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ABSTRACT Introduction: Contrast-associated acute kidney injury (CA-AKI) is a deterioration of kidney function that occurs after the administration of a iodinated contrast medium (ICM). Most studies that defined this phenomenon used older ICMs that were more prone of causing CA-AKI. In the past decade, several articles questioned the true incidence of CA-AKI. However, there is still a paucity of a data about the safety of newer ICM. Objective: To assess the incidence of CA-AKI in hospitalized patients that were exposed to computed tomography (CT) with and without ICM. Methods: Prospective cohort study with 1003 patients who underwent CT in a tertiary hospital from December 2020 through March 2021. All inpatients aged > 18 years who had a CT scan during this period were screened for the study. CA-AKI was defined as a relative increase of serum creatinine of ≥ 50% from baseline or an absolute increase of ≥ 0.3 mg/dL within 18 to 48 hours after the CT. Chi-squared test, Kruskal-Wallis test, and linear regression model with restricted cubic splines were used for statistical analyses. Results: The incidence of CA-AKI was 10.1% in the ICM-exposed group and 12.4% in the control group when using the absolute increase criterion. The creatinine variation from baseline was not significantly different between groups. After adjusting for baseline factors, contrast use did not correlate with worse renal function. Conclusion: The rate of CA-AKI is very low, if present at all, with newer ICMs, and excessive caution regarding contrast use is probably unwarranted.
RESUMO Introdução: Lesão renal aguda associada ao contraste (LRA-AC) é uma deterioração da função renal que ocorre após a administração de meio de contraste iodado (MCI). A maioria dos estudos que definiram esse fenômeno utilizaram MCI mais antigos, mais propensos a causar LRA-AC. Na última década, diversos artigos questionaram a verdadeira incidência de LRA-AC. Entretanto, ainda há escassez de dados sobre a segurança dos MCI mais novos. Objetivo: Avaliar a incidência de LRA-AC em pacientes hospitalizados expostos à tomografia computadorizada (TC) com e sem MCI. Métodos: Estudo de coorte prospectivo com 1.003 pacientes submetidos a TC em hospital terciário, de dezembro/2020 a março/2021. Todos os pacientes internados com idade ≥ 18 anos que realizaram TC nesse período foram selecionados. A LRA-AC foi definida como aumento relativo de creatinina sérica de ≥ 50% em relação ao valor basal ou aumento absoluto de ≥ 0,3 mg/dL dentro de 18 a 48 horas após a TC. Utilizamos o teste qui-quadrado, teste de Kruskal-Wallis e modelo de regressão linear com splines cúbicos restritos para análises estatísticas. Resultados: A incidência de LRA-AC foi 10,1% no grupo exposto ao MCI e 12,4% no grupo controle ao usar o critério de aumento absoluto. A variação da creatinina em relação ao valor basal não foi significativamente diferente entre os grupos. Após ajuste para fatores basais, o uso de contraste não se correlacionou com pior função renal. Conclusão: A taxa de LRA-AC é muito baixa, caso exista, com MCIs mais novos, e a cautela excessiva quanto ao uso de contraste provavelmente não se justifica.
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SUMMARY OBJECTIVE: This study aimed to evaluate the diagnostic efficiency of contrast-to-noise and signal-to-noise ratios created by the contrast medium in detecting lymph nodes. METHODS: In this study, 57 short-axis subcentimeter lymph nodes in 40 cardiac computed tomography patients with noncontrast- and contrast-enhanced phases were evaluated. The contrast-to-noise ratios and signal-to-noise ratios of noncontrast- and contrast-enhanced lymph node-mediastinal fat and aortic-mediastinal fat tissues were determined. In addition, lymph nodes in noncontrast- and contrast-enhanced series were evaluated subjectively. RESULTS: There was a significant difference in lymph node-mediastinal fat signal-to-noise values between the contrast and noncontrast phases (p=0.0002). In the contrast phase, aortic density values were found to be 322.04±18.51 HU, lymph node density values were 76.41±23.41 HU, and mediastinal adipose tissue density values were −65.73±22.96 HU. Aortic-mediastinal fat contrast-to-noise ratio value was 20.23±6.92 and the lymph node-mediastinal fat contrast-to-noise ratio value was 6.43±2.07. A significant and moderate correlation was observed between aortic-mediastinal fat and lymph node-mediastinal fat contrast-to-noise ratio values in the contrast phase (r=0.605; p<0.001). In the contrast-enhanced series, there was a significant increase in the subjective detection of lymph nodes (p=0.0001). CONCLUSION: In the detection of paratracheal lymph nodes, the contrast agent increases the detection of short-axis subcentimeter lymph nodes quantitatively and qualitatively. Contrast enhances and facilitates the detection of paratracheal lymph nodes.
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Objective:To investigate the predictive value of serum cystatin C (Cys-C) and renal artery resistance index (RRI) 24 h before coronary CT angiography (CTA) examination in contrast-induced nephropathy(CIN).Methods:Sixty-four patients with coronary heart disease who received coronary CTA examination in Hebei Petro China Central Hospital from January 2020 to March 2021 were selected as the research subjects. According to the incidence of CIN after coronary CTA examination, they were divided into the case group (25 patients) and the normal group(39 patients). Serum Cys-C level was measured by automatic biochemical analyzer at 24 h before CTA examination, and RRI value was measured by color Doppler ultrasound. Risk factors of CIN after CTA examination were analyzed by Logistic regression. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive value of serum Cys-C, RRI and the combination of the two indexes in CIN.Results:Compared with the control group, the dosage of contrast agent, patients with hypertension, serum Cys-C level at 24 h before CTA examination and RRI value in the case group were higher than those in the normal group: (85.53 ± 16.27) ml vs. (64.37 ± 15.08) ml, 80.00%(20/25) vs. 56.41%(22/39), (1.36 ± 0.18)mg/L vs.(1.02 ± 0.21) mg/L, 0.743 ± 0.093 vs. 0.632 ± 0.081, there were statistical differences ( P<0.05). Multivariate Logistic regression analysis showed that the amount of contrast agent, hypertension, serum Cys-C level at 24 h before CTA examination and RRI value were independent risk factor for CIN after CTA examination ( P<0.05). The results of ROC curve analysis showed that serum Cys-C (>1.318 mg/L) combined with RRI value (>0.653) at 24 h before CTA examination predicted CIN with the highest area under the curve was 0.922, sensitivity was 92.5% and specificity was 81.6%. Conclusions:The incidence of CIN after CTA is related to the dosage of contrastant, hypertension, serum Cys-C level and RRI value at 24 h before CTA. The combination of Cys-C level and RRI value has a high predictive value for the occurrence of CIN.
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Objective: Adverse reactions are sometimes induced by contrast media used for medical imaging and can be life-threatening. Thus, appropriate management is important for patient safety. The purpose of this study was to clarify the actual management of adverse reactions induced by contrast media in hospitals, the opportunities for intervention by hospital pharmacy departments and the attitudes of hospital pharmacists regarding the risk of adverse reactions.Methods: A self-administered questionnaire survey was conducted in the pharmacy departments of 16 hospitals (approximately 200 to 1,000 beds) located in the Tokyo metropolitan area of Japan. The survey asked about the presence or absence of internal rules or manuals regarding contrast media administration at each hospital, the management status of patients with risk factors for adverse reactions, the opportunities for interventions by pharmacists, and the opportunities for discussion regarding contrast media administration among pharmacists and other professionals.Results: Of the 16 hospitals, 10 responded to the questionnaires, and 7 of them had internal rules or manuals. These rules or manuals stipulated actions such as “do not administer contrast media” to patients with risk factor(s) for adverse reactions. For inpatients, there were opportunities for pharmacist interventions, such as drug management and guidance services and initial interviews upon hospital admission. However, for outpatients the opportunities for interventions were limited. At 5 of the 10 hospitals, pharmacists discussed contrast administration with physicians, radiologists, and other healthcare professionals.Conclusion: The present study reveal that many hospitals take great care in deciding on the administration of contrast media to patients at risk of adverse drug reactions. Our results indicate that the limited opportunities for “outpatient intervention" is an issue in the hospital pharmacy department's participation for proper use of contrast media.
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To expand the single-dose duration over which noninvasive clinical and preclinical cancer imaging can be conducted with high sensitivity, and well-defined spatial and temporal resolutions, a facile strategy to prepare ultrasmall nanoparticulate X-ray contrast media (nano-XRCM) as dual-modality imaging agents for positron emission tomography (PET) and computed tomography (CT) has been established. Synthesized from controlled copolymerization of triiodobenzoyl ethyl acrylate and oligo(ethylene oxide) acrylate monomers, the amphiphilic statistical iodocopolymers (ICPs) could directly dissolve in water to afford thermodynamically stable solutions with high aqueous iodine concentrations (>140 mg iodine/mL water) and comparable viscosities to conventional small molecule XRCM. The formation of ultrasmall iodinated nanoparticles with hydrodynamic diameters of ca. 10 nm in water was confirmed by dynamic and static light scattering techniques. In a breast cancer mouse model, in vivo biodistribution studies revealed that the 64Cu-chelator-functionalized iodinated nano-XRCM exhibited extended blood residency and higher tumor accumulation compared to typical small molecule imaging agents. PET/CT imaging of tumor over 3 days showed good correlation between PET and CT signals, while CT imaging allowed continuous observation of tumor retention even after 10 days post-injection, enabling longitudinal monitoring of tumor retention for imaging or potentially therapeutic effect after a single administration of nano-XRCM.
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ABSTRACT BACKGROUND: Adhesive small bowel obstruction is one of the most common causes of surgical emergencies, representing about 15% of hospital admissions. Defining the need and timing of surgical intervention still remains a challenge. AIMS: To report the experience of using meglumine-based water-soluble contrast in a tertiary hospital in southern Brazil, comparing with the world literature. METHODS: Patients suspected of having adhesive small bowel obstruction, according to their clinical conditions, underwent an established protocol, consisting of the administration of water-soluble contrast, followed by plain abdominal radiograph within 12 hours and by a new clinical evaluation. The protocol was initiated after starting conservative management, including fasting and placement of a nasogastric tube, as well as intravenous fluid reposition. RESULTS: A total of 126 patients were submitted to the protocol. The water-soluble contrast test sensitivity and specificity after the first radiograph were 94.6 and 91.0%, respectively; after the second radiograph, these values were 92.3 and 100%. The general test values for sensitivity and specificity were 91.9 and 100%, respectively. CONCLUSIONS: The measure parameters evaluated in this study were similar to those found in the literature, contributing to endorse the importance of this test in the evaluation of patients with adhesive small bowel obstruction. The particular relevance of this study was the similar results that were found using a different type of meglumine-based contrast, which is available in Brazil.
RESUMO RACIONAL: A obstrução intestinal por bridas é uma das causas mais comuns de atendimento em emergências cirúrgicas, representando cerca de 15% das internações hospitalares. Definir a necessidade e o momento da intervenção cirúrgica ainda permanece um desafio. OBJETIVOS: Relatar a experiência do uso de contraste hidrossolúvel à base de meglumina em um hospital terciário do sul do Brasil, comparando com a literatura mundial. MÉTODOS: Pacientes com suspeita de obstrução do intestino delgado por bridas, de acordo com suas condições clínicas, foram submetidos a um protocolo estabelecido, que consiste na administração de contraste hidrossolúvel, seguido de radiografia abdominal simples em 12 horas e, posteriormente, de nova avaliação clínica. O protocolo foi iniciado após manejo conservador inicial, incluindo jejum e sonda nasogástrica, bem como reposição de fluidos intravenosos. RESULTADOS: Foram submetidos ao protocolo 126 pacientes. A sensibilidade e a especificidade após a primeira radiografia foram de 94,6 e de 91%, respectivamente; após a segunda radiografia, esses valores foram de 92,3 e 100%. Os valores gerais do teste para sensibilidade e especificidade foram 91,9 e 100%. CONCLUSÕES: Os parâmetros de medida avaliados neste estudo foram semelhantes aos encontrados na literatura, contribuindo para endossar a importância deste teste na avaliação de pacientes com obstrução adesiva do intestino delgado. A relevância particular deste estudo foram os resultados semelhantes encontrados usando tipos diferente de contraste hidrossolúveis, disponíveis no Brasil.
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Resumo Fundamento A nefropatia induzida por contraste (NIC) é definida como deterioração da função renal, representada por um aumento da creatinina sérica ≥25% ou ≥0,5 mg/dL até 72 horas após a exposição ao meio de contraste iodado (MCI). A medida preventiva mais eficaz até o momento é a hidratação venosa (HV). Pouco se sabe sobre a eficácia da hidratação oral (HO) ambulatorial. Objetivo Investigar se a HO ambulatorial com água é tão eficaz quanto a HV com solução salina a 0,9% na prevenção de NIC em procedimentos coronarianos eletivos. Métodos Neste estudo observacional retrospectivo, foram analisados prontuários médicos e dados laboratoriais para coletar dados de indivíduos submetidos a procedimentos coronarianos percutâneos com MCI. Os dados coletados entre 2012 e 2015 avaliaram indivíduos que foram submetidos à HV e entre 2016 e 2020 (após a implementação de um protocolo de HO), os indivíduos que foram submetidos à HO em casa antes e depois de procedimentos coronarianos, conforme orientação da equipe de enfermagem. A significância estatística adotada foi de α=0,05. Resultados No total, 116 pacientes foram incluídos neste estudo, 58 no grupo HV e 58 no grupo HO. Observou-se incidência de NIC de 15% (9/58) no grupo que recebeu HV e 12% (7/58) no grupo que recebeu HO (p=0,68). Conclusão O protocolo de HO realizado pelo paciente parece ser tão eficaz quanto o protocolo de HV hospitalar na proteção renal de indivíduos suscetíveis a desenvolver NIC em intervenções coronarianas eletivas. Essas descobertas devem ser testadas em ensaios mais abrangentes.
Abstract Background Contrast-induced nephropathy (CIN) is defined as worsening renal function, represented by an increase in serum creatinine of ≥ 25% or ≥ 0.5 mg/dL up to 72 h after exposure to iodinated contrast medium (ICM). The most effective preventive measure to date is intravenous hydration (IVH). Little is known about the effectiveness of outpatient oral hydration (OH). Objetive To investigate whether outpatient OH with water is as effective as IVH with 0.9% saline solution in preventing CIN in elective coronary procedures. Methods In this retrospective observational study, we analyzed the medical records and laboratory data of individuals undergoing percutaneous coronary procedures with ICM. Data collected between 2012 and 2015 refer to individuals who underwent IVH and those collected between 2016 and 2020 (after implementation of an OH protocol) correspond to individuals who underwent OH at home before and after coronary procedures as instructed by the nursing team. Statistical significance was established at α = 0.05. Results In total, 116 patients were included in this study: 58 in the IVH group and 58 in the OH group. An incidence of CIN of 15% (9/58) was observed in the group that received IVH and an incidence of 12% (7/58) was seen in the group that received OH (p = 0.68). Conclusion The OH protocol, performed by the patient, appears to be as effective as the in-hospital IVH protocol for the renal protection of individuals susceptible to CIN in elective coronary interventions. These findings should be put to test in larger trials.
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Objective:To explore the predictive value of transrectal multimodal ultrasound and prostate specific antigen (PSA) in clinically organ-confined prostate cancer.Methods:It was a cross-sectional study. The clinical data of patients with suspected prostate nodules treated in the First Hospital of Shanxi Medical University from May 2014 to April 2020 were analyzed retrospectively. Of the patients, 48 cases of clinically organ-confined prostate cancer and 51 cases of benign prostatic hyperplasia confirmed by clinical data and pathology were selected as research objects. The characteristics of transrectal multimodal ultrasound in the two groups were compared. Combined with PSA, logistic regression analysis was applied to screen the statistically significant features, and then the diagnosis model was established, and odds ratio of the variables were compared. The receiver operating characteristic (ROC) curve was constructed to analyze the predicting ability of the diagnosis model.Results:Four features were obtained with logistic regression analysis finally, including enhancement type, enhancement degree, elastography mode and PSA. The odds ratio of enhancement degree was higher than those of the other independent variables. The area under ROC curve of the diagnosis model was 0.868 ( P<0.01), the cut-off value was 0.514. The sensitivity and specificity of the diagnosis model in predicting clinically organ-confined prostate cancer was 79.2% and 80.4%, respectively. Conclusions:This combined diagnosis model of transrectal multimodal ultrasound and PSA has a certain clinical value in predicting clinically organ-confined prostate cancer.
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Objective:To investigate the value of gray value (GV) measurement of subtraction images in contrast-enhanced spectral mammography (CESM) in the differential diagnosis of breast benign and malignant calcification.Methods:This was a retrospective study. A total of 95 patients received CESM only with mammographic calcifications without any associated mass or distortions from March 2017 to July 2021 in Peking University Cancer Hospital were enrolled. The patients were all female with an average age of 34-76(48±7) years. The craniocaudal (CC) projection of bilateral breasts was obtained prior to the mediolateral-oblique (MLO) projection. Two radiologists were asked to independently review the images to diagnose the calcification as either benign or malignant based on the presence of enhancement on subtracted imaging. GV of the calcification and background parenchyma including breast parenchyma tissue, the pectoralis major muscle and subcutaneous fatty tissue were measured by another two radiologists. The difference of lesion to background parenchyma GV (D GV) and lesion to background parenchyma gray value ratio (DR GV) were calculated. The consistency of observers was compared using the Kappa statistic. The stability of GV was evaluated with coefficient of variation. Differences of GV, D GV and DR GV between benign and malignant calcification were compared using t test or Mann-Whitney U test. Receiver operating characteristic (ROC) curves were used to analyze the efficacy of GV in differentiating benign from malignant calcification. Comparisons between diagnostic efficacies were performed using χ 2 tests. Results:Totally 97 calcification (35 malignant and 62 benign) from 95 patients were enrolled. The consistency and stability of GV values on MLO and CC projections measured by two physicians were high. The GV, D GV and DR GV of malignant calcification were significantly higher than those of the benign lesions ( P<0.05). The area under the ROC curve for the differential diagnosis of benign and malignant calcification by GV in the MLO and CC positions was 0.799 and 0.843, respectively. Threshold of calcified area GV=2015.5 in CC position, its diagnostic accuracy was 76.8%, which was similar to the subjective diagnosis of radiologists (82.1%, 78/95, P>0.05). Conclusion:Quantitative GV on subtracted imaging of CESM can differentiate benign from malignant breast calcification, especially on craniocaudal projection.
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Contexto: la lesión renal aguda inducida por contraste se ha convertido en un tema de gran interés en la comunidad médica a nivel mundial, siendo la tercera causa de lesión renal aguda adquirida en el hospital. Objetivo: el presente artículo presenta una revisión de la literatura con el fin de actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica y que es sometida a procedimientos con medios de contraste. Metodología: en esta revisión narrativa de la literatura, presentamos la definición, los factores de riesgo, el enfoque clínico y las medidas preventivas de la nefropatía inducida por contraste en pediatría. Resultados: se define que hay un deterioro en la función renal aguda después de la administración del medio de contraste en donde se excluyen otras posibles etiologías y se establece una verdadera relación causal con la sustancia. Los factores de riesgo son múltiples, sin embargo, factores estrictamente relacionados en los niños no han sido establecidos en su totalidad. El abordaje de los pacientes que van a ser sometidos a estudios con medios de contraste inicia desde una historia clínica, un examen físico y unas medidas de laboratorio que permiten evaluar el estado basal de cada paciente para instaurar medidas preventivas. Por su parte, las estrategias de prevención de esta condición son múltiples, sin embargo, no existen guías basadas en la evidencia acerca de esta condición en el paciente pediátrico. Conclusiones: el artículo presenta una revisión de la literatura sobre lesión renal aguda para actualizar los conceptos de esta patología en el personal de la salud que está en contacto con la población pediátrica que se somete a procedimientos con medios de contraste.
Context: Contrast-induced acute kidney injury has become a topic of great interest in the medical community worldwide, being the third cause of hospital-acquired acute kidney injury. Purpose: This article presents a review of the literature in order to update the concepts of this pathology in health personnel who are in contact with the pediatric population that undergoes procedures with contrast media. Methodology: In this narrative review of the literature, we present the definition, risk factors, clinical approach, and preventive measures of contrast-induced nephropathy in pediatrics. Results: It is defined as a deterioration in acute renal function after the administration of the contrast medium where other possible etiologies are excluded and a true causal relationship with the substance is established. The risk factors are multiple; nevertheless; Strictly related factors in children have not been fully established. The approach to patients who are going to undergo studies with contrast media begins with a clinical history, physical examination, and laboratory measurements that allow the baseline status of each patient to be evaluated in order to establish preventive measures. The prevention strategies of this condition are multiple; however, there are no evidence-based guidelines on this condition in pediatric patients. Conclusions: This article presents a review of the literature in order to update the concepts of acute kidney injury in health personnel who are in contact with the pediatric population that undergoes procedures with contrast media.
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Introducción: el uso de técnicas de imagenología es habitual e incluso indispensable en algunos procesos diagnósticos. Sin embargo, su indicación en mujeres embarazadas y en período de lactancia es controvertida. Objetivo: presentar una revisión narrativa sobre los riesgos asociados al uso de imágenes con radiación y medio de contraste en embarazo y periodo de lactancia, con énfasis en las recomendaciones y aplicaciones clínicas que el médico tratante debe tener presente al momento de su indicación. Métodos: se realizó una revisión bibliográfica de la literatura relevante sobre los riesgos y consideraciones especiales del uso de medios de contraste en el embarazo y lactancia. Resultados: los riesgos de la radiación ionizante sobre el feto varían de acuerdo al estadio del embarazo, por lo que la indicación del estudio debe ponderar los riesgos y beneficios. En las dosis clínicas en embarazo y lactancia, el uso de contraste yodado como basados en gadolinio no tienen efectos deletéreos en la salud de la madre ni la del feto. Sin embargo, las sociedades internacionales recomiendan limitar su uso. Conclusión: si bien la indicación de estudios de imagen que utilizan radiación ionizante en el embarazo y lactancia es seguro, el médico clínico debe conocer los posibles riesgos de la radiación ionizante en este grupo de pacientes. Respecto a los medios de contraste, el único efecto adverso reportado es la disfunción tiroidea transitoria en hijos de madres que recibieron medios de contraste yodado.
Introduction: the use of imaging techniques is essential in some diagnostic processes. However, its indication in pregnant and lac-tating women is controversial. Objective: To present a narrative review of the risks associated with using images with radiation and contrast media in pregnancy and lactation. Emphasis will be put on the recommendations and clinical applications that the physician must consider before its indication. Methods: a bibliographic review of the relevant literature on the risks and special considerations of contrast media in pregnancy and lactation was performed. Results: the risks of ionising radiation on the fetus vary according to the stage of pregnancy, so the indication of the study must balance the risks and benefits. The use of iodinated and gadolinium-based con-trast agents in clinical doses in pregnancy and lactation has no effects on the health of the mother or the fetus. However, international societies recommend limiting its use. Conclusion: Although the indication for imaging studies using ionising radiation in pregnancy and lactation is safe, the clinician must be aware of the possible risks of ionising radiation in this group of patients. The only adverse effect reported is transient thyroid dysfunction in children of mothers who received iodinated contrast media.
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Radiation , Breast Feeding , Pregnancy , Contrast Media , Radiation, Ionizing , Diagnosis , FetusABSTRACT
Resumo Objetivo: Mensurar os tempos de trânsito de contraste (TTCs) entre o sítio de injeção em veia antecubital e a veia cava superior, tronco arterial pulmonar e aorta ascendente em exames de tomografia computadorizada de artérias coronárias de pacientes sem história de doenças cardiovasculares ou pulmonares, definindo padrões de normalidade para esses tempos de circulação. Materiais e Métodos: Os TTCs entre o sítio de injeção e a veia cava superior, tronco arterial pulmonar e aorta ascendente foram medidos com base nas imagens de monitoração (bolus tracking). O débito cardíaco foi calculado com base nas imagens de angiotomografia computadorizada pelo método geométrico e correlacionado com os TTCs. Resultados: Foram analisados 43 pacientes. O TTC médio entre o tronco arterial pulmonar e a aorta ascendente foi de 7,2 s, entre a veia cava superior e o tronco arterial pulmonar foi de 3 s e entre a veia antecubital e a aorta ascendente foi de 13 s. Houve tendência a correlação entre o TTC e o débito cardíaco, com valor de p de 0,055. Conclusão: Os valores de normalidade do TTC entre a veia cava superior, tronco arterial pulmonar e aorta ascendente foram estabelecidos, servindo de base para avaliação clínica.
Abstract Objective: To measure the transit times (TTs) of contrast agents among the injection site (antecubital vein), superior vena cava, pulmonary trunk, and ascending aorta, in coronary computed tomography angiography (CTA) examinations of outpatients with no history of cardiovascular or lung disease, thus defining reference values for those TTs. Materials and Methods: The contrast TTs from the injection site (antecubital vein) to the superior vena cava, from the superior vena cava to the pulmonary trunk, and from the pulmonary trunk to the ascending aorta were measured by monitoring contrast enhancement in real time (bolus tracking). Cardiac output was measured by the geometric method during the CTA examination and was correlated with the contrast TT. Results: Forty-three individuals were analyzed. The mean contrast TT was 13.1 s overall (from the antecubital vein to the ascending aorta), 3.0 s from the superior vena cava to the pulmonary trunk, and 7.2 s from the pulmonary trunk to the ascending aorta. There was a tendency toward a correlation between contrast TT and cardiac output (p = 0.055). Conclusion: The reference values established here for contrast TTs among the superior vena cava, pulmonary trunk, and ascending aorta will serve as a basis for clinical evaluation.
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Resumo Fundamento Demonstrou-se recentemente que a aplicação de ultrassom de alta energia com microbolhas, técnica conhecida como sonotrombólise, causa a dissolução de trombos intravasculares e aumenta a taxa de recanalização angiográfica no infarto agudo do miocárdio com supradesnivelamento do segmento ST (IAM-CSST). Objetivo Avaliar o efeito da sonotrombólise nos índices de motilidade e perfusão miocárdicas em pacientes com IAM-CSST, utilizando a ecocardiografia com perfusão miocárdica em tempo real (EPMTR). Método Uma centena de pacientes com IAM-CSST foram randomizados em dois grupos: Terapia (50 pacientes tratados com sonotrombólise e angioplastia coronária primária) e Controle (50 pacientes tratados com angioplastia coronária primária). Os pacientes realizaram EPMTR para analisar a fração de ejeção do ventrículo esquerdo (FEVE), o índice de escore de motilidade segmentar (IEMS) e o número de segmentos com defeito de perfusão miocárdica, 72 horas após o IAM-CSST e com 6 meses de acompanhamento. Foi considerado significativo p < 0,05. Resultados Pacientes tratados com sonotrombólise apresentaram FEVE mais alta que o grupo Controle em 72 horas (50 ± 10% vs. 44 ± 10%; p = 0,006), e essa melhora foi mantida em seis meses (53 ± 10% vs. 48 ± 12%; p = 0,008). O IEMS foi similar nos grupos Terapia e Controle em 72 horas (1,62 ± 0,39 vs. 1,75 ± 0,40; p = 0,09), mas tornou-se menor no grupo Terapia em 6 meses (1,46 ± 0,36 vs. 1,64 ± 0,44; p = 0,02). O número de segmentos com defeito de perfusão não foi diferente entre os grupos em 72 horas (5,92 ± 3,47 vs. 6,94 ± 3,39; p = 0,15), mas ficou menor no grupo Terapia em 6 meses (4,64 ± 3,31 vs. 6,57 ± 4,29; p = 0,01). Conclusão A sonotrombólise em pacientes com IAM-CSST resulta na melhora dos índices de motilidade e perfusão ventricular ao longo do tempo.
Abstract Background It has recently been demonstrated that the application of high-energy ultrasound and microbubbles, in a technique known as sonothrombolysis, dissolves intravascular thrombi and increases the angiographic recanalization rate in patients with ST-segment-elevation myocardial infarction (STEMI). Objective To evaluate the effects of sonothrombolysis on left ventricular wall motion and myocardial perfusion in patients with STEMI, using real-time myocardial perfusion echocardiography (RTMPE). Methods One hundred patients with STEMI were randomized into the following 2 groups: therapy (50 patients treated with sonothrombolysis and primary coronary angioplasty) and control (50 patients treated with primary coronary angioplasty). The patients underwent RTMPE for analysis of left ventricular ejection fraction (LVEF), wall motion score index (WMSI), and number of segments with myocardial perfusion defects 72 hours after STEMI and at 6 months of follow-up. P < 0.05 was considered statistically significant. Results Patients treated with sonothrombolysis had higher LVEF than the control group at 72 hours (50% ± 10% versus 44% ± 10%; p = 0.006), and this difference was maintained at 6 months of follow-up (53% ± 10% versus 48% ± 12%; p = 0.008). The WMSI was similar in the therapy and control groups at 72 hours (1.62 ± 0.39 versus 1.75 ± 0.40; p = 0.09), but it was lower in the therapy group at 6 months (1.46 ± 0.36 versus 1.64 ± 0.44; p = 0.02). The number of segments with perfusion defects on RTMPE was similar in therapy and control group at 72 hours (5.92 ± 3.47 versus 6.94 ± 3.39; p = 0.15), but it was lower in the therapy group at 6 months (4.64 ± 3.31 versus 6.57 ± 4.29; p = 0.01). Conclusion Sonothrombolysis in patients with STEMI resulted in improved wall motion and ventricular perfusion scores over time.
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Objective:To explore the application value of dual contrast-enhanced ultrasound in the differential diagnosis of renal cystic lesions.Methods:Eighty-four cases with renal cysts who were diagnosed by routine ultrasound in Zhejiang Cancer Hospital and Zhejiang Xiaoshan Hospital from January 2019 to October 2020 were included in the study. Intravenous contrast-enhanced ultrasound and enhanced MRI were performed to differentiate benign and malignant cysts. Patients with benign cysts underuent intravenous pyelography and intracapsular contrast-enhanced ultrasound. Before sclerotheraphy to exclude renal pelvic cysts. The diagnostic results of dual radiography were compared with MRI and intravenous pyelography.Results:Among 84 patients with suspected renal cysts, the diagnostic accuracy of enhanced MRI for cystic renal cancer was 97.62%, and the sensitivity was 97.62%. The diagnostic accuracy of intravenous contrast-enhanced ultrasound was 98.81, the sensitivity was 100%, and the specificity was 98.73%. There was no statistically significant difference between the two groups (all P>0.05). 77 cases were diagnosed as benign renal cysts, the detection rate of intravenous pyelography was 9.1% (7/77), the detection rate of renal pelvic cysts by intracystic ultrasonography was 6.5% (5/77). With intravenous pyelography as the gold standard, the diagnostic accuracy of intracapsular contrast-enhanced ultrasound was 97.4% (75/77), the sensitivity was 71.4% (5/7), and the specificity was 100% (70/70). Conclusions:Compared with enhanced magnetic resonance and intravenous pyelography before renal cyst sclerosing therapy, there is no difference in diagnostic efficiency of double contrast ultrasound for benign and malignant cysts. The diagnostic efficiency of renal pelvic cysts is high, and the operation is convenient. It can identify cystic renal cancer and cysts from the renal pelvis and improve the safety of sclerotherapy.
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Objective:To investigate the application value of contrast-enhanced ultrasound (CEUS) before and after microwave ablation of thyroid nodules.Methods:Fifty-six patients (79 thyroid nodules) who received microwave ablation of thyroid nodules in Huaian Medical District, General Hospital of Eastern Theater Command from March 2016 to October 2019 were included in this study. CEUS was performed before microwave ablation to accurately assess the size, number and blood supply of thyroid nodules as well as the position of the feeding vessels. CEUS was performed immediately after microwave ablation to determine whether the lesion area was thoroughly ablated and to measure the volume of thyroid nodules. At 1, 3, 6 and 12 months after surgery, the level of thyroid hormone was measured and the absorption of thyroid nodules was evaluated.Results:Preoperative CEUS showed that among the 79 thyroid nodules, 42 were solid nodules that had different degrees of enhancement, including 33 annular homogeneously highly enhanced nodules and 9 heterogeneously highly enhanced nodules; 24 were cystic mixed solid nodules that had solid components, including 16 homogeneously highly enhanced nodules and 8 nodules with only local high enhancement in the solid component; 13 were cystic nodules, including 9 nodules with septa and 3 nodules with contrast medium on the diaphragm. Contrast medium was still visible around three nodules immediately after microwave ablation. Ablation continued in three nodules until there was no contrast medium. The incidence of complications during and after treatment was 0%. The average volume of the thyroid nodules before treatment was (7.52 ± 6.74) cm3. At 1, 3, 6 and 12 months after surgery, the average volume of the thyroid nodules was (6.06 ± 5.19) cm3, (3.06 ± 2.85) cm3, (1.32 ± 1.23) cm3 and (0.59 ± 0.52) cm 3, respectively. There was significant difference in volume of thyroid nodules between before and after microwave ablation ( F = 96.32, P < 0.001). Conclusion:Preoperative CEUS can determine the distribution of the blood supply of thyroid nodules and the course of the feeding vessels, identify the needle-entering position for microwave ablation and the primary ablation area, improve the accuracy of treatment, and reduce the occurrence of complications such as bleeding. Postoperative CEUS can determine whether lesion area is thoroughly ablated, reduce residual lesions and excessive ablation.
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Objective:To investigate the application value of contrast-enhanced ultrasound combined with serum CXC chemokine ligand 8 (CXCL8) and CXC chemokine receptor 2 (CXCR2) levels detection in the efficacy evaluation of patients with primary liver cancer after transcatheter arterial chemoembolization (TACE) .Methods:A total of 80 patients with primary liver cancer who were diagnosed and treated in Huanggang Central Hospital of Hubei Province from June 2019 to January 2022 were selected as the research objects. The therapeutic efficacy was evaluated 2 months after TACE treatment. According to the pathological diagnosis, the patients were divided into complete inactivation group ( n=30) and residual lesion group ( n=50) . The levels of serum CXCL8 and CXCR2 were measured by enzyme linked immunosorbent assay (ELISA) double antibody sandwich method, and contrast-enhanced ultrasonography was performed on the patients. Receiver operating characteristic (ROC) curve was applied to analyze the value of serum CXCL8 and CXCR2 in evaluating the efficacy of TACE in patients with primary liver cancer. Kappa test was applied to test the consistency of contrast-enhanced ultrasound and contrast-enhanced ultrasound combined with serum CXCL8 and CXCR2 in evaluating the efficacy of TACE in patients with primary liver cancer and the results of pathological diagnosis. Results:Compared with the complete inactivation group, the levels of serum CXCL8 [ (7.12±1.68) ng/ml vs. (5.07±1.25) ng/ml] and CXCR2 [ (3.62±0.79) ng/ml vs. (2.43±0.67) ng/ml] in the residual lesion group were obviously higher ( t=5.79, P<0.001; t=6.89, P<0.001) . The areas under the curve of CXCL8 and CXCR2 in evaluating the efficacy of TACE in patients with primary liver cancer were 0.827 and 0.801 respectively, the specificities were 73.3% and 76.7%, and the sensitivities were 70.0% and 72.0% respectively. The concordance between contrast-enhanced ultrasound and pathological diagnosis was moderate, and the Kappa value was 0.49 ( P<0.001) . The concordance between contrast-enhanced ultrasound combined with serum CXCL8 and CXCR2 and pathological diagnosis was high, and the Kappa value was 0.62 ( P<0.001) . The sensitivity of contrast-enhanced ultrasound combined with serum CXCL8 and CXCR2 in evaluating the efficacy of TACE in patients with primary liver cancer was 90.0%, which was higher than the sensitivity of contrast-enhanced ultrasound (72.0%, χ2=5.26, P=0.022) , CXCL8 (70.0%, χ2=6.25, P=0.012) and CXCR2 (72.0%, χ2=5.26, P=0.022) . Conclusion:Contrast-enhanced ultrasound can detect residual lesions after TACE in patients with primary liver cancer to a certain extent, and its combination with serum CXCL8 and CXCR2 can effectively improve the evaluation efficiency of the efficacy of TACE treatment in patients with primary liver cancer.
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Abstract We aimed to determine the effects of boric acid and quercetin on contrast media-induced nephropathy in rats. Thirty-two rats were divided into four equal groups with eight rats in each group: the control (C) group, contrast media (CM) group, contrast media plus boric acid (CMB) group, and contrast media plus quercetin (CMQ) group. Boric acid (H3(BO)3, 4% solution) at a dose of 200 mg/kg was administered by oral gavage to rats in the group CMB once daily for 4 consecutive days (days 1 to 4). Quercetin at a dose of 50 mg/kg was administered by oral gavage to rats in the CMQ group once daily for 4 consecutive days (days 1 to 4). A significant decrease was found in the serum urea and creatinine levels in the CMQ group compared with the CM group (P <0.01). The serum nitrite and nitrate levels were higher in the CM group than in the C group and were lower in the CMQ group than in the CM group (P <0.01). A significant decrease in the severity of tubular necrosis was found in the CMQ group compared to the CM group (P <0.05). Quercetin had protective effects against contrast nephropathy, but no beneficial effect of boric acid was found.
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ABSTRACT Objective: to discuss the social representations about peripheral venipuncture and the use of contrast media of people submitted to radiological examinations, referring to stressor concept. Method: this is qualitative research, outlined in the procedural approach of the Social Representation Theory, carried out with 57 users undergoing computed tomography and magnetic resonance imaging at a university hospital in Juiz de Fora, Minas Gerais, Brazil. In-depth individual interviews triggered by guiding questions were conducted in January 2019. The contents of the interviews were fully transcribed and content analysis was carried out in three stages (pre-analysis, material exploration and treatment/interpretation of results). We established thematic analysis based on the dimensions and representational origins, which made it possible to discuss the findings anchored in the concepts of stressors, allowing the identification of three categories based on intrapersonal, interpersonal and transpersonal stressors. Results: puncture and examination were represented by individual, group, professional and therapeutic environment experiences, classified into the following categories: itinerary and conceptions on puncture and contrasted examinations based on intrapersonal stressors; shared relationships on puncture and examination, based on interpersonal stressors; and experiences in the therapeutic environment of a diagnostic imaging service, based on transpersonal stressors. Conclusion: the social representations were signified by examination, results and impacts on life, portraying stressors based on images/feelings of doubt and positive behaviors rationally justified, which explain human responses to reified content, enabling the restructuring of health care and nursing.
RESUMEN Objetivo: discutir las representaciones sociales sobre la venopunción periférica y el uso de medios de contraste en personas sometidas a exámenes radiológicos, refiriéndose al concepto de estresores. Método: investigación cualitativa, enmarcada en el enfoque procedimental de la Teoría de las Representaciones Sociales, realizada con 57 usuarios sometidos a tomografía computarizada y resonancia magnética en un hospital universitario de Juiz de Fora, Minas Gerais, Brasil. Se realizaron entrevistas individuales en profundidad desencadenadas por preguntas orientadoras en enero de 2019. Los contenidos de las entrevistas se transcribieron íntegramente y se realizó un análisis de contenido en tres etapas (preanálisis, exploración del material y tratamiento/interpretación de los resultados). El análisis de contenido temático-categoría establecido a partir de las dimensiones y orígenes representacionales permitió discutir los hallazgos anclados en los conceptos de estresores, permitiendo la identificación de tres categorías a partir de estresores intrapersonales, interpersonales y transpersonales. Resultados: la punción y el examen fueron representados por las experiencias individuales y grupales, con los profesionales y el ambiente terapéutico, clasificados en las categorías: itinerario y concepciones sobre punción y exámenes contrastados, a partir de estresores intrapersonales; relaciones compartidas sobre punción y examen, basadas en estresores interpersonales; y experiencias en el ambiente terapéutico de un servicio de diagnóstico por imagen, basado en estresores transpersonales. Conclusión: las representaciones sociales fueron significadas por el examen, los resultados y los impactos en la vida, retratando estresores a partir de imágenes/sentimientos de duda y comportamientos positivos justificados racionalmente, que explican las respuestas humanas a los contenidos cosificados, posibilitando la reestructuración de los cuidados de salud y enfermería.
RESUMO Objetivo: discutir as representações sociais sobre a punção venosa periférica e o uso de meios de contraste de pessoas submetidas a exames radiológicos, referenciando-se no conceito de estressores. Método: pesquisa qualitativa, delineada na abordagem processual da Teoria das Representações Sociais, realizada com 57 usuários submetidos a exames de Tomografia Computadorizada e Ressonância Magnética em um Hospital Universitário de Juiz de Fora, Minas Gerais, Brasil. Realizaram-se entrevistas individuais em profundidade desencadeadas por questões norteadoras em janeiro de 2019. Os conteúdos das entrevistas foram transcritos na íntegra e realizou-se análise de conteúdo em três etapas (pré-análise, exploração do material e tratamento/interpretação dos resultados). A análise temático-categorial estabelecida a partir das dimensões e origens representacionais possibilitou a discussão dos achados ancorada nos conceitos de estressores, permitindo a identificação de três categorias baseadas nos estressores intrapessoais, interpessoais e transpessoais. Resultados: a punção e o exame foram representados pelas vivências individuais, grupais, com profissionais e ambiente terapêutico, classificados nas categorias: itinerário e concepções sobre punção e exames contrastados, com base em estressores intrapessoais; relações compartilhadas sobre a punção e o exame, fundamentadas em estressores interpessoais e vivências no ambiente terapêutico de um serviço de diagnóstico por imagem, a partir dos estressores transpessoais. Conclusão: as representações sociais foram significadas por exame, resultado e impactos na vida, retratando estressores alicerçados em imagens/sentimentos de dúvida e comportamentos positivos justificados racionalmente, que explicitam respostas humanas a conteúdos reificados, possibilitando a reestruturação do cuidado em saúde e em enfermagem.
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ABSTRACT Objective: To analyze the incidence, risk factors, and associations of clinical outcomes for contrast-induced acute kidney injury (CI-AKI) in patients with acute coronary syndrome (ACS) after coronary angioplasty. Method: Prospective cohort of 182 patients followed for three months after undergoing angioplasty, from July 2020 to June 2021. The analyzed variables were sociodemographic, clinical, and those related to the procedure. Results: The incidence of CI-AKI was 35.7% (n = 65) and was associated with old age, diabetes mellitus, and chronic kidney disease (p = 0.004, p < 0.001, and p = 0.009, respectively). Out of the 17 patients who died within 90 days, 76.5% had CI-AKI (n = 13), the odds ratio between death and CI-AKI was approximately 7.2 times (95% confidence interval (CI), [2.41;26.36]; p = 0.001). The decrease of one unit in the patient's baseline hemoglobin showed a 6.5% increase for CI-AKI (95% CI, [−0.089; −0.040]; p < 0.0001). Conclusion: CI-AKI is prevalent in patients with ACS after angioplasty and is related to diabetes mellitus and chronic kidney disease, showing high mortality rates.
RESUMEN Objetivo: Analizar la incidencia, los factores de riesgo y las asociaciones de resultados clínicos para Lesión Renal Aguda Inducida por Contraste (LRA-IC) en pacientes con Síndrome Coronario Agudo (SCA) después de angioplastia coronaria. Método: Cohorte prospectiva de 182 pacientes monitorizados durante tres meses tras realizada la angioplastia, en el periodo entre julio de 2020 y junio de 2021. Se evaluaron las variables sociodemográficas, clínicas y relacionadas con el procedimiento. Resultados: La incidencia de LRA-IC fue del 35,7% (n = 65) y se asoció con la edad avanzada, la diabetes mellitus y la enfermedad renal crónica (p = 0,004, p < 0,001 y p = 0,009, respectivamente). De los 17 pacientes que fallecieron dentro de los 90 días, el 76,5% tenía LRA-IC (n = 13), la razón de probabilidad entre muerte y LRA-IC fue aproximadamente 7,2 veces (intervalo de confianza, IC del 95%, [2,41;26,36]; p = 0,001). La disminución de una unidad en la hemoglobina basal del paciente demostró un aumento del 6,5% para LRA-IC (IC del 95%, [-0,089; -0,040]; p < 0,0001). Conclusión: En los pacientes con SCA después de angioplastia, la LRA-IC tiene una alta incidencia y está relacionada con la diabetes mellitus y la enfermedad renal crónica, presentando altas tasas de mortalidad.
RESUMO Objetivo: Analisar a incidência, os fatores de risco e as associações dos desfechos clínicos para Lesão Renal Aguda Induzida Por Contraste (LRA-IC) em pacientes com Síndrome Coronariana Aguda (SCA) após angioplastia coronariana. Método: Coorte prospectivo de 182 pacientes seguidos por três meses após angioplastia, entre julho de 2020 e junho de 2021. As variáveis foram sociodemográficas, clínicas e relacionadas ao procedimento. Resultados: A incidência de LRA-IC foi de 35,7% (n = 65) e esteve associada à idade avançada, diabetes mellitus e doença renal crônica (respectivamente p = 0,004, p < 0,001 e p = 0,009). Dos 17 pacientes que faleceram em até 90 dias, 76,5% tiveram LRA-IC (n = 13), a razão de chances entre óbito e LRA-IC foi de aproximadamente 7,2 vezes (intervalo de confiança (IC) 95%, [2,41;26,36]; p = 0.001). A diminuição de uma unidade na hemoglobina basal do paciente demonstrou um aumento de 6,5% para LRA-IC (IC 95%, [-0,089; -0,040]; p < 0,0001). Conclusão: Em pacientes com SCA após angioplastia, a LRA-IC tem alta incidência e está relacionada com diabetes mellitus e doença renal crônica, apresentando altos índices de mortalidade.