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In order to promote the rational clinical use of gadolinium-based contrast agents （GBCA） and to provide a reference for physicians to prescribe such contrast agents and for pharmacists to review prescriptions， the consensus working group launched the preparation project of “Consensus on whole-process pharmaceutical care for GBCA” according to domestic and foreign guidelines and consensus. The Zhujiang Hospital of Southern Medical University took the lead and cooperated with clinical experts and pharmaceutical experts from several domestic medical institutions to discuss and summarize the basic pharmacological effect of GBCA， types， pharmacokinetics， pharmacodynamics， indications， contraindications， precautions， usage and dosage， adverse drug reactions， and finally forms the consensus. The main contents of this consensus include an overview of various types of GBCA， rational clinical use of drugs， security management and whole-process pharmaceutical care process， etc.， for reference by physicians and pharmacists in medical institutions at all levels.
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In real-time ultrasound,molecular targeted contrast agent is introduced into the blood circulation through peripheral intravenous injection to enhance the imaging signal of target lesions after binding to the corresponding intravascular receptors,which can realize early diagnosis,staging of diseases,assessment of treatment response,and targeted treatment.In addition,molecular targeted ultrasound contrast agents provide a platform for the delivery of drugs and genes via microbubbles,and nanoscale contrast agents can be infiltrated through vascular endothelium into the interstitial space of the lesion for imaging or treatment.The available studies of molecular targeted ultrasound contrast agents mainly focus on the preclinical trials.Some clinical trials have been conducted in humans and preliminarily confirm the safety and feasibility of targeted ultrasound contrast agents.The molecular targeted ultrasound contrast agents enjoy a broad prospect in clinical application.
Subject(s)
Humans , Contrast Media/chemistry , Molecular Targeted Therapy , Ultrasonography/methods , Diagnostic ImagingABSTRACT
Abstract Objective: To assess the practical aspects of the use of various gadolinium-based contrast agents (GBCAs) by radiologists. Materials and Methods: Ten experienced radiologists from different regions of Brazil participated in a Delphi panel querying their use of various GBCAs, including linear and macrocyclic classes (1.0 and 0.5 M), in terms of the choice of agent, volume and dosage of the agents, and associated safety concerns. Results: The response rate was 100% for all questions. GBCAs are safe in terms of acute adverse reactions, and nephrogenic systemic fibrosis is rare. The deposition of gadolinium in the brain and other tissues is a concern among the experts. Macrocyclic agents are preferable to linear agents; an injection volume below 0.1 mL/kg of a 1.0 M agent could result in good-quality images with additional long-term safety, but there is no published evidence to support this recommendation. The majority of experts preferred not to administer GBCAs to pregnant patients. Conclusion: When choosing a GBCA, it is important to consider the characteristics of the gadolinium deposition in patient tissues and minimize potential risks. Furthermore, medical education programs are needed to increase the awareness of the potential risks of gadolinium deposition and thus avoid instances of overexposure to the contrast agent.
Resumo Objetivo: Avaliar aspectos práticos do uso de agentes de contraste à base de gadolínio (gadolinium-based contrast agents - GBCAs) por médicos especialistas em radiologia. Materiais e Métodos: Dez radiologistas de diferentes regiões do Brasil foram convidados a participar de um painel Delphi com perguntas sobre o uso de GBCAs lineares e macrocíclicos (1,0 e 0,5 M), em termos de dosagem, volume injetado e preocupações relacionadas à segurança. Resultados: A taxa de resposta foi de 100% para todas as perguntas. GBCAs são seguros em relação a reações adversas agudas, e os casos de fibrose nefrogênica sistêmica são raros. O depósito de gadolínio no cérebro e em outros tecidos é uma preocupação de todo o painel. Agentes macrocíclicos são preferíveis aos lineares. Um volume menor que 0,1 mL/kg injetado de contraste macrocíclico 1,0 M poderia oferecer imagem com boa qualidade e benefício adicional em longo prazo, entretanto, não há evidências publicadas que apóiem tal recomendação. A maioria prefere não administrar GBCA em gestantes. Conclusão: É importante considerar as características de deposição e minimizar potenciais riscos ao se escolher um GBCA. Ações de educação médica são necessárias para a conscientização dos potenciais riscos da presença de gadolínio em longo prazo e evitar a sobre-exposição ao agente de contraste.
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BACKGROUND: For the bone-specific imaging, a structure-inherent targeting of bone tissue recently has been reported a new strategy based on incorporation of targeting moieties into the chemical structure of near-infrared (NIR) contrast agents, while conventional methods require covalent conjugation of bone-targeting ligands to NIR contrast agents. This will be a new approach for bone-targeted imaging by using the bifunctional NIR contrast agents. METHODS: The goal of this review is to provide an overview of the recent advances in optical imaging of bone tissue, highlighting the structure-inherent targeting by developing NIR contrast agents without the need for a bone-targeting ligand such as bisphosphonates. RESULTS: A series of iminodiacetated and phosphonated NIR contrast agents for the structure-inherent targeting of bone tissue showed excellent bone-targeting ability in vivo without non-specific binding. Additionally, the phosphonated NIR contrast agents could be useful in the diagnosis of bone metastasis. CONCLUSION: By developing bone-targeted NIR contrast agents, optical imaging of bone tissue makes it very attractive for preclinical studies of bone growth or real-time fluorescence guided surgery resulting in high potential to shift the clinical paradigms.
Subject(s)
Bone and Bones , Bone Development , Contrast Media , Diagnosis , Diphosphonates , Fluorescence , Ligands , Neoplasm Metastasis , Optical Imaging , Surgery, Computer-AssistedABSTRACT
: As interventional techniques developed, more and more neurovascular diseases achieve good results by endovascular treatment. Meanwhile, cerebral angiography is also the gold standard for the diagnosis of most cerebrovascular diseases. Transient cortical blindness (TCB) is a rare complication of cerebral angiography with unclear mechanism. We report a case of dissecting aneurysm in the left vertebral artery treated by stent-assisted coiling,and patient experienced postoperative binocular complete vision loss fora short period TCB was diagnosed after relevant examinations performed. Patient's vision recovered completely after symptomatic treatment. Literatures were reviewed and the pathogenesis, imaging characteristics and treatment of TCB were summarized.
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Objective@#To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis.@*Methods@#The agent was a biotinylated, fluorescent-labelled, lipid-coated, liquid perfluorocarbon emulsion. Physico-chemical properties of the agent were measured, including size distribution, Zeta Potential, concentration and so on. Ischemia-reperfusion models were created in rats, and then exposed to biotinylated anti-MCP-1 monoclonal antibody, rhodamine avidin and biotinylated, FITC-labelled nanoparticles, respectively. Echocardiography was taken before and after injection. Frozen sections of their hearts were observed under fluorescence microscope.@*Results@#The particle diameter, zeta potential and concentration of lipid nanoparticles were (172.30±52.06)nm, (-33.10±6.50)mV and (2.28±0.46)×1011/ml, respectively. From the short-axis view, the myocardium under endocardium of anterior wall was enhanced obviously. While myocardium of other walls were still. The lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope, while neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium.@*Conclusions@#The viable myocardium can be targeted and acoustically enhanced by the self-made nano-scale ultrasound contrast agent. This new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium.
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Objective To prepare a kind of lipid nanoparticle ultrasound contrast agents with the ability to target to viable myocardium for diagnosis . Methods T he agent was a biotinylated ,fluorescent‐labelled ,lipid‐coated , liquid perfluorocarbon emulsion . Physico‐chemical properties of the agent were measured ,including size distribution ,Zeta Potential ,concentration and so on . Ischemia‐reperfusion models were created in rats ,and then exposed to biotinylated anti‐MCP‐1 monoclonal antibody ,rhodamine avidin and biotinylated ,FITC‐labelled nanoparticles ,respectively . Echocardiography was taken before and after injection . Frozen sections of their hearts were observed under fluorescence microscope . Results T he particle diameter ,zeta potential and concentration of lipid nanoparticles were ( 172 .30 ± 52 .06) nm ,( －33 .10 ± 6 .50) mV and ( 2 .28 ± 0 .46 ) × 1011/ml ,respectively . From the short‐axis view ,the myocardium under endocardium of anterior wall was enhanced obviously . While myocardium of other walls were still . T he lipid nanoparticles located in the myocardium of anterior wall and gave out bright green and red fluorescence under fluorescence microscope ,w hile neither lipid nanoparticles nor fluorescence were found in other sites of ventricular myocardium . Conclusions The viable myocardium can be targeted and acoustically enhanced by the self‐made nano‐scale ultrasound contrast agent . T his new agent has potential to improve sensitivity and specificity for noninvasive identifying viable myocardium .
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Characterizing inflammation and fibrosis in Crohn's disease (CD) is necessary to guide clinical management, but distinguishing the two remains challenging. Novel ultrasound (US) techniques: contrast-enhanced US (CEUS) and shear wave elastography (SWE) offer great potential in evaluating disease activity in pediatric patients. Three patients ages 16 to 20 with known CD underwent CEUS and SWE to characterize bowel wall inflammation and fibrosis. Magnetic resonance enterography, endoscopy, or surgical pathology findings are also described when available. The patients' disease activity included acute inflammation, chronic inflammation with stricture formation, and a fibrotic surgical anastomosis without inflammation. CEUS was useful in determining the degree of inflammation, and SWE identified bowel wall fibrosis. Used together these techniques allow for better characterization of the degree of fibrosis and inflammation in bowel strictures. With further validation CEUS and SWE may allow for improved characterization of bowel strictures and disease flares in pediatric patients suffering from CD.
Subject(s)
Adolescent , Humans , Anastomosis, Surgical , Constriction, Pathologic , Contrast Media , Crohn Disease , Elasticity Imaging Techniques , Endoscopy , Fibrosis , Inflammation , Inflammatory Bowel Diseases , Pathology, Surgical , Pediatrics , UltrasonographyABSTRACT
Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging. Recently, a large amount of evidence indicates that change of magnetic resonance signal in deep brain nuclei is related to repeated injection of GBCAs. Especially in the dentatum and pallidum the gadolinium deposition is most obvious. This paper reviews the research status and policy progress of brain deposition of GBCAs, and introduces the relationship between gadolinium deposition in the brain and the type of GBCAs.
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As a minimally invasive method, sentinel lymph node biopsy (SLNB) in conjunction with guidance methods is the standard method to determine cancer metastasis in breast. The desired guidance methods for SLNB should be capable of precise SLN localization for accurate diagnosis of micro-metastases at an early stage of cancer progression and thus facilitate reducing the number of SLN biopsies for minimal surgical complications. For this, high sensitivity to the administered dyes, high spatial and contrast resolutions, deep imaging depth, and real-time imaging capability are pivotal requirements. Currently, various methods have been used for SLNB guidance, each with their own advantages and disadvantages, but no methods meet the requirements. In this review, we discuss the conventional SLNB guidance methods in this perspective. In addition, we focus on the role of the PA imaging modality on real-time SLN identification and biopsy guidance. In particular, PA-based hybrid imaging methods for precise SLN identification and efficient biopsy guidance are introduced, and their unique features, advantages, and disadvantages are discussed.
Subject(s)
Biopsy , Breast , Coloring Agents , Contrast Media , Diagnosis , Lymph Nodes , Methods , Neoplasm Metastasis , Optical Imaging , Sentinel Lymph Node Biopsy , UltrasonographyABSTRACT
Photoacoustic microscopy (PAM) has become an increasingly popular technology for biomedical applications, providing anatomical, functional, and molecular information. In this concise review, we first introduce the basic principles and typical system designs of PAM, including optical-resolution PAM and acoustic-resolution PAM. The major imaging characteristics of PAM, i.e. spatial resolutions, penetration depth, and scanning approach are discussed in detail. Then, we introduce the major biomedical applications of PAM, including anatomical imaging across scales from cellular level to organismal level, label-free functional imaging using endogenous biomolecules, and molecular imaging using exogenous contrast agents. Lastly, we discuss the technical and engineering challenges of PAM in the translation to potential clinical impacts.
Subject(s)
Contrast Media , Microscopy , Molecular Imaging , Weights and MeasuresABSTRACT
Naphthalocyanines (Ncs) are a family of aromatic small molecule with large near infrared extinction coefficients, making them appealing contrast agent candidates for photoacoustic imaging (PAI). Depending on the substitutions on the Nc periphery or metal center, different spectrally-resolved absorption peak wavelengths are possible, which can enable photoacoustic contrast multiplexing. Owing to their generally poor aqueous solubility, approaches have been developed to modify Ncs or formulate them as biocompatible contrast agents for PAI. Due to their inherent capacity for metal ion chelation, Ncs hold potential for complementary multimodal contrast imaging techniques such as ⁶⁴Cu positron emission tomography. In this research perspective, we highlight some recent reports involving the use of Ncs in PAI.
Subject(s)
Humans , Absorption , Contrast Media , Multimodal Imaging , Positron-Emission Tomography , SolubilityABSTRACT
Abstract A large number of gadolinium chelates have recently been tested in clinical trials. Some of those have already been approved for clinical use in the United States and Europe. Thus, new diagnostic perspectives have been incorporated into magnetic resonance imaging studies. Among such gadolinium chelates are hepatobiliary-specific contrast agents (HSCAs), which, due to their property of being selectively taken up by hepatocytes and excreted by the biliary ducts, have been widely used for the detection and characterization of focal hepatic lesions. In comparison with conventional magnetic resonance cholangiography (MRC), HSCA-enhanced MRC provides additional information, with higher spatial resolution and better anatomic evaluation of a non-dilated biliary tree. A thorough anatomic assessment of the biliary tree is crucial in various hepatic surgical procedures, such as complex resection in patients with colorectal cancer and living-donor liver transplantation. However, the use of HSCA-enhanced MRC is still limited, because of a lack of data in the literature and the poor familiarity of radiologists regarding its main indications. This pictorial essay aims to demonstrate the use of HSCA-enhanced MRC, with particular emphasis on anatomical analysis of the biliary tree, clinical applications, and the most important imaging findings.
Resumo Recentemente, um grande número de quelantes de gadolínio tem sido testado em ensaios laboratoriais. Alguns deles já foram inclusive aprovados para uso clínico nos Estados Unidos e na Europa. Com isso, novas perspectivas diagnósticas foram incorporadas nos estudos de ressonância magnética. Dentre estes quelantes de gadolínio, os contrastes hepatobiliares específicos (CHBEs) têm sido amplamente utilizados para a caracterização e detecção de lesões focais hepáticas, essencialmente pela propriedade de serem captados pelos hepatócitos e excretados na via biliar. Além disso, os CHBEs trouxeram novas informações na avaliação da árvore biliar quando comparados à colangiorressonância convencional, proporcionando uma maior resolução espacial e melhor avaliação da anatomia da árvore biliar não dilatada. A avaliação da anatomia biliar é de fundamental importância em cirurgias hepáticas, como ressecções complexas em tumores colorretais ou no transplante hepático com doador vivo, porém, o uso dos CHBEs ainda é restrito para estes propósitos. Em razão da escassa literatura sobre o tema e da pouca familiaridade dos radiologistas com as principais indicações, o presente ensaio iconográfico tem por objetivo demonstrar o uso de CHBEs na avaliação perioperatória das vias biliares, ressaltando a avaliação anatômica, as indicações e os principais achados de imagem.
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Objective To investigate the factors causing exudation of drugs by intravenous contrast medium in CT enhanced scan, and to analyze the corresponding measures. Methods From January 2016 to June 2017 in the First People's Hospital of Jiande City 61 cases of drug extravasation enhanced CT scanning in patients as the research object, through the observation of the drug leakage factors to agents in this group of patients with intravenous contrast and record, in order to find out measures. Results The statistics show, this group of patients with drug extravasation factors: 12 years of age, the incidence rate was 63.93％ (39/61) injection velocity; the incidence rate of 3.0～4.0ml/s was 70.49％ (42/61);small vein injection of vascular forearm 80.33％ (49/61); osmotic pressure, the incidence rate of 300mOsm/kgH2O was 83.61％ (51/61). Conclusion CT scan causes intravenous contrast agent oozing drugs are various, according to the specific selection of patients with drug exudation measures, can effectively improve the patients clinicalcharacteristics of blood stasis, swelling, pain, and has important practical value.
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The application of medical imaging technology is playing an important role in diagnosis and treatment of cancer.In clinic,the most commonly used imaging technology to detect cancers are X-ray computed tomo graphy,nuclide imaging,magnetic resonance imaging and near-infrared fluorescence imaging.Contrast agents could enhance imaging signals and increase the sensitivity and accuracy of cancer detection.Neverthness,most of clinically used contrast agents have problems such as short retention time and tumor targeting insufficient,which is not favorable to cancer detecting.So it is of great significance to develop tumor targeting contrast agents.Currently,targeting strategies are divided into three types:passive targeting,active targeting and activatable targeting.In this review,we conclude the recent progress and applications of tumor targeting contrast agents of different imaging modilities.Besides,the future development of tumor targeting contrast agents is also prospected.
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Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.
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Objective To evaluate the efficacy of nonionic contrast agent, CT, in intravenous enhanced scan. Methods 84 cases of patients with CT venous enhancement scanning were admitted in our hospital from January 2016 to December 2016, ioversol dosage is 80~100 mL, the injection speed is 3~6 mL/s, both in the scan and enhanced scan before 2 h, immediately after scanning after 1 h, 48 h to record vital signs, observation of the injection site, ECG, enhanced scan in the 2 h before and after 48 h enhancement scanning, blood biochemical examination and renal function tests, and immediately, in enhanced scan and scan after scan after 15 min, 1 h and 48 h in different time periods of adverse reactions were observed and recorded. Results The excellent rate of systemic tolerance was 100%, 7 cases had flushing and thermal sensation, accounting for 8.3%. Slight adverse reactions occurred in 1 cases, accounting for 1.2%. No moderate or severe adverse reactions occurred. Conclusion The use of non-ionic contrast agent CT in intravenous enhanced scan, low adverse reaction rate, high safety, and has a very important application value.
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Objective To evaluate the diagnostic value of magnetic resonance angiography and CT angiography in cerebrovascular disease and the characteristics of the respective contrast agents. Methods A total of 120 patients diagnosed with cerebrovascular disease in our hospital from May 2015 to May 2016 underwent magnetic resonance angiography and CT angiography, of which the former application of paramagnetic contrast agents, the application of iodine contrast agent, and digital subtraction angiography within 7 d and subtraction angiography as diagnostic standard.Then the results of two methods were compared in diagnosis of cerebral vascular disease. Results The specificity of magnetic resonance arterial examination and CT angiography in cerebral arterial stenosis were 98.20%, 90.20%, the sensitivity were 90.90% and 100%; The specificity of magnetic resonance arterial examination and CT angiography in moyamoya disease were 95.00% and 90.00%, the sensitivity were 100.00% and 100.00%; The specificity of magnetic resonance arterial examination and CT angiography in brain aneurysm were 86.44%, 85.15%, the sensitivity were 100.00%, 84.69%. Conclusion MR angiography is superior to CT angiography in the diagnosis of cerebral aneurysms, and the imaging contrast agents have their own characteristics, which can enhance the effect of the examination.
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Objective To evaluate the feasibility and efficacy of intra-cavity contrast enhanced ultrasound (ICCE-US) in percutanous nephrolithotomy for nephrolithiasis patients with slight or no hydronephrosis.Methods From March 2016 to March 2017,ICCE-US-guided PCNL was performed in 35,patients who had kidney stones with slight hydronephrosis in 11 and without hydronephrosis in 24.The sample comprised 20 males and 15 females,including 10 with renal pelvic calculi alone,17 with renal pelvic calculi combined with renal calyx calculi,and 8 with partial staghorn calculi.Mean age was 46.8 years (ranging,28-75 years).The size of calculi ranged from 2.5 cm to 5.0 cm [mean(3.6 ± 1.2) cm].In the prone position,the preferred calyces are the posterior ones,which were enhanced by sulfur hexafluoride microbubbles (SonoVue) retrogradely injected through ureteral catheter.An 18-gauge needle was inserted toward the desirable calyx.Successful renal entry was confirmed by administration of ultrasound contrast agents into the collecting system via the needle regardless of whether spontaneous urine drainage was observed.A guidewire was passed through the needle to renal collecting system.Subsequently,the needle was removed.And the renal tract was dilated to F18-F20 size with dilators.Finally,holmium laser lithotripsy was performed through nephroscopy.Results Posterior calyces and its fornix were revealed under contrast-enhanced ultrasound in all patients.The successive access rate was 100％.The average time for establishing the access was (8 ±2.6)min (ranging 5-10 min).The mean number of needle passes was (1.5 ± 0.3) times per kidney,ranged from 1 to 3 times.Hemoglobin level averagely reduced (11.3 ± 3.7) g/ L (ranging 6-15 g/L) within 24 hours postoperatively.No major complications,such as adjacent organs injuries or collecting system perforation were observed.No blood transfusion was needed.The mean hospital stay was (5.6 ± 1.2) days (ranging 5-7 days).The stone-free rate was 91.4％ (32/35).Conclusions ICCE-US can demonstrate clearly about the posterior calyces and its fornix as well as puncture needle site by contrast enhancement in the nephrolithiasis patients with slight or no hydronephrosis.It has the potential to improve the accuracy and successive rate of puncture resulting in a decrease in the puncture-related complications.
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Objective To evaluate the efficacy of nonionic contrast agent, CT, in intravenous enhanced scan. Methods 84 cases of patients with CT venous enhancement scanning were admitted in our hospital from January 2016 to December 2016, ioversol dosage is 80~100 mL, the injection speed is 3~6 mL/s, both in the scan and enhanced scan before 2 h, immediately after scanning after 1 h, 48 h to record vital signs, observation of the injection site, ECG, enhanced scan in the 2 h before and after 48 h enhancement scanning, blood biochemical examination and renal function tests, and immediately, in enhanced scan and scan after scan after 15 min, 1 h and 48 h in different time periods of adverse reactions were observed and recorded. Results The excellent rate of systemic tolerance was 100%, 7 cases had flushing and thermal sensation, accounting for 8.3%. Slight adverse reactions occurred in 1 cases, accounting for 1.2%. No moderate or severe adverse reactions occurred. Conclusion The use of non-ionic contrast agent CT in intravenous enhanced scan, low adverse reaction rate, high safety, and has a very important application value.