Updated guidelines for intravenous contrast use for CT and MRI

Huynh, Kevin; Baghdanian, Arthur H.; Sun, Derek; Kolli, K.; Zagoria, Ronald J.

doi:10.1007/s10140-020-01751-y

Cited by 52 publications

(60 citation statements)

References 104 publications

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“…It was observed that while the 'free' Gd 3+ controls diffusion equilibrated, there was very little metal detected from the iTSL and no obvious increasing trend over the 48 h study. This is in-line with previous reports which demonstrated greatly reduced Gd 3+ leakage from the macrocyclic chelators under serum conditions compared to linear chelators [38,39]. We concluded that iTSL was safe for i.v.…”

Section: Avoidance Of Gadolinium Toxicitysupporting

confidence: 93%

“…Free Gd 3+ cations are toxic due to interference with Ca 2+ -dependant biochemical processes, amongst other effects [38]. This toxicity is greatly reduced when the metal is chelated but there are currently concerns due to the demonstrated links between the use of Gd-based MRI contrast agents and rare but serious incidents of nephrogenic systemic fibrosis in patients with poor kidney function [39]. Therefore, there is a question as to the safety of gadolinium contrast agents that may 'leak' Gd 3+ due to chelation competition from biomolecules in the body [40].…”

Section: Avoidance Of Gadolinium Toxicitymentioning

confidence: 99%

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MR-labelled liposomes and focused ultrasound for spatiotemporally controlled drug release in triple negative breast cancers in mice

et al. 2021

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Rationale: Image-guided, triggerable, drug delivery systems allow for precisely placed and highly localised anti-cancer treatment. They contain labels for spatial mapping and tissue uptake tracking, providing key location and timing information for the application of an external stimulus to trigger drug release. High Intensity Focused Ultrasound (HIFU or FUS) is a non-invasive approach for treating small tissue volumes and is particularly effective at inducing drug release from thermosensitive nanocarriers. Here, we present a novel MR-imageable thermosensitive liposome (iTSL) for drug delivery to triple-negative breast cancers (TNBC). Methods: A macrocyclic gadolinium-based Magnetic Resonance Imaging (MRI) contrast agent was covalently linked to a lipid. This was incorporated at 30 mol% into the lipid bilayer of a thermosensitive liposome that was also encapsulating doxorubicin. The resulting iTSL-DOX formulation was assessed for physical and chemical properties, storage stability, leakage of gadolinium or doxorubicin, and thermal-or FUS-induced drug release. Its effect on MRI relaxation time was tested in phantoms. Mice with tumours were used for studies to assess both tumour distribution and contrast enhancement over time. A lipid-conjugated near-infrared fluorescence (NIRF) probe was also included in the liposome to facilitate the real time monitoring of iTSL distribution and drug release in tumours by NIRF bioimaging. TNBC (MDA-MB-231) tumour-bearing mice were then used to demonstrate the efficacy at retarding tumour growth and increasing survival. Results: iTSL-DOX provided rapid FUS-induced drug release that was dependent on the acoustic power applied. It was otherwise found to be stable, with minimum leakage of drug and gadolinium into buffers or under challenging conditions. In contrast to the usually suggested longer FUS treatment we identified that brief (~3 min) FUS significantly enhanced iTSL-DOX uptake to a targeted tumour and triggered near-total release of encapsulated doxorubicin, causing significant growth inhibition in the TNBC mouse model. A distinct reduction in the tumours' average T1 relaxation times was attributed to the iTSL accumulation. Conclusions: We demonstrate that tracking iTSL in tumours using MRI assists the application of FUS for precise drug release and therapy.

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Section: Avoidance Of Gadolinium Toxicitysupporting

confidence: 93%

Section: Avoidance Of Gadolinium Toxicitymentioning

confidence: 99%

MR-labelled liposomes and focused ultrasound for spatiotemporally controlled drug release in triple negative breast cancers in mice

et al. 2021

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“…A uniform risk screening questionnaire and risk assessment prior to CM administration could limit unnecessary laboratory tests for low-risk patients. 23 Only 24% of the radiology departments in this study followed the recommendation of using both serum creatinine and cystatin C for calculation of eGFR. This could influence patient safety due to the potential impact on patients with abnormally low muscle mass or liver cirrhosis/failure where overestimation of serum creatininebased estimates of eGFR might occur.…”

Section: Discussionmentioning

confidence: 92%

“…17 The importance of assessing potential risk factors prior to administration of iodinated CM has been pointed out in a recently published review. 23 The routines for identification of high-risk patients as well as for documentation have not been investigated in our study but consistency in this process seems important and valuable to assess in future studies. A uniform risk screening questionnaire and risk assessment prior to CM administration could limit unnecessary laboratory tests for low-risk patients.…”

Section: Discussionmentioning

confidence: 99%

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

Bjällmark

Bazzi

Karlsson³

et al. 2021

Radiography

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Introduction: Guidelines concerning intravenous iodinated contrast media (CM) during computed tomography (CT) examinations are important to follow to minimize the risk for post-contrast acute kidney injury (PC-AKI). The purpose of this study was to investigate the radiology departmental policy compliance with Swedish guidelines concerning PC-AKI. Methods: In February 2020, an electronic survey was distributed to the responsible radiographer at 41 radiology departments in all university hospitals and medium-sized hospitals in Sweden. The questions focused on routines around renal functional tests, individualized contrast administration and handling of patients with diabetes mellitus taking metformin. Results: The response rate was 83%. Seventy-six percent (n ¼ 26) of radiology departments calculated estimated glomerular filtration rate (eGFR) from serum creatinine prior to CM administration, but only 24% (n ¼ 8) followed the recommendation to calculate eGFR from both serum creatinine and cystatin C. For acute/inpatients, 55% (n ¼ 18) followed the recommendation that renal functional tests should be performed within 12 h before CM administration. For elective patients, 97% (n ¼ 33) followed the recommendation to have eGFR newer than three months which is acceptable for patients with no history of disease that may have affected renal function. Approximately 80% of the radiology departments followed the recommendation that CM dose always should be individually adjusted to patient eGFR. Seventy-six percent (n ¼ 26) followed the recommendation to continue with metformin at eGFR 45 ml/min. Conclusion: Compliance with the national guidelines was high regarding routines around renal functional tests, dose adjustment of CM and metformin discontinuation. Improvements can be made in using both cystatin C and serum creatinine for eGFR calculations as well as ensuring renal function tests within 12 h for acute/inpatients with acute disease that may affect renal function. Implications for practice: This study raises awareness of the importance of adhering to guidelines in healthcare. To have knowledge about the current level of compliance regarding PCI-AKI is important to maintain and develop effective clinical implementation of guidelines. The variation in practice seen in this study emphasizes the need of more effective implementation strategies to ensure adherence with best practice.

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“…No sedatives are routinely used for mother or fetus. Contrast agent administration is contraindicated (10).…”

Section: Setting and Mri Protocolmentioning

confidence: 99%

Brain fetal neuroradiology: a beginner’s guide

Moltoni¹,

Talenti²,

Righini³

2021

Transl Pediatr

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Updated guidelines for intravenous contrast use for CT and MRI

Cited by 52 publications

References 104 publications

MR-labelled liposomes and focused ultrasound for spatiotemporally controlled drug release in triple negative breast cancers in mice

MR-labelled liposomes and focused ultrasound for spatiotemporally controlled drug release in triple negative breast cancers in mice

Radiology departmental policy compliance with Swedish guidelines regarding post-contrast acute kidney injury for examinations with iodinated contrast media

Brain fetal neuroradiology: a beginner’s guide

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