Gadolinium-DTPA as X-ray contrast medium in clinical studies

The aim of this study was to investigate the contrast effects of gadolinium (Gd) in patients undergoing digital subtraction angiography (DSA), intravenous urography (IVU) and CT. 15 patients attending for coeliac axis DSA (n = 5), abdominal CT (n = 5) and IVU (n = 5) were injected with 0.3 mmol kg-1 Gd-DTPA, the maximum approved dose. For DSA and IVU, images were categorized as being of diagnostic or non-diagnostic quality. For CT, enhancement was measured in Hounsfield Units (HU). On CT, enhancement with Gd was reproducible in all cases; average peak aortic enhancement was 75 HU but duration was short. On IVU, four of five studies yielded positive pyelograms but all nephrograms were relatively poor. On DSA, all five patients had diagnostic arteriograms and four of five indirect portograms were of diagnostic quality. In all 15 cases, enhancement was weaker than that achieved with routine dosage of iodinated agents. In conclusion, Gd chelates may be clinically useful in X-ray studies under certain circumstances on patients with contraindications to iodinated agents. Higher doses than currently approved would be potentially useful.     

水溶性对比剂在不孕症子宫输卵管造影的应用价值

子宫输卵管造影(hysterosalpingography，HSG)是诊断不孕症常用的理想方法，尤其是在基层医院，利用水溶性对比剂行子宫输卵管造影的病例近年来明显增多，我们利用76％泛影葡胺行子宫输卵管造影116例。现就此法对不孕症的应用价值进行研究探讨。     

Digital mammography using iodine-based contrast media: initial clinical experience with dynamic contrast medium enhancement

PURPOSE: We sought to evaluate the potential of dynamic contrast enhancement after the intravenous administration of an iodine-based contrast medium in full-field digital mammography. MATERIAL AND METHODS: A protocol for image acquisition was established for contrast-enhanced mammography and the mammography unit (Senographe 2000D, GE Healthcare, Buc, France) changed as required. The effect of the protocol parameters on imaging was investigated. Subsequently, 21 patients with 25 suspicious lesions of the breast (10 benign, 1 borderline, and 14 malignant) underwent mammography with administration of an iodine-based contrast medium (Ultravist 370, Schering AG, Berlin, Germany), after approval of ethical committee as well as permission of German federal office for Radiation protection, and informed consent from each patient was obtained. Three sequential digital mammographic images of the respective breast were acquired after administration of the contrast medium at a dose of 1 mL/kg body weight and a flow of 4 mL/s. The postcontrast images were acquired 60, 120, and 180 seconds after administration. Subsequently, the precontrast image was logarithmically subtracted from the postcontrast images. Enhancement of the lesions was measured in absolute terms as well as relative to the enhancement of the glandular tissue. The subtracted images were evaluated for lesion depiction and dynamic contrast enhancement. Lesion-enhancement kinetics were compared with the histologic findings. RESULTS: All malignant lesions were identified on the contrast-enhanced images of digital mammography. Three of the tumors (2 malignant, 1 benign) were detected only by contrast-enhanced mammography and not by standard mammography. Dynamic enhancement curves of benign and malignant tumors in contrast-enhanced mammography look similar to the curves known from gadolinium-enhanced magnetic resonance imaging. Nevertheless differentiation between malignant and benign tumors based on the enhancement patterns cannot be directly taken over from magnetic resonance imaging, as suggested by our initial results. The results are somewhat better when tumor enhancement relative to surrounding glandular tissue is used instead of absolute enhancement. CONCLUSION: The results of this preliminary study suggest that contrast-enhanced digital mammography is a potentially useful tool for the detection and the differentiation of benign and malignant breast lesions.     

超声造影在肝脏疾病中的应用进展

随着一代代新型超声对比剂的相继问世和造影成像技术的不断发展 ,超声造影成像已成为超声医学界关注的热点 ,其在肝脏疾病诊断、鉴别诊断与肝肿瘤非手术治疗疗效监测中的应用不但广泛 ,而且具有独到的优点和重要的临床价值。本文综合文献资料 ,对超声对比剂与成像技术加以概括 ,并将超声造影在肝脏疾病中的临床应用现状与进展进行综述。     

Epilepsy in patients with brain metastases triggered by intravenous contrast medium

187 patients with histologically proven primary neoplasms underwent computed tomography (CT) of the brain following intravenous administration of contrast medium. Eight developed focal epileptic seizures 2 to 4 minutes after the start of the injection. In three of these patients, in whom there was CT evidence of bilateral mass lesions of the brain, this epileptic activity became generalised into grand mal seizures, and two died in status epilepticus. In the other five patients with unilateral deposits in the brain, the focal fits corresponded to the site of the lesion shown by CT. Three of the patients had follow-up electroencephalography (EEG) examinations which showed unilateral focal activity, and their EEG foci correlated with the CT findings.     

螺旋CT增强扫描非离子型对比剂不良反应的护理预防及处理

CT增强扫描,是用高压注射器通过静脉快速注入对比剂,按所需的时间再行扫描,增强扫描利用了病变组织与相邻正常组织间的吸收差别,从而更清楚地显示病变,不仅提高了病变的检出率,而且对定性诊断颇有帮助。随着CT技术的快速发展,特别是多层螺旋CT的应用,CT增强扫描已成为一种不可缺少的重要诊断手段,随之对比剂的应用机会也日益增多,     

Side effects and pharmacokinetics of nonionic iodinated contrast medium in hemodialyzed patients

We conducted contrast CT scanning on 22 dialysis patients using the same method as usually applied to cases with normal renal function and studied the incidences and types of side effects and the pharmacological kinetics of non-ionic iodine contrast medium (Iopamiron 370, 100 ml). During the followup period (five days at most), we found localized urtication as a side effect in only one case (4.5%). Therefore we speculate that non-ionic contrast medium is a safe agent in dialysis patients, as long as it is cautiously used. After contrast medium injection, we conducted dialysis twice, which definitely decreased total blood iodine content. The extraction ratio at first dialysis was particularly high (73% on average). We recognized a statistically positive correlation between this extraction ratio and dialyzer size. Although two cases studied proved the notable acceleration of vicarious excretion in dialysis patients, this acceleration appeared only with high total blood iodine content. This phenomenon was considered mainly due to excretion from the hepatobiliary tract. Vicarious excretion appeared relatively soon after contrast medium injection (within a few hours), but showed a slower decreasing tendency.     

Amipaque as contrast medium for intraosseous phlebography.

The degree of pain produced by Amipaque 260 and Isopaque 260 at intraosseous phlebography in patients with varicose ulcerations in the ankle region was compared. Amipaque produced less pain than Isopaque. No complications or side-effects occurred during the observation period of about one year.     

Unusual local reaction to iodinated contrast medium.

Injection of water-soluble contrast medium into a foot vein in a 5-month-old infant was complicated by intense edema and vesicle formation above the site of injection. This was due to local toxic effect of contrast medium entering the lymphatic system with backflow into the skin. The method by which the contrast medium entered the lymphatics could not be determined.     

Protective effect against repeat adverse reactions to iodinated contrast medium: Premedication vs. changing the contrast medium

Objectives

The purpose of this study was to assess the protective effect of premedication and changing contrast media (CM) against repeat adverse reactions (ARs) to iodinated CM.

Methods

Between January 2006 and September 2014, 771 cases with previous ARs to CM were administered CM. The same CM that had caused ARs previously was administered to 491 cases (220 without premedication [defined as the control group], and 271 with premedication [the premedication alone group]). A different CM from the previous CM was given to 280 cases (58 without premedication [the changing CM alone group], and 222 with premedication [the premedication and changing CM group]).

Results

The control group had 61 repeat ARs (27.7%). The premedication alone group had 47 ARs (17.3%, p<0.01). The changing CM alone group had 3 ARs (5.2%, p<0.001). Three ARs (7.9%) were observed in 38 cases changing from one to another low-osmolar nonionic CM. Twenty cases with previous ARs to the high-osmolar CM and to the low-osmolar ionic CM showed no ARs. The premedication and changing CM group had 6 ARs (2.7%, p<0.001).

Conclusion

Premedication prior to contrast for patients with previous ARs may be protective, however, changing CM was more effective.

Key Points

? In patients with previous adverse reactions, changing contrast media is recommended. ? Premedication is unnecessary against previous reactions to high-osmolar or ionic CM. ? Changing from one to another low-osmolar non-ionic CM may be effective.

     

稀释对比剂注射法在64层螺旋CT冠状动脉成像中的应用研究

目的比较不同对比剂方案对冠状动脉成像的影响。方法 60例临床疑诊冠心病患者在行回顾性心电门控64-层螺旋CT冠状动脉造影检查中,根据不同对比剂方案随机分为以下3组:A组(20例)先注射对比剂,后注射生理盐水;B组(20例)先注射对比剂,后注射对比剂与盐水以3∶7比例配制的稀释液;C组(20例)先注射对比剂,后注射对比剂与盐水以1∶1比例配制的稀释液。分别测量所有患者冠状动脉左主干、左前降支、左回旋支及右冠状动脉的CT值。对获自显示冠状动脉、右心室均匀性及左心室壁的数据,利用SPSS13.0软件进行统计学分析与比较。结果在冠状动脉左主干、左前降支、左回旋支测得的CT值以及右心室均匀性显示,各组间均无显著性差异(P>0.05),然而,左心室壁的显示在A、B组之间或A、C组之间均有显著性差异(P=0.0001),在B、C组之间亦有显著性差异(P=0.0007)。结论在64层螺旋CT冠状动脉增强扫描中,稀释对比剂方案优于传统的注射方案(A组),以3∶7比例配制的稀释液(B组)为最佳方案。     

The use of a low-osmolality contrast medium in hysterosalpingography: comparison with a conventional contrast medium

Hexabrix 320 has been compared with Conray 280 in a randomised double-blind study of 97 patients undergoing hysterosalpingography. Although the lower osmolality and higher viscosity of Hexabrix should make it an ideal hysterosalpingographic agent, no differences were detected between the two contrast media, either in the incidence of side-effects or in radiographic image quality.     

128层螺旋CT颈部血管CTA检查不同对比剂注射方案的应用及优化

目的：探讨128层螺旋CT颈部血管CTA检查时,在保证图像质量满足诊断需求前提下的最佳对比剂注射方案。方法：选取我院行颈部血管CTA检查的患者96例,随机分为A、B、C 3组各32例。A组注射对比剂40 mL,生理盐水20 mL;B组注射对比剂50 mL,生理盐水20 mL;C组注射对比剂60 mL,生理盐水20 mL。每组先行平扫,注射对比剂后再扫描一次,将2次所得数据传至工作站进行图像后处理,由2名具有20年以上工作经验的影像科诊断医师对图像进行主观评价,评价内容包括颈动脉成像质量、有无上腔静脉伪影干扰及有无颈静脉成像。对主动脉弓处CT值进行客观评价,将主客观评价数据行统计学处理。结果：经Kappa检验,2名医师的评价结果具有良好的一致性（K>0.75）。3组图像质量评分、对比剂静脉伪影情况评价及造影后图像主动脉弓处CT值两两比较,A组与B组、A组与C组间差异均有统计学意义（均P<0.05）,B组与C组间差异无统计学意义（P>0.05）。结论：128层螺旋CT颈部血管CTA检查时,注射对比剂50 mL,生理盐水20 mL为最佳对比剂注射方案。