ABSTRACT
PURPOSE: To determine the most efficacious dose of gadodiamide for three-dimensional (3D) contrast-enhanced (CE) magnetic resonance angiography (MRA) of the renal arteries on a patient level based on the sensitivity in detecting the main hemodynamically relevant (> or =50% or occlusion) renal artery stenosis (RAS) using intra-arterial digital subtraction angiography (IA DSA) as the gold standard. MATERIALS AND METHODS: This prospective, randomized, double-blind, parallel-group, multicenter study included 273 patients referred to IA DSA for suspected RAS. Patients underwent 3D CE MRA after injection of 0.01, 0.05, 0.1, or 0.2mmol/kg of body weight gadodiamide (0.5mmol/ml). The images were assessed for location and degree of RAS by independent blinded readers (MRA: three readers, IA DSA: one reader). Hypothesis testing for a significant trend in sensitivity across dose groups was based on the one-sided Cochran-Armitage style trend test for each independent MRA reader. RESULTS: The lowest dose group (0.01mmol/kg) proved non-efficacious in detecting hemodynamically relevant (i.e., > or =50% or occlusion) RAS. A statistically significant dose trend (p<0.001) was shown for each of the three independent readers. Depending on reader, the sensitivity obtained with 0.05, 0.1, and 0.2mmol/kg was 63.9-86.1%, 75.8-91.4% and 80.6-90.6%, the specificity was 66.7-73.9%, 59.3-75.0%, and 59.3-75.0% and accuracy was 67.8-78.9%, 75.4-77.4%, and 76.3-81.0%, for the three dose groups, respectively. There were eight non-severe adverse events (AEs). Three serious AEs occurring in one patient were judged not related to gadodiamide by the on-site investigator. CONCLUSION: A significant dose trend between the four doses examined was observed. The lowest dose (0.01mmol/kg) differed significantly from those of the other three doses. Based on the analysis of the primary and secondary endpoints, 0.1mmol/kg gadodiamide appears to be the most suitable dose in diagnosing hemodynamically relevant RAS. The present study also demonstrated gadodiamide to be safe and well tolerated.
Subject(s)
Contrast Media , Gadolinium DTPA , Image Enhancement/methods , Imaging, Three-Dimensional/methods , Magnetic Resonance Angiography/methods , Renal Artery Obstruction/diagnosis , Adult , Aged , Aged, 80 and over , Angiography, Digital Subtraction , Contrast Media/administration & dosage , Contrast Media/adverse effects , Dose-Response Relationship, Drug , Double-Blind Method , Female , Gadolinium DTPA/administration & dosage , Gadolinium DTPA/adverse effects , Humans , Image Processing, Computer-Assisted/methods , Injections, Intravenous , Male , Middle Aged , Prospective Studies , Safety , Sensitivity and Specificity , Treatment OutcomeABSTRACT
Actinic keratoses (AKs) are the most common epithelial premalignant lesions seen by dermatologists today. The vast therapeutic armamentarium for treating AKs can be roughly divided into 2 categories: topical and surgical/physical modalities. It is important for clinicians to be familiarized with the various therapeutic options for treating AKs and to deliver individualized treatments. This article will review the surgical and physical modalities available for the treatment of AKs.
Subject(s)
Keratosis/therapy , Cryosurgery , Dermabrasion , Electrosurgery , Humans , Keratolytic Agents , Keratosis/surgery , Laser Therapy , Phototherapy , Precancerous Conditions/surgery , Precancerous Conditions/therapy , Skin Neoplasms/surgery , Skin Neoplasms/therapyABSTRACT
An idiopathic inflammatory dermatosis, lichen planus (LP) involves the skin, mucosa, or both, in a variety of clinical forms. The involvement of the mucous membranes is seen frequently and usually is asymptomatic, but occasionally, LP can be complicated by extensive painful erosions. We report the case of a 44-year-old man who presented with a 3-year history of isolated lower lip erosions, for which the diagnosis of LP was made. This report represents only the fourth case of LP exclusively localized on the lower lip.
