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Budoff MJ, Lee HS, Roy SK, Shekar C. Efficacy and Safety of Iodixanol in Computed Coronary Tomographic Angiography and Cardiac Catheterization. J Cardiovasc Dev Dis 2023; 10:449. [PMID: 37998507 PMCID: PMC10671983 DOI: 10.3390/jcdd10110449] [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: 09/29/2023] [Revised: 10/26/2023] [Accepted: 10/26/2023] [Indexed: 11/25/2023] Open
Abstract
Iodixanol is an iso-osmolar non-ionic dimeric hydrophilic contrast agent with a higher viscosity than the monomeric agents. It is the only Food and Drug Administration (FDA)-approved iso-osmolar agent in the United States, and it is the only contrast agent with an FDA-approved indication for use in cardiac computed tomographic angiography (CCTA), to assist in the diagnostic evaluation of patients with suspected coronary artery disease. In clinical studies, it has been noted to have fewer side effects and similar image quality when compared to low-osmolar contrast media. This can be attributed to the pharmacological properties of iodixanol. These contrast agents are used for coronary computed tomography angiography and cardiac catheterization. In this article, the use, tolerability, and efficacy of iodixanol are reviewed, specifically evaluating the use of CCTA and coronary angiography, including outcome studies, randomized trials, and comparisons to other contrast agents.
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Affiliation(s)
- Matthew J. Budoff
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | | | - Sion K. Roy
- Department of Cardiology, Lundquist Institute, Harbor-UCLA Medical Center, 1124 W Carson Street, Torrance, CA 90502, USA;
| | - Chandana Shekar
- Department of Cardiology, College of Medicine, Banner-University of Arizona, 1111 E McDowell Road, Phoenix, AZ 85006, USA;
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Intravenous Contrast Material for Cardiac Computed Tomography: Results From the Open-label Multicenter, Multivendor Italian Registry of Contrast Material Use in Cardiac Computed Tomography. J Thorac Imaging 2023; 38:128-135. [PMID: 36821381 DOI: 10.1097/rti.0000000000000644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The Italian Registry of Contrast Material use in Cardiac Computed Tomography (iRCM-CCT) is a multicenter, multivendor, observational study on the use of contrast media (CM) in patients undergoing cardiac computed tomography (CCT). The aim of iRCM-CCT is to assess image quality and safety profile of intravenous CM compounds. MATERIALS AND METHODS iRCM-CCT enrolled 1842 consecutive patients undergoing CCT (≥50 per site) at 20 cluster sites with the indication of suspected coronary artery disease. Demographic characteristics, CCT, and CM protocols, clinical indications, safety markers, radiation dose reports, qualitative (ie, poor vascular enhancement) and quantitative (ie, HU attenuation values) image parameters were recorded. A centralized coordinating center collected and assessed all image parameters. RESULTS The cohort included 891 men and 951 women (age: 63±14 y, body mass index: 26±4 kg/m2) studied with ≥64 detector rows computed tomography scanners and different iodinated intravenous CM protocols and compounds (iodixanol, iopamidol, iohexol, iobitridol, iopromide, and iomeprol). The following vascular attenuation was reported: 504±147 HU in the aorta, 451±146 HU in the right coronary artery, 474±146 HU in the left main, 451±146 HU in the left anterior descending artery, and 441±149 HU in the circumflex artery. In 4% of cases the image quality was not satisfactory due to poor enhancement. The following adverse reactions to CM were recorded: 6 (0.3%) extravasations and 17 (0.9%) reactions (11 mild, 4 moderate, 2 severe). CONCLUSIONS In a multicenter registry on CM use during CCT the prevalence of CM-related adverse reactions was very low. The appropriate use of CM is a major determinant of image quality.
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Im DJ, Kim YH, Choo KS, Kang JW, Jung JI, Won Y, Kim HR, Chung MH, Han K, Choi BW. Comparison of Coronary Computed Tomography Angiography Image Quality With High-concentration and Low-concentration Contrast Agents: The Randomized CONCENTRATE Trial. J Thorac Imaging 2023; 38:120-127. [PMID: 36821380 DOI: 10.1097/rti.0000000000000633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To confirm that the image quality of coronary computed tomography (CT) angiography with a low tube voltage (80 to 100 kVp), iterative reconstruction, and low-concentration contrast agents (iodixanol 270 to 320 mgI/mL) was not inferior to that with conventional high tube voltage (120 kVp) and high-concentration contrast agent (iopamidol 370 mgI/mL). MATERIALS AND METHODS This prospective, multicenter, noninferiority, randomized trial enrolled a total of 318 patients from 8 clinical sites. All patients were randomly assigned 1: 1: 1 for each contrast medium of 270, 320, and 370 mgI/mL. CT scans were taken with a standard protocol in the high-concentration group (370 mgI/mL) and with 20 kVp lower protocol in the low-concentration group (270 or 320 mgI/mL). Image quality and radiation dose were compared between the groups. Image quality was evaluated with a score of 1 to 4 as subject image quality. RESULTS The mean HU, signal-to-noise ratio, and contrast-to-noise ratio of the 3 groups were significantly different (all P<0.0001). The signal-to-noise ratio and contrast-to-noise ratio of the low-concentration groups were significantly lower than those of the high-concentration group (P<0.05). However, the image quality scores were not significantly different among the 3 groups (P=0.745). The dose length product and effective dose of the high-concentration group were significantly higher than those of the low-concentration group (P<0.0001 and 0.003, respectively). CONCLUSIONS The CT protocol with iterative reconstruction and lower tube voltage for low-concentration contrast agents significantly reduced the effective radiation dose (mean: 3.7±2.7 to 4.1±3.1 mSv) while keeping the subjective image quality as good as the standard protocol (mean: 5.7±3.4 mSv).
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Affiliation(s)
- Dong Jin Im
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine
| | - Yun-Hyeon Kim
- Department of Radiology, Chonnam National University Hospital, Chonnam University Medical School, Gwangju
| | - Ki Seok Choo
- Department of Radiology, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Pusan
| | - Joon-Won Kang
- Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine
| | - Jung Im Jung
- Department of Radiology, Seoul St. Mary's Hospital
| | - Yoodong Won
- Department of Radiology, Uijeongbu St. Mary's Hospital, Catholic University of Korea, Uijeongbu
| | - Hyo Rim Kim
- Department of Radiology, Yeouido St. Mary's Hospital, Catholic University of Korea, Seoul
| | - Myung Hee Chung
- Department of Radiology, Bucheon St. Mary's Hospital, Catholic University of Korea, Bucheon, Republic of Korea
| | - Kyunghwa Han
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine
| | - Byoung Wook Choi
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine
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Otgonbaatar C, Ryu JK, Shin J, Kim HM, Seo JW, Shim H, Hwang DH. Deep learning reconstruction allows for usage of contrast agent of lower concentration for coronary CTA than filtered back projection and hybrid iterative reconstruction. Acta Radiol 2023; 64:1007-1017. [PMID: 35979586 DOI: 10.1177/02841851221118476] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND The demand for homogeneous and higher vascular contrast enhancement is critical to provide an appropriate interpretation of abnormal vascular findings in coronary computed tomography angiography (CTA). PURPOSE To evaluate the effect of various contrast media concentrations (Iohexol-370, Iohexol-300, Iohexol-240) and image reconstructions (filtered back projection [FBP], hybrid iterative reconstruction [IR], and deep learning reconstruction [DLR]) on coronary CTA. MATERIAL AND METHODS A total of 63 patients referred for coronary CTA between July and October 2021 were enrolled in this prospective study, and they randomly received one of three contrast media. CTA images were reconstructed with FBP, hybrid IR, and DLR. The CT attenuation, image noise, signal-to-noise ratio (SNR), and contrast-to-noise ratio (CNR) were calculated for all three images. The images were subjectively evaluated by two radiologists in terms of overall image quality, artifacts, image noise, and vessel wall delineation on a 5-point Likert scale. RESULTS The application of DLR resulted in significantly lower image noise; higher CT attenuation, SNR, and CNR; and better subjective analysis among the three different concentrations of contrast media groups (P < 0.001). There was no significant difference in the CT attenuation of the left ventricle (P = 0.089) and coronary arteries (P = 0.072) between hybrid IR at Iohexol-300 and DLR at Iohexol-240. Furthermore, application of DLR to the Iohexol-240 significantly improved SNR and CNR; it achieved higher subjective scores compared with hybrid IR at Iohexol-300 (P < 0.001). CONCLUSION We suggest that using DLR with Iohexol-240 contrast media is preferable to hybrid IR with Iohexol-300 contrast media in coronary CTA.
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Affiliation(s)
- Chuluunbaatar Otgonbaatar
- Department of Radiology, 26725Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jae-Kyun Ryu
- Medical Imaging AI Research Center, 496517Canon Medical Systems Korea, Seoul, Republic of Korea
| | - Jaemin Shin
- Department of Neurology, 58934Korea University Guro Hospital, Seoul, Republic of Korea
| | - Han Myun Kim
- Department of Radiology, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
| | - Jung Wook Seo
- Department of Radiology, 119750Inje University Ilsan Paik Hospital, Goyang, Republic of Korea
| | - Hackjoon Shim
- Medical Imaging AI Research Center, 496517Canon Medical Systems Korea, Seoul, Republic of Korea
- ConnectAI Research Center, 37991Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Dae Hyun Hwang
- Department of Radiology, 65521Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Republic of Korea
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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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Tang X, Zhang Y, Wang T, Ma Y, Shi H, Yin R, Zou P, Cao J, Pan C. Image quality and diagnostic accuracy of different dosages of iodixanol in computed tomography angiography and perfusion of overweight patients with coronary artery stenosis: A feasibility study. Med Eng Phys 2022; 110:103818. [PMID: 35618562 DOI: 10.1016/j.medengphy.2022.103818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/11/2022] [Accepted: 05/09/2022] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Iodixanol contrast media with different doses using computed tomography angiography (CTA) and perfusion (CTP) to diagnose coronary artery disease (CAD) in overweight patients lacks assessment. Our study compared iodixanol 320 mg I/ml and 270 mg I/ml on image quality and accuracy of CTA combined CTP (CTA-CTP) to diagnose CAD. METHODS Overweight patients with suspected of CAD were randomized into iodixanol 270 group (received iodixanol 270 mg I/ml) and iodixanol 320 group (received iodixanol 320 mg I/ml). Based on these characteristics data, receiver operating characteristic (ROC) curve and corresponding area under the curve (AUC) were plotted to assess the sensitivity and specificity of the two administrations. RESULTS The subjective definition score, signal to noise ratio, and CT value of aorta in iodixanol 320 group were higher than iodixanol 270 group. In iodixanol 270 group: the image exhibited a normal state of both vessels and myocardial perfusion; and the AUC, specificity, and sensitivity were 0.376, 66.67, and 80.46, respectively. In iodixanol 320 group: the image exhibited a diameter stenosis in right coronary artery and myocardial infarction of inferior wall and proximal inferior wall septum, as well as myocardial perfusion defects; and the AUC, specificity, and sensitivity in iodixanol 320 group were 0.824, 75.00, and 89.87, respectively. CONCLUSION Accuracy and image quality of iodixanol 320 mg I/ml in the diagnosis of CAD with CTA-CTP was higher than using iodixanol 270 mg I/ml.
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Affiliation(s)
- Xiaoqiang Tang
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Yong Zhang
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Tao Wang
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Yi Ma
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Haifeng Shi
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Ruohan Yin
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Ping Zou
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Jian Cao
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China
| | - Changjie Pan
- Department of Radiology, The Affiliated Changzhou No.2 People's Hospital of Nanjing Medical University, Changzhou 213164, China.
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Wang Y, Chen Y, Liu P, Lv W, Wu J, Wei M, Shi D, Wu X, Liu W, Tao X, Hu H, Ma X, Yang X, Xue H, Jin Z. Clinical effectiveness of contrast medium injection protocols for 80-kV coronary and craniocervical CT angiography-a prospective multicenter observational study. Eur Radiol 2022; 32:3808-3818. [PMID: 35103828 DOI: 10.1007/s00330-021-08505-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 10/22/2021] [Accepted: 12/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVE Decreasing X-ray tube voltage is an effective way to reduce radiation and contrast dose, especially in non-obese patients. The current study focuses on CTA in non-obese patients to evaluate image quality and feasibility of 80-kV acquisition protocols with varying iodine delivery rates (IDR) and contrast concentrations in routine clinical practice. METHODS A prospective observational study in patients ≥ 18 years and ≤ 90 kg referred for coronary or craniocervical CTA at 10 centers in China (ClinicalTrials.gov: NCT02840903). Patients were divided into four groups: a standard 100-kV protocol (370 mgI/ml, IDR 1.48 gI/s), and three 80-kV protocols (370 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 1.2 gI/s; 300 mgI/ml, IDR 0.96gI/s). The primary outcome was contrast opacification of target vascular segments. Secondary outcomes were image quality (contrast-to-noise ratio, signal-to-noise ratio, visual image quality, and diagnostic confidence assessment), radiation, and iodine dose. RESULTS From July 2016 to July 2017, 1213 patients were enrolled: 614 coronary and 599 craniocervical CTA. The mean contrast opacification was ≥ 300 HU for 80-kV 1.2 gI/s IDR scanned segments; IDR 0.96 gI/s led to lower opacification. Image quality and diagnostic confidence were fair to excellent (≥ 98% of images), despite lower contrast-to-noise ratios and signal-to-noise ratios in 80-kV images. Compared to the standard protocol, 80-kV protocols led to 44-52% radiation dose reductions (p < 0.001) and 19% iodine dose reductions (p < 0.001). CONCLUSION Eighty-kilovolt 1.2 gI/s IDR protocols can be recommended for coronary and craniocervical CTA in non-obese patients, reducing radiation and iodine dose without compromising image quality. KEY POINTS • Using low-voltage scanning CTA protocols, in which tube voltage and iodine delivery rate are reduced proportionally (voltage: 80 kV, IDR: 1.2 gI/s), reduces radiation and contrast dose without compromising image quality in routine clinical practice. • Reducing iodine delivery rate beyond direct proportionality to tube voltage is not beneficial.
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Affiliation(s)
- Yining Wang
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Yu Chen
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Peijun Liu
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Wan Lv
- The First People's Hospital of Yulin, # 495, JiaoYu Central Road, Yulin, 537000, Guangxi, China
| | - Jianlin Wu
- Affiliated Zhongshan Hospital of Dalian University, # 6, Jiefang Road Zhongshan District, Dalian, 116001, Liaoning, China
| | - Mengqi Wei
- The First Affiliated Hospital of Air Force Medical University, # 15 Changle West Road, Xian, 710032, Shanxi, China
| | - Dapeng Shi
- Henan Provincial People's Hospital, # 7, Weiwu Road, Zhengzhou, 450000, Henan, China
| | - Xianheng Wu
- The Second People's Hospital of Shantou, # 28, Waimalu Road, Shantou, 515031, Guangdong, China
| | - Wenya Liu
- The First Affiliated Hospital of Xinjiang Medical University, # 137, Liyushan South Road, Urumqi, 830054, Xinjiang, China
| | - Xiaofeng Tao
- Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, # 639, Zaoju Road, Shanghai, 200011, China
| | - Hongjie Hu
- Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3 Qinchun East Road, Hangzhou, 310016, Zhejiang, China
| | - Xiangxing Ma
- Qilu Hospital of Shandong University (Qingdao), North District, # 758, Hefei Road, Qingdao, 266035, Shandong, China
| | - Xiaozheng Yang
- Medical Affairs, Bayer Healthcare Co. Ltd, Dongshanhuan Central Road, Beijing, 100010, China
| | - Huadan Xue
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China
| | - Zhengyu Jin
- Peking Union Medical College Hospital, Shuaifuyan Wangfujing District, Beijing, 100730, China.
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Pop M. Cardiothoracic CTA in Infants Referred for Aortic Arch Evaluation-Retrospective Comparison of Iomeprol 350, Ioversol 350, Iopromide 370 and Iodixanol 320. CHILDREN (BASEL, SWITZERLAND) 2021; 8:children8110949. [PMID: 34828662 PMCID: PMC8623802 DOI: 10.3390/children8110949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 10/14/2021] [Accepted: 10/20/2021] [Indexed: 11/16/2022]
Abstract
Background: Computed tomography angiography (CTA) in infants is considered one of the most challenging radiological examinations due to difficulties in balancing start delay, contrast agent (CA) volume and flow in order to achieve optimal opacification of the large vessels. This study aimed to compare the contrast enhancement achieved by four CAs when taking into consideration CA injection parameters and patient characteristics. Methods: We performed a retrospective assessment of forty-eight consecutive cardiothoracic CTAs performed for aortic arch evaluation on children aged 0–1 year. All examinations were performed using the same 64-slice scanner and power injector using the bolus tracking technique. Axial 0.6 mm slices were used to measure large vessel enhancement using regions of interest at the level of the main pulmonary artery, ascending and descending aorta. The recorded variables included anthropometric measurements, CA type, flow rate, volume, and the average Hounsfield unit (HU) values of the blood pool. Descriptive statistics are presented as averages and standard deviations (SD) for normal distributed data or otherwise as medians and interquartile ranges (IQRs). Results: We found no statistically significant differences between age and anthropometric parameters when looking at different CAs. The median CA volume was 7 (IQR, 7–9) mL with the average flow rate of 0.94 (SD, 0.23) mL/s. Ascending aorta average HU values were 605.9 (SD, 177.23) for Iomeprol 350, 626 (SD, 183.83) for Ioversol 350, 530.83 (SD, 175.56) for Iopromide 370 and 354.91 (SD, 115.81) for Iodixanol 320. The difference in HU value for Iodixanol 320 compared to the other CAs was statistically significant. Similar differences were found for the other vascular structures. Conclusion: In CTA of infants suspected of aortic arch hypoplasia/coarctation, Iodixanol 320 provided up to 40% less enhancement of the great vessels when compared to Iomeprol 350, Ioversol 350 and Iopromide 370.
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Affiliation(s)
- Marian Pop
- ME1 Department, “George Emil Palade” University of Medicine Pharmacy Sciences and Technology of Tirgu Mures, 540142 Tirgu Mures, Romania; ; Tel.: +40-749-260-920
- Radiology and Medical Imaging Department, Tirgu Mures Emergency Institute for Cardiovascular Diseases and Heart Transplant, 540136 Tirgu Mures, Romania
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Zhang H, Fu H, Fu X, Zhang J, Zhang P, Yang S, Zeng Z, Fu N, Guo Z. Glycosylated hemoglobin levels and the risk for contrast-induced nephropathy in diabetic patients undergoing coronary arteriography/percutaneous coronary intervention. BMC Nephrol 2021; 22:206. [PMID: 34078303 PMCID: PMC8173735 DOI: 10.1186/s12882-021-02405-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 05/16/2021] [Indexed: 12/18/2022] Open
Abstract
Backgrounds Diabetes mellitus is an independent risk factor for Contrast-induced nephropathy (CIN) in patients undergoing Coronary arteriography (CAG)/percutaneous coronary intervention (PCI). Glycosylated hemoglobin (HbA1c) is the gold standard to measure blood glucose control, which has important clinical significance for evaluating blood glucose control in diabetic patients in the past 3 months. This study aimed to assess whether preoperative HbA1c levels in diabetic patients who received CAG/PCI impacted the occurrence of postoperative CIN. Methods We reviewed the incidence of preoperative HbA1c and postoperative CIN in 670 patients with CAG/PCI from January 1, 2020 to October 30, 2020 and divided the preoperative HbA1c levels into 5 groups. Blood samples were collected at admission, 48 h and 72 h after operation to measure the Scr value of patients. Categorical variables were compared using a chi-square test, and continuous variables were compared using an analysis of variance. Fisher’s exact test was used to compare the percentages when the expected frequency was less than 5. Univariable and multivariable logistic regression analysis was used to exclude the influence of confounding factors, and P for trend was used to analyze the trend between HbA1c levels and the increased risk of CIN. Results Patients with elevated HbA1c had higher BMI, FBG, and LDL-C, and they were more often on therapy with hypoglycemic agents, Insulin and PCI. They also had higher basal, 48 h and 72 h Scr. The incidence of CIN in the 5 groups of patients were: 9.8, 11.9, 15.2, 25.3, 48.1%. (p < 0.0001) The multivariate analysis confirmed that in the main high-risk subgroup, patients with elevated HbA1C levels (≥8.8%) had a higher risk of CIN disease. Trend test showed the change of OR (1.000,1.248,1.553,2.625,5.829). Conclusions Studies have shown that in diabetic patients undergoing CAG/PCI, elevated HbA1c is independently associated with the risk of CIN, and when HbA1c > 9.5%, the incidence of CIN trends increase. Therefore, we should attach great importance to patients with elevated HbA1c at admission and take more active measures to prevent CIN.
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Affiliation(s)
- H Zhang
- Clinical College of Chest,Tianjin Medical University, Tianjin, China.,Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - H Fu
- Tianjin Medical University, Tianjin, China
| | - X Fu
- Tianjin Medical University, Tianjin, China
| | - J Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - P Zhang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - S Yang
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China
| | - Z Zeng
- Tianjin Medical University, Tianjin, China
| | - N Fu
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
| | - Z Guo
- Department of Cardiology, Tianjin Chest Hospital, No. 261, Taierzhuang South Road, Jinnan District, Tianjin, 300222, China.
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Fu H, Zhang J, Zhang H, Zhang P, Fu X, Zeng Z, Zhang X, Li W, Yang S, Liu X, Fu N. Trimetazidine can prevent the occurrence of contrast-induced nephropathy after percutaneous coronary intervention in elderly patients with renal insufficiency. Perfusion 2020; 36:603-609. [PMID: 32909511 DOI: 10.1177/0267659120957856] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Contrast-induced nephropathy (CIN) has become a common cause of hospital-acquired acute kidney injury in elderly patients. Trimetazidine (TMZ) is a type of anti-ischemic drug developed in recent years, which can reduce the incidence of CIN. This study aimed to evaluate the efficacy of TMZ in the prevention of contrast-induced nephropathy in elderly patients with renal insufficiency undergoing percutaneous coronary intervention (PCI) and to explore the mechanism of action. METHODS A total of 310 elderly patients with renal insufficiency undergoing elective PCI were enrolled and randomly assigned to a control group (n = 155, hydration only) and a TMZ group (n = 155, 20 mg thrice daily orally 24 hours before and 72 hours after PCI). The primary endpoint of the study was the incidence of CIN, which was defined as an increase of 25% or more, or an absolute increase of 0.5 mg/dL or more in serum creatinine from baseline value, at 48 to 72 hours following the exposure to contrast media (CM). RESULTS The incidence of CIN was significantly lower in the TMZ group than that in the control group (3.2% vs. 9.7%, p = 0.021). There was no difference regarding the incidence of major adverse events during hospitalization between the TMZ group and control group (1.9% vs. 2.6%, p = 1.000). Binary logistic regression results showed that TMZ was protective factors of CIN (OR = 0.274; 95% CI: 0.089-0.847; p = 0.025). CONCLUSION Therefore, we came to the conclusion that prophylactic administration of TMZ can prevent the occurrence of CIN in elderly patients with renal insufficiency undergoing PCI and has a certain protective effect on the renal function of patients. According to the experimental results and the mechanism of TMZ on cardiomyocytes, we speculate that TMZ increases kidney glucose metabolism, reduces fatty acid oxidation, and also has a protective effect on kidney free radical damage and ischemia-reperfusion injury.
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Affiliation(s)
- Han Fu
- Tianjin Medical University, Tianjin, China
| | | | | | | | | | | | - Xue Zhang
- Tianjin Medical University, Tianjin, China
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11
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Fu JJ, Guo JJ, Qin AP, Yu XY, Zhang Q, Lei XP, Huang YG, Chen MY, Li JX, Zhang Y, Liu JP, Dang YY, Wu D, Zhao XY, Lin ZX, Lin YL, Li SP, Zhang LY. Bismuth chelate as a contrast agent for X-ray computed tomography. J Nanobiotechnology 2020; 18:110. [PMID: 32762751 PMCID: PMC7412782 DOI: 10.1186/s12951-020-00669-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Accepted: 07/30/2020] [Indexed: 01/12/2023] Open
Abstract
Backgrounds Due to the unexpected side effects of the iodinated contrast agents, novel contrast agents for X-ray computed tomography (CT) imaging are urgently needed. Nanoparticles made by heavy metal elements are often employed, such as gold and bismuth. These nanoparticles have the advantages of long in vivo circulation time and tumor targeted ability. However, due to the long residence time in vivo, these nanoparticles may bring unexpected toxicity and, the preparation methods of these nanoparticles are complicated and time—consuming. Methods In this investigation, a small molecular bismuth chelate using diethylenetriaminepentaacetic acid (DPTA) as the chelating agent was proposed to be an ideal CT contrast agent. Results The preparation method is easy and cost—effective. Moreover, the bismuth agent show better CT imaging for kidney than iohexol in the aspect of improved CT values. Up to 500 µM, the bismuth agent show negligible toxicity to L02 cells and negligible hemolysis. And, the bismuth agent did not induce detectable morphology changes to the main organs of the mice after intravenously repeated administration at a high dose of 250 mg/kg. The pharmacokinetics of the bismuth agent follows the first—order elimination kinetics and, it has a short half—life time of 0.602 h. The rapid clearance from the body promised its excellent biocompatibility. Conclusions This bismuth agent may serve as a potential candidate for developing novel contrast agent for CT imaging in clinical applications.
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Affiliation(s)
- Ji-Jun Fu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China. .,School of Materials Science and Energy Engineering, Foshan University, Foshan, 528000, China.
| | - Jun-Jie Guo
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China.,Department of Medical Imaging, Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Ai-Ping Qin
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xi-Yong Yu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Qiang Zhang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xue-Ping Lei
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yu-Gang Huang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Ming-Yue Chen
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Jie-Xia Li
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yu Zhang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Jing-Ping Liu
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yuan-Ye Dang
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Dan Wu
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Xiao-Ya Zhao
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Zhong-Xiao Lin
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China
| | - Yin-Lei Lin
- School of Materials Science and Energy Engineering, Foshan University, Foshan, 528000, China
| | - Song-Pei Li
- The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, 510700, Guangdong, China.
| | - Ling-Yan Zhang
- Department of Medical Imaging, The Third Affiliated Hospital, Southern Medical University, Guangzhou, China.
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12
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Effect of low-osmolar iopamidol or iso-osmolar iodixanol on heart rate and experienced pain during ECG-gated cardiac CT. Clin Imaging 2020; 68:13. [PMID: 32562920 DOI: 10.1016/j.clinimag.2020.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022]
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13
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Alhelaly MM, Abdelhakim AM, Ellotf H, Khaled A, Soliman AM, Attia MM. Comparative effect of iso-osmolar versus low-osmolar contrast media on vascular attenuation, image quality, and heart rate changes in coronary CT angiography: A systematic review and meta-analysis. Clin Imaging 2020; 61:69-79. [PMID: 31982704 DOI: 10.1016/j.clinimag.2020.01.016] [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: 10/02/2019] [Revised: 01/14/2020] [Accepted: 01/15/2020] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Comparison of iso-osmolar contrast media (IOCM) and low-osmolar contrast media (LOCM) for vascular attenuation, image quality, heart rate changes, and common patient discomfort symptoms. METHODS We searched PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL). We included only randomized controlled trials. Screening, data extraction, and quality assessment were done by three independent authors. RevMan 5.3 software was used for meta-analysis. RESULTS Nine studies (n = 1831 participants) were found eligible and included in the meta-analysis. There was no difference between the both contrast media for vascular attenuation (mean difference = -21.31; 95% confidence interval -49.81 to 7.19; p = 0.14), image quality (standardized mean difference = 0.13; 95% confidence interval -0.07 to 0.33; p = 0.19), heart rate variability (standardized mean difference = -0.61; 95% confidence interval -1.30 to 0.09; p = 0.09), heat sensation (risk ratio = 0.79; 95% confidence interval 0.56 to 1.11; p = 0.17), and nausea or vomiting (risk ratio = 0.82; 95% confidence interval 0.52 to 1.28; p = 0.38). Moreover, IOCM resulted in a heart rate that was lower by 0.9 beat per minute (bpm) compared to LOCM (mean difference = -0.92; 95% confidence interval -1.81 to -0.03; p = 0.04). CONCLUSIONS Both IOCM and LOCM have similar vascular enhancement, image quality, heart rate variability, and similar risk for patient discomfort. Furthermore, IOCM resulted in a slightly lower heart rate by 0.9 bpm.
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Affiliation(s)
- Mohamed M Alhelaly
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt.
| | | | - Hamed Ellotf
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
| | - Anas Khaled
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
| | - Ahmed M Soliman
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
| | - Mahmoud M Attia
- Al-Azhar University, Damietta Faculty of Medicine, New Damietta City, Damietta, Egypt
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14
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Yin WH, Yu YT, Zhang Y, An YQ, Hou ZH, Gao Y, Wang HP, Lu B, De Santis D, Rollins JD, Schoepf UJ. Contrast medium injection protocols for coronary CT angiography: should contrast medium volumes be tailored to body weight or body surface area? Clin Radiol 2020; 75:395.e17-395.e24. [PMID: 31924327 DOI: 10.1016/j.crad.2019.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2019] [Accepted: 12/06/2019] [Indexed: 11/26/2022]
Abstract
AIM To compare the uniformity and image quality between contrast media injection protocols adjusted for patient body weight (BW) versus body surface area (BSA) during coronary computed tomography (CT) angiography (CCTA). MATERIALS AND METHODS Consecutive patients (n=489) with suspected coronary artery disease were randomised prospectively to one of two CCTA protocols. In the BW protocol (n=245), patients received individualised iodine delivery rates (≤50 kg: 1 g/s; 51-60 kg: 1.2 g/s; 61-70 kg: 1.4 g/s; 71-80 kg: 1.6 g/s; 81-90 kg: 1.8 g/s; 91-100 kg: 2 g/s; >100 kg: 2.2 g/s). In the BSA protocol (n=244), patients received 9,600 mg iodine/m2 of contrast medium over 12 seconds. Attenuation and image noise were measured. Signal-to-noise ratio and contrast-to-noise ratio were calculated. Image quality was scored. Attenuation was assessed for correlation with BW and BSA using linear regression. RESULTS There were no statistically significant differences in mean arterial attenuation (396.8±47.6 versus 395.8±42.2 HU, p=0.804; 95% confidence interval: -7 to 9), image noise (25.2±5.8 versus 25.5±5.4 HU; p=0.549), signal-to-noise ratio (16.7±4.4 versus 16.6±3.6; p=0.902), contrast-to-noise ratio (25.1±5.8 versus 25.8±7.4; p=0.258) or image quality scores (4.1±0.9 versus 4±0.9; p=0.770) between the BW and BSA protocols. There was no correlation between BW and aortic attenuation or between BSA and aortic attenuation (p=0.324 and 0.932, respectively). CONCLUSION The average contrast media attenuation and image quality was comparable between BW-adjusted protocol and BSA-adjusted protocol.
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Affiliation(s)
- W-H Yin
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Y-T Yu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Y Zhang
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China; Department of Radiology, Affiliated Hospital of Guizhou Medical University, Guiyang, Guizhou, 550004, People's Republic of China
| | - Y-Q An
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Z-H Hou
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - Y Gao
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - H-P Wang
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China
| | - B Lu
- Department of Radiology, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People's Republic of China.
| | - D De Santis
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - J D Rollins
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - U J Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
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15
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Zou Y, Wei Y, Sun Y, Bao J, Yao F, Li Z, Meng F, Hu C, Storm G, Zhong Z. Cyclic RGD-Functionalized and Disulfide-Crosslinked Iodine-Rich Polymersomes as a Robust and Smart Theranostic Agent for Targeted CT Imaging and Chemotherapy of Tumor. Theranostics 2019; 9:8061-8072. [PMID: 31754381 PMCID: PMC6857068 DOI: 10.7150/thno.37184] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 08/28/2019] [Indexed: 02/07/2023] Open
Abstract
There is tremendous interest in integrating CT imaging with chemotherapy; however, reported iodine-based nanosystems such as nanogels and nano-emulsions display typically reduced contrast coefficient, low drug loading and stability, and poor targetability. Here, cRGD-functionalized disulfide-crosslinked iodine-rich polymersomes (cRGD-XIPs) were designed as a novel, robust and smart theranostic agent and investigated for targeted CT imaging and chemotherapy of malignant tumors. Methods: cRGD-XIPs were prepared from co-self-assembly of poly(ethylene glycol)-b-poly(dithiolane trimethylene carbonate-co-iodinated trimethylene carbonate) (PEG-P(DTC-IC)) and cRGD-PEG-P(DTC-IC) block copolymers. In vitro and in vivo CT contrast effect of cRGD-XIPs was studied using αvβ3-overexpressing B16 melanoma as a tumor model in comparison with clinical agent iohexol. The therapeutic efficacy of doxorubicin-loaded cRGD-XIPs (cRGD-XIPs-Dox) to B16 melanoma was investigated and compared with XIPs-Dox (non-targeted), cRGD-IPs-Dox (non-crosslinked) and free Dox. Results: cRGD-XIPs were formed with 55.5 wt.% iodine and ca. 90 nm in diameter. cRGD-XIPs-Dox with a Dox loading of 15.3 wt.% bared superior colloidal stability and reduction-responsive drug release. Notably, blank cRGD-XIPs showed a maximum-tolerated dose (MTD) > 400 mg iodine equiv./kg while cRGD-XIPs-Dox had an MTD > 150 mg Dox equiv./kg, ca. 15-fold improvement over free Dox. cRGD-XIPs revealed superior CT contrast effect and achieved 46.5- and 24.0-fold better enhancement of CT imaging of B16 melanoma than iohexol at 4 h following intratumoral and intravenous injection, respectively. cRGD-XIPs-Dox displayed an elimination half-life of 6.5 h and an elevated accumulation of 6.68% ID/g in the tumors. Furthermore, cRGD-XIPs-Dox was significantly more effective than XIPs-Dox and cRGD-XPs-Dox in inhibiting growth of B16 melanoma model. Conclusion: This proof-of-concept study demonstrates that cRGD-XIPs are a robust, non-toxic and smart polymeric theranostic agent that can not only significantly enhance CT imaging of tumors but also mediate efficient tumor-targeted chemotherapy. XIPs offer a unique and safe platform for theranostic polymersomes that pre-select patients using CT imaging prior to targeted chemotherapy with the same system.
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Akbarzadeh A, Khorramirouz R, Ghorbani F, Beigi RSH, Hashemi J, Kajbafzadeh AM. Preparation and characterization of human size whole heart for organ engineering: scaffold microangiographic imaging. Regen Med 2019; 14:939-954. [PMID: 31592738 DOI: 10.2217/rme-2018-0111] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Definitive treatment for end-stage heart failure is heart transplantation, however, this is associated with several limitations. Aim: We decellularized and assessed ovine hearts through coronary perfusion. To evaluate in situ recellularization, a decellular graft was transplanted hetrotopically into the omental wrap. Results: Cell removal was confirmed by DNA count (11.68 ± 3.42 ng/mg dry weight). Elastic, reticular and collagen fiber were well preserved. There was a slight change in both glycosaminoglycan (7.01 ± 1.36 to 8.37 ± 0.32 μg/mg) and collagen (32.37 ± 2.3 to 36.31 ± 2.1) μg/mg (p > 0.05). Angiography and blood circulation revealed an intact vascular network. Implantation led to proper vascularization. Image J indicated CD31: 23.98 ± 12.3; CD34: 48.67 ± 19.5 and αSMA: 78.33 ± 27.8 inch/cm. Conclusion: Bio-scaffold of human size heart is achievable for future steps employing this technique.
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Affiliation(s)
- Aram Akbarzadeh
- Pediatric Urology & Regenerative Medicine Research Center, Section of Tissue Engineering & Stem Cells Therapy, Children's Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Reza Khorramirouz
- Pediatric Urology & Regenerative Medicine Research Center, Section of Tissue Engineering & Stem Cells Therapy, Children's Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Fariba Ghorbani
- Tracheal Diseases Research Center (TDRC), National Research Institute of Tuberculosis & Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Reza Seyyed Hossein Beigi
- Pediatric Urology & Regenerative Medicine Research Center, Section of Tissue Engineering & Stem Cells Therapy, Children's Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Hashemi
- Faculty of Medicine, North Khorasan, University of Medical Sciences, Bojnurd, Iran
| | - Abdol-Mohammad Kajbafzadeh
- Pediatric Urology & Regenerative Medicine Research Center, Section of Tissue Engineering & Stem Cells Therapy, Children's Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
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Rengo M, Dharampal A, Lubbers M, Kock M, Wildberger JE, Das M, Niezen A, van Tilborg F, Kofflard M, Laghi A, Krestin G, Nieman K. Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON). Eur Radiol 2019; 29:6109-6118. [PMID: 31016447 DOI: 10.1007/s00330-019-06196-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/27/2019] [Accepted: 03/22/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To compare the effect of contrast medium iodine concentration on contrast enhancement, heart rate, and injection pressure when injected at a constant iodine delivery rate in coronary CT angiography (CTA). METHODS One thousand twenty-four patients scheduled for coronary CTA were prospectively randomized to receive one of four contrast media: iopromide 300 mg I/ml, iohexol 350 mg I/ml, iopromide 370 mg I/ml, or iomeprol 400 mg I/ml. Contrast media were delivered at an equivalent iodine delivery rate of 2.0 g I/s. Intracoronary attenuation was measured and compared (per vessel and per segment). Heart rate before and after contrast media injection was documented. Injection pressure was recorded (n = 403) during contrast medium injection and compared between groups. RESULTS Intracoronary attenuation values were similar for the different contrast groups. The mean attenuation over all segments ranged between 384 HU for 350 mg I/ml and 395 HU for 400 mg I/ml (p = 0.079). Dose-length product (p = 0.8424), signal-to-noise ratio (all p > 0.05), time to peak (p = 0.324), and changes in heart rate (p = 0.974) were comparable between groups. The peak pressures differed: 197.4 psi for 300 mg I/ml (viscosity 4.6 mPa s), 229.8 psi for 350 mg I/ml (10.4 mPa s), 216.1 psi for 370 mg I/ml (9.5 mPa s), and 243.7 psi for 400 mg I/ml (12.6 mPa s) (p < 0.0001). CONCLUSION Intravascular attenuation and changes in heart rate are independent of iodine concentration when contrast media are injected at the same iodine delivery rate. Differences in injection pressures are associated with the viscosity of the contrast media. KEY POINTS • The contrast enhancement in coronary CT angiography is independent of the iodine concentration when contrast media are injected at body temperature (37 °C) with the same iodine delivery rate. • Iodine concentration does not influence the change in heart rate when contrast media are injected at identical iodine delivery rates. • For a fixed iodine delivery rate and contrast temperature, the viscosity of the contrast medium affects the injection pressure.
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Affiliation(s)
- Marco Rengo
- Faculty of Pharmacy and Medicine, University of Rome Sapienza, Latina, Italy
| | - Anoeshka Dharampal
- Departments of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marisa Lubbers
- Departments of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marc Kock
- Department of Radiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Joachim E Wildberger
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - Marco Das
- Department of Radiology and Nuclear Medicine, Maastricht UMC+, Maastricht, the Netherlands
| | - André Niezen
- Department of Radiology and Nuclear medicine, Maasstad Ziekenhuis, Rotterdam, the Netherlands
| | - Fiek van Tilborg
- Department of Radiology, Elisabeth-TweeSteden Ziekenhuis, Tilburg, The Netherlands
| | - Marcel Kofflard
- Department of Cardiology, Albert Schweitzer Ziekenhuis, Dordrecht, the Netherlands
| | - Andrea Laghi
- Department of Surgical and Medical Sciences and Translational Medicine, University of Rome Sapienza, Rome, Italy
| | - Gabriel Krestin
- Department of Radiology, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Koen Nieman
- Departments of Radiology and Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands. .,Stanford University School of Medicine and Cardiovascular Institute, 300 Pasteur Dr, Room H2157, Stanford, CA, 94305, USA.
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Zucker EJ, Kino A, Schmiedeskamp H, Hinostroza V, Fleischmann D, Chan FP. Feasibility and utility of dual-energy chest CTA for preoperative planning in pediatric pulmonary artery reconstruction. Int J Cardiovasc Imaging 2019; 35:1473-1481. [PMID: 31016501 DOI: 10.1007/s10554-019-01602-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/09/2019] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to assess in pediatric pulmonary artery (PA) reconstruction candidates the feasibility and added utility of preoperative chest computed tomography angiography (CTA) using dual-energy technique, from which perfused blood volume (PBV)/iodine maps can be generated as a surrogate of pulmonary perfusion. Pediatric PA reconstruction patients were prospectively recruited for a new dose-neutral dual-energy CTA protocol. For each case, the severity of anatomic PA obstruction was graded by two pediatric cardiovascular radiologists in consensus using a modified Qanadli index. PBV maps were qualitatively reviewed and auto-segmented using Siemens syngo.via software. Associations between Qanadli scores and PBV were assessed with Spearman correlation (r) and ROC analysis. Effective radiation doses were estimated from dose-length product and ICRP 103 k-factors, using cubic Hermite spline interpolation. 19 patients were recruited with mean (SD) age of 6.0 (5.1), 11 (57.9%) female, 11 (73.7%) anesthetized. Higher QS correlated with lower PBV, both on a whole lung (r = - 0.54, p < 0.001) and lobar (r = - 0.50, p < 0.001) basis. The lung with lowest absolute PBV was predictive of the lung with highest Qanadli score, with AUC of 0.70 (95% CI 0.47-0.93). Qualitatively, PBV maps were heterogeneous, corresponding to multifocal PA stenoses, with decreased iodine content in areas of most severe obstruction. In conclusion, dual-energy chest CTA is feasible for pediatric PA reconstruction candidates. PBV maps show deficits in regions of more severe anatomic obstruction and may serve as a novel biomarker in this population.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA.
| | - Aya Kino
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
| | - Heiko Schmiedeskamp
- Siemens Medical Solutions USA, 40 Liberty Boulevard, Malvern, PA, 19355, USA
| | - Virginia Hinostroza
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
| | - Dominik Fleischmann
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
| | - Frandics P Chan
- Department of Radiology, Stanford University School of Medicine, 725 Welch Road, Stanford, CA, 94305, USA
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19
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Schoepf UJ. Contrast Media for Coronary CT Angiography: Should an Iso-osmolar Agent Be Used? Radiology 2017; 286:81-82. [PMID: 29261462 DOI: 10.1148/radiol.2017172170] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- U Joseph Schoepf
- From the Division of Cardiovascular Imaging, Department of Radiology and Radiological Science; Division of Cardiology, Department of Medicine; and Division of Pediatric Cardiologym Department of Pediatrics, Medical University of South Carolina, Ashley River Tower, 25 Courtenay Dr, MSC 226, Charleston, SC 29425-2260
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