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Stammen L, Mihl C, Vandewall J, Pennetta F, Hersbach A, Wildberger JE, Martens B. Influence of Contrast Media Temperature and Concentration on Patient Comfort and Safety in Computed Tomography: CATCHY II Trial. Invest Radiol 2024; 59:577-582. [PMID: 38240647 DOI: 10.1097/rli.0000000000001063] [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: 07/04/2024]
Abstract
BACKGROUND Previous research on the necessity to reduce the viscosity of contrast media (CM) by either prewarming CM before injection during computed tomography (CT) or by using less concentrated CM has yielded conflicting results. In addition, there is limited evidence on patient comfort. OBJECTIVES The aim of the study was to examine if prewarming CM, with varying CM concentrations, is superior to CM at room temperature, with respect to patient comfort and safety in CT. MATERIALS AND METHODS All elective patients scheduled for contrast-enhanced CT scans at Maastricht University Medical Center+ between October 27, 2021 and October 31, 2022 were eligible for inclusion when a questionnaire evaluating patient comfort was completed. This 1-year period was divided into 4 intervals (4 groups): group 1 (370 mg I/mL, 37°C), group 2 (370 mg I/mL, room temperature), group 3 (300 mg I/mL, 37°C), and group 4 (300 mg I/mL, room temperature). All CT scans were performed using state of the art equipment (Siemens Healthineers; SOMATOM Force and SOMATOM Definition AS, Forchheim, Germany). Contrast media injections were performed using a dual-head power injector (Stellant; Bayer Healthcare, Berlin, Germany) and individualized to body weight and/or tube voltage, depending on the CM protocols. After the CT scan, patients completed a questionnaire covering the primary outcomes comfort, pain, and adverse events such as feelings of heat, nausea, vomiting, itchiness, urticaria, difficulty breathing, dizziness, goosebumps, or an odd taste. Technicians were asked to report any adverse events, including extravasation and allergic-like reactions. The secondary outcome involved attenuation (in Hounsfield unit, HU), which was evaluated by assessing the HU of the coronary arteries for vascular CT, and liver enhancement in portal venous CT. The Kruskal-Wallis test was used for continuous scale outcomes and χ 2 tests for examining adverse events. RESULTS Results showed no significant differences examining comfort score ( P = 0.054), pain sensation ( P = 0.469), extravasation ( P = 0.542), or allergic-like reaction ( P = 0.253). Significant differences among the 4 groups were found with respect to heat sensation and dizziness ( P = 0.005 and P = 0.047, respectively), showing small effect sizes. All other adverse effects showed no significant results. No significant differences were observed in coronary attenuation among the 4 groups in coronary CT angiography ( P = 0.113). When analyzing attenuation in portal venous CT scans, significant differences were found among the 4 groups ( P = 0.008). CONCLUSIONS Administrating prewarmed CM is nonsuperior compared with CM at room temperature in relation to patient comfort and safety, regardless of CM concentration. These findings suggest that prewarming CM before usage is unnecessary, which will improve the efficiency of daily clinical workflow and brings environmentally friendly benefits.
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Affiliation(s)
- Lion Stammen
- From the Department of Radiology and Nuclear Medicine, Maastricht University Medical Center, Maastricht, the Netherlands (L.S., C.M., J.V., F.P., A.H., J.E.W., B.M.); and CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, the Netherlands (L.S., C.M., J.E.W., B.M.)
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Zhang Y, Yuan D, Qi K, Zhang M, Zhang W, Wei N, Li L, Lv P, Gao J, Liu J. Feasibility Analysis of Individualized Low Flow Rate Abdominal Contrast-Enhanced Computed Tomography in Chemotherapy Patients: Dual-Source Computed Tomography With Low Tube Voltage. J Comput Assist Tomogr 2024:00004728-990000000-00319. [PMID: 38693081 DOI: 10.1097/rct.0000000000001624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/03/2024]
Abstract
PURPOSE The aim of the study is to investigate the feasibility of using dual-source computed tomography (CT) combined with low flow rate and low tube voltage for postchemotherapy image assessment in cancer patients. METHODS Ninety patients undergoing contrast-enhanced CT scans of the upper abdomen were prospectively enrolled and randomly assigned to groups A, B, and C (n = 30 each). In group A, patients underwent scans at 120 kVp with 448 mgI/kg. Patients in group B underwent scans at 100 kVp with 336 mgI/kg. Patient in group C underwent scans at 70 kVp with of 224 mgI/kg. Quantitative measurements including the CT number, standard deviation of CT number, signal-to-noise ratio, contrast-to-noise ratio, subjective reader scores, and the volume and flow rate of contrast agent were evaluated for each group. RESULTS There was no statistically significant difference in the subjective image scores within the three groups except for the kidney (all P > 0.05). Group C showed significantly higher CT values, lower noise levels, and higher signal-to-noise ratio and contrast-to-noise ratio values in the majority of the regions of interest compared to the other groups (P < 0.05). In group C, the contrast agent dose was decreased by 46% compared to group A (79.48 ± 12.24 vs 42.7 ± 8.6, P < 0.01), and the contrast agent injection rate was reduced by 22% (2.7 ± 0.41 vs 2.1 ± 0.4, P < 0.01). CONCLUSIONS The use of 70 kVp tube voltage combined with low iodine flow rates prove to be a more effective approach in solving the challenge of compromised blood vessels in postchemotherapy tumor patients, without reducing image quality and diagnostic confidence.
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Affiliation(s)
- Yicun Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Dian Yuan
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Ke Qi
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Mengyuan Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Weiting Zhang
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Nannan Wei
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | | | - Peijie Lv
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Jianbo Gao
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
| | - Jie Liu
- From the The Department of Radiology, The First Affiliated Hospital of Zhengzhou, University, Zhengzhou
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Albano D, Mallardi C, Afat S, Agnollitto PM, Caruso D, Cannella R, Carriero S, Chupetlovska K, Clauser P, D'Angelo T, De Santis D, Dioguardi Burgio M, Dumic-Cule I, Fanni SC, Fusco S, Gatti M, Gitto S, Jankovic S, Karagechev T, Klontzas ME, Koltsakis E, Leithner D, Matišić V, Muscogiuri G, Penkova R, Polici M, Serpi F, Sofia C, Snoj Z, Akinci D'Antonoli T, Vernuccio F, Vieira J, Vieira AC, Wielema M, Zerunian M, Messina C. How young radiologists use contrast media and manage adverse reactions: an international survey. Insights Imaging 2024; 15:92. [PMID: 38530547 DOI: 10.1186/s13244-024-01658-z] [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: 12/01/2023] [Accepted: 02/25/2024] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVES To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR). METHODS A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed. RESULTS Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25-39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient's lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively. CONCLUSION Training in CM use and management ADR should be implemented in the training of radiology residents. CRITICAL RELEVANCE STATEMENT We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions. KEY POINTS • This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy.
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Affiliation(s)
- Domenico Albano
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy.
- Dipartimento Di Scienze Biomediche, Chirurgiche Ed Odontoiatriche, Università Degli Studi Di Milano, Milan, Italy.
| | - Carmen Mallardi
- Scuola Di Specializzazione in Radiodiagnostica, Università Degli Studi Di Milano, Milan, Italy
| | - Saif Afat
- Department of Diagnostic and Interventional Radiology, Eberhard Karls University Tuebingen, Tuebingen, Germany
| | - Paulo Moraes Agnollitto
- Ribeirão Preto Medical School, Radiology Division of the Department of Medical Imaging, Hematology and Clinical Oncology, University of São Paulo, São Paulo, Ribeirão Preto, Brazil
| | - Damiano Caruso
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Roberto Cannella
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Serena Carriero
- Department of Radiology and Interventional Radiology, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Kalina Chupetlovska
- Department of Radiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paola Clauser
- Department of Biomedical Imaging and Image-Guided Therapy, Division of General and Pediatric Radiology, Medical University of Vienna, Vienna, Austria
| | - Tommaso D'Angelo
- Diagnostic and Inverventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
- Department of Radiology and Nuclear Medicine, Erasmus MC, Rotterdam, The Netherlands
| | - Domenico De Santis
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Marco Dioguardi Burgio
- Department of Radiology, Hôpital Beaujon, AP-HP.Nord, 100 Boulevard du Général Leclerc, 92110, Clichy, France
- Université Paris Cité, INSERM, Centre de Recherche Sur L'inflammation, 75018, Paris, France
| | - Ivo Dumic-Cule
- Department of Diagnostic and Interventional Radiology, University Hospital Centre Zagreb, Kispaticeva 12, 10000, Zagreb, Croatia
- University North, 104 Brigade 3, 42000, Varazdin, Croatia
| | | | - Stefano Fusco
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Marco Gatti
- Radiology Unit, Department of Surgical Sciences, University of Turin, Turin, Italy
| | - Salvatore Gitto
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Sonja Jankovic
- Center for Radiology, University Clinical Center Nis, Nis, Republic of Serbia
| | | | - Michail E Klontzas
- Department of Radiology, School of Medicine, University of Crete, Heraklion, Crete, Greece
- Department of Medical Imaging, University Hospital of Heraklion, Heraklion, Crete, Greece
| | - Emmanouil Koltsakis
- Department of Radiology, Karolinska University Hospital of Stockholm, Stockholm, Sweden
| | - Doris Leithner
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Vid Matišić
- St. Catherine Specialty Hospital, 10000, Zagreb, Croatia
| | | | - Ralitsa Penkova
- Radiology Department, Acibadem City Clinic Tokuda Hospital, 51B Nikola Y. Vaptsarov Blvd, Sofia, 1407, Bulgaria
| | - Michela Polici
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
- PhD School in Traslational Medicine and Oncology, Department of Medical Surgical Sciences and Translational Medicine, Faculty of Medicine and Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Francesca Serpi
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
| | - Carmelo Sofia
- Diagnostic and Inverventional Radiology Unit, Department of Biomedical Sciences and Morphological and Functional Imaging, University of Messina, Messina, Italy
| | - Ziga Snoj
- Radiology Institute, University Medical Centre Ljubljana, Zaloška 7, Ljubljana, Slovenia
| | - Tugba Akinci D'Antonoli
- Institute of Radiology and Nuclear Medicine, Cantonal Hospital Baselland, Liestal, Switzerland
| | - Federica Vernuccio
- Section of Radiology, Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - João Vieira
- Radiology, Hospital Divino Espírito Santo, Ponta Delgada, Portugal
| | - Ana Catarina Vieira
- Radiology Department, Hospital CUF Porto, Porto, Portugal
- Faculty of Medicine, University of Porto, Porto, Portugal
| | - Mirjam Wielema
- Department of Radiology, Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
| | - Marta Zerunian
- Department of Medical Surgical Sciences and Translational Medicine, Sant'Andrea University Hospital, Sapienza - University of Rome, Rome, Italy
| | - Carmelo Messina
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- Department of Biomedical Sciences for Health, Università Degli Studi Di Milano, Milan, Italy
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Du Y, Wang YN, Wang Q, Qi XH, Shi GF, Jia LT, Wang XM, Shi JB, Liu FY, Wang LJ, Liu X. A comparison of the use of contrast media with different iodine concentrations for enhanced computed tomography. Front Physiol 2023; 14:1141135. [PMID: 37064921 PMCID: PMC10101225 DOI: 10.3389/fphys.2023.1141135] [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: 01/10/2023] [Accepted: 03/03/2023] [Indexed: 04/18/2023] Open
Abstract
Objective: In this study, we compared the enhancement of blood vessels and liver parenchyma on enhanced computed tomography (CT) of the upper abdomen with two concentrations of contrast media (400 and 300 mg I/mL) based on similar iodine delivery rate (IDR) of 0.88 and 0.9 g I/s and iodine load of 450 mg I/kg. Methods: We randomly assigned 160 patients into two groups: iomeprol 400 mg I/mL (A group) and iohexol 300 mg I/mL (B group). The CT attenuation values of the main anatomical structures in the two groups with different scanning phases were measured and the image quality of the two groups was analyzed and compared. The peak pressure and local discomfort (including fever and pain) during contrast medium injection were recorded. Results: The mean attenuation value of the abdominal aorta was 313.6 ± 29.6 in the A group and 322.4 ± 30.1 in the B group during the late arterial phase (p = 0.8). Meanwhile, the mean enhancement values of the portal vein were 176.2 ± 19.3 and 165.9 ± 24.5 in the A and B groups, respectively, during the portal venous phase (p = 0.6). The mean CT values of liver parenchyma were 117.1 ± 15.3 and 108.8 ± 18.7 in the A and B groups, respectively, during the portal venous phase (p = 0.9). There was no statistical difference in image quality, peak injection pressure (psi), and local discomfort between the two groups (p > 0.05). Conclusion: When a similar IDR and the same iodine load are used, CT images with different concentrations of contrast media have the same subjective and objective quality, and can meet the diagnostic needs.
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Kul M, Kuru Öz D, Gürsoy Coruh A, Özalp Ateş F, Gülpınar B, Uzun Ç, Atasoy K. Biphasic split-bolus injection protocol for routine contrast-enhanced chest CT: comparison with conventional early-phase single bolus technique. Br J Radiol 2022; 95:20210775. [PMID: 35171718 PMCID: PMC10996411 DOI: 10.1259/bjr.20210775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 02/03/2022] [Accepted: 02/08/2022] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES To present a routine contrast-enhanced chest CT protocol with a split-bolus injection technique achieving combined early- and delayed phase images with a single aquisition, and to compare this technique with a conventional early-phase single-bolus chest CT protocol we formerly used at our institution, in terms of attenuation of great thoracic vessels, pleura, included hepatic and portal venous enhancement, contrast-related artifacts, and image quality. METHODS A total of 202 patients, who underwent routine contrast-enhanced chest CT examination aquired with either conventional early-phase single-bolus technique (group A,n = 102) or biphasic split-bolus protocol (group B,n = 100), were retrospectively included. Attenuation measurements were made by two radiologists independently on mediastinal window settings using a circular ROI at the following sites: main pulmonary artery (PA) at its bifurcation level, thoracal aorta (TA) at the level of MPA bifurcation,portal vein (PV) at porta hepatis, left and right hepatic lobe, and if present, thickened pleura (>2 mm) at the level with the most intense enhancement. Respective normalized enhancement values were also calculated. Contrast-related artifacts were graded and qualitative evaluation of mediastinal lymph nodes was performed by both reviewers independently. Background noise was measured and contrast-to-noise ratios (CNRs) of the liver and TA were calculated. RESULTS While enhancement of thoracic vessels and normalised MPA enhancement did not differ significantly between both groups (p > 0.05), enhancement and normalised enhancement of pleura, liver parenchyma and PV was significantly greater in group B (p < 0.001). Perivenous artifacts limiting evaluation were less frequent in group B than in A and mediastinal lymph nodes were judged to be evaluated worse in group A than in group B with an excellent agreement between both observers. No significant difference was detected in CNRTA (p = 0.633), whereas CNR liver was higher in group B (p < 0.001). CONCLUSION Our split-bolus chest CT injection protocol enables simultaneous enhancement for both vascular structures and soft tissues, and thus, might raise diagnostic confidence without the need of multiple acquisitions. ADVANCES IN KNOWLEDGE We think that this CT protocol might also be a promising alternative in lung cancer staging, where combined contrast-enhanced CT of the chest and abdomen is indicated. We therefore suggest to further evaluate its diagnostic utility in this setting, in particular in comparison with a late delayed chest-upper abdominal CT imaging protocol.
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Affiliation(s)
- Melahat Kul
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | - Diğdem Kuru Öz
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | | | - Funda Özalp Ateş
- Department of Biostatistics, School of Medicine, Manisa Celal
Bayar University, Manisa,
Turkey
| | - Başak Gülpınar
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | - Çağlar Uzun
- Department of Radiology, School of Medicine, Ankara
University, Ankara,
Turkey
| | - K.Çetin Atasoy
- Department of Radiology, School of Medicine, Koç
University, İstanbul,
Turkey
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Costa AF, Peet K. Contrast media injection protocol for portovenous phase abdominal CT: does a fixed injection duration improve hepatic enhancement over a fixed injection rate? Abdom Radiol (NY) 2021; 46:2968-2975. [PMID: 33386915 DOI: 10.1007/s00261-020-02919-3] [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: 10/14/2020] [Revised: 12/10/2020] [Accepted: 12/12/2020] [Indexed: 11/28/2022]
Abstract
PURPOSE To assess whether a fixed contrast media (CM) injection duration improves the magnitude and inter-patient variability in hepatic enhancement over a fixed injection rate. METHODS Outpatients who underwent portovenous phase abdominal CT (fixed duration, February-November 2018; fixed rate, January-July 2020) with 1.22 mL/kg iohexol 350 were included. Subjects with liver, kidney or heart disease were excluded. The number of subjects and injection protocols were as follows: fixed duration arm, 56 women, 60 men, 35 s injection duration; fixed rate arm, 66 women, 62 men, 3 mL/s injection rate. Liver attenuation measurements were obtained from regions of interest on pre- and post-contrast images. Mean hepatic enhancement (MHE) and MHE normalized to iodine dose (MHE/I) were compared (unpaired t-tests and F-tests). RESULTS There was no statistically significant difference in age, weight, body mass index or CM dosing (p > 0.05). Enhancement indices were significantly lower in the fixed rate group as compared to the fixed duration group, as follows: MHE, 50.0 ± 12 vs. 54.8 ± 11 HU (p = 0.001); and MHE/I, 1.53 ± 0.43 vs. 1.66 ± 0.51 HU/g, (p = 0.04). However, there was no significant difference in the variances of MHE (p = 0.51) and MHE/I (p = 0.08). CONCLUSION A fixed CM injection duration yields a greater magnitude in hepatic enhancement indices than a fixed injection rate. Inter-patient variability in hepatic enhancement indices do not significantly differ between the two injection protocols.
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Affiliation(s)
- 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.
| | - Kris Peet
- 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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CT based radiomic approach on first line pembrolizumab in lung cancer. Sci Rep 2021; 11:6633. [PMID: 33758304 PMCID: PMC7988058 DOI: 10.1038/s41598-021-86113-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 02/24/2021] [Indexed: 02/06/2023] Open
Abstract
Clinical evaluation poorly predicts outcomes in lung cancer treated with immunotherapy. The aim of the study is to assess whether CT-derived texture parameters can predict overall survival (OS) and progression-free survival (PFS) in patients with advanced non-small-cell lung cancer (NSCLC) treated with first line Pembrolizumab. Twenty-one patients with NSLC were prospectively enrolled; they underwent contrast enhanced CT (CECT) at baseline and during Pembrolizumab treatment. Response to therapy was assessed both with clinical and iRECIST criteria. Two radiologists drew a volume of interest of the tumor at baseline CECT, extracting several texture parameters. ROC curves, a univariate Kaplan-Meyer analysis and Cox proportional analysis were performed to evaluate the prognostic value of texture analysis. Twelve (57%) patients showed partial response to therapy while nine (43%) had confirmed progressive disease. Among texture parameters, mean value of positive pixels (MPP) at fine and medium filters showed an AUC of 72% and 74% respectively (P < 0.001). Kaplan-Meyer analysis showed that MPP < 56.2 were significantly associated with lower OS and PFS (P < 0.0035). Cox proportional analysis showed a significant correlation between MPP4 and OS (P = 0.0038; HR = 0.89[CI 95%:0.83,0.96]). In conclusion, MPP could be used as predictive imaging biomarkers of OS and PFS in patients with NSLC with first line immune treatment.
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Caruso D, Rosati E, Panvini N, Rengo M, Bellini D, Moltoni G, Bracci B, Lucertini E, Zerunian M, Polici M, De Santis D, Iannicelli E, Anibaldi P, Carbone I, Laghi A. Optimization of contrast medium volume for abdominal CT in oncologic patients: prospective comparison between fixed and lean body weight-adapted dosing protocols. Insights Imaging 2021; 12:40. [PMID: 33743100 PMCID: PMC7981367 DOI: 10.1186/s13244-021-00980-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Accepted: 02/26/2021] [Indexed: 11/25/2022] Open
Abstract
Background Patient body size represents the main determinant of parenchymal enhancement and by adjusting the contrast media (CM) dose to patient weight may be a more appropriate approach to avoid a patient over dosage of CM. To compare the performance of fixed-dose and lean body weight (LBW)-adapted contrast media dosing protocols, in terms of image quality and parenchymal enhancement. Results One-hundred cancer patients undergoing multiphasic abdominal CT were prospectively enrolled in this multicentric study and randomly divided in two groups: patients in fixed-dose group (n = 50) received 120 mL of CM while in LBW group (n = 50) the amount of CM was computed according to the patient’s LBW. LBW protocol group received a significantly lower amount of CM (103.47 ± 17.65 mL vs. 120.00 ± 0.00 mL, p < 0.001). Arterial kidney signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) and pancreatic CNR were significantly higher in LBW group (all p ≤ 0.004). LBW group provided significantly higher arterial liver, kidney, and pancreatic contrast enhancement index (CEI) and portal venous phase kidney CEI (all p ≤ 0.002). Significantly lower portal vein SNR and CNR were observed in LBW-Group (all p ≤ 0.020). Conclusions LBW-adapted CM administration for abdominal CT reduces the volume of injected CM and improves both image quality and parenchymal enhancement.
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Affiliation(s)
- Damiano Caruso
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Elisa Rosati
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Nicola Panvini
- Diagnostic Imaging Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Marco Rengo
- Diagnostic Imaging Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Davide Bellini
- Diagnostic Imaging Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Giulia Moltoni
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Benedetta Bracci
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Elena Lucertini
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Marta Zerunian
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Michela Polici
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Domenico De Santis
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Elsa Iannicelli
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Paolo Anibaldi
- Hospital Direction and Clinical Departments, Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy
| | - Iacopo Carbone
- Diagnostic Imaging Unit, Department of Medico-Surgical Sciences and Biotechnologies, ICOT Hospital, "Sapienza" University of Rome, Via Franco Faggiana, 1668, 04100, Latina, Italy
| | - Andrea Laghi
- Radiology Unit, Department of Surgical and Medical Sciences and Translational Medicine, Sapienza University of Rome - Sant'Andrea University Hospital, Via di Grottarossa, 1035-1039, 00189, Rome, Italy.
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Badia S, Picchia S, Bellini D, Ferrari R, Caruso D, Paolantonio P, Carbone I, Laghi A, Rengo M. The Role of Contrast-Enhanced Imaging for Colorectal Cancer Management. CURRENT COLORECTAL CANCER REPORTS 2019. [DOI: 10.1007/s11888-019-00443-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Best Protocol for Combined Contrast-Enhanced Thoracic and Abdominal CT for Lung Cancer: A Single-Institution Randomized Crossover Clinical Trial. AJR Am J Roentgenol 2018; 210:1226-1234. [DOI: 10.2214/ajr.17.19185] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
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11
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Kambadakone AR, Fung A, Gupta RT, Hope TA, Fowler KJ, Lyshchik A, Ganesan K, Yaghmai V, Guimaraes AR, Sahani DV, Miller FH. LI-RADS technical requirements for CT, MRI, and contrast-enhanced ultrasound. Abdom Radiol (NY) 2018; 43:56-74. [PMID: 28940042 DOI: 10.1007/s00261-017-1325-y] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Accurate detection and characterization of liver observations to enable HCC diagnosis and staging using LI-RADS requires a technically adequate imaging exam. To help achieve this objective, LI-RADS has proposed technical requirements for CT, MR, and contrast-enhanced ultrasound of liver. This article reviews the technical requirements for liver imaging, including the description of minimum acceptable technical standards, such as the scanner hardware requirements, recommended dynamic imaging phases, and common technical challenges of liver imaging.
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Affiliation(s)
- Avinash R Kambadakone
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA.
| | - Alice Fung
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Rajan T Gupta
- Department of Radiology, Duke University School of Medicine, Durham, NC, USA
| | - Thomas A Hope
- Department of Radiology, University of California San Francisco, San Francisco, CA, USA
| | - Kathryn J Fowler
- Department of Radiology, Washington University School of Medicine, St Louis, MO, USA
| | - Andrej Lyshchik
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA, USA
| | - Karthik Ganesan
- Department of Radiology, Sir HN Reliance Foundation Hospital and Research Centre, Mumbai, India
| | - Vahid Yaghmai
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Alexander R Guimaraes
- Department of Diagnostic Radiology, Oregon Health and Science University, Portland, OR, USA
| | - Dushyant V Sahani
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, White 270, Boston, MA, 02114, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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12
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Chen W, Li Z, Shuai T, Qian L, Deng L, Liao K, Zhang K, Jia B, Song B. Qualitative and Quantitative Assessment of Abdominal and Pelvic CT Image Quality Using Iopromide With Different Concentrations of Iodine (300 and 370 mg I/mL). AJR Am J Roentgenol 2017; 209:904-910. [PMID: 28726507 DOI: 10.2214/ajr.16.17302] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The purpose of this study was to analyze the quality of MDCT images obtained using iopromide with two different concentrations of iodine (300 and 370 mg I/mL) in daily clinical settings. SUBJECTS AND METHODS Patients from 38 hospitals in China undergoing abdominal or pelvic CT with iopromide were prospectively recruited. MDCT was performed using iopromide with an iodine concentration of 300 or 370 mg I/mL. CT quality image was graded as excellent, good, adequate, and poor. Objective indicators were the contrast-to-noise ratio (CNR) and signal-to-noise ratio (SNR). Outcomes were compared according to organ studied, tumor type (benign vs malignant), saline usage, and type of MDCT (16-MDCT vs 64-MDCT). RESULTS A total of 4506 patients (63.7% men) with a mean (± SD) age of 56.3 ± 14.1 years and mean body mass index (weight in kilograms divided by the square of height in meters) of 23.2 ± 3.3 were included. Iopromide with 300 mg I/mL was used for 3042 patients (67.5%), and 370 mg I/mL was used for 1464 patients (32.2%). A total of 1847 scans (41.0%) had excellent image quality, 2454 (54.5%) had good quality, 176 (3.9%) had adequate quality, and 29 (0.6%) had poor quality. No differences were noted between CT scans that did or did not use saline, 16-MDCT versus 64-MDCT scans, and 300 versus 370 mg I/mL iopromide. Variations in the CNR and SNR were noted between the two iodine concentrations with respect to other parameters examined. CONCLUSION Iopromide with both concentrations of iodine provided acceptable image quality, though according to CNR and SNR, one or the other may provide better quality in different situations.
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Affiliation(s)
- Weixia Chen
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Zhenlin Li
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Tao Shuai
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Lingling Qian
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Liping Deng
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Kai Liao
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Kai Zhang
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Bangsheng Jia
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
| | - Bin Song
- 1 Department of Radiology, West China Hospital, Sichuan University, No. 37, Guoxue Alley, Chengdu, Sichuan Province, P. R. China 610041
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Optimizing Contrast Media Injection Protocols in Computed Tomography Angiography at Different Tube Voltages. J Comput Assist Tomogr 2017; 41:804-810. [DOI: 10.1097/rct.0000000000000613] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Paparo F, Garello I, Bacigalupo L, Marziano A, Galletto Pregliasco A, Rollandi L, Puppo C, Mattioli F, Puntoni M, Rollandi GA. CT of the abdomen: Degree and quality of enhancement obtained with two concentrations of the same iodinated contrast medium with fixed iodine delivery rate and total iodine load. Eur J Radiol 2014; 83:1995-2000. [DOI: 10.1016/j.ejrad.2014.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 07/09/2014] [Accepted: 07/15/2014] [Indexed: 01/21/2023]
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