Extravasation of radiographic contrast media: prevention, diagnosis, and treatment

Contrast media extravasation represents a not unusual problem in radiological practice. Incidence, patient-, and procedure-related risk factors, pathogenesis, and clinical manifestations of extravasation injuries are discussed with a review of recent literature, and a practical preventive approach is proposed. A diagnostic and therapeutic protocol, to be applied whenever contrast extravasation is detected, includes radiographic assessment of compartmentalization, antidote application, local care, and clinical follow-up; indications for surgical consultation and adverse event reporting are provided.     

Reducing the risk of iodine-based and MRI contrast media administration: Recommendation for a questionnaire at the time of booking

This paper presents a practical questionnaire to be used when a contrast medium examination is requested. The questionnaire is based on the guidelines from the European Society of Urogenital Radiology. Its aim is to identify patients at increased risk of clinically relevant renal and non-renal adverse reactions to iodine-based and MRI contrast agents. The questionnaire should be completed by the referring physician when the examination is requested.     

Contrast medium extravasation injury: guidelines for prevention and management

Extravasation of contrast material is a well-recognized complication of contrast-enhanced imaging studies. The management of this complication is contentious; therefore, the Contrast Media Safety Committee of The European Society of Urogenital Radiology decided to review the literature and issue guidelines. A comprehensive literature search was carried out. The resulting report was discussed at the 8th European Symposium on Urogenital Radiology in Genoa, Italy. Automated power injection may result in extravasation of large volumes and may or can lead to severe tissue damage. Infants, young children and unconscious and debilitated patients are particularly at risk of extravasation during contrast media injection. Fortunately, most extravasations result in minimal swelling or erythema, with no long-term sequelae; however, severe skin necrosis and ulceration may occur. Large volumes of high osmolar contrast media are known to induce significant tissue damage. Compartment syndrome may be seen associated with extravasation of large volumes. Conservative management is often adequate, but in serious cases the advice of a plastic surgeon is recommended. Based on the review simple guidelines for prophylaxis and management of contrast medium extravasation injuries are proposed. Electronic Publication     

Acute reactions to intravascular contrast media: types, risk factors, recognition, and specific treatment

Acute, potentially life-threatening systemic reactions to contrast media are less frequent with lower osmolality, nonionic contrast agents, but they are not totally eliminated. Severe reactions remain a reality in all radiology departments. Typical reactions to contrast media include nausea and/or vomiting, scattered to extensive urticaria, bronchospastic reaction, hypotension (isolated) with compensating tachycardia, anaphylactoid reaction, vagal reaction, cardiovascular collapse, convulsion, and seizure. For each type of reaction, rapid recognition and initiation of specific corrective therapy enhance response and minimize side effects of drugs. Specific drugs for treating each reaction type are reviewed, including recommended dose, contraindications, and alternative choices. An approach to the high-risk patient and prevention of acute systemic reactions is discussed and pretreatment protocols are outlined.     

Epicondylar injury in sport: epidemiology, type, mechanisms, assessment, management and prevention

Epicondylar injuries in sports with overhead or repetitive arm actions are frequent and often severe. Acute injury that results in inflammation should be termed epicondylitis and is usually the result of large valgus forces with medial distraction and lateral compression. Epicondylosis develops over a longer period of time from repetitive forces and results in structural changes in the tendon. Epicondylalgia refers to elbow pain at either the medial or lateral epicondyl of the elbow related to tendinopathy of the common flexor or extensor tendon origins at these points. Pain is usually associated with gripping, resisted wrist extension and certain movements such as in tennis and golf, hence the common terms 'tennis elbow' (lateral epicondylsis) and 'golf elbow' (medial epicondylossi). A variety of assessment and diagnostic tools are available to aid the clinician in their comprehensive evaluation of the patient to ensure correct diagnosis and the appropriate conservative or surgical management strategy. Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness. The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. Medical practitioners should have a good understanding of the mechanisms of injury in order to help treat and prevent the re-occurrence of injuries. More emphasis by medical and sport science personnel working with coaches and athletes needs to be placed on prevention of elbow injury in sport through improved joint strength, biomechanically sound sport technique and use of appropriate sport equipment.     

Effects of intravenous contrast media on cortical and medullary blood flow in the rat kidney

The effect of slow intravenous infusion of contrast medium (CM) (1600 mg I/kg body weight) on cortical blood flow (BF) and medullary BF in rat kidneys was investigated by laser-Doppler flowmetry on either renal cortex or exposed renal papillas (inner medulla). The effect on cortical BF was evaluated after infusion of either ioxaglate, iohexol, or ioxithalamate. Mannitol and Ringer's solution were used as control substances. The effect on medullary BF was examined after infusion of either ioxaglate, iohexol, iopamidol, ioxithalamate, or mannitol. BF was measured continuously during a 30-minute control period and a 60-minute experimental period, starting with the CM infusion. Cortical BF was unchanged in the ioxaglate group and significantly increased in the iohexol, ioxithalamate, and mannitol groups (P less than .05). Medullary BF was moderately increased in the ioxaglate group (P less than .05) but moderately decreased in the groups that received iohexol, iopamidol, ioxithalamate, or mannitol (P less than .05). The reduction in medullary BF following infusion of the ratio 3.0 nonionic CM and of the ratio 1.5 ionic CM might be one contributory mechanism to the pathogenesis of CM nephropathy, especially in the presence of microangiopathy in the kidney.     

Ionic versus nonionic contrast media: safety, tolerance, and rationale for use

After several years of clinical experience worldwide and numerous high-quality, randomized controlled trials in humans, the marked improvement in patient tolerance and safety of low osmolar contrast media (ionic and nonionic) has been demonstrated. Iohexol (Omnipaque), Iopamidol (Isovue), Ioxaglate (Hexabrix), and Ioversol (Optiray) are all now available in the United States.     

Ionic versus nonionic contrast media: Safety,tolerance, and rationale for use

After several years of clinical experience worldwide and numerous high-quality, randomized controlled trials in humans, the marked improvement in patient tolerance and safety of low osmolar contrast media (ionic and nonionic) has been demonstrated [1–5]. Iohexol (Omnipaque), Iopamidol (Isovue), Ioxaglate (Hexabrix), and Ioversol (Optiray) are all now available in the United States.     

持续颅内压监测防治颅脑创伤后肾功能损害

目的 探讨持续颅内压(ICP)监测指导颅脑创伤后甘露醇治疗对保护肾功能的效果. 方法 回顾性比较2010年1月-2012年1月收治的颅脑创伤患者168例.患者分为ICP监测组(ICP组,77例)和非ICP监测组(对照组,91例),动态观察患者血浆胱抑素C、肌酐和尿素的变化,记录甘露醇使用量、患者住院天数、6个月GOS评分等. 结果 两组在入院伤情、肾功能、年龄、性别等方面差异无统计学意义.对照组肾功能衰竭发生率是ICP组的2.2倍(P＜0.05).ICP组的甘露醇用量[(443±133)g]仅为对照组[(1 620±412)g]的27.35％(P＜0.01);ICP组甘露醇使用时间[(4.8±3.8)d]也显著少于对照组[(7.2±2.3)d](P＜0.01);6个月GOS评分ICP组明显好于对照组(P＜0.05);伤后第7,14和21天血浆胱抑素C、肌酐浓度和第14天尿素浓度ICP组均明显低于对照组(P＜0.05). 结论 颅脑创伤治疗过程中采用ICP监测可显著减少甘露醇的用量与时间,有效预防和减少颅脑创伤后肾功能衰竭的发生.     

High-concentration contrast media in neurological multidetector-row CT applications: implications for improved patient management in neurology and neurosurgery

Dynamic CT scanning after intravenous injection of iodine contrast medium (CM) was proposed in the very early days of CT. The goal was to characterize tissue by extracting information from the temporal course of enhancement. In the early 1980s, modeling algorithms were already described in the literature for the quantitative calculation of cerebral blood flow (CBF). However, cerebral applications suffered from the insufficient temporal resolution available at that time and the central nervous system was already seen primarily as an MRI domain. The renaissance of dynamic CT in neurological applications came in the middle of the 1990s with the introduction of thrombolytic therapy in acute stroke. With CT being the primary imaging modality, getting additional hemodynamic information from the same device without having to move the patient appeared attractive. Multimodal CT protocols allow a comprehensive diagnosis of the emergency stroke patient in less than 15 minutes by combining nonenhanced CT (NECT), perfusion CT (PCT) and CT angiography (CTA). Dynamic PCT can also render important information in patients with intraaxial brain tumors, allowing differentiation not only between lymphoma and glioma but also between low-grade and high-grade glioma by quantifying local cerebral blood volume (CBV) and permeability of the blood-brain barrier (BBB). Hoever, even if a shorter imaging time permits a reduction in volume of CM, adequate total iodine levels must be preserved for dynamic CT applications. Increased concentrations of iodine are therefore helpful to obtain adequate total iodine levels for imaging.