Incidence of contrast-associated acute kidney injury: a prospective cohort / Incidência de lesão renal aguda associada ao contraste: uma coorte prospectiva

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.

Radiomics models based on gadolinium-ethoxybenzyl-diethylenetriamine pentaacetic acid enhanced hepatobiliary phase MRI for assessing clinical pathological stage of hepatic fibrosis / 中国介入影像与治疗学

Objective To observe the value of radiomics models based on gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid(Gd-EOB-DTPA)enhanced hepatobiliary phase(HBP)MRI for assessing clinical pathological stage of hepatic fibrosis(HF).Methods Data of 240 patients with pathologically/clinically diagnosed and clinical pathological staged HF who underwent Gd-EOB-DTPA enhanced MR examination were retrospectively analyzed.The liver-to-muscle signal intensity ratio(SIR1)and liver-to-spleen signal intensity ratio(SIR2)were measured based on HBP images.Radiomics features of HBP images were extracted and screened to construct radiomics models.The signal intensity ratio(SIR)-radiomics combined models were constructed based on SIR and radiomics signatures.Receiver operating characteristic(ROC)curves were drawn to evaluate the efficacy of each model for assessing clinical pathological stage of HF.Results The area under the curve(AUC)of SIR1 and SIR2 models for assessing clinical pathological stage of HF were 0.63-0.70 and 0.65-0.71,respectively.The most effective radiomics model for assessing HF,significant HF,advanced HF and early cirrhosis was support vector machine(SVM),SVM,light gradient boosting machine and K-nearest neighbor model,respectively,with the AUC in validation set of 0.87,0.82,0.81 and 0.80,respectively,while the AUC of SIR-radiomics combined models in validation set of 0.88,0.82,0.82 and 0.81,respectively.Conclusion The radiomics models based on Gd-EOB-DTPA enhanced HBP MRI were helpful for assessing clinical pathological stage of HF.Combining with HBP SIR could improve their efficacy.

Application progresses of ultrasound contrast agent Sonazoid in liver diseases / 中国介入影像与治疗学

With the rapid development of contrast-enhanced ultrasound(CEUS),Sonazoid,a new generation of ultrasound microbubbles contrast agent came into being.The unique Kupffer phase of Sonazoid could greatly prolong the intrahepatic developing time,hence providing more valuable information for diagnosis,treatment and follow-up of liver diseases.The progresses of Sonazoid applicated in liver diseases were reviewed in this article.

Expert consensus on contrast-induced encephalopathy in China 2023 / 中国脑血管病杂志

Contrast-induced encephalopathy(CIE)is a rare neurological complication of the intravascular application of a contrast media.The clinical manifestation of CIE which is easily misdiagnosed in clinical is not specific.Recently,with the extensive development of interventional diagnosis and therapy in different disciplines,case report of CIE patient is increasing yearly.At present,there is not a uniform diagnosis and treatment standard for CIE in China and abroad.Chinese Federation of Interventional Clinical Neurosciences organized relevant experts in China and developed the expert consensus,to provide suggestions and references for clinicians at all levels to prevent,identify and treat CIE.

Abdominal no Contrast and Contrast-Enhanced Multi-Slice CT After Orally Diluted Iodide in Diagnosis of Time Segment for Gastrointestinal Fistula Secondary to Acute Pancreatitis / 中国医学影像学杂志

Purpose To evaluate the diagnostic accuracy of abdominal plain scan and contrast-enhanced multi-slice CT after orally diluted iodide in time segment(Post-ODI ANCCE-MSCT)for gastrointestinal fistula(GIF)secondary to acute pancreatitis(AP).Materials and Methods A total of 108 patients with late AP in the prospective and continuously collected database of Hunan Provincial People's Hospital from January 2017 to December 2022 were retrospectively extracted.Their demographic information and clinical features were recorded and GIF were screened by Post-ODI ANCCE-MSCT.The comprehensive clinical diagnosis results within 5 days thereafter were used as reference standards.The sensitivity,specificity,positive predictive value,negative predictive value and accuracy of Post-ODI ANCCE-MSCT for diagnosing GIF secondary to AP were calculated using a four-cell table,and the consistency of the two methods was evaluated by Kappa test and McNemar's test.Results Sensitivity was 91.5%(95%CI 78.7%-97.2%),specificity was 98.4%(95%CI 90.0%-99.9%),positive predictive value was 97.7%(95%CI 86.5%-99.9%),negative predictive value was 93.8%(95%CI 84.0%-98.0%),and the accuracy was 95.4%(95%CI 91.4%-99.3%),respectively.The Kappa value was 0.905,and P value was 0.375 via McNemar's test.Conclusion Post-ODI ANCCE-MSCT can diagnose GIF secondary to AP in a simple,non-invasive,rapid and accurate way,and provide earlier,more accurate and reliable image basis for clinical diagnosis and treatment.

Contrast-Enhanced Ultrasound in Assessing the Blood Perfusion of Kidney in Type 2 Diabetic Nephropathy / 中国医学影像学杂志

Purpose To explore the clinical value of quantitative assessment of renal perfusion using ultrasound contrast imaging for the auxiliary diagnosis of type 2 diabetic nephropathy.Materials and Methods This prospective study was conducted from May 2017 to December 2019 at the First Medical Center of Chinese PLA General Hospital.A total of 41 patients with type 2 diabetes and renal function abnormalities,who were scheduled for renal biopsy,underwent contrast-enhanced ultrasound.Differences in contrast imaging parameters,including time to peak in the renal cortex,peak enhancement,mean transit time local,and area under the curve between diabetic nephropathy and focal segmental glomerulosclerosis were compared,and the correlation between imaging parameters and pathological results was analyzed.Results Among 41 patients,30 cases were diagnosed as diabetic nephropathy,and 11 cases were diagnosed as focal segmental glomerulosclerosis.The peak enhancement and area under the curve in the diabetic nephropathy group were significantly lower than those in the focal segmental glomerulosclerosis group[peak enhancement:3 837.16(2 449.16,5 929.16)vs.8 508.00(4 334.88,21 201.00),Z=-2.766,P=0.006;area under the curve:0.14±0.05 vs.0.19±0.05,t=-3.135,P=0.003].In the diabetic nephropathy group,peak enhancement showed a negative correlation with the global glomerulosclerosis rate(r=-0.489,P=0.006).Conclusion Contrast-enhanced ultrasound can quantitatively evaluate renal perfusion and has certain clinical value in assisting the diagnosis of type 2 diabetic nephropathy.

Clinical study of ulinastatin in prevention and treatment of CIAKI in elderly coronary heart disease patients with CKD / 中华老年心脑血管病杂志

Objective To investigate the protective and treatment role of ulinastatin(UTI)on con-trast-induced acute kidney injury(CIAKI)in the elderly with coronary heart disease(CHD)and chronic kidney diseases(CKD).Methods A total of 321 elderly CHD inpatients complicated with CKD undergoing coronary angiography admitted in the First Medical Center of Chinese PLA Gen-eral Hospital from November 2021 to November 2022 were enrolled consecutively and then divid-ed into UTI group(n=161)and hydration group(n=160).Their cardiac and renal function pa-rameters were collected and analyzed before and 2 d after intervention.The changes in above pa-rameters and incidence of CIAK were observed and compared between the two groups.Results In 2 d after intervention,the UTI group had significantly lower Scr,urea,CysC,homocysteine and NT-proBNP,but higher eGFR than the hydration group(P＜0.01).There were 62 patients(62/321,19.3％)developing CIAKI,including 17 from the UTI group and 45 from the hydration group,and statistical difference was observed in the incidence(10.6％vs 28.1％,P＜0.01).For the patients with comorbidities of hypertension,diabetes,hyperlipidemia and hyperuricemia,the incidence of CIAKI was obviously lower in the UTI group than the hydration group(P＜0.01).Multivariate logistic regression analysis showed that UTI was an independent protective factor for occurrence of CIAKI(OR=0.348,95％CI:0.180-0.673,P=0.001).Conclusion UTI can im-prove renal function and reduce the risk of CIAKI in elderly CHD patients with CKD.

Relationship between intracranial high-density foci and progressive stroke in patients with acute ischemic stroke after intravascular intervention / 中华神经科杂志

Objective:To investigate the relationship between intracerebral high-density foci and progressive stroke (PS) morbidity by using dual-energy CT, which can quantify the intracerebral high-density foci of patients with acute ischemic stroke after endovascular treatment.Methods:Ninety-two patients with acute ischemic stroke who received interventional treatment in Gaozhou People′s Hospital from May 2019 to August 2020, and underwent dual-energy CT scan immediately after intervention, were analyzed. The patients were divided into PS group ( n=35) and non-PS group ( n=57) according to the National Institutes of Health Stroke Scale (NIHSS) score, and the patients whose NIHSS score increased≥4 points within 72 hours of stroke were included in the PS group, while the patients whose NIHSS score increased<4 points were included in the non-PS group. The clinical data, volume of high-density foci and CT values were compared between the 2 groups. Logistic regression analysis was used to adjust for confounding factors and screen for risk factors. The correlations of the admission NIHSS score, presence and volume of high-density lesions, maximum CT (CTmax) value and average CT (CTave) value with the onset of PS were analyzed, and the receiver operating characteristic curve was used to screen predictive indicators of PS. Results:In the PS group, the NIHSS score (18.80±8.50 vs 14.40±9.58, t=2.229, P=0.028), proportion of high-density foci [29/35(82.9%) vs 32/57 (56.1%), χ 2=6.928, P=0.008], high-density focal volume [13.23 (39.33) cm 3vs 0.76 (9.82) cm 3, U=1 440.000, P<0.001], CTmax value [80.00 (92.00) HU vs 65.00 (87.50) HU, U=1 337.000, P=0.005] and CTave value [53.48 (23.79) HU vs 45.94 (55.11) HU, U=1 345.000, P=0.004] were higher than those in the non-PS group. The NIHSS score ( OR=1.054, 95% CI 1.004-1.106, P=0.033; rs=0.255, 95% CI 0.051-0.447, P=0.014), presence of high-density foci ( OR=3.776, 95% CI 1.358-10.503, P=0.011; rs=0.274, 95% CI 0.093-0.460, P=0.008), high-density focal volume ( OR=1.026, 95% CI 1.003-1.049, P=0.027; rs=0.381, 95% CI 0.183-0.560, P<0.001), CTmax value ( OR=1.006, 95% CI 1.001-1.011, P=0.014; rs=0.292, 95% CI 0.088-0.475, P=0.005) and CTave value ( OR=1.021, 95% CI 1.007-1.035, P=0.004; rs=0.299, 95% CI 0.092-0.484, P=0.004) were all risk factors affecting PS morbidity and were positively correlated with PS morbidity. The area under the receiver operating characteristic curve of NIHSS score, high-density lesion volume, CTmax value, and CTave value to predict the onset of PS was 0.652, 0.722, 0.670 and 0.674, respectively. The volume of high-density lesions had moderate predictive value for the onset of PS. Conclusions:For AIS patients, CT examination should be performed immediately after interventional operation. The volume, CTmax value and CTave value of high-density lesions newly appeared in the ischemic area are positively correlated with the onset of PS. Quantifying the volume of high-density lesions can help to predict the onset of PS.

Current Status and Issues of Countermeasures against Immediate Allergy Caused by Contrast Media in Hospitals: / 医薬品情報学

Objective: Contrast media side effects range from minor ones such as itching and vomiting to life-threatening ones such as hypotension and loss of consciousness. The purpose of this study was to determine how contrast media side effects are actually managed in hospitals nationwide, as well as to identify opportunities for the pharmacy department to be involved in contrast media administration, and pharmacists’ awareness of the risk of contrast media side effects. Methods: A self-administered, unmarked questionnaire survey was conducted in the pharmacy departments of 2,000 hospitals nationwide. The survey asked about the existence of internal rules and manuals regarding contrast media at each facility, how to deal with patients at risk for side effects, opportunities for intervention with patients by the pharmacy department, and opportunities for discussion among pharmacists and other professionals regarding the administration of contrast media. Results: Of the 2,000 facilities, 96 responded to the questionnaire, among which 69 had internal regulations or manuals. In those with manuals, the manuals stipulated measures such as not administering contrast media or administering premedication in the case of patients with a history of contrast media side effects. In facilities where the manual recommended premedication, it was found that premedication was administered in both inpatient and outpatient settings. Regarding the role of the pharmacy department, it was found that intervention in all items related to risk factors for adverse drug reactions was achieved for only about 10% of the outpatients. Conclusion: This study revealed that many facilities are involved in the management of contrast media side effects. The results indicate that there is scope for pharmacy departments to intervene more proactively in outpatient settings to ensure appropriate contrast media use in the future.

Research progress in the prevention of contrast-related acute kidney injury / 天津医药

Contrast-associated acute kidney injury(CA-AKI)is an important complication caused by the use of contrast medium(CM)in diagnostic or interventional surgery.At present,it has become one of the major causes of acute renal insufficiency in hospitalized patients.Choosing a relatively low toxic CM and reducing the exposure time and dose of CM can prevent CA-AKI occurrence to some extent.Drugs such as statins and postoperative hydration can reduce the risk of CA-AKI.In addition,nanomedicine has shown a benefit in animal models.This paper reviews the current prevention and treatment of CA-AKI to lay the foundation for further study of new interventions and provide a theoretical basis for clinical treatment.

Effect of contrast medium on early detection and analysis of mediastinal lymph nodes in computed tomography

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.

Research Progress of Gd-EOB-DTPA Enhanced MRI in Evaluating Liver Function in Liver Cirrhosis / 中国医学影像学杂志

Liver function can reflect the severity of cirrhosis,and has important clinical value for disease monitoring,efficacy evaluation and surgical risk prediction.At present,the methods commonly used in clinical evaluation of liver function include blood biochemical examination,drug excretion test,comprehensive scoring system and routine imaging examination.All these methods have their limitations.Gd-EOB-DTPA is a hepatocellular specific contrast agent,which is taken up and excreted by liver cells and can directly reflect liver function.Therefore,it is expected to achieve non-invasive segental quantitative evaluation of liver function through enhanced MRI of Gd-EOB-DTPA,which is the focus of current research.In this paper,the methods of Gd-EOB-DTPA enhanced MRI for liver function assessment were reviewed,and the feasibility of Gd-EOB-DTPA in liver function assessment was discussed.

The clinical value of spectral CT combined with orthopedic metal artifact reduction technology in reducing artifacts from contrast media in enhanced chest CT of breast cancer patients / 中华放射学杂志

Objective:To access the efficacy of monoenergetic imaging from spectral CT combined with metal artifact reduction for orthopedic implants (O-MAR) on reducing contrast hardening artifacts in the vein on the injection side, and determining the optimal monoenergetic spectral range to improve the display of axillary lymph node.Methods:A total of 35 patients with breast cancer who underwent chest-enhanced CT scans were enrolled in this retrospective study. The original data were reconstructed to obtain a total of 35 sets of images, including one conventional image, 17 groups of monoenergetic images, and 17 groups of monoenergetic+O-MAR images. The areas of interest were delineated in the high and low-density artifact area on the injection side of the same layer contrast agent, and the contralateral ectopectoralis. The CT value and its standard deviation (SD) were recorded respectively, the artifact area was measured, and the number of axillary lymph nodes was recorded. The difference in CT values (ΔCT 1, ΔCT 2) and the artifact index (AI1 and AI 2) of the high and low-density artifact areas relative to the contralateral ectopectoralis in the same layer were calculated respectively. Friedman test and Wilcoxon signed-rank test were used to compare the differences of ΔCT, AI, artifact area, and number of lymph nodes among the three imaging modalities, and the Kappa test was used to compare the differences in subjective evaluation. Results:As the energy level increased, compared to the conventional image, monoenergetic image, ΔCT 1 absolute value, ΔCT 2 absolute value, AI 1, and AI 2 showed a trend of initially low and then high, artifact area decreased, and the number of detected lymph nodes increased ( P<0.01). Compared to other energy levels, when the monoenergetic image was 100 keV, ΔCT 1 value, 140 keV for ΔCT 2 value, 120 keV for AI 1 value, and 130 keV for AI 2 value were close to zero, and the number of detected lymph nodes was highest at 110-200 keV. In contrast, in the monoenergetic+O-MAR images, ΔCT 1 absolute value showed a trend of initially low and then high, but, ΔCT 2 absolute value, AI 1, AI 2, and artifact area all significantly decreased, whereas the number of detected lymph nodes significantly increased (χ 2 values were 916.23, 895.93, 387.08, 519.41, 890.10, and 1027.98, respectively. All P<0.01). Compared to other energy levels, when the monoenergetic+O-MAR image was at 100 keV, ΔCT 1 value was close to zero, while ΔCT 2 value became close to zero with increasing energy level, and the number of detected lymph nodes was highest at 110-200 keV. As the energy level increased, the ΔCT 1, AI 1, AI 2, and artifact area of monoenergetic+O-MAR images were significantly smaller than those of monoenergetic images at the same energy level, and the number of detected lymph nodes was significantly higher than that of monoenergetic images ( P<0.01). The subjective scores for 110-200 keV monoenergetic images and 100-200 keV monoenergetic+O-MAR images were both higher than 4, and the score for monoenergetic+O-MAR images was significantly higher than that of single-energy spectrum images. The agreement between the two radiologists in assessing subjective scores was good. Conclusion:At 100-120 keV level, spectral CT monoenergetic combined with O-MAR imaging technique has the best performance in removing hardening-induced artifacts of chest-enhanced CT contrast agent and detecting and displaying axillary lymph nodes.

Differential diagnosis of benign and malignant breast calcification by quantitative measurement of gray value on contrast-enhanced spectral mammography / 中华放射学杂志

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.

Value of transrectal multimodal ultrasound combined with prostate specific antigen in predicting clinically organ-confined prostate cancer / 中华健康管理学杂志

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.

The predictive value of renal artery resistance index combined with cystatin C in contrast-induced nephropathy after coronary artery CT angiography / 中国医师进修杂志

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.

Association between acute adverse reactions to iodinated contrast media and anxiety in patients undergoing contrast-enhanced CT examination / 中南大学学报(医学版)

OBJECTIVES@#As the use of iodinated contrast media has become more widely with advances in imaging, several guidelines have suggested that anxiety increases the risk of acute adverse reactions associated with iodinated contrast media. This study aims to evaluate the impact of anxiety on the occurrence of acute adverse reactions (AAR) to iodinated contrast media in patients undergoing contrast-enhanced CT examinations.@*METHODS@#Inpatients who underwent contrast-enhanced CT examinations at the Third Xiangya Hospital between February and October 2021 were prospectively recruited. Prior to the imaging examinations, all patients completed the Generalized Anxiety Disorder Scale-7 (GAD-7) assessment before the imaging examinations to determine the severity of anxiety, which was categorized as mild, moderate, or severe. Based on the occurrence of AAR, patients were classified into an AAR group and a non-AAR group. The difference in anxiety was compared between the 2 groups. Multivariate logistic regression analysis was used to identify independent risk factors associated with AAR. To ensure comparability between the 2 groups, propensity score matching (PSM) was utilized to align the clinical characteristics. Subsequently, the difference in anxiety within the matched groups was analyzed.@*RESULTS@#The study comprised 880 patients, with 80 patients in the AAR group and 800 patients in the non-AAR group. There was a significant difference in proportion of patients with mild-severe anxiety between the 2 groups (75% in the AAR group and 36% in the non-AAR group, P<0.001). Additionally, differences were also observed in occupation, income, underlying diseases, and allergy history (all P<0.001). The results of multivariate logistic regression analysis revealed that patients' income, allergy history, and anxiety were independent risk factors for AAR to iodinated contrast media (all P<0.05). Following PSM, each matched group included 66 cases, and no significant differences in clinical characteristics were observed between the 2 groups (all P>0.05). However, the proportion of patients with mild-severe anxiety remained significantly higher in the AAR group compared to the non-AAR group (75% in the AAR group and 31% in the non-AAR group, P<0.001).@*CONCLUSIONS@#Anxiety is associated with an increased risk of AAR to iodinated contrast media in patients undergoing contrast-enhanced CT examinations, suggesting the clinical importance of screening for anxiety before imaging examinations.

Management of Adverse Reactions to Contrast Media and the Involvement of the Pharmaceutical Department in Hospitals: a Questionnaire Survey / 医薬品情報学

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.

Research progress on desensitization of hypersensitivity reaction to iodinated contrast media / 浙江大学学报·医学版

Desensitization therapy for iodinated contrast media (ICM) aims to induce drug tolerance in patients with a history of severe allergic reactions to ICM in a short time. Currently, there is no widely accepted consensus on inducing desensitization to avoid severe allergic responses to ICM. The clinically successful cases have shown that prophylactic use of antihistamines and glucocorticoids can increase the desensitization effect; repeatedly desensitizing and gradually increasing the dose can be conducive to establishing better tolerance to ICM. Most desensitization effects, including stress resistance, can endure 24-48 h. The mechanisms of desensitization therapy remain unclear, the initial dose, administration interval and dose gradient are largely based on clinical experiences and the reaction of patients. This article reviews the current research progress on ICM-related allergies, desensitization methods and related mechanisms, as well as the benefits and hazards of desensitization, to provide a reference for desensitization treatment of hypersensitivity to ICM .

Ultrasmall, elementary and highly translational nanoparticle X-ray contrast media from amphiphilic iodinated statistical copolymers

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.