碘对比剂性肾病研究的进展

本介绍了近期对碘对比例剂肾病的临床，机制，病理改变与预防方法的研究情况，对比剂性肾病多隐袭，无明显临床症状，但其病理改变却是不可逆的，随对比剂应用剂量的逐渐增加，对比剂性肾损害应引起足够的重视。     

不同碘对比剂对甲状腺功能的影响

随着医学影像学的迅速发展,碘对比剂已成为目前医学影像诊断及介入治疗中最常用的药物,特别是非离子型碘对比剂的应用近年来呈现快速增长。但随之而来的各种不良反应成为困扰人们的新难题,如:对比剂过敏反应、对比剂心血管反应、对比剂肾病及对比剂甲状腺毒性等。由于认识的不断完善,对比剂甲状腺毒性也日益引起人们的重视,本文就不同碘对比剂对甲状腺功能的影响做一综述。     

血管注射碘对比剂相关迟发性不良反应的更新研究

定义迟发性不良反应(LAR)指注射对比剂后1h至1周所出现的不良反应。必要性鉴于对LAR的前瞻性研究增多及相关的病理生理内容的进展,欧洲泌尿生殖影像协会下属的对比剂安全委员会整理了文献数据,并更新相关指     

静脉注射MRI对比剂后不良反应三例

病例资料 病例1,患者,女,44岁.诊断为"子宫肌瘤",因"恶性胸水,胸闷,下腹部疼痛,头晕",为排除癌细胞扩散行盆腔及头部MRI检查.增强扫描前告知患者将静脉注射对比剂,询问患者有无过敏史.患者自述对碘对比剂过敏,且反应为休克症状,故对此次检查感到紧张.遂告知该患者磁共振增强对比剂的不良反应少见.并予心理护理,平缓其紧张情绪.快速静脉注射离子型磁共振对比剂10ml过程中,患者无不良反应.     

肾病患者静脉注射碘对比剂应用专家共识

随着对碘对比剂与肾损伤关系的深入研究和认知,尤其是在静脉注射碘对比剂的情况下,对比剂后急性肾损伤（PC-AKI）的概念已经取代对比剂肾病这一术语。国际上多个组织和学会据此更新了碘对比剂使用指南或共识。为普及和规范我国肾病患者静脉注射碘对比剂的应用,中华医学会放射学分会质量控制与安全管理专业委员会组织专家参阅大量文献并结...     

含碘对比剂在数字化全野乳腺X线摄影中的应用:初步结果

目的 :探讨含碘对比剂在数字化全野乳腺X线摄影中的应用价值。方法 :初期模型研究后 ,对 7例患者行数字乳腺X线摄影 (美国GE公司Senographe 2 0 0 0D) ,即用一种特殊的滤线束 ,在注射 80ml碘对比剂 (Ultravist 3 70 ,德国ScheringAG)前 ,以及注射后 60、12 0和 180s进行乳腺摄影 ,将增强前后的乳腺X线摄影进行减影 ,并将减影图像与动态增强MRI对比研究。结果 :采用初期模型研究摸索出的对比增强数字乳腺摄影条件进行人体乳腺摄影 ,显示所有病例肿瘤内的对比剂聚积较好。结论 :在乳腺X线摄影中采用特殊的滤线法、合适的X线参数、适当…     

碘对比剂外渗皮肤反应不同治疗方案的对照研究

目的:比较不同治疗方案对碘对比剂皮肤外渗反应的治疗效果。方法:自2010年1月至2012年1月,对84例碘对比剂皮肤外渗反应病例随机使用硫酸镁敷剂+冷敷、磺胺嘧啶银敷剂+冷敷和单纯冷敷治疗。分别在反应后第1、2、3、7天评估皮肤颜色、肢体肿胀程度、局部循环以及患肢功能状况。比较不同治疗方案的治疗效果。结果:45例外渗反应在1天后、18例在2天后、11例在3天后基本痊愈,仅1例出现骨筋膜室综合征,经切开治疗后痊愈,病程超过7天。其中磺胺嘧啶银+冷敷组痊愈最快(χ2a-b=32.56,Pa-b=0.001,χ2b-c=41.02,Pb-c<0.001)。出现反应后1～3天内磺胺嘧啶银组皮肤颜色恢复显著快于其他两组(χ2皮肤a-b=23.10,P皮肤a-b=0.006;χ2皮肤b-c=24.87,P皮肤b-c=0.003);反应后7天,三组在各项评分方面无显著差异(P>0.05)。结论:绝大部分碘对比剂皮肤外渗反应在1天内均有显著好转,7天内基本可痊愈;外渗反应可引起骨筋膜室综合征,宜早诊断并手术治疗;磺胺嘧啶银+冷敷治疗效果更佳。     

水溶性碘对比剂的合理应用

水溶性碘对比剂的临床应用有近百年的历史，由于多重原因，常有不良反应发生。因此正确了解和掌握水溶性碘对比剂的理化性质，药动力学，不良反应机制是十分必要的，也为安全使用各类水溶性碘对比剂提供了安全保障。     

碘过敏试验阴性的碘对比剂副反应三例探讨

众所周知,使用碘对比剂常规要做碘过敏试验.但是,碘过敏试验阴性患者,在实施静脉尿路造影过程中也会发生某些不适反应.有时,甚至是比较严重的反应.笔者遇到3例,现报道如下.     

Renal effects of the non-ionic contrast medium iopentol after intravenous injection in healthy volunteers

Renal effects of the new non-ionic contrast medium iopentol in increasing doses were assessed and compared with the effects of physiologic saline. Twenty-four healthy male volunteers, allocated to three dose groups, were given iopentol intravenously in doses of 0.3, 0.6, and 1.2 g I/kg body weight, respectively. The highest dose group was also given physiologic saline separately as a control. The diuresis increased in all groups, most in the highest dose group, and with a concomitant fall of urine osmolality and increase in osmolar clearance. A slight decrease of serum osmolality, creatinine and urea occurred at 3 hours due to hemodilution. The glomerular filtration rate was unaffected by iopentol. The urinary excretion of albumin and beta 2-microglobulin was unchanged. However, urinary N-acetyl-beta-glucosaminidase and alkaline phosphatase increased significantly, most in the highest dose group. All changes were reversible.     

Intrathecal injection of contrast medium to prevent polymethylmethacrylate leakage during percutaneous vertebroplasty

The major technical drawback of percutaneous vertebroplasty is the potential for neural compromise from leakage of polymethylmethaorylate into epidural or perivertebral veins. We have combined the procedure of intrathecal injection of contrast medium with vertebroplasty to better delineate spinal canal encroachment during injection when the posterior vertebral wall is compromised by myeloma.     

The effects of a hyperosmolar intravenous contrast medium on blood viscosity

The effects of the hyperosmolar contrast medium, diatrizoate meglumine (Renografin-76) on blood viscosity and other metabolic parameters were measured in 20 immature piglets. Intravenous contrast medium caused a significant (P less than .5) increase in serum osmolality, cardiac output, and urine output, and a decrease in hematocrit. There was a fall in blood viscosity that was not statistically significant. These changes, which are attributed to an acute shift of fluid into the hyperosmolar vascular compartment, were greatest at 3 minutes following injection and subsequently returned towards baseline levels. We conclude that blood viscosity is not increased following intravenous injection of hyperosmolar radiocontrast media.     

下肢动脉CT成像中不同对比剂注射方案与对比剂剂量的相关性研究

目的 比较下肢动脉CT成像中2种不同对比剂注射方案对对比剂剂量的影响.方法 收集临床上怀疑下肢动脉疾病行CTA检查的患者50例,随机分为A、B组,对比剂碘普罗胺(350 mg I/mL).A组注射流率4mL/s,对比剂用量1.2 mL/kg.B组第1期5 mL/s注射20 mL,第2期3mL/s注射剩余量;B组对比剂总量=1.2 mL/kg×体质量-4 mL/s×(B方案对比剂注射时间-A方案对比剂注射时间).对2组腹主动脉-髂动脉段、股动脉-腘动脉段、小腿动脉段、足背或足底动脉段4个动脉段图像质量进行评分;测量4个动脉段CT值,记录2组对比剂剂量.均进行独立样本t检验.结果 B组4个动脉段图像质量评分、平均CT值均低于A组,差异均无统计学意义(P＞0.05).A组和B组对比剂剂量为(89.08士11.45)mL和(72.61士10.34)mL,差异有统计学意义(P＜0.05).结论 对比剂流率5 mL/s+3 mL/s分期注射可在不影响图像质量的前提下降低下肢动脉CTA的对比剂用量.     

Study of bolus geometry after intravenous contrast medium injection: dynamic and quantitative measurements (Chronogram) using an X-ray CT device

An X-ray computed tomographic (CT) scanner was used to measure and image transmission profiles of a single 8 mm thick object slice digitally with a high temporal (up to 20 ms), spatial (1.1 mm), and density (0.5%) resolution. This special digital radiography imaging mode is called a Chronogram. It produces a time-history of measured attenuation values but not a normal anatomical image. After intravenous bolus injection of contrast medium, bolus shape as a function of time and bolus passage times can be imaged. Absolute iodine concentrations in blood vessels and soft tissue can be evaluated at any time in all body regions. The Chronogram has the potential to quantify physiological parameters such as enhancement, passage times, and relative blood flow through pairs of arteries or symmetrically arranged organs and to measure absolute iodine concentrations. As a disadvantage, patient motion can prevent quantitative evaluation. This drawback can, however, be turned into an advantage in that all kinds of motion can be measured, for example, movement and pulsation of the heart.     

胃挫伤致上消化道出血4例诊治体会

回顾性总结胃挫伤致上消化道出血病例的诊治经验。认为早期诊断、积极手术是治疗成功的关键。