The response of aquatic ecosystems to the interactive effects of stratospheric ozone depletion, UV radiation, and climate change

Variations in stratospheric ozone and changes in the aquatic environment by climate change and human activity are modifying the exposure of aquatic ecosystems to UV radiation. These shifts in exposure have consequences for the distributions of species, biogeochemical cycles, and services provided by aquatic ecosystems. This Quadrennial Assessment presents the latest knowledge on the multi-faceted interactions between the effects of UV irradiation and climate change, and other anthropogenic activities, and how these conditions are changing aquatic ecosystems. Climate change results in variations in the depth of mixing, the thickness of ice cover, the duration of ice-free conditions and inputs of dissolved organic matter, all of which can either increase or decrease exposure to UV radiation. Anthropogenic activities release oil, UV filters in sunscreens, and microplastics into the aquatic environment that are then modified by UV radiation, frequently amplifying adverse effects on aquatic organisms and their environments. The impacts of these changes in combination with factors such as warming and ocean acidification are considered for aquatic micro-organisms, macroalgae, plants, and animals (floating, swimming, and attached). Minimising the disruptive consequences of these effects on critical services provided by the world's rivers, lakes and oceans (freshwater supply, recreation, transport, and food security) will not only require continued adherence to the Montreal Protocol but also a wider inclusion of solar UV radiation and its effects in studies and/or models of aquatic ecosystems under conditions of the future global climate.

Fragmentation and release of pristine and functionalized carbon nanotubes from epoxy-nanocomposites during accelerated weathering

There is an increasing volume of nano-enabled materials in the market. Once composites containing nano-additives are disposed of, weathering could deteriorate their structures, releasing nanoparticles and risking exposure of humans and aquatic organisms. Composite degradation due to environmental aging continues, including structural deterioration resulting in cracking, fragmentation, and release of microplastics and nano-additives to the environment. This research aims to study the degradation and release of initially embedded nanomaterials (NMs) from composites and their toxicity. The molecular interaction of carbon nanotube (CNT)/polymer composites is critical for modifying the polymer properties. This study investigated the interactions of functional multiwalled carbon nanotube (MWCNT) composites which affect their release during accelerated weathering processes. Different epoxy-MWCNT composites were prepared by filling a polymer with pure MWCNTs and MWCNTs functionalized with acid (- COOH ) and amine (- NH 2 ) groups. The physical and chemical changes of aged composites were characterized by gravimetric analysis, contact angle measurements, FTIR, SEM, and laser confocal microscopy. A loss of hydrophobicity was observed for composite surfaces long before surface cracks materialized. Released polymer fragments and nanoparticles were analyzed in wash water using TEM, FTIR and Raman spectroscopy. The environmental risks for long-term use of CNT-polymer composites and the influence of fillers on the extent of chemical photodegradation depended on the combination of polymer and fillers. If nanoparticles are released from the matrix, the high surface-to-volume ratio and reactivity of NMs make them highly dynamic in environmental systems. Exposure to these released NMs could negatively affect human health and the environment. This study provides fragmentation and CNT particle release data that could describe how molecular-level interactions between functionalized CNTs and epoxy polymers affect the aging and release of CNTs. A toxicity assessment based on a reactive oxygen species (ROS) formation assay and MTS assay for cell viability and activity of the released polymer and CNT fragments and leachate showed moderate levels of cytotoxicity of released materials as compared to pristine epoxy plates.

Nano-enabled pesticides for sustainable agriculture and global food security

Achieving sustainable agricultural productivity and global food security are two of the biggest challenges of the new millennium. Addressing these challenges requires innovative technologies that can uplift global food production, while minimizing collateral environmental damage and preserving the resilience of agroecosystems against a rapidly changing climate. Nanomaterials with the ability to encapsulate and deliver pesticidal active ingredients (AIs) in a responsive (for example, controlled, targeted and synchronized) manner offer new opportunities to increase pesticidal efficacy and efficiency when compared with conventional pesticides. Here, we provide a comprehensive analysis of the key properties of nanopesticides in controlling agricultural pests for crop enhancement compared with their non-nanoscale analogues. Our analysis shows that when compared with non-nanoscale pesticides, the overall efficacy of nanopesticides against target organisms is 31.5% higher, including an 18.9% increased efficacy in field trials. Notably, the toxicity of nanopesticides toward non-target organisms is 43.1% lower, highlighting a decrease in collateral damage to the environment. The premature loss of AIs prior to reaching target organisms is reduced by 41.4%, paired with a 22.1% lower leaching potential of AIs in soils. Nanopesticides also render other benefits, including enhanced foliar adhesion, improved crop yield and quality, and a responsive nanoscale delivery platform of AIs to mitigate various pressing biotic and abiotic stresses (for example, heat, drought and salinity). Nonetheless, the uncertainties associated with the adverse effects of some nanopesticides are not well-understood, requiring further investigations. Overall, our findings show that nanopesticides are potentially more efficient, sustainable and resilient with lower adverse environmental impacts than their conventional analogues. These benefits, if harnessed appropriately, can promote higher crop yields and thus contribute towards sustainable agriculture and global food security.

Fragmentation of polymer nanocomposites: modulation by dry and wet weathering, fractionation, and nanomaterial filler

In recent years, an increasing number of polymeric composites incorporating engineered nanomaterials (ENMs) have reached the market. Such nano-enabled products (NEPs) present enhanced performance through improved mechanical, thermal, UV protection, electrical, and gas barrier properties. However, little is known about how environmental weathering impacts ENM release, especially for high-tonnage NEPs like kaolin products, which have not been extensively examined by the scientific community. Here we study the simulated environmental weathering of different polymeric nanocomposites (epoxy, polyamide, polypropylene) filled with organic (multiwalled carbon nanotube, graphene, carbon black) and inorganic (WS2, SiO2, kaolin, Fe2O3, Cu-phthalocyanines) ENMs. Multiple techniques were employed by researchers at three laboratories to extensively evaluate the effect of weathering: ultraviolet-visible spectroscopy (UV-vis), Fourier transform infrared spectroscopy (FTIR), optical microscopy, contact angle measurements, gravimetric analysis, analytical ultracentrifugation (AUC), transmission electron microscopy (TEM), scanning electron microscopy (SEM) and Raman spectroscopy. This work aimed to elucidate the extent to which weathering protocol (i.e. wet vs. dry) and diverse filler characteristics modulate fragment release and polymer matrix degradation. In doing so, it expanded the established NanoRelease protocol, previously used for analyzing fragment emission, by evaluating two significant additions: (1) simulated weathering with rain events and (2) fractionation of sample leachate prior to analysis. Comparing different composite materials and protocols demonstrated that the polymer matrix is the most significant factor in NEP aging. Wet weathering is more realistic than dry weathering, but dry weathering seems to provide a more controlled release of material over wet. Wet weathering studies could be complicated by leaching, and the addition of a fractionation step can improve the quality of UV-vis measurements.

Simulating graphene oxide nanomaterial phototransformation and transport in surface water

The production of graphene-family nanomaterials (GFNs) has increased appreciably in recent years. Graphene oxide (GO) has been found to be the most toxic nanomaterial among GFNs and, to our knowledge, no studies have been conducted to model its fate and transport in the environment. Lab studies show that GO undergoes phototransformation in surface waters under sunlight radiation resulting in formation of photoreduced GO (rGO). In this study, the recently updated Water Quality Analysis Simulation Program (WASP8) is used to simulate time-dependent environmental exposure concentrations of GO and its major phototransformation product, rGO, for Brier Creek, GA, USA at two flow scenarios under a constant loading of GO to the river for a period of 20 years. Analysis shows that the degree of phototransformation is closely associated with river flow condition: up to of 40% of GO undergoes phototransformation at low flow condition, whereas only 2.5% of GO phototransformation occurs at mean flow condition. River flow and heteroaggregation exhibit a 'competing' effect in determining the formation of rGO heteroagglomerates. Mass fraction analysis indicates that the vast majority of rGO heteroagglomerates settle to the sediment layers due to the settling of suspended solids. Simulation of natural recovery after removal of the GO source suggests that free GO and rGO are the immediate contaminants of concern in the studied surface water system, while rGO heteroaggregated with suspended solids can have a long-term ecological impact on both the water column and sediments.

Modeling framework for simulating concentrations of solute chemicals, nanoparticles, and solids in surface waters and sediments: WASP8 Advanced Toxicant Module

Toxicant concentrations in surface waters are of environmental concern due to their potential impacts to humans and wildlife. Numerical models provide system insight, support management decisions, and provide scenario testing on the impacts of toxicants. The Water Quality Analysis Simulation Program (WASP) is a widely used framework for developing site-specific models for simulating toxicant concentrations in surface waters and sediments over a range of complexities and temporal and spatial scales. WASP8, with the Advanced Toxicant module, has been recently released, incorporating a complete architecture redesign for an increased number of state variables and different state variable types. WASP8 incorporates a new structure for simulating light intensity and photoreactions in the water column, including the distinction of 10 different wavelength bands, and nanoparticle heteroaggregation to solids. We present a hypothetical case study, using the Cape Fear River, North Carolina as a representative example for simulating solute chemicals, nanoparticles, and solids to demonstrate the new and updated capabilities of WASP8.

Environmental fate of multiwalled carbon nanotubes and graphene oxide across different aquatic ecosystems

The industrial use and widespread application of carbon-based nanomaterials have caused a rapid increase in their production over the last decades. However, toxicity of these materials is not fully known and is still being investigated for potential human and ecological health risks. Detecting carbon-based nanomaterials in the environment using current analytical methods is problematic, making environmental fate and transport modeling a practical way to estimate environmental concentrations and assess potential ecological risks. The Water Quality Analysis Simulation Program 8 (WASP8) is a dynamic, spatially resolved fate and transport model for simulating exposure concentrations in surface waters and sediments. Recently, WASP has been updated to incorporate processes for simulating the fate and transport of nanomaterials including heteroaggregation and phototransformation. This study examines the fate and transport of multiwalled carbon nanotubes (MWCNT), graphene oxide (GO) and reduced graphene oxide (rGO) in four aquatic ecosystems in the southeastern United States. Sites include a seepage lake, a coastal plains river, a piedmont river and an unstratified, wetland lake. A hypothetical 50-year release is simulated for each site-nanomaterial pair to analyze nanomaterial distribution between the water column and sediments. For all nanomaterials, 99% of the mass loaded moves though systems of high and low residence times without being heteroaggregated and deposited in the sediments. However, significant accumulation in the sediments does occur over longer periods of time. Results show that GO and rGO had the highest mass fraction in the water column of all four sites. MWCNT were found predominantly in the sediments of the piedmont river and seepage lake but were almost entirely contained in the water column of the coastal plains river and wetland lake. Simulated recovery periods following the release estimate 37+ years for lakes and 1-4 years for rivers to reduce sediment nanomaterial concentrations by 50% suggesting that carbon-based nanomaterials have the potential for long-term ecological effects.

Incidence of somatic and F+ coliphage in Great Lake Basin recreational waters

There is a growing interest for the use of coliphage as an alternative indicator to assess fecal pollution in recreational waters. Coliphage are a group of viruses that infect Escherichia coli and are considered as potential surrogates to infer the likely presence of enteric viral pathogens. We report the use of a dead-end hollow fiber ultrafiltration single agar layer method to enumerate F+ and somatic coliphage from surface waters collected from three Great Lake areas. At each location, three sites (two beaches; one river) were sampled five days a week over the 2015 beach season (n = 609 total samples). In addition, culturable E. coli and enterococci concentrations, as well as 16 water quality and recreational area parameters were assessed such as rainfall, turbidity, dissolved oxygen, pH, and ultra violet absorbance. Overall, somatic coliphage levels ranged from non-detectable to 4.39 log₁₀ plaque forming units per liter and were consistently higher compared to F+ (non-detectable to 3.15 log₁₀ PFU/L), regardless of sampling site. Coliphage concentrations weakly correlated with cultivated fecal indicator bacteria levels (E. coli and enterococci) at 75% of beach sites tested in study (r = 0.28 to 0.40). In addition, ultraviolet light absorption and water temperature were closely associated with coliphage concentrations, but not fecal indicator bacteria levels suggesting different persistence trends in Great Lake waters between indicator types (bacteria versus virus). Finally, implications for coliphage water quality management and future research directions are discussed.

Using Integrated Environmental Modeling to Assess Sources of Microbial Contamination in Mixed-Use Watersheds

Microbial fate and transport in watersheds should include a microbial source apportionment analysis that estimates the importance of each source, relative to each other and in combination, by capturing their impacts spatially and temporally under various scenarios. A loosely configured software infrastructure was used in microbial source-to-receptor modeling by focusing on animal- and human-impacted mixed-use watersheds. Components include data collection software, a microbial source module that determines loading rates from different sources, a watershed model, an inverse model for calibrating flows and microbial densities, tabular and graphical viewers, software to convert output to different formats, and a model for calculating risk from pathogen exposure. The system automates, as much as possible, the manual process of accessing and retrieving data and completes input data files of the models. The workflow considers land-applied manure from domestic animals on undeveloped areas; direct shedding (excretion) on undeveloped lands by domestic animals and wildlife; pastureland, cropland, forest, and urban or engineered areas; sources that directly release to streams from leaking septic systems; and shedding by domestic animals directly to streams. The infrastructure also considers point sources from regulated discharges. An application is presented on a real-world watershed and helps answer questions such as: What are the major microbial sources? What practices contribute to contamination at the receptor location? What land-use types influence contamination at the receptor location? and Under what conditions do these sources manifest themselves? This research aims to improve our understanding of processes related to pathogen and indicator dynamics in mixed-use watershed systems.

Capturing Microbial Sources Distributed in a Mixed-use Watershed within an Integrated Environmental Modeling Workflow

Many watershed models simulate overland and instream microbial fate and transport, but few provide loading rates on land surfaces and point sources to the waterbody network. This paper describes the underlying equations for microbial loading rates associated with 1) land-applied manure on undeveloped areas from domestic animals; 2) direct shedding (excretion) on undeveloped lands by domestic animals and wildlife; 3) urban or engineered areas; and 4) point sources that directly discharge to streams from septic systems and shedding by domestic animals. A microbial source module, which houses these formulations, is part of a workflow containing multiple models and databases that form a loosely configured modeling infrastructure which supports watershed-scale microbial source-to-receptor modeling by focusing on animal- and human-impacted catchments. A hypothetical application - accessing, retrieving, and using real-world data - demonstrates how the infrastructure can automate many of the manual steps associated with a standard watershed assessment, culminating in calibrated flow and microbial densities at the watershed's pour point.

NanoRelease: Pilot interlaboratory comparison of a weathering protocol applied to resilient and labile polymers with and without embedded carbon nanotubes

A major use of multi-walled carbon nanotubes (MWCNTs) is as functional fillers embedded in a solid matrix, such as plastics or coatings. Weathering and abrasion of the solid matrix during use can lead to environmental releases of the MWCNTs. Here we focus on a protocol to identify and quantify the primary release induced by weathering, and assess reproducibility, transferability, and sensitivity towards different materials and uses. We prepared 132 specimens of two polymer-MWCNT composites containing the same grade of MWCNTs used in earlier OECD hazard assessments but without UV stabilizer. We report on a pilot inter-laboratory comparison (ILC) with four labs (two US and two EU) aging by UV and rain, then shipping for analysis. Two labs (one US and one EU) conducted the release sampling and analysis by Transmission Electron Microscopy (TEM), Inductively Coupled Plasma- Mass Spectrometry (ICP-MS), UltravioleteVisible Spectroscopy (UVeVis), Analytical Ultracentrifugation (AUC), and Asymmetric Flow Field Flow Fractionation (AF4). We compare results between aging labs, between analysis labs and between materials. Surprisingly, we found quantitative agreement between analysis labs for TEM, ICP-MS, UVeVis; low variation between aging labs by all methods; and consistent rankings of release between TEM, ICP-MS, UVeVis, AUC. Significant disagreement was related primarily to differences in aging, but even these cases remained within a factor of two.

Potential release scenarios for carbon nanotubes used in composites

The expected widespread use of carbon nanotube (CNT)-composites in consumer products calls for an assessment of the possible release and exposure to workers, consumers and the environment. Release of CNTs may occur at all steps in the life cycle of products, but to date only limited information is available about release of CNTs from actual products and articles. As a starting point for exposure assessment, exploring sources and pathways of release helps to identify relevant applications and situations where the environment and especially humans may encounter releases of CNTs. It is the aim of this review to identify various potential release scenarios for CNTs used in polymers and identify the greatest likelihood of release at the various stages throughout the life-cycle of the product. The available information on release of CNTs from products and articles is reviewed in a first part. In a second part nine relevant release scenarios are described in detail: injection molding, manufacturing, sports equipment, electronics, windmill blades, fuel system components, tires, textiles, incineration, and landfills. Release from products can potentially occur by two pathways; (a) where free CNTs are released directly, or more frequently (b) where the initial release is a particle with CNTs embedded in the matrix, potentially followed by the subsequent release of CNTs from the matrix. The potential for release during manufacturing exists for all scenarios, however, this is also the situation when exposure can be best controlled. For most of the other life cycle stages and their corresponding release scenarios, potential release of CNTs can be considered to be low, but it cannot be excluded totally. Direct release to the environment is also considered to be very low for most scenarios except for the use of CNTs in tires where significant abrasion during use and release into the environment would occur. Also the possible future use of CNTs in textiles could result in consumer exposure. A possibility for significant release also exists during recycling operations when the polymers containing CNTs are handled together with other polymers and mainly occupational users would be exposed. It can be concluded that in general, significant release of CNTs from products and articles is unlikely except in manufacturing and subsequent processing, tires, recycling, and potentially in textiles. However except for high energy machining processes, most likely the resulting exposure for these scenarios will be low and to a non-pristine form of CNTs. Actual exposure studies, which quantify the amount of material released should be conducted to provide further evidence for this conclusion.

Using the Q10 model to simulate E. coli survival in cowpats on grazing lands

Microbiological quality of surface waters can be affected by microbial load in runoff from grazing lands. This effect, with other factors, depends on the survival of microorganisms in animal waste deposited on pastures. Since temperature is a leading environmental parameter affecting survival, it indirectly impacts water microbial quality. The Q10 model is widely used to predict the effect of temperature on rates of biological processes, including survival. Objectives of this work were to (i) evaluate the applicability of the Q10 model to Escherichia coli inactivation in bovine manure deposited on grazing land (i.e., cowpats) and (ii) identify explanatory variables for the previously reported E. coli survival dynamics in cowpats. Data utilized in this study include published results on E. coli concentrations in natural and repacked cowpats from research conducted the U.S. (Virginia and Maryland), New Zealand, and the United Kingdom. Inspection of the datasets led to conceptualizing E. coli survival (in cowpats) as a two-stage process, in which the initial stage was due to growth, inactivation or stationary state of the population and the second stage was the approximately first-order inactivation. Applying the Q10 model to these datasets showed a remarkable similarity in inactivation rates, using the thermal time. The reference inactivation rate constant of 0.042 (thermal days)(-1) at 20 °C gave a good approximation (R(2)=0.88) of all inactivation stage data with Q10=1.48. The reference inactivation rate constants in individual studies were no different from the one obtained by pooling all data (P<0.05). The rate of logarithm of the E. coli concentration change during the first stage depended on temperature. Duration of the first stage, prior to the first-order inactivation stage and the initial concentration of E. coli in cowpats, could not be predicted from available data. Diet and age are probable factors affecting these two parameters however, until their environmental and management predictors are known, microbial water quality modeling must treat them as a stochastic source of uncertainty in simulation results.

Influence of inorganic ions on aggregation and adsorption behaviors of human adenovirus

In this study, we investigated the influence of inorganic ions on the aggregation and deposition (adsorption) behavior of human adenovirus (HAdV). Experiments were conducted to determine the surface charge and size of HAdV and viral adsorption capacity of sand in different salt conditions. The interfacial potential energy was calculated using extended Derjaguin and Landau, Verwey and Overbeek (XDLVO) and steric hindrance theories to interpret the experimental results. Results showed that different compositions of inorganic ions have minimal effect on varying the iso-electric point pH (pH(iep)) of HAdV (ranging from 3.5 to 4.0). Divalent cations neutralized/shielded virus surface charge much more effectively than monovalent cations at pH above pH(iep). Consequently, at neutral pH the presence of divalent cations enhanced the aggregation of HAdV as well as its adsorption to sand. Aggregation and adsorption behaviors generally agreed with XDLVO theory; however, in the case of minimal electrostatic repulsion, steric force by virus' fibers can increase the energy barrier and distance of secondary minimum, resulting in limited aggregation and deposition. Overall, our results indicated that subsurface water with low hardness residing in sandy soils may have a higher potential of being contaminated by HAdV.

Influence of inorganic ions on aggregation and adsorption behaviors of human adenovirus

In this study, we investigated the influence of inorganic ions on the aggregation and deposition (adsorption) behavior of human adenovirus (HAdV). Experiments were conducted to determine the surface charge and size of HAdV and viral adsorption capacity of sand in different salt conditions. The interfacial potential energy was calculated using extended Derjaguin and Landau, Verwey and Overbeek (XDLVO) and steric hindrance theories to interpret the experimental results. Results showed that different compositions of inorganic ions have minimal effect on varying the iso-electric point pH (pH(iep)) of HAdV (ranging from 3.5 to 4.0). Divalent cations neutralized/shielded virus surface charge much more effectively than monovalent cations at pH above pH(iep). Consequently, at neutral pH the presence of divalent cations enhanced the aggregation of HAdV as well as its adsorption to sand. Aggregation and adsorption behaviors generally agreed with XDLVO theory; however, in the case of minimal electrostatic repulsion, steric force by virus' fibers can increase the energy barrier and distance of secondary minimum, resulting in limited aggregation and deposition. Overall, our results indicated that subsurface water with low hardness residing in sandy soils may have a higher potential of being contaminated by HAdV.

The postoperative lumbar spine: evaluation of epidural scar over a 1-year period

PURPOSE

We documented the morphological changes on enhanced MR imaging studies that occur in epidural scar over a period of 1 year after lumbar diskectomy.

METHODS

The study population was culled from a randomized, multicenter clinical trial designed to evaluate the efficacy of a device inhibiting postoperative epidural fibrosis after single-level, unilateral laminectomy/diskectomy for herniated lumbar disk. Analysis was restricted to 71 control subjects who did not receive the device. All patients underwent surgery after receiving clinical and MR examinations, with follow-up MR studies at 6 and 12 months. Evaluation of all MR images was performed by one interpreter, who was blinded to treatment arm and clinical findings. The extent of epidural scar seen at the 6- and 12-month MR examinations was graded on a scale of 0 to 4 for each quadrant at each imaging section encompassing the surgical level.

RESULTS

Eighty-five percent of the patients had no change in the amount of anterior epidural scar between the 6- and 12-month MR examinations; 75% of the patients showed no change in the amount of posterior epidural scar between the 6- and 12-month examinations.

CONCLUSION

The majority of our patients had no change in the amount of epidural scarring visible at enhanced MR imaging over a 1-year period after lumbar laminectomy/diskectomy.

The postoperative lumbar spine: enhanced MR evaluation of the intervertebral disk

PURPOSE

To document the pattern of enhancement and morphologic changes on MR images that occur in the intervertebral disk and adjacent vertebral bodies after diskectomy and to correlate the presence of intervertebral disk enhancement with the preoperative and postoperative clinical findings.

METHODS

Preoperatively, and at 3 months and 6 months after surgery, 94 adults who had first-time surgery for a herniated lumbar intervertebral disk that was associated with radiculopathy, expressed as leg symptoms or signs (with or without lower back pain), were asked to respond to a questionnaire regarding pain, were given serial physical examinations, and were examined with contrast-enhanced MR imaging. The measures of clinical outcome that were evaluated included the straight leg raise sign, radicular pain, and lower back pain. Type of disk herniation, intervertebral disk enhancement, disk space height, and degenerative end-plate changes were also assessed.

RESULTS

Of the 94 patients evaluated, 19 (20%) had postoperative intervertebral disk enhancement that was not present on the preoperative study. The pattern of enhancement was remarkably consistent, with 18 of the cases showing linear enhancement within the intervertebral disk, manifested as two thin bands paralleling the end plates. End-plate enhancement was present in 7 (37%) of the 19 patients with disk enhancement. There were no significant associations between disk enhancement and specific clinical symptoms before or after surgery.

CONCLUSION

Our group of asymptomatic postoperative patients had anular enhancement (curette site), disk enhancement, and vertebral end-plate enhancement on MR images without evidence of disk space infection. This finding points out the need to understand asymptomatic postoperative changes that are sequelae of surgery and not necessarily indicators of infection.

Evaluation of renal masses detected by excretory urography: cost-effectiveness of sonography versus CT

OBJECTIVE

The purpose of this study was to compare the cost-effectiveness of sonography and CT for the evaluation of renal masses discovered at excretory urography.

MATERIALS AND METHODS

The records of 225 patients with a renal mass shown by urography who then had either sonography or CT within 3 months were reviewed retrospectively. The number, location, and size of lesions; initial and subsequent imaging tests; and final diagnoses were determined. Using the current Medicare reimbursements for sonography and CT, we calculated the economic implications of using sonography or CT as the initial examination. Any effect of the location or size of the lesion on the most cost-effective examination was also determined.

RESULTS

Twenty-one percent of patients had both initial sonography and follow-up CT because of indeterminate findings or detection of a solid mass that required further staging. When CT was done first, CT findings were equivocal in 12%, necessitating follow-up sonography. At the prevailing charges, CT would have to be needed in 70% of patients initially imaged with sonography to justify the use of CT as the initial examination. The location and size of the lesion did not affect the need for CT at a rate (greater than 70%) that would economically justify use of CT as the first imaging test. Eighty-six percent of patients with a mass detected by urography had either a simple cyst or no evidence of a mass on sonography or CT.

CONCLUSION

Sonography is the most cost-effective imaging method for the workup of a renal mass detected at urography. The number of sonographic examinations in which findings are indeterminate or positive (for a solid mass) is not sufficiently high to warrant replacement of sonography by CT, regardless of the size and location of the lesion. CT should be reserved for a limited number of specific indications.

Use of contrast material for spiral CT of the abdomen: comparison of hepatic enhancement and vascular attenuation for three different contrast media at two different delay times

OBJECTIVE

The purpose of this study was to determine the relative effects of delay time, contrast agent concentration, and contrast agent volume on hepatic enhancement and on aortic and portal vein attenuation for contrast-enhanced spiral CT of the abdomen. The effect of delay time was evaluated by comparing two different delay times for each of three IV contrast media. Three different media were tested to identify whether the effects were different with different iodine concentrations and doses or with different volumes of contrast medium.

SUBJECTS AND METHODS

A total of 169 patients who underwent contrast-enhanced CT of the abdomen with spiral CT imaging were evaluated for enhancement of the liver parenchyma and for postenhancement attenuation of the aorta and portal vein. Total iodine doses of 30 g as 100 ml of iohexol 300 or 125 ml of ioversol 240 and of 40 g as 125 ml of ioversol 320 were evaluated at delay times of 45 and 60 sec and with a low-flow monophasic injection at a rate of 2 ml/sec.

RESULTS

For each contrast medium tested, a 60-sec delay provided greater hepatic enhancement than did a 45-sec delay (43 vs 32 H for iohexol 300, 37 vs 28 H for ioversol 240, and 50 vs 39 H for ioversol 320; all comparisons, p < or = .0001). The aortic attenuation achieved in the abdomen after contrast medium administration was significantly greater with a 45-sec delay than with a 60-sec delay for iohexol 300 (p = .0290) but not for the other contrast media. The portal vein attenuation achieved after contrast medium administration was significantly greater with a 60-sec delay than with a 45-sec delay for all three contrast media (p = .0051).

CONCLUSION

When IV contrast material was injected with a low-flow-rate monophasic bolus, a delay time of 60 sec, longer than that typically used for dynamic incremental scanning, provided greater hepatic enhancement in spiral CT. This result was significant for the three contrast media tested. Aortic attenuation was significantly greater at shorter delay times when a smaller volume of contrast material was injected. Portal vein attenuation was greater at longer delay times, suggesting that the optimal delay time may be longer than 60 sec. Further work to determine the optimal scanning window for hepatic enhancement in spiral CT by use of time-density curves is indicated.