Management of metastatic colorectal cancer in patients ≥70 years - a single center experience.

Background: Age-standardized mortality rates for metastatic colorectal cancer (mCRC) are highest among elderly patients. In current clinical guidelines, treatment recommendations for this patient population are based on a limited number of clinical trials. Patients and methods: In this monocentric, retrospective analysis we characterized patients aged ≥70 years undergoing systemic therapy for mCRC and overall survival (OS) was investigated. Results: We included 117 unselected, consecutive mCRC patients aged ≥70 years undergoing systemic therapy for mCRC between February 2009 and July 2022. Median OS was 25.6 months (95% CI: 21.8-29.4). The median age was 78 years (range: 70-90) and 21%, 48%, 26% and 5% had an ECOG performance score of 0, 1, 2, and 3, respectively. The median number of systemic therapy lines was 2 (range: 1-5). The choice of first-line chemotherapy backbone (doublet/triplet versus mono) did not impact OS (HR: 0.83, p=0.50) or the probability of receiving subsequent therapy (p=0.697). Metastasectomy and/or local ablative treatment in the liver, lung, peritoneum and/or other organs were applied in 26 patients (22%) with curative intent. First-line anti-EGFR-based therapy showed a trend towards longer OS compared to anti-VEGF-based therapy or chemotherapy alone in left-sided mCRC (anti-EGFR: 39.3 months versus anti-VEGF: 27.3 months versus chemotherapy alone: 13.8 months, p=0.105). In multivariable analysis, metastasectomy and/or local ablative treatment with curative intent (yes versus no, HR: 0.22, p<0.001), the ECOG performance score (2 versus 0, HR: 3.07, p=0.007; 3 versus 0, HR: 3.66, p=0.053) and the presence of liver metastases (yes versus no, HR: 1.79, p=0.049) were independently associated with OS. Conclusions: Our findings corroborate front-line monochemotherapy in combination with targeted therapy as the treatment of choice for elderly mCRC patients with palliative treatment intent. Metastasectomy and/or local ablative treatment with curative intent are feasible and may improve OS in selected elderly mCRC patients.

Manufacturing flexible vascular models for cardiovascular surgery planning and endovascular procedure simulations: An approach to segmentation and post-processing with open-source software and end-user 3D printers.

306Three-dimensional (3D)-printed vascular models for cardiovascular surgery planning and endovascular procedure simulations often lack realistic biological tissues mimicking material properties, including flexibility or transparency, or both. Transparent silicone or silicone-like vascular models were not available for end-user 3D printers and had to be fabricated using complex and cost-intensive workarounds. This limitation has now been overcome by novel liquid resins with biological tissue properties. These new materials enable simple and low-cost fabrication of transparent and flexible vascular models using end-user stereolithography 3D printers and are promising technological advances toward more realistic patient-specific, radiation-free procedure simulations and planning in cardiovascular surgery and interventional radiology. This paper presents our patient-specific manufacturing process of fabricating transparent and flexible vascular models using freely available open-source software for segmentation and 3D post-processing, aiming to facilitate the integration of 3D printing into clinical care.

Endovascular embolization techniques in acute thoracic and abdominal bleedings can be technically reproduced and trained in a standardized simulation setting using SLA 3D printing: a 1-year single-center study.

BACKGROUND: Endovascular embolization techniques are nowadays well established in the management of acute arterial bleedings. However, the education and training of the next generation of interventionalists are still based on the traditional apprenticeship model, where the trainee learns and practices directly at the patient, which potentially affects the patient's safety. The objective of this study was to design and develop a standardized endovascular simulation concept for the training of acute bleeding embolizations, based on real-life cases. RESULTS: An adaptable and cost-effective endovascular simulator was developed using an in-house 3D print laboratory. All thoracic and abdominal acute bleeding embolizations over more than a year with appropriate pre-interventional computed tomography scans were included to manufacture 3D printed vascular models. A peristaltic pump was used to generate pulsatile flow curves. Forty embolization cases were engaged in this study, and 27 cases were fully reproduced in the simulation setting (69.23%). The simulation success was significantly lower in pulmonary embolizations (p = 0.031) and significantly higher in soft tissue (p = 0.032) and coil embolizations (p = 0.045). The overall simulation success was 7.8 out of 10 available points. CONCLUSIONS: Using stereolithography 3D printing in a standardized simulation concept, endovascular embolization techniques for treating acute internal hemorrhages in the chest and abdomen can be simulated and trained based on the patient-specific anatomy in a majority of the cases and at a broad spectrum of different causes.

Practice patterns among thyroid cancer surgeons: implications of performing a prophylactic central neck dissection.

BACKGROUND: Indications for performing a prophylactic central neck dissection (pCND) in papillary thyroid cancer (PTC) remain controversial. It is unclear how identification of lymph node (LN) metastases should impact the decision to treat with radioactive iodine (RAI). The goals of this study were to identify indications for performing pCND and identify factors that predict the use of adjuvant RAI. METHODS: This was a population based cross-sectional analysis. A prospectively collected database identified 594 patients who underwent total thyroidectomy +/- CND. A multivariate model was constructed to identify indications for pCND and predictors of the use of RAI. RESULTS: 425 CNDs were performed of which 224 were prophylactic. Conventional risk factors (age, tumor size, extra-thyroidal extension) were not associated with performing a pCND. The presence of clinically suspicious lymphadenopathy was the only factor associated with performing CND, thus rendering the CND therapeutic. Positive LNs were retrieved in 39 % of pCND's, upstaging 87 patients. Among all peri-operative predictors of receiving RAI, presence of LN metastases was the strongest predictor [OR = 5.9 (3.7-9.5)], while tumor size was a modest predictor [OR = 1.8 (1.5-2.1)]. Other conventional risk factors did not predict use of adjuvant RAI. CONCLUSIONS: Conventional risk factors were not indications for performing a pCND, implying that the decision was based on individual surgeon preference. Performing pCND upstaged 39 % of patients from cN0 to pN1a, increasing the likelihood of receiving RAI 6-fold. Conventional risk factors were not predictors of receiving adjuvant RAI. This highlights the need for a unified approach to performing a pCND and administering RAI.

Extent of central neck dissection among thyroid cancer surgeons: Cross-sectional analysis.

BACKGROUND: It is unclear if surgeons are performing comprehensive central neck dissections for well-differentiated thyroid cancer. The purpose of this study was to determine mean lymph node retrieval in central neck dissection as well as variability across surgeons and institutions. METHODS: A prospectively collected database identified 18 surgeons performing 425 central neck dissections, 313 unilateral and 112 bilateral. Demographics, perioperative, and pathologic factors were analyzed. RESULTS: Mean lymph node yield was 7.4 and 11.9 for unilateral and bilateral central neck dissection, respectively. Although 224 central neck dissections were prophylactic, both total and pathologic lymph node yields were significantly higher in therapeutic central neck dissection. There was a significant variation in lymph node yield across individual surgeons, institutions, and regions. High-volume central neck dissection surgeons have significantly lower lymph node yield compared to low-volume surgeons. CONCLUSION: Central neck dissection seems to be performed adequately; however, there is a significant variation in lymph node yield. Future initiatives should try to standardize the central neck dissections performed, with emphasis on obtaining a sufficient yield. © 2015 Wiley Periodicals, Inc. Head Neck 38: E328-E332, 2016.

The impact of compliance in posttreatment surveillance in head and neck squamous cell carcinoma.

IMPORTANCE: Posttreatment surveillance (PTS) is a key component in the treatment of patients with head and neck cancer. It is unclear how beneficial this is in improving patients' survival. OBJECTIVE: To determine how compliance with follow-up affects clinical outcomes in patients with head and neck squamous cell carcinoma. DESIGN, SETTING, AND PARTICIPANTS: This was a retrospective cohort study at a tertiary academic center of a total of 332 patients with head and neck squamous cell carcinoma who had completed both treatment and follow-up at the University of Kansas Medical Center. Patient and tumor characteristics, socioeconomic status, and geographic data were collected. EXPOSURES: Compliance with PTS. MAIN OUTCOMES AND MEASURES: The effect of compliance with PTS on overall survival. RESULTS: Compliance with PTS, US Census tract income level, and the distance patients travel for follow-up had significant effects on survival (P = .001, P = .001, and P = .01, respectively). Cox proportional hazard models revealed that more advanced disease (hazard ratio [HR], 1.76 [95% CI, 1.21-2.58]; P = .003), middle (HR, 1.64 [95% CI, 1.13-2.39]; P = .009) and moderate (HR, 1.90 [95% CI, 1.18-3.06]; P = .008) census tract income level, and age (HR, 1.03 [95% CI, 1.01-1.04]; P < .001), were significantly associated with an increased risk of death. There was an association between compliance and tobacco cessation (P = .003), as well as the distance a patient lived from the medical center (P = .008). CONCLUSIONS AND RELEVANCE: Patients with head and neck squamous cell carcinoma were significantly more likely to survive with completion of follow-up and tobacco cessation. Compliance with PTS was associated with smoking cessation and traveling less than 200 miles for follow-up.

Postpartum woman with pneumomediastinum and reverse (inverted) takotsubo cardiomyopathy: a case report.

INTRODUCTION: Pneumomediastinum is known to occur during labor. Patients typically present with chest pain and symptoms may be suspicious, for example of pulmonary embolism or aortic dissection. The condition itself, however, is rather harmless and self-limiting.Takotsubo cardiomyopathy is associated with psychologically or physiologically stressful events and its symptoms mimic myocardial infarction. Yet, symptoms often improve quickly as the initially impaired cardiac function is usually restored within days or weeks.Although the initial presentation of the patient in this case report was dramatic, the clinical course was positive and the patient could be quickly dismissed in a good general condition. To the best of our knowledge, no presentation of a combined occurrence of postpartum pneumomediastinum and reverse (inverted) takotsubo cardiomyopathy exists. CASE PRESENTATION: We present the case of a 30-year-old Caucasian woman with sudden onset of thoracic back and chest pain approximately 24 hours after an otherwise unremarkable vaginal delivery. A contrast-enhanced chest computed tomography showed cervical and mediastinal emphysema without proof for pulmonary embolism or aortic dissection. She received a symptomatic analgesic treatment and was dismissed to the obstetrics department for monitoring.Within hours, slightly increased levels of troponin I were observed without corresponding electrocardiography changes. Immediate cardiac catheterization and a cardiovascular magnetic resonance imaging (performed within 24 hours) revealed basal to midventricular hypokinesia, but were otherwise unremarkable. A low-dose treatment for congestive heart failure was initiated, under which symptoms subsided within days. She was dismissed after 12 days in a good general condition. CONCLUSIONS: Although the clinical presentation of the combination of the diseases initially was dramatic, the prognosis is positive. In the context of the preceding delivery, knowledge about the postpartum pneumomediastinum lets the radiologist of the emergency department quickly make this diagnosis. The takotsubo cardiomyopathy, however, needs broader diagnostics to not miss intervention-requiring causes.

Use of a Low-fidelity simulator to improve trans-nasal fibre-optic flexible laryngoscopy in the clinical setting: a randomized, single-blinded, prospective study.

BACKGROUND: Trans-nasal flexible fibre-optic laryngoscopy (TFFL) is an essential skill for otolaryngologists. There is evidence to suggest that simulators help residents acquire procedural skills. The objective of this study was to examine the effect of simulation on endoscopy skill acquistion. METHODS: A randomized controlled trial was conducted utilizing medical students and junior residents with limited experience in TFFL. Learners all performed a baseline endoscopy and were then randomized to receive either 45 minutes of simulation training or not. Following this, a second endoscopy was performed. Time to adequate visualization of the glottis, the percentage of time adequate visualization of the airway was maintained, and the number of collisions with mucosa were analyzed. Qualitative assessments were also obtained from the learner, patient, and staff laryngologist. RESULTS: Time to adequate visualization of the glottis and the number of mucosal collisions were significantly less during the second endoscopy, irrespective of the use of simulation (84.8 sec vs. 68 sec, p < 0.01; 5.0 vs. 3.2, p < 0.01, respectively). Analysis using a two-way ANOVA with interaction established that none of the quantitative measures analyzed in this study improved with the addition of simulation. CONCLUSION: Improvements in time to visualization of the glottis and number of mucosal contacts were seen between the first and second endoscopy irrespective of simulator use. No additional benefit was conferred with the use of a low-fidelity simulator.

Radiologic reporting for paranasal sinus computed tomography: a multi-institutional review of content and consistency.

OBJECTIVES/HYPOTHESIS: To optimize clinical care, radiologic reporting should consistently include clinically pertinent information. The purpose of this study was to: 1) determine the current satisfaction of otolaryngologists with paranasal sinus computed tomography (CT) radiologic reporting and 2) evaluate the comprehensiveness of paranasal sinus CT radiologic reporting. STUDY DESIGN: Two parts: 1) A national survey of all practicing otolaryngologists in Canada and 2) a retrospective review of paranasal sinus CT scan radiologic reporting. METHODS: A national survey of all Canadian otolaryngologists was conducted in September 2011. Questions were focused on eliciting the current satisfaction with sinus CT radiologic reporting. At two major centers (Alberta Health Services-Calgary Zone and the Ottawa Hospital), all sinus CT scans performed over a 2-year period were identified (9,739), and 100 from each center were randomly selected for analysis. The radiology reports were scrutinized to determine if seven critical and 11 noncritical items were mentioned. RESULTS: Many (22%) otolaryngologists are dissatisfied with current sinus CT radiologic reporting, and the majority (67%) would like more clinically useful information. All predefined sinus CT items were inconsistently reported. Anterior ethmoid artery anatomy, ethmoid skull base integrity, and sphenoethmoidal cell were the most infrequently reported critical items. CONCLUSIONS: This study has demonstrated that important information is inconsistently reported for sinus CT, and most otolaryngologists would like to see more clinically relevant content in radiology reports. Optimizing the reporting of sinus CT scans will improve communication between the radiologist and other clinicians managing patients with sinonasal disease. LEVEL OF EVIDENCE: 2b.

Occult multifocal papillary thyroid microcarcinoma presenting as a supraclavicular mass containing anaplastic thyroid carcinoma.

IMPORTANCE: There are reports in the literature of anaplastic thyroid carcinoma in cervical lymph nodes with evidence of only papillary carcinoma in the thyroid gland. There have been no cases of this clinical scenario with only papillary microcarcinoma in the thyroid gland. OBSERVATIONS: We describe the case of a 60-year-old man who initially presented with an enlarged right, level 5, supraclavicular lymph node. Initial fine-needle aspiration demonstrated evidence of papillary thyroid carcinoma. The final pathologic finding in the thyroid gland showed only multiple foci of papillary thyroid microcarcinoma. The index neck mass showed evidence of anaplastic thyroid carcinoma. CONCLUSIONS AND RELEVANCE: This is the first instance in the literature in which anaplastic thyroid carcinoma has appeared in metastatic cervical lymph nodes with only a focus of papillary microcarcinoma in the thyroid gland. With this case, we hope to build awareness of this rare finding.

Polyethylene implants in nasal septal restoration.

IMPORTANCE: Numerous techniques have been described to repair nasal septal perforations (SPs). However, many are technically challenging, with varying degrees of success. OBJECTIVE: To evaluate the use of polyethylene (Medpor; Porex Technologies) implants in the closure of nasal SPs. DESIGN AND SETTING: Prospective cohort study in an academic research setting. PARTICIPANTS: Fourteen patients with a nasal SP were identified between March 1, 2008, and February 1, 2011. INTERVENTION: Each patient underwent repair of the nasal SP with a polyethylene orbital sheet implant. After measuring the size of the SP, the implant was trimmed and shaped to fit appropriately. The implant was then placed between bilateral mucoperichondrial flaps using an endonasal approach. MAIN OUTCOME AND MEASURE: Successful closure of the nasal SP with an intact polyethylene graft and complete remucosalization by the 1-year follow-up visit. RESULTS: The most common initial symptoms of SPs were nasal obstruction, crusting, and epistaxis. The SPs ranged from 0.5 to 4.0 cm in diameter. Thirteen of 14 patients (93%) who underwent repair of their nasal SPs with a polyethylene implant had successful closure. CONCLUSION AND RELEVANCE: The use of polyethylene implants is effective and technically easy and is associated with low patient morbidity because it does not require the harvesting of tissue from other donor sites. LEVEL OF EVIDENCE: 4.

The significance of Streptococcus anginosus group in intracranial complications of pediatric rhinosinusitis.

OBJECTIVE: To assess the significance of the Streptococcus anginosus group in intracranial complications of pediatric patients with rhinosinusitis. DESIGN: Retrospective cohort study. SETTING: Tertiary pediatric hospital. PATIENTS: A 20-year review of medical records identified patients with intracranial complications resulting from rhinosinusitis. In the 50 cases identified, S anginosus was the most commonly implicated bacterial pathogen in 14 (28%). Documented data included demographics, cultured bacteria, immune status, sinuses involved, type of intracranial complication, otolaryngologic surgical and neurosurgical intervention, type and duration of antibiotics used, and resulting neurologic deficits. Complications and outcomes of cases of S anginosus group-associated rhinosinusitis were compared with those of other bacteria. MAIN OUTCOME MEASURES: The severity and outcomes of intracranial complications of pediatric rhinosinusitis due to S anginosus group bacteria compared with other bacteria. RESULTS: Infection caused by the S anginosus group resulted in more severe intracranial complications (P = .001). In addition, patients with S anginosus group-associated infections were more likely to require neurosurgical intervention (P < .001) and develop long-term neurologic deficits (P = .02). Intravenous antibiotics were administered for a longer duration (P < .001) for S anginosus group-associated infections. CONCLUSIONS: Rhinosinusitis associated with the S anginosus group should be considered a more serious infection relative to those caused by other pathogens. Streptococcus anginosus group bacteria are significantly more likely than other bacteria to cause more severe intracranial complications and neurologic deficits and to require neurosurgical intervention. A low threshold for intervention should be used for infection caused by this pathogen.

Fiber-optic endoscopic evaluation of swallowing (FEES): predictor of swallowing-related complications in the head and neck cancer population.

BACKGROUND: The treatment of head and neck cancer is associated with significant dysphagia and morbidity. Prescribing a safe oral diet in this population is challenging. METHODS: Data from 116 consecutive patients having 189 fiber-optic endoscopic evaluation of swallowing (FEES) examinations over a 3-year period were analyzed. All patients had been treated for head and neck cancer and subsequently were assessed by FEES. The primary outcome was the incidence of swallowing-related adverse events resulting from the FEES-based dietary recommendations. RESULTS: There were 10 episodes of aspiration pneumonia, 4 episodes of airway obstruction, 3 unanticipated insertions of gastrostomy tubes, and 2 unexplained deaths within the study period. The overall rate of adverse events was 10.1%. The only statistically significant predictor of adverse events was the Rosenbek score (p = .03). CONCLUSIONS: Our experience is that FEES guides appropriate and safe diet recommendations in this population.

Endoluminal therapy in patients with peripheral arterial disease: prospective assessment of quality of life in 190 patients.

OBJECTIVE: The objective of our study was to assess the impact of endoluminal treatment on health-related quality of life in patients with peripheral arterial disease. SUBJECTS AND METHODS: Changes in quality of life were prospectively evaluated in 190 patients before and 1, 3, 6, and 12 months after treatment. Physical, emotional, and general health components were determined using the short-form (36 items) health survey (SF-36). Claudicant patients were compared with patients who had critical limb ischemia. The influence of the lesion location (iliac, femoropopliteal, or crural) restenosis, and additional interventions on quality of life were evaluated. RESULTS: Six- and 12-month follow-up data were available for 136 and 103 patients, respectively. Significant improvements in quality of life were observed in most of the patients after the intervention. Many of the SF-36 scores decreased from the 6- to the 12-month follow-up but remained significantly higher than the score before the intervention. Reduction of bodily pain was the most evident effect of treatment. Claudicant patients seemed to benefit more from treatment than patients with critical limb ischemia. In terms of SF-36 scores, percutaneous transluminal angioplasty of the crural arteries was equally as effective as endoluminal revascularization of the iliac and femoropopliteal arteries and multilevel interventions were as effective as single-level interventions. The occurrence of a restenosis was significantly related to lower SF-36 scores, and restenosis not followed by a second intervention was associated with lower SF-36 scores. CONCLUSION: Although there were several differences between the groups, significant improvements in quality of life up to 12 months after endoluminal therapy were observed in most patients.

Hydronephrotic kidney: pediatric three-dimensional US for relative renal size assessment--initial experience.

PURPOSE: To prospectively evaluate accuracy of three-dimensional (3D) ultrasonography (US) for assessment of relative renal size in infants and children with hydronephrosis. MATERIALS AND METHODS: Informed consent was obtained from parents and also from children who were older than 8 years. Study was approved by ethics committee. Two-dimensional (2D) US, 3D US, and scintigraphy were performed in 40 patients with hydronephrosis (age range, neonate to 16 years; seven girls, 33 boys) without acute renal disease. Twenty patients also underwent magnetic resonance (MR) urography. US and MR urography were performed by one experienced pediatric radiologist; 3D US and MR urographic volume calculations were performed by specifically trained radiologists. Three-dimensional US was performed with integrated 3D volume probes or external system based on electromagnetic positioning devices. At 2D US, kidney volume was calculated with application of ellipsoid equation. At MR urography and 3D US, real renal parenchymal volume was calculated with subtraction of dilated collecting system. Split renal function was assessed with static renal scintigraphy. Three-dimensional US results were graded with respect to image quality and compared with results of 2D US, scintigraphy, and MR urography by using mean difference percentage and standard deviation of the difference. All investigations were performed with blinding. Inter- and intraobserver variability were calculated with coefficient of variation. RESULTS: In 76 of 80 kidneys, 3D US image of diagnostic quality was obtained. Three-dimensional US volume measurements compared well with MR urographic measurements (mean difference, -2.5% +/- 7.8 [standard deviation] vs 25.8% +/- 32.2 for 2D US) and with scintigraphically assessed split renal function (mean difference, 1.2% +/- 9.2 vs 15.9% +/- 43.8 for 2D US). Intra- and interobserver variability were +/-6.4% and +/-9.9%, respectively. CONCLUSION: Initial experience with renal 3D US indicates that it is an accurate method for assessment of renal parenchymal volume and relative renal size, provided there is no acute renal disease.

Aortoiliac enhancement during computed tomography angiography with reduced contrast material dose and saline solution flush: influence on magnitude and uniformity of the contrast column.

RATIONALE AND OBJECTIVES: To compare the magnitude and uniformity of aortoiliac contrast enhancement obtained from uniphasic contrast material injections versus contrast material injections with reduced iodine dose followed by a saline flush in aortoiliac multislice CT angiography (CTA). METHODS: Twenty-nine patients with abdominal aortic aneurysms underwent aortoiliac CTA using protocols A and B. With protocol A, 120 mL contrast material (300 mgI/mL), and with protocol B, 100 mL contrast material followed by a 40-mL saline solution flush were administered at a flow rate of 4 mL/s. Quantitative analysis was performed by calculating mean aortoiliac attenuation, mean plateau deviation, and mean difference between maximum and minimum attenuation value for both groups. Qualitative analysis was performed by visual assessment of vascular enhancement using 2-dimensional and 3-dimensional postprocessing techniques. RESULTS: The mean aortoiliac attenuation with protocol A was 291 +/- 62 HU, and with protocol B it was 285 +/- 61 HU. The difference of 6 HU was not statistically significant (P = 0.27). Mean plateau deviation was significantly smaller using protocol A than protocol B (16 +/- 9 HU vs. 20 +/- 10 HU, P = 0.03). In addition, the mean difference between maximum and minimum attenuation value was significantly smaller with protocol A than with protocol B (59 +/- 29 HU vs. 72 +/- 32 HU, P = 0.01). Visual analysis showed no difference in contrast material magnitude and homogeneity between the protocols. CONCLUSIONS: In aortoiliac CTA, a saline solution flush after contrast material bolus allows an iodine dose reduction of approximately 20 mL without impairing the magnitude of contrast enhancement but degrades the uniformity of the contrast column. However, the degradation does not affect visual analysis.

Improvement of parenchymal and vascular enhancement using saline flush and power injection for multiple-detector-row abdominal CT.

The aim of this study was to determine if a saline solution flush following low dose contrast material bolus improves parenchymal and vascular enhancement during abdominal multiple detector-row computed tomography (MDCT). Forty-one patients (24 men and 17 women; mean age 49 years, age range 27-86 years) underwent abdominal MDCT (collimation 4x5 mm, 15-mm table increment, reconstruction interval 5 mm, gantry rotation period 0.8 s) with a single- as well as with a double syringe power injector. Indication for examination were benign and malignant tumors and inflammatory diseases. Patients received 100 ml nonionic contrast material (300 mgI/ml) alone or pushed with 20 ml saline solution. Mean enhancement values for both protocols were measured in the liver, the spleen, the pancreas, the renal cortex, the portal vein, the inferior vena cava and the abdominal aorta. Double syringe power-injector protocol led to significantly higher parenchymal and vascular enhancement than single syringe power-injector protocol (p<0.05). The improvement in mean enhancement of the liver was 9 +/- 9 HU, of the spleen 8 +/- 10 HU, of the pancreas 7 +/- 9 HU, and of the renal cortex 8 +/- 20 HU. The improvement in mean enhancement of the portal vein was 10 +/- 17 HU of the inferior vena cava 8 +/- 13 HU and of the abdominal aorta 10 +/- 17 HU. The use of a double syringe power injector with saline flush following contrast material bolus significantly improves parenchymal and vascular enhancement during contrast-enhanced abdominal MDCT with low iodine doses.

Abdominal multidetector row computed tomography: reduction of cost and contrast material dose using saline flush.

OBJECTIVE: To evaluate the potential of a saline solution flush after the contrast material bolus in abdominal multidetector row CT (MDCT) in contrast material dose and cost reduction. METHODS: Abdominal MDCT was performed in 78 patients who were assigned randomly to 2 groups receiving 120 mL nonionic contrast material (300 mgI/mL) alone or 100 mL of the same contrast material pushed with 40 mL of saline solution. Mean attenuation values for both groups were measured in the liver, the spleen, the pancreas, the portal vein, the inferior vena cava, and the abdominal aorta. Cost analyses were performed for both groups. RESULTS: There was no significant difference in parenchymal and vascular enhancement between both groups. The difference of the enhancement was 2 HU for the liver (P = 0.11), 2 HU for the spleen (P = 0.44), 3 HU for the pancreas (P = 0.38), 9 HU for the portal vein (P = 0.11), 3 HU for the inferior vena cava (P = 0.55), and 10 HU for the aorta (P = 0.06). Taking the costs of contrast material, saline solution, and disposal material into account, 7.30 dollars was saved by the patient using a saline solution flush. CONCLUSIONS: Using a saline flush after the contrast material bolus in abdominal MDCT allows an iodine dose reduction of approximately 6 g, or 17%, without impairing mean parenchymal and vascular enhancement and a cost reduction of 7.30 dollars per patient.