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OBJECTIVE：To investiga te main risk factors for adverse drug reactions （ADR）of skin by intravenous injection of iodine contrast agent. METHODS ：From Jan. 2009 to Apr. 2020，the patients suffering from skin ADR after enhanced CT with iodine contrast agent were collected from our hospital. The basic information ，laboratory test results before using iodine contrast agent and ADR related information were collected through hospital information system （HIS）. The use of iodine contrast agent ，main manifestations of skin ADR and drug combination were analyzed statistically. Taking the sex ，age，body mass index （BMI），the dosage of iodine contrast agent ，length of stay ，laboratory examination ，tumor history ，basic disease ，allergy history ，drinking history as independent variables ，the incidence of skin ADR related to iodine contrast agent was analyzed by single factor analysis ，and the variables with statistically significant were selected for multivariate Logistic stepwise regression analysis. RESULTS ：There were 157 cases of skin ADR ，involving 79 males（50.3％）and 78 females（49.7％）. The age ranged from 19 to 86 years old ，being（52.68± 18.73）years old in average. BMI was 14.6-40.7 kg/m2，being（22.5±3.7） kg/m2. 67 cases（42.68％）were treated with iprodione ，34 cases（21.66％）with iodixanol ，31 cases（19.74％）with iohexol and 25 cases（15.92％）with iopamidol ；the dose of iodine contrast agent were 50-100 mL，being（73.06±13.29）mL in average. There was no significant difference among different dosage of 4 kinds of iodine contrast agents （P≤0.05）. Among 4 kinds of iodine contrast agents ，the incidence of skin ADR induced by iopromide was the highest（0.197％）. The skin ADR related to iodine contrast agent was mainly acute （89.2％），the severity was mild （75.2％），and urticaria（38.9％）was the most common. After symptomatic treatment ，135 cases were cured ，13 cases were improved and 9 cases were not improved. Among the patients with iodine contrast agent related skin ADR ，the incidence of ADR induced by combined use of anti infective drugs was the highest （33.1％）；however，the combined use of anti-tumor drugs was the main cause of severe skin ADR. The length of stay ｛11～20 d[OR＝1.21，95％CI（1.07，1.20），P＝0.042]、21～30 d[OR＝1.39，95％CI（1.12，1.52），P＝0.035]、31～40 d[OR＝1.15，95％CI（1.03，1.37），P＝0.008]、＞40 d[OR＝1.33，95％CI（1.28，1.53），P＝0.003]｝，respitatory and circulatory system tumor history[OR ＝1.51，95％CI（1.35，1.61），P＝0.037]，injection allergy history[OR ＝1.50，95％CI（1.37，1.59），P＝0.005] can significantly increase the incidence of iodine contrast agent related skin ADR. CONCLUSIONS ：The main manifestation of skin ADR related to iodine contrast agent was urticaria. The main risk factors of skin ADR related to iodine contrast agent were length of stay （＞ 10 d），respiratory and circulatory system tumor history and injection allergy history.
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Objective To investigate the feasibility of using a specific iodine delivery rate in coronary computed tomography angiography(CCTA) to obtain high and uniform image quality in patients with different body weight, according to the latest guideline of contrast medium injection protocol. Methods A total of 159 consecutive patients who had undergone CCTA for ruling out coronary heart disease were prospectively enrolled and divided into five subgroups according to body weight: ≤60, 60-70, 70-80, 80-90,>90 kg, the former three subgroups were scanned using 100 kV tube voltage, the latter two subgroups were scanned using 120 kV tube voltage. All patients were injected with the contrast agent of which concentration was 370 mgI/ml, using a specific iodine delivery rate (1.0, 1.2, 1.4, 2.0 and 2.2 mgI/s, respectively). The Shapiro?Wilk test was performed to assess the normality of data distribution, including the CT attenuations in the aortic root, proximal left anterior descending artery, the distal segments of the right coronary artery, signal?to?noise ratio (SNR), contrast?to?noise ratio (CNR) and subjective image quality scores. Parameters accorded with normal distribution were compared by analysis of variance (ANOVA). Results There were no statistical differences in the CT attenuations (HU) of the aortic root (368.7±32.4, 356.7±30.8, 366.0±34.6, 360.7±25.0, 352.3±28.4, respectively, F=1.541, P=0.19); This was also true for the proximal segments of the left anterior descending arteries and the distal segments of right coronary arteries (all P>0.05). Also, there were no statistical differences of SD, CNR and SNR in neither the proximal part of the left anterior descending coronary arteries nor the distal right coronary arteries in these five groups (all P>0.05); There were no statistical differences in subjective scores of each group (3.91±0.23, 3.83±0.30, 3.94± 0.21, 3.90±0.27, 3.95±0.20, respectively, F=1.202, P=0.36). Conclusion For patients undergoing CCTA with different body weights, using guideline introduced iodine delivery rate injection protocol of contrast medium could achieve consistent vascular enhancement with satisfied image quality. This protocol is promising to make personalized and standardized CCTA possibly.
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Objective To investigate the feasibility of using optimized protocol of iodine contrast agent with fixed injection time in triple-rule-out CT examination of acute chest pain patients. Methods A prospective study was conducted. The patients who underwent triple-rule-out CT examination of acute chest pain at the Second Hospital of Shanxi Medical University from September 2017 to June 2018 were enrolled. According to the patient's body mass index (BMI), they were divided into BMI ≤ 23 kg/m2 group and BMI > 23 kg/m2 group. The patients in each group were subdivided into two subgroups according to the random number table, and they were given two iodine contrast injection protocols with fixed injection time (14 s). Protocol 1 was performed with 55 mL of total iodinated contrast media: iodinated contrast media was first injected at 5.0 mL/s for 8 s, followed by the same contrast media injection at 2.5 mL/s for 6 s, finally followed by injection of 40 mL of saline at a rate of 2.5 mL/s. Protocol 2 with 60 mL of total iodinated contrast media: iodinated contrast media was first injected at 5.0 mL/s for 10 s, followed by the same contrast media injection at 2.5 mL/s for 4 s, finally followed by injection of 40 mL of saline at a rate of 2.5 mL/s. The primary and objective evaluation was conducted on the image quality of the patients' blood vessels in different segments. The primary score, CT value and contrast-to-noise ratio (CNR) of the pulmonary artery, coronary artery, aorta and total effective radiation dose for the examination were recorded. Results A total of 92 patients were enrolled in the analysis. There were 44 patients in BMI≤ 23 kg/m2 group, in which 22 patients received in protocol 1 and protocol 2, 48 patients in BMI > 23 kg/m2 group, in which 24 patients in protocol 1 and protocol 2, respectively. There was no significant difference in the effective radiation dose between the two subgroups receiving different injection protocols in different BMI groups (mSv: 6.7±1.1 vs. 6.5±0.8 between protocol 1 and protocol 2 in BMI ≤ 23 kg/m2 group; 7.8±1.0 vs. 8.0±1.1 between protocol 1 and protocol 2 in BMI > 23 kg/m2 group, both P > 0.05). In BMI ≤ 23 kg/m2 group, the CT value, CNR and primary scores of pulmonary artery images in patients receiving protocol 2 were significantly higher than those receiving protocol 1 [CT value (HU): 584±110 vs. 472±86 for main pulmonary artery, 561±93 vs. 467±78 for left pulmonary artery, 555±91 vs. 472±83 for right pulmonary artery; CNR: 24.2±7.5 vs. 18.7±4.6 for main pulmonary artery, 23.2±6.8 vs. 18.6±4.8 for left pulmonary artery, 22.9±6.7 vs. 18.8±4.7 for right pulmonary artery; primary score:4.0 (4.0, 4.0) vs. 3.5 (3.0, 4.0), all P < 0.05]; and there was no statistically significant difference in the primary or objective evaluation of coronary artery or aortic image quality between the two protocols. In BMI > 23 kg/m2 group, the CT value, CNR and primary scores of coronary artery and aortic images in patients receiving protocol 2 were significantly higher than those receiving protocol 1 [CT value (HU): 369±63 vs. 315±61 for proximal right coronary artery (RCA), 388±63 vs. 323±63 for proximal left coronary artery (LCA), 328±83 vs. 272±51 for ascending aorta, 348±82 vs. 272±49 for aortic arch; CNR: 15.0±4.6 vs. 12.3±4.7 for proximal RCA, 15.7±3.8 vs. 12.8±5.2 for proximal LCA, 13.2±5.3 vs. 10.4±4.1 for ascending aorta, 14.1±5.3 vs. 10.4±3.9 for aortic arch; primary score: 4.0 (3.0, 4.0) vs. 3.0 (3.0, 4.0) for coronary, 4.0 (3.0, 4.0) vs. 3.0 (2.0, 4.0) for aorta; all P < 0.05]; and there was no statistically significant difference in the primary or objective evaluation of pulmonary artery image quality between the two protocols. Conclusions The effective radiation dose of triple-rule-out CT examination of acute chest pain is relatively low. The low-dose iodine contrast agent application program with fixed injection time can meet the needs of clinical diagnosis of triple-rule-out CT examination of acute chest pain patients. For patients with BMI ≤ 23 kg/m2, both protocols 1 and 2 can obtain excellent image quality; in order to avoid the influence of superior vena cava artifacts, protocol 1 is recommended. For patients with BMI > 23 kg/m2, application protocol 2 can obtain stable, excellent image quality that is more suitable for clinical applications.
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Objective To evaluate the effect of iodine contrast agent on the biological responses of CT examination. Methods A total of sixty patients with suspected urinary tract disease who underwent computed tomography urography ( CTU ) examination were randomly divided into control group and experimental group. The control group was treated with routine CTU, where only CT scan was performed on the first day. CTU was added after 3 days. The test group was treated with fractional injection CTU and injected with enhanced scanning agent on the first day. Before and after CT examination, the patients′peripheral blood was collected and the number of γ-H2AX foci in lymphocytes ( mononuclear cells) was measured by immunofluorescence, and the differences of DNA damage in these two groups were observed. Results Before and after CT examination, the number ofγ-H2AX foci was 0. 06 ± 0. 02 and 1. 06 ± 0. 27 in the lymphocytes of control group,0. 06 ± 0. 03 and 1. 42 ± 0. 50 in the test group, respectively. Hence, the number ofγ-H2AX foci in the test group was increased by 38. 14%. Moreover, the change ofγ-H2AX foci in these two groups was not influenced by gender, but correlated with ages( between≤50 years old and>50 years old) in control group (t= -4. 76, P<0. 05) and in test group(t= -8. 16, P <0. 05). Conclusions The iodine contrast agent can increase DNA damage of CT examination, and therefore the use of iodine contrast agent in CT should be reduced as much as possible in clinical work.
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Objective To explore the related factors of contrast agent leakage in CT enhanced scanning and to find out its preventive measures.Methods The clinical data of 46 patients with iodine leakage in the CT enhanced scanning during 2015 were retrospectively analyzed.Results The leakage rate had statistically significant difference between different patient's genders(P＜0.05).The leakage rate was related to the age of the patients(P＜0.01).The leakage rate showed the increasing trend with the increase of injection rate(P＜0.05).The leakage rate was related to the concentration of the contrast agent(P＜0.05).The leakage rate had no increasing trend with the increase of injection dose(P=0.675).The leakage rate was related to the years of injection nurses engaging this working(P＜0.01).Conclusion The leakage rate of female patients was higher than that of male.The older the patients,the greater the contrast agent concentration,the faster the injection rate and the lower the working years of injection nurses,the greater the leakage rate.
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Objective To explore the related factors of contrast agent leakage in CT enhanced scanning and to find out its preventive measures.Methods The clinical data of 46 patients with iodine leakage in the CT enhanced scanning during 2015 were retrospectively analyzed.Results The leakage rate had statistically significant difference between different patient's genders(P＜0.05).The leakage rate was related to the age of the patients(P＜0.01).The leakage rate showed the increasing trend with the increase of injection rate(P＜0.05).The leakage rate was related to the concentration of the contrast agent(P＜0.05).The leakage rate had no increasing trend with the increase of injection dose(P=0.675).The leakage rate was related to the years of injection nurses engaging this working(P＜0.01).Conclusion The leakage rate of female patients was higher than that of male.The older the patients,the greater the contrast agent concentration,the faster the injection rate and the lower the working years of injection nurses,the greater the leakage rate.
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Objective Through analyzing the causes of iodine contrast agent extravasation,nursing managers develop effective solutions timely and take appropriate precautionary measures to ensure the safety of patients effectively.Methods 600 patients undergoing CT contrast enhanced scan were selected,300 patients from May 2009 to April 2010 were set as the control group and were given routine nursing care,300 patients from May 2010 to April 2011 were set as the study group and they adopted effective preventive measures.The incidence of adverse events after injection of iodine contrast agent between the two groups was compared.Results The incidence of iodine contrast medium extravasation in the study group was significantly reduced to 2％ after taking a series of preventive measures,which was lower than 10％ of the control group.Conclusions Taking a series of preventive measures can reduce the incidence of adverse events of iodine contrast agent extravasation,ensure the safety of patients,decrease the frequency of nursing complaints and nursing deficiencies,as well as improve the quality of nursing service.
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Objective: To discuss the imaging features of esophageal fistula and the value of intervention.Methods: We retrospectively analyzed the complete clinical data of 12 cases of esophageal fistula treated from June 2000 to May 2008,of whom,2 developed esophago-thoracis fistula and esophago-mediastinum fistula respectively after conservative radiotherapy,and 10 developed esophageal fistula after surgery for esophageal cancer.All the patients received iodine-based oral contrast,spiral CT scanning and intraperitoneal stent implantation for fistula closure.Results: Iodine-based oral contrast showed that the contrast agent overflowed into the chest in 8 cases,into the airway in 3 and into the mediastinum in 1.Spiral CT scanning revealed 8 cases of pleural fistula and 2 cases of remnant stomach-airway fistula,but failed to display the other 2 because of the small size.Intraperitoneal stent implantation was successfully accomplished in all the cases,which helped to close the fistula,take in food,stop bucking,control lung,mediastinum and other infections,and improve the patients' quality of life.Conclusion: Esophageal fistula can be effectively diagnosed based on the findings of iodine-based oral contrast and spiral CT scanning.As a novel technique,intraperitoneal stent implantation for fistula closure,simple,safe and with obvious immediate effect,is well worth promoting.