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David F Kallmes - One of the best experts on this subject based on the ideXlab platform.

  • frequency of acute kidney injury following Intravenous Contrast Medium administration a systematic review and meta analysis
    Radiology, 2013
    Co-Authors: Jennifer S Mcdonald, Robert J Mcdonald, Jules Comin, Eric E Williamson, Richard W Katzberg, Mohammad Hassan Murad, David F Kallmes
    Abstract:

    Controlled Contrast Medium-induced nephropathy studies demonstrate similar rates of acute kidney injury, dialysis, and death in patients who received Intravenous Contrast Medium and in control groups of patients who did not receive Contrast Medium.

  • frequency of acute kidney injury following Intravenous Contrast Medium administration a systematic review and meta analysis
    Radiology, 2013
    Co-Authors: Jennifer S Mcdonald, Robert J Mcdonald, Jules Comin, Eric E Williamson, Richard W Katzberg, Hassan M Murad, David F Kallmes
    Abstract:

    PURPOSE: To perform a systematic review and meta-analysis of controlled studies examining the incidence of acute kidney injury (AKI) and other outcomes in patients exposed to Intravenous (i.v.) Contrast Medium compared with patients who underwent an imaging examination without Contrast Medium or were otherwise unexposed (control group). MATERIALS AND METHODS: MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched for all articles published through September 2011 that contained search terms related to nephrotoxicity following Intravenous Contrast Medium administration. Two independent reviewers identified studies in which the incidence of AKI in patients exposed to i.v. Contrast Medium was directly compared with the incidence of AKI in unexposed patients through analysis of changes in serum creatinine level or estimated glomerular filtration rate 48-72 hours following imaging procedures or admission. Study characteristics and outcomes of AKI, dialysis, and mortality were extracted by using a standardized protocol. Relative risk (RR) was calculated by using random-effects models and was tested in subgroups of different patient comorbidities, Contrast Medium types, and AKI diagnostic criteria. RR results of less than 1.00 indicated that there was a higher incidence of these outcomes in the group that did not receive Contrast Medium (non-Contrast Medium group). RESULTS: Of the 1489 studies originally identified, 13 nonrandomized studies (0.9%) representing 25,950 patients met inclusion criteria. In the group that received Contrast Medium (Contrast Medium group), risk of AKI (RR = 0.79; 95% confidence interval [CI]: 0.62, 1.02; P = .07), death (RR = 0.95; 95% CI: 0.55, 1.67; P = .87), and dialysis (RR = 0.88; 95% CI: 0.23, 3.43; P = .85) was similar, compared with the risk of AKI in the non-Contrast Medium group. This pattern was observed regardless of i.v. Contrast Medium type, diagnostic criteria for AKI, or whether patients had diabetes mellitus or renal insufficiency. CONCLUSION: Controlled Contrast Medium-induced nephropathy studies demonstrate a similar incidence of AKI, dialysis, and death between the Contrast Medium group and control group. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121460/-/DC1.

  • frequency of acute kidney injury following Intravenous Contrast Medium administration a systematic review and
    2013
    Co-Authors: Jennifer S Mcdonald, Robert J Mcdonald, Jules Comin, Eric E Williamson, Richard W Katzberg, Hassan M Murad, David F Kallmes
    Abstract:

    MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched for all articles published through September 2011 that contained search terms related to nephrotoxicity following Intravenous Contrast Medium administration. Two independent reviewers identified studies in which the inci dence of AKI in patients exposed to IV Contrast Medium was directly compared with the incidence of AKI in unexposed patients through analysis of changes in serum creatinine level or estimated glomerular filtration rate 48–72 hours following imaging procedures or admission. Study characteristics and outcomes of AKI, dialysis, and mortality were extracted by using a standardized protocol. Relative risk (RR) was calculated by using random-effects models and was tested in subgroups of different patient comorbidities, Contrast Medium types, and AKI diagnostic criteria. RR results of less than 1.00 indicated that there was a higher incidence of these outcomes in the group that did not receive Contrast Medium (non–Contrast Medium group). Results: Of the 1489 studies originally identified, 13 nonrandom ized studies (0.9%) representing 25 950 patients met inclusion criteria. In the group that received Contrast Medium (Contrast Medium group), risk of AKI (RR = 0.79; 95% confidence interval [CI]: 0.62, 1.02; P = .07), death (RR = 0.95; 95% CI: 0.55, 1.67; P = .87), and dialysis (RR = 0.88; 95% CI: 0.23, 3.43; P = .85) was similar, compared with the risk of AKI in the non–Contrast Medium group. This pattern was observed regardless of IV Contrast Medium type, diagnostic criteria for AKI, or whether patients had diabetes mellitus or renal insufficiency.

Richard W Katzberg - One of the best experts on this subject based on the ideXlab platform.

  • frequency of acute kidney injury following Intravenous Contrast Medium administration a systematic review and meta analysis
    Radiology, 2013
    Co-Authors: Jennifer S Mcdonald, Robert J Mcdonald, Jules Comin, Eric E Williamson, Richard W Katzberg, Mohammad Hassan Murad, David F Kallmes
    Abstract:

    Controlled Contrast Medium-induced nephropathy studies demonstrate similar rates of acute kidney injury, dialysis, and death in patients who received Intravenous Contrast Medium and in control groups of patients who did not receive Contrast Medium.

  • frequency of acute kidney injury following Intravenous Contrast Medium administration a systematic review and meta analysis
    Radiology, 2013
    Co-Authors: Jennifer S Mcdonald, Robert J Mcdonald, Jules Comin, Eric E Williamson, Richard W Katzberg, Hassan M Murad, David F Kallmes
    Abstract:

    PURPOSE: To perform a systematic review and meta-analysis of controlled studies examining the incidence of acute kidney injury (AKI) and other outcomes in patients exposed to Intravenous (i.v.) Contrast Medium compared with patients who underwent an imaging examination without Contrast Medium or were otherwise unexposed (control group). MATERIALS AND METHODS: MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched for all articles published through September 2011 that contained search terms related to nephrotoxicity following Intravenous Contrast Medium administration. Two independent reviewers identified studies in which the incidence of AKI in patients exposed to i.v. Contrast Medium was directly compared with the incidence of AKI in unexposed patients through analysis of changes in serum creatinine level or estimated glomerular filtration rate 48-72 hours following imaging procedures or admission. Study characteristics and outcomes of AKI, dialysis, and mortality were extracted by using a standardized protocol. Relative risk (RR) was calculated by using random-effects models and was tested in subgroups of different patient comorbidities, Contrast Medium types, and AKI diagnostic criteria. RR results of less than 1.00 indicated that there was a higher incidence of these outcomes in the group that did not receive Contrast Medium (non-Contrast Medium group). RESULTS: Of the 1489 studies originally identified, 13 nonrandomized studies (0.9%) representing 25,950 patients met inclusion criteria. In the group that received Contrast Medium (Contrast Medium group), risk of AKI (RR = 0.79; 95% confidence interval [CI]: 0.62, 1.02; P = .07), death (RR = 0.95; 95% CI: 0.55, 1.67; P = .87), and dialysis (RR = 0.88; 95% CI: 0.23, 3.43; P = .85) was similar, compared with the risk of AKI in the non-Contrast Medium group. This pattern was observed regardless of i.v. Contrast Medium type, diagnostic criteria for AKI, or whether patients had diabetes mellitus or renal insufficiency. CONCLUSION: Controlled Contrast Medium-induced nephropathy studies demonstrate a similar incidence of AKI, dialysis, and death between the Contrast Medium group and control group. SUPPLEMENTAL MATERIAL: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.12121460/-/DC1.

  • frequency of acute kidney injury following Intravenous Contrast Medium administration a systematic review and
    2013
    Co-Authors: Jennifer S Mcdonald, Robert J Mcdonald, Jules Comin, Eric E Williamson, Richard W Katzberg, Hassan M Murad, David F Kallmes
    Abstract:

    MEDLINE, EMBASE, Scopus, and the Cochrane Library were searched for all articles published through September 2011 that contained search terms related to nephrotoxicity following Intravenous Contrast Medium administration. Two independent reviewers identified studies in which the inci dence of AKI in patients exposed to IV Contrast Medium was directly compared with the incidence of AKI in unexposed patients through analysis of changes in serum creatinine level or estimated glomerular filtration rate 48–72 hours following imaging procedures or admission. Study characteristics and outcomes of AKI, dialysis, and mortality were extracted by using a standardized protocol. Relative risk (RR) was calculated by using random-effects models and was tested in subgroups of different patient comorbidities, Contrast Medium types, and AKI diagnostic criteria. RR results of less than 1.00 indicated that there was a higher incidence of these outcomes in the group that did not receive Contrast Medium (non–Contrast Medium group). Results: Of the 1489 studies originally identified, 13 nonrandom ized studies (0.9%) representing 25 950 patients met inclusion criteria. In the group that received Contrast Medium (Contrast Medium group), risk of AKI (RR = 0.79; 95% confidence interval [CI]: 0.62, 1.02; P = .07), death (RR = 0.95; 95% CI: 0.55, 1.67; P = .87), and dialysis (RR = 0.88; 95% CI: 0.23, 3.43; P = .85) was similar, compared with the risk of AKI in the non–Contrast Medium group. This pattern was observed regardless of IV Contrast Medium type, diagnostic criteria for AKI, or whether patients had diabetes mellitus or renal insufficiency.

  • Intravenous Contrast Medium induced nephrotoxicity is the medical risk really as great as we have come to believe
    Radiology, 2010
    Co-Authors: Richard W Katzberg, Jeffrey H Newhouse
    Abstract:

    We believe that modern Contrast media pose only a small risk to renal function and that the creatinine thresholds (creatinine levels above which Contrast media are withheld for CT) should be increased to improve the accuracy of CT examinations.

Andrew L Warshaw - One of the best experts on this subject based on the ideXlab platform.

  • Intravenous Contrast Medium aggravates the impairment of pancreatic microcirculation in necrotizing pancreatitis in the rat
    Annals of Surgery, 1995
    Co-Authors: Jan Schmidt, T Foitzik, Andrew L Warshaw, H G Hotz, Eduard Ryschich, Heinz J Buhr, C Herfarth, E Klar
    Abstract:

    BACKGROUND: Previous reports demonstrated that radiographic Contrast Medium, as used in Contrast-enhanced computed tomography, increases acinar necrosis and mortality in experimental pancreatitis. The authors studied the possibility that these changes may be related to an additional impairment of pancreatic microcirculation. METHODS: Fifty Wistar rats had acute pancreatitis induced by intraductal glycodeoxycholic acid (10 mmol/L for 10 min) and Intravenous cerulein (5 micrograms/kg/hr for 6 hrs). After rehydration (16 mL/kg), pancreatic capillary perfusion was quantified by means of intravital microscopy at baseline before Intravenous infusion of Contrast Medium (n = 25) or saline (n = 25), and 30 and 60 minutes thereafter. In addition to total capillary flow, capillaries were categorized as high- or low-flow (> or < 1.6 nL/min). RESULTS: Pancreatic capillary flow did not change in either high- or low-flow capillaries after saline infusion. However, Contrast Medium infusion induced a significant decrease of total capillary flow (p < 0.001). Analysis according to the relative flow rate revealed that this was primarily because of a significant additional reduction of perfusion in low-flow capillaries (p < 0.0001). Furthermore, complete capillary stasis was observed in 15.9 +/- 3.4% after Contrast Medium as compared with 3.2 +/- 1.2% after saline infusion (p < 0.006). CONCLUSION: Radiographic Contrast Medium aggravates the impairment of pancreatic microcirculation in experimental necrotizing pancreatitis.

  • Intravenous Contrast Medium impairs oxygenation of the pancreas in acute necrotizing pancreatitis in the rat
    Archives of Surgery, 1994
    Co-Authors: T Foitzik, D G Bassi, Carlos Fernandezdel Castillo, Andrew L Warshaw, David W Rattner
    Abstract:

    Objective: Contrast-enhanced computed tomography is widely used to evaluate severe acute necrotizing pancreatitis (ANP) by demonstrating areas of malperfusion, which might indicate irreversible necrosis. Because of our prior finding that the Intravenous Contrast Medium (CM) accentuates the severity of ANP by promoting further necrosis and higher mortality, we sought to investigate the mechanism by which this injury is mediated. Design: Mild acute pancreatitis was induced in Sprague-Dawley rats with Intravenous caerulein hyperstimulation; and severe ANP, with Intravenous caerulein plus intraductal glycodeoxycholic acid. Control animals and rats with pancreatitis were randomized to be given Intravenous CM or saline. Main Outcome Measure: Diffuse reflectance spectroscopy was used to measure the index of hemoglobin content and oxygen saturation in pancreatic tissues in vivo. Results: Oxygen saturation of hemoglobin was increased in animals with mild acute pancreatitis (AP) (mean [±SEM], 58.7%±1.2% vs 55.2%±1.5% in control animals; P P P Conclusions: The prolonged reduction of oxygen saturation of hemoglobin in the pancreas following the administration of Intravenous CM in rats with severe ANP indicates that CM impairs the pancreatic microcirculation in necrotizing forms of AP. This may explain our previous finding that CM increases pancreatic injury and mortality in rodents with ANP, and it underlines our concern that the use of Contrast-enhanced computed tomography early in human AP may promote the evolution of pancreatic necrosis. (Arch Surg. 1994;129:706-711)

  • Intravenous Contrast Medium accentuates the severity of acute necrotizing pancreatitis in the rat
    Gastroenterology, 1994
    Co-Authors: T Foitzik, D G Bassi, Carlos Fernandezdel Castillo, David W Rattner, Jan Schmidt, Kent B Lewandrowski, Andrew L Warshaw
    Abstract:

    Background/Aims: Contrast-enhanced computed tomography (CECT) is used to show areas of decreased pancreatic perfusion in severe acute pancreatitis (AP). To evaluate possible adverse effects of the Contrast Medium (CM) on the course of AP, the impact of Intravenous CM in AP of graded severity in the rat was studied. Methods: Pancreatitis of three levels of severity was induced in Sprague-Dawley rats with Intravenous cerulein hyperstimulation plus time- and pressure-controlled intraductal infusion of saline or glycodeoxycholic acid. At 7 hours, control and pancreatitis animals received Intravenous ionic CM, nonionic CM, or saline. The principal outcome measures were 24-hour survival, trypsinogen activation peptides (TAP) in ascites, and histological acinar necrosis score. Results: There was no measurable effect of CM on the index features in control animals or animals with mild or moderate AP. In severe AP, CM caused a significant increase in mortality, ascites TAP, and necrosis score. Conclusions: Intravenous CM increases pancreatic injury when administered early in the course of severe experimental AP. Because CM may convert borderline ischemia to irreversible necrosis, CECT performed early in pancreatitis to show poor perfusion and predict areas of necrosis may depict a self-fulfilling prophecy. Early CECT should be reconsidered and perhaps avoided.

T Foitzik - One of the best experts on this subject based on the ideXlab platform.

  • Intravenous Contrast Medium aggravates the impairment of pancreatic microcirculation in necrotizing pancreatitis in the rat
    Annals of Surgery, 1995
    Co-Authors: Jan Schmidt, T Foitzik, Andrew L Warshaw, H G Hotz, Eduard Ryschich, Heinz J Buhr, C Herfarth, E Klar
    Abstract:

    BACKGROUND: Previous reports demonstrated that radiographic Contrast Medium, as used in Contrast-enhanced computed tomography, increases acinar necrosis and mortality in experimental pancreatitis. The authors studied the possibility that these changes may be related to an additional impairment of pancreatic microcirculation. METHODS: Fifty Wistar rats had acute pancreatitis induced by intraductal glycodeoxycholic acid (10 mmol/L for 10 min) and Intravenous cerulein (5 micrograms/kg/hr for 6 hrs). After rehydration (16 mL/kg), pancreatic capillary perfusion was quantified by means of intravital microscopy at baseline before Intravenous infusion of Contrast Medium (n = 25) or saline (n = 25), and 30 and 60 minutes thereafter. In addition to total capillary flow, capillaries were categorized as high- or low-flow (> or < 1.6 nL/min). RESULTS: Pancreatic capillary flow did not change in either high- or low-flow capillaries after saline infusion. However, Contrast Medium infusion induced a significant decrease of total capillary flow (p < 0.001). Analysis according to the relative flow rate revealed that this was primarily because of a significant additional reduction of perfusion in low-flow capillaries (p < 0.0001). Furthermore, complete capillary stasis was observed in 15.9 +/- 3.4% after Contrast Medium as compared with 3.2 +/- 1.2% after saline infusion (p < 0.006). CONCLUSION: Radiographic Contrast Medium aggravates the impairment of pancreatic microcirculation in experimental necrotizing pancreatitis.

  • Intravenous Contrast Medium impairs oxygenation of the pancreas in acute necrotizing pancreatitis in the rat
    Archives of Surgery, 1994
    Co-Authors: T Foitzik, D G Bassi, Carlos Fernandezdel Castillo, Andrew L Warshaw, David W Rattner
    Abstract:

    Objective: Contrast-enhanced computed tomography is widely used to evaluate severe acute necrotizing pancreatitis (ANP) by demonstrating areas of malperfusion, which might indicate irreversible necrosis. Because of our prior finding that the Intravenous Contrast Medium (CM) accentuates the severity of ANP by promoting further necrosis and higher mortality, we sought to investigate the mechanism by which this injury is mediated. Design: Mild acute pancreatitis was induced in Sprague-Dawley rats with Intravenous caerulein hyperstimulation; and severe ANP, with Intravenous caerulein plus intraductal glycodeoxycholic acid. Control animals and rats with pancreatitis were randomized to be given Intravenous CM or saline. Main Outcome Measure: Diffuse reflectance spectroscopy was used to measure the index of hemoglobin content and oxygen saturation in pancreatic tissues in vivo. Results: Oxygen saturation of hemoglobin was increased in animals with mild acute pancreatitis (AP) (mean [±SEM], 58.7%±1.2% vs 55.2%±1.5% in control animals; P P P Conclusions: The prolonged reduction of oxygen saturation of hemoglobin in the pancreas following the administration of Intravenous CM in rats with severe ANP indicates that CM impairs the pancreatic microcirculation in necrotizing forms of AP. This may explain our previous finding that CM increases pancreatic injury and mortality in rodents with ANP, and it underlines our concern that the use of Contrast-enhanced computed tomography early in human AP may promote the evolution of pancreatic necrosis. (Arch Surg. 1994;129:706-711)

  • Intravenous Contrast Medium accentuates the severity of acute necrotizing pancreatitis in the rat
    Gastroenterology, 1994
    Co-Authors: T Foitzik, D G Bassi, Carlos Fernandezdel Castillo, David W Rattner, Jan Schmidt, Kent B Lewandrowski, Andrew L Warshaw
    Abstract:

    Background/Aims: Contrast-enhanced computed tomography (CECT) is used to show areas of decreased pancreatic perfusion in severe acute pancreatitis (AP). To evaluate possible adverse effects of the Contrast Medium (CM) on the course of AP, the impact of Intravenous CM in AP of graded severity in the rat was studied. Methods: Pancreatitis of three levels of severity was induced in Sprague-Dawley rats with Intravenous cerulein hyperstimulation plus time- and pressure-controlled intraductal infusion of saline or glycodeoxycholic acid. At 7 hours, control and pancreatitis animals received Intravenous ionic CM, nonionic CM, or saline. The principal outcome measures were 24-hour survival, trypsinogen activation peptides (TAP) in ascites, and histological acinar necrosis score. Results: There was no measurable effect of CM on the index features in control animals or animals with mild or moderate AP. In severe AP, CM caused a significant increase in mortality, ascites TAP, and necrosis score. Conclusions: Intravenous CM increases pancreatic injury when administered early in the course of severe experimental AP. Because CM may convert borderline ischemia to irreversible necrosis, CECT performed early in pancreatitis to show poor perfusion and predict areas of necrosis may depict a self-fulfilling prophecy. Early CECT should be reconsidered and perhaps avoided.

Kazuhiro Kitajima - One of the best experts on this subject based on the ideXlab platform.

  • accuracy of integrated fdg pet Contrast enhanced ct in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer
    European Radiology, 2009
    Co-Authors: Erena Yamasaki, Kazuhiro Kitajima, Yasushi Kaji, Koji Murakami, Kazuro Sugimura
    Abstract:

    The purpose is to evaluate the accuracy of integrated 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET)/computed tomography ((CT) with Intravenous Contrast Medium in detecting pelvic and paraaortic lymph node metastasis in patients with uterine cancer, with surgical and histopathological findings used as the reference standard. Forty-five patients with endometrial or uterine cervical cancer underwent radical hysterectomy, including pelvic lymphadenectomy with or without paraaortic lymphadenectomy, after PET/CT. PET/CT findings were interpreted by two experienced radiologists in consensus. The criterion for malignancy on PET/CT images was increased tracer uptake by the lymph node, independent of node size. The overall node-based sensitivity, specificity, PPV, NPV and accuracy of PET/CT for detecting nodal metastases were 51.1% (23/45), 99.8% (1,927/1,931), 85.2% (23/27), 98.9% (1,927/1,949) and 98.7% (1,950/1,976), respectively. The sensitivity for detecting metastatic lesions 4 mm or less in short-axis diameter was 12.5% (2/16), that for between 5 and 9 mm was 66.7% (16/24), and that for 10 mm or larger was 100.0% (5/5). The overall patient-based sensitivity, specificity, positive predictive value ((PPV), negative predictive value (NPV), and accuracy were 50% (6/12), 90.9% (30/33), 66.7% (6/9), 83.3% (30/36) and 80.0% (36/45), respectively. Integrated FDG-PET/Contrast-enhanced CT is superior to conventional imaging, but only moderately sensitive in predicting lymph node metastasis preoperatively in patients with uterine cancer.