Whole-Body MR Angiography in Patients with Peripheral Arterial Disease

Total Page:16

File Type:pdf, Size:1020Kb

Whole-Body MR Angiography in Patients with Peripheral Arterial Disease PHD THESIS DANISH MEDICAL BULLETIN Whole-body MR angiography in patients with peripheral arterial disease Yousef Jesper Wirenfeldt Nielsen IV. Nielsen YW, Eiberg JP, Løgager VB, Just S, Schroeder TV, Thomsen HS. Patient acceptance of whole-body MRA – a This review has been accepted as a thesis together with four previously published papers by the University of Copenhagen on the 4 th of June 2010 and defended on the prospective questionnaire study. Acta Radiol 2010; 18 th of October 2010. 51:277-83. Tutors: Henrik S. Thomsen, Torben V. Schroeder & Jonas P. Eiberg Official opponents: Håkan Ahlstrøm , Tim Leiner & Ulf Helgstrand 1.1 STUDY AIMS Correspondence: Department of Diagnostic Radiology, Copenhagen University The principal aim of the study was to investigate whole-body Hospital Herlev. Herlev Ringvej 75 – DK 2730. Denmark. magnetic resonance angiography (WB-MRA) as diagnostic tool in E-mail: ywnielsen@gmail.com patients with peripheral arterial disease (PAD). Focus has been on feasibility of WB-MRA with body coil acquisition, means of im- proving the technique, and patient acceptance of the method. Dan Med Bull 2010;57(12)B4231 Both an extracellular and a blood-pool MRI contrast agent have been used in the study. However, it has not been a study aim to perform a large scale comparison of WB-MRA using different contrast agents. 1. GENERAL PART Specific aims of individual studies This thesis is divided into 3 main sections: A general part, a special Study I part, and a conclusion. The general part describes the background The aim of this study was to investigate the feasibility of perform- for the study, and outlines the study aims. The special part sum- ing WB-MRA in a 3 Tesla (T) MRI system with use of body coil marises the results of the research, with reference to the original acquisition and a blood-pool contrast agent. papers. Overall results of the study are discussed in the conclu- sion. Study II The aim of this study was to determine the impact of a hybrid The thesis is based on 4 original studies: scan technique on the diagnostic performance of 3T WB-MRA using an extracellular contrast agent. I. Nielsen YW, Eiberg JP, Løgager VB, Hansen MA, Schroeder TV, Thomsen HS. Whole-body MR angiography with body Study III coil acquisition at 3T in patients with peripheral arterial The aim of this study was to investigate if addition of infra- disease using the contrast agent gadofosveset trisodium. genicular steady-state MRA (SS-MRA) to first-pass imaging im- Acad Radiol 2009; 16:654-61. proves diagnostic performance compared to first-pass imaging alone, in WB-MRA of patients with PAD. II. Nielsen YW, Eiberg JP, Løgager VB, Schroeder TV, Just S, Thomsen HS. Whole-body magnetic resonance angiogra- Study IV phy at 3 Tesla using a hybrid protocol in patients with pe- This study assessed patient acceptance of WB-MRA compared to ripheral arterial disease. Cardiovasc Intervent Radiol 2009; conventional x-ray angiography. 32:877-86. III. Nielsen YW, Eiberg JP, Løgager VB, Just S, Schroeder TV, 1.2 BACKGROUND Thomsen HS. Whole-body MRA with additional steady- state acquisition of the infra-genicular arteries in patients 1.2.1 Atherosclerosis with peripheral arterial disease. Cardiovasc Intervent Ra- Atherosclerotic cardiovascular disease (CVD) is the leading cause diol 2009; Epub Dec 3. of death in the Western world [1]. This chapter gives a brief over- view of the pathogenesis, risk factors and pharmacological treat- DANISH MEDICAL BULLETIN 1 ment of atherosclerosis. Finally, the systemic nature of athero- Intermittent claudication, defined as exercise-induced pain in the sclerosis will be discussed. muscles of the leg, is the earliest and most frequent symptom of Atherosclerosis is characterized by plaque formation in the walls PAD. Claudication begins after a reproducible length of walk, and of the large and medium size arteries. The first event in plaque resolves within few minutes after the patient stops walking. With formation is migration of monocytes into the arterial intima, disease progression (critical limb ischemia), PAD patients have where they differentiate into macrophages. These absorb lipids rest pain, and clinical findings might include ischemic ulceration and become foam cells. Arterial fatty streaks consist of intimal and gangrene. The Fontaine classification is the classic scheme collections of foam cells, and are considered the primary athero- used to describe the severity of PAD (Table 1) [12]. Patients in sclerotic lesion. More advanced stages of atherosclerosis occur Fontaine class III and IV suffer critical limb ischemia. when the lipid-loaded foam cells become apoptotic and release PAD is a frequent disease. In a population-based study, PAD (an- lipids to the extracellular space. This accelerates collagen produc- kle-brachial index <0.9) was present in 19% of subjects > 55 years tion and a true atherosclerotic plaque consisting of a lipid core old [13]. Traditional cardiovascular risks factors (advanced age, surrounded by a fibrous cap is the result [2]. Initially, the plaque male gender, diabetes, smoking, hypertension, hyperlipidaemia) does not narrow the arterial lumen by in-growth, instead remod- are related to PAD [14]. Due to con-comitant atherosclerotic elling occurs and the plaque expands through the outer layers of complications in the coronary and cerebrovascular beds, PAD the arterial wall. However, at some point compensatory enlarge- patients have increased risk of mortality compared to the general ment is no longer possible, and the plaque begins to expand population [15]. inwards leading to progressive reduction of the arterial lumen. An accurate medical history and thorough physical examination Artherosclerotic plaques usually do not cause ischemic symptoms are important factors in the diagnostic approach to the PAD pa- before luminal narrowing exceeds 50%. Hence, a large quantum tient. However, exact determination of the extent of atheroscle- of asymptomatic atherosclerosis may be present once symptoms rosis requires diagnostic imaging, which is the subject of the next occur. The majority of acute cardiovascular events are due to chapter. plaque complications that acutely occlude the arterial lumen [3]. Treatment options of PAD include preventive measures against Plaque rupture causes platelet aggregation and formation of an atherosclerosis, surgery, and endovascular interventions. Preven- occluding thrombus at the site of the plaque (atherothrombosis). tive measures with life-style modifications (smoking cessation and Additionally, particulate matter may also be shed from the rup- exercise) as well as pharmacological interventions (antihyperten- tured plaque leading to embolization. Together, these mecha- sives, antiplatelets, blood sugar control, antihyperlipidaemics) are nisms account for most of the acute ischemic manifestations of the most important part of PAD treatment [14]. Surgical proce- atherosclerosis (unstable angina, myocardial infarction, and dures are endarterectomy, bypass grafting, and amputation, ischemic stroke). whereas endovascular interventions are PTA (percutaneous trans- Established risk factors for atherosclerosis include hypertension, luminal angioplasty) and stent placement. diabetes, dyslipidaemia, smoking, obesity, and physical inactivity [4]. Lifestyle modifications such as reductions in the amount of Table 1. The Fontaine classification dietary fat, calorie control, exercise, and smoking cessation are Stage Symptoms / Findings important factors in prevention of atherosclerosis. Pharmacologi- I Asymptomatic cal treatment of hypertension, diabetes, and dyslipidaemia is also essential in management of patients with atherosclerosis. An- II a Intermittant claudication other important mechanism in atherosclerosis treatment is plate- Pain-free walking distance > 200 m let inhibition, since platelets are key components in the atherothrombotic process succeeding plaque rupture. II b Intermittant claudication Presence of atherosclerosis in one vascular bed often implies Pain-free walking distance < 200 m presence of the disease in other vascular territories. Hence, atherosclerosis is regarded a systemic disease. Predisposed sites III Rest pain for atherosclerosis exist in the vascular tree including the carot- IV Tissue loss and/or gangrene ids, coronaries, aorta, renal arteries, and lower extremity arteries from the level of the aortic bifurcation. Low shear stress acting on the endothelium in the outer areas of vessel bifurcations is be- lieved to play a role in the development of atherosclerosis in these predisposed areas [5]. 1.2.3 Diagnostic imaging of atherosclerosis Numerous studies have investigated the systemic nature of atherosclerosis. In patients with peripheral arterial disease (PAD) Numerous imaging methods are used clinically to depict athero- con-comitant carotid stenosis has been found in 25% [6;7], renal sclerotic lesions. This chapter gives an overview of these meth- artery stenosis in 14% [8], and coronary heart disease (CHD) in ods. 46% [9]. Similary, 14% of patients with primary CHD also suffer PAD [10]. A recent study showed that polyvascular disease (> 1 Conventional x-ray angiography region) is present in 71% of vascular surgery patients with athero- In conventional x-ray angiography a catheter is placed inside the sclerosis [11]. arterial system. Most commonly, the common femoral artery is used to gain arterial access, but other options include brachial 1.2.2 Peripheral arterial disease and trans-lumbar access. With the catheter tip advanced
Recommended publications
  • Title 16. Crimes and Offenses Chapter 13. Controlled Substances Article 1
    TITLE 16. CRIMES AND OFFENSES CHAPTER 13. CONTROLLED SUBSTANCES ARTICLE 1. GENERAL PROVISIONS § 16-13-1. Drug related objects (a) As used in this Code section, the term: (1) "Controlled substance" shall have the same meaning as defined in Article 2 of this chapter, relating to controlled substances. For the purposes of this Code section, the term "controlled substance" shall include marijuana as defined by paragraph (16) of Code Section 16-13-21. (2) "Dangerous drug" shall have the same meaning as defined in Article 3 of this chapter, relating to dangerous drugs. (3) "Drug related object" means any machine, instrument, tool, equipment, contrivance, or device which an average person would reasonably conclude is intended to be used for one or more of the following purposes: (A) To introduce into the human body any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (B) To enhance the effect on the human body of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; (C) To conceal any quantity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state; or (D) To test the strength, effectiveness, or purity of any dangerous drug or controlled substance under circumstances in violation of the laws of this state. (4) "Knowingly" means having general knowledge that a machine, instrument, tool, item of equipment, contrivance, or device is a drug related object or having reasonable grounds to believe that any such object is or may, to an average person, appear to be a drug related object.
    [Show full text]
  • 207/2015 3 Lääkeluettelon Aineet, Liite 1. Ämnena I Läkemedelsförteckningen, Bilaga 1
    207/2015 3 LÄÄKELUETTELON AINEET, LIITE 1. ÄMNENA I LÄKEMEDELSFÖRTECKNINGEN, BILAGA 1. Latinankielinen nimi, Suomenkielinen nimi, Ruotsinkielinen nimi, Englanninkielinen nimi, Latinskt namn Finskt namn Svenskt namn Engelskt namn (N)-Hydroxy- (N)-Hydroksietyyli- (N)-Hydroxietyl- (N)-Hydroxyethyl- aethylprometazinum prometatsiini prometazin promethazine 2,4-Dichlorbenzyl- 2,4-Diklooribentsyyli- 2,4-Diklorbensylalkohol 2,4-Dichlorobenzyl alcoholum alkoholi alcohol 2-Isopropoxyphenyl-N- 2-Isopropoksifenyyli-N- 2-Isopropoxifenyl-N- 2-Isopropoxyphenyl-N- methylcarbamas metyylikarbamaatti metylkarbamat methylcarbamate 4-Dimethyl- ami- 4-Dimetyyliaminofenoli 4-Dimetylaminofenol 4-Dimethylaminophenol nophenolum Abacavirum Abakaviiri Abakavir Abacavir Abarelixum Abareliksi Abarelix Abarelix Abataceptum Abatasepti Abatacept Abatacept Abciximabum Absiksimabi Absiximab Abciximab Abirateronum Abirateroni Abirateron Abiraterone Acamprosatum Akamprosaatti Acamprosat Acamprosate Acarbosum Akarboosi Akarbos Acarbose Acebutololum Asebutololi Acebutolol Acebutolol Aceclofenacum Aseklofenaakki Aceklofenak Aceclofenac Acediasulfonum natricum Asediasulfoni natrium Acediasulfon natrium Acediasulfone sodium Acenocoumarolum Asenokumaroli Acenokumarol Acenocumarol Acepromazinum Asepromatsiini Acepromazin Acepromazine Acetarsolum Asetarsoli Acetarsol Acetarsol Acetazolamidum Asetatsoliamidi Acetazolamid Acetazolamide Acetohexamidum Asetoheksamidi Acetohexamid Acetohexamide Acetophenazinum Asetofenatsiini Acetofenazin Acetophenazine Acetphenolisatinum Asetofenoli-isatiini
    [Show full text]
  • Physician Services Fee Schedule
    REPORT: RS04328‐R1328 NORTH CAROLINA DEPARTMENT OF HEALTH AND HUMAN SERVICES PHYSICIAN FEE SCHEDULE AS OF: 05/11/2017 Physician Fee Schedule Provider Specialty 001 Effective Date: 1/1/2018 The inclusion of a rate on this table does not guarantee that a service is covered. Please refer to the Medicaid Billing Guide and the Medicaid and Health Choice Clinical Policies on the DMA Web Site. Providers should always bill their usual and customary charges. Please use the monthly NC Medicaid Bulletins for additions, changes and deletion to this schedule. Medicaid Maximum Allowable NON- FACILITY FACILITY PROCEDURE CODE MODIFIER PROCEDURE DESCRIPTION RATE RATE EFFECTIVE DATE 01967 NEURAXIAL LABOR ANALGESIA/ANESTHESIA FOR $ 209.63 $ 209.63 01996 DAILY HOSPITAL MANAGEMENT OF EPIDURAL OR $ 38.93 $ 38.93 10021 FINE NEEDLE ASPIRATION; WITHOUT IMAGING $ 52.36 $ 100.48 10022 FINE NEEDLE ASPIRATION; WITH IMAGING GUI $ 51.97 $ 103.17 10030 GUIDE CATHET FLUID DRAINAGE $ 126.07 $ 615.23 10035 PERQ DEV SOFT TISS 1ST IMAG $ 74.46 $ 437.80 10036 PERQ DEV SOFT TISS ADD IMAG $ 37.49 $ 379.35 10040 ACNE SURGERY $ 63.53 $ 72.20 10060 DRAINAGE OF ABSCESS $ 67.39 $ 77.74 10061 DRAINAGE OF ABSCESS $ 120.14 $ 133.85 10080 DRAINAGE OF PILONIDAL CYST $ 68.87 $ 114.75 10081 DRAINAGE OF PILONIDAL CYST $ 120.71 $ 181.14 10120 FOREIGN BODY REMOVAL, SKIN $ 66.08 $ 94.90 10121 FOREIGN BODY REMOVAL, SKIN $ 135.29 $ 185.09 10140 DRAINAGE OF BLOOD EFFUSION $ 86.33 $ 109.27 10160 PUNCTURE DRAINAGE OF LESION $ 69.52 $ 88.81 10180 INCISION AND DRAINAGE, COMPLEX $ 127.40 $ 164.05
    [Show full text]
  • Gadolinium Based Contrast Agents
    CE Credits Available CONSIDERATIONS IN THE SELECTION OF A NEW GADOLINIUM-BASED CONTRAST AGENT SUPPLEMENT TO MAY 2014 THE JOURNAL OF PRACTICAL MEDICAL IMAGING AND MANAGEMENT Considerations in the Selection of a New Gadolinium-Based Contrast Agent Michael F. Tweedle, PhD Emanuel Kanal, MD, FACR, FISMRM Robert Muller, PhD Stefanie Spielman Professor of Radiology Professor of Radiology and Neuroradiology Department of General, Organic & The Ohio State University University of Pittsburgh Medical Center Biochemical Chemistry Columbus, OH Pittsburgh, PA University of Mons Mons, Belgium Supported by an unrestricted educational grant from © May 2014 www.appliedradiology.com SUPPLEMENT TO APPLIED RADIOLOGY n 1 Publisher Kieran Anderson Executive Editor Cristen Bolan Art and Production Barbara A. Shopiro Applied Radiology and this supplement, Considerations in the Selection of a New Gadolinium-Based Contrast Agent, are published by Anderson Publishing, Ltd. The journal does not warrant the expertise of any author in a particular field, nor is it responsible for any statements by such authors. The opinions expressed in this supplement are those of the authors. They do not imply endorsement of advertised products and do not necessarily reflect the opinions or recommendations of our sponsors or the editors and staff of Applied Radiology. Copyright © 2014 by Anderson Publishing, Ltd., 180 Glenside Avenue, Scotch Plains, NJ 07076 All rights reserved. Cover images courtesy of Howard A. Rowley, MD. Considerations in the Selection of a New Gadolinium-Based Contrast Agent Our 3 esteemed faculty summarize the similarities and differences among the gadolinium-based contrast agents (GBCAs) currently utilized for magnetic resonance imaging (MRI), with emphasis on stability and relaxivity.
    [Show full text]
  • DISSERTATION INVESTIGATION of CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY for the EVALUATION of EQUINE ARTICULAR CARTILAGE Su
    DISSERTATION INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Submitted by Bradley B. Nelson Department of Clinical Sciences In partial fulfillment of the requirements For the Degree of Doctor of Philosophy Colorado State University Fort Collins, Colorado Fall 2017 Doctoral Committee: Advisor: Christopher E. Kawcak Co-Advisor: Laurie R. Goodrich C. Wayne McIlwraith Mark W. Grinstaff Myra F. Barrett Copyright by Bradley Bernard Nelson 2017 All Rights Reserved ABSTRACT INVESTIGATION OF CATIONIC CONTRAST-ENHANCED COMPUTED TOMOGRAPHY FOR THE EVALUATION OF EQUINE ARTICULAR CARTILAGE Osteoarthritis and articular cartilage injury are substantial problems in horses causing joint pain, lameness and decreased athleticism resonant of the afflictions that occur in humans. This debilitating joint disease causes progressive articular cartilage degeneration and coupled with a poor capacity to heal necessitates that articular cartilage injury is detected early before irreparable damage ensues. The use of diagnostic imaging is critical to identify and characterize articular cartilage injury, though currently available methods are unable to identify these early degenerative changes. Cationic contrast-enhanced computed tomography (CECT) uses a cationic contrast media (CA4+) to detect the early molecular changes that occur in the extracellular matrix. Glycosaminoglycans (GAGs) within the extracellular matrix are important for the providing the compressive stiffness of articular cartilage and their degradation is an early event in the development of osteoarthritis. Cationic CECT imaging capitalizes on the electrostatic attraction between CA4+ and GAGs; exposing the proportional relationship between the amount of GAGs present within and the amount of CA4+ that diffuses into the tissue. The amount of CA4+ that resides in the tissue is then quantified through CECT imaging and estimates tissue integrity through nondestructive assessment.
    [Show full text]
  • Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers
    Magn Reson Med Sci ©2015 Japanese Society for Magnetic Resonance in Medicine MAJOR PAPER E-pub ahead of print by J-STAGE doi:10.2463/mrms.2015-0005 Intraindividual Crossover Comparison of Gadoxetic Acid Dose for Liver MRI in Normal Volunteers 1,2 1,3 1 4 Utaroh MOTOSUGI *, Peter BANNAS ,DiegoHERNANDO , Mahdi SALMANI RAHIMI , 5 1,4,6–8 James H. HOLMES , and Scott B. REEDER 1Department of Radiology, University of Wisconsin, Madison, WI 53792-3252, USA 2Department of Radiology, University of Yamanashi, Yamanashi, Japan 3Department of Radiology, University Hospital Hamburg-Eppendorf, Hamburg, Germany 4Department of Biomedical Engineering, University of Wisconsin, Madison, USA 5Global MR Applications and Workflow,GEHealthcare,Madison,USA 6Department of Medical Physics, University of Wisconsin, Madison, USA 7Department of Medicine, University of Wisconsin, Madison, USA 8Department of Emergency Medicine, University of Wisconsin, Madison, USA (Received January 15, 2015; Accepted March 25, 2015; published online June 23, 2015) Purpose: We performed a quantitative intraindividual comparison of the performance of 0.025- and 0.05-mmol/kg doses for gadoxetic acid-enhanced liver magnetic resonance (MR) imaging. Materials and Methods: Eleven healthy volunteers underwent liver MR imaging twice, once with a 0.025- and once with a 0.05-mmol/kg dose of gadoxetic acid. MR spectrosco- py and 3-dimensional gradient-echo T1-weighted images (3D-GRE) were obtained before and 3, 10, and 20 min after injection of the contrast medium to measure T1 and T2 values and signal-to-noise ratio (SNR) and contrast-to-noise ratio (CNR) performance. During the dynamic phase, highly time-resolved 3D-GRE was used to estimate the relative CNR (CNRrel) of the hepatic artery and portal vein (PV) to the liver.
    [Show full text]
  • Accuracy of Gadoteridol Enhanced MR-Angiography in the Evaluation Of
    Zaccagna et al. Neurovascular Imaging (2015) 1:9 DOI 10.1186/s40809-015-0009-7 RESEARCH ARTICLE Open Access Accuracy of gadoteridol enhanced MR- angiography in the evaluation of carotid artery stenosis Fulvio Zaccagna1, Beatrice Sacconi1, Luca Saba2, Isabella Ceravolo1, Andrea Fiorelli1, Iacopo Carbone1, Alessandro Napoli1, Michele Anzidei1* and Carlo Catalano1 Abstract Background: To compare image quality and diagnostic performance of Gadoteridol-enhanced MR angiography (MRA) with Gadobutrol-enhanced MRA in the evaluation of carotid artery stenosis. Methods: MRA was performed in 30 patients with carotid stenosis diagnosed at DUS. Patients were randomly assigned to group A (Gadobutrol-enhanced MRA) or group B (Gadoteridol-enhanced MRA). All examinations were performed with a 3T MR system. Image quality was assessed qualitatively by a 3-grade scale and quantitatively with SNR measurements. Diagnostic performance in the assessment of stenosis, plaque length and morphology was evaluated in the two MRA groups by accuracy calculation and RoC curves analysis using CTA as reference standard. Statistically significant differences in SNR and quality scale were evaluated by the Independent-Samples T Test and Mann–Whitney test, while the Z-statistics was used to compare diagnostic accuracy in the two groups. Results: Image quality was graded adequate to excellent for both GBCAs, without significant differences (p = 0.165). SNR values were not significantly different in group B (Gadoteridol-enhanced MRA) as compared to group A (Gadobutrol-enhanced MRA) (89.32 ± 70.4 vs 81.09 ± 28.38; p = 0.635). Diagnostic accuracy was 94 % for the evaluation of stenosis degree and 94 % for the identification of ulcerated plaques in group A, while it was 93 % for the evaluation of stenosis degree and 76 % for the identification of ulcerated plaques in group B, without statistically significant differences (p = 0.936).
    [Show full text]
  • Gadofosveset-Enhanced Magnetic Resonance Imaging As a Problem-Solving Tool for Diagnosing Colorectal Liver Metastases: a Case Report
    363 Case Report Gadofosveset-enhanced magnetic resonance imaging as a problem-solving tool for diagnosing colorectal liver metastases: a case report Helen Cheung, Paul Karanicolas, Natalie Coburn, Calvin Law, Laurent Milot Sunnybrook Health Sciences Centre, University of Toronto, Canada Correspondence to: Helen Cheung. Sunnybrook Health Sciences Centre, University of Toronto, Canada. Email: hmc.cheung@mail.utoronto.ca. Abstract: Due to significant improvements in morbidity and mortality, surgery with curative intent is now the standard of care for patients with colorectal liver metastases who are surgical candidates. As a result, highly accurate preoperative per-lesion diagnosis is crucial. However, in some instances, this remains limited with standard techniques, including magnetic resonance imaging (MRI) with conventional contrast agents. Delayed retention of contrast of fibrotic liver metastases on MRI with extracellular contrast agents may mimic the late retention of contrast in hemangiomas and represent a diagnostic pitfall that limits diagnosis. Early preliminary work suggests that this imaging pitfall may not be seen on MRI with intravascular contrast agents (e.g., gadofosveset). This case report describes a surgical patient with colorectal liver metastases where gadofosveset-enhanced liver MRI was helpful in determining patient management. Keywords: Colorectal cancer; metastases; liver; gadofosveset; contrast agent Submitted Dec 21, 2017. Accepted for publication Jan 17, 2018. doi: 10.21037/qims.2018.01.06 View this article at: http://dx.doi.org/10.21037/qims.2018.01.06 Introduction but this remains limited, possibly due to delayed retention of contrast of some fibrotic liver metastases, which mimics Colorectal cancer is the second leading cause of cancer benign hemangiomas (5).
    [Show full text]
  • Injection of Contrast Media V7 – 2010 13 5
    ACR Manual on Contrast Media Version 8 2012 ACR Committee on Drugs and Contrast Media ACR Manual on Contrast Media Version 8 2012 ACR Committee on Drugs and Contrast Media © Copyright 2012 American College of Radiology ISBN: 978-1-55903-009-0 Table of Contents Topic Last Updated Page 1. Preface. V8 – 2012 . 3 2. Introduction . V7 – 2010 . 4 3. Patient Selection and Preparation Strategies . V7 – 2010 . 5 4. Injection of Contrast Media . V7 – 2010 . 13 5. Extravasation of Contrast Media . V7 – 2010 . 17 6. Adverse Events After Intravascular Iodinated Contrast Media . V8 – 2012 . 21 Administration 7. Contrast Media Warming . V8 – 2012 . 29 8. Contrast-Induced Nephrotoxicity . V8 – 2012 . 33 9. Metformin . V7 – 2010 . 43 10. Contrast Media in Children . V7 – 2010 . 47 11. Iodinated Gastrointestinal Contrast Media in Adults: Indications . V7 – 2010 . 55 and Guidelines 12. Adverse Reactions to Gadolinium-Based Contrast Media . V7 – 2010 . 59 13. Nephrogenic Systemic Fibrosis (NSF) . V8 – 2012 . 63 14. Treatment of Contrast Reactions . V8 – 2012 . 73 15. Administration of Contrast Media to Pregnant or Potentially . V6 – 2008. 75 Pregnant Patients 16. Administration of Contrast Media to Breast-Feeding Mothers . V6 – 2008 . 79 Table 1 – Indications for Use of Iodinated Contrast Media . V6 – 2008 . 81 Table 2 – Organ or System-Specific Adverse Effects from the Administration . V7 – 2010 . 82 of Iodine-Based or Gadolinium-Based Contrast Agents Table 3 – Categories of Reactions . V7 – 2010 . 83 Table 4 – Management of Acute Reactions in Children . V7 – 2010 . 84 Table 5 – Management of Acute Reactions in Adults . V6 – 2008 . 86 Table 6 – Equipment for Emergency Carts . V6 – 2008 .
    [Show full text]
  • Lääkealan Turvallisuus- Ja Kehittämiskeskuksen Päätös
    Lääkealan turvallisuus- ja kehittämiskeskuksen päätös N:o xxxx lääkeluettelosta Annettu Helsingissä xx päivänä maaliskuuta 2016 ————— Lääkealan turvallisuus- ja kehittämiskeskus on 10 päivänä huhtikuuta 1987 annetun lääke- lain (395/1987) 83 §:n nojalla päättänyt vahvistaa seuraavan lääkeluettelon: 1 § Lääkeaineet ovat valmisteessa suolamuodossa Luettelon tarkoitus teknisen käsiteltävyyden vuoksi. Lääkeaine ja sen suolamuoto ovat biologisesti samanarvoisia. Tämä päätös sisältää luettelon Suomessa lääk- Liitteen 1 A aineet ovat lääkeaineanalogeja ja keellisessä käytössä olevista aineista ja rohdoksis- prohormoneja. Kaikki liitteen 1 A aineet rinnaste- ta. Lääkeluettelo laaditaan ottaen huomioon lää- taan aina vaikutuksen perusteella ainoastaan lää- kelain 3 ja 5 §:n säännökset. kemääräyksellä toimitettaviin lääkkeisiin. Lääkkeellä tarkoitetaan valmistetta tai ainetta, jonka tarkoituksena on sisäisesti tai ulkoisesti 2 § käytettynä parantaa, lievittää tai ehkäistä sairautta Lääkkeitä ovat tai sen oireita ihmisessä tai eläimessä. Lääkkeeksi 1) tämän päätöksen liitteessä 1 luetellut aineet, katsotaan myös sisäisesti tai ulkoisesti käytettävä niiden suolat ja esterit; aine tai aineiden yhdistelmä, jota voidaan käyttää 2) rikoslain 44 luvun 16 §:n 1 momentissa tar- ihmisen tai eläimen elintoimintojen palauttami- koitetuista dopingaineista annetussa valtioneuvos- seksi, korjaamiseksi tai muuttamiseksi farmako- ton asetuksessa kulloinkin luetellut dopingaineet; logisen, immunologisen tai metabolisen vaikutuk- ja sen avulla taikka terveydentilan
    [Show full text]
  • Active Moiety Name FDA Established Pharmacologic Class (EPC) Text
    FDA Established Pharmacologic Class (EPC) Text Phrase PLR regulations require that the following statement is included in the Highlights Indications and Usage heading if a drug is a member of an EPC [see 21 CFR 201.57(a)(6)]: Active Moiety Name “(Drug) is a (FDA EPC Text Phrase) indicated for [indication(s)].” For each listed active moiety, the associated FDA EPC text phrase is included in this document. For more information about how FDA determines the EPC Text Phrase, see the 2009 "Determining EPC for Use in the Highlights" guidance and 2013 "Determining EPC for Use in the Highlights" MAPP 7400.13.
    [Show full text]
  • Application for Inclusion of Gadolinium-Based Contrast Agents to the WHO
    Application for inclusion of Gadolinium‐based contrast agents to the WHO Essential List of Medicines Submitted by Daniel Patiño, PhD (McMaster) Faculty of Medicine University of Antioquia, Medellin, Colombia Holger J. Schünemann, MD, PhD Chair and Professor, Departments of Clinical Epidemiology and Biostatistics Co‐Director, WHO Collaborating Center for Evidence Informed Policy, McMaster University Potential conflicts of interest Dr. Patiño and Dr. Schünemann declare that they have no COI. Date: Dec 15, 2014 1 Application to add Gadolinium‐based contrast agents to the WHO Essential List of Medicines 1. Summary statement of the proposal for inclusion, change or deletion Currently the 18th edition of WHO Model List of Essential Medicines does not include gadolinium‐based contrast agents (Gd‐CAs) under 14.2 radio contrast media classification. Since the introduction of gadopentate dimeglumine in 1988, gadolinium‐based contrast agents have significantly improved the diagnostic efficacy of Magnetic Resonance Image (MRI) (1). Gadolinium‐based contrast agents are intravenous agents used for contrast enhancement with magnetic resonance imaging (MRI) and with magnetic resonance angiography (MRA). The Gd‐CAs are available for different types of MR scan varying from product to product, including liver, brain and whole body scan. This application proposes to add Gd‐CAs for the complementary list of WHO Essential List of Medicines to be used in the detection of lymph node metastases. It will focus on the following ‘general purpose’ Gd‐CAs: gaodopentate dimeglumine, gadodiamide, gadoversetamide, gadobenate dimeglumine, gadoteridol, gadoteric acid, gadobutrol. We will not include the ‘newer’ Gd‐CAs that are organ specific like the hepatobiliary‐specific contrast agents that are available for imaging the liver (e.g., gadoxetic acid).
    [Show full text]