1
|
Lyons JG, Shinde MU, Maro JC, Petrone A, Cosgrove A, Kempner ME, Andrade SE, Mwidau J, Stojanovic D, Hernández-Muñoz JJ, Toh S. Use of the Sentinel System to Examine Medical Product Use and Outcomes During Pregnancy. Drug Saf 2024:10.1007/s40264-024-01447-z. [PMID: 38940904 DOI: 10.1007/s40264-024-01447-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2024] [Indexed: 06/29/2024]
Abstract
While many pregnant individuals use prescription medications, evidence supporting product safety during pregnancy is often inadequate. Existing electronic healthcare data sources provide large, diverse samples of health plan members to allow for the study of medical product utilization during pregnancy, as well as pregnancy, maternal, and infant outcomes. The Sentinel System is a national medical product surveillance system that includes administrative claims and electronic health record databases from large national and regional health insurers. In addition to these data sources, Sentinel develops and maintains a sizeable selection of analytic tools to facilitate epidemiologic analyses in a way that protects patient privacy and health system autonomy. In this article, we provide an overview of Sentinel System infrastructure, including the Mother-Infant Linkage Table, parameterizable analytic tools, and algorithms to estimate gestational age and identify pregnancy outcomes. We also describe past and future Sentinel work that contributes to our understanding of the way medical products are used and the safety of these products during pregnancy.
Collapse
Affiliation(s)
- Jennifer G Lyons
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA.
| | - Mayura U Shinde
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Judith C Maro
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Andrew Petrone
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Austin Cosgrove
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Maria E Kempner
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Susan E Andrade
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| | - Jamila Mwidau
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Danijela Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - José J Hernández-Muñoz
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, US Food and Drug Administration, Silver Spring, MD, USA
| | - Sengwee Toh
- Division of Therapeutics Research and Infectious Disease Epidemiology, Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA, 02215, USA
| |
Collapse
|
2
|
Whitworth P, Courtney KG, Oto A, Allen BC, Akin O, Barker SJ, Bartel TB, DuBeau C, Gerena M, Kraft KH, Lew SQ, Mankowski Gettle L, Turkbey B, Uyeda JW, Nikolaidis P. ACR Appropriateness Criteria® Hydronephrosis on Prior Imaging-Unknown Cause. J Am Coll Radiol 2024; 21:S144-S167. [PMID: 38823942 DOI: 10.1016/j.jacr.2024.02.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Accepted: 02/28/2024] [Indexed: 06/03/2024]
Abstract
Initial imaging evaluation of hydronephrosis of unknown etiology is a complex subject and is dependent on clinical context. In asymptomatic patients, it is often best conducted via CT urography (CTU) without and with contrast, MR urography (MRU) without and with contrast, or scintigraphic evaluation with mercaptoacetyltriglycine (MAG3) imaging. For symptomatic patients, CTU without and with contrast, MRU without and with contrast, MAG3 scintigraphy, or ultrasound of the kidneys and bladder with Doppler imaging are all viable initial imaging studies. In asymptomatic pregnant patients, nonionizing imaging with US of the kidneys and bladder with Doppler imaging is preferred. Similarly, in symptomatic pregnant patients, US of the kidneys and bladder with Doppler imaging or MRU without contrast is the imaging study of choice, as both ionizing radiation and gadolinium contrast are avoided in pregnancy. The American College of Radiology Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a multidisciplinary expert panel. The guideline development and revision process support the systematic analysis of the medical literature from peer reviewed journals. Established methodology principles such as Grading of Recommendations Assessment, Development, and Evaluation or GRADE are adapted to evaluate the evidence. The RAND/UCLA Appropriateness Method User Manual provides the methodology to determine the appropriateness of imaging and treatment procedures for specific clinical scenarios. In those instances where peer reviewed literature is lacking or equivocal, experts may be the primary evidentiary source available to formulate a recommendation.
Collapse
Affiliation(s)
- Pat Whitworth
- Thomas F. Frist, Jr. College of Medicine, Belmont University, Nashville, Tennessee.
| | - Kelsey G Courtney
- Research Author, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Aytekin Oto
- Panel Chair, University of Chicago, Chicago, Illinois
| | - Brian C Allen
- Panel Vice Chair, Duke University Medical Center, Durham, North Carolina
| | - Oguz Akin
- Memorial Sloan Kettering Cancer Center, New York, New York
| | | | - Twyla B Bartel
- Global Advanced Imaging, PLLC, Little Rock, Arkansas; Commission on Nuclear Medicine and Molecular Imaging
| | - Catherine DuBeau
- Dartmouth Geisel School of Medicine, Hanover, New Hampshire; American Geriatrics Society
| | - Marielia Gerena
- Stony Brook University Medical Center, Stony Brook, New York
| | - Kate H Kraft
- University of Michigan, Ann Arbor, Michigan; American Urological Association
| | - Susie Q Lew
- George Washington University, Washington, District of Columbia; American Society of Nephrology
| | | | - Baris Turkbey
- National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Jennifer W Uyeda
- Brigham & Women's Hospital, Boston, Massachusetts; Committee on Emergency Radiology-GSER
| | | |
Collapse
|
3
|
Iacobellis F, Di Serafino M, Russo C, Ronza R, Caruso M, Dell’Aversano Orabona G, Camillo C, Sabatino V, Grimaldi D, Rinaldo C, Barbuto L, Verde F, Giacobbe G, Schillirò ML, Scarano E, Romano L. Safe and Informed Use of Gadolinium-Based Contrast Agent in Body Magnetic Resonance Imaging: Where We Were and Where We Are. J Clin Med 2024; 13:2193. [PMID: 38673466 PMCID: PMC11051151 DOI: 10.3390/jcm13082193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2024] [Revised: 03/28/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have helped to improve the role of magnetic resonance imaging (MRI) for the diagnosis and treatment of diseases. There are currently nine different commercially available gadolinium-based contrast agents (GBCAs) that can be used for body MRI cases, and which are classifiable according to their structures (cyclic or linear) or biodistribution (extracellular-space agents, target/specific-agents, and blood-pool agents). The aim of this review is to illustrate the commercially available MRI contrast agents, their effect on imaging, and adverse reaction on the body, with the goal to lead to their proper selection in different clinical contexts. When we have to choose between the different GBCAs, we have to consider several factors: (1) safety and clinical impact; (2) biodistribution and diagnostic application; (3) higher relaxivity and better lesion detection; (4) higher stability and lower tissue deposit; (5) gadolinium dose/concentration and lower volume injection; (6) pulse sequences and protocol optimization; (7) higher contrast-to-noise ratio at 3.0 T than at 1.5 T. Knowing the patient's clinical information, the relevant GBCAs properties and their effect on body MRI sequences are the key features to perform efficient and high-quality MRI examination.
Collapse
Affiliation(s)
- Francesca Iacobellis
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Marco Di Serafino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Camilla Russo
- Neuroradiology Unit, Department of Neuroscience Santobono-Pausilipon Children’s Hospital, 80122 Naples, Italy;
| | - Roberto Ronza
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Martina Caruso
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuseppina Dell’Aversano Orabona
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Costanza Camillo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Vittorio Sabatino
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Dario Grimaldi
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Chiara Rinaldo
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Luigi Barbuto
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Francesco Verde
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Giuliana Giacobbe
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Maria Laura Schillirò
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| | - Enrico Scarano
- Department of Radiology, “San Carlo” Hospital, 85100 Potenza, Italy;
| | - Luigia Romano
- Department of General and Emergency Radiology, “A. Cardarelli” Hospital, 80131 Naples, Italy; (M.D.S.); (M.C.); (G.D.O.); (C.C.); (V.S.); (D.G.); (C.R.); (L.B.); (F.V.); (G.G.); (M.L.S.); (L.R.)
| |
Collapse
|
4
|
Gomez EN, Ahmed TM, Macura K, Fishman EK, Vaught AJ. CT angiography for characterization of advanced placenta accreta spectrum: indications, risks, and benefits. Abdom Radiol (NY) 2024; 49:842-854. [PMID: 37987857 DOI: 10.1007/s00261-023-04105-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
Placenta accreta spectrum disorder (PASD) encompasses various types of abnormal placentation in which chorionic villi directly adhere to or invade the myometrium. The incidence of PASD has dramatically risen in the US over the past 3 decades owing to the increased rates of patients undergoing cesarean sections. While PASD remains a significant cause of maternal morbidity and mortality, accurate prenatal identification and characterization of PASD is associated with improved outcomes. Although ultrasound is the first-line imaging modality in the evaluation of PASD, with MRI serving as an adjunct, computed tomography angiography (CTA) may also offer unique diagnostic advantages in cases of advanced PASD by providing superior visualization of placental and abdominopelvic vasculature and enabling the creation of comprehensive vascular maps to roadmap complex surgical interventions. This paper represents the first evaluation of CTA as a diagnostic tool and operative planning aid in this context. Appropriate indications and diagnostic advantages of CTA in this setting are reviewed, and key multimodal imaging features of normal and abnormal placentation are highlighted.
Collapse
Affiliation(s)
- Erin N Gomez
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA.
| | - Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Katarzyna Macura
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Arthur J Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| |
Collapse
|
5
|
Iyad N, S.Ahmad M, Alkhatib SG, Hjouj M. Gadolinium contrast agents- challenges and opportunities of a multidisciplinary approach: Literature review. Eur J Radiol Open 2023; 11:100503. [PMID: 37456927 PMCID: PMC10344828 DOI: 10.1016/j.ejro.2023.100503] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 06/09/2023] [Accepted: 06/23/2023] [Indexed: 07/18/2023] Open
Abstract
Contrast agents is used in magnetic resonance imaging (MRI) to improve the visibility of the details of the organ structures. Gadolinium-based contrast agent (GBCA) has been used since 1988 in MRI for diagnostic and follow-up of patients, the gadolinium good properties make it an effective choice for enhance the signal in MRI by increase its intensity and shortening the relaxation time of the proton. Recently, many studies show a gadolinium deposition in different human organs due to release of free gadolinium various body organs or tissue, which led to increased concern about the use of gadolinium agents, in this study, the potential diseases that may affect the patient and side effects that appear on the patient and related to accumulation of gadolinium were clarified, the study focused on the organs such as brain and bones in which gadolinium deposition was found and the lesions associated with it, and the diseases associated with gadolinium retention includes Nephrogenic Systemic Fibrosis (NSF) and Gadolinium deposition disease (GDD). Some studies tended to improve the contrast agents by developing a new non-gadolinium agents or development of next-generation gadolinium agents. In this review article the latest knowledge about MRI contrast agent.
Collapse
Affiliation(s)
- Nebal Iyad
- Ibn Rushd Radiology Centre, Hebron, Palestine
| | - Muntaser S.Ahmad
- Ibn Rushd Radiology Centre, Hebron, Palestine
- Department of Medical Imaging, Faculty of Allied Medical Health, Palestine Ahliya University, Dheisha, Bethlehem, Palestine
| | - Sanaa G. Alkhatib
- Department of Medical Imaging, Faculty of Allied Medical Health, Palestine Ahliya University, Dheisha, Bethlehem, Palestine
| | - Mohammad Hjouj
- Medical Imaging Department, Faculty of Health Professions, Al-Quds University, Abu Deis - Main Campus, Jerusalem, Palestine
| |
Collapse
|
6
|
Maralani PJ, Pai V, Ertl-Wagner BB. Safety of Magnetic Resonance Imaging in Pregnancy. RADIOLOGIE (HEIDELBERG, GERMANY) 2023; 63:34-40. [PMID: 37747489 DOI: 10.1007/s00117-023-01207-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023]
Abstract
Magnetic resonance imaging is being increasingly used to diagnose and follow up a variety of medical conditions in pregnancy, both for maternal and fetal indications. However, limited data regarding its safe use in pregnancy may be a source of anxiety and avoidance for both patients and their healthcare providers. In this review, we critically discuss the main safety concerns of Magnetic Resonance Imaging (MRI) in pregnancy including energy deposition, acoustic noise, and use of contrast agents, supported by data from animal and human studies. Use of maternal sedatives and concerns related to occupational exposure in pregnant personnel are also addressed. Exposure to gadolinium-based contrast agents and sedation for MRI during pregnancy should be avoided whenever feasible.
Collapse
Affiliation(s)
- Pejman Jabehdar Maralani
- Department of Medical Imaging, Sunnybrook Health Sciences Centre, Bayview Avenue, Room AG270C, 2075, Toronto, Ontario, Canada.
| | - Vivek Pai
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| | - Birgit B Ertl-Wagner
- Department of Medical Imaging, University of Toronto, The Hospital for Sick Children, 555 University Ave, M5G 1X8, Toronto, ON, Canada
| |
Collapse
|
7
|
Panico C, Bottazzi S, Russo L, Avesani G, Celli V, D’Erme L, Cipriani A, Mascilini F, Fagotti A, Scambia G, Sala E, Gui B. Prediction of the Risk of Malignancy of Adnexal Masses during Pregnancy Comparing Subjective Assessment and Non-Contrast MRI Score (NCMS) in Radiologists with Different Expertise. Cancers (Basel) 2023; 15:5138. [PMID: 37958313 PMCID: PMC10648807 DOI: 10.3390/cancers15215138] [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: 08/18/2023] [Revised: 10/18/2023] [Accepted: 10/19/2023] [Indexed: 11/15/2023] Open
Abstract
Ovarian cancer represents 7% of all cancers in pregnant women. Characterising an ovarian mass during pregnancy is essential to avoid unnecessary treatment and, if treatment is required, to plan it accordingly. Although ultrasonography (US) is the first-line modality to characterise adnexal masses, MRI is indicated when adnexal masses are indeterminate at the US examination. An MRI risk stratification system has been proposed to assign a malignancy probability based on the adnexal lesion's MRI, but features of the scoring system require the administration of intravenous gadolinium-based contrast agents, a method that might have a limited use in pregnant women. The non-contrast MRI score (NCMS) has been used and evaluated in non-pregnant women to characterise adnexal masses indeterminate at the US examination. Therefore, we evaluated the diagnostic accuracy of the NCMS in pregnant women, analysing 20 cases referred to our specialised institution. We also evaluated the diagnostic agreement between two radiologists with different expertise. The two readers classified ovarian masses as benign or malignant using both subjective assessment (SA), based on the interpretive evaluation of imaging findings derived from personal experience, and the NCMS, which includes five categories where 4 and 5 indicate a high probability of a malignant mass. The expert radiologist correctly classified 90% of the diagnoses, using both SA and the NCMS, relying on a sensitivity of 85.7% and a specificity of 92.3%, with a false positive rate of 7.7% and a false negative rate of 14.3%. The non-expert radiologist correctly identified patients at a lower rate, especially using the SA. The analysis of the inter-observer agreement showed a K = 0.47 (95% CI: 0.48-0.94) for the SA (agreement in 71.4% of cases) and a K = 0.8 (95% CI: 0.77-1.00) for the NCMS (agreement in 90% of cases). Although in pregnant patients, non-contrast MRI is used, our results support the use of a quantitative score, i.e., the NCMS, as an accurate tool. This procedure may help less experienced radiologists to reduce the rate of false negatives or positives, especially in centres not specialised in gynaecological imaging, making the MRI interpretation easier and more accurate for radiologists who are not experts in the field, either.
Collapse
Affiliation(s)
- Camilla Panico
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Silvia Bottazzi
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Luca Russo
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Giacomo Avesani
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Veronica Celli
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Luca D’Erme
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Alessia Cipriani
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| | - Floriana Mascilini
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (A.F.); (G.S.)
| | - Anna Fagotti
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (A.F.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Giovanni Scambia
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (F.M.); (A.F.); (G.S.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Evis Sala
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
- Faculty of Medicine and Surgery, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Benedetta Gui
- Department of Diagnostic Imaging, Oncological Radiotherapy and Haematology, Fondazione Policlinico Universitario A. Gemelli IRCCS, 00168 Rome, Italy; (C.P.); (S.B.); (L.R.); (V.C.); (L.D.); (A.C.); (E.S.); (B.G.)
| |
Collapse
|
8
|
Arian A, Seyed-Kolbadi FZ, Yaghoobpoor S, Ghorani H, Saghazadeh A, Ghadimi DJ. Diagnostic accuracy of intravoxel incoherent motion (IVIM) and dynamic contrast-enhanced (DCE) MRI to differentiate benign from malignant breast lesions: A systematic review and meta-analysis. Eur J Radiol 2023; 167:111051. [PMID: 37632999 DOI: 10.1016/j.ejrad.2023.111051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 08/01/2023] [Accepted: 08/14/2023] [Indexed: 08/28/2023]
Abstract
PURPOSE Magnetic resonance imaging (MRI) can reduce the need for unnecessary invasive diagnostic tests by nearly half. In this meta-analysis, we investigated the diagnostic accuracy of intravoxel incoherent motion modeling (IVIM) and dynamic contrast-enhanced (DCE) MRI in differentiating benign from malignant breast lesions. METHOD We systematically searched PubMed, EMBASE, and Scopus. We included English articles reporting diagnostic accuracy for both sequences in differentiating benign from malignant breast lesions. Articles were assessed by quality assessment of diagnostic accuracy studies-2 (QUADAS-2) questionnaire. We used a bivariate effects model for standardized mean difference (SMD) analysis and diagnostic test accuracy analysis. RESULTS Ten studies with 537 patients and 707 (435 malignant and 272 benign) lesions were included. The D, f, Ktrans, and Kep mean values significantly differ between benign and malignant lesions. The pooled sensitivity (95 % confidence interval) and specificity were 86.2 % (77.9 %-91.7 %) and 70.3 % (56.5 %-81.1 %) for IVIM, and 93.8 % (85.3 %-97.5 %) and 68.1 % (52.7 %-80.4 %) for DCE, respectively. Combined IVIM and DCE depicted the highest area under the curve of 0.94, with a sensitivity and specificity of 91.8 % (82.8 %-96.3 %) and 87.6 % (73.8 %-94.7 %), respectively. CONCLUSIONS Combined IVIM and DCE had the highest diagnostic accuracy, and multiparametric MRI may help reduce unnecessary benign breast biopsy.
Collapse
Affiliation(s)
- Arvin Arian
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Cancer Research Institute, Imam Khomeini Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Zahra Seyed-Kolbadi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Evidence-Based Medicine Study Center, Hormozgan University of Medical Sciences, Bandar Abass, Iran
| | - Shirin Yaghoobpoor
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; Student Research Committee, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hamed Ghorani
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amene Saghazadeh
- Systematic Review and Meta-Analysis Expert Group (SRMEG), Universal Scientific Education and Research Network (USERN), Tehran, Iran; Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences (TUMS), Tehran, Iran
| | - Delaram J Ghadimi
- Advanced Diagnostic and Interventional Radiology Research Center (ADIR), Tehran University of Medical Sciences, Tehran, Iran; School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Quantitative MR Imaging and Spectroscopy Group (QMISG), Tehran University of Medical Sciences, Tehran, Iran.
| |
Collapse
|
9
|
Alghamdi SA. Gadolinium-Based Contrast Agents in Pregnant Women: A Literature Review of MRI Safety. Cureus 2023; 15:e38493. [PMID: 37273372 PMCID: PMC10237509 DOI: 10.7759/cureus.38493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2023] [Indexed: 06/06/2023] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used in magnetic resonance imaging (MRI) to enhance the visualisation and characterisation of the region of interest/lesion. Internal structures are well seen with MRI with good spatial resolution. Although MRI is generally considered safe during pregnancy, concerns have been raised regarding the safety of GBCAs, particularly during the first trimester. Limited studies have been conducted to assess the safety of GBCAs in pregnant women, with conflicting results. A comprehensive literature search was conducted using PubMed, SpringerLink, Medscape, ResearchGate and Wiley Online Library. The search terms included various combinations of MRI, pregnancy, first trimester, gadolinium contrast agents, foetus, risk, and toxicity. The search criteria were articles published in English in the last 20 years and indexed in the MEDLINE or Embase databases. The majority of studies found no definitive evidence that GBCAs are harmful during pregnancy, particularly during the first trimester. Some studies reported no increased risk of adverse outcomes in infants exposed to GBCAs during the first trimester. However, other studies showed inconsistent results. Retrospective cohort studies provided some reassurance regarding the safety of GBCAs when indicated in pregnant women but did not address potential long-term adverse outcomes in infants exposed to GBCAs during gestation. The literature review also highlights the importance of further evaluating the subacute and chronic effects of GBCA exposure in infants. The safety of GBCAs during pregnancy, particularly during the first trimester, remains uncertain. More large-scale, long-term studies are needed to clarify the safety of GBCAs in pregnant women and their potential effects on foetal and neonatal outcomes. Until conclusive evidence is available, healthcare providers should carefully weigh the benefits and risks of using GBCAs during pregnancy and consider alternative imaging modalities, such as non-contrast MRI or ultrasound, when necessary.
Collapse
Affiliation(s)
- Sami A Alghamdi
- Department of Radiological Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, SAU
| |
Collapse
|
10
|
Diagnostic et prise en charge d’une grossesse gémellaire associant une môle complète à un fœtus vivant : à propos d’un cas. IMAGERIE DE LA FEMME 2023. [DOI: 10.1016/j.femme.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
|
11
|
Imaging modalities and optimized imaging protocols in pregnant patients with cancer. ABDOMINAL RADIOLOGY (NEW YORK) 2023; 48:1579-1589. [PMID: 36688976 DOI: 10.1007/s00261-023-03798-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 12/29/2022] [Accepted: 01/02/2023] [Indexed: 01/24/2023]
Abstract
Medical imaging during pregnancy may be necessary to diagnose conditions that affect the outcome of the mother and fetus. Diagnosis and staging of cancer in pregnant women can be particularly challenging due to fear of inherent risk to the fetus, lack of standardized imaging protocols, and ethical challenges posed while choosing the best imaging option. Ultrasound and MRI, due to lack of ionizing radiation, are preferred over CT and nuclear imaging. The latter may be considered only if the benefits of imaging outweigh maternal and fetal risk without exceeding the cumulative established fetal radiation dose threshold. This article provides an overview of all currently available imaging options that can be used for imaging cancer during pregnancy to support the best possible maternal and fetal outcomes.
Collapse
|
12
|
Lopez-Lopez V, Navaratne L, Ferreras D, Gil PJ, Bansal VK, Mattila A, Parra-Membrives P, Marco TG, Ruiz-Manzanera JJ, Nassar AHM, Sánchez-Bueno F, Robles-Campos R, Martinez-Isla A. Laparoscopic bile duct exploration during pregnancy: a multi-center case series and literature review. Langenbecks Arch Surg 2023; 408:45. [PMID: 36662260 DOI: 10.1007/s00423-023-02793-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/02/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND The physiological changes of pregnancy increase the risk of gallstone formation and choledocholithiasis. Traditionally, endoscopic retrograde cholangiopancreatography (ERCP) has been the main approach for managing choledocholithiasis during pregnancy, but recent progress in laparoscopic bile duct exploration (LBDE) has demonstrated this technique as a safe and effective alternative option. METHODS A retrospective multicenter study of all patients who underwent LBDE during pregnancy from five centers with proven experience in LBDE between January 2010 and June 2020 was performed. The primary endpoint was to analyze the role of LBDE during pregnancy and to further characterize its position as a safe and effective alternative for the management of choledocholithiasis. A systematic review of the published literature relating to LBDE during pregnancy until February 2022 was also performed. RESULTS Five institutions reported performing LBDE during pregnancy in 8 patients. Median surgical time was 75 min (range: 60-140 min). The bile duct was cleared successfully in all patients, and the median hospital stay was 2 days (range: 1-3 days). The literature review identified a total of 7 patients with a successful CBD clearance rate of 86%. There were no major maternal, fetal, or pregnancy-related complications in any of the total 15 patients included. The symptomatic common bile duct lithiasis with deranged liver function tests was the most frequent indication (n=7). CONCLUSION LBDE during pregnancy appears to be safe and effective. More evidence reporting outcomes of LBDE during pregnancy is needed before any strong recommendations can be made.
Collapse
Affiliation(s)
- Víctor Lopez-Lopez
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain.
| | - Lalin Navaratne
- Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, London North West University Healthcare NHS Trust, London, UK
| | - David Ferreras
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Pedro Jose Gil
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Virinder K Bansal
- Department of Surgical Disciplines, All India Institute of Medical Sciences, New Delhi, India
| | - Anne Mattila
- Department of Surgery, Central Finland Hospital Nova, Jyväskylä, Finland
| | - Pablo Parra-Membrives
- Hepatobiliary and Pancreatic Surgery Unit, Valme University Hospital, Sevilla, Spain
| | - Tania Gaspar Marco
- Department of Gynecology and Obstetrics, Vega Baja Hospital, Alicante, Spain
| | - Juan Jose Ruiz-Manzanera
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ahmad H M Nassar
- University Hospital Monklands, Lanarkshire, and University of Glasgow, Scotland, UK
| | - Francisco Sánchez-Bueno
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Ricardo Robles-Campos
- Department of General, Visceral and Transplantation Surgery, Clinic and University Hospital Virgen de la Arrixaca, IMIB-ARRIXACA, Murcia, Spain
| | - Alberto Martinez-Isla
- Department of Upper GI Surgery, Northwick Park & St Mark's Hospitals, London North West University Healthcare NHS Trust, London, UK
| |
Collapse
|
13
|
Dell’Aquila K, Hodges H, Moshiri M, Katz DS, Elojeimy S, Revzin MV, Tembelis M, Revels JW. Imaging evaluation of lymphoma in pregnancy with review of clinical assessment and treatment options. Abdom Radiol (NY) 2023; 48:1663-1678. [PMID: 36595067 PMCID: PMC9808767 DOI: 10.1007/s00261-022-03779-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 12/11/2022] [Accepted: 12/12/2022] [Indexed: 01/04/2023]
Abstract
Lymphoma-related malignancies can be categorized as Hodgkin's lymphoma (HL) or non-Hodgkin's lymphoma (NHL) based on histologic characteristics. Although quite rare during pregnancy, HL and NHL are the fourth and fifth most common malignancies during the pregnancy period, respectively. Given the rarity of lymphoma among pregnant patients, radiologists are usually unfamiliar with the modifications required for staging and treatment of this population, even those who work at centers with busy obstetrical services. Therefore, this manuscript serves to not only review the abdominopelvic imaging features of lymphoma in pregnancy, but it also discusses topics including birthing parent and fetal lymphoma-related prognosis, both antenatal and postpartum, current concepts in the management of pregnancy-related lymphoma, as well as the current considerations regarding birthing parent onco-fertility.
Collapse
Affiliation(s)
- Kevin Dell’Aquila
- grid.260914.80000 0001 2322 1832New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY USA
| | - Hannah Hodges
- grid.266832.b0000 0001 2188 8502Department of Radiology, University of New Mexico, Albuquerque, NM USA
| | - Mariam Moshiri
- grid.412807.80000 0004 1936 9916Department of Radiology, Vanderbilt University Medical Center, Nashville, TN USA
| | - Douglas S. Katz
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island, Mineola, NY USA
| | - Saeed Elojeimy
- grid.259828.c0000 0001 2189 3475Department of Radiology, Medical University of South Carolina, Charleston, SC USA
| | - Margarita V. Revzin
- grid.47100.320000000419368710Department of Radiology, Yale University School of Medicine, New Haven, CT USA
| | - Miltiadis Tembelis
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island, Mineola, NY USA
| | - Jonathan W. Revels
- grid.137628.90000 0004 1936 8753Department of Radiology, New York University Langone Health–Long Island Division, 560 1St Avenue, 2nd Floor, New York, NY 10016 USA
| |
Collapse
|
14
|
Brown JS, Mendelsohn AB, Nam YH, Maro JC, Cocoros NM, Rodriguez-Watson C, Lockhart CM, Platt R, Ball R, Dal Pan GJ, Toh S. The US Food and Drug Administration Sentinel System: a national resource for a learning health system. J Am Med Inform Assoc 2022; 29:2191-2200. [PMID: 36094070 PMCID: PMC9667154 DOI: 10.1093/jamia/ocac153] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2022] [Revised: 06/18/2022] [Accepted: 08/18/2022] [Indexed: 07/23/2023] Open
Abstract
The US Food and Drug Administration (FDA) created the Sentinel System in response to a requirement in the FDA Amendments Act of 2007 that the agency establish a system for monitoring risks associated with drug and biologic products using data from disparate sources. The Sentinel System has completed hundreds of analyses, including many that have directly informed regulatory decisions. The Sentinel System also was designed to support a national infrastructure for a learning health system. Sentinel governance and guiding principles were designed to facilitate Sentinel's role as a national resource. The Sentinel System infrastructure now supports multiple non-FDA projects for stakeholders ranging from regulated industry to other federal agencies, international regulators, and academics. The Sentinel System is a working example of a learning health system that is expanding with the potential to create a global learning health system that can support medical product safety assessments and other research.
Collapse
Affiliation(s)
- Jeffrey S Brown
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Aaron B Mendelsohn
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Young Hee Nam
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Judith C Maro
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Noelle M Cocoros
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Carla Rodriguez-Watson
- Reagan-Udall Foundation for the Food and Drug Administration, Washington, District of Columbia, USA
| | - Catherine M Lockhart
- Biologics and Biosimilars Collective Intelligence Consortium, Alexandria, Virginia, USA
| | - Richard Platt
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Robert Ball
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Gerald J Dal Pan
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Sengwee Toh
- Corresponding Author: Sengwee Toh, ScD, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, 401 Park Drive, Suite 401 East, Boston, MA 02215, USA;
| |
Collapse
|
15
|
Winterstein AG, Thai TN, Nduaguba S, Smolinski NE, Wang X, Sahin L, Krefting I, Gelperin K, Bird ST, Rasmussen SA. Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy. Am J Obstet Gynecol 2022; 228:465.e1-465.e11. [PMID: 36241080 DOI: 10.1016/j.ajog.2022.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Concerns have been raised about prenatal exposure to magnetic resonance imaging with gadolinium-based contrast agents because of nonclinical findings of gadolinium retention in fetal tissue and 1 population-based study reporting an association with adverse pregnancy outcomes. OBJECTIVE This study aimed to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death and neonatal intensive care unit admission. STUDY DESIGN We constructed a retrospective cohort of >11 million Medicaid-covered pregnancies between 1999 and 2014 to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death (primary endpoint) and neonatal intensive care unit admissions (secondary endpoint). Medicaid claims data were linked to medical records, Florida birth and fetal death records, and the National Death Index to validate the outcomes and gestational age estimates. Pregnancies with multiples, concurrent cancer, teratogenic drug exposure, magnetic resonance imaging focused on fetal or pelvic evaluation, undetermined gadolinium-based contrast agent use, or those preceded by or contemporaneous with congenital anomaly diagnoses were excluded. We adjusted for potential confounders with standardized mortality ratio weighting using propensity scores. RESULTS Among 5991 qualifying pregnancies, we found 11 fetal or neonatal deaths in the gadolinium-based contrast agent magnetic resonance imaging group (1.4%) and 73 in the non-gadolinium-based contrast agent magnetic resonance imaging group (1.4%) with an adjusted relative risk of 0.73 (95% confidence interval, 0.34-1.55); the neonatal intensive care unit admission adjusted relative risk was 1.03 (0.76-1.39). Sensitivity analyses investigating the timing of magnetic resonance imaging or repeat magnetic resonance imaging exposure during pregnancy and simulating the impact of exposure misclassification corroborated these results. CONCLUSION This study addressed the safety concerns related to prenatal exposure to gadolinium-based contrast agents used in magnetic resonance imaging and the risk thereof on fetal and neonatal death or the need for neonatal intensive care unit admission. Although the results on fatal or severe acute effects are reassuring, the impact on subacute outcomes was not evaluated.
Collapse
Affiliation(s)
- Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL.
| | - Thuy N Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Leyla Sahin
- Division of Pediatrics and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, MD
| | - Ira Krefting
- Division of Imaging and Radiation Medicine, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Kate Gelperin
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Steven T Bird
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Sonja A Rasmussen
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL; Departments of Pediatrics, College of Medicine, University of Florida, Gainesville, FL; Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL
| |
Collapse
|
16
|
Boere I, Lok C, Poortmans P, Koppert L, Painter R, Vd Heuvel-Eibrink MM, Amant F. Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities. Best Pract Res Clin Obstet Gynaecol 2022; 82:46-59. [PMID: 35644793 DOI: 10.1016/j.bpobgyn.2022.05.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/02/2022]
Abstract
Although it is uncommon in general, breast cancer is the most commonly diagnosed cancer during pregnancy. While treatment for pregnant patients should adhere to treatment guidelines for non-pregnant patients, there exist specific considerations concerning diagnosis, staging, oncological treatment, and obstetrical care. Imaging and staging are preferably performed using breast ultrasound and mammography. Other ionizing radiation imaging modalities, including computed tomography (CT) and Positron Emission Tomography/ Computed Tomography (PET/CT), can be selectively performed when the estimated benefit for the mother outweighs the risks to the foetus, e.g., when the results will change clinical management. MRI is appropriate to stage for distant disease on the indication. Breast cancer during pregnancy is less often hormone receptor-positive and more frequently triple-negative breast cancer compared to age-matched controls. The basic principle is that women should receive state-of-the-art oncological treatment without delay if possible and that the pregnancy should be maintained as long as possible. Treatment strategy should be multidisciplinary defined, carefully weighing the selection, sequence, and timing of treatment modalities depending on patient-, tumour-, and pregnancy-related characteristics, as well as patient preferences. Initiating cancer treatment during pregnancy often decreases the risks of early delivery and prematurity. Breast cancer surgery is possible during all trimesters. Radiotherapy is possible during pregnancy in the first half of pregnancy. Chemotherapy can be safely administered starting from 12 weeks of gestational age, but endocrine and HER2 targeted therapy are contraindicated throughout the whole pregnancy. Importantly, foetal growth should be monitored and long-term follow-up of the children is encouraged in dedicated centres.
Collapse
Affiliation(s)
- Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Christianne Lok
- Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Philip Poortmans
- Iridium Network and University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Linetta Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rebecca Painter
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marry M Vd Heuvel-Eibrink
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederic Amant
- Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands; Gynecologic Oncology, UZ Leuven, Belgium
| |
Collapse
|
17
|
Clear E, Grant RA, Carroll M, Brassey CA. A Review and Case Study of 3D Imaging Modalities for Female Amniote Reproductive Anatomy. Integr Comp Biol 2022; 62:icac027. [PMID: 35536568 PMCID: PMC10570564 DOI: 10.1093/icb/icac027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/20/2022] [Indexed: 11/13/2022] Open
Abstract
Recent advances in non-invasive imaging methods have revitalised the field of comparative anatomy, and reproductive anatomy has been no exception. The reproductive systems of female amniotes present specific challenges, namely their often internal "hidden" anatomy. Quantifying female reproductive systems is crucial to recognising reproductive pathologies, monitoring menstrual cycles, and understanding copulatory mechanics. Here we conduct a review of the application of non-invasive imaging techniques to female amniote reproductive anatomy. We introduce the commonly used imaging modalities of computed tomography (CT) and magnetic resonance imaging (MRI), highlighting their advantages and limitations when applied to female reproductive tissues, and make suggestions for future advances. We also include a case study of micro CT and MRI, along with their associated staining protocols, applied to cadavers of female adult stoats (Mustela erminea). In doing so, we will progress the discussion surrounding the imaging of female reproductive anatomy, whilst also impacting the fields of sexual selection research and comparative anatomy more broadly.
Collapse
Affiliation(s)
- Emma Clear
- Department of Natural Sciences, Manchester Metropolitan University, Chester St, Manchester M1 5GD, UK
- Williamson Park Zoo, Quernmore Road, Lancaster, Lancashire LA1 1UX, UK
| | - Robyn A Grant
- Department of Natural Sciences, Manchester Metropolitan University, Chester St, Manchester M1 5GD, UK
| | - Michael Carroll
- Department of Life Sciences, Manchester Metropolitan University, Chester St, Manchester M1 5GD, UK
| | - Charlotte A Brassey
- Department of Natural Sciences, Manchester Metropolitan University, Chester St, Manchester M1 5GD, UK
| |
Collapse
|
18
|
Gadolinium-based contrast agent accelerates the migration of astrocyte via integrin αvβ3 signaling pathway. Sci Rep 2022; 12:5850. [PMID: 35393504 PMCID: PMC8990080 DOI: 10.1038/s41598-022-09882-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 03/29/2022] [Indexed: 11/08/2022] Open
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) are chemicals injected intravenously during magnetic resonance imaging to enhance the diagnostic yield. Repeated use of GBCAs causes their deposition in the brain. Such deposition may affect various neuronal cells, including astrocytes. In this study, we examined the effect of GBCAs (Omniscan, Magnescope, Magnevist, and Gadovist) on astrocyte migration, which is critical for formation of neurons during development and maintaining brain homeostasis. All GBCAs increased cell migration and adhesion with increased actin remodelling. Knockdown of integrin αvβ3 by RNAi or exposure to integrin αvβ3 inhibitor reduced astrocyte migration. GBCAs increased phosphorylation of downstream factors of αvβ3, such as FAK, ERK1/2, and Akt. The phosphorylation of all these factors were reduced by RNAi or integrin αvβ3 inhibitor. GBCAs also increased the phosphorylation of their downstream factor, Rac1/cdc42, belonging to the RhoGTPases family. Coexposure to the selective RhoGTPases inhibitors, decreased the effects of GBCAs on cell migration. These findings indicate that GBCAs exert their action via integrin αvβ3 to activate the signaling pathway, resulting in increased astrocyte migration. Thus, the findings of the study suggest that it is important to avoid the repeated use of GBCAs to prevent adverse side effects in the brain, particularly during development.
Collapse
|
19
|
How Could Nanomedicine Improve the Safety of Contrast Agents for MRI during Pregnancy? SCI 2022. [DOI: 10.3390/sci4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnancy is a delicate state, during which timely investigation of possible physiological anomalies is essential to reduce the risk of maternal and fetal complications. Medical imaging encompasses different technologies to image the human body for the diagnosis, course of treatment management, and follow-up of diseases. Ultrasound (US) is currently the imaging system of choice for pregnant patients. However, sonographic evaluations can be non-effective or give ambiguous results. Therefore, magnetic resonance imaging (MRI), due to its excellent tissue penetration, the possibility of acquisition of three-dimensional anatomical information, and its high spatial resolution, is considered a valid diagnostical alternative. Nevertheless, currently employed contrast agents to improve the MRI image quality are harmful to the fetus. Because of their ability to cross the placenta, their use on pregnant patients is avoided. This review will firstly recapitulate the most common non-obstetrical, obstetrical, and fetal indications for magnetic resonance imaging on pregnant women. Fetal safety risks, due to the use of strong magnetic fields and exogenous contrast agents, will be presented. Then, possible advantages of nanostructured contrast agents compared to current molecular ones are explored. Nanosystems’ characteristics affecting contrast efficiency, and their potential for improving contrast-enhanced MRI’s safety in pregnant women, are discussed. Lastly, promising examples of nanoparticles as safer alternatives to current MRI contrast agents in pregnancy are discussed.
Collapse
|
20
|
MRI in Pregnancy and Precision Medicine: A Review from Literature. J Pers Med 2021; 12:jpm12010009. [PMID: 35055324 PMCID: PMC8778056 DOI: 10.3390/jpm12010009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.
Collapse
|
21
|
Suarez EA, Haug N, Hansbury A, Stojanovic D, Corey C. Prescription medication use and baseline health status of women with live-birth deliveries in a national data network. Am J Obstet Gynecol MFM 2021; 4:100512. [PMID: 34656737 DOI: 10.1016/j.ajogmf.2021.100512] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 10/03/2021] [Accepted: 10/10/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND The US Food and Drug Administration increasingly uses administrative databases to conduct surveillance of medications used during pregnancy. To assess adverse fetal effects, administrative records must be linked between the mother and infant. The Sentinel Initiative's Mother-Infant Linkage Table provides a large cohort of linked deliveries from national, regional, and public insurance claims in the United States for the US Food and Drug Administration to conduct surveillance. OBJECTIVE This study aimed to describe baseline health conditions and prescription medication use during pregnancy in cohorts of women with a live-birth delivery linked and not linked to an infant. STUDY DESIGN Live-birth deliveries in women aged 10 to 54 years with at least 391 days of medical and drug coverage before delivery were identified in the Sentinel Mother-Infant Linkage Table from 2000 to 2019. Two cohorts were created for analysis: deliveries linked to infant records (linked deliveries, n=2,320,805) and deliveries unable to be linked to an infant (not-linked deliveries, n=504,785). Baseline health conditions, pregnancy history, healthcare utilization, and pregnancy conditions were defined using International Classification of Diseases, Ninth Revision, and International Classification of Diseases, Tenth Revision, diagnosis and procedure codes. Medication exposure was identified in a 90-day prepregnancy period and in each trimester. RESULTS Few notable differences were observed between the linked and not-linked deliveries except for maternal age and preterm birth; the not-linked cohort was 3.4 years younger on average and more likely to have a preterm delivery. At baseline among the linked deliveries, the most common conditions were depression and anxiety (5.2% each), acquired hypothyroidism (5.0%), pain conditions (3.9%), and asthma (2.8%). Among linked deliveries, 6.9% had evidence of gestational diabetes mellitus, 3.9% had gestational hypertension, and 4.5% had preeclampsia or eclampsia. The most commonly used medications during pregnancy in the linked deliveries were antibacterials (41.6%) and antiemetics (21.5%); similar medication use patterns were observed in the not-linked cohort. Age trends were observed for some medication groups; anti-infectives, pain medications, and antiemetics were more common in younger mothers, whereas endocrine medications were more common in older mothers. CONCLUSION Similarities between the linked and not-linked cohorts suggested that the ability to link mother and infant records is not influenced by maternal health status. In the linked cohort, the prevalence of specific pregnancy complications and medication use were similar to previously reported national estimates. Some baseline comorbidities, such as obesity and smoking, may be underestimated in the Sentinel Mother-Infant Linkage.
Collapse
Affiliation(s)
- Elizabeth A Suarez
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA (Dr Suarez, Ms Haug, and Mr Hansbury).
| | - Nicole Haug
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA (Dr Suarez, Ms Haug, and Mr Hansbury)
| | - Aaron Hansbury
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, MA (Dr Suarez, Ms Haug, and Mr Hansbury)
| | - Danijela Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD (Dr Stojanovic and Ms Corey)
| | - Catherine Corey
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, United States Food and Drug Administration, Silver Spring, MD (Dr Stojanovic and Ms Corey)
| |
Collapse
|
22
|
Keegan S, Gravell R, Belfield J, Wiles R. Urological imaging in the pregnant patient. BJU Int 2021; 128:519-522. [PMID: 34581481 DOI: 10.1111/bju.15580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- S Keegan
- Liverpool University Hospitals NHS Foundation Trust
| | - R Gravell
- Liverpool University Hospitals NHS Foundation Trust
| | - J Belfield
- Liverpool University Hospitals NHS Foundation Trust
| | - R Wiles
- Liverpool University Hospitals NHS Foundation Trust
| |
Collapse
|
23
|
Khairinisa MA, Ariyani W, Tsushima Y, Koibuchi N. Effects of Gadolinium Deposits in the Cerebellum: Reviewing the Literature from In Vitro Laboratory Studies to In Vivo Human Investigations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18147214. [PMID: 34299664 PMCID: PMC8305034 DOI: 10.3390/ijerph18147214] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2021] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 12/30/2022]
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) are chemicals injected intravenously during magnetic resonance imaging (MRI) to enhance the diagnostic yield. The repeated use of GBCAs can cause their deposition in the brain, including the cerebellum. Such deposition may affect various cell subsets in the brain and consequently cause behavioral alterations due to neurotoxicity. Caution should thus be exercised in using these agents, particularly in patients who are more likely to have repeated enhanced MRIs during their lifespan. Further studies are required to clarify the toxicity of GBCAs, and potential mechanisms causing neurotoxicity have recently been reported. This review introduces the effects of GBCAs in the cerebellum obtained from in vitro and in vivo studies and considers the possible mechanisms of neurotoxicity involved.
Collapse
Affiliation(s)
- Miski Aghnia Khairinisa
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
- Program Study of Pharmacy, Faculty of Mathematics and Natural Sciences, Bandung Islamic University, Bandung 40116, Indonesia
| | - Winda Ariyani
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
- Research Fellow of Japan Society for the Promotion of Science, Tokyo 102-0083, Japan
- Correspondence: (W.A.); (N.K.)
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
- Gunma University Initiative for Advanced Research (GIAR), Maebashi 371-8511, Japan
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi 371-8511, Japan;
- Correspondence: (W.A.); (N.K.)
| |
Collapse
|
24
|
Andrade SE, Shinde M, Moore Simas TA, Bird ST, Bohn J, Haynes K, Taylor LG, Lauring JR, Longley E, McMahill-Walraven CN, Trinacty CM, Saphirak C, Delude C, DeLuccia S, Zhang T, Cole DV, DiNunzio N, Gertz A, Fazio-Eynullayeva E, Stojanovic D. Validation of an ICD-10-based algorithm to identify stillbirth in the Sentinel System. Pharmacoepidemiol Drug Saf 2021; 30:1175-1183. [PMID: 34089206 DOI: 10.1002/pds.5300] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 05/24/2021] [Accepted: 06/01/2021] [Indexed: 11/08/2022]
Abstract
PURPOSE To develop and validate an International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM)-based algorithm to identify cases of stillbirth using electronic healthcare data. METHODS We conducted a retrospective study using claims data from three Data Partners (healthcare systems and insurers) in the Sentinel Distributed Database. Algorithms were developed using ICD-10-CM diagnosis codes to identify potential stillbirths among females aged 12-55 years between July 2016 and June 2018. A random sample of medical charts (N = 169) was identified for chart abstraction and adjudication. Two physician adjudicators reviewed potential cases to determine whether a stillbirth event was definite/probable, the date of the event, and the gestational age at delivery. Positive predictive values (PPVs) were calculated for the algorithms. Among confirmed cases, agreement between the claims data and medical charts was determined for the outcome date and gestational age at stillbirth. RESULTS Of the 110 potential cases identified, adjudicators determined that 54 were stillbirth events. Criteria for the algorithm with the highest PPV (82.5%; 95% CI, 70.9%-91.0%) included the presence of a diagnosis code indicating gestational age ≥20 weeks and occurrence of either >1 stillbirth-related code or no other pregnancy outcome code (i.e., livebirth, spontaneous abortion, induced abortion) recorded on the index date. We found ≥90% agreement within 7 days between the claims data and medical charts for both the outcome date and gestational age at stillbirth. CONCLUSIONS Our results suggest that electronic healthcare data may be useful for signal detection of medical product exposures potentially associated with stillbirth.
Collapse
Affiliation(s)
- Susan E Andrade
- The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Mayura Shinde
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Tiffany A Moore Simas
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts, USA
| | - Steven T Bird
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Justin Bohn
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Kevin Haynes
- Department of Scientific Affairs, HealthCore, Inc., Wilmington, Delaware, USA
| | - Lockwood G Taylor
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| | - Julianne R Lauring
- Department of Obstetrics and Gynecology, University of Massachusetts Medical School/UMass Memorial Health Care, Worcester, Massachusetts, USA
| | - Erin Longley
- Community Health Care Family Medicine Residency, Tacoma, Washington, USA
| | - Cheryl N McMahill-Walraven
- CVS Health Clinical Trial Services, Part of the CVS Health Family of Companies, Blue Bell, Pennsylvania, USA
| | - Connie M Trinacty
- Kaiser Permanente Center for Integrated Health Care Research Hawaii and Office of Public Health Studies, University of Hawai'i Manoa, Honolulu, Hawaii, USA
| | - Cassandra Saphirak
- The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Christopher Delude
- The Meyers Primary Care Institute, a joint endeavor of the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, University of Massachusetts Medical School, Worcester, Massachusetts, USA
| | - Sandra DeLuccia
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Tancy Zhang
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - David V Cole
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Nina DiNunzio
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Autumn Gertz
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Elnara Fazio-Eynullayeva
- Department of Population Medicine, Harvard Pilgrim Health Care Institute and Harvard Medical School, Boston, Massachusetts, USA
| | - Danijela Stojanovic
- Office of Surveillance and Epidemiology, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, Maryland, USA
| |
Collapse
|
25
|
Jabehdar Maralani P, Kapadia A, Liu G, Moretti F, Ghandehari H, Clarke SE, Wiebe S, Garel J, Ertl-Wagner B, Hurrell C, Schieda N. Canadian Association of Radiologists Recommendations for the Safe Use of MRI During Pregnancy. Can Assoc Radiol J 2021; 73:56-67. [PMID: 34000852 DOI: 10.1177/08465371211015657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is associated with concerns among patients and health professionals with regards to fetal safety. In this work, the Canadian Association of Radiologists (CAR) Working Group on MRI in Pregnancy presents recommendations for the use of MRI in pregnancy, derived from literature review as well as expert panel opinions and discussions. The working group, which consists of academic subspecialty radiologists and obstetrician-gynaecologists, aimed to provide updated, evidence-based recommendations addressing safety domains related to energy deposition, acoustic noise, and gadolinium-based contrast agent use based on magnetic field strength (1.5T and 3T) and trimester scanned, in addition to the effects of sedative use and occupational exposure.
Collapse
Affiliation(s)
| | - Anish Kapadia
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Grace Liu
- Department of Obstetrics and Gynecology, 7938University of Toronto, Toronto, Ontario, Canada
| | - Felipe Moretti
- Department of Obstetrics and Gynecology, 12365University of Ottawa, Ottawa, Ontario, Canada
| | - Hournaz Ghandehari
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, 3688Dalhousie University, Halifax, Nova Scotia, Canada
| | - Sheldon Wiebe
- Department of Medical Imaging, 12371University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Juliette Garel
- Département de radiologie, radio-oncologie et médecine nucléaire, Université de Montréal, Montréal, Québec, Canada
| | - Birgit Ertl-Wagner
- Department of Medical Imaging, 7938University of Toronto, Toronto, Ontario, Canada
| | - Casey Hurrell
- Research and Policy Development - Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, 12365University of Ottawa, Ottawa, Ontario, Canada
| |
Collapse
|
26
|
Kontrastverstärkte MRT in der Schwangerschaft häufiger als gedacht. ROFO-FORTSCHR RONTG 2021. [DOI: 10.1055/a-1072-8648] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
27
|
Whitmore CC, Hawley RE, Min JY, Mitchel E, Daugherty JR, Griffin MR, Grijalva CG. Building a Data Linkage Foundation for Mother-Child Pharmacoepidemiology Research. Pharmaceut Med 2020; 35:39-47. [PMID: 33369725 DOI: 10.1007/s40290-020-00371-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/05/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND Expanding our understanding of the effects of maternal medication exposure through research is a public health priority and will help inform both clinical and policy decision making, ultimately improving outcomes for pregnant women and their children. OBJECTIVE Our objective was to describe a linked-data research platform that facilitates studies of pregnancy medication exposures and policy changes on maternal and child health outcomes. METHODS Mothers receiving Medicaid benefits were probabilistically linked with newborns in the Tennessee Medicaid program (TennCare) through three distinct linkage processes. Medicaid claims data and state birth and fetal death certificate records (vital records) were used to identify and link potential mothers, deliveries, and newborn children. The linkage process started with the creation of a merged pool of potential mothers and eligible deliveries, which was linked to vital records and to children's records. In the last step, linked records from the preceding steps were combined into the final Mother-child linked records. For each data linkage step, rubrics and scoring systems for exact and partial matches and mismatches among key linkage fields were applied and used to examine the strength of the probabilistic linkages. Summary linkage yields for year 2013 are reported for illustration purposes. RESULTS Among the 84,253 potential deliveries, 1,761,557 eligible potential mothers, and 51,400 eligible children identified in Tennessee Medicaid records in 2013, a total of 60,265 of these records were uniquely linked to vital records, including 46,172 (77%) with linked mother-child-vital records. Among the 51,400 eligible children records identified in Tennessee Medicaid for that year, 97% (50,053) had at least one link to vital records or a mother-delivery record. In linked records, the median maternal age was 24 years, and the median gestational age was 39 weeks. About 33% of pregnant women underwent cesarean birth, and 1% of births were classified as complicated deliveries. CONCLUSIONS Supplementing existing Medicaid claims data with birth certificate records complements administrative claims information and allows for detailed assessments of pregnancy exposures and policy changes on mother and child outcomes.
Collapse
Affiliation(s)
- Christine C Whitmore
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA. .,Vanderbilt University Medical Center, Nashville, TN, USA.
| | - R Eric Hawley
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, TN, USA.,CGS Administrators, Nashville, TN, USA
| | - Jea Young Min
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, TN, USA.,Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY, USA
| | - Ed Mitchel
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - James R Daugherty
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Marie R Griffin
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA
| | - Carlos G Grijalva
- Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN, USA.,Vanderbilt University Medical Center, Nashville, TN, USA.,Veterans Health Administration Tennessee Valley Healthcare System, Geriatric Research and Education Clinical Center, Health Services Research and Development Center, Nashville, TN, USA
| |
Collapse
|
28
|
Ypsilantis P, Souftas V, Vyza V, Vraila M, Chatzaki M, Ypsilantou I, Pitiakoudis M. Magnetic resonance imaging for early pregnancy diagnosis in the laboratory rat. Lab Anim 2020; 55:262-269. [PMID: 33210577 DOI: 10.1177/0023677220972744] [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] [Indexed: 11/16/2022]
Abstract
Pregnancy diagnosis and embryo counting are important end points in reproductive, developmental biology and toxicology studies. The purpose of the present study was to assess the feasibility and efficacy of magnetic resonance imaging (MRI) for early pregnancy diagnosis and embryo counting in the laboratory rat. Female Wistar rats were subjected to whole-body MRI scanning using a 1.5T MRI scanner, employing a isotropic T2-weighted 3D short-tau inversion recovery sequence from day 8 to day 12 post coitum (pc) or without prior mating, under general anaesthesia for pregnancy diagnosis and embryo counting. MRI examination was followed by laparotomy and visual inspection of the uterus to verify MRI findings. By day 8 pc, uterine bulges, characteristic of pregnancy, were depicted as oval-shaped structures of high intensity signal. By day 10 pc, embryonic vesicles were detected at the medial side of the uterine bulges. Pregnancy was diagnosed with 0% false-negative diagnosis and 100% accuracy by day 11 pc, while embryos were counted with 100% accuracy by day 12 pc. In conclusion, MRI proved to be a feasible and reliable non-invasive imaging method of early pregnancy diagnosis and embryo counting in the laboratory rat.
Collapse
Affiliation(s)
- Petros Ypsilantis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Vasileios Souftas
- Laboratory of Diagnostic and Therapeutic Radiology, University General Hospital of Alexandroupolis, Greece
| | - Victoria Vyza
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Marianthi Vraila
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Marilena Chatzaki
- Laboratory of Diagnostic and Therapeutic Radiology, University General Hospital of Alexandroupolis, Greece
| | - Ifigenia Ypsilantou
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| | - Michael Pitiakoudis
- Laboratory of Experimental Surgery and Surgical Research, School of Medicine, Democritus University of Thrace, Greece
| |
Collapse
|
29
|
Abstract
MRI is a powerful diagnostic tool with excellent soft tissue contrast that uses nonionizing radiation. These advantages make MRI an appealing modality for imaging the pregnant patient; however, specific risks inherent to the magnetic resonance environment must be considered. MRI may be performed without and/or with intravenous contrast, which adds further fetal considerations. The risks of MRI with and without intravenous contrast are reviewed as they pertain to the pregnant or lactating patient and to the fetus and nursing infant. Relevant issues for gadolinium-based contrast agents and ultrasmall paramagnetic iron oxide particles are reviewed.
Collapse
Affiliation(s)
- Jason T Little
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Candice A Bookwalter
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
30
|
Tweet MS, Lewey J, Smilowitz NR, Rose CH, Best PJM. Pregnancy-Associated Myocardial Infarction: Prevalence, Causes, and Interventional Management. Circ Cardiovasc Interv 2020; 13:CIRCINTERVENTIONS120008687. [PMID: 32862672 PMCID: PMC7854968 DOI: 10.1161/circinterventions.120.008687] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Pregnancy-associated myocardial infarction is a primary contributor to maternal cardiovascular morbidity and mortality. Specific attention to the cause of myocardial infarction, diagnostic evaluation, treatment strategies, and postevent care is necessary when treating women with pregnancy-associated myocardial infarction. This review summarizes the current knowledge, consensus statements, and essential nuances.
Collapse
Affiliation(s)
- Marysia S Tweet
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN (M.S.T., P.J.M.B.)
| | - Jennifer Lewey
- Division of Cardiovascular Medicine, University of Pennsylvania Perelman School of Medicine, Philadelphia (J.L.)
| | - Nathaniel R Smilowitz
- Leon H. Charney Division of Cardiology, Department of Medicine, New York University School of Medicine, New York, NY (N.R.S.)
| | - Carl H Rose
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Mayo Clinic College of Medicine, Rochester, MN (C.H.R.)
| | - Patricia J M Best
- Department of Cardiovascular Diseases, Mayo Clinic College of Medicine and Science, Rochester, MN (M.S.T., P.J.M.B.)
| |
Collapse
|