ABSTRACT
OBJECTIVE: To document the prevalence and pattern of risk factors for contrast-induced nephrotoxicity (CIN) in an outpatient population referred for contrast-enhanced computed tomography (CT) (CECT) studies. METHODS: Over a 4-month period, 3261 patients presenting for CT studies were asked to consent to a survey of CIN risk factors. Among these patients, 957 were outpatients who received contrast material before the CT study. Demographic information and available serum creatinine (SCr) data for these patients were extracted from medical records and then analysed. A telephone questionnaire to document risk factors was administered to 200 of these patients, who were outpatients not referred from the emergency department or on dialysis. RESULTS: Among the 200 surveyed patients, 69% reported risk factors for CIN or for kidney function impairment (low estimated glomerular filtration rate [eGFR]) at baseline. Among these patients, 43% reported multiple (2 or more) risk factors. Patients older than the mean age of 53 years had a higher incidence of having multiple risk factors when compared with those younger than this age. Patients with kidney function impairment at baseline had a higher incidence of having multiple risk factors when compared with those with normal kidney function. Among the patients with no SCr investigation in the 3 months preceding a CECT, 64% had multiple risk factors. In the study population of 957 outpatients undergoing CECT, 52% had SCr measurements within 3 months before the study. An eGFR of less than 60 mL/min/1.73 m(2) was found in 17% of the study population, and, in 0.6%, the eGFR was less than 30 mL/min/1.73 m(2). CONCLUSION: In an ambulatory outpatient population, many patients presenting for outpatient CECT studies will have risk factors for CIN or for kidney function impairment (low eGFR) at baseline. Kidney function assessment, therefore, is indicated in this patient population before CECT.
Subject(s)
Contrast Media/adverse effects , Kidney Diseases/chemically induced , Tomography, X-Ray Computed , Aged , Creatinine/blood , Female , Glomerular Filtration Rate/physiology , Humans , Kidney Diseases/physiopathology , Kidney Function Tests , Male , Middle Aged , Outpatients , Prevalence , Risk Assessment , Risk Factors , Surveys and QuestionnairesABSTRACT
A patient with spontaneous intracranial hypotension due to a spinal cerebrospinal fluid (CSF) leak required localization of the leakage site prior to surgical management. Conventional, computed tomography and prone digital subtraction myelography failed to localize the dural tear, which was postulated to be dorsally located. We present here a digital subtraction myelographic approach to accurately localize a dorsal site of CSF leakage by injecting iodinated contrast via a lumbar drain with the patient in the supine position.
Subject(s)
Angiography, Digital Subtraction/methods , Cerebrospinal Fluid Rhinorrhea/diagnostic imaging , Cerebrospinal Fluid Rhinorrhea/etiology , Intracranial Hypotension/complications , Intracranial Hypotension/diagnostic imaging , Myelography/methods , Patient Positioning/methods , Adult , Cerebrospinal Fluid Leak , Diagnosis, Differential , Humans , Male , Radiographic Image Enhancement/methodsABSTRACT
Mechanical low back pain is a common indication for Nuclear Medicine imaging. Whole-body bone scan is a very sensitive but poorly specific study for the detection of metabolic bone abnormalities. The accurate localisation of metabolically active bone disease is often difficult in 2D imaging but single photon emission computed tomography/computed tomography (SPECT/CT) allows accurate diagnosis and anatomic localisation of osteoblastic and osteolytic lesions in 3D imaging. We present a clinical case of a patient referred for evaluation of chronic lower back pain with no history of trauma, spinal surgery, or cancer. Planar whole-body scan showed heterogeneous tracer uptake in the lumbar spine with intense localisation to the right lateral aspect of L3. Integrated SPECT/CT of the lumbar spine detected active bone metabolism in the right L3/L4 facet joint in the presence of minimal signs of degenerative osteoarthrosis on CT images, while a segment demonstrating more gross degenerative changes was more quiescent with only mild tracer uptake. The usefulness of integrated SPECT/CT for anatomical and functional assessment of back pain opens promising opportunities both for multi-disciplinary clinical assessment and treatment for manual therapists and for research into the effectiveness of manual therapies.
