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"Reimer, Peter"
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Post-contrast acute kidney injury – Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors
PurposeThe Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.Areas covered in part 1Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs.Key Points• PC-AKI is the preferred term for renal function deterioration after contrast medium.• PC-AKI has many possible causes.• The risk of AKI caused by intravascular contrast medium has been overstated.• Important patient risk factors for PC-AKI are CKD and dehydration.
Journal Article
Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients
ObjectivesThe Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.Areas covered in part 2Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium.Key points• In CKD, hydration reduces the PC-AKI risk• Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis• No drugs have been consistently shown to reduce the risk of PC-AKI• Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m2• Dialysis schedules need not change when intravascular contrast medium is given
Journal Article
Contrast induced nephropathy: updated ESUR Contrast Media Safety Committee guidelines
Purpose
The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN).
Areas covered
Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic measures used to reduce the incidence of CIN, and the management of patients receiving metformin.
Key Points
• Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed.
• CIN risk is lower with intravenous than intra-arterial iodinated contrast medium.
• eGFR of 45 ml/min/1.73 m
2
is CIN risk threshold for intravenous contrast medium.
• Hydration with either saline or sodium bicarbonate reduces CIN incidence.
• Patients with eGFR ≥60 ml/min/1.73 m
2
receiving contrast medium can continue metformin normally.
Journal Article
Assessment of Therapy Response to Transarterial Radioembolization for Liver Metastases by Means of Post-treatment MRI-Based Texture Analysis
IntroductionTo determine whether post-treatment magnetic resonance imaging (MRI)-based texture analysis of liver metastases (LM) may be suited predicting therapy response to transarterial radioembolization (TARE) during follow-up.Materials and MethodsThirty-seven patients with LM treated by TARE (mean age 63.4 years) between January 2006 and December 2014 were identified in this retrospective feasibility study. They underwent dynamic contrast-enhanced and hepatocellular phase MRI after TARE (mean 2.2 days). Response was evaluated on follow-up imaging scheduled in intervals of 3 months (median follow-up, 7.3 months) based on response evaluation criteria in solid tumors 1.1 (RECIST 1.1). Results of texture analysis [mean, standard deviation, skewness (s), kurtosis (k), entropy and uniformity] were compared between patients with progressive disease (PD) and patients with stable disease (SD), partial or complete response (PR/CR). Receiver operating characteristics including the area under the curve (AUC) and cutoff values including the sensitivity and specificity were calculated.ResultsAccording to RECIST 1.1, 24 patients (64.9%) had PD, 8 SD (21.6%) and 5 PR (13.5%). MRI-based texture analysis showed an earlier differentiation between patients with and without PD when compared with RECIST 1.1. Median k (2.88 vs. 2.35) in arterial phase MRI and median s (0.48 vs. 0.25) and k (2.85 vs. 2.25) in venous phase MRI were significantly different (p < 0.05). The AUC for k derived from arterial phase MRI was 0.73 (cutoff = 2.55, sensitivity = 0.83, specificity = 0.62) (p < 0.05). The AUC for s and k in venous phase MRI was 0.76 (cutoff = 0.35, sensitivity = 0.71, specificity = 0.85) (p > 0.05) and 0.83 (cutoff = 2.50, sensitivity = 0.75, specificity = 0.85) (p < 0.05).ConclusionThis study indicates the potential of MRI-based texture analysis at arterial and venous phase MRI for the early prediction of PD after TARE.Level of EvidenceIV.
Journal Article
Differentiation of pseudoprogression and real progression in glioblastoma using ADC parametric response maps
The purpose of this study was to investigate whether a voxel-wise analysis of apparent diffusion coefficient (ADC) values may differentiate between progressive disease (PD) and pseudoprogression (PsP) in patients with high-grade glioma using the parametric response map, a newly introduced postprocessing tool.
Twenty-eight patients with proven PD and seven patients with PsP were identified in this retrospective feasibility study. For all patients ADC baseline and follow-up maps on four subsequent MRIs were available. ADC maps were coregistered on contrast enhanced T1-weighted follow-up images. Subsequently, enhancement in the follow-up contrast enhanced T1-weighted image was manually delineated and a reference region of interest (ROI) was drawn in the contralateral white matter. Both ROIs were transferred to the ADC images. Relative ADC (rADC) (baseline)/reference ROI values and rADC (follow up)/reference ROI values were calculated for each voxel within the ROI. The corresponding voxels of rADC (follow up) and rADC (baseline) were subtracted and the percentage of all voxels within the ROI that exceeded the threshold of 0.25 was quantified.
rADC voxels showed a decrease of 59.2% (1st quartile (Q1) 36.7; 3rd quartile (Q3) 78.6) above 0.25 in patients with PD and 18.6% (Q1 3.04; Q3 26.5) in patients with PsP (p = 0.005). Receiver operating characteristic curve analysis showed the optimal decreasing rADC cut-off value for identifying PD of > 27.05% (area under the curve 0.844±0.065, sensitivity 0.86, specificity 0.86, p = 0.014).
This feasibility study shows that the assessment of rADC using parametric response maps might be a promising approach to contribute to the differentiation between PD and PsP. Further research in larger patient cohorts is necessary to finally determine its clinical utility.
Journal Article
Ferucarbotran (Resovist): a new clinically approved RES-specific contrast agent for contrast-enhanced MRI of the liver: properties, clinical development, and applications
Ferucarbotran (Resovist) is the second clinically approved superparamagnetic iron oxide developed for contrast-enhanced MRI of the liver. The purpose of this review is to provide an overview on the properties, clinical development, and application of ferucarbotran. Safety data obtained during clinical phases I-III revealed a total of 162 adverse events within 1053 patients, of which 75 were classified as possibly, probably, or definitely drug related. The majority of events occurred within the first 3 h (73 of 75) and was of mild intensity. The agent significantly improves the detection of hypovascular focal liver lesions with a comparable sensitivity in lesion detection to CTAP but without a relevant loss in specificity. Furthermore, ferucarbotran leads to a significant improvement of the sensitivity for lesion classification and characterization of the most frequent liver lesions. Contrast-enhanced MRA is not feasible and the angiographic effect is not sufficient to allow for postprocessing of data into maximum intensity projections. Intraindividual studies at low-field (0.2 T) and high-field (1.5 T) showed similar rates for lesion detection. The time window for contrast-enhanced MRI of the liver is at least 1 day up to 4 days. The compound can be regarded as safe and well tolerated. Even bolus injections caused no cardiovascular side effects, lumbar back pain, or clinically relevant laboratory changes. The examination time can be kept short with T1- and T2-weighted pre-contrast sequences, dynamic MRI over 10 min, and finally accumulation phase T2-weighted MRI. Patients who may benefit in particular are surgical candidates for resection, transplantation, or interventional therapies, and patients with liver cirrhosis and/or suspected hepatocellular carcinoma to either exclude malignancy or to define the extent of disease, the location of lesions, and the type of newly detected lesions.
Journal Article
Resilience of a peatland in Central Sumatra, Indonesia to past anthropogenic disturbance: Improving conservation and restoration designs using palaeoecology
1. Tropical peatlands, which provide important functions such as biodiversity provisioning and carbon (C) storage, are currently threatened by land-use conversions. Thus, conservation and restoration efforts are needed to maintain their functions. Conservation concepts aiming to separate human from ecosystems are no longer conceivable. Therefore, understanding peatland resilience to human disturbance, that is the ability of peatland ecosystems to maintain their structure and function despite perturbations and to return to their predisturbance states, can assist with integrating human needs into conservation strategies and improving restoration effectiveness. 2. Understanding ecosystem resilience is often impeded by a lack of long-term data, which can be obtained from palaeoecological studies. Located close to the archaeological remains of the Malayu Empire, the Sungai Buluh peatland in Sumatra, Indonesia provides an opportunity to study the resilience of a tropical peatland to past human disturbance. We subjected a 250-cm-long peat core to palynological, charcoal and C content analyses to delineate the anthropogenic impact on the peatland and the ecosystem's response. 3. The results revealed that extensive human activities in Sungai Buluh such as logging, grazing/cut-and-carry, and wild-harvesting started soon after humans occupied the vicinity of the peatland c. 1,000 cal yr BP. Even without fire use and cultivation, these activities were able to alter vegetation composition and decrease the peatland's C sequestration capacity. 4. Following site abandonment after the demise of the Malayu Empire at c. 600 cal yr BP, the palaeoecological record suggests that the Sungai Buluh peatland recovered in terms of both floristic composition and C sink function, with the latter recovering faster (c. 60 years) than the former (c. 170 years). 5. Synthesis. The palaeoecological record from Sungai Buluh provides the first evidence of tropical peatland recovery following human disturbance, which can help improve present peatland conservation/restoration strategies. The design of peatland wise-use strategies can mimic the \"resilience-friendly\" human activities identified in this study. Consideration should also be given to selecting rapidly regenerating taxa for cost-and-effort-efficient restoration strategies. Additionally, the 170-year recovery time of the Sungai Buluh peatland suggests that the 60 year timeframe currently allocated in most tropical peatland restoration projects may be insufficient.
Journal Article
Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines
Purpose
To update the guidelines of the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) on nephrogenic systemic fibrosis and gadolinium-based contrast media.
Areas covered
Topics reviewed include the history, clinical features and prevalence of nephrogenic systemic fibrosis and the current understanding of its pathophysiology. The risk factors for NSF are discussed and prophylactic measures are recommended. The stability of the different gadolinium-based contrast media and the potential long-term effects of gadolinium in the body have also been reviewed.
Key Points
•
Clinical features, risk factors and prevention of nephrogenic systemic fibrosis are reviewed
•
Patients with GFR below 30 ml/min/1.73 m
2
have increased risk of developing NSF
•
Low stability gadolinium contrast media show the strongest association with NSF
•
Following guidelines regarding gadolinium contrast agents minimises the risk of NSF
•
Potential long-term harm from gadolinium accumulation in the body is discussed
Journal Article
Transthoracic robot-assisted minimally invasive diaphragmatic rupture repair: a case report
Background
Nontraumatic diaphragmatic rupture is a rare condition with clinical presentations ranging from asymptomatic to severe respiratory or gastrointestinal symptoms. Owing to its nonspecific nature, it can be difficult to differentiate from other diaphragmatic disorders.
Case presentation
We present a case of a 35-year-old German woman with a right-sided nontraumatic diaphragmatic rupture, presenting with recurrent hypertensive crises and acute dyspnea. Although initially misdiagnosed, further clinical and radiological evaluations suggestive of diaphragmatic elevation led to the decision to proceed with robot-assisted thoracoscopic surgery.
Conclusion
This case underscores the diagnostic challenges of non-traumatic diaphragmatic rupture, especially in complex clinical scenarios. It highlights the importance of thorough clinical assessment, appropriate imaging, and timely surgical intervention. Robot-assisted thoracoscopic surgery proved to be a safe and effective therapeutic option and should be considered in select cases where conventional diagnostics fail to provide definitive answers.
Journal Article