1
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MacLeod CA, Gauthier I, Davenport MS, McGrath TA, Khan F, Dos Santos MP, McInnes MDF, Schieda N. Adverse Events Associated with Intra-Arterial Administration of Gadolinium-Based Contrast Agents: A Systematic Review and Meta-Analysis. J Vasc Interv Radiol 2022; 34:568-577.e10. [PMID: 36464013 DOI: 10.1016/j.jvir.2022.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2022] [Revised: 11/08/2022] [Accepted: 11/19/2022] [Indexed: 12/03/2022] Open
Abstract
PURPOSE To determine the risk of immediate hypersensitivity reactions (HRs), contrast-associated acute kidney injury (CA-AKI), nephrogenic systemic fibrosis (NSF), and gadolinium retention associated with use of intra-arterial gadolinium-based contrast agents (GBCAs). MATERIALS AND METHODS MEDLINE, Embase, and Cochrane Central Register of Controlled Trials were searched from 1988 (GBCAs approved for clinical use) to March 2021 for studies reporting adverse events associated with intra-arterial administration of GBCAs. The number of adverse events and GBCA administrations were used to calculate incidence in individual studies, and results across studies were pooled using random-effects meta-analysis. RESULTS There were 72 studies (patients = 1,221) that reported on HR, 59 studies (patients = 1,142) that reported on CA-AKI, and 6 studies (patients = 291) that reported on NSF. No studies reported gadolinium retention as an outcome. Based on 5 events and 1,451 GBCA administrations, the incidence of HR per 100 administrations was 0.95 (95% CI, 0.52-1.51). Based on 90 events and 1,318 GBCA administrations, the incidence of CA-AKI per 100 administrations was 5.94 (95% CI, 3.92-8.34). Based on 7 events and 361 GBCA administrations, the incidence of NSF per 100 Group I GBCA administrations was 4.72 (95% CI, 0.35-13.70). There were no unconfounded NSF events after Group II GBCA administration. CONCLUSIONS HRs to intra-arterial administration of GBCAs are rare, with no serious reactions. Limited data demonstrate a higher-than-expected rate of CA-AKI; however, multiple confounding factors were noted. Thus, any causative link of CA-AKI to GBCA remains controversial. Also, severe physiologic reactions (including life-threatening arrhythmias) during coronary angiography have been reported.
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Affiliation(s)
- Chad A MacLeod
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Isabelle Gauthier
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Matthew S Davenport
- Department of Radiology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan
| | - Trevor A McGrath
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Faizan Khan
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | | | - Mathew D F McInnes
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Department of Epidemiology, University of Ottawa, Ottawa, Ontario, Canada
| | - Nicola Schieda
- Department of Radiology, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
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2
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Reutershan T, Effarah HH, Lagzda A, Barty CPJ. Numerical evaluation of high-energy, laser-Compton x-ray sources for contrast enhancement and dose reduction in clinical imaging via gadolinium-based K-edge subtraction. APPLIED OPTICS 2022; 61:C162-C178. [PMID: 35201049 PMCID: PMC10619702 DOI: 10.1364/ao.446189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
Conventional x-ray sources for medical imaging utilize bremsstrahlung radiation. These sources generate large bandwidth (BW) x-ray spectra with large fractions of photons that impart a dose, but do not contribute to image production. X-ray sources based on laser-Compton scattering can have inherently small energy BWs and can be tuned to low dose-imparting energies, allowing them to take advantage of atomic K-edge contrast enhancement. This paper investigates the use of gadolinium-based K-edge subtraction imaging in the context of mammography using a laser-Compton source through simulations quantifying contrast and dose in such imaging systems as a function of laser-Compton source parameters. Our simulations indicate that a K-edge subtraction image generated with a 0.5% BW (FWHM) laser-Compton x-ray source can obtain an equal contrast to a bremsstrahlung image with only 3% of the dose.
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Affiliation(s)
- Trevor Reutershan
- Department of Physics and Astronomy, University of California – Irvine, CA, 92617
- Beckman Laser Institute and Medical Clinic, University of California – Irvine, CA, 92697
| | - Haytham H. Effarah
- Department of Physics and Astronomy, University of California – Irvine, CA, 92617
- Beckman Laser Institute and Medical Clinic, University of California – Irvine, CA, 92697
| | - Agnese Lagzda
- Lumitron Technologies, Inc., 5201 California Ave, Suite 100, Irvine, CA, 92617, USA
| | - C. P. J. Barty
- Department of Physics and Astronomy, University of California – Irvine, CA, 92617
- Beckman Laser Institute and Medical Clinic, University of California – Irvine, CA, 92697
- Lumitron Technologies, Inc., 5201 California Ave, Suite 100, Irvine, CA, 92617, USA
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3
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Guragai N, Roman S, Vasudev R, Rampal U, Randhawa P, Shamoon F, Virk H, Bikkina M, Moses JW, Motivala A. Gadolinium-based coronary angiography in a patient with prior known anaphylaxis to iodine-based dye. J Community Hosp Intern Med Perspect 2021; 11:286-288. [PMID: 33889340 PMCID: PMC8043562 DOI: 10.1080/20009666.2021.1890337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Gadodiamide is a gadolinium-based chemical element that is considered safe and well tolerated in patients without renal dysfunction and is therefore routinely used as a contrast agent in magnetic resonance imaging. Although radio-opaque, it is not frequently used for coronary angiography due to its less than optimal image quality and prohibitive cost. Our center’s previous experience was less than satisfactory but the addition of a power injection system yielded good quality diagnostic images. We report a case of 63 years old male with a known history of severe, life-threatening anaphylactic reaction to previous iodinated dye presenting with persistent angina despite optimal medical therapy. Coronary and bypass graft angiography was performed using 24 cc of undiluted Gadodiamide (OMNISCAN) with a power injector (ACIST®) without any incidents or premedication with an interpretable angiogram.
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Affiliation(s)
- Nirmal Guragai
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Sherif Roman
- Department of Internal Medicine, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Rahul Vasudev
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Upamanyu Rampal
- Department of Cardiology, St. Joseph's Hospital and Medical Center, Phoenix, AZ, USA
| | - Preet Randhawa
- Department of Cardiology, St. Michael's Medical Center, Newark, NJ, USA
| | - Fayez Shamoon
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Hartaj Virk
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Mahesh Bikkina
- Department of Cardiology, St Joseph's University Medical Center, Paterson, NJ, USA
| | - J W Moses
- Department of Cardiology New York-Presbyterian Hospital/Columbia University Medical Center, NY, USA
| | - Apurva Motivala
- Department of Cardiology, Englewood Hospital and Medical Center, Englewood, NJ, USA
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4
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Tajti P, Ayoub M, Nuehrenberg T, Mashayekhi K. Coronary physiology and percutaneous intervention managed with gadolinium road mapping and intravascular ultrasound in hyperthyroidism. Cardiol J 2021; 28:642-645. [PMID: 33645627 DOI: 10.5603/cj.a2021.0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2020] [Revised: 07/10/2020] [Accepted: 07/13/2020] [Indexed: 11/25/2022] Open
Affiliation(s)
- Peter Tajti
- Department of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany.,Gottsegen György Hungarian Institute of Cardiology, Budapest, Hungary
| | - Mohamed Ayoub
- Department of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Thomas Nuehrenberg
- Department of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany
| | - Kambis Mashayekhi
- Department of Interventional Cardiology, Cardiology and Angiology II, University Heart Center Freiburg - Bad Krozingen, Germany.
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5
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Kulpe S, Dierolf M, Günther B, Brantl J, Busse M, Achterhold K, Pfeiffer F, Pfeiffer D. Spectroscopic imaging at compact inverse Compton X-ray sources. Phys Med 2020; 79:137-144. [PMID: 33271418 DOI: 10.1016/j.ejmp.2020.11.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 10/22/2020] [Accepted: 11/07/2020] [Indexed: 10/22/2022] Open
Abstract
While K-edge subtraction (KES) imaging is a commonly applied technique at synchrotron sources, the application of this imaging method in clinical imaging is limited although results have shown its superiority to conventional clinical subtraction imaging. Over the past decades, compact synchrotron X-ray sources, based on inverse Compton scattering, have been developed to fill the gap between conventional X-ray tubes and synchrotron facilities. These so called inverse Compton sources (ICSs) provide a tunable, quasi-monochromatic X-ray beam in a laboratory setting with reduced spatial and financial requirements. This allows for the transfer of imaging techniques that have been limited to synchrotrons until now, like KES imaging, into a laboratory environment. This review article presents the first studies that have successfully performed KES at ICSs. These have shown that KES provides improved image quality in comparison to conventional X-ray imaging. The results indicate that medical imaging could benefit from monochromatic imaging and KES techniques. Currently, the clinical application of KES is limited by the low K-edge energy of available iodine contrast agents. However, several ICSs are under development or already in commissioning which will provide monochromatic X-ray beams with higher X-ray energies and will enable KES using high-Z elements as contrast media. With these developments, KES at an ICS has the ability to become an important tool in pre-clinical research and potentially advancing existing clinical imaging techniques.
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Affiliation(s)
- Stephanie Kulpe
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany.
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Johannes Brantl
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Madleen Busse
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics and Munich School of BioEngineering, Technical University of Munich, James-Franck-Str. 1, 85748 Garching, Germany; Department of Diagnostic and Interventional Radiology, Munich School of Medicine and Klinikum rechts der Isar, Ismaniger Str. 22, 81675 Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Munich School of Medicine and Klinikum rechts der Isar, Ismaniger Str. 22, 81675 Munich, Germany
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6
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Poonaki E, Esfandyar M, Hejazinia H, Sadat Ebrahimi SE, Pirali Hamedani M, Farzaneh J, Shafiee Ardestani M. N-acetylcysteine-PLGA nano-conjugate: effects on cellular toxicity and uptake of gadopentate dimeglumine. IET Nanobiotechnol 2020; 14:470-478. [PMID: 32755956 DOI: 10.1049/iet-nbt.2019.0374] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Gadolinium as a contrast agent in MRI technique combined with DTPA causes contrast induced nephropathy (CIN) and nephrogenic systemic fibrosis (NSF) which can reduce by usage of antioxidants such as N-acetyl cysteine by increasing the membrane's permeability leads to lower cytotoxicity. In this study, N-acetyl cysteine-PLGA Nano-conjugate was synthesized according to stoichiometric rules of molar ratios andafter assessment by FTIR, NMR spectroscopy and Atomic Force Microscopy (AFM) imaging was combined with Magnevist® (gadopentetate dimeglumine) and its effects on the renal cells were evaluated. MTT [3-(4,5-Dimethylthiazol-2-yl)-2,5-Diphenyltetrazolium Bromide] and cellular uptake assays have indicated relatively significant toxicity of magnevist (P < 0.05) on three cell lines including HEK293, MCF7 and L929 compared to other synthesized ligands that shown no toxicity. Moreover, systemic evaluation has shown no notable changes of blood urea nitrogen (BUN) and creatinine in kidney of mice. In consequence, antioxidant effect was increased as well as the renal toxicity of the contrast agent reduced at the cell level. As a result, PLGA-NAC nano-conjugate can be a promising choice for decreasing the magnevist toxicity for treatment and prevention of CIN and will be able to open a new horizon to research on reduction of toxicity of contrast agents by using nanoparticles.
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Affiliation(s)
- Elham Poonaki
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohammad Esfandyar
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
| | - Hadi Hejazinia
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | | | | | - Jafar Farzaneh
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehdi Shafiee Ardestani
- Department of Radiopharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
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7
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Kulpe S, Dierolf M, Günther B, Brantl J, Busse M, Achterhold K, Gleich B, Pfeiffer F, Pfeiffer D. Dynamic K-edge Subtraction Fluoroscopy at a Compact Inverse-Compton Synchrotron X-ray Source. Sci Rep 2020; 10:9612. [PMID: 32541788 PMCID: PMC7295988 DOI: 10.1038/s41598-020-66414-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 05/20/2020] [Indexed: 11/09/2022] Open
Abstract
X-ray fluoroscopy is a commonly applied diagnostic tool for morphological and functional evaluation of the intestine in clinical routine. Acquisition of repetitive X-ray images following oral or rectal application of iodine contrast agent visualizes the time dependent distribution of the contrast medium, and helps to detect for example leakages, tumors or functional disorders. However, movements of the intestine and air trapped inside usually prevent temporal subtraction imaging to be applied to fluoroscopy of the gastrointestinal tract. K-edge subtraction (KES) imaging would enable subtraction fluoroscopy because it allows for imaging of moving organs with little artefacts. Although KES imaging is a well established technique at synchrotron sources, this imaging method is not applied in clinical routine as it relies on brilliant synchrotron radiation. Recently emerging compact synchrotron X-ray sources could provide a quasi-monochromatic, high-flux X-ray beam and allow for the application of KES in a laboratory environment. Here, we present a filter-based dynamic KES approach at the Munich Compact Light Source (MuCLS), the first user-dedicated installation of a compact synchrotron X-ray source worldwide. Compared to conventional temporal subtraction X-ray radiography, our approach increases the contrast while reducing the generated image artefacts.
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Affiliation(s)
- Stephanie Kulpe
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany. .,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany.
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany.,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany.,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany
| | - Johannes Brantl
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany.,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany
| | - Madleen Busse
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany.,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany.,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, James-Franck-Str. 1, 85748, Garching, Germany.,Munich School of BioEngineering, Technical University of Munich, Boltzmannstr. 11, 85748, Garching, Germany.,Department of Diagnostic and Interventional Radiology, Munich School of Medicine and Klinikum rechts der Isar, Ismaniger Str. 22, 81675, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Munich School of Medicine and Klinikum rechts der Isar, Ismaniger Str. 22, 81675, Munich, Germany
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8
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Kulpe S, Dierolf M, Braig EM, Günther B, Achterhold K, Gleich B, Herzen J, Rummeny E, Pfeiffer F, Pfeiffer D. K-edge subtraction imaging for iodine and calcium separation at a compact synchrotron x-ray source. J Med Imaging (Bellingham) 2020; 7:023504. [PMID: 32341936 DOI: 10.1117/1.jmi.7.2.023504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 04/06/2020] [Indexed: 11/14/2022] Open
Abstract
Purpose: About one third of all deaths worldwide can be traced to some form of cardiovascular disease. The gold standard for the diagnosis and interventional treatment of blood vessels is digital subtraction angiography (DSA). An alternative to DSA is K-edge subtraction (KES) imaging, which has been shown to be advantageous for moving organs and for eliminating image artifacts caused by patient movement. As highly brilliant, monochromatic x-rays are required for this method, it has been limited to synchrotron facilities so far, restraining the applicability in the clinical routine. Over the past decades, compact synchrotron x-ray sources based on inverse Compton scattering have been evolving; these provide x-rays with sufficient brilliance and meet spatial and financial requirements for laboratory settings or university hospitals. Approach: We demonstrate a proof-of-principle KES imaging experiment using the Munich Compact Light Source (MuCLS), the first user-dedicated installation of a compact synchrotron x-ray source worldwide. A series of experiments were performed both on a phantom and an excised human carotid to demonstrate the ability of the proposed KES technique to separate the iodine contrast agent and calcifications. Results: It is shown that the proposed filter-based KES method allows for the iodine-contrast agent and calcium to be clearly separated, thereby providing x-ray images only showing one of the two materials. Conclusions: The results show that the quasimonochromatic spectrum of the MuCLS enables filter-based KES imaging and can become an important tool in preclinical research and possible future clinical diagnostics.
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Affiliation(s)
- Stephanie Kulpe
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Martin Dierolf
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Eva-Maria Braig
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Benedikt Günther
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Klaus Achterhold
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Bernhard Gleich
- Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Julia Herzen
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany
| | - Ernst Rummeny
- Munich School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Franz Pfeiffer
- Technical University of Munich, Chair of Biomedical Physics, Department of Physics, Garching, Germany.,Technical University of Munich, Munich School of BioEngineering, Garching, Germany.,Munich School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
| | - Daniela Pfeiffer
- Munich School of Medicine and Klinikum rechts der Isar, Department of Diagnostic and Interventional Radiology, Munich, Germany
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9
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K-edge Subtraction Computed Tomography with a Compact Synchrotron X-ray Source. Sci Rep 2019; 9:13332. [PMID: 31527643 PMCID: PMC6746727 DOI: 10.1038/s41598-019-49899-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Accepted: 08/31/2019] [Indexed: 11/30/2022] Open
Abstract
In clinical diagnosis, X-ray computed tomography (CT) is one of the most important imaging techniques. Yet, this method lacks the ability to differentiate similarly absorbing substances like commonly used iodine contrast agent and calcium which is typically seen in calcifications, kidney stones and bones. K-edge subtraction (KES) imaging can help distinguish these materials by subtracting two CT scans recorded at different X-ray energies. So far, this method mostly relies on monochromatic X-rays produced at large synchrotron facilities. Here, we present the first proof-of-principle experiment of a filter-based KES CT method performed at a compact synchrotron X-ray source based on inverse-Compton scattering, the Munich Compact Light Source (MuCLS). It is shown that iodine contrast agent and calcium can be clearly separated to provide CT volumes only showing one of the two materials. These results demonstrate that KES CT at a compact synchrotron source can become an important tool in pre-clinical research.
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10
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Kulpe S, Dierolf M, Braig E, Günther B, Achterhold K, Gleich B, Herzen J, Rummeny E, Pfeiffer F, Pfeiffer D. K-edge subtraction imaging for coronary angiography with a compact synchrotron X-ray source. PLoS One 2018; 13:e0208446. [PMID: 30532277 PMCID: PMC6287837 DOI: 10.1371/journal.pone.0208446] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/16/2018] [Indexed: 11/19/2022] Open
Abstract
About one third of all deaths worldwide can be traced back to cardiovascular diseases. An interventional radiology procedure for their diagnosis is Digital Subtraction Angiography (DSA). An alternative to DSA is K-Edge subtraction (KES) imaging, which has been shown to be advantageous for moving organs and eliminating image artifacts caused by patient movement. As highly brilliant, monochromatic X-rays are required for this method, it has been limited to synchrotron facilities so far, restraining the feasibility in clinical routine. Compact synchrotron X-ray sources based on inverse Compton scattering, which have been evolving substantially over the past decade, provide X-rays with sufficient brilliance that meet spatial and financial requirements affordable in laboratory settings or for university hospitals. In this work, we demonstrate a first proof-of-principle K-edge subtraction imaging experiment using the Munich Compact Light Source (MuCLS), the first user-dedicated installation of a compact synchrotron X-ray source worldwide. It is shown experimentally that the technique of KES increases the visibility of small blood vessels overlaid by bone structures.
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Affiliation(s)
- Stephanie Kulpe
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- * E-mail:
| | - Martin Dierolf
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Eva Braig
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Benedikt Günther
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Klaus Achterhold
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Bernhard Gleich
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Julia Herzen
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
| | - Ernst Rummeny
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Franz Pfeiffer
- Chair of Biomedical Physics, Department of Physics, Technical University of Munich, Garching, Germany
- Munich School of BioEngineering, Technical University of Munich, Garching, Germany
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
| | - Daniela Pfeiffer
- Department of Diagnostic and Interventional Radiology, Klinikum rechts der Isar, Technical University of Munich, Munich, Germany
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11
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Mono-Energy Coronary Angiography with a Compact Synchrotron Source. Sci Rep 2017; 7:42211. [PMID: 28181544 PMCID: PMC5299841 DOI: 10.1038/srep42211] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2016] [Accepted: 01/06/2017] [Indexed: 11/30/2022] Open
Abstract
X-ray coronary angiography is an invaluable tool for the diagnosis of coronary artery disease. However, the use of iodine-based contrast media can be contraindicated for patients who present with chronic renal insufficiency or with severe iodine allergy. These patients could benefit from a reduced contrast agent concentration, possibly achieved through application of a mono-energetic x-ray beam. While large-scale synchrotrons are impractical for daily clinical use, the technology of compact synchrotron sources strongly advanced during the last decade. Here we present a quantitative analysis of the benefits a compact synchrotron source can offer in coronary angiography. Simulated projection data from quasi-mono-energetic and conventional x-ray tube spectra is used for a CNR comparison. Results show that compact synchrotron spectra would allow for a significant reduction of contrast media. Experimentally, we demonstrate the feasibility of coronary angiography at the Munich Compact Light Source, the first commercial installation of a compact synchrotron source.
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Mariani J, Guedes C, Soares P, Zalc S, Campos CM, Lopes AC, Spadaro AG, Perin MA, Filho AE, Takimura CK, Ribeiro E, Kalil-Filho R, Edelman ER, Serruys PW, Lemos PA. Intravascular ultrasound guidance to minimize the use of iodine contrast in percutaneous coronary intervention: the MOZART (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy) randomized controlled trial. JACC Cardiovasc Interv 2014; 7:1287-93. [PMID: 25326742 DOI: 10.1016/j.jcin.2014.05.024] [Citation(s) in RCA: 122] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Revised: 04/25/2014] [Accepted: 05/22/2014] [Indexed: 01/05/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate the impact of intravascular ultrasound (IVUS) guidance on the final volume of contrast agent used in patients undergoing percutaneous coronary intervention (PCI). BACKGROUND To date, few approaches have been described to reduce the final dose of contrast agent in PCIs. We hypothesized that IVUS might serve as an alternative imaging tool to angiography in many steps during PCI, thereby reducing the use of iodine contrast. METHODS A total of 83 patients were randomized to angiography-guided PCI or IVUS-guided PCI; both groups were treated according to a pre-defined meticulous procedural strategy. The primary endpoint was the total volume contrast agent used during PCI. Patients were followed clinically for an average of 4 months. RESULTS The median total volume of contrast was 64.5 ml (interquartile range [IQR]: 42.8 to 97.0 ml; minimum, 19 ml; maximum, 170 ml) in the angiography-guided group versus 20.0 ml (IQR: 12.5 to 30.0 ml; minimum, 3 ml; maximum, 54 ml) in the IVUS-guided group (p < 0.001). Similarly, the median volume of contrast/creatinine clearance ratio was significantly lower among patients treated with IVUS-guided PCI (1.0 [IQR: 0.6 to 1.9] vs. 0.4 [IQR: 0.2 to 0.6, respectively; p < 0.001). In-hospital and 4-month outcomes were not different between patients randomized to angiography-guided and IVUS-guided PCI. CONCLUSIONS Thoughtful and extensive use of IVUS as the primary imaging tool to guide PCI is safe and markedly reduces the volume of iodine contrast compared with angiography-alone guidance. The use of IVUS should be considered for patients at high risk of contrast-induced acute kidney injury or volume overload undergoing coronary angioplasty. (Minimizing cOntrast utiliZation With IVUS Guidance in coRonary angioplasTy [MOZART]; NCT01947335).
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Affiliation(s)
- José Mariani
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Cristiano Guedes
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Soares
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Silvio Zalc
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Carlos M Campos
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil; Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Augusto C Lopes
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts
| | - André G Spadaro
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Marco A Perin
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Antonio Esteves Filho
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Celso K Takimura
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Expedito Ribeiro
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Roberto Kalil-Filho
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil
| | - Elazer R Edelman
- Institute of Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, Massachusetts; Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Patrick W Serruys
- Thoraxcenter, Erasmus Medical Center, Rotterdam, the Netherlands; Imperial College London, London, United Kingdom
| | - Pedro A Lemos
- Department of Interventional Cardiology, Heart Institute (InCor), University of São Paulo Medical School, Sao Paulo, Brazil.
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Saleh L, Juneman E, Movahed MR. The use of gadolinium in patients with contrast allergy or renal failure requiring coronary angiography, coronary intervention, or vascular procedure. Catheter Cardiovasc Interv 2011; 78:747-54. [PMID: 21780275 DOI: 10.1002/ccd.22907] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Accepted: 11/18/2010] [Indexed: 11/10/2022]
Abstract
Coronary artery angiography remains an important procedure for the assessment of coronary arteries. It requires injection of iodinated contrast for the opacification of coronary arteries. Severe allergy to iodine contrast and renal insufficiency are two main problems with iodine-based contrast media. Gadolinium (Gd) has different chemical structure with no cross reactivity with iodine-based contrast media in patients with iodine allergy. The use of Gd is commonly used in contrast-enhanced magnetic resonance imaging for image enhancement, making it a potential alternative in patients in whom iodine is contraindicated. The aim of this manuscript is to review the available literature on the use of Gd in patients with contraindication to iodine contrast due to allergy or in patients with severe renal failure requiring coronary or vascular procedures.
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Affiliation(s)
- Layth Saleh
- Division of Cardiology, The Southern Arizona VA Health Care System, Tucson, AZ, USA
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Bibliography. Current world literature. Diseases of the aorta, pulmonary, and peripheral vessels. Curr Opin Cardiol 2008; 23:646-7. [PMID: 18830082 DOI: 10.1097/hco.0b013e328316c259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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