1-weighted positive contrast and leads to artifacts in standard MRI protocols. Optimization of protocols for ferumoxytol deployment is necessary to realize its potential. Methods We present first-in-human clinical results of the Quantitative Ultrashort Time-to-Echo Contrast Enhanced (QUTE-CE) MRA technique using the superparamagnetic iron oxide nanoparticle agent ferumoxytol for vascular imaging of the head/brain in 15 subjects at 3.0T. The QUTE-CE MRA method was implemented on a 3T scanner using a stack-of-spirals 3D Ultrashort Time-to-Echo sequence. Time-of-flight MRA and standard TE T1-weighted (T1w) images were also collected. For comparison, gadolinium-enhanced blood pool phase images were obtained retrospectively from clinical practice. Signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and intraluminal signal heterogeneity (ISH) were assessed and compared across approaches with Welch's two-sided t-test. Results Fifteen volunteers (54 ± 17 years old, 9 women) participated. QUTE-CE MRA provided high-contrast snapshots of the arterial and venous networks with lower intraluminal heterogeneity. QUTE-CE demonstrated significantly higher SNR (1707 ± 226), blood-tissue CNR (1447 ± 189), and lower ISH (0.091 ± 0.031) compared to ferumoxytol T1-weighted (551 ± 171; 319 ± 144; 0.186 ± 0.066, respectively) and time-of-flight (343 ± 104; 269 ± 82; 0.190 ± 0.016, respectively), with p < 0.001 in each comparison. The high CNR increased the depth of vessel visualization. Vessel lumina were captured with lower heterogeneity. Conclusion Quantitative Ultrashort Time-to-Echo Contrast-Enhanced MR angiography provides approximately 5-fold superior contrast with fewer artifacts compared to other contrast-enhanced vascular imaging techniques using ferumoxytol or gadolinium, and to noncontrast time-of-flight MR angiography, for clinical vascular imaging. This trial is registered with NCT03266848.
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Affiliation(s)
- Liam Timms
- Department of Physics, Northeastern University, Boston, MA, USA
| | - Tianyi Zhou
- Department of Physics, Northeastern University, Boston, MA, USA
| | - Ju Qiao
- Department of Mechanical and Industrial Engineering, Northeastern University, Boston, MA, USA
| | - Codi Gharagouzloo
- Gordon Center for Medical Imaging, Massachusetts General Hospital, Boston, MA, USA
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Rita Maria Lahoud
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - John W. Chen
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Srinivas Sridhar
- Department of Physics, Northeastern University, Boston, MA, USA
- Department of Chemical Engineering, Northeastern University, Boston, MA, USA
- Department of Bioengineering, Northeastern University, Boston, MA, USA
- Theranano LLC, Newton, MA, USA
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5
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Iacobellis F, Di Serafino M, Russo C, Ronza R, Caruso M, Dell’Aversano Orabona G, Camillo C, Sabatino V, Grimaldi D, Rinaldo C, Barbuto L, Verde F, Giacobbe G, Schillirò ML, Scarano E, Romano L. Safe and Informed Use of Gadolinium-Based Contrast Agent in Body Magnetic Resonance Imaging: Where We Were and Where We Are. J Clin Med 2024; 13:2193. [PMID: 38673466 PMCID: PMC11051151 DOI: 10.3390/jcm13082193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which are classifiable according to their structures (cyclic or linear) or biodistribution (extracellular-space agents, target/specific-agents, and blood-pool agents). The aim of this review is to illustrate the commercially available MRI contrast agents, their effect on imaging, and adverse reaction on the body, with the goal to lead to their proper selection in different clinical contexts. When we have to choose between the different GBCAs, we have to consider several factors: (1) safety and clinical impact; (2) biodistribution and diagnostic application; (3) higher relaxivity and better lesion detection; (4) higher stability and lower tissue deposit; (5) gadolinium dose/concentration and lower volume injection; (6) pulse sequences and protocol optimization; (7) higher contrast-to-noise ratio at 3.0 T than at 1.5 T. Knowing the patient's clinical information, the relevant GBCAs properties and their effect on body MRI sequences are the key features to perform efficient and high-quality MRI examination.
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Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Camilla Russo
- Neuroradiology Unit, Department of Neuroscience Santobono-Pausilipon Children’s Hospital, 80122 Naples, Italy;
| | - Roberto Ronza
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Martina Caruso
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Costanza Camillo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Dario Grimaldi
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Luigi Barbuto
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Francesco Verde
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuliana Giacobbe
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Enrico Scarano
- Department of Radiology, “San Carlo” Hospital, 85100 Potenza, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
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Coimbra S, Rocha S, Sousa NR, Catarino C, Belo L, Bronze-da-Rocha E, Valente MJ, Santos-Silva A. Toxicity Mechanisms of Gadolinium and Gadolinium-Based Contrast Agents-A Review. Int J Mol Sci 2024; 25:4071. [PMID: 38612881 PMCID: PMC11012457 DOI: 10.3390/ijms25074071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have been used for more than 30 years to improve magnetic resonance imaging, a crucial tool for medical diagnosis and treatment monitoring across multiple clinical settings. Studies have shown that exposure to GBCAs is associated with gadolinium release and tissue deposition that may cause short- and long-term toxicity in several organs, including the kidney, the main excretion organ of most GBCAs. Considering the increasing prevalence of chronic kidney disease worldwide and that most of the complications following GBCA exposure are associated with renal dysfunction, the mechanisms underlying GBCA toxicity, especially renal toxicity, are particularly important. A better understanding of the gadolinium mechanisms of toxicity may contribute to clarify the safety and/or potential risks associated with the use of GBCAs. In this work, a review of the recent literature concerning gadolinium and GBCA mechanisms of toxicity was performed.
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Affiliation(s)
- Susana Coimbra
- 1H-TOXRUN—1H-Toxicology Research Unit, University Institute of Health Sciences, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Advanced Polytechnic and University Cooperative, CRL, 4585-116 Gandra, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Susana Rocha
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Nícia Reis Sousa
- Departamento de Ciências e Tecnologia da Saúde, Instituto Superior Politécnico de Benguela, Benguela, Angola
| | - Cristina Catarino
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Luís Belo
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Elsa Bronze-da-Rocha
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria João Valente
- National Food Institute, Technical University of Denmark, Kongens Lyngby, 2800 Copenhagen, Denmark
| | - Alice Santos-Silva
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
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7
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Guaricci AI, Sturdà F, Russo R, Basile P, Baggiano A, Mushtaq S, Fusini L, Fazzari F, Bertandino F, Monitillo F, Carella MC, Simonini M, Pontone G, Ciccone MM, Grandaliano G, Vezzoli G, Pesce F. Assessment and management of heart failure in patients with chronic kidney disease. Heart Fail Rev 2024; 29:379-394. [PMID: 37728751 PMCID: PMC10942934 DOI: 10.1007/s10741-023-10346-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/04/2023] [Indexed: 09/21/2023]
Abstract
Heart failure (HF) and chronic kidney disease (CKD) are two pathological conditions with a high prevalence in the general population. When they coexist in the same patient, a strict interplay between them is observed, such that patients affected require a clinical multidisciplinary and personalized management. The diagnosis of HF and CKD relies on signs and symptoms of the patient but several additional tools, such as blood-based biomarkers and imaging techniques, are needed to clarify and discriminate the main characteristics of these diseases. Improved survival due to new recommended drugs in HF has increasingly challenged physicians to manage patients with multiple diseases, especially in case of CKD. However, the safe administration of these drugs in patients with HF and CKD is often challenging. Knowing up to which values of creatinine or renal clearance each drug can be administered is fundamental. With this review we sought to give an insight on this sizable and complex topic, in order to get clearer ideas and a more precise reference about the diagnostic assessment and therapeutic management of HF and CKD.
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Affiliation(s)
- Andrea Igoren Guaricci
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy.
| | - Francesca Sturdà
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Roberto Russo
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124, Bari, Italy
| | - Paolo Basile
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Andrea Baggiano
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Saima Mushtaq
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Laura Fusini
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Fabio Fazzari
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Fulvio Bertandino
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Francesco Monitillo
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Maria Cristina Carella
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Marco Simonini
- Nephrology and Dialysis Unit, IRCCS San Raffaele Scientific Institute, 20132, Milan, Italy
| | - Gianluca Pontone
- Department of Perioperative Cardiology and Cardiovascular Imaging, Centro Cardiologico Monzino, IRCCS, 20138, Milan, Italy
| | - Marco Matteo Ciccone
- University Cardiologic Unit, Interdisciplinary Department of Medicine, Polyclinic University Hospital, University of Bari Aldo Moro, Piazza Giulio Cesare 11, 70121, Bari, Italy
| | - Giuseppe Grandaliano
- Department of Medical and Surgical Sciences, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Giuseppe Vezzoli
- Department of Nephrology and Dialysis, Vita Salute San Raffaele University, 20132, Milan, Italy
| | - Francesco Pesce
- Department of Precision and Regenerative Medicine and Ionian Area, University of Bari Aldo Moro, 70124, Bari, Italy
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8
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Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
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Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
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Fujita S, Sano K, Cruz G, Velasco C, Kawasaki H, Fukumura Y, Yoneyama M, Suzuki A, Yamamoto K, Morita Y, Arai T, Fukunaga I, Uchida W, Kamagata K, Abe O, Kuwatsuru R, Saiura A, Ikejima K, Botnar R, Prieto C, Aoki S. MR Fingerprinting for Contrast Agent-free and Quantitative Characterization of Focal Liver Lesions. Radiol Imaging Cancer 2023; 5:e230036. [PMID: 37999629 DOI: 10.1148/rycan.230036] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
Purpose To evaluate the feasibility of liver MR fingerprinting (MRF) for quantitative characterization and diagnosis of focal liver lesions. Materials and Methods This single-site, prospective study included 89 participants (mean age, 62 years ± 15 [SD]; 45 women, 44 men) with various focal liver lesions who underwent MRI between October 2021 and August 2022. The participants underwent routine clinical MRI, non-contrast-enhanced liver MRF, and reference quantitative MRI with a 1.5-T MRI scanner. The bias and repeatability of the MRF measurements were assessed using linear regression, Bland-Altman plots, and coefficients of variation. The diagnostic capability of MRF-derived T1, T2, T2*, proton density fat fraction (PDFF), and a combination of these metrics to distinguish benign from malignant lesions was analyzed according to the area under the receiver operating characteristic curve (AUC). Results Liver MRF measurements showed moderate to high agreement with reference measurements (intraclass correlation = 0.94, 0.77, 0.45, and 0.61 for T1, T2, T2*, and PDFF, respectively), with underestimation of T2 values (mean bias in lesion = -0.5%, -29%, 5.8%, and -8.2% for T1, T2, T2*, and PDFF, respectively). The median coefficients of variation for repeatability of T1, T2, and T2* values were 2.5% (IQR, 3.6%), 3.1% (IQR, 5.6%), and 6.6% (IQR, 13.9%), respectively. After considering multicollinearity, a combination of MRF measurements showed a high diagnostic performance in differentiating benign from malignant lesions (AUC = 0.92 [95% CI: 0.86, 0.98]). Conclusion Liver MRF enabled the quantitative characterization of various focal liver lesions in a single breath-hold acquisition. Keywords: MR Imaging, Abdomen/GI, Liver, Imaging Sequences, Technical Aspects, Tissue Characterization, Technology Assessment, Diagnosis, Liver Lesions, MR Fingerprinting, Quantitative Characterization Supplemental material is available for this article. © RSNA, 2023.
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Affiliation(s)
- Shohei Fujita
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Katsuhiro Sano
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Gastao Cruz
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Carlos Velasco
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Hideo Kawasaki
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Yuki Fukumura
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Masami Yoneyama
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Akiyoshi Suzuki
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Kotaro Yamamoto
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Yuichi Morita
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Takashi Arai
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Issei Fukunaga
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Wataru Uchida
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Koji Kamagata
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Osamu Abe
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Ryohei Kuwatsuru
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Akio Saiura
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Kenichi Ikejima
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - René Botnar
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Claudia Prieto
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
| | - Shigeki Aoki
- From the Departments of Radiology (S.F., K.S., H.K., A. Suzuki, K.Y., Y.M., T.A., I.F., W.U., K.K., R.K., S.A.), Human Pathology (Y.F.), Hepatobiliary-Pancreatic Surgery (A. Saiura), and Gastroenterology (K.I.), Juntendo University School of Medicine, 1-2-1 Hongo, Bunkyo, Tokyo 113-8421, Japan; Department of Radiology, The University of Tokyo, Tokyo, Japan (S.F., Y.M., O.A.); Department of Biomedical Engineering, School of Biomedical Engineering and Imaging Sciences, King's College London, London, England (G.C., C.V., R.B., C.P.); Department of Radiology, University of Michigan, Ann Arbor, Mich (G.C.); Department of MR Clinical Science, Philips Japan, Tokyo, Japan (M.Y.); School of Engineering, Pontificia Universidad Católica de Chile, Santiago, Chile (R.B., C.P.); and Millennium Institute for Intelligent Healthcare Engineering, Santiago, Chile (R.B., C.P.)
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Azzawri AA, Yildirim IH, Yegin Z, Dusak A. Expression of GRP78 and its copartners in HEK293 and pancreatic cancer cell lines (BxPC-3/PANC-1) exposed to MRI and CT contrast agents. NUCLEOSIDES, NUCLEOTIDES & NUCLEIC ACIDS 2023; 43:391-416. [PMID: 37787049 DOI: 10.1080/15257770.2023.2263496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
Endoplasmic reticulum (ER) stress-associated chaperones trigger a defense mechanism called as unfolded protein response (UPR) which can manage apoptosis and be determinative in cell fate. Both anticancer drug effects and potential toxicity effects of magnetic resonance imaging (MRI) and computed tomography (CT) contrast agents were aimed to be evaluated. For this purpose, we investigated expression profiles of endoplasmic reticulum stress-associated chaperone molecules in human pancreatic tumor lines BxPC-3 and PANC-1 and control human embryonic kidney cells 293 (HEK293) induced with a variety of gadolinium and iohexol contrast agents. Protein expression levels of ER stress-associated chaperones (master regulator: GRP78/Bip and its copartners: Calnexin, Ero1, PDI, CHOP, IRE1α and PERK) were evaluated with Western blotting. Expression levels at mRNA level were also assessed for GRP78/Bip and CHOP with real-time PCR. Induction of cells was carried out with four different Gd-based contrast agents (GBCAs): (Dotarem, Optimark, Primovist and Gadovist) and two different iohexol agents (Omnipol, Omnipaque). CT contrast agents tested in the study did not result in significant ER stress in HEK293 cells. However, they do not seem to have theranostic potential in pancreas cancer through ER pathway. The potential efficiency of macrocyclic MRI contrast agents to provoke apoptosis via ER stress-associated chaperones in BxPC-3 cells lends credibility for their future theranostic use in pancreas cancer as long as undesired toxicity effects were carefully considered. ER stress markers and/or contrast agents seem to have promising potential to be translated into the clinical practice to manage pancreas cancer progression.
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Affiliation(s)
| | | | - Zeynep Yegin
- Medical Laboratory Techniques Program, Vocational School of Health Services, Sinop University, Sinop, Turkey
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Nair A, Pandit N, Kavadichanda C. Role of [68Ga]-pentixafor positron emission tomography/computed tomography imaging in assessing disease activity in patients with lupus nephritis: A pilot study. Lupus 2023; 32:1267-1275. [PMID: 37691452 DOI: 10.1177/09612033231201625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/12/2023]
Abstract
OBJECTIVE The primary objective of our study was to evaluate renal uptake of 68Ga-pentixafor in patients with lupus nephritis. Eighteen patients who satisfied the inclusion criteria were included in our study. METHODS The study participants were patients with histopathologically confirmed lupus nephritis who were referred to our department for 68Ga-pentixafor PET/CT scan. We studied the renal images in these patients for uptake patterns based on purely visual as well as semi-quantitative parameters. The visual parameters included uptake relative to the spleen and liver. Semi-quantitative analysis involved the uptake as given by SUVmax. These parameters were correlated with the patients' biochemical as well as histological parameters. Kendall's tau-b test was used to look for an association between renal uptake by visual assessment and histopathological findings. Mean SUVmax values were compared by using the Mann-Whitney U test and a p value < .05 was considered to be statistically significant. RESULTS No significant association between the mean renal SUVmax of the bilateral kidneys in pentixafor PET and histopathological class was observed. We did not observe any heterogeneity in uptake patterns that could be attributed to the disease process in our patients. CONCLUSION 68Ga-pentixafor PET is not a suitable imaging modality for assessment of disease activity in lupus nephritis patients. There is a void in non-invasive testing for patients with this chronic and often disabling condition which calls for further research in this area.
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Affiliation(s)
- Ahalya Nair
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Nandini Pandit
- Department of Nuclear Medicine, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
| | - Chengappa Kavadichanda
- Department of Clinical Immunology, Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, India
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Wentworth BJ, Khot R, Caldwell SH. The Many Faces of Primary Sclerosing Cholangitis: Controversy Abounds. Dig Dis Sci 2023; 68:3514-3526. [PMID: 37358638 DOI: 10.1007/s10620-023-08003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/10/2023] [Indexed: 06/27/2023]
Abstract
Primary sclerosing cholangitis (PSC) is notoriously challenging to manage given its heterogeneity with regard to diagnosis, management, and progression. The lack of disease-modifying therapy and variable rate of onset of cirrhosis, portal hypertension-related decompensating events, jaundice, pruritus, biliary complications, and need for liver transplantation is deeply unsettling to clinicians and patients alike. Recent updated practice guidance by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver endeavored to highlight some of these challenges. However, these references only briefly address clinical dilemmas that providers face on a daily basis. This review aims to further discuss these controversial topics, including providing insight into the utility of ursodeoxycolic acid, the significance of alkaline phosphatase normalization, when to consider PSC variants and mimickers, and the implications of continuous hepatobiliary malignancy screening. In particular, there has been a growing body of literature raising concern about repeat exposure to gadolinium-containing contrast. Patients with PSC are potentially at risk for large lifetime exposure to gadolinium related to frequent magnetic resonance imaging scans and whether this carries any negative long-term adverse effects remains unknown.
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Affiliation(s)
- Brian J Wentworth
- Division of Gastroenterology and Hepatology, School of Medicine, University of Virginia, PO Box 800708, Charlottesville, VA, 22908, USA.
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, School of Medicine, University of Virginia, PO Box 800708, Charlottesville, VA, 22908, USA
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Kuwatsuru Y, Hirano T, Wakabayashi R, Ishisaki JY, Sokooshi H, Kuwatsuru R. Changes in renal function over time in outpatients with eGFR ≥ 30 mL/min/1.73 m 2: implication for timing of renal function testing before contrast-enhanced CT imaging. Jpn J Radiol 2023; 41:994-1006. [PMID: 37040025 PMCID: PMC10469099 DOI: 10.1007/s11604-023-01425-y] [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] [Received: 10/24/2022] [Accepted: 04/01/2023] [Indexed: 04/12/2023]
Abstract
PURPOSE To evaluate the associations between comorbidities and kidney function decline at 6-month and 1-year follow-up in outpatients with initial estimated glomerular filtration rate (eGFR) ≥ 30 mL/min/1.73 m2. MATERIALS AND METHODS Outpatients aged 18 and older with confirmed diagnosis, who had eGFR ≥ 30 mL/min/1.73 m2 measured between April 2017 and March 2019, were included in this retrospective observational study. Of them, 30,595 included outpatients had 6-month eGFR test and 27,698 included outpatients had 1-year eGFR test. The outpatients were further divided into two groups based on initial eGFR: between 30 and 59 and ≥ 60 mL/min/1.73 m2. Impaired renal function was defined as eGFR declined to below 30 mL/min/1.73 m2. The comorbidities with P values less than 0.1 identified in univariable logistic regression models were entered into the multivariable analysis with backward selection, thereby identifying comorbidities that increased the risk of eGFR decline at 6-month and 1-year follow-up. RESULTS Outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2 were 175.94 times more likely to have eGFR decline at 6 months, and were 94.10 times more likely to have eGFR decline at 1 year, compared with their corresponding initial eGFR ≥ 60 counterparts. Multivariable logistic regression analyses disclosed that chronic kidney disease, hypertension, and heart failure were independent risk factors for eGFR decline in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2. CONCLUSIONS Outpatients with initial eGFR ≥ 60 mL/min/1.73 m2 might not need routine eGFR test prior to contrast-enhanced CT scan for 1 year. In addition, chronic kidney disease, hypertension, and heart failure increased the risk of declined renal function, particularly, in outpatients with initial eGFR between 30 and 59 mL/min/1.73 m2.
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Affiliation(s)
- Yoshiki Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takahiro Hirano
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Clinical Study Support Inc., 2F Daiei Bldg., 1-11-20 Nishiki, Naka-ku, Nagoya, 460-0003, Japan
| | - Ryozo Wakabayashi
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
- Clinical Study Support Inc., 2F Daiei Bldg., 1-11-20 Nishiki, Naka-ku, Nagoya, 460-0003, Japan
| | - Juliana Yumi Ishisaki
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Hideaki Sokooshi
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Ryohei Kuwatsuru
- Department of Radiology, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
- Department of Real-World Evidence and Data Assessment, Graduate School of Medicine, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan.
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14
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Liu M, Yuan J, Wang G, Ni N, Lv Q, Liu S, Gong Y, Zhao X, Wang X, Sun X. Shape programmable T1- T2 dual-mode MRI nanoprobes for cancer theranostics. NANOSCALE 2023; 15:4694-4724. [PMID: 36786157 DOI: 10.1039/d2nr07009j] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
The shape effect is an important parameter in the design of novel nanomaterials. Engineering the shape of nanomaterials is an effective strategy for optimizing their bioactive performance. Nanomaterials with a unique shape are beneficial to blood circulation, tumor targeting, cell uptake, and even improved magnetism properties. Therefore, magnetic resonance imaging (MRI) nanoprobes with different shapes have been extensively focused on in recent years. Different from other multimodal imaging techniques, dual-mode MRI can provide imaging simultaneously by a single instrument, which can avoid differences in penetration depth, and the spatial and temporal resolution of multiple imaging devices, and ensure the accurate matching of spatial and temporal imaging parameters for the precise diagnosis of early tumors. This review summarizes the latest developments of nanomaterials with various shapes for T1-T2 dual-mode MRI, and highlights the mechanism of how shape intelligently affects nanomaterials' longitudinal or transverse relaxation, namely sphere, hollow, core-shell, cube, cluster, flower, dumbbell, rod, sheet, and bipyramid shapes. In addition, the combination of T1-T2 dual-mode MRI nanoprobes and advanced therapeutic strategies, as well as possible challenges from basic research to clinical transformation, are also systematically discussed. Therefore, this review will help others quickly understand the basic information on dual-mode MRI nanoprobes and gather thought-provoking ideas to advance the subfield of cancer nanomedicine.
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Affiliation(s)
- Menghan Liu
- School of Chemistry and Pharmaceutical Engineering, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
| | - Jia Yuan
- School of Chemistry and Pharmaceutical Engineering, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
| | - Gongzheng Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Nengyi Ni
- Department of Chemical and Biomolecular Engineering, National University of Singapore, 117585, Singapore
| | - Qian Lv
- School of Chemistry and Pharmaceutical Engineering, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
| | - Shuangqing Liu
- School of Chemistry and Pharmaceutical Engineering, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
| | - Yufang Gong
- School of Chemistry and Pharmaceutical Engineering, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
| | - Xinya Zhao
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Ximing Wang
- Department of Radiology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, 250021, China.
| | - Xiao Sun
- School of Chemistry and Pharmaceutical Engineering, Medical Science and Technology Innovation Center, Shandong First Medical University & Shandong Academy of Medical Sciences, Jinan 250000, China.
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Lildal SK, Hansen ESS, Laustsen C, Nørregaard R, Bertelsen LB, Madsen K, Rasmussen CW, Osther PJS, Jung H. Gadolinium-enhanced MRI visualizing backflow at increasing intra-renal pressure in a porcine model. PLoS One 2023; 18:e0281676. [PMID: 36795705 PMCID: PMC9934347 DOI: 10.1371/journal.pone.0281676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2022] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
INTRODUCTION Intrarenal backflow (IRB) is known to occur at increased intrarenal pressure (IRP). Irrigation during ureteroscopy increases IRP. Complications such as sepsis is more frequent after prolonged high-pressure ureteroscopy. We evaluated a new method to document and visualize intrarenal backflow as a function of IRP and time in a pig model. METHODS Studies were performed on five female pigs. A ureteral catheter was placed in the renal pelvis and connected to a Gadolinium/ saline solution 3 ml/L for irrigation. An occlusion balloon-catheter was left inflated at the uretero-pelvic junction and connected to a pressure monitor. Irrigation was successively regulated to maintain steady IRP levels at 10, 20, 30, 40 and 50 mmHg. MRI of the kidneys was performed at 5-minute intervals. PCR and immunoassay analyses were executed on the harvested kidneys to detect potential changes in inflammatory markers. RESULTS MRI showed backflow of Gadolinium into the kidney cortex in all cases. The mean time to first visual damage was 15 minutes and the mean registered pressure at first visual damage was 21 mmHg. On the final MRI the mean percentage of IRB affected kidney was 66% after irrigation with a mean maximum pressure of 43 mmHg for a mean duration of 70 minutes. Immunoassay analyses showed increased MCP-1 mRNA expression in the treated kidneys compared to contralateral control kidneys. CONCLUSIONS Gadolinium enhanced MRI provided detailed information about IRB that has not previously been documented. IRB occurs at even very low pressures, and these findings are in conflict with the general consensus that keeping IRP below 30-35 mmHg eliminates the risk of post-operative infection and sepsis. Moreover, the level of IRB was documented to be a function of both IRP and time. The results of this study emphasize the importance of keeping IRP and OR time low during ureteroscopy.
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Affiliation(s)
| | | | - Christoffer Laustsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Rikke Nørregaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lotte Bonde Bertelsen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Kirsten Madsen
- Department of Clinical Pathology, Odense University Hospital, Odense, Denmark
| | - Camilla W. Rasmussen
- Department of Clinical Medicine, MR Research Centre, Aarhus University, Aarhus, Denmark
| | - Palle Jörn Sloth Osther
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Vejle Hospital–a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Helene Jung
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Urology, Vejle Hospital–a part of Lillebaelt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
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Shankar DS, Rybalko DA, Goldman D, Nowakowski FS, Hausman MR. Applications of Vascular Imaging and Interventional Radiology Modalities in the Upper Extremity: A Review. J Hand Surg Am 2023; 48:165-176. [PMID: 36333243 DOI: 10.1016/j.jhsa.2022.09.016] [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: 09/19/2021] [Revised: 04/30/2022] [Accepted: 09/14/2022] [Indexed: 01/01/2023]
Abstract
Hand and upper extremity (HUE) vascular disorders are encountered frequently by hand surgeons in clinical practice. A wide array of imaging and vascular interventional radiology modalities exists for the diagnosis and treatment of HUE vascular disorders, some of which may not be familiar to the HUE surgeons. In this review article, we summarize the vascular imaging and vascular interventional radiology modalities and their relative advantages, disadvantages, and indications with respect to HUE pathology. We aim to familiarize HUE surgeons with the available types of diagnostic and therapeutic options for HUE vascular pathologies and aid interdisciplinary communication with vascular interventional radiology specialists during the clinical decision-making process.
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Affiliation(s)
- Dhruv S Shankar
- Icahn School of Medicine at Mount Sinai, New York, New York.
| | | | - Daryl Goldman
- Icahn School of Medicine at Mount Sinai, New York, New York
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17
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Madken M, Gotra A, Qazi S, Fairhead T, Burns KD. Successful Endovascular Management of Resistant Hypertension Post Kidney Transplant: A Case Report. Can J Kidney Health Dis 2022; 9:20543581221119896. [PMID: 36160314 PMCID: PMC9493670 DOI: 10.1177/20543581221119896] [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: 05/29/2022] [Indexed: 11/18/2022] Open
Abstract
Rationale: Transplant renal artery stenosis (TRAS) is a well-recognized and potentially reversible
cause of resistant hypertension post transplantation and can affect 1% to 23% of
recipients. Stenosis of the iliac segment proximal to the transplant renal artery
(proximal TRAS) causing dysfunction of the transplanted kidney is less common with
reported incidence of 2% to 3%. Presentation typically occurs between 3 months and 2
years post transplant but may happen at any time. Noninvasive investigations such as
Doppler ultrasound, computed tomography (CT) angiogram, and magnetic resonance angiogram
are useful in initial evaluation, but definitive diagnosis of hemodynamically
significant stenosis often requires formal angiogram. Transplant renal artery stenosis
should be suspected in any kidney transplant recipient with worsening hypertension
and/or deterioration in kidney function which is otherwise unexplained. We present the
case of a kidney transplant recipient with resistant hypertension and impaired graft
function, secondary to severe impairment of graft blood flow from proximal iliac system
occlusion. Presenting concerns of the patient: A 74-year-old female 15 years post live donor kidney transplant presented with graft
dysfunction (serum Cr 229 μmol/L) and resistant hypertension, requiring use of 8
antihypertensive medications. On physical examination, blood pressure was 160/92 mm Hg
with no tenderness over the renal graft in the right lower abdominal quadrant and no
audible bruit in kidney allograft area. Diagnosis: Transplant Doppler ultrasound showed reversal of flow in the right external iliac
artery suggestive of ipsilateral proximal iliac occlusion. Pre-procedure CT demonstrated
severe atherosclerotic burden within the aorta and bilateral iliac systems. The
anastomosed right renal artery appeared patent. Interventions: Conventional angiogram showed occlusion of the right common and proximal external iliac
arteries with retrograde perfusion of the transplant kidney via the contralateral left
iliac system and aorta. Subintimal recanalization of the right iliac system was
performed with angioplasty and kissing stent placement at the aortic bifurcation with
stents extending into the proximal right external iliac artery. Post deployment
angiogram demonstrated renewed patency of the right iliac system, with restoration of
antegrade perfusion to the transplant kidney. Outcomes: The patient’s blood pressure decreased significantly after the procedure, with
improvement in graft function. After 6 months, the patient continued to have optimally
controlled blood pressure (on 3 medications) and stable graft function (serum Cr 74
μmol/L). Teaching points: Our case describes proximal TRAS and the contribution of renal hypoperfusion to
hypertension and impaired graft function, with the potential for reversibility.
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Affiliation(s)
- Mohit Madken
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Akshat Gotra
- Division of Vascular & Interventional Radiology, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, ON, Canada
| | - Shakeel Qazi
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Canada
| | - Todd Fairhead
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
| | - Kevin D Burns
- Division of Nephrology, Department of Medicine, The Ottawa Hospital Research Institute, University of Ottawa, ON, Canada
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18
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Gallo-Bernal S, Patino-Jaramillo N, Calixto CA, Higuera SA, Forero JF, Lara Fernandes J, Góngora C, Gee MS, Ghoshhajra B, Medina HM. Nephrogenic Systemic Fibrosis in Patients with Chronic Kidney Disease after the Use of Gadolinium-Based Contrast Agents: A Review for the Cardiovascular Imager. Diagnostics (Basel) 2022; 12:diagnostics12081816. [PMID: 36010167 PMCID: PMC9406537 DOI: 10.3390/diagnostics12081816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-enhanced cardiac magnetic resonance has revolutionized cardiac imaging in the last two decades and has emerged as an essential and powerful tool for the characterization and treatment guidance of a wide range of cardiovascular diseases. However, due to the high prevalence of chronic renal dysfunction in patients with cardiovascular conditions, the risk of nephrogenic systemic fibrosis (NSF) after gadolinium exposure has been a permanent concern. Even though the newer macrocyclic agents have proven to be much safer in patients with chronic kidney disease and end-stage renal failure, clinicians must fully understand the clinical characteristics and risk factors of this devastating pathology and maintain a high degree of suspicion to prevent and recognize it. This review aimed to summarize the existing evidence regarding the physiopathology, clinical manifestations, diagnosis, and prevention of NSF related to the use of gadolinium-based contrast agents.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Correspondence:
| | - Nasly Patino-Jaramillo
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
| | - Camilo A. Calixto
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Department of Radiology Boston Children’s Hospital, Boston, MA 02115, USA
| | - Sergio A. Higuera
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
| | - Julian F. Forero
- Division of Radiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia;
| | - Juliano Lara Fernandes
- Jose Michel Kalaf Research Institute, Radiologia Clinica de Campinas, São Paulo 13092-123, Brazil;
| | - Carlos Góngora
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; (C.G.); (B.G.)
| | - Michael S. Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | - Brian Ghoshhajra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; (C.G.); (B.G.)
| | - Hector M. Medina
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
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Orlacchio A, Guastoni C, Beretta GD, Cosmai L, Galluzzo M, Gori S, Grassedonio E, Incorvaia L, Marcantoni C, Netti GS, Passamonti M, Porta C, Procopio G, Rizzo M, Roma S, Romanini L, Stacul F, Casinelli A. SIRM-SIN-AIOM: appropriateness criteria for evaluation and prevention of renal damage in the patient undergoing contrast medium examinations-consensus statements from Italian College of Radiology (SIRM), Italian College of Nephrology (SIN) and Italian Association of Medical Oncology (AIOM). Radiol Med 2022; 127:534-542. [PMID: 35303246 PMCID: PMC9098565 DOI: 10.1007/s11547-022-01483-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Accepted: 03/08/2022] [Indexed: 11/04/2022]
Abstract
The increasing number of examinations and interventional radiological procedures that require the administration of contrast medium (CM) in patients at risk for advanced age and/or comorbidities highlights the problem of CM-induced renal toxicity. A multidisciplinary group consisting of specialists of different disciplines—radiologists, nephrologists and oncologists, members of the respective Italian Scientific Societies—agreed to draw up this position paper, to assist clinicians increasingly facing the challenges posed by CM-related renal dysfunction in their daily clinical practice. The major risk factor for acute renal failure following CM administration (post-CM AKI) is the preexistence of renal failure, particularly when associated with diabetes, heart failure or cancer. In accordance with the recent guidelines ESUR, the present document reaffirms the importance of renal risk assessment through the evaluation of the renal function (eGFR) measured on serum creatinine and defines the renal risk cutoff when the eGFR is < 30 ml/min/1.73 m2 for procedures with intravenous (i.v.) or intra-arterial (i.a.) administration of CM with renal contact at the second passage (i.e., after CM dilution with the passage into the pulmonary circulation). The cutoff of renal risk is considered an eGFR < 45 ml/min/1.73 m2 in patients undergoing i.a. administration with first-pass renal contact (CM injected directly into the renal arteries or in the arterial district upstream of the renal circulation) or in particularly unstable patients such as those admitted to the ICU. Intravenous hydration using either saline or Na bicarbonate solution before and after CM administration represents the most effective preventive measure in patients at risk of post-CM AKI. In the case of urgency, the infusion of 1.4% sodium bicarbonate pre- and post-CM may be more appropriate than the administration of saline. In cancer patients undergoing computed tomography, pre- and post-CM hydration should be performed when the eGFR is < 30 ml/min/1.73 m2 and it is also advisable to maintain a 5 to 7 days interval with respect to the administration of cisplatin and to wait 14 days before administering zoledronic acid. In patients with more severe renal risk (i.e., with eGFR < 20 ml/min/1.73 m2), particularly if undergoing cardiological interventional procedures, the prevention of post-CM AKI should be implemented through an internal protocol shared between the specialists who treat the patient. In magnetic resonance imaging (MRI) using gadolinium CM, there is a lower risk of AKI than with iodinated CM, particularly if doses < 0.1 mmol/kg body weight are used and in patients with eGFR > 30 ml/min/1.73 m2. Dialysis after MRI is indicated only in patients already undergoing chronic dialysis treatment to reduce the potential risk of systemic nephrogenic fibrosis.
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Affiliation(s)
- Antonio Orlacchio
- Radiology Unit, Department of Surgical Science, University of Rome "Tor Vergata", Rome, Italy. .,Emergency Radiology, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy.
| | | | | | - Laura Cosmai
- Nephology Unit, Azienda Ospedaliera San Carlo Borromeo di Milano, Milan, Italy
| | - Michele Galluzzo
- Emergency Radiology, Azienda Ospedaliera San Camillo-Forlanini, Rome, Italy
| | - Stefania Gori
- Department of Oncology, IRCC Ospedale Sacro Cuore Don Calabria, Negrar Valpolicella, Italy
| | | | | | - Carmelita Marcantoni
- Nephology UnitSan Marco Hospital, Azienda Ospedaliero Universitaria, Catania, Italy
| | | | | | | | - Giuseppe Procopio
- Genito-Urinary Medical Oncology, Fondazione Istituto Nazionale Tumori, Milano, Italy
| | - Mimma Rizzo
- Oncology Unit, Hospital Santa Chiara, Trento, Italy
| | - Silvia Roma
- Radiology Unit, Hospital F. Spaziani, Frosinone, Italy
| | - Laura Romanini
- Radiology Unit, Ospedale di Cremona, ASST Cremona, Cremona, Italy
| | - Fulvio Stacul
- Department of Radiology, Maggiore Hospital, Azienda Sanitaria Universitaria Integrata di Trieste, Trieste, Italy
| | - Alice Casinelli
- Emergency Radiology, Policlinico Tor Vergata, Viale Oxford, 81, 00133, Rome, Italy
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20
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Poznański P, Lepiesza A, Jędrzejuk D, Mazanowska O, Bolanowski M, Krajewska M, Kamińska D. Is a Patient with Paget's Disease of Bone Suitable for Living Kidney Donation?-Decision-Making in Lack of Clinical Evidence. J Clin Med 2022; 11:jcm11061485. [PMID: 35329811 PMCID: PMC8951425 DOI: 10.3390/jcm11061485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Revised: 02/24/2022] [Accepted: 03/08/2022] [Indexed: 12/25/2022] Open
Abstract
Living donor kidney transplantation is a widely performed medical procedure. Living kidney donation requires an in-depth health assessment of candidates. The potential living kidney donor must remain healthy after kidney removal. A consequence of donation can be a decrease in glomerular filtration rate (GFR), and donors can become at risk of developing chronic kidney disease (CKD). We present a rationale for potential living kidney donor withdrawal due to Paget's disease of bone (PDB) based on a literature review. The treatment for PDB includes the use of, for example, non-steroidal anti-inflammatory drugs (NSAIDs), which can lead to acute kidney injury (AKI) as well as CKD, or bisphosphonates, which are not recommended for patients with decreased GFR.
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Affiliation(s)
- Paweł Poznański
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
| | - Agnieszka Lepiesza
- Department of Vascular, General and Transplantation Surgery, Jan Mikulicz-Radecki University Clinical Hospital, Borowska 213, 50-556 Wroclaw, Poland;
| | - Diana Jędrzejuk
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeze L. Pasteura 4, 50-367 Wroclaw, Poland;
- Correspondence:
| | - Oktawia Mazanowska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
| | - Marek Bolanowski
- Department of Endocrinology, Diabetes and Isotope Therapy, Wroclaw Medical University, Wybrzeze L. Pasteura 4, 50-367 Wroclaw, Poland;
| | - Magdalena Krajewska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
| | - Dorota Kamińska
- Department of Nephrology and Transplantation Medicine, Wroclaw Medical University, Borowska 213, 50-556 Wroclaw, Poland; (P.P.); (O.M.); (M.K.); (D.K.)
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Gauthier ID, Macleod CA, Sathiadoss P, McGrath TA, Nair V, Schieda N. Risk of nephrogenic systemic fibrosis (NSF) in oncology patients receiving gadoxetic acid and updated risk of estimate of NSF in patients receiving gadoxetic acid with moderate and severe renal impairment. Abdom Radiol (NY) 2022; 47:1196-1201. [PMID: 34997298 DOI: 10.1007/s00261-021-03367-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Revised: 11/22/2021] [Accepted: 11/24/2021] [Indexed: 11/01/2022]
Abstract
OBJECTIVES Gadoxetic acid (GA) is a half-biliary excreted gadolinium-based contrast agent (GBCA) administered at lower dose than gadobenic acid with similar ionic structure. Gadobenic acid is considered low-risk for nephrogenic systemic fibrosis (NSF) in patients with impaired renal function; however, safety of GA is unclear. The objective of this study was to determine the incidence of NSF in oncology patients undergoing GA-enhanced MRI and to update the risk estimate of NSF in patients receiving GA with severe renal impairment. MATERIALS AND METHODS We retrospectively identified GA-enhanced MRI performed for treatment planning in confirmed cancer patients between March 2011 and December 2020. Serum creatinine values within 180 days of GA administration were retrieved and estimated glomerular filtration rate (eGFR) calculated. The eGFR value nearest to each MRI examination was used. The search result was linked to a prospectively maintained registry of reported cases of NSF. An updated literature review was conducted to identify published cases of NSF related to GA administration in patients with severe renal impairment (eGFR < 30 mL/min/1.73 m2 or on dialysis) and the incidence of NSF with 95% confidence intervals (CI) was determined combining published data with our results. RESULTS 192 oncology patients underwent GA-enhanced MRI, mean age was 65.6 ± 11.8 years with 73 women. The mean eGFR was 89.6 ± 33.0 mL/min/1.73 m2. There were 33 patients with moderate (eGFR 30-60 mL/min/1.73 m2) and 1 patient with severe (eGFR < 30 mL/min/1.73 m2) renal impairment. There were no reported cases of NSF. Updated literature review including our results identified 340 patients with severe renal impairment or on dialysis with zero cases of NSF (0/340; 95% confidence intervals 0% and 0.9%). CONCLUSION No cases of NSF were documented in this study related to gadoxetic acid use in oncology patients, including those with moderate and severe renal impairment. Recent data indicate use of gadoxetic acid in patients with renal impairment can be considered low-risk.
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Yekeler E, Krishnamurthy G, Smith CL, Escobar FA, Pinto E, Rapp JB, Otero HJ, White AM, Dori Y, Biko DM. Dynamic contrast-enhanced MR lymphangiography: feasibility of using ferumoxytol in patients with chronic kidney disease. Eur Radiol 2022; 32:2564-2571. [PMID: 35001156 DOI: 10.1007/s00330-021-08448-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 10/28/2021] [Accepted: 10/29/2021] [Indexed: 01/18/2023]
Abstract
PURPOSE To assess the feasibility of direct intra-lymphatic administration of diluted ferumoxytol as a T1-positive contrast agent for dynamic contrast-enhanced MR lymphangiography (DCMRL) imaging of the central lymphatics in children with renal disease. METHODS In vitro scan of dilute ferumoxytol was initially performed using time-resolved and high-resolution 3D gradient echo (GRE) sequences with short TE values (1 to 1.5 ms). A ferumoxytol concentration of 0.25 to 0.40 mg/mL was found to retain high signal in the T1-weighted sequences. DCMRL was then performed in 4 children with renal disease with the same 3D GRE sequences administrating diluted ferumoxytol via intra-mesenteric (IM), intra-hepatic (IH), and intra-nodal (IN) routes (6 to 9 mL to each site; average total dose of 0.75 mg/kg) by slow hand injection (0.5 to 1.0 mL/min). The signal-to-noise ratio (SNR) of the lymphatics was measured for quantitative evaluation. RESULTS Ferumoxytol-enhanced DCMRL was technically successful in all patients. Contrast conspicuity within the lymphatics was sufficient without subtraction. The mean SNR was significantly higher than the muscle (50.1 ± 12.2 vs 13.2 ± 2.8; t = 15.9; p < .001). There were no short-term complications attributed to the administration of ferumoxytol in any of the four patients. CONCLUSION Magnetic resonance lymphangiography using ferumoxytol via IN, IH, and IM access is a new method to directly visualize the central lymphatic system and can be applied safely in patients with renal failure based on our preliminary report of four cases. Ferumoxytol-enhanced DCMRL shows diagnostic image quality by using 3D GRE sequences with short TE values and appropriate dilution of ferumoxytol. KEY POINTS • MR lymphangiography using ferumoxytol via intra-nodal, intra-hepatic, and intra-mesenteric access is a new method to directly visualize the central lymphatic system from the groin to the venous angle. • FDCMRL can be applied safely in patients with renal failure based on our preliminary report of four cases. • FDCMRL shows diagnostic image quality by using 3D GRE sequences with short TE values and appropriate dilution of the ferumoxytol.
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Affiliation(s)
- Ensar Yekeler
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, 19104, USA.
| | - Ganesh Krishnamurthy
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Christopher L Smith
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Fernando A Escobar
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Erin Pinto
- Center for Lymphatic Imaging and Interventions, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Yoav Dori
- Division of Cardiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
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Viteri B, Calle-Toro JS, Ballester L, Darge K, Furth S, Khrichenko D, Van Batavia J, Otero H. Potential benefits of functional magnetic resonance urography (fMRU) over MAG3 renal scan in children with obstructive uropathy. J Pediatr Urol 2021; 17:659.e1-659.e7. [PMID: 34426090 PMCID: PMC8865459 DOI: 10.1016/j.jpurol.2021.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 05/18/2021] [Accepted: 07/06/2021] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Functional renal imaging, most commonly with MAG3 nuclear medicine renal scan, is recommended in the evaluation of children with urinary tract dilation (UTD) suspected of obstructive uropathy. Alternatively, renal function can be evaluated with functional Magnetic Resonance Urography (fMRU), which has superior anatomic detail. However, there are not enough data comparing both methods' equivalency. In this study, we compare the functional and obstruction parameters of fMRU and MAG3 in a pediatric cohort presenting with obstructive uropathy. STUDY DESIGN This is an IRB-approved retrospective review of all children undergoing fMRU at a single, free-standing children's hospital between May 2008 and September 2017. Patients who also underwent a MAG3 renal scan within 6 months and who had no interval surgical intervention were included in the study. Bladder catheterization was performed prior to both imaging studies. RESULTS 735 children had 988 fMRU studies performed during the study period. 37 unique patients (13 girls and 24 boys) with median age of 6 months (range: 2 mo-19 y) were included in the final sample. Median time interval between studies was 70 days (range 6-179 days). The majority of participants (26/37, 70.3%) presented with UTD P3 and had diagnosis of uretero-pelvic junction obstruction (UPJO) in 21/37. Differential renal function (DRF) was used to group 10 fMRU and 9 MAG3 patients as normal; 9 fMRU and 11 MAG3 as mild; 11 fMRU and 6 MAG3 as moderate; and 7 fMRU and 6 MAG3 as severe; Wilcoxon signed-rank test (p = 0.5106). Results were similar for DRF among patients with and without duplex kidneys. In the analysis of obstruction, using reference standard T½ MAG3 ≥ 20 min, a greater or equal than 6 min renal transit time (RTT) from fMRU showed a specificity of 94%, a sensitivity of 62%, and an AUC of 0.827. DISCUSSION AND CONCLUSIONS The differential renal function determined by MAG3 and fMRU in children was not statistically different, therefore we concluded that it was similar and potentially equivalent. Better correlation was shown in patients who had normal split kidney function. While the tests are clinically equivalent, the variability of DRF within each clinical category (i.e., normal, mild, moderate, severe) is not surprising, because MAG3 does not clearly differentiate the dilated collecting system from the functional parenchymal tissue, while fMRU does. Using MAG3 as the gold standard, fMRU was 94.74% specific and 5% more sensitive in detecting UPJO with a RTT of 6min vs. 8min.
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Affiliation(s)
- Bernarda Viteri
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA.
| | - Juan S Calle-Toro
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Lance Ballester
- Division of Biostatistics and Data Management Core, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Kassa Darge
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Susan Furth
- Division of Pediatric Nephrology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Dmitry Khrichenko
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Jason Van Batavia
- Division of Urology, Department of Surgery, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Hansel Otero
- Division of Body Imaging, Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Meier EL, Sheppard SM, Goldberg EB, Kelly CR, Walker A, Ubellacker DM, Vitti E, Ruch K, Hillis AE. Dysfunctional Tissue Correlates of Unrelated Naming Errors in Acute Left Hemisphere Stroke. LANGUAGE, COGNITION AND NEUROSCIENCE 2021; 37:330-347. [PMID: 35665076 PMCID: PMC9159539 DOI: 10.1080/23273798.2021.1980593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/14/2020] [Accepted: 08/31/2021] [Indexed: 06/15/2023]
Abstract
Most naming error lesion-symptom mapping (LSM) studies have focused on semantic and/or phonological errors. Anomic individuals also produce unrelated word errors, which may be linked to semantic or modality-independent lexical deficits. To investigate the neural underpinnings of rarely-studied unrelated errors, we conducted LSM analyses in 100 individuals hospitalized with a left hemisphere stroke who completed imaging protocols and language assessments. We used least absolute shrinkage and selection operator regression to capture relationships between naming errors and dysfunctional brain tissue metrics (regional damage or hypoperfusion in vascular territories) in two groups: participants with and without impaired single-word auditory comprehension. Hypoperfusion-particularly within the parietal lobe-was an important error predictor, especially for the unimpaired group. In both groups, higher unrelated error proportions were associated with primarily ventral stream damage, the language route critical for processing meaning. Nonetheless, brain metrics implicated in unrelated errors were distinct from semantic error correlates.
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Affiliation(s)
- Erin L. Meier
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Shannon M. Sheppard
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Communication Sciences and Disorders, Chapman University, Irvine, CA
| | - Emily B. Goldberg
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Catherine R. Kelly
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Alexandra Walker
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | | | - Emilia Vitti
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Kristina Ruch
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Argye E. Hillis
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD
- Department of Cognitive Science, Johns Hopkins University, Baltimore, MD
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So YH, Lee W, Park EA, Kim PK. Investigation of the Characteristics of New, Uniform, Extremely Small Iron-Based Nanoparticles as T1 Contrast Agents for MRI. Korean J Radiol 2021; 22:1708-1718. [PMID: 34402245 PMCID: PMC8484154 DOI: 10.3348/kjr.2020.1455] [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: 12/13/2020] [Revised: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to evaluate the magnetic resonance (MR) characteristics and applicability of new, uniform, extremely small iron-based nanoparticles (ESIONs) with 3–4-nm iron cores using contrast-enhanced magnetic resonance angiography (MRA). Materials and Methods Seven types of ESIONs were used in phantom and animal experiments with 1.5T, 3T, and 4.7T scanners. The MR characteristics of the ESIONs were evaluated via phantom experiments. With the ESIONs selected by the phantom experiments, animal experiments were performed on eight rabbits. In the animal experiments, the in vivo kinetics and enhancement effect of the ESIONs were evaluated using half-diluted and non-diluted ESIONs. The between-group differences were assessed using a linear mixed model. A commercially available gadolinium-based contrast agent (GBCA) was used as a control. Results All ESIONs showed a good T1 shortening effect and were applicable for MRA at 1.5T and 3T. The relaxivity ratio of the ESIONs increased with increasing magnetic field strength. In the animal experiments, the ESIONs showed peak signal intensity on the first-pass images and persistent vascular enhancement until 90 minutes. On the 1-week follow-up images, the ESIONs were nearly washed out from the vascular structures and organs. The peak signal intensity on the first-pass images showed no significant difference between the non-diluted ESIONs with 3-mm iron cores and GBCA (p = 1.000). On the 10-minutes post-contrast images, the non-diluted ESIONs showed a significantly higher signal intensity than did the GBCA (p < 0.001). Conclusion In the phantom experiments, the ESIONs with 3–4-nm iron oxide cores showed a good T1 shortening effect at 1.5T and 3T. In the animal experiments, the ESIONs with 3-nm iron cores showed comparable enhancement on the first-pass images and superior enhancement effect on the delayed images compared to the commercially available GBCA at 3T.
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Affiliation(s)
- Young Ho So
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Eun Ah Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Pan Ki Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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Ferumoxytol-enhanced ultrashort TE MRA and quantitative morphometry of the human kidney vasculature. Abdom Radiol (NY) 2021; 46:3288-3300. [PMID: 33666735 DOI: 10.1007/s00261-021-02984-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 01/28/2021] [Accepted: 02/09/2021] [Indexed: 10/22/2022]
Abstract
PURPOSE To evaluate the feasibility of Quantitative Ultrashort-Time-to-Echo Contrast-Enhanced (QUTE-CE) MRA using ferumoxytol as a contrast agent for abdominal angiography in the kidney. METHODS Four subjects underwent ferumoxytol-enhanced MRA with the 3D UTE Spiral VIBE WIP sequence at 3 T. Image quality metrics were quantified, specifically the blood Signal-to-Noise Ratio (SNR), blood-tissue Contrast-to-Noise Ratio (CNR) and Intraluminal Signal Heterogeneity (ISH) from both the aorta and inferior vena cava (IVC). Morphometric analysis of the vessels was performed using manual approach and semi-automatic approach using Vascular Modeling ToolKit (VMTK). Image quality and branching order were compared between QUTE-CE MRA and the Gadolinium (Gd) CEMRA reference image. RESULTS QUTE-CE MRA provides a bright blood snapshot that delineates arteries and veins equally in the same scan. The maximum SNR and CNR values were 3,282 ± 1,218 and 1,295 ± 580, respectively - significantly higher than available literature values using other CEMRA techniques. QUTE-CE MRA had lower ISH and depicted higher vessel branching order (7th vs 3rd) within the kidney compared to a standard dynamic clinical Gd CEMRA scan. Morphometric analysis yielded quantitative results for the total kidney volume, total cyst volume and for diameters of the branching arterial network down to the 7th branch. Vessel curvature was significantly increased (p < 0.001) in the presence of a renal cyst compared to equivalent vessels in normal kidney regions. CONCLUSION QUTE-CE MRA is feasible for kidney angiography, providing greater detail of kidney vasculature, enabling quantitative morphometric analysis of the abdominal and intra-renal vessels and yielding metrics relevant to vascular diseases while using a contrast agent ferumoxytol that is safe for CKD patients.
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27
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Chen K, Li P, Zhu C, Xia Z, Xia Q, Zhong L, Xiao B, Cheng T, Wu C, Shen C, Zhang X, Zhu J. Mn(II) Complex of Lipophilic Group-Modified Ethylenediaminetetraacetic Acid (EDTA) as a New Hepatobiliary MRI Contrast Agent. J Med Chem 2021; 64:9182-9192. [PMID: 34152137 DOI: 10.1021/acs.jmedchem.1c00393] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Liver-specific contrast agents (CAs) can improve the Magnetic resonance imaging (MRI) detection of focal and diffuse liver lesions by increasing the lesion-to-liver contrast. A novel Mn(II) complex, Mn-BnO-TyrEDTA, with a lipophilic group-modified ethylenediaminetetraacetic acid (EDTA) structure as a ligand to regulate its behavior in vivo, is superior to Gd-EOB-DTPA in terms of a liver-specific MRI contrast agent. An MRI study on mice demonstrated that Mn-BnO-TyrEDTA can be rapidly taken up by hepatocytes with a combination of hepatobiliary and renal clearance pathways. Bromosulfophthalein (BSP) inhibition imaging, biodistribution, and cellular uptake studies confirmed that the mechanism of hepatic targeting of Mn-BnO-TyrEDTA is the hepatic uptake of the amphiphilic anion contrast agent mediated by organic anion transporting polypeptides (OATPs) expressed by functional hepatocytes.
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Affiliation(s)
| | - Pan Li
- Department of Radiotherapy, Sichuan Cancer Hospital & Institute, Chengdu 610041, China
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28
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Alabousi M, Davenport MS. Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease and the Risk of Nephrogenic Systemic Fibrosis: Radiology In Training. Radiology 2021; 300:279-284. [PMID: 34060939 DOI: 10.1148/radiol.2021210044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 66-year-old male patient with end-stage chronic kidney disease undergoing maintenance dialysis and with a history of group I intravenous gadolinium-based contrast media (GBCM) administration presented with clinical and pathologic findings consistent with nephrogenic systemic fibrosis. A summary of the evidence and recommendations for use of intravenous GBCM in patients with kidney disease is presented. © RSNA, 2021.
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Affiliation(s)
- Mostafa Alabousi
- From the Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8 (M.A.); and Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.)
| | - Matthew S Davenport
- From the Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8 (M.A.); and Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.)
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Jabehdar Maralani P, Kapadia A, Liu G, Moretti F, Ghandehari H, Clarke SE, Wiebe S, Garel J, Ertl-Wagner B, Hurrell C, Schieda N. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J 2021; 73:56-67. [PMID: 34000852 DOI: 10.1177/08465371211015657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.
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Affiliation(s)
| | - Anish Kapadia
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Grace Liu
- Department of Obstetrics and Gynecology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Hournaz Ghandehari
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juliette Garel
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Casey Hurrell
- Research and Policy Development - Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, 12365University of Ottawa, Ottawa, Ontario, Canada
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Apelt K, Bijkerk R, Lebrin F, Rabelink TJ. Imaging the Renal Microcirculation in Cell Therapy. Cells 2021; 10:cells10051087. [PMID: 34063200 PMCID: PMC8147454 DOI: 10.3390/cells10051087] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 12/12/2022] Open
Abstract
Renal microvascular rarefaction plays a pivotal role in progressive kidney disease. Therefore, modalities to visualize the microcirculation of the kidney will increase our understanding of disease mechanisms and consequently may provide new approaches for evaluating cell-based therapy. At the moment, however, clinical practice is lacking non-invasive, safe, and efficient imaging modalities to monitor renal microvascular changes over time in patients suffering from renal disease. To emphasize the importance, we summarize current knowledge of the renal microcirculation and discussed the involvement in progressive kidney disease. Moreover, an overview of available imaging techniques to uncover renal microvascular morphology, function, and behavior is presented with the associated benefits and limitations. Ultimately, the necessity to assess and investigate renal disease based on in vivo readouts with a resolution up to capillary level may provide a paradigm shift for diagnosis and therapy in the field of nephrology.
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Affiliation(s)
- Katerina Apelt
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Roel Bijkerk
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
| | - Franck Lebrin
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Physics for Medicine Paris, Inserm, CNRS, ESPCI Paris, Paris Sciences et Lettres University, 75005 Paris, France
| | - Ton J. Rabelink
- Department of Internal Medicine-Nephrology, Leiden University Medical Center, 2333ZA Leiden, The Netherlands; (K.A.); (R.B.); (F.L.)
- Einthoven Laboratory of Vascular and Regenerative Medicine, Leiden University Medical Center, 2333ZA Leiden, The Netherlands
- Correspondence:
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Srivastava A, Tomar B, Prajapati S, Gaikwad AB, Mulay SR. Advanced non-invasive diagnostic techniques for visualization and estimation of kidney fibrosis. Drug Discov Today 2021; 26:2053-2063. [PMID: 33617976 DOI: 10.1016/j.drudis.2021.02.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 12/22/2020] [Accepted: 02/12/2021] [Indexed: 12/17/2022]
Abstract
Kidney fibrosis is marked by excessive extracellular matrix deposition during disease progression. Unfortunately, existing kidney function parameters do not predict the extent of kidney fibrosis. Moreover, the traditional histology methods for the assessment of kidney fibrosis require liquid and imaging biomarkers as well as needle-based biopsies, which are invasive and often associated with kidney injury. The repetitive analyses required to monitor the disease progression are therefore difficult. Hence, there is an unmet medical need for non-invasive and informative diagnostic approaches to monitor kidney fibrosis during the progression of chronic kidney disease. Here, we summarize the modern advances in diagnostic imaging techniques that have shown promise for non-invasive estimation of kidney fibrosis in pre-clinical and clinical studies.
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Affiliation(s)
- Anjali Srivastava
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Bhawna Tomar
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Smita Prajapati
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India
| | - Anil Bhanudas Gaikwad
- Department of Pharmacy, Birla Institute of Technology and Science Pilani, Pilani Campus, 333031, India
| | - Shrikant R Mulay
- Division of Pharmacology, CSIR-Central Drug Research Institute, Lucknow, 226031, India.
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Liu H, Liu H, Yang Z, Wang K. Bone Mineral Density in Population Long-Term Exposed to Rare Earth Elements from a Mining Area of China. Biol Trace Elem Res 2021; 199:453-464. [PMID: 32361884 DOI: 10.1007/s12011-020-02165-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 04/15/2020] [Indexed: 12/17/2022]
Abstract
This study aims to investigate the effects of individuals' exposure to rare earth elements (REEs) on bone metabolism. Adopting the inductively coupled plasma mass spectrometry, we measured REEs and eight other elements (Ca, Fe, Cu, Na, K, Zn, Mg, and P) in the hair of 53 miners exposed to REEs from Baiyunebo and 57 healthy farmers as the control group. Furthermore, bone mineral density (BMD) in both groups was assessed by dual-energy X-ray absorptiometry. Analysis of variance showed that the concentrations of La, Ce, Pr, Nd, Tb, Ho, Tm, and Yb in male hair of exposed group were significantly higher compared with the control group, whereas the concentrations of Ca and Fe in exposed group were significantly lower; the results of female hair, except for Ce, Tb, Ho, Tm, and Yb, were consistent with male hair. Student's t test showed that the BMD of exposed males at lumbar vertebrae, femoral neck, greater trochanter, and intertrochanter was significantly lower than that of controls, and exposed females reported lower BMD values at lumbar vertebrae and femoral neck. Multiple linear regression analysis showed that concentrations of differential REEs were inversely related to BMD in males, and concentrations of Ca and Fe were positively related to BMD both in males and females. Our study suggests that long-term environmental and occupational exposure leads to REE accumulation, and a low level of iron and calcium due to the competitive binding of REEs, which together induce bone metabolism disorders, and further reduce BMD.
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Affiliation(s)
- Heming Liu
- Department of Orthopaedics, The 1st Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia Province, China.
| | - Haiyan Liu
- Department of Intervention Therapy, The 1st Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia Province, China
| | - Zenghua Yang
- Department of Orthopaedics, The 1st Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia Province, China
| | - Kunzheng Wang
- Department of Orthopaedics, The 2nd Affiliated Hospital of Xi'an Jiaotong University, Xi'an, Shannxi Province, China
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Farrow JM, Kern SQ, Gryzinski GM, Sundaram CP. Nephron-sparing management of upper tract urothelial carcinoma. Investig Clin Urol 2021; 62:389-398. [PMID: 34190434 PMCID: PMC8246013 DOI: 10.4111/icu.20210113] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/12/2021] [Accepted: 06/07/2021] [Indexed: 11/18/2022] Open
Abstract
Urothelial carcinoma of the upper urinary tract is uncommon and presents unique challenges for diagnosis and management. Nephroureterectomy has been the preferred management option, but it is associated with significant morbidity. Nephron-sparing treatments are a valuable alternative and provide similar efficacy in select cases. A PubMed literature review was performed in English language publications using the following search terms: urothelial carcinoma, upper tract, nephron-sparing, intraluminal and systemic therapy. Contemporary papers published within the last 10 years were primarily included. Where encountered, systematic reviews and meta-analyses were given priority, as were randomized controlled trials for newer treatments. Core guidelines were referenced and citations reviewed for inclusion. A summary of epidemiological data, clinical diagnosis, staging, and treatments focusing on nephron-sparing approaches to upper tract urothelial carcinoma (UTUC) are outlined. Nephron-sparing management strategies are viable options to consider in patients with favorable features of UTUC. Adjunctive therapies are being investigated but the data remains mixed. Protocol variability and dosage differences limit statistical interpretation. New mechanisms to improve treatment dwell times in the upper tracts are being designed with promising preliminary results. Studies investigating systemic therapies are ongoing but implications for nephron-sparing management are uncertain. Nephron-sparing management is an acceptable treatment modality best suited for favorable disease. More work is needed to determine if intraluminal and/or systemic therapies can further optimize treatment outcomes beyond resection alone.
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Affiliation(s)
- Jason M Farrow
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA.
| | - Sean Q Kern
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Gustavo M Gryzinski
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
| | - Chandru P Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, IN, USA
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Schieda N, van der Pol CB, Walker D, Tsampalieros AK, Maralani PJ, Woo S, Davenport MS. Adverse Events to the Gadolinium-based Contrast Agent Gadoxetic Acid: Systematic Review and Meta-Analysis. Radiology 2020; 297:565-572. [DOI: 10.1148/radiol.2020200073] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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Costa AF. The Risk of Nephrogenic Systemic Fibrosis in Group II and III Gadolinium-Based Contrast Agents. Can Assoc Radiol J 2020; 71:536. [DOI: 10.1177/0846537119888408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Andreu F. Costa
- Department of Diagnostic Radiology, QE II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
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Gopireddy DR, Mahmoud H, Baig S, Le R, Bhosale P, Lall C. "Renal emergencies: a comprehensive pictorial review with MR imaging". Emerg Radiol 2020; 28:373-388. [PMID: 32974867 DOI: 10.1007/s10140-020-01852-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 09/17/2020] [Indexed: 12/11/2022]
Abstract
Superior soft-tissue contrast and high sensitivity of magnetic resonance imaging (MRI) for detecting and characterizing disease may provide an expanded role in acute abdominal and pelvic imaging. Although MRI has traditionally not been exploited in acute care settings, commonly used in biliary obstruction and during pregnancy, there are several conditions in which MRI can go above and beyond other modalities in diagnosis, characterization, and providing functional and prognostic information. In this manuscript, we highlight how MRI can help in further assessment and characterization of acute renal emergencies. Currently, renal emergencies are predominantly evaluated with ultrasound (US) or computed tomography (CT) scanning. US may be limited by various patient factors and technologist experience while CT imaging with intravenous contrast administration can further compromise renal function. With the advent of rapid, robust non-contrast MRI, and magnetic resonance angiography (MRA) imaging studies with short scan times, free-breathing techniques, and lack of ionization radiation, the utility of MRI for renal evaluation might be superior to CT not only in diagnosing an emergent renal process but also by providing functional and prognostic information. This review outlines the clinical manifestations and the key imaging findings for acute renal processes including acute renal infarction, hemorrhage, and renal obstruction, among other entities, to highlight the added value of MRI in evaluating the finer nuances in acute renal emergencies.
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Affiliation(s)
- Dheeraj Reddy Gopireddy
- Department of Radiology, UF College of Medicine-Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA.
| | - Hagar Mahmoud
- Department of Diagnostic Radiology, the University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Saif Baig
- Imaging Informatics and Artificial Intelligence, University of Florida, College Medicine, Gainesville, FL, USA
| | - Rebecca Le
- Jacksonville Center for Clinical Research, University of Florida, Gainesville, FL, USA
| | - Priya Bhosale
- Department of Diagnostic Radiology, the University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Chandana Lall
- Department of Radiology, UF College of Medicine-Jacksonville, 2nd Floor, Clinical Center, 655 West 8th Street, C90, Jacksonville, FL, 33209, USA
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van der Veen SJ, Hollak CEM, van Kuilenburg ABP, Langeveld M. Developments in the treatment of Fabry disease. J Inherit Metab Dis 2020; 43:908-921. [PMID: 32083331 PMCID: PMC7540041 DOI: 10.1002/jimd.12228] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 02/10/2020] [Accepted: 02/17/2020] [Indexed: 12/19/2022]
Abstract
Enzyme replacement therapy (ERT) with recombinant α-galactosidase A (r-αGAL A) for the treatment of Fabry disease has been available for over 15 years. Long-term treatment may slow down disease progression, but cardiac, renal, and cerebral complications still develop in most patients. In addition, lifelong intravenous treatment is burdensome. Therefore, several new treatment approaches have been explored over the past decade. Chaperone therapy (Migalastat; 1-deoxygalactonojirimycin) is the only other currently approved therapy for Fabry disease. This oral small molecule aims to improve enzyme activity of mutated α-galactosidase A and can only be used in patients with specific mutations. Treatments currently under evaluation in (pre)clinical trials are second generation enzyme replacement therapies (Pegunigalsidase-alfa, Moss-aGal), substrate reduction therapies (Venglustat and Lucerastat), mRNA- and gene-based therapy. This review summarises the knowledge on currently available and potential future options for the treatment of Fabry disease.
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Affiliation(s)
- Sanne J. van der Veen
- Department of Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
| | - Carla E. M. Hollak
- Department of Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
| | - André B. P. van Kuilenburg
- Department of Clinical Chemistry, Gastroenterology & MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
| | - Mirjam Langeveld
- Department of Endocrinology and MetabolismAmsterdam UMC, University of AmsterdamAZAmsterdamThe Netherlands
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Rudnick MR, Wahba IM, Leonberg-Yoo AK, Miskulin D, Litt HI. Risks and Options With Gadolinium-Based Contrast Agents in Patients With CKD: A Review. Am J Kidney Dis 2020; 77:517-528. [PMID: 32861792 DOI: 10.1053/j.ajkd.2020.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs that bind free gadolinium more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for free gadolinium in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating gadolinium deposition in brain and a possible systemic syndrome attributed to GBCAs. Radiologic advances have resulted in several new imaging modalities that can be used in the severe CKD population and that do not require GBCA administration. In this article, we critically review GBCA use in patients with severe CKD and provide recommendations regarding GBCA use in this population.
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Affiliation(s)
- Michael R Rudnick
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA.
| | - Ihab M Wahba
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA; Corporal Michael J Crescenz Philadelphia Veterans Affairs Hospital Philadelphia, PA
| | - Amanda K Leonberg-Yoo
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA
| | - Dana Miskulin
- Division of Nephrology, Tufts University School of Medicine, Boston, MA
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Baroni RH, Bauab T, Bittencourt LK, D'Ippolito G, Goldman SM, Hohgraefe Neto G, Manzella A, Rocha AJ, Sonoda LA, Takeda FS. Practical recommendations for the safe use of gadolinium in magnetic resonance imaging: a Delphi expert panel study. Radiol Bras 2020; 53:216-222. [PMID: 32904664 PMCID: PMC7458558 DOI: 10.1590/0100-3984.2019.0074] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To assess the practical aspects of the use of various gadolinium-based contrast agents (GBCAs) by radiologists. Materials and Methods Ten experienced radiologists from different regions of Brazil participated in a Delphi panel querying their use of various GBCAs, including linear and macrocyclic classes (1.0 and 0.5 M), in terms of the choice of agent, volume and dosage of the agents, and associated safety concerns. Results The response rate was 100% for all questions. GBCAs are safe in terms of acute adverse reactions, and nephrogenic systemic fibrosis is rare. The deposition of gadolinium in the brain and other tissues is a concern among the experts. Macrocyclic agents are preferable to linear agents; an injection volume below 0.1 mL/kg of a 1.0 M agent could result in good-quality images with additional long-term safety, but there is no published evidence to support this recommendation. The majority of experts preferred not to administer GBCAs to pregnant patients. Conclusion When choosing a GBCA, it is important to consider the characteristics of the gadolinium deposition in patient tissues and minimize potential risks. Furthermore, medical education programs are needed to increase the awareness of the potential risks of gadolinium deposition and thus avoid instances of overexposure to the contrast agent.
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Affiliation(s)
- Ronaldo Hueb Baroni
- Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil
| | - Tufik Bauab
- Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil
| | | | - Giuseppe D'Ippolito
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | - Suzan Menasce Goldman
- Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil
| | | | - Adonis Manzella
- Hospital da Restauração, Recife, PE, Centro Diagnóstico Lucilo Ávila Junior, Recife, PE, Brazil
| | - Antonio José Rocha
- Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Grupo DASA, São Paulo, SP, Brazil
| | - Luis Augusto Sonoda
- Instituto de Gastroenterologia de São Paulo (Igesp), São Paulo, SP, Hospital Nipo Brasileiro, São Paulo, SP, Brazil
| | - Fabio Seichi Takeda
- Ultramed Medical Services, Londrina, PR, Medvia Diagnósticos, Porto Alegre, RS, Brazil
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Nikolaidou C, Karamitsos T. Should everyone have an MRI in heart failure? Cardiovasc Diagn Ther 2020; 10:549-553. [PMID: 32695635 DOI: 10.21037/cdt.2019.12.06] [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]
Affiliation(s)
- Chrysovalantou Nikolaidou
- Oxford Centre for Clinical Magnetic Resonance Research, Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, UK
| | - Theodoros Karamitsos
- First Department of Cardiology, AHEPA University Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Lin BS, Chen CW, Zhou SK, Tseng YH, Wang SC, Huang YK. Evaluation of static ulcer on lower extremities using wireless wearable near-infrared spectroscopy device: Effect of deep venous thrombosis on TRiggered Angiography Non-Contrast-Enhanced sequence magnetic resonance imaging. Phlebology 2020; 35:814-823. [PMID: 32700650 DOI: 10.1177/0268355520935739] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
BACKGROUND Venous leg ulcers, or static leg ulcers, are chronic wounds associated with ambulatory venous hypertension of the lower extremities as a consequence of venous valve reflux, reduce venous capacitance, poor calf venous pump, heart failure, or in conjunction with venous obstruction. A static ulcer with venous thrombosis in a pelvic or thigh vein responds favorably to anticoagulation agents. However, anticoagulation is less effective and even harmful when ambulatory venous hypertension has another cause such as venous reflux, poorly heart function, and poor calf venous pump. METHOD TRiggered Angiography Non-Contrast-Enhanced (TRANCE) magnetic resonance imaging (MRI) exploits differences in vascular signal intensity during the cardiac cycle for subsequent image subtraction, providing detailed radiation-free venograms without the use of contrast agents. The method is a new tool for evaluating the presence of thrombosis in the venous systems. TRANCE-MRI was employed to document the existence of venous thrombosis within the eight patients in this study. Subsequently, we used a wireless wearable near-infrared spectroscopy device to compare deep vein thrombosis-associated and non-deep vein thrombosis-associated static ulcers. The sampling depths were 5 and 10 mm, representing the dermis and subcutaneous tissue, respectively. RESULT There are four patients with venous leg ulcers proven with venous thrombosis by TRANCE-MRI and are classified as deep vein thrombosis group. Compared with the non-deep vein thrombosis group, the deep vein thrombosis group had less deoxyhemoglobin, less total hemoglobin, and a significantly lower H2O signal in the 5-mm sampling depth (dermis level). And eight health participants were included as control group. Wounded patients (including deep vein thrombosis and non-deep vein thrombosis patients) have higher H2O concentration on the 5-mm depth sampling than control group. In the 10-mm sampling depth (subcutaneous level), the deoxyhemoglobin and tissue oxygen saturation of the deep vein thrombosis group were lower than those of the non-deep vein thrombosis group, and the H2O concentration was higher than non-deep vein thrombosis group. Patients with static foot ulcers and deep vein thrombosis had similar oxyhemoglobin, deoxyhemoglobin, total hemoglobin, and tissue oxygen saturation than did those without deep vein thrombosis in 5-mm depth sampling (dermis level). Notably, the H2O signal of patients with non-deep vein thrombosis-associated static ulcers was higher for the 5-mm sampling depth. CONCLUSION In patients with static ulcers and deep vein thrombosis, the H2O level may be higher in the 10-mm sampling depth, indicating that those patients had more subcutaneous water. In patients with non-deep vein thrombosis static foot ulcer, the near-infrared spectroscopy (NIRS) indicated worse fluid retention in the dermis level. The H2O value in the NIRS may be different owing to underline the cause of the venous leg ulcers.
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Affiliation(s)
- Bor-Shyh Lin
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Chien-Wei Chen
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan.,Institute of Medicine, Chung Shan Medical University, Taichung
| | - Shao-Kui Zhou
- Institute of Imaging and Biomedical Photonics, National Chiao Tung University, Tainan
| | - Yuan-Hsi Tseng
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Shih-Chung Wang
- Department of Diagnostic Radiology, and Wound Center, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
| | - Yao-Kuang Huang
- Division of Thoracic and Cardiovascular Surgery, College of Medicine, Chia Yi Chang Gung Memorial Hospital, Chia-Yi and Chang Gung University, Taoyuan
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Wiefels C, Lamai O, Kandolin R, Birnie D, Leung E, Mesquita CT, Beanlands R. The Role of 18F-FDG PET/CT in Cardiac Sarcoidosis. INTERNATIONAL JOURNAL OF CARDIOVASCULAR SCIENCES 2020. [DOI: 10.36660/ijcs.20200033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Choudhary NS, Saraf N, Saigal S, Soin AS. Non-enhanced magnetic resonance as a surveillance tool for hepatocellular carcinoma: Many unresolved issues. J Hepatol 2020; 73:212. [PMID: 32247683 DOI: 10.1016/j.jhep.2020.01.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 01/08/2020] [Indexed: 12/04/2022]
Affiliation(s)
- Narendra Singh Choudhary
- Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India
| | - Neeraj Saraf
- Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India.
| | - Sanjiv Saigal
- Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India
| | - Arvinder S Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta, The Medicity, Gurgaon, India
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Affiliation(s)
- Moises Vasquez
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
| | - Eike Nagel
- Institute for Experimental and Translational Cardiovascular Imaging, Klinikum der Johann Wolfgang Goethe-Universitat Frankfurt, Frankfurt am Main, Germany
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Walker DT, Davenport MS, McGrath TA, McInnes MDF, Shankar T, Schieda N. Breakthrough Hypersensitivity Reactions to Gadolinium-based Contrast Agents and Strategies to Decrease Subsequent Reaction Rates: A Systematic Review and Meta-Analysis. Radiology 2020; 296:312-321. [PMID: 32427558 DOI: 10.1148/radiol.2020192855] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Background Hypersensitivity reactions to gadolinium-based contrast agents (GBCAs) that occur despite corticosteroid premedication (breakthrough reactions) are not well understood. Purpose To determine the GBCA breakthrough reaction rate overall and according to GBCA class and to determine the effect of using an alternative GBCA or allergy skin testing on the risk of a breakthrough reaction. Materials and Methods In this systematic review and meta-analysis, MEDLINE (from 1946 to 2019), Embase (from 1947 to 2019), and the Cochrane Central Register of Controlled Trials (2019 only) were searched for patients with a breakthrough reaction to a GBCA who were undergoing repeat GBCA administration. Breakthrough reaction rates were determined with random-effects modeling and meta-regression. Secondary analyses of GBCA class, switching to an alternative GBCA, and allergy skin testing were assessed. Quality Assessment of Diagnostic Accuracy Studies 2 was used to determine risk of bias and applicability. Percentages are meta-regression results and do not directly reflect raw data. Results Of the 148 identified studies, 23 were included, encompassing 120 patients and 130 GBCA administrations. The overall breakthrough reaction rate was 39% (95% confidence interval [CI]: 30%, 49%; 37 of 103 administrations). Breakthrough reaction rates for macrocyclic (36%; 95% CI: 25%, 48%; 23 of 64 administrations) and protein-binding linear (31%; 95% CI: 1%, 94%; [one of seven administrations) GBCAs did not differ (P = .90). There were insufficient analyzable data for gadodiamide, gadoversetamide, and gadopentetate. Hypersensitivity reaction rate after switching GBCAs was 50% (95% CI: 21%, 79%; three of nine administrations) with and 71% (95% CI: 21%, 95%; four of five administrations) without corticosteroid premedication, which did not differ (P = .82 and P = .17, respectively) from the observed rate when using corticosteroid premedication and the same GBCA (36%; 95% CI: 26%, 48%; 37 of 84 administrations). Hypersensitivity reaction rate after allergy skin testing (17%; 95% CI: 7%, 29%; zero of 21 studies) did not differ when compared with use of the same agent with corticosteroid premedication (P = .10). Meta-analysis limitations were the small number of patients and the high risk of bias. Conclusion Patients with a prior hypersensitivity reaction to a gadolinium-based contrast agent (GBCA) often had breakthrough reactions. The effect of switching to an alternative GBCA or using allergy skin testing to decrease reaction risk lacked enough available data for meaningful comparisons. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Prince in this issue.
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Affiliation(s)
- Daniel T Walker
- From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.)
| | - Matthew S Davenport
- From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.)
| | - Trevor A McGrath
- From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.)
| | - Matthew D F McInnes
- From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.)
| | - Tara Shankar
- From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.)
| | - Nicola Schieda
- From the Department of Medical Imaging, The Ottawa Hospital, 1053 Carling Ave, Room C159, Ottawa, ON, Canada K1Y 4E9 (D.T.W., T.A.M., M.D.F.M., N.S.); Department of Radiology, University of Michigan Medical Center, Ann Arbor, Mich (M.S.D.); and Allergy and Immunology Associates of Ann Arbor PC, Ann Arbor, Mich (T.S.)
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Tammaro O, Costagliola di Polidoro A, Romano E, Netti PA, Torino E. A Microfluidic Platform to design Multimodal PEG - crosslinked Hyaluronic Acid Nanoparticles (PEG-cHANPs) for diagnostic applications. Sci Rep 2020; 10:6028. [PMID: 32265496 PMCID: PMC7138812 DOI: 10.1038/s41598-020-63234-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 03/27/2020] [Indexed: 12/23/2022] Open
Abstract
The combination of different imaging modalities can allow obtaining simultaneously morphological and functional information providing a more accurate diagnosis. This advancement can be reached through the use of multimodal tracers, and nanotechnology-based solutions allow the simultaneous delivery of different diagnostic compounds moving a step towards their safe administration for multimodal imaging acquisition. Among different processes, nanoprecipitation is a consolidate method for the production of nanoparticles and its implementation in microfluidics can further improve the control over final product features accelerating its potential clinical translation. A Hydrodynamic Flow Focusing (HFF) approach is proposed to produce through a ONE-STEP process Multimodal Pegylated crosslinked Hyaluronic Acid NanoParticles (PEG-cHANPs). A monodisperse population of NPs with an average size of 140 nm is produced and Gd-DTPA and ATTO488 compounds are co-encapsulated, simultaneously. The results showed that the obtained multimodal nanoparticle could work as MRI/Optical imaging probe. Furthermore, under the Hydrodenticity effect, a boosting of the T1 values with respect to free Gd-DTPA is preserved.
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Affiliation(s)
- Olimpia Tammaro
- University of Naples Federico II, Department of Chemical, Materials and Production Engineering (DICMaPI), P.le Tecchio 80, 80125, Naples, Italy
- Fondazione Istituto Italiano di Tecnologia, IIT, Largo Barsanti e Matteucci 53, 80125, Naples, Italy
| | - Angela Costagliola di Polidoro
- University of Naples Federico II, Department of Chemical, Materials and Production Engineering (DICMaPI), P.le Tecchio 80, 80125, Naples, Italy
- Fondazione Istituto Italiano di Tecnologia, IIT, Largo Barsanti e Matteucci 53, 80125, Naples, Italy
| | - Eugenia Romano
- University of Naples Federico II, Department of Chemical, Materials and Production Engineering (DICMaPI), P.le Tecchio 80, 80125, Naples, Italy
- Fondazione Istituto Italiano di Tecnologia, IIT, Largo Barsanti e Matteucci 53, 80125, Naples, Italy
| | - Paolo Antonio Netti
- University of Naples Federico II, Department of Chemical, Materials and Production Engineering (DICMaPI), P.le Tecchio 80, 80125, Naples, Italy
- Fondazione Istituto Italiano di Tecnologia, IIT, Largo Barsanti e Matteucci 53, 80125, Naples, Italy
- Interdisciplinary Research Center on Biomaterials, CRIB, University of Naples Federico II, P.le Tecchio 80, 80125, Naples, Italy
| | - Enza Torino
- University of Naples Federico II, Department of Chemical, Materials and Production Engineering (DICMaPI), P.le Tecchio 80, 80125, Naples, Italy.
- Fondazione Istituto Italiano di Tecnologia, IIT, Largo Barsanti e Matteucci 53, 80125, Naples, Italy.
- Interdisciplinary Research Center on Biomaterials, CRIB, University of Naples Federico II, P.le Tecchio 80, 80125, Naples, Italy.
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Oloko A, Talreja H, Davis A, McCormick B, Clark E, Akbari A, Kong J, Hiremath S. Does Iodinated Contrast Affect Residual Renal Function in Dialysis Patients? A Systematic Review and Meta-Analysis. Nephron Clin Pract 2020; 144:176-184. [DOI: 10.1159/000505576] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Accepted: 12/19/2019] [Indexed: 11/19/2022] Open
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Soloff EV, Wang CL. Safety of Gadolinium-Based Contrast Agents in Patients with Stage 4 and 5 Chronic Kidney Disease: a Radiologist's Perspective. KIDNEY360 2020; 1:123-126. [PMID: 35372905 DOI: 10.34067/kid.0000502019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Erik V Soloff
- Radiology Department, University of Washington, Seattle, Washington
| | - Carolyn L Wang
- Radiology Department, University of Washington, Seattle, Washington
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Rouvière O, Cornelis F, Brunelle S, Roy C, André M, Bellin MF, Boulay I, Eiss D, Girouin N, Grenier N, Hélénon O, Lapray JF, Lefèvre A, Matillon X, Ménager JM, Millet I, Ronze S, Sanzalone T, Tourniaire J, Rocher L, Renard-Penna R. Imaging protocols for renal multiparametric MRI and MR urography: results of a consensus conference from the French Society of Genitourinary Imaging. Eur Radiol 2020; 30:2103-2114. [PMID: 31900706 DOI: 10.1007/s00330-019-06530-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 09/19/2019] [Accepted: 10/18/2019] [Indexed: 12/23/2022]
Abstract
OBJECTIVES To develop technical guidelines for magnetic resonance imaging aimed at characterising renal masses (multiparametric magnetic resonance imaging, mpMRI) and at imaging the bladder and upper urinary tract (magnetic resonance urography, MRU). METHODS The French Society of Genitourinary Imaging organised a Delphi consensus conference with a two-round Delphi survey followed by a face-to-face meeting. Two separate questionnaires were issued for renal mpMRI and for MRU. Consensus was strictly defined using a priori criteria. RESULTS Forty-two expert uroradiologists completed both survey rounds with no attrition between the rounds. Fifty-six of 84 (67%) statements of the mpMRI questionnaire and 44/71 (62%) statements of the MRU questionnaire reached final consensus. For mpMRI, there was consensus that no injection of furosemide was needed and that the imaging protocol should include T2-weighted imaging, dual chemical shift imaging, diffusion-weighted imaging (use of multiple b-values; maximal b-value, 1000 s/mm2) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic) contrast-enhanced imaging; late imaging (more than 10 min after injection) was judged optional. For MRU, the patients should void their bladder before the examination. The protocol must include T2-weighted imaging, anatomical fast T1/T2-weighted imaging, diffusion-weighted imaging (use of multiple b-values; maximal b-value, 1000 s/mm2) and fat-saturated single-bolus multiphase (unenhanced, corticomedullary, nephrographic, excretory) contrast-enhanced imaging. An intravenous injection of furosemide is mandatory before the injection of contrast medium. Heavily T2-weighted cholangiopancreatography-like imaging was judged optional. CONCLUSION This expert-based consensus conference provides recommendations to standardise magnetic resonance imaging of kidneys, ureter and bladder. KEY POINTS • Multiparametric magnetic resonance imaging (mpMRI) aims at characterising renal masses; magnetic resonance urography (MRU) aims at imaging the urinary bladder and the collecting systems. • For mpMRI, no injection of furosemide is needed. • For MRU, an intravenous injection of furosemide is mandatory before the injection of contrast medium; heavily T2-weighted cholangiopancreatography-like imaging is optional.
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Affiliation(s)
- Olivier Rouvière
- Department of Urinary and Vascular Imaging, Hôpital Edouard Herriot, Hospices Civils de Lyon, 5, place d'Arsonval, 69347, Lyon, France.
- Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France.
| | - François Cornelis
- Department of Radiology, Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Serge Brunelle
- Department of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - Catherine Roy
- Department of Radiology B, CHU de Strasbourg, Nouvel Hôpital Civil, Strasbourg, France
| | - Marc André
- Department of Radiology, Hôpital Européen, Marseille, France
| | - Marie-France Bellin
- Department of Diagnostic and Interventional Radiology, Groupe Hospitalier Paris Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- IR4M, UMR 8081, Service hospitalier Joliot Curie, Orsay, France
| | - Isabelle Boulay
- Department of Radiology, Fondation Hôpital Saint Joseph, Paris, France
| | - David Eiss
- Department of Adult Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Nicolas Grenier
- Department of Diagnostic and Interventional Adult Imaging, CHU de Bordeaux, Bordeaux, France
- Université de Bordeaux, Bordeaux, France
| | - Olivier Hélénon
- Department of Adult Radiology, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris, Paris, France
- Paris Descartes University, Sorbonne Paris Cité, Paris, France
| | | | - Arnaud Lefèvre
- Centre d'Imagerie Médicale Tourville, Paris, France
- Department of Radiology, American Hospital of Paris, Neuilly, France
| | - Xavier Matillon
- Faculté de médecine Lyon Est, Université de Lyon, Université Lyon 1, Lyon, France
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
- CarMeN Laboratory, INSERM U1060, Lyon, France
| | | | - Ingrid Millet
- Department of Radiology, Hôpital Lapeyronie, Montpellier, France
- Université de Montpellier, Montpellier, France
| | - Sébastien Ronze
- Imagerie médicale Val d'Ouest Charcot (IMVOC), Ecully, France
| | - Thomas Sanzalone
- Department of Radiology, Centre Hospitalier de Valence, Valence, France
| | - Jean Tourniaire
- Department of Radiology, Clinique Rhône Durance, Avignon, France
| | - Laurence Rocher
- Department of Diagnostic and Interventional Radiology, Groupe Hospitalier Paris Sud, Assistance Publique-Hôpitaux de Paris, Le Kremlin Bicêtre, France
- Université Paris Sud, Le Kremlin Bicêtre, France
- IR4M, UMR 8081, Service hospitalier Joliot Curie, Orsay, France
| | - Raphaële Renard-Penna
- Academic Department of Radiology, Hôpital Pitié-Salpêtrière and Hôpital Tenon, Assistance Publique-Hôpitaux de Paris, Paris, France
- Sorbonne Universités, GRC no 5, ONCOTYPE-URO, Paris, France
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50
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Kamali M, Clarke SE, Costa AF. Evaluation of liver MRI examinations with two dosages of gadobenate dimeglumine: a blinded intra-individual study. Abdom Radiol (NY) 2020; 45:36-44. [PMID: 31372778 DOI: 10.1007/s00261-019-02158-1] [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: 11/28/2022]
Abstract
PURPOSE There is discrepancy in the literature regarding the optimal dose of gadobenate for liver MRI. We evaluated the quality of liver MRIs performed in the same individual using two dosages. METHODS With ethics approval, this retrospective study evaluated sixty patients who underwent liver MRIs between July 2015 and May 2017 (low dose, 0.06 mmol/kg) and May 2017 and September 2018 (standard dose, 0.10 mmol/kg). Regions of interest were drawn over the aorta, portal veins, and liver on unenhanced and post-contrast phases; relative enhancement values were compared (paired t-tests). Two blinded radiologists graded the arterial and portal venous sequences of each MRI from 1 to 4 (1 = suboptimal, 2 = adequate, 3 = good, 4 = excellent); grades were compared overall and in cirrhotic and non-cirrhotic subgroups (Wilcoxon signed-rank test). Radiologists graded each MRI pair from 1 to 5 (1 = substantially inferior, 2 = slightly inferior, 3 = equivalent, 4 = slightly improved, 5 = substantially improved). Inter-reader agreement was assessed (kappa statistic). RESULTS Relative enhancement increased significantly with the standard dose for all structures on all phases (p < 0.05). For both radiologists and both post-contrast phases, individual grades of the low- and standard-dose MRIs were similar, including the cirrhotic and non-cirrhotic subgroups (p > 0.05). Compared to the low-dose MRIs, the number of standard-dose MRIs graded 1-5 were 9, 31, 97, 88, and 11 for all patients, and 6, 13, 26, 45, and 6 in cirrhotics. Inter-observer agreement was fair-moderate (Κ range 0.23-0.45). CONCLUSIONS Although the standard dose of gadobenate yields greater relative enhancement, there is overall little improvement in subjective imaging quality. A trend towards better image quality is observed in cirrhotics.
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Affiliation(s)
- Mahsa Kamali
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
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