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Photoacoustics has been broadly studied in biomedicine, for both human and small animal tissues. Photoacoustics uniquely combines the absorption contrast of light or radio frequency waves with ultrasound resolution. Moreover, it is non-ionizing and non-invasive, and is the fastest growing new biomedical method, with clinical applications on the way. This review provides a brief recap of recent developments in photoacoustics in biomedicine, from basic principles to applications. The emphasized areas include the new imaging modalities, hybrid detection methods, photoacoustic contrast agents and the photoacoustic Doppler effect, as well as translational research topics.

Abstract This study was conducted to re-evaluate the utility of subendometrial enhancement (SEE) in assessing the interface between the endometrium and myometrium. In total, 110 women who underwent pelvic magnetic resonance imaging (MRI) for non-endometrial gynecologic diseases were enrolled in this prospective study. Two radiologists independently assessed the presence or absence of subendometrial enhancement (SEE) on dynamic contrast-enhanced (CE) MRI. A subgroup analysis was performed to evaluate the impact of menstrual status on the detection of SEE. Identified areas of SEE were rated using a 4-point Likert scale to determine their reliability in assessing the interface between the endometrium and myometrium. SEE was identified in 44.5% (49/110) of cases by radiologist 1 and in 39.1% (43/110) by radiologist 2. A subgroup analysis indicated no significant differences in the detection of SEE based on menstrual status. The identified areas of SEE were deemed reliable for assessing the interface between the endometrium and myometrium in 24.5% (12/49) of the cases evaluated by radiologist 1 and in 32.6% (14/43) of those evaluated by radiologist 2. Among the 110 women studied, reliable areas of SEE for assessing the interface between the endometrium and myometrium were observed in 10.9% (n = 12) by radiologist 1 and 12.7% (n = 14) by radiologist 2. The evaluation of SEE using dynamic CE MRI may be limited in its ability to assess the interface between the endometrium and myometrium.

Abstract This study aimed to evaluate the impact of contrast media application on CT attenuation of the bone using a novel calcium-only imaging technique (VCa) from dual-layer spectral detector CT (DLCT), which enables CT-based bone mineral density measurement unimpeded by soft tissue components. For this, true non-contrast (TNC) and venous phase images (VP) of n = 97 patients were acquired. CT attenuation of the first lumbar vertebra (L1) was measured in TNC-VCa, VP-VCa, and in virtual non-contrast images (VNC). CT attenuation was significantly higher in VP-VCa than in TNC-VCa (p

Contrast-induced nephropathy is one of the serious complications in patients with renal dysfunction who underwent administration of intravascular contrast media. To overcome this, an approach of drastic reductions in contrast volume and the use of intravascular ultrasound has been adopted in some clinical cases. This report emphasizes the potential benefits of zero-contrast multivessel percutaneous coronary intervention in a patient presenting with acute-on-chronic kidney disease.

Background Contrast media administration during diagnostic and invasive procedures in high risk patients for nephrotoxicity is a common problem in clinical practice. Radiological procedures using intravascular iodinated contrast injection media have been widely used for therapeutic purposes. Contrast-induced nephropathy (CIN) is a serious complication of angiographic procedures and results from administration of contrast media (CM), which increases morbidity and mortality rates. Case Description We present these 10 cases with high risk of CIN and diverse characteristics. A new generation iso-osmolar CM (iodixanol) was administered in these cases. Three of the cases experienced CIN events, where one patient experienced an improvement in his condition, but two other patients experienced complications and eventually died due to the underlying disease. The other 6 cases did not experience CIN after receiving CM, which was due to better preparation beforehand. One patient with a history of regular hemodialysis, underwent immediate post-operative dialysis with CM, and no evaluation of the incidence of CIN was required. Conclusion Of the 10 cases observed, 3 of them experienced CIN which was caused by the severity of the patient’s condition and lack of preparation time before the CM procedure. Management of CIN is complex, starting from the pre-treatment evaluation until 72 hours or more after the CM procedure. This case series suggests that even new generation CM (including iodixanol) may be severely nephrotoxic, when administered to high risk patients. The amount of CM given must be below the maximum limit and adjusted to the patient’s condition. Additionally, we review the complex mechanisms involved in management of CM nephrotoxicity.

ABSTRACT Introduction and objectives: Contrast-induced-acute kidney injury (CI-AKI) is a potential complication of angiographic procedures. The DyeVert Contrast Reduction system (Osprey Medical, United States) is a device to reduce the concentration of contrast medium (CM) in the kidneys by decreasing the amount of CM delivered to patients. Unlike manual systems, few data are available on the DyeVert Power XT system, which is used in conjunction with automated contrast injection. The main aim of our study was to evaluate its effectiveness during percutaneous coronary interventions (PCI). Methods: Between 2020 and 2022, 101 patients who underwent PCI with the DyeVert Power XT system (case group) were enrolled to evaluate the amount of CM saved through the use of this device, as well as the rate, severity, and predictors of CI-AKI. Patients who underwent PCI without the use of the device (control group) were enrolled to create a matched group allowing assessment of differences in CM and the CI-AKI rate. Results: : In the case group, the amount of CM saved was 114 ± 42 mL, representing an average of 32% of the total CM. Fourteen patients (13.9%) developed CI-AKI. The only independent predictors of CI-AKI were hematocrit (OR, 0.86; 95%CI, 0.74-0.99; P = .04) and ejection fraction (OR, 0.88; 95%CI, 0.82-0.95; P = .001). As a result of diversion by the device, the amount of CM delivered was lower in the case group than in controls (252 vs 267 mL; P = .42), but this difference was nonsignificant. Equally, the reduction in CI-AKI (14.3% vs 16.3%) was nonsignificant. Conclusions: Hematocrit and ejection fraction may be more important predictors of CI-AKI than the CM volume normally used during PCI in the general population. The net practical benefit of DyeVert Power XT was low.

Study Design A prospective longitudinal cohort study. Purpose To evaluate the efficacy of two different techniques of transforaminal epidural steroid injection (TFESI) with contrast and without contrast in treating lumbar radiculopathy. Overview of Literature Epidural injections are one of the most frequently used nonsurgical treatment options for managing lumbar radiculopathy. This study aims to simplify the TFESI technique, which is effective and requires less effort to replicate. Methods We collected data on 118 patients who underwent TFESI without contrast versus TFESI with contrast for lumbar radiculopathy. The pain was evaluated using a Numerical Rating Scale (NRS) for pain at 5 minutes, 2 hours, 2 weeks, and 2 months. The functional status was assessed using the Oswestry Disability Index (ODI) score. The operation time and fluoroscopic dosage were also measured using this score. Results Two groups of patients with radiculopathy were studied, comprising of 56 patients in the non-contrast group (NC group) and 62 patients in the contrast group (C group). There was a significant decrease in pain, as evaluated by NRS, in the C group compared to the NC group at 5 minutes post-procedure (3.39±1.54 vs. 3.86±0.72, with a p-value of 0.039). There was no significant difference in NRS scores at 2 hours, 2 weeks, and 2 months, as well as in ODI scores. The operation time and fluoroscopic dosage were lower in the group without contrast compared to the contrast group, with 12.58±3.30 minutes per level vs. 16.70±5.94 minutes per level (p

Abstract Objective To identify the risk factors for moderate and severe contrast media extravasation and provide effective guidance to reduce the degree of extravasation injuries. Methods We observed 224 adult patients who underwent contrast media extravasation at Xiangya Hospital of Central South University, Hunan Provincial Maternal and Child Healthcare Hospital, and Xiangya Changde Hospital, Hunan Province between January 1, 2018 and December 31, 2022. Risk factors for moderate extravasation injuries were evaluated using univariate and multivariate logistic regression. Results Among 224 patients, 0 (0%) had severe, 18 (8.0%) had moderate, and 206 (92.0%) had mild contrast media extravasation injury. Multivariate logistic regression analysis revealed malignant tumors (odds ratio [OR] = 6.992, 95% confidence interval [CI]: 1.674–29.208), Iohexol (OR = 9.343, 95% CI 1.280–68.214), large-volume (> 50 mL) extravasation (OR = 5.773, 95% CI 1.350‒24.695), and injection site (back of the hand) (OR = 13.491, 95% CI 3.056–59.560) as independent risk factors for moderate injury. Conclusion Risk factors for moderate contrast media extravasation injury are malignant tumors, iohexol, large-volume (> 50 mL) extravasation, and back-of-the-hand injection. Analysis of these risk factors can help reduce the degree of injury after extravasation. Clinical relevance statement High-risk patients with extravasation support should choose the appropriate contrast media type, avoiding back-of-the-hand injections. We recommend that patients with cancer be implanted with a high-pressure resistant central venous catheter and receive effective measures to timely detect and reduce extravasation.

Objective(s): Contrast media (CM) are used for diagnostic or therapeutic intervention purposes in medicine. The main adverse reaction after the administration of CM is contrast-induced nephropathy (CIN). This complication is the third cause of renal failure after hospital treatment. The current study is designed to investigate the possible protective effect of trans-sodium crocetinate (TSC), derived from carotenoid crocetin, against sodium amidotrizoate/meglumine amidotrizoate (SAMA) induced cytotoxicity in HEK-293 cells.Materials and Methods: HEK-293 cells were incubated with different concentrations of TSC (1, 2.5, 5, 10, 25, and 50 µM, for 48 hr) and then SAMA (7 mgI/ml, for 24 hr) was added. The cell viability, intracellular ROS, and phosphatidyl serine exposure were detected by MTT assay, DCFH-DA, and annexin V-FITC/PI method, respectively. The P-ERK/ERK ratio, apoptosis (Bax/Bcl-2 ratio and cleaved caspase-3), and autophagy (LC3 II/I ratio and beclin-1) markers in cells were evaluated by the western blot method.Results: The exposure of HEK-293 cells to SAMA reduced viability, increased apoptotic cells, enhanced ROS production, and subsequently decreased P-ERK/ERK ratio. Similarly, SAMA enhanced apoptosis (Bax/Bcl-2 ratio and cleaved caspase-3) and autophagy (LC3 II/I ratio and beclin-1) markers in HEK-293 cells. The pretreatment of cells with TSC before exposure to SAMA significantly attenuated contrast-induced cytotoxicity. TSC reduced intracellular ROS production and activated the phosphorylation of ERK. In addition, TSC decreased the levels of apoptosis and autophagy proteins. Conclusion: The pretreatment of HEK-293 cells with TSC can decrease contrast-induced cytotoxicity through antioxidant effect and modulate ERK, apoptosis, and autophagy pathways.

Aim. To assess the role of atorvastatin to the frequency of contrast-induced acute kidney injury (CI-AKI) in patients with cardiovascular diseases (CVD) undergoing computed tomography (CT) with intravenous contrast media. Materials and methods. One hundred patients with CVD undergoing CT with with intravenous contrast media administration were included in prospective observational study (ClinicalTrials.gov ID NCT04666389). Patients were divided into 3 groups 16 (15.8%) patients receiving atorvastatin at a dose of 80 mg 24 hours and 40 mg before the CT and 40 mg after; 33 (32.7%) patients 40 mg before the CT and 40 mg after; 52 (51.5%) people not receiving statin therapy. The primary endpoint was CI-AKI according to KDIGO criteria: the 25% rise (or 0.5 mg/dl) of serum creatinine from baseline assessed 4872 hours after administration of contrast media. There were 51% of men. The average age was 59.7714.4. The most frequent cardiovascular disease was hypertension 86%. Results. CI-AKI was diagnosed in 4 (3.96%) patients. At the same time, it was not possible to establish statistically significant relationships (p0.05) between risk factors and the development of CI-AKI. Statins can be a successful way to prevent this complication. Conclusion. Cardiovascular diseases may increase the risk of CI-AKI after computed tomography with intravenous contrast media administration. Therefore, it is recommended to evaluate the serum creatinine concentration in such patients.

Introduction: Pulmonary Thromboembolism (PTE) and Venous Thromboembolism (VTE) are prevalent conditions with a high mortality rate and need immediate medical attention. The initial and standard imaging techniques are Computed Tomography Pulmonary Angiography (CTPA) for the diagnosis of PTE and Colour Doppler Ultrasonography (CDUS) for Deep Vein Thrombosis (DVT). However, there can be some issues when using these two different approaches, like the requirement for a separate area and more time. With the so-called indirect Computed Tomography Venography (CTV) approach, thrombi in the deep venous system that may cause PTE can be examined right after pulmonary CT Angiography (CTA) without the need for additional contrast agent. Aim: To determine the accuracy of indirect CTV for the diagnosis of deep venous thrombosis in patients with suspected PTE. Materials and Methods: This cross-sectional study was conducted in the Department of Radiology in Government Stanley Medical College, Chennai, Tamil Nadu, India, India from June 2021 to May 2022. A total of 50 patients with a probable diagnosis of PTE and was established with CTA were included. All 50 patients underwent indirect CTV and CDU on the same day. For indirect CTV lower extremities between the iliac crest and the popliteal region were scanned without administration of extra contrast medium. Colour Doppler Ultrasound (CDUS) was considered as Gold standard. To find the efficacy of CTV in determining DVT the Receiver Operating Characteristics curve (ROC) was used. Results: Of the total 50 patients, who were enrolled in the study, 21 (42%) patients were females and 29 (58%) patients were males. The mean age of the study subjects was 43.5±12.1 years. Among these DVT was detected in 25/50 patients (50.0%) by Doppler Sonography, Similarly DVT was detected in 23/50 patients (46%) by CTV. The sensitivity of CTV was 76% and the specificity was 84%, Positive Predictive Value (PPV) of 82.6%, Negative Predictive Values (NPV) of 77.8%. The p-value and kappa value between CTV and CDUS was calculated as 0.0005 and 0.600, respectively. Conclusion: According to the results of the present study, a combined CTA indirect CTV method can determine the DVT with a moderate level of sensitivity and specificity.

The human nature of curiosity, wonder, and ingenuity date back to the age of humankind. In parallel with our history of civilization, interest in scientific approaches to unravel mechanisms underlying natural phenomena has been developing. Recent years have witnessed unprecedented growth in research in the area of pharmaceuticals and medicine. The optimism that nanotechnology (NT) applied to medicine and drugs is taking serious steps to bring about significant advances in diagnosing, treating, and preventing disease—a shift from fantasy to reality. The growing interest in the future medical applications of NT leads to the emergence of a new field for nanomaterials (NMs) and biomedicine. In recent years, NMs have emerged as essential game players in modern medicine, with clinical applications ranging from contrast agents in imaging to carriers for drug and gene delivery into tumors. Indeed, there are instances where nanoparticles (NPs) enable analyses and therapies that cannot be performed otherwise. However, NPs also bring unique environmental and societal challenges, particularly concerning toxicity. Thus, clinical applications of NPs should be revisited, and a deep understanding of the effects of NPs from the pathophysiologic basis of a disease may bring more sophisticated diagnostic opportunities and yield more effective therapies and preventive features. Correspondingly, this review highlights the significant contributions of NPs to modern medicine and drug delivery systems. This study also attempted to glimpse the future impact of NT in medicine and pharmaceuticals. [ABSTRACT FROM AUTHOR]

Background: Iodine-based contrast media are used to obtain contrast-enhanced computed tomography (CECT) images for better visualization of anatomical structures and improved diagnostic accuracy. These contrast agents are water soluble and are primarily eliminated through renal route. Studies on the acute effects of these agents on the hepatic function are very few in literature. This study was conducted to assess the change of serum parameters of hepatic function within 1 week of administration of the contrast agents. Aims and Objectives: The aim of the study was to study the acute effect of iodinated contrast media on liver function test. Materials and Methods: Patients attending radiology department for CECT, pre-advised by physicians as part of the treatment protocol of their specific indication were invited to participate in the study. Patients of either gender with normal kidney function test were included in the study. The study was a single-arm, observational prospective study designed to evaluate the change in liver function tests in the study participants after administration of iodinated contrast agent for CECT. All patients who participated in the study provided written informed consent (n=50). Blood sample was obtained for hepatic function tests before administration of the contrast agent and after 3–7 days of CECT. The parameters observed were serum glutamic-oxaloacetic transaminase, serum glutamic-pyruvic transaminase, alkaline phosphatase (ALP), serum bilirubin-total bilirubin, direct bilirubin, indirect bilirubin, serum protein-total protein, serum albumin, and serum globulin. Paired t-test was used to find out the significant differences between the respective blood parameters before and after the CECT. P

Background: Lowering the amount of iodinated contrast material and tube voltage may increase pulmonary artery opacification and thrombus identification without compromising picture quality. Objectives: To explore the efficiency of using lower tube voltage and a lower contrast medium dose for conducting computed tomography for pulmonary angiography (CTPA) aiming to increase its accuracy in detecting pulmonary thromboembolism (PTE). Subjects and Methods:100 patients scheduled for CTPA with a preoperative diagnosis of PTE were grouped into two: group A, (50 patients) got 1 mL/kg at 120 kV and group B, (50 patients) received 0.5 mL/kg at 80 kV.The technique of bolus tracking was implemented.Values of midpoint of multiple pulmonary artery divisions were used to assess attenuation.Significant values are those that exceed 300 Hounsfield units (HU). The dosage of radiation received by the patient, defined as the effective dose, was compared between groups. Results: Total mean attenuationdata for the pulmonary arteries have shown to be substantially greater in group-B compared to group-A (39110.4HU vs. 335.97.9HU, P=0.001). Moreover, total dose length product (DLP) values were substantially lower in group-B (934.9 mGy.cm vs. 384.443 mGy.cm, P=0.001). While effective dose values have shown to be significantly lower in group-B (2.90.3 mSv vs. 13.21.8 mSv, P 0.001). Conclusion: Low-kilovoltage technique and low quantity of iodinated contrast are useful in conducting (CTPA) with high accuracy in detection of pulmonary thromboembolism.

Acute kidney injury (AKI) is a significant predictor of mortality in patients who underwent transcatheter aortic valve replacement (TAVR). Early identification and management of AKI can mitigate further complications and improve survival. The incidence and predictors of acute kidney injury in patients with TAVR were evaluated in different studies. Our aim is to evaluate EuroSCORE II and STS score in terms of predicting AKI following TAVR. One hundred and five patients who underwent TAVR procedure due to severe aortic stenosis in our clinic were retrospectively screened. Demographic, laboratory, echocardiographic and procedural data were collected retrospectively. AKI was defined according to the valve academic research consortium-2 (VARC-2). Sixty-five (61.9%) patients out of 105 were females with a mean age of 77.00 ±4.88 years. AKI developed in 31.4% of all patients who underwent TAVR. The mean ±standard deviation (SD) STS score was 8.03±2.30 while mean ±SD EuroSCORE II was 10.93±7.53. Mean±SD STS score and EuroSCORE II were 14.35±7.66 and 22.34 ±6.07 in patients who developed AKI respectively and 5.26 ±2.41 and 4.88 ±3.07 respectively in those who did not develop AKI. Multivariate analysis revealed that STS (odds ratio: 1.30; 95% CI: 1.04 to 1.62; p=0.02) and EuroSCORE II (odds ratio: 1.26; 95% CI: 1.10 to 1.44; p=0.001) were independent predictors of AKI. A EuroSCORE cut-off value of 6.16 exhibited a 91% sensitivity and 68% specificity while STS score cut-off value of 6.30 showed 84% sensitivity and 75% specificity in predicting AKI following TAVR. STS score and EuroSCORE II which were developed for the prediction of postoperative mortality may be the predictors of AKI in patients following TAVR. [Med-Science 2021; 10(3.000): 905-11]

Introduction: Contrast-induced nephropathy is one of the most serious adverse effects of radiocontrast agents usage. It is currently listed in the literature as the third most common cause of iatrogenic acute kidney injury. Aim of the study: The aim of this study is to provide an overview of the extent, severity and prevention of CIN. It is to shed a broader light on this disease entity and be a helpful resource in the future for other clinicians struggling with CIN. Methods and materials: A literature review was conducted using the PubMed database, using the keywords: "contrast-induced nephropathy"; "acute kidney injury"; "contrast media". Results: Pathogenesis of CIN is not entirely clear. There are many risk factors being e.g. diabetes, chronic kidney disease, advanced age (patients over 75 years old). Prevention methods include restricting contrast volume to a minimum, balancing the patient's volaemia before contrast administration or perioperative saline hydration to normalise volaemia. Conclusion: CIN is a significant health problem, which can be a life threat. Despite the fact that the exact pathogenesis of the condition still remains unknown, the CIN prophylaxis becomes more and more effective due to better recognition of risk factors and the usage of adequate prevention measures appropriate to the patients' condition. More studies, with larger test groups, are needed to better define both the pathomechanism of contrast-induced acute kidney injury and new, more effective ways of prevention and treatment of this condition.

The use of conventional contrast media for diagnostic purposes (in particular, Gd-containing and iodinated agents) causes a large number of complications, the most common of which is contrast-induced nephropathy. It has been shown that after exposure to contrast agents, oxidative stress often occurs in patients, especially in people suffering from various diseases. Antioxidants in the human body can diminish the pathological consequences of the use of contrast media by suppressing oxidative stress. This review considers the research studies on the role of antioxidants in preventing the negative consequences of the use of contrast agents in diagnostics (mainly contrast-induced nephropathy) and the clinical trials of different antioxidant drugs against contrast-induced nephropathy. Composite antioxidant/contrast systems as theranostic agents are also considered.

Objective: To evaluate the effect of contrast enhanced abdominopelvic magnetic resonance imaging (MRI), using a 3 Tesla scanner, on expression and methylation level of ATM and AKT genes in human peripheral blood lymphocytes. Materials and Methods: In this prospective in vivo study, blood samples were obtained from 20 volunteer patients with mean age of 43 ± 8 years (range 32-68 years) before contrast enhanced MRI, 2 hours and 24 hours after contrast enhanced abdominopelvic 3 Tesla MRI. After separation of mononuclear cells from peripheral blood, using Ficoll-Hypaque, we analyzed gene expression changes of ATM and AKT genes 2 hours and 24 hours after MRI using quantitative reverse transcription polymerase chain reaction (qRT-PCR). We also evaluated methylation percentage of the above mentioned genes in before, 2 hours and 24 hours after MRI, using MethySYBR method. Results: Fold change analysis, in comparison with the baseline, respectively showed 1.1 ± 0.7 and 0.8 ± 0.5 mean of gene expressions in 2 and 24 hours after MRI for ATM, while the results were 1.4 ± 0.6 and 1.4 ± 1 for AKT (P>0.05). Methylation of the ATM gene promoter were 8.8 ± 1.5%, 9 ± 0.6% and 9 ± 0.8% in before contrast enhanced MRI, 2 and 24 hours after contrast enhanced MRI, respectively (P>0.05). Methylation of AKT gene promoter in before contrast enhanced MRI, 2 hours and 24 hours after contrast enhanced MRI was 5.4 ± 2.5, 5 ± 3.2, 4.9 ± 2.9 respectively (P>0.05). Conclusion: Contrast enhanced abdominopelvic MRI using 3 Tesla scanner apparently has no negative effect on the expression and promoter methylation level of ATM and AKT genes involved in the repair pathways of genome.

Objective: Evaluate th0e diagnostic performance of abdominal tomography without oral contrast medium in patients with abdominal pain. Materials and methods: Abdominal tomographies of patients with abdominal pain were included, between September 1 and December 31, 2015 at the Hospital Universitario San Vicente Fundación. For the analysis of the tomographies with or without oral contrast, the definitive diagnostic result in the surgical intervention or by clinical diagnosis was considered as a reference test. We calculated the sensitivity, specificity and positive and negative predictive values with their respective 95% confidence intervals for tomography with and without oral contrast. Results: 128 abdominal tomographies, 91 with oral contrast and 37 without this type of contrast were evaluated. The tomography without oral contrast had a sensitivity and specificity very similar to the tomography with contrast, with values of 84% and 91.6%, respectively. Conclusion: The performance of the tomography with oral contrast was similar to the tomography without oral contrast, with values close to 90%. The acquisition of tomography with oral contrast took almost 3 times longer than that required in the studies without oral contrast.

Abstract Background Fetal surgery is increasingly performed to correct congenital defects. Currently, fetal brain perfusion cannot be assessed intra-operatively. The purpose of this study was to determine if contrast-enhanced ultrasound (CEUS) could be used to monitor fetal cerebral perfusion during fetal surgery and if parameters correlate with fetal hemodynamics or acid/base status. Methods Cannulated fetal sheep were insufflated with carbon dioxide gas in an extra-uterine support device and in utero to mimic fetal surgery. Fetal heart rate, mean arterial pressure, and arterial blood gases were serially measured. CEUS examinations of the brain were performed and time-dependent metrics were quantified to evaluate perfusion. The relationships between measured parameters were determined with mixed linear effects models or two-way repeated measures analysis of variance. Results 6 fetal sheep (113 ± 5 days) insufflated at multiple time-points (n = 20 experiments) in an extra-uterine support device demonstrated significant correlations between time-dependent perfusion parameters and fetal pH and carbon dioxide levels. In utero, 4 insufflated fetuses (105 ± 1 days) developed hypercarbic acidosis and had reductions in cerebral perfusion parameters compared to age-matched controls (n = 3). There was no significant relationship between cerebral perfusion parameters and fetal hemodynamics. Conclusions CEUS-derived cerebral perfusion parameters can be measured during simulated fetal surgery and strongly correlate with fetal acid/base status.

Background and purpose: Computed tomography scan (CT) is highly capable of diagnosing abdominal and pelvic lesions. Injection of contrast media at appropriate concentration and volume provides the least side effects and the highest image quality. This study aimed at investigating the volume of contrast medium injected and the level of image contrast compared to the standard model, in the imaging department of referral hospitals in Mazandaran province, Iran. Materials and methods: In this quantitative descriptive study, CT scan imaging protocols in abdominal examinations and physical characteristics of the patients were recorded The difference in the volume injected of contrast media were compared between conventional method and standard method. Several CT scan images with different contrast levels were divided into four image quality groups by two experienced radiologists based on the ratio of contrast to image noise (CNR) of the organs. The percentage of adherence of the centers to the standard method and the percentage of each image quality group was calculated using descriptive statistics. Results: The CT scan imaging centers showed low adherence (37%) to the standard method (weight-based injection). Among the images investigated, 51.6% had excellent and good contrast levels. There was no correlation between patients’ weight and the volume of contrast medium injected (P

ABSTRACT Introduction and objectives: Between 10% and 25% of patients hospitalized due to an acute coronary syndrome develop acute kidney injury, a condition associated with higher morbidity and mortality rates. Scores have been developed to predict the occurrence of post-coronary angiography contrast-induced nephropathy (CIN) in patients with acute coronary syndrome. The objective of this study was to assess the association between microalbuminuria and post-coronary angiography CIN in patients with acute coronary syndrome. Methods: Patients admitted with acute coronary syndrome in whom a coronary angiography was performed during their hospitalization and with urinary albumin-to-creatinine ratio (ACR) assessment within the first 24 hours were analyzed. The best ACR cutoff value for coronary angiography-induced CIN was determined using the C-statistic measure. The receiver operating characteristic (ROC) curves were built to compare between the predictive ability of the Mehran score alone and also in combination with the ACR. Results: A total of 148 patients were analyzed. Median age was 64 years (56-73), 35% were women, mean creatinine clearance rate at admission was 86 mL/min (66-107) and the ACR was 5 mg/g (0-14). The analysis showed that 9.6% of the patients developed post-coronary angiography CIN with ACR levels ≥ 20 mg/g compared to 1.6% when these levels were < 20 mg/g. The area under the ROC curve of the Mehran score to predict the development of post-coronary angiography CIN was 0.75 (95%CI, 0.68-0.81) and when the ACR was added it went up to 0.82 (95%CI, 0.76-0.87). Conclusions: The ACR levels at admission were associated with the development of post-coronary angiography CIN and bring added value to an already validated predictive score. Therefore, the ACR should be used as a simple and accessible tool to detect and prevent this severe complication in patients with acute coronary syndrome.

Abstract:Background and aims: Contrast-induced nephropathy (CIN) is one of the most common reasons for acute kidney failure. Because of the increasing use of contrasts for computed tomography and angiography and coronary interventions, the incidence of CIN is on rise. CIN is a serious and common side effect ofthe use of contrasts. Despite taking of preventative measures, around 30-70% of patients are at risk of CIN. Researchers thus are seeking out appropriate approaches to prevent CIN. Positive effects of many medicinal plants, with antioxidant and anti-inflammatory properties and high efficiency and safety, in decreasing serum creatinine levels have been demonstrated. This study was conducted to collect evidence on the medicinal plants that are effective in decreasing serum creatinine levels and CINdevelopmentMethods: For this purpose, the key words contrast media, herbal, acute kidney injury, and nephropathy were used to retrieve relevant articles indexed in Google Scholar, Magiran, Elsevier, and PubMed. Then, the eligible articles were included in the review.Results: The results of studies are reported in Table.Conclusion: Although some studies have suggested that some herbs have a toxic effect on kidney function, in the present review, most plants could help decrease serum creatinine levels and improve renal function.

Sulfasalazine, a non-antibiotic sulfonamide, is associated with severe hypersensitivity reactions, including Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome. We report a case of sulfasalazine-induced DRESS syndrome that relapsed following the administration of visipaque® (iodixanol). Macular rashes, pruritus, and an acute exacerbation of dyspnea were immediately observed after the administration of contrast media. It seems that patients suffering from DRESS syndrome are sensitive to the administration of other new medications with a high possibility of hypersensitive reactions. It can be concluded that iodinated contrast media should be used cautiously in patients with DRESS syndrome.

Molecular ultrasound imaging or targeted contrast-enhanced ultrasound (CEUS) is a relatively new technique that has varied applications to augment both diagnostics and therapeutics. Ultrasound contrast agents are conjugated to ligands that bind with specific biomarkers in the areas of interest which can then be quantified using ultrasound technology. This technique has numerous clinical applications including studying pathophysiology of disease, improving diagnostic sensitivity and specificity, and improving localized drug delivery. This technology, most notably, has proven useful in numerous oncologic and cardiovascular applications. Given ultrasound’s advantages over other radiographic studies including its low cost, lack of ionizing radiation, portability, ability to provide real-time imaging, and non-invasiveness, recent investigations have expanded the utility of molecular ultrasound. In this review, we briefly review targeted ultrasound contrast agents and explore the current applications of molecular ultrasound as well as future applications based on the currently published literature.

Frequency of Contrast Nephropathy after Intravenous Contrasted Computerized Tomography Scan in The Patients Admitted to Emergency DepartmentObjective: In this study, we aimed to determine contrast nephropathy incidence in patients who admitted to emergency department and got intravenous contrasted computerized tomography scan. Materials and Methods: Medical records patients who admitted to the emergency department between October 2013 and October 2014 and underwent intravenous contrasted computerized tomography scan were examined. 142 patients over 16 years old were included in our study. Patient data on demographics, clinical and laboratory findings, previous diagnoses, prognoses and prophylactic treatments were collected and examined. Results: 50,7 % of the patients were female and 49,3 % were male. The mean age was 52,0. 11,2 % of the patients had contrast nephropathy. When the patients were examined separately at 72th and 120th hours, the incidence of radiocontrast nephropathy was found as 9,2 % and 8,5 %, respectively. Women and patients who had diabetes mellitus, low glomerular filtration rate and malignancy were found to have a high risk for contrast nephropathy.Conclusion: Intravenous contrast usage has increased in emergency departments. Appropriate risk assessment should be made and prophylactic treatment should be administered to the patients with high risk. Also, serum creatinine values should be examined before intravenous contrast administration and should be monitored closely after the exposure.

Wellens syndrome (WS) is identified by ECG changes in the precordial leads after resolution of angina chest pain. WS indicates critical stenosis of the proximal left anterior descending (LAD) artery. On the other hand, Kounis syndrome (KS) is an allergic reaction to various substances resulting in acute coronary syndrome. Contrast media can trigger the allergic reaction associated with KS. We describe a patient with WS who developed an allergic reaction to contrast media after percutaneous coronary intervention and experienced recurren myocardial infarction on re-exposure.

Background: The excess volume of contrast media (CM) is a marker of a more severe coronary culprit lesion and longer intervention duration in patients undergoing cardiac procedures. However, it is unclear whether the contrast volume is directly correlated with worse clinical outcomes. The aim of this study was to investigate the association between contrast dose and the incidence of 1-year major adverse cardiac and cerebrovascular events (MACCE) and all-cause bleeding events in patients undergoing cardiac catheterization and coronary angiography (CAG). Methods: We prospectively enrolled 10,961 consecutive patients diagnosed with coronary heart disease expecting CAG from 2012 to 2013. The study population was pursued with a follow-up duration of 1 year. The predictive value of contrast volume, divided into quartiles, for the risk of MACCE and all-cause bleeding events was assessed using logistic regression analysis. Results: The cumulative incidence of 1-year MACCE was 8.65%, which was directly associated with increasing contrast volume. In particular, MACCE was observed in 7.16%, 7.89%, 9.31%, and 11.73% of cases in the contrast volume quartile Q1 (≤100 ml), Q2 (101–140 ml), Q3 (141–200 ml), and Q4 (>200 ml), respectively (P < 0.001). Moreover, the incidence of 1-year all-cause bleeding events was noted in 4.70%, 5.93%, 7.28%, and 8.21% of patients in Q1, Q2, Q3, and Q4, respectively (P < 0.001). The survival analysis showed that the 1-year MACCE rate was higher in patients using greater CM volume during the CAG. CM volume used >140 ml was associated with the occurrence of 1-year MACCE, and the incidence was dramatically elevated in patients exceeding a contrast volume of 200 ml (P = 0.007). Conclusion: Our data suggested that higher contrast volume was significantly correlated with an increased risk of MACCE and all-cause bleeding events in patients undergoing cardiac catheterization. Trial Registration: ClinicalTrials.gov, NCT01735305; https://clinicaltrials.gov/ct2/show/NCT01735305?id=NCT017353057rank=1.

Background: Using contrast media is very important in diagnosis and identification of organ from the surrounding tissue. Contrast media can alter radiation absorption of studied organs following by enhanced image contrast. This study aimed to assess the influence of contrast media on treatment planning and dose calculation in radiation therapy of pelvic cancers. Methods: Six patients with pelvic area cancer with two sets of computed tomography (CT) images, one with contrast media and another without it, were studied and the effects of contrast media were studied. Findings: After using contrast media, an increase of 2.91% in monitor unit (MU) for right lateral (RL) field and decreases of 0.59%, 0.75%, and 1.47% in monitor unit anterior-posterior (AP), posterior-anterior (PA), and left lateral (LL) fields was obtained in rectum cancer, respectively. For bladder cancer, a decrease of 0.34% in monitor unit for AP filed and increases of 1.57%, 0.46%, and 0.39% in monitor unit for PA, RL and LL fields was calculated, respectively. For cervix cancer, a decrease of 1.1% for AP field and an increase of 0.68% for PA field were obtained. Conclusion: Regarding dose-volume histograms (DVHs) and calculated monitor units, the results showed that the dose differences between the plans for the CT images with and without contrast media were less than 1%. Of course to ensure the effect of contrast media on the amount of delivered dose to the target organ, study on more patients is recommended.

Contrast-induced encephalopathy (CIE) is a rare complication of angiography. Presently reported is the case of a patient diagnosed with CIE following peripheral angioplasty with the non-ionic contrast agent, iohexol. A 66-year-old male patient described intermittent claudication and peripheral arterial disease was suspected. Lower extremity angiography was performed, and following dilation of a 7.0x150-mm balloon, a 9.0x57-mm stent was placed in the lesioned vessel. The patient subsequently developed confusion and cortical blindness, and a seizure occurred 1 hour after the procedure. An emergency cerebral computed tomography scan did not reveal any signs of intracerebral hemorrhage. The neurological symptoms disappeared within 24 hours after hydration and sedative medication. CIE was diagnosed based on the patient`s clinical course findings and cerebral imaging.

Contrast-induced acute kidney injury (CI-AKI) is defined as an acute kidney failure following iodine-based contrast medium administration determining relevant health and socio-sanitary implications. Knowledge of pathophysiology, early diagnosis, and prevention in patients at risk are critical points in CI-AKI management. Determination of risk and functional kidney evaluation must precede every iodine-based contrast medium (CM) administration in order to eventually introduce medical prophylaxis. Furthermore, early laboratoristic evaluation after iodine-based CM exposure should be performed for a prompt identification of acute kidney injury. Therefore, clinicians must know and strictly follow valid recommendations to minimize the development of complications.