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Hou Y, Zhu C, Ban G, Shen Z, Liang Y, Chen K, Wang C, Shi H. Advancements and Challenges in the Application of Metal-Organic Framework (MOF) Nanocomposites for Tumor Diagnosis and Treatment. Int J Nanomedicine 2024; 19:6295-6317. [PMID: 38919774 PMCID: PMC11198007 DOI: 10.2147/ijn.s463144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Nanoscale metal-organic frameworks (MOFs) offer high biocompatibility, nanomaterial permeability, substantial specific surface area, and well-defined pores. These properties make MOFs valuable in biomedical applications, including biological targeting and drug delivery. They also play a critical role in tumor diagnosis and treatment, including tumor cell targeting, identification, imaging, and therapeutic methods such as drug delivery, photothermal effects, photodynamic therapy, and immunogenic cell death. The diversity of MOFs with different metal centers, organics, and surface modifications underscores their multifaceted contributions to tumor research and treatment. This review is a summary of these roles and mechanisms. The final section of this review summarizes the current state of the field and discusses prospects that may bring MOFs closer to pharmaceutical applications.
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Affiliation(s)
- Yingze Hou
- School of Intelligent Medical Engineering, Sanquan College of Xinxiang Medical University, Xinxiang, 453003, People’s Republic of China
- Clinical Medical College, Sanquan College of Xinxiang Medical University, Xinxiang, 453003, People’s Republic of China
| | - Can Zhu
- Department of Urology, The Second Clinical Medical College of Anhui Medical University, Hefei, 230032, People’s Republic of China
| | - Ge Ban
- School of Intelligent Medical Engineering, Sanquan College of Xinxiang Medical University, Xinxiang, 453003, People’s Republic of China
| | - Zhean Shen
- Heart Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310000, People’s Republic of China
| | - Yingbing Liang
- Department of Chemistry and Biotechnology, Graduate School of Engineering Tottori University Koyama-Minami 4-101, Tottori, 680-8552, Japan
| | - Kun Chen
- School of Intelligent Medical Engineering, Sanquan College of Xinxiang Medical University, Xinxiang, 453003, People’s Republic of China
| | - Chenbo Wang
- School of Intelligent Medical Engineering, Sanquan College of Xinxiang Medical University, Xinxiang, 453003, People’s Republic of China
| | - Heng Shi
- Heart Center, The Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, 310000, People’s Republic of China
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Gao Y, Xie H, Chang CW, Peng J, Pan S, Qiu RLJ, Wang T, Ghavidel B, Roper J, Zhou J, Yang X. CT-based synthetic iodine map generation using conditional denoising diffusion probabilistic model. Med Phys 2024. [PMID: 38889368 DOI: 10.1002/mp.17258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Revised: 04/17/2024] [Accepted: 06/03/2024] [Indexed: 06/20/2024] Open
Abstract
BACKGROUND Iodine maps, derived from image-processing of contrast-enhanced dual-energy computed tomography (DECT) scans, highlight the differences in tissue iodine intake. It finds multiple applications in radiology, including vascular imaging, pulmonary evaluation, kidney assessment, and cancer diagnosis. In radiation oncology, it can contribute to designing more accurate and personalized treatment plans. However, DECT scanners are not commonly available in radiation therapy centers. Additionally, the use of iodine contrast agents is not suitable for all patients, especially those allergic to iodine agents, posing further limitations to the accessibility of this technology. PURPOSE The purpose of this work is to generate synthetic iodine map images from non-contrast single-energy CT (SECT) images using conditional denoising diffusion probabilistic model (DDPM). METHODS One-hundered twenty-six head-and-neck patients' images were retrospectively investigated in this work. Each patient underwent non-contrast SECT and contrast DECT scans. Ground truth iodine maps were generated from contrast DECT scans using commercial software syngo.via installed in the clinic. A conditional DDPM was implemented in this work to synthesize iodine maps. Three-fold cross-validation was conducted, with each iteration selecting the data from 42 patients as the test dataset and the remainder as the training dataset. Pixel-to-pixel generative adversarial network (GAN) and CycleGAN served as reference methods for evaluating the proposed DDPM method. RESULTS The accuracy of the proposed DDPM was evaluated using three quantitative metrics: mean absolute error (MAE) (1.039 ± 0.345 mg/mL), structural similarity index measure (SSIM) (0.89 ± 0.10) and peak signal-to-noise ratio (PSNR) (25.4 ± 3.5 db) respectively. Compared to the reference methods, the proposed technique showcased superior performance across the evaluated metrics, further validated by the paired two-tailed t-tests. CONCLUSION The proposed conditional DDPM framework has demonstrated the feasibility of generating synthetic iodine map images from non-contrast SECT images. This method presents a potential clinical application, which is providing accurate iodine contrast map in instances where only non-contrast SECT is accessible.
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Affiliation(s)
- Yuan Gao
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Huiqiao Xie
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Chih-Wei Chang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Junbo Peng
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Shaoyan Pan
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Richard L J Qiu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Tonghe Wang
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Beth Ghavidel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Justin Roper
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Waldron JL, Glennon CM, Kroshinsky DA, Khan DA, Wolfson AR. Drug Allergy Mimics. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:1122-1129.e1. [PMID: 38325764 DOI: 10.1016/j.jaip.2024.01.047] [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: 10/18/2023] [Revised: 01/10/2024] [Accepted: 01/29/2024] [Indexed: 02/09/2024]
Abstract
When approaching a case of apparent drug allergy, the consulting clinician should consider a broad differential diagnosis. This article presents a series of cases that could be commonly referred to an allergist for assessment as "drug allergy," however, a real diagnosis exists that mandates a different diagnostic and treatment strategy, including a case of inducible laryngeal obstruction, multiple drug intolerance syndrome, viral rash, seizure due to metastatic malignancy, and hemophagocytic lymphohistiocytosis initially diagnosed as drug reaction and eosinophilia with systemic symptoms. The initial misdiagnoses of these patients delayed or interfered with their medical care, emphasizing the importance of accurate diagnoses for the benefit of our patients.
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Affiliation(s)
- Jamie L Waldron
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass
| | - Colleen M Glennon
- Department of Dermatology, Duke University Medical Center, Durham, NC
| | | | - David A Khan
- Department of Internal Medicine, Division of Allergy & Immunology, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Anna R Wolfson
- Harvard Medical School, Boston, Mass; Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Mass; Massachusetts General Physicians Organization, Massachusetts General Hospital, Boston, Mass.
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Joaquim J, Matos C, Mateos-Campos R. Iopromide safety assessment in a radiology department: A seven-year retrospective characterization of adverse events. INTERNATIONAL JOURNAL OF RISK & SAFETY IN MEDICINE 2024; 35:117-129. [PMID: 37807788 DOI: 10.3233/jrs-230021] [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: 10/10/2023]
Abstract
BACKGROUND Since the mid-20th century, contrast agents have been widely used in radiology due to their ability to provide high-definition radiographic images and greater precision in diagnostic exams. Different types of contrast agents are used in image diagnosis, namely radiological media. Despite being considered safe, there are still uncertainties about their safety profile, interactions, and incidence of adverse drug reactions in real-world settings. OBJECTIVE To characterise the pattern of adverse events, during 7 years, in a radiology unit. METHODS We performed a retrospective observational and descriptive study at an Image Center in Portugal between August 2012 and October 2019. A total of 77,449 computed tomography (CT) were registered, and from those 15,640 cases of iopromide were used as a contrast agent. The authors have accessed, under the authorization, the data of adverse events and procedures after the event. RESULTS Most of the hypersensitivity events were immediate or with a short time of onset, with the majority of cases developing events with skin involvement and mild degree, where the most common events were papules (n = 60), pruritus (n = 42), erythema (n = 27) and urticaria (n = 14). Severe events, including hypersensitivity, were mainly represented by vomiting (n = 11), stridor (n = 8), breathing difficulties (n = 7) and syncope (n = 3). Abdominal-pelvic CT exam presented a higher frequency of adverse events. CONCLUSION Despite all the current information about iopromide usage, the utilization of this agent is not abstent of risks and its safety profile not fully established. Most frequent symptoms were local, as skin adverse events, including papules, pruritus and erythema. Common medications used to treat or control adverse events were frequently hydrocortisone, clemastine and methylprednisolone.
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Affiliation(s)
- João Joaquim
- Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal
- Department of Pharmaceutical Sciences, Pharmacy Faculty, University of Salamanca (USAL), Salamanca, Spain
| | - Cristiano Matos
- Polytechnic Institute of Coimbra, Coimbra Health School, Coimbra, Portugal
| | - Ramona Mateos-Campos
- Area of Preventive Medicine and Public Health, Department of Biomedical and Diagnostic Sciences, University of Salamanca, Salamanca, Spain
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Jia Y, Szewczyk-Bieda M, Greenhalgh R, Drinkwater K. Preventing post-contrast acute kidney injury and hypersensitivity reactions: UK national audit. Clin Radiol 2023; 78:e898-e907. [PMID: 37612224 DOI: 10.1016/j.crad.2023.07.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 07/06/2023] [Accepted: 07/23/2023] [Indexed: 08/25/2023]
Abstract
AIM To audit UK radiology departmental protocols related to the prevention of Iodine-based contrast media (ICM) adverse drug reactions (ADRs) and to assess their compliance with the Royal College of Radiologists (RCR) endorsed Royal Australian and New Zealand College of Radiologists' 2018 Iodinated Contrast Guidelines. MATERIALS AND METHODS Questionnaires were sent to all UK acute National Health Service (NHS) providers treating adult patients with an audit lead registered with the RCR (162 providers encompassing 211 hospital radiology departments). The questionnaire included three main sections: renal function screening, renal protection regimens, and hypersensitivity reactions prevention and follow-up. Data collection was conducted between April and July 2022. RESULTS Sixty-one per cent (129/211) of departments responded, representing 67% of eligible providers. An independent imaging services provider supplied one additional set of data (n=130 overall). Of the responding departments, for post-contrast acute kidney injury (PC-AKI), 41% and 56% had the recommended risk assessment for inpatients and outpatients, respectively. Renal function testing was often over-utilised, and their results were applied improperly. Sixty-eight per cent of departments used the advised threshold for considering renal protection. For hypersensitivity reactions, 9% of departments had the correct risk assessment. Thirty-six per cent of departments had the correct risk mitigation protocol for identified high-risk patients. The documentation and follow-up for hypersensitivity reactions were similarly inadequate. CONCLUSION Local protocols on preventing ICM ADRs were largely non-compliant with RCR guidelines. Departments need to update their protocols in line with current evidence to avoid iatrogenic morbidity or unnecessary tests and over-precaution.
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Affiliation(s)
- Y Jia
- Department of Medicine, Imperial College London, London, UK.
| | - M Szewczyk-Bieda
- Department of Clinical Radiology, Ninewells Hospital, NHS Tayside, Dundee, UK
| | - R Greenhalgh
- Department of Radiology, London North West University Healthcare NHS Trust, London, UK
| | - K Drinkwater
- Directorate of Education and Professional Practice, The Royal College of Radiologists, London, UK
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Asch D, Callahan MJ, Thomas KL, Desai S, Pahade JK. Management of Severe Allergic-Like Contrast Media Reactions: Pitfalls and Strategies, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol 2023. [PMID: 37818959 DOI: 10.2214/ajr.23.30044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/13/2023]
Abstract
Adverse reactions to contrast media are often high-acuity events that are uncommon potentially life-threatening. Nonetheless, these events are treatable, and radiologists may be called upon to manage a contrast media reaction. However, because these events are infrequent, they are prone to management errors. This article highlights common pitfalls and practical tips for the management of acute contrast media reactions in children and adults. Recognition of frequent management errors and implementation of the mitigation strategies presented can ameliorate risk and improve patient outcomes. These measures include proper training on reaction management and medication administration, the prompt use of IM epinephrine autoinjectors whenever a severe allergic-like reaction is suspected, the use of visual aids for quick reference in the setting of a reaction, and the recognition of adverse events that are not allergic-like reactions, which commonly require only supportive care.
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Affiliation(s)
- Daniella Asch
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | | | - Kerry L Thomas
- University of North Carolina at Chapel Hill, School of Medicine, Department of Radiology
| | - Sagar Desai
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
| | - Jay K Pahade
- Department of Radiology & Biomedical Imaging, Yale School of Medicine
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Sullivan CM, Paul NS, Rieder MJ. Bridging the gap between bench and clinic: the importance of understanding the mechanism of iodinated contrast media hypersensitivity. Br J Radiol 2023; 96:20220494. [PMID: 36395475 PMCID: PMC10997019 DOI: 10.1259/bjr.20220494] [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: 05/10/2022] [Revised: 10/28/2022] [Accepted: 11/09/2022] [Indexed: 11/18/2022] Open
Abstract
Since the advent of CT, iodinated contract media (ICM) has become one of the most regularly administered intravenous medications in clinical settings. Although considered generally safe, ICM is one of the most common causes of adverse drug reactions in clinical practice, accounting for more than 2 million adverse reactions worldwide. Currently, there are few useful tools to diagnose patient hypersensitivity, with the major limitation being the lack of consensus regarding the mechanisms of hypersensitivity to ICM. While there is an overwhelming abundance of literature pertaining to clinical features including incidence, symptomatology, and risk, few studies have further investigated the underlying mechanisms behind their clinical observations. Of the available literature discussing pathophysiology, most primary studies were completed over 20 years ago, since which the molecular characteristics of ICM have changed. Furthermore, many reviews mentioning pathophysiology fail to adequately emphasize the clinical importance of understanding the molecular pathways involved in hypersensitivity. In this review, we aim to emphasize the clinical relevance of pathophysiology as it relates to the prediction and diagnosis of hypersensitivity reactions to ICM. To this end, we will first briefly characterize hypersensitivity reactions to ICM with respect to epidemiology and clinical presentation. We will then present the existing evidence supporting various proposed mechanisms of hypersensitivity, highlighting the gaps that remain in the mechanistic delineation of both immediate and delayed reactions. Finally, we discuss the possibility of in vitro testing as a way to predict and diagnose hypersensitivity reactions, pending a more complete elucidation of mechanisms.
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Affiliation(s)
- Caitlin M Sullivan
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
| | - Narinder S Paul
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
| | - Michael J Rieder
- Undergraduate Medicine, Schulich School of Medicine and
Dentistry, University of Western Ontario, London, ON,
Canada
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Gupta A, Sood A, Fuhrer E, Djanashvili K, Agrawal G. Polysaccharide-Based Theranostic Systems for Combined Imaging and Cancer Therapy: Recent Advances and Challenges. ACS Biomater Sci Eng 2022; 8:2281-2306. [PMID: 35513349 DOI: 10.1021/acsbiomaterials.1c01631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Designing novel systems for efficient cancer treatment and improving the quality of life for patients is a prime requirement in the healthcare sector. In this regard, theranostics have recently emerged as a unique platform, which combines the benefits of both diagnosis and therapeutics delivery. Theranostics have the desired contrast agent and the drugs combined in a single carrier, thus providing the opportunity for real-time imaging to monitor the therapy results. This helps in reducing the hazards related to treatment overdose or underdose and gives the possibility of personalized therapy. Polysaccharides, as natural biomolecules, have been widely explored to develop theranostics, as they act as a matrix for simultaneously loading both contrast agents and drugs for their utility in drug delivery and imaging. Additionally, their remarkable physicochemical attributes (biodegradability, satisfactory safety profile, abundance, and diversity in functionality and charge) can be tuned via postmodification, which offers numerous possibilities to develop theranostics with desired characteristics. Hence, we provide an overview of recent advances in polysaccharide matrix-based theranostics for drug delivery combined with magnetic resonance imaging, computed tomography, positron emission tomography, single photon emission computed tomography, and ultrasound imaging. Herein, we also summarize the toxicity assessment of polysaccharides, associated contrast agents, and nanotoxicity along with the challenges and future research directions.
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Affiliation(s)
- Aastha Gupta
- School of Basic Sciences, Indian Institute of Technology Mandi, Himachal Pradesh-175075, India
| | - Ankur Sood
- School of Basic Sciences, Indian Institute of Technology Mandi, Himachal Pradesh-175075, India
| | - Erwin Fuhrer
- School of Computing and Electrical Engineering, Indian Institute of Technology Mandi, Himachal Pradesh-175075, India
| | - Kristina Djanashvili
- Department of Biotechnology, Delft University of Technology, Van der Maasweg 9, 2629 HZ Delft, The Netherlands
| | - Garima Agrawal
- School of Basic Sciences, Indian Institute of Technology Mandi, Himachal Pradesh-175075, India
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Rauch S. Contrast media and side effects. Nucl Med Mol Imaging 2022. [DOI: 10.1016/b978-0-12-822960-6.00189-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Hu T, Oda M, Hayashi Y, Lu Z, Kumamaru KK, Akashi T, Aoki S, Mori K. Aorta-aware GAN for non-contrast to artery contrasted CT translation and its application to abdominal aortic aneurysm detection. Int J Comput Assist Radiol Surg 2021; 17:97-105. [PMID: 34674136 DOI: 10.1007/s11548-021-02492-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 09/03/2021] [Indexed: 01/01/2023]
Abstract
PURPOSE Artery contrasted computed tomography (CT) enables accurate observations of the arteries and surrounding structures, thus being widely used for the diagnosis of diseases such as aneurysm. To avoid the complications caused by contrast agent, this paper proposes an aorta-aware deep learning method to synthesize artery contrasted CT volume form non-contrast CT volume. METHODS By introducing auxiliary multi-resolution segmentation tasks in the generator, we force the proposed network to focus on the regions of aorta and the other vascular structures. Then, the segmentation results produced by the auxiliary tasks were used to extract aorta. The detection of abnormal CT images containing aneurysm was implemented by estimating the maximum axial radius of aorta. RESULTS In comparison with the baseline models, the proposed network with auxiliary tasks achieved better performances with higher peak signal-noise ratio value. In aorta regions which are supposed to be the main region of interest in many clinic scenarios, the average improvement can be up to 0.33dB. Using the synthesized artery contrasted CT, the F score of aneurysm detection achieved 0.58 at slice level and 0.85 at case level. CONCLUSION This study tries to address the problem of non-contrast to artery contrasted CT modality translation by employing a deep learning model with aorta awareness. The auxiliary tasks help the proposed model focus on aorta regions and synthesize results with clearer boundaries. Additionally, the synthesized artery contrasted CT shows potential in identifying slices with abdominal aortic aneurysm, and may provide an option for patients with contrast agent allergy.
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Affiliation(s)
- Tao Hu
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | - Masahiro Oda
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
- Information Strategy Office, Information and Communications, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | - Yuichiro Hayashi
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | - Zhongyang Lu
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan
| | | | - Toshiaki Akashi
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Shigeki Aoki
- Department of Radiology, Juntendo University, Bunkyo-ku, Tokyo, Japan
| | - Kensaku Mori
- Graduate School of Informatics, Nagoya University, Chikusa-ku, Nagoya, Aichi, Japan.
- Research Center for Medical Bigdata, National Institute of Informatics, Chiyoda-ku, Tokyo, Japan.
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Salem HT, Sabek EAS. Value of Coronary Calcium Scoring in Symptomatic and Asymptomatic Coronary Artery Disease Patients. Curr Med Imaging 2021; 17:517-523. [PMID: 33100206 DOI: 10.2174/1573405616666201023142030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 08/08/2020] [Accepted: 09/15/2020] [Indexed: 11/22/2022]
Abstract
AIM AND OBJECTIVE The study aimed to estimate the relationship between Coronary Calcium Scoring (CCS) and the presence of different degrees of obstructive coronary artery disease (CAD) to avoid unnecessary examinations and hence unnecessary radiation exposure and contrast injection. BACKGROUND Coronary Calcium Scoring (CCS) is a test that uses x-ray equipment to produce pictures of the coronary arteries to determine the degree of its narrowing by the build-up of calcified plaques. Despite the lack of definitive data linking ionizing radiation with cancer, the American Heart Association supports widely that practitioners of Computed tomography Coronary Angiography (CTCA) should keep "patient radiation doses as low as reasonably achievable but consistent with obtaining the desired medical information". METHODS Data obtained from 275 CTCA examinations were reviewed. Radiation effective doses were estimated for both CCS and CTCA, and measures to keep them as low as possible were presented. CCS and Framingham risk estimates were compared to obtain the final results of CTCA to detect sensitivity and specificity of each one in detecting obstructive lesions. RESULTS CCS is a strong discriminator for obstructive CAD with high sensitivity and specificity and correlates well with the degree of obstruction even more than Framingham risk estimate, which has high sensitivity and low specificity. CONCLUSION CCS helps to reduce the effective radiation dose if properly evaluated to skip unnecessary CTCA if obstructive lesions are unlikely, and this as a test does not use contrast material, thus harmful effect on the kidney will be avoided as most of the coronary atherosclerotic patients have renal problems.
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Affiliation(s)
- Hala T Salem
- Department of Health and Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
| | - Eman A S Sabek
- Department of Health and Radiation Research, National Center for Radiation Research and Technology (NCRRT), Egyptian Atomic Energy Authority (EAEA), Cairo, Egypt
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Koh E, Kim YJ, Kang N, Jin SR, Lee JY, Eo H, Choi DC, Lee BJ. Incidence of adverse drug reaction among 6 iodinated contrast media. ALLERGY ASTHMA & RESPIRATORY DISEASE 2021. [DOI: 10.4168/aard.2021.9.2.84] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Eunsil Koh
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yu Jin Kim
- Radiology Nursing Department, Samsung Medical Center, Seoul, Korea
| | - Noeul Kang
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Seong-Rye Jin
- Radiology Nursing Department, Samsung Medical Center, Seoul, Korea
| | - Jin-Young Lee
- Health Promotion Center, Samsung Medical Center, Seoul, Korea
| | - Hong Eo
- Department of Radiology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Dong-Chull Choi
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Byung-Jae Lee
- Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Nam SY, Ahn SJ, Jang YR, Chun YS, Park HK, Choi SJ, Choi HY, Kim JH. Diagnostic accuracy of non-contrast abdominopelvic computed tomography scans in follow-up of breast cancer patients. Br J Radiol 2020; 94:20201087. [PMID: 33306919 DOI: 10.1259/bjr.20201087] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the effectiveness of follow-up with non-enhanced CT (NECT) in patients with breast cancer. METHODS The present retrospective study included 1396 patients with breast cancer. Group A included patients with no metastasis to evaluate the diagnostic performance of NECT in detecting newly developed metastasis. Group B included patients with known hepatic metastasis to evaluate the accuracy of NECT for the assessment of hepatic metastasis. RESULTS Group A included 895 patients (mean age 52.8 years). Among them, 145 patients had 160 metastases. The per-patient sensitivities for diagnosing newly developed metastasis were 68.3 and 53.8% according to the two reviewers, while the per-lesion sensitivities were 89.4 and 85.0%. Sensitivities for bone metastasis were 98.9 and 95.9%, while sensitivities for hepatic metastasis were 73.7 and 68.4%. In group B, the accuracy of hepatic metastasis response evaluation according to the RECIST criteria was 70.8% for reviewer 1 and 63.8% for reviewer 2. CONCLUSIONS NECT showed inadequate diagnostic performance in detecting newly developed metastasis and in evaluating the response of hepatic metastasis. However, NECT can be utilized as a follow-up modality in patients with decreased renal function or hypersensitivity to iodinated contrast media. ADVANCES IN KNOWLEDGE The risk of side effects of contrast media should be considered as important when NECT can be utilized as a follow-up modality in decreased renal function patients.
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Affiliation(s)
- Sang Yu Nam
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Su Joa Ahn
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Young Rock Jang
- Department of Internal Medicine, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Yong Soon Chun
- Department of Surgery Breast Cancer Center, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Heung Kyu Park
- Department of Surgery Breast Cancer Center, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Seung Joon Choi
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Hye Young Choi
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
| | - Jeong Ho Kim
- Department of Radiology, Gil Medical Center of Gachon University, Incheon, South Korea
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Iordache AM, Docea AO, Buga AM, Mitrut R, Albulescu D, Zlatian O, Ianosi S, Ianosi G, Neagoe D, Sifaki M, Rogoveanu OC, Branisteanu DE, Calina D. The incidence of skin lesions in contrast media-induced chemical hypersensitivity. Exp Ther Med 2018; 17:1113-1124. [PMID: 30679982 PMCID: PMC6327547 DOI: 10.3892/etm.2018.7056] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Accepted: 10/08/2018] [Indexed: 12/18/2022] Open
Abstract
Contrast agents are used in radiology to increase the sensibility and specificity of radiological techniques. Some of these compounds have side effects that include organ toxicity (with kidney being the most affected organ) and hypersensitivity reactions. We performed multiple PubMed searches from January, 2008 to January, 2018 for studies regarding adverse reactions to compounds used as contrast agents in imagistic techniques. The initial research identified 929 records written in English. After further excluding 223 non-human studies, 292 articles that had irrelevant designs as reviews, meta-analysis, commentaries, editorials and case reports, 414 studies were selected for retrieval. After reading the abstracts, we excluded 363 studies as they had little relevance to the study. In total, 51 full-articles were assessed for eligible studies to be included. Finally, 20 articles were included in the analysis. In our systematic literature search the incidence of overall skin immediate reactions to iodinated contrast media (ICM) had an incidence between 1.15 and 0.12%, depending on the cohort analyzed in the studies. The percentage of cutaneous manifestations in the cohort that experienced immediate hypersensitivity reactions was between 33.33 and 87.7%. The most frequent skin manifestations were urticaria, rashes, pruritus and limited facial edema. Non-iodinated contrast agents have a safer profile compared with ICM, the incidence of immediate adverse reactions being very low in gadolinium-based contrast agents and other agents used for contrast-enhanced ultrasound. The incidence of delayed reactions was between 10.1 and 0.03%. In the studies analyzed by us the main adverse reactions due to delayed hypersensitivity phenomena were cutaneous manifestations that were present between 70.27 and 100% of the cases. Regarding the risk factors for developing immediate adverse reactions, being female was a predisposing factor accompanied by history of allergy and history of reactions to contrast media. An accurate anamnesis of the patients and a correctly conducted pretreatment can limit the incidence and the severity of the adverse reactions and also can avoid the life occurrence of life-threatening reactions.
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Affiliation(s)
- Andrei Mihai Iordache
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Anca Oana Docea
- Department of Toxicology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ana Maria Buga
- Department of Biochemistry, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Radu Mitrut
- Department of Cardiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Dana Albulescu
- Department of Radiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Ovidiu Zlatian
- Department of Microbiology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Simona Ianosi
- Department of Dermatology, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Gabriel Ianosi
- Department of Surgery, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Daniela Neagoe
- Department of Internal Medicine, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | - Maria Sifaki
- Laboratory of Toxicology, Medical School, University of Crete, 71003 Heraklion, Crete, Greece
| | - Otilia Constantina Rogoveanu
- Department of Physical Medicine and Rehabilitation, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
| | | | - Daniela Calina
- Department of Clinical Pharmacy, University of Medicine and Pharmacy of Craiova, 200349 Craiova, Romania
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Boyd B, Zamora CA, Castillo M. Managing Adverse Reactions to Contrast Agents. Magn Reson Imaging Clin N Am 2018; 25:737-742. [PMID: 28964463 DOI: 10.1016/j.mric.2017.06.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Adverse reactions to iodinated and gadolinium-based contrast agents occur at an incidence of less than 1%. Although the exact pathophysiologic mechanisms are not completely understood, the treatment regimens are well accepted. Skin testing may be helpful in patients with a history of severe allergiclike reaction to aid in the selection of alternative contrast agents. Premedication should only be used for a history of allergiclike reaction. Imaging team members should be familiar with signs and symptoms of contrast reactions to allow for prompt assessment and treatment. A plan of action should be in place for contrast reactions and rehearsed regularly.
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Affiliation(s)
- Brian Boyd
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, 2107 Old Clinic Building, Campus Box 7510, Chapel Hill, NC 27599-7510, USA.
| | - Carlos A Zamora
- Division of Neuroradiology, Department of Radiology, University of North Carolina School of Medicine, 3320 Old Infirmary, Campus Box 7510, Chapel Hill, NC 27599-7510, USA
| | - Mauricio Castillo
- Department of Radiology, University of North Carolina School of Medicine, 3326 Old Infirmary, Campus Box 7510, Chapel Hill, NC 27599-7510, USA
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16
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Kim MJ, Lee BR, Choi YH, Kang DY, Kang HR, Suh DI. Clinical characteristics of adverse reaction to radiocontrast media in children - A single center experience. ALLERGY ASTHMA & RESPIRATORY DISEASE 2018. [DOI: 10.4168/aard.2018.6.6.315] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Min Jung Kim
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Bo Ra Lee
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Young Hun Choi
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Dong Yoon Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
- Department of Preventive Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Hye-Ryun Kang
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea
| | - Dong In Suh
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
- Drug Safety Monitoring Center, Seoul National University Hospital, Seoul, Korea
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17
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Andreucci M, Faga T, Serra R, De Sarro G, Michael A. Update on the renal toxicity of iodinated contrast drugs used in clinical medicine. Drug Healthc Patient Saf 2017; 9:25-37. [PMID: 28579836 PMCID: PMC5447694 DOI: 10.2147/dhps.s122207] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
An important side effect of diagnostic contrast drugs is contrast-induced acute kidney injury (CI-AKI; a sudden decrease in renal function) occurring 48-72 hours after injection of a contrast drug that cannot be attributed to other causes. Its existence has recently been challenged, because of some retrospective studies in which the incidence of AKI was not different between subjects who received a contrast drug and those who did not, even using propensity score matching to prevent selection bias. For some authors, only patients with estimated glomerular filtration rate <30 mL/min/1.73 m2 are at significant risk of CI-AKI. Most agree that when renal function is normal, there is no CI-AKI risk. Many experimental studies, however, are in favor of the existence of CI-AKI. Contrast drugs have been shown to cause the following changes: renal vasoconstriction, resulting in a rise in intrarenal resistance (decrease in renal blood flow and glomerular filtration rate and medullary hypoxia); epithelial vacuolization and dilatation and necrosis of proximal tubules; potentiation of angiotensin II effects, reducing nitric oxide (NO) and causing direct constriction of descending vasa recta, leading to formation of reactive oxygen species in isolated descending vasa recta of rats microperfused with a solution of iodixanol; increasing active sodium reabsorption in the thick ascending limbs of Henle's loop (increasing O2 demand and consequently medullary hypoxia); direct cytotoxic effects on endothelial and tubular epithelial cells (decrease in release of NO in vasa recta); and reducing cell survival, due to decreased activation of Akt and ERK1/2, kinases involved in cell survival/proliferation. Prevention is mainly based on extracellular volume expansion, statins, and N-acetylcysteine; conflicting results have been obtained with nebivolol, furosemide, calcium-channel blockers, theophylline, and hemodialysis.
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Affiliation(s)
| | | | - Raffaele Serra
- Interuniversity Center of Phlebolymphology (CIFL), International Research and Educational Program in Clinical and Experimental Biotechnology, Department of Medical and Surgical Sciences
| | - Giovambattista De Sarro
- Pharmacology Unit, Department of Health Sciences, Magna Graecia University, Catanzaro, Italy
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18
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Non-ionic iodinated contrast media related immediate reactions: A mechanism study of 27 patients. Leg Med (Tokyo) 2017; 24:56-62. [DOI: 10.1016/j.legalmed.2016.11.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Revised: 11/01/2016] [Accepted: 11/27/2016] [Indexed: 11/18/2022]
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19
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Heshmatzadeh Behzadi A, Prince MR. Preventing Allergic Reactions to Gadolinium-Based Contrast Agents. Top Magn Reson Imaging 2016; 25:275-279. [PMID: 27748715 DOI: 10.1097/rmr.0000000000000106] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Although the low incidence of immediate-type gadolinium-based contrast agent (GBCA) allergic reactions is widely known, preventing these reactions and properly managing them to reduce their adverse sequel can improve the already exceedingly favorable GBCA safety profile. This review article should help those who order, supervise, or administer GBCA contrast agents, including recognizing and handling allergic reaction risks intrinsic to their use. Areas of focus include factors indicating increased allergic reaction risk, patient selection strategies, skin testing, premedication, and treatment of adverse events.
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Affiliation(s)
- Ashkan Heshmatzadeh Behzadi
- *Department of Radiology, Weill Cornell Medical Center †Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY
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20
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Should patients with risk factors be tested for hypersensitivity to contrast media: a prospective study. Radiol Med 2016; 121:660-6. [PMID: 27117293 DOI: 10.1007/s11547-016-0646-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2016] [Accepted: 04/18/2016] [Indexed: 12/18/2022]
Abstract
BACKGROUND Previous hypersensitivity reactions to contrast media (CM), atopy, atopic disease, drug allergy, and age (20-29 or >55) are risk factors for CM hypersensitivity reactions. Our aim was to evaluate whether these risk factors should prompt skin testing for diagnosing CM allergy. METHODS The study was conducted among patients referred for allergy testing with CM. Skin tests were performed with non ionic or gadolinium CM, recommended by a radiologist. After completion of tests patients were telephonically queried on their symptoms of reactions. RESULTS 151 risk patients (53 men, 98 women; mean age 55.2) were included in the study. Only 13 (9 %) had a history of hypersensitivity reaction to CM. Compared with the other patients, atopy was significantly more common in patients with a history of CM hypersensitivity reactions. Female gender and mean age were also higher, but not significant. All of the tests with CMs were negative. Only one patient reported urticaria within 1-2 min after administration of CM (telephonically). CONCLUSIONS Atopy can increase the risk of CM allergy. However, skin tests with CMs may be inefficient, unnecessary, and time-consuming, except in cases with a history of CM allergy. Premedication protocols appear to be beneficial in patients with a history of CM allergy and cannot be recommended for patients with well-controlled asthma, rhinitis, atopic dermatitis or history of drug allergy.
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21
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Park BB, Park CH, Nho IY, Kim HS, Kang NK, Chang SI, Kim JM. Prevalence and clinical features of hypersensitivity reaction to contrast media after prescreening skin test. ALLERGY ASTHMA & RESPIRATORY DISEASE 2016. [DOI: 10.4168/aard.2016.4.6.442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Affiliation(s)
- Bo Bae Park
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - Chang Han Park
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - In Young Nho
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - Hae Sung Kim
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - Nam Kyu Kang
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - Suk Il Chang
- Department of Internal Medicine, Sung-Ae General Hospital, Seoul, Korea
| | - Jang Min Kim
- Department of Radiology, Sung-Ae General Hospital, Seoul, Korea
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22
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Beckett KR, Moriarity AK, Langer JM. Safe Use of Contrast Media: What the Radiologist Needs to Know. Radiographics 2015; 35:1738-50. [DOI: 10.1148/rg.2015150033] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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23
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24
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Yoon SH, Lee SY, Kang HR, Kim JY, Hahn S, Park CM, Chang YS, Goo JM, Cho SH. Skin tests in patients with hypersensitivity reaction to iodinated contrast media: a meta-analysis. Allergy 2015; 70:625-37. [PMID: 25649510 DOI: 10.1111/all.12589] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/28/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Patients with a previous history of hypersensitivity reaction (HSR) to iodinated contrast media (ICM) are at high risk of the development of HSR to ICM. Many studies have tried to evaluate the diagnostic potential of skin tests in this population but have not yet reached a common conclusion. We investigated the role of skin tests in patients with HSR to ICM in terms of positive rate, cross-reactivity rate, and tolerability to skin test-negative ICM according to the type of HSR. METHODS We performed literature searches of the MEDLINE and EMBASE databases and included studies where skin tests were performed in patients with HSR to ICM, with extractable outcomes. Outcomes were pooled using a random-effects model. RESULTS Twenty-one studies were included. Pooled per-patient positive rates of skin tests were 17% (95% CI, 10-26%) in patients with immediate HSR, and up to 52% (95% CI, 31-72%) when confined to severe immediate HSR. Among patients with nonimmediate HSR, the positive rate was 26% (95% CI, 15-41%). The pooled per-patient cross-reactivity rate was higher in nonimmediate HSR (68%; 95% CI, 48-83%) than that in immediate HSR (39%; 95% CI, 29-50%). Median per-test cross-reactivity rates between pairs of ICM were 7% (IQR, 6-9%) in immediate HSR and 38% (IQR, 22-51%) in nonimmediate HSR. Pooled per-patient recurrence rates of HSR to skin test-negative ICM were 7% (95% CI, 4-14%) in immediate HSR and 35% (95% CI, 19-55%) in nonimmediate HSR. CONCLUSION Skin tests may be helpful in diagnosing and managing patients with HSR to ICM, especially in patients with severe immediate HSR.
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Affiliation(s)
- S. H. Yoon
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
| | - S.-Y. Lee
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
- Department of Internal Medicine; Seoul National University Bundang Hospital; Seongnam Korea
| | - H.-R. Kang
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - J.-Y. Kim
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
| | - S. Hahn
- Department of Medicine; Seoul National University College of Medicine; Seoul Korea
| | - C. M. Park
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
- Cancer Research Institute; Seoul National University; Seoul Korea
| | - Y.-S. Chang
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University Bundang Hospital; Seongnam Korea
| | - J. M. Goo
- Department of Radiology; Seoul National University College of Medicine; Seoul Korea
- Institute of Radiation Medicine; Seoul National University Medical Research Center; Seoul Korea
- Cancer Research Institute; Seoul National University; Seoul Korea
| | - S.-H. Cho
- Institute of Allergy and Clinical Immunology; Seoul National University Medical Research Center; Seoul Korea
- Department of Internal Medicine; Seoul National University College of Medicine; Seoul Korea
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25
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Anaphylactoid Reactions to the Nonvascular Administration of Water-Soluble Iodinated Contrast Media. AJR Am J Roentgenol 2015; 204:1140-5. [DOI: 10.2214/ajr.15.14507] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Brockow K, Sánchez-Borges M. Hypersensitivity to contrast media and dyes. Immunol Allergy Clin North Am 2015; 34:547-64, viii. [PMID: 25017677 DOI: 10.1016/j.iac.2014.04.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
This article updates current knowledge on hypersensitivity reactions to diagnostic contrast media and dyes. After application of a single iodinated radiocontrast medium (RCM), gadolinium-based contrast medium, fluorescein, or a blue dye, a hypersensitivity reaction is not a common finding; however, because of the high and still increasing frequency of those procedures, patients who have experienced severe reactions are nevertheless frequently encountered in allergy departments. Evidence on allergologic testing and management is best for iodinated RCM, limited for blue dyes, and insufficient for fluorescein. Skin tests can be helpful in the diagnosis of patients with hypersensitivity reactions to these compounds.
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Affiliation(s)
- Knut Brockow
- Department of Dermatology and Allergy Biederstein, Technische Universität München, Biedersteiner Strasse 29, Munich 80802, Germany.
| | - Mario Sánchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico Docente La Trinidad, Clínica El Avila, 6a transversal de Altamira, piso 8, consultorio 803, Caracas 1060, Venezuela
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27
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Siegrist PT, Sumitsuji S, Kumada M, Kaneda H, Tachibana K, Nanto S. Contrast-free diagnosis and treatment of coronary artery disease guided by integrated cardiac imaging: concept and first clinical experience. Cardiovasc Interv Ther 2015; 31:51-5. [PMID: 25612793 DOI: 10.1007/s12928-015-0315-7] [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: 09/30/2014] [Accepted: 01/03/2015] [Indexed: 11/24/2022]
Abstract
The use of iodinated contrast media (ICM) remains a potential hazard for patients undergoing diagnostic cardiac imaging and percutaneous coronary intervention. In particular patients with history of prior adverse reaction to a contrast agent are at a high risk in case of re-exposure, even if designated premedication is administered. Based on a patient with recurrent angina pectoris and history of systemic anaphylactic reaction to ICM, we describe the logical stepwise approach from diagnostic imaging to safe and successful imaging guided percutaneous coronary intervention without the use of contrast agent.
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Affiliation(s)
- Patrick T Siegrist
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka Suita, Osaka, 565-0871, Japan
| | - Satoru Sumitsuji
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka Suita, Osaka, 565-0871, Japan.
| | - Masahiro Kumada
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka Suita, Osaka, 565-0871, Japan
| | - Hideaki Kaneda
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka Suita, Osaka, 565-0871, Japan
| | - Kouichi Tachibana
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka Suita, Osaka, 565-0871, Japan
| | - Shinsuke Nanto
- Department of Advanced Cardiovascular Therapeutics, Osaka University Graduate School of Medicine, 2-2 Yamada-oka Suita, Osaka, 565-0871, Japan
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Influence of iodinated contrast media on the activities of histamine inactivating enzymes diamine oxidase and histamine N-methyltransferase in vitro. Allergol Immunopathol (Madr) 2014; 42:324-8. [PMID: 23578781 DOI: 10.1016/j.aller.2013.01.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2012] [Revised: 01/16/2013] [Accepted: 01/19/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Iodinated contrast media can cause pseudoallergic reactions associated with histamine release in significant numbers of patients. To clarify whether these adverse reactions may be aggravated by a compromised histamine catabolism we asked if radiographic contrast agents in vitro inhibit the histamine inactivating enzymes diamine oxidase (DAO) and histamine N-methyltransferase (HMT). METHODS Nine iodinated contrast agents were tested in vitro. Following pre-incubation of purified porcine kidney DAO and recombinant human HMT with 0.1-10mM of the respective contrast medium (H2O and specific inhibitors of DAO and HMT as controls) enzyme activities were determined by using radiometric micro assays. RESULTS None of the contrast media irrespective of their structure showed significant inhibition of the activities of DAO and HMT. Pre-incubation of the enzymes with specific inhibitors led to complete inhibition of the respective enzymatic activity. CONCLUSIONS The iodinated contrast media tested in vitro did not exhibit inhibition of histamine converting enzymes at physiologically relevant concentrations. However due to the in vitro character of this study these results do not directly reflect the in vivo situation.
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29
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Acute Adverse Reactions to Contrast Media: Mechanisms and Prevention. MEDICAL RADIOLOGY 2014. [DOI: 10.1007/174_2013_926] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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30
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Craig S, Naidoo P. Emergencies in radiology: a survey of radiologists and radiology trainees. J Med Imaging Radiat Oncol 2013; 58:164-71. [PMID: 24118884 DOI: 10.1111/1754-9485.12125] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2013] [Accepted: 07/31/2013] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Emergencies in radiology are infrequent but potentially lethal. Australian and New Zealand radiologists are advised to undergo resuscitation training at least every three years; however, little is known about their experience and confidence in managing common emergencies relevant to their clinical practice. This paper describes the current experience and confidence of radiologists and radiology trainees in Australia and New Zealand in the management of common medical emergencies. METHODS A cross-sectional online survey of trainees and fellows of the Royal Australian and New Zealand College of Radiology collected data on training and learning preferences relating to resuscitation and life-support skills, access to emergency medical care, and knowledge, confidence and ability in managing a variety of medical emergencies. RESULTS There were 602 responses to the survey (response rate 23.4%). The majority of respondents were interested in learning more about the management of contrast reactions, cardiac arrest, ischaemic chest pain and basic life support. Self-rated knowledge, confidence and ability were higher in respondents who had completed life-support training within the previous three years. In this group, however, more than 40% rated their ability at managing contrast reactions as poor or fair, while more than 60% rated their ability as poor or fair for management of cardiac arrest, basic life support, advanced life support and dosing of adrenaline. Preferred resuscitation training modalities included simulation, small-group tutorials and workshops. CONCLUSION Self-reported level of skill and expertise in the management of potential emergencies in radiology is suboptimal among a large number of respondents. Consideration should be given to addressing this by improving access to specific training.
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Affiliation(s)
- Simon Craig
- Emergency Department, Monash Medical Centre, Clayton, Victoria, Australia; Southern Clinical School, Monash University, Clayton, Victoria, Australia
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31
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He SH, Zhang HY, Zeng XN, Chen D, Yang PC. Mast cells and basophils are essential for allergies: mechanisms of allergic inflammation and a proposed procedure for diagnosis. Acta Pharmacol Sin 2013; 34:1270-83. [PMID: 23974516 DOI: 10.1038/aps.2013.88] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Accepted: 06/12/2013] [Indexed: 02/06/2023] Open
Abstract
The current definition of allergy is a group of IgE-mediated diseases. However, a large portion of patients with clinical manifestations of allergies do not exhibit elevated serum levels of IgE (sIgEs). In this article, three key factors, ie soluble allergens, sIgEs and mast cells or basophils, representing the causative factors, messengers and primary effector cells in allergic inflammation, respectively, were discussed. Based on current knowledge on allergic diseases, we propose that allergic diseases are a group of diseases mediated through activated mast cells and/or basophils in sensitive individuals, and allergic diseases include four subgroups: (1) IgE dependent; (2) other immunoglobulin dependent; (3) non-immunoglobulin mediated; (4) mixture of the first three subgroups. According to our proposed definition, pseudo-allergic-reactions, in which mast cell or basophil activation is not mediated via IgE, or to a lesser extent via IgG or IgM, should be non-IgE-mediated allergic diseases. Specific allergen challenge tests (SACTs) are gold standard tests for diagnosing allergies in vivo, but risky. The identification of surface membrane activation markers of mast cells and basophils (CD203c, CCR3, CD63, etc) has led to development of the basophil activation test (BAT), an in vitro specific allergen challenge test (SACT). Based on currently available laboratory allergy tests, we here propose a laboratory examination procedure for allergy.
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Boyacioglu M, Turgut H, Akgullu C, Eryilmaz U, Kum C, Onbasili OA. The effect of L-carnitine on oxidative stress responses of experimental contrast-induced nephropathy in rats. J Vet Med Sci 2013; 76:1-8. [PMID: 23965850 PMCID: PMC3979958 DOI: 10.1292/jvms.13-0202] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study was conducted to investigate the prophylactic effects of carnitine
against contrast-induced nephropathy (CIN) and its relation to oxidant/antioxidant status
in kidney, liver, heart, spleen and lung tissues in a CIN rat model. Twenty-eight adult
male Wistar rats were divided into 4 groups, the control, contrast media (CM), carnitine
and contrast media+carnitine (CM+carnitine) groups. Animals were placed in individual
metabolism cages, and on the 2nd day, rats were deprived of water for 24 hr. On the 3rd
day, contrast media were administered to groups CM and CM+carnitine. L-carnitine was
administered on days 2, 3 and 4. Histopathological changes were evaluated in the right
kidney after euthanization. Superoxide dismutase (SOD) and catalase (CAT) activities and
glutathione (GSH) and malondialdehyde (MDA) levels were measured in renal, liver, heart,
spleen and lung tissues. The SOD activities in the renal (P<0.05),
liver (P<0.001) and spleen (P<0.05) tissues were
increased in the carnitine group. The CAT activities in the spleen tissue were decreased
(P<0.01) only in the CM group. Renal (P<0.05),
liver (P<0.001), spleen (P<0.001) and lung tissue
(P<0.01) GSH levels were found to be higher in the carnitine group.
In renal, liver and lung tissues, the MDA levels increased in the CM group
(P<0.001). The histopathological findings showed that L-carnitine
may have a preventative effect in alleviating the negative effects of CIN. Similar to
this, L-carnitine may play a major role in the stability of the antioxidant status in the
kidney, liver, spleen and lung of the CIN rat model.
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Affiliation(s)
- Murat Boyacioglu
- Department of Pharmacology and Toxicology, Faculty of Veterinary Medicine, Adnan Menderes University, Aydin, Turkey
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Bae YJ, Hwang YW, Yoon SY, Kim S, Lee T, Lee YS, Kwon HS, Cho YS, Shin MJ, Moon HB, Kim TB. The Effectiveness of Automatic Recommending System for Premedication in Reducing Recurrent Radiocontrast Media Hypersensitivity Reactions. PLoS One 2013; 8:e66014. [PMID: 23840391 PMCID: PMC3686826 DOI: 10.1371/journal.pone.0066014] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2013] [Accepted: 04/29/2013] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Non-ionic radiocontrast media (RCM) is rarely associated with hypersensitivity reactions. Premedication of patients who reacted previously to RCM with systemic corticosteroids and/or antihistamines can help reduce recurrent hypersensitivity reactions. However, premedication is still not prescribed in many cases for various reasons. This study aimed to determine the effectiveness of our novel RCM hypersensitivity surveillance and automatic recommending system for premedication. METHODS AND RESULTS Hospitalized patients with a history of RCM hypersensitivity were identified in an electronic medical record system that included a mandatory reporting system for past adverse drug reactions. In 2009, a novel automatic prescription system was added that classified index RCM reactions by severity and dispensed appropriate corticosteroid and/or antihistamine pretreatment prior to new RCM exposures. The data from 12 months under the previous system and 12 months under the current system were compared. The two systems had similar overall premedication rates (91% and 95%) but the current system was associated with a significantly higher corticosteroid premedication rate (65% vs. 14%), which significantly reduced the breakthrough reaction rate (6.7% vs. 15.2%). The current system was also associated with increased corticosteroid and antihistamine premedication of patients with a mild index reaction (61% vs. 7%) and a reduction in their breakthrough reaction rate (6% vs. 15%). CONCLUSIONS Premedication with corticosteroid and/or antihistamine, which was increased by our novel automatic prescription system, significantly reduced breakthrough reactions in patients with a history of RCM hypersensitivity.
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Affiliation(s)
- Yun-Jeong Bae
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Health Medicine, Health Screening and Promotion Center, Asan Medical Center, Seoul, Korea
| | - Ye Won Hwang
- Pharmacovigilance Center, Asan Medical Center, Seoul, Korea
| | - Sun-young Yoon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sujeong Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Taehoon Lee
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yoon Su Lee
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, Seoul, Korea
| | - You Sook Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, Seoul, Korea
| | - Myung Jin Shin
- Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hee-Bom Moon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Bum Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Pharmacovigilance Center, Asan Medical Center, Seoul, Korea
- * E-mail:
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Clinical value of radiocontrast media skin tests as a prescreening and diagnostic tool in hypersensitivity reactions. Ann Allergy Asthma Immunol 2013; 110:258-62. [PMID: 23535089 DOI: 10.1016/j.anai.2013.01.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 01/07/2013] [Accepted: 01/07/2013] [Indexed: 01/12/2023]
Abstract
BACKGROUND Some radiocontrast media (RCM) hypersensitivity reactions may have underlying IgE- or T-cell-mediated mechanisms. RCM skin testing may be useful for predicting future reactions. OBJECTIVE To investigate the clinical value of RCM skin testing before computed tomography and after RCM hypersensitivity reactions. METHODS Patients who underwent RCM skin testing were a prospective sample of convenience at a single medical center and were tested just before their pending nonionic RCM-enhanced computed tomogram. In addition, skin test data of patients who were referred to the allergy clinic because of their previous RCM hypersensitivity reactions were reviewed retrospectively. RESULTS A total of 1048 patients enrolled in the study prospectively. Of these, 672 (64.1%) had never been exposed to RCM. Of the 376 previously exposed to RCM, 61 (16.2%) had a history of at least one mild RCM-associated reaction, 56 (91.8%) had immediate reactions, and 5 had no-immediate reactions. There was only 1 positive immediate hypersensitivity RCM skin test result (0.09%). There were 51 mild immediate reactions (4.9%), 1 moderate immediate reaction (0.09%), 8 mild nonimmediate reactions (0.76%), and 1 moderate nonimmediate reaction (0.09%). There was only 1 positive delayed hypersensitivity skin test result (0.09%), retrospectively determined, in 1 (11.1%) of the nonimmediate RCM-associated reactions. Sensitivity of RCM skin testing was significantly higher with severe immediate reactions (57.1%) than mild reactions (12.9%) and moderate reactions (25.0%) in the retrospective review of diagnostic skin test data (P = .03). CONCLUSION RCM skin testing for screening is of no clinical utility in predicting hypersensitivity reactions. RCM skin testing may have modest utility in retrospectively evaluating severe adverse reactions.
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Böhm I, Heverhagen JT, Klose KJ. Classification of acute and delayed contrast media-induced reactions: proposal of a three-step system. CONTRAST MEDIA & MOLECULAR IMAGING 2012; 7:537-41. [DOI: 10.1002/cmmi.1475] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Ingrid Böhm
- Department of Diagnostic Radiology; Philipps University of Marburg; Marburg; Germany
| | | | - Klaus J. Klose
- Department of Diagnostic Radiology; Philipps University of Marburg; Marburg; Germany
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Arana E, Catalá-López F. Cost–effectiveness of iodinated contrast media for CT scanning in Spain: a decision-based analysis. ACTA ACUST UNITED AC 2012. [DOI: 10.2217/iim.12.9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Kim HH, Choi JY, Oh MK, Kim EY, Ghim JR, Choi SJ, Shin JG. Retrospective Analysis of Adverse Reactions to Iodinated Contrast Media in Korean. ACTA ACUST UNITED AC 2012. [DOI: 10.12793/jkscpt.2012.20.2.165] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Hee Hyun Kim
- Department of Pharmacology, Inje University College of Medicine, Korea
| | - Ji yeob Choi
- Department of Biomedical Sciences, Seoul National University College of Medicine, Korea
| | - Min Kyung Oh
- Department of Pharmacology, Inje University College of Medicine, Korea
| | - Eun Young Kim
- Department of Clinical Pharmacology, Inje University Busanpaik Hospital, Korea
| | - Jong Ryul Ghim
- Department of Clinical Pharmacology, Inje University Busanpaik Hospital, Korea
| | - Seok Jin Choi
- Department of Radiology, Inje University Busanpaik Hospital, Korea
| | - Jae Gook Shin
- Department of Pharmacology, Inje University College of Medicine, Korea
- Department of Clinical Pharmacology, Inje University Busanpaik Hospital, Korea
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Moneret-Vautrin DA, Codreanu F, Drouet M, Plaud B, Karila C, Valfrey J, Debaene B, Malinovsky JM, Mertes JM. [Allergologic screening and management of patients with previous self-reported hypersensitivity reactions. Société française d'anesthésie et réanimation. Société française d'allergologie]. ACTA ACUST UNITED AC 2011; 30:246-63. [PMID: 21397445 DOI: 10.1016/j.annfar.2011.01.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- D-A Moneret-Vautrin
- Service de médecine interne, immunologie clinique et allergologie, hôpital central, avenue du Maréchal de-Lattre-de-Tassigny, Nancy cedex, France.
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Late adverse reactions to intravascular iodine based contrast media: an update. Eur Radiol 2011; 21:2305-10. [DOI: 10.1007/s00330-011-2200-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Revised: 05/18/2011] [Accepted: 05/27/2011] [Indexed: 12/11/2022]
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Caffarelli C, Stringari G, Pajno GB, Peroni D, Franceschini F, Iacono ID, Bernardini R. Perioperative Allergy: Risk Factors. Int J Immunopathol Pharmacol 2011; 24:S27-34. [DOI: 10.1177/03946320110240s305] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Perioperative anaphylactic as well as anaphylactoid reactions can be elicited by drugs, diagnostic agents, antiseptics, disinfectants and latex. In some individuals, allergic reactions occur in the absence of any evident risk factor. Previous history of specific safe exposure to a product does not permit to exclude the risk of having a reaction. We have systematically reviewed characteristics in the patient's history or clinical parameters that affect the risk of developing reactions during anesthesia. Evidence shows that patients with previous unexplained reaction during anesthesia are at risk for perioperative allergic reactions. An allergic reaction to an agent is associated with previous reaction to a product that is related with the culprit agent. Multiple surgery procedures, professional exposure to latex and allergy to fruit are associated with an increased frequency of latex allergy. It has been shown that in some instances, allergic perioperative reactions may be more common in atopic patients and in female.
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Affiliation(s)
- C. Caffarelli
- Pediatric Clinic, Department of Pediatrics, University of Parma, Parma, Italy
| | - G. Stringari
- Pediatric Clinic, Department of Pediatrics, University of Parma, Parma, Italy
| | - G. B. Pajno
- Allergy Unit, Department of Pediatrics, University of Messina, Messina, Italy
| | - D.G. Peroni
- Department of Pediatrics, University of Verona, Verona, Italy
| | - F. Franceschini
- Pediatric Unit, “Ospedali Riuniti“, University Hospital, Ancona, Italy
| | - I. Dello Iacono
- Pediatric Unit, “Fatebenefratelli” Hospital, Benevento, Italy
| | - R. Bernardini
- Pediatric Unit, “San Giuseppe” Hospital, Empoli, Florence, Italy
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Böhm I, Speck U, Schild HH. Pilot study on basophil activation induced by contrast medium. Fundam Clin Pharmacol 2011; 25:267-76. [DOI: 10.1111/j.1472-8206.2010.00826.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hong H, Yang Y, Liu B, Cai W. Imaging of Abdominal Aortic Aneurysm: the present and the future. Curr Vasc Pharmacol 2011; 8:808-19. [PMID: 20180767 DOI: 10.2174/157016110793563898] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 01/07/2010] [Indexed: 01/02/2023]
Abstract
Abdominal Aortic Aneurysm (AAA) is a common, progressive, and potentially lethal vascular disease. A major obstacle in AAA research, as well as patient care, is the lack of technology that enables non-invasive acquisition of molecular/cellular information in the developing AAA. In this review we will briefly summarize the current techniques (e.g. ultrasound, computed tomography, and magnetic resonance imaging) for anatomical imaging of AAA. We also discuss the various functional imaging techniques that have been explored for AAA imaging. In many cases, these anatomical and functional imaging techniques are not sufficient for providing surgeons/clinicians enough information about each individual AAA (e.g. rupture risk) to optimize patient management. Recently, molecular imaging techniques (e.g. optical and radionuclide-based) have been employed to visualize the molecular alterations associated with AAA, which are discussed in this review. Lastly, we try to provide a glance into the future and point out the challenges for AAA imaging. We believe that the future of AAA imaging lies in the combination of anatomical and molecular imaging techniques, which are largely complementary rather than competitive. Ultimately, with the right molecular imaging probe, clinicians will be able to monitor AAA growth and evaluate the risk of rupture accurately, so that the life-saving surgery can be provided to the right patients at the right time. Equally important, the right imaging probe will also allow scientists/clinicians to acquire critical data during AAA development and to more accurately evaluate the efficacy of potential treatments.
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Affiliation(s)
- Hao Hong
- Department of Radiology, School of Medicine and Public Health, University of Wisconsin - Madison, Madison, WI 53705-2275, USA
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Goksel O, Aydın O, Atasoy C, Akyar S, Demirel YS, Misirligil Z, Bavbek S. Hypersensitivity reactions to contrast media: prevalence, risk factors and the role of skin tests in diagnosis--a cross-sectional survey. Int Arch Allergy Immunol 2011; 155:297-305. [PMID: 21293150 DOI: 10.1159/000320760] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Accepted: 08/25/2010] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Hypersensitivity to contrast media (CMs) may be common and serious. AIM To evaluate the prevalence of CM hypersensitivity, risk factors associated with it and the role of skin testing in its diagnosis. METHODS A structured questionnaire was administered to patients who underwent computed tomography during a 1-year period. Skin tests with CMs, including skin prick tests (SPTs), intradermal tests (IDTs) and patch tests (PTs), were conducted on CM reactors (n = 24). Volunteers who tolerated CM exposure or had never been exposed to any CMs served as controls (n = 37). RESULTS A total of 1,131 patients (630 females and 501 males; mean age 55 ± 14.2 years) were enrolled in the study. The prevalence of historical and current CM reactors was 33/1,131 (2.92%) and 8/1,105 (0.72%), respectively. The skin was the most affected site, with mild to moderate reactions. Female gender, a history of doctor-diagnosed asthma, drug allergy, food allergy and psychiatric diseases were significant risk factors. The sensitivities of SPTs and early readings of IDTs in the diagnosis of immediate reactions were 0 and 20%, respectively, and the specificities were 94.6 and 91.4%, respectively. For early readings of IDTs, the positive predictive value (PPV) and negative predictive value (NPV) were 40 and 80%, respectively. For nonimmediate reactions, the sensitivities of delayed readings of IDTs and PTs were 14.3 and 25%, respectively; specificity was 100% for both tests. The PPV was 100% for both of these tests, and the NPVs were 85.4 and 82.4%, respectively. CONCLUSIONS Our findings are comparable with the incidence, profile and risk factors associated with CM hypersensitivity reported previously. Skin testing with CMs has a high specificity, but its role in diagnosis is limited due to low sensitivity.
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Affiliation(s)
- Ozlem Goksel
- Department of Pulmonary Diseases, Division of Allergy and Clinical Immunology, Ankara University, Ankara, Turkey
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Kim SH, Lee SH, Lee SM, Kang HR, Park HW, Kim SS, Cho SH, Min KU, Kim YY, Chang YS. Outcomes of premedication for non-ionic radio-contrast media hypersensitivity reactions in Korea. Eur J Radiol 2010; 80:363-7. [PMID: 20619990 DOI: 10.1016/j.ejrad.2010.06.014] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2010] [Accepted: 06/09/2010] [Indexed: 01/28/2023]
Abstract
BACKGROUND Radio-contrast media (CM)-related adverse reactions are important clinical problems that may cause fatal anaphylaxis. Accordingly, it has been common practice to premedicate patients who have had previous reactions to CM with corticosteroids, antihistamines, and H2 blockers to prevent hypersensitive reactions. However, the effectiveness of premedication has not been properly demonstrated, especially in cases related to non-ionic CM. In this study, we evaluated the effectiveness of premedication at preventing of non-ionic CM immediate-type hypersensitivity reactions. METHODS A total of 30 patients who had been pretreated with corticosteroid and H1 antihistamines and/or H2 blockers in a 3-year period were enrolled. The results of premedication were evaluated in terms of clinical characteristics and the features of breakthrough reactions. RESULTS Hypersensitivity reactions were not prevented in 5 of the 30 patients who had experienced prior CM reactions (overall recurrence rate after premedication 16.7%; 4/17 patients with mild previous reactions, and 1/13 patients with severe previous reactions). The recurrence rate after premedication was significantly higher in patients with mild previous reactions than in those with severe reactions (23.5% vs. 7.7%; p<0.001). The breakthrough reactions were similar to the prior reactions in terms of severity and clinical manifestations. CONCLUSION Premedication with corticosteroid and H1 antihistamines and/or H2 blockers effectively prevent non-ionic CM-related adverse events in most patients who have had severe previous reactions to CM. However, physicians should be aware of the possibility of premedication failing and of breakthrough reactions, even in cases in which the previous reactions were mild.
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Affiliation(s)
- Sae-Hoon Kim
- Department of Internal Medicine, Seoul National University College of Medicine, and Department of Internal Medicine, Seoul National University Bundang Hospital, Republic of Korea.
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Miki S. Reply to Böhm. Cardiovasc Intervent Radiol 2010. [DOI: 10.1007/s00270-010-9801-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Caimmi S, Benyahia B, Suau D, Bousquet-Rouanet L, Caimmi D, Bousquet PJ, Demoly P. Clinical value of negative skin tests to iodinated contrast media. Clin Exp Allergy 2010; 40:805-10. [DOI: 10.1111/j.1365-2222.2010.03493.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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