Static, Dynamic and First-Pass MR Imaging of Musculoskeletal Lesions Using Gadodiamide Injection

Forty-five patients with known or suspected musculoskeletal tumors were examined with static and dynamic MR imaging to evaluate the safety, tolerability and diagnostic utility of gadodiamide injection and to assess the diagnostic value of dynamic MR imaging and parametric “first-pass” (FP) images. The proportion of patients presenting more diagnostic information on the contrast-enhanced compared to the precontrast spin-echo examinations was determined. The dynamic enhancement characteristics were evaluated with time-intensity curves and parametric images of the FP enhancement rate. The tolerance of gadodiamide injection was good. Contrast enhancement was useful for delineating tumor from muscle, and differentiating viable from necrotic tissue and cystic from solid lesions. Malignant tumors showed a significantly higher slope value, earlier onset of enhancement, and higher maximum enhancement than benign lesions. However, slope values could not be used to predict the malignant potential of a lesion, due to overlap between highly vascular benign and low vascular malignant lesions. By displaying highly vascular areas, parametric FP images provided useful information on the most active part in a tumor before biopsy and for assessing the incorporation of bone-chip allografts. Static, dynamic and FP MR imaging using gadodiamide injection appears safe and provides useful information for diagnosis, biopsy and follow-up of musculoskeletal lesions.

[Influence of maize kernel hardness on flour hydration and cooking properties]

Knowledge of the association between cooking properties and endosperm hardness may help nutritionist and processors to select raw materials for preparing maize based food products, particularly those eaten as cooked dispersions. Seven commercial maize cultivars differing in hardness were selected to evaluate endosperm hardness on the kernels and some characteristics such as composition and hydration and cooking properties on the grits obtained from those maizes. Results show that the differences in endosperm hardness (directly related to grits protein content) can explain the differences in swelling and amylographic consistencies values. Cultivars with the hardest endosperm show the lowest values at high temperature. They also show the lowest amylographic consistencies. On the other hand softer endosperms present the highest swelling power and the highest amylographic consistencies. These differences are attributed to the restriction for starch swelling caused by the protein matrix. Endosperm hardness measurements and swelling power at 95 degrees C, can be useful to select cultivars that are going to be used to prepare maize based foods like atoles, polenta, etc.

Safety and efficacy of contrast-enhanced MRI in the brain, head and neck: gadodiamide injection versus gadopentate dimeglumine

The objective of the present study was to evaluate the safety and efficacy of gadodiamide injection, a non ionic MRI contrast medium in comparison with the ionic agent gadopentate dimeglumine. Two groups of 50 patients with known or suspected lesions of the brain or head and neck were enrolled in a double -blind, randomised trial. In the gadopentate dimeglumine group three patients reported four adverse events, and in the gadodiamide injection group, four patients reported four side effects. All events were minor. Two radiologists analyzed pre and post-contrast MR images. The parameters evaluated were the number of lesions, delineation of the lesion, gain of diagnostic information, and final diagnosis. Both contrast media gave identical diagnostic information.

Iopentol (Imagopaque 350) compared with iohexol (Omnipaque 350) in pediatric cardioangiography. A clinical trial assessing adverse events, ECG, blood pressure and diagnostic information

A non-ionic, monomeric, low-osmolar contrast medium, iopentol (Imagopaque, Nycomed Imaging AS, Oslo, Norway) has been compared with iohexol (Omnipaque, Nycomed Imaging AS, Oslo, Norway) in a double-blind, randomized, parallel-group trial in children. The aims of the study were to compare the safety and radiographic efficacy of iopentol 350 mg I/ml versus those of iohexol 350 mg I/ ml in pediatric cardioangiography. Seventy-three children, of whom 35 received iopentol and 38 iohexol, were included in the evaluation. The quality of overall diagnostic information was excellent or adequate in all patients. There were no statistically significant differences between numbers of patients reporting adverse events nor number of patients reporting discomfort in the two groups. Three patients in the iopentol group and two patients in the iohexol group reported adverse events. Heat sensation was reported by 4 patients in the iopentol group and 5 patients in the iohexol group. Following injection of contrast medium, there were no differences between the groups regarding ECG, heart rate and systolic blood pressure at the site of injection. Iopentol was demonstrated to be as effective, safe and well tolerated as iohexol in pediatric cardioangiography.

Clinical evaluation of gadodiamide injection in paediatric MR imaging

The safety and efficacy of intravenous gadodiamide injection, 0.1 mmol/kg body weight, have been evaluated in an open label, non-comparative as to drug, phase III clinical trial in 50 children from 6 months to 13 years of age, referred for MRI requiring the injection of a contrast medium. The central nervous system and other body areas were examined with T1 sequences before and after intravenous injection of the contrast medium. Overall safety was very good and no clinically relevant changes were evident as regards heart rate and venous blood oxygen saturation after injection. No adverse event or discomfort was experienced by conscious patients that could with certainty be related to the contrast medium, but slight movements were observed in two sedated patients that could be related to the injection. Comparing pre- and post-injection images, additional diagnostic information could be obtained from the latter in 41 patients (82%). In these images, the number of lesions detected increased and they were generally better delineated and their size more easily estimated. The results of this trial indicate that gadodiamide injection is safe and effective for MRI examinations in children.

Ferristene as intestinal MR contrast agent. Distribution and safety of a fast ingestion procedure with oral metoclopramide

PURPOSE

To compare the small bowel distribution and safety of a fast ingestion procedure of ferristene to those of the standard ingestion procedure.

MATERIAL AND METHODS

Sixty-four patients received 0.5 g/l ferristene in 800 ml water. Thirty-four patients of the fast ingestion group ingested ferristene with 20 mg of oral metoclopramide during the course of 30 min before MR imaging and received an i.v. injection of an antiperistaltic agent during the MR study. Thirty patients of the standard group ingested ferristene during the course of 2 h, without additional drugs. Ferristene distribution was assessed by 2 reviewers and adverse events were recorded.

RESULTS

More than 50% of the small bowel segments analyzed were filled with ferristene in 30 patients in the fast ingestion group and in 28 patients in the standard ingestion group. One patient in each group experienced nausea and/or vomiting. Some bloating or sensation of fullness was reported by 2 patients in the fast ingestion group and by 3 patients in the standard ingestion group.

CONCLUSION

The distribution of ferristene in the small bowel and the safety of the procedure were thus similar in the 2 groups using either a fast ingestion procedure with oral metoclopramide or the more time-consuming standard ingestion procedure.

Static, dynamic and first-pass MR imaging of musculoskeletal lesions using gadodiamide injection

Forty-five patients with known or suspected musculoskeletal tumors were examined with static and dynamic MR imaging to evaluate the safety, tolerability and diagnostic utility of gadodiamide injection and to assess the diagnostic value of dynamic MR imaging and parametric "first-pass" (FP) images. The proportion of patients presenting more diagnostic information on the contrast-enhanced compared to the precontrast spin-echo examinations was determined. The dynamic enhancement characteristics were evaluated with time-intensity curves and parametric images of the FP enhancement rate. The tolerance of gadodiamide injection was good. Contrast enhancement was useful for delineating tumor from muscle, and differentiating viable from necrotic tissue and cystic from solid lesions. Malignant tumors showed a significantly higher slope value, earlier onset of enhancement, and higher maximum enhancement than benign lesions. However, slope values could not be used to predict the malignant potential of a lesion, due to overlap between highly vascular benign and low vascular malignant lesions. By displaying highly vascular areas, parametric FP images provided useful information on the most active part in a tumor before biopsy and for assessing the incorporation of bone-chip allografts. Static, dynamic and FP MR imaging using gadodiamide injection appears safe and provides useful information for diagnosis, biopsy and follow-up of musculoskeletal lesions.

Gadodiamide injection at 0.1 and 0.3 mmol/kg body weight: a phase III double-blind, parallel, randomised clinical investigation of known or suspected central nervous system lesions at 1.5 T

We studied 78 patients with clinically suspected central nervous system abnormalities (66 intracranial, 12 spinal) by MRI before and after administration of the nonionic contrast medium gadodiamide injection. A parallel, double-blind, randomised design was followed. Two dosages were used: 38 patients underwent studies with 0.1 mmol/kg body weight (b.w.) and 40 with 0.3 mmol/kg b.w. MRI showed abnormalities in 36 of the 38 patients receiving the lower dose and 39 of the 40 patients receiving the higher dose. In 3 patients from each group more lesions were seen following injection than before. The contrast medium improved the delineation of abnormal structures and assessment of tumour size and increased their signal intensity indices in both groups, but especially at the higher dose. Administration of gadodiamide injection provided more diagnostic information in about 75% of the patients, independently of the dose. There were no reports of discomfort, but 7 patients reported adverse events considered unrelated to the gadodiamide injection. The two doses were found to be equally safe and efficient for diagnosis.

A double-blind study comparing safety, tolerability and efficacy of iodixanol 320 mgI/ml and ioxaglate 320 mgI/ml in cerebral arteriography

Iodixanol is a new nonionic dimer, isotonic with blood at all concentrations. Iodixanol 320 mgI/ml was compared in a double-blind, randomized study to the ionic dimer ioxaglate 320 mgI/ml for evaluation of safety and efficacy parameters during cerebral arteriography. Eighty adult patients were enrolled and all completed the trial. Radiographic efficacy was assessed from the diagnostic information and the radiographic density. Safety was evaluated by recording discomfort and other adverse events, changes in ECG, heart rate and blood pressure, changes in intra-arterial blood pressure and circulation time. No difference between the two contrast media were noted radiographically. No clinically important changes from baseline or between the two contrast media were found in ECG, heart rate, blood pressure or intra-arterial blood pressure. Although not statistically significant, a somewhat longer mean circulation time was found with iodixanol, probably due to its slightly higher viscosity. Injection-associated warmth sensation and pain were more intense with ioxaglate than with iodixanol, and pain was statistically more frequent after injection of ioxaglate. A high incidence of adverse events other than discomfort is reported in this study, mainly related to the selective arteriographic procedure itself. The adverse events related to the contrast medium were more frequent with ioxaglate (27% of the total number of adverse events) than with iodixanol (10%). The new isotonic nonionic dimer iodixanol offers significantly better comfort to the patient than does ioxaglate. This is an important feature, especially in relatively risky procedures that are unpleasant for the patients, such as conventional cerebral angiography.

Gadodiamide injection as a contrast medium for MRI of the central nervous system: a comparison with gadolinium-DOTA

The tolerance and diagnostic efficacy of a new nonionic, intravenous MRI contrast medium, gadodiamide injection (Omniscan) are reported and compared with those of gadolinium-DOTA after completion of a double-blind, randomized, parallel study in 60 patients using a dose of 0.1 mmol/kg. Two patients were excluded from the statistical analysis after trial entrance since no contrast medium was injected. The indications for the MRI examination were known or suspected CNS lesions. Vital signs, chemical and haematological parameters were monitored. No significant abnormalities were observed, confirming the excellent tolerance of both contrast media. The usefulness of gadolinium-containing contrast media was again documented, since in 8.6% (5/58) of the patients the lesion(s) could be seen only after injection. Contrast enhancement was seen in 87.8% (43/49) of the patients with abnormal findings, and provided additional diagnostic information in 24.5% (12/49). Lack of contrast enhancement in 12.2% (6/49) of patients with abnormal findings was a significant negative finding.