1
|
Sodagari F, Davenport MS, Asch D, Cavallo JJ, Cohan RH, Ellis JH, Pahade JK. A Survey of Practicing Radiologists on the Use of Premedication Before Intravenous Iodinated Contrast Medium Administration. J Am Coll Radiol 2023:S1546-1440(23)00532-X. [PMID: 37516161 DOI: 10.1016/j.jacr.2023.04.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 03/24/2023] [Accepted: 04/04/2023] [Indexed: 07/31/2023]
Abstract
OBJECTIVE To determine whether updated guidance by the ACR in 2017 advocating use of intravenous (IV) premedication in emergency department (ED) patients and inpatients with reported iodinated contrast allergy was associated with a change in clinical practice. METHODS An anonymous survey was distributed via e-mail in October 2020 to practicing radiologist members of the ACR interrogating use of corticosteroid premedication for two clinical vignettes: an indicated routine (perform within 24 hours) inpatient contrast-enhanced CT (CE-CT) and an indicated urgent (perform within 6 hours) ED CE-CT. In both scenarios, the patient had a prior moderate hypersensitivity reaction to iodinated contrast media. Clinical management was evaluated. Data were compared to historical controls from 2009. RESULTS The response rate was 11% (724 of 6,616). For the inpatient scenario, 72% (518 of 724) would use corticosteroid premedication with CE-CT, and 28% (200 of 724) would perform noncontrast CT. For the ED scenario, 67% (487 of 724) would use corticosteroid premedication with CE-CT, and 30% (217 of 724) would perform noncontrast CT. Oral premedication (85%, 439 of 518) was preferred for routine inpatients, and rapid IV premedication (89%, 433 of 487) was preferred for urgent ED patients. Of those who provided rapid IV dosing data in the ED, two doses of corticosteroids were used by 53% (216 of 410) and one dose was used by 45% (185 of 410), with academic radiologists more likely than private or hybrid practice radiologists to administer two doses (74% [74 of 100] versus 48% [151 of 312], P < .001, odds ratio, 3.03; 95% confidence interval, 1.84-5.00). Rapid IV premedication was more commonly used in 2020 than in 2009 (60% [433 of 724] versus 29% [20 of 69], P < .001, odds ratio, 3.65; 95% confidence interval, 2.12-6.26). Antihistamine use was common in both inpatient (93%, 480 of 518) and ED settings (92%, 447 of 487). Only 32% (229 of 721) of radiologists practiced in accordance with ACR guidelines, suggesting no need for routine premedication before CE-CT in patients with prior severe hypersensitivity reaction to gadolinium-based contrast media. Nonetheless, most (93%, 670 of 724) said the ACR Manual on Contrast Media was a major determinant of their practice. CONCLUSIONS Use of rapid IV premedication in urgent settings has increased since 2009, following updated ACR guidelines, but there is disagreement over whether one or two corticosteroid doses is required. Despite reported high reliance on ACR guidelines, deviations from those guidelines remain common. In general, when ACR guidelines were not followed, it was in a risk-averse direction.
Collapse
Affiliation(s)
- Faezeh Sodagari
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts, and Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Chair, ACR RFS Women and Diversity Advisory Group; Past-Past President, RFS of Radiological Society of Connecticut. https://twitter.com/fsodagari
| | - Mathew S Davenport
- Michigan Medicine, Ann Arbor, Michigan; Service Chief and Vice Chair in Department of Radiology at Michigan Medicine, Vice Chair of the Commission on Quality and Safety for ACR, Board of Directors for Society of Advanced Body Imaging. https://twitter.com/MattDavenportMD
| | - Daniella Asch
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Associate Medical Director for Quality & Safety, Yale Radiology; Member, ACR Committee on Drugs and Contrast Media
| | - Joseph J Cavallo
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Medical Director, Emergency Radiology; Assistant Director, Informatics; Member, ACR Committee on Drugs and Contrast Media. https://twitter.com/jcavallo972
| | - Richard H Cohan
- Michigan Medicine, Department of Radiology, University of Michigan Hospital, Ann Arbor, Michigan. https://twitter.com/Rich_Cohan
| | - James H Ellis
- Michigan Medicine, Department of Radiology, University Hospital, Ann Arbor, Michigan; Member, ACR Committee on Drugs and Contrast Media
| | - Jay K Pahade
- Department of Radiology and Biomedical Imaging, Yale School of Medicine, New Haven, Connecticut; Vice Chair of Quality & Safety, Yale Radiology; Member, ACR Committee on Drugs and Contrast Media.
| |
Collapse
|
2
|
Wasnik AP, Davenport MS, Kaza RK, Weadock WJ, Udager A, Keshavarzi N, Nan B, Maturen KE. Diagnostic accuracy of MDCT in differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis. Clin Imaging 2018; 50:223-228. [PMID: 29679780 DOI: 10.1016/j.clinimag.2018.04.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Revised: 04/05/2018] [Accepted: 04/11/2018] [Indexed: 01/01/2023]
Abstract
OBJECTIVE To determine the diagnostic accuracy of multi-detector CT (MDCT) for differentiating gallbladder cancer from acute and xanthogranulomatous cholecystitis using previously described imaging features. METHODS In this IRB approved HIPAA-compliant retrospective cohort study, contrast-enhanced MDCT of histologically confirmed acute cholecystitis (n = 17), xanthogranulomatous cholecystitis (n = 25), and gallbladder cancer (n = 18) were reviewed independently by three abdominal radiologists blinded to outcome. The primary outcome was the diagnostic accuracy of MDCT for the differentiation of gallbladder cancer from cholecystitis (acute and xanthogranulomatous) using various imaging parameters. Kappa (κ) statistics and two-way mixed-model single-measure intra-class correlation statistics (ICC) were calculated for each imaging feature and the final radiologic diagnosis. RESULTS Inter-rater agreement was moderate to substantial (κ = 0.43-0.70), sensitivity 0.67-0.78, specificity 0.22-0.33 and the positive likelihood ratio was 4.28-8.56 for the differentiation of gallbladder cancer from benign gallbladder pathology. Only three imaging findings: disrupted gallbladder mucosa (κ = 0.68), intraluminal gallstones (κ = 0.66), and gallbladder wall thickness (ICC = 0.63) had substantial inter-rater agreement. The following had slight or no agreement: intramural hypoattenuating nodules (κ = 0.17), transient hepatic attenuation differences (κ = 0.14), gallbladder wall calcification (κ = -0.01), gallbladder wall enhancement (κ = 0.18), and omental or mesenteric invasion (κ = 0.08). In the final multivariate model, the following were significant predictors useful in making or excluding diagnosis of gallbladder cancer: focal gallbladder wall thickening (p = 0.003, OR: 13.09 [95% CI: 2.40-71.48]), pericholecystic "fat stranding" (p = 0.018, OR: 0.10 [95% CI: 0.01-0.66]), and maximum short axis lymph node diameter (p = 0.043, OR: 1.18 [95% CI: 1.00-1.38]). CONCLUSION MDCT has moderate sensitivity, poor specificity, and moderate-to-substantial inter-rater repeatability for the differentiation of gallbladder cancer from acute and xanthogranulomatous cholecystitis.
Collapse
Affiliation(s)
- Ashish P Wasnik
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States.
| | - Mathew S Davenport
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Ravi K Kaza
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - William J Weadock
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Aaron Udager
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Nahid Keshavarzi
- Michigan Institute of Clinical & Health Research (MICHR), University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| | - Bin Nan
- Department of Statistics, School of Public Health, University of Michigan, Ann Arbor, MI 48109, United States
| | - Katherine E Maturen
- Department of Radiology, University of Michigan Health System, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, United States
| |
Collapse
|
3
|
Piert M, Shao X, Raffel D, Davenport MS, Montgomery J, Kunju LP, Hockley BG, Siddiqui J, Scott PJH, Chinnaiyan AM, Rajendiran T. Preclinical Evaluation of 11C-Sarcosine as a Substrate of Proton-Coupled Amino Acid Transporters and First Human Application in Prostate Cancer. J Nucl Med 2017; 58:1216-1223. [PMID: 28302759 DOI: 10.2967/jnumed.116.173179] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2016] [Accepted: 02/14/2017] [Indexed: 12/14/2022] Open
Abstract
Sarcosine is a known substrate of proton-coupled amino acid transporters (PATs), which are overexpressed in selected tissues and solid tumors. Sarcosine, an N-methyl derivative of the amino acid glycine and a metabolic product of choline, plays an important role for prostate cancer aggressiveness and progression. Methods:11C-radiolabeled sarcosine was tested as a new PET imaging probe in comparison with 11C-choline in 2 prostate cancer tumor xenograft models (DU-145 and PC-3). We characterized 11C-sarcosine transport in PC-3 and LNCaP tumor cells and performed 11C-sarcosine PET with CT in the first human subject with localized Gleason 4 + 3 prostate cancer. Target metabolite analyses of sarcosine and its natural precursors, glycine and choline, were performed from independent human prostate tissues. Results: In vitro assays indicated blockage of 11C-sarcosine uptake into PC-3 and LNCaP tumor cells by excess unlabeled (cold) sarcosine. 5-hydroxy-l-tryptophan, but not 2-aminobicyclo-(2,2,1)-heptane-2-carboxylic acid, competitively inhibited 11C-sarcosine tumor cell uptake, confirming PAT-mediated transport. In vivo tumor-to-background ratios (TBRs) obtained from 11C-sarcosine PET were significantly elevated compared with 11C-choline in DU-145 (TBR: 1.92 ± 0.11 for 11C-sarcosine vs. 1.41 ± 0.13 for 11C-choline [n = 10; P < 0.002]) and PC-3 tumors (TBR: 1.89 ± 0.2 for 11C-sarcosine vs. 1.34 ± 0.16 for 11C-choline [n = 7; P < 0.002]). 11C-sarcosine produced high-contrast images in 1 case of localized clinically significant prostate cancer. Target metabolite analyses revealed significant stepwise increases of sarcosine, glycine, and choline tissue levels from benign prostate tissue to localized prostate cancer and subsequently metastatic disease. 11C-sarcosine showed a favorable radiation dosimetry with an effective dose estimate of 0.0045 mSv/MBq, resulting in 2.68 mSv for a human subject (600-MBq dose). Conclusion:11C-sarcosine is a novel radiotracer for PATs and shows initial utility for prostate cancer imaging, with potential benefit over commonly used 11C-choline.
Collapse
Affiliation(s)
- Morand Piert
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Xia Shao
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - David Raffel
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | | | | | | | - Brian G Hockley
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Javed Siddiqui
- Pathology Department, University of Michigan, Ann Arbor, Michigan; and.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Peter J H Scott
- Department of Radiology, University of Michigan, Ann Arbor, Michigan
| | - Arul M Chinnaiyan
- Pathology Department, University of Michigan, Ann Arbor, Michigan; and.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| | - Thekkelnaycke Rajendiran
- Pathology Department, University of Michigan, Ann Arbor, Michigan; and.,Michigan Center for Translational Pathology, University of Michigan, Ann Arbor, Michigan
| |
Collapse
|
4
|
Glazer DI, Davenport MS, Khalatbari S, Cohan RH, Ellis JH, Caoili EM, Stein EB, Childress JC, Masch WR, Brown JM, Mollard BJ, Montgomery JS, Palapattu GS, Francis IR. Mass-like peripheral zone enhancement on CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer. ACTA ACUST UNITED AC 2015; 40:560-70. [PMID: 25193787 DOI: 10.1007/s00261-014-0233-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine whether focal peripheral zone enhancement on routine venous-phase CT is predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer. MATERIALS AND METHODS IRB approval was obtained and informed consent waived for this HIPAA-compliant retrospective study. Forty-three patients with higher-grade prostate cancer (≥Gleason 4 + 3) and 96 with histology-confirmed lower-grade (≤Gleason 3 + 4 [n = 47]) or absent (n = 49) prostate cancer imaged with venous-phase CT comprised the study population. CT images were reviewed by ten blinded radiologists (5 attendings, 5 residents) who scored peripheral zone enhancement on a scale of 1 (benign) to 5 (malignant). Mass-like peripheral zone enhancement was considered malignant. Likelihood ratios (LR) and specificities were calculated. Multivariate conditional logistic regression analyses were conducted. RESULTS Scores of "5" were strongly predictive of higher-grade prostate cancer (pooled LR+ 9.6 [95% CI 5.8-15.8]) with rare false positives (pooled specificity: 0.98 [942/960, 95% CI 0.98-0.99]; all 10 readers had specificity ≥95%). Attending scores of "5" were more predictive than resident scores of "5" (LR+: 14.7 [95% CI 5.8-37.2] vs. 7.6 [95% CI 4.2-13.7]) with similar specificity (0.99 [475/480, 95% CI 0.98-1.00] vs. 0.97 [467/480, 95% CI 0.96-0.99]). Significant predictors of an assigned score of "5" included presence of a peripheral zone mass (p < 0.0001), larger size (p < 0.0001), and less reader experience (p = 0.0008). Significant predictors of higher-grade prostate cancer included presence of a peripheral zone mass (p = 0.0002) and larger size (p < 0.0001). CONCLUSION Focal mass-like peripheral zone enhancement on routine venous-phase CT is specific and predictive of higher-grade (Gleason 4 + 3 and higher) prostate cancer.
Collapse
Affiliation(s)
- D I Glazer
- Department of Radiology, University of Michigan Health System, B2-A209P, Ann Arbor, MI, 48109, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
5
|
Feuerlein S, Davenport MS, Krishnaraj A, Merkle EM, Gupta RT. Computed high b-value diffusion-weighted imaging improves lesion contrast and conspicuity in prostate cancer. Prostate Cancer Prostatic Dis 2015; 18:155-60. [DOI: 10.1038/pcan.2015.5] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2014] [Revised: 11/06/2014] [Accepted: 12/10/2014] [Indexed: 12/20/2022]
|
6
|
Higham TE, Davenport MS, Jayne BC. Maneuvering in an arboreal habitat: the effects of turning angle on the locomotion of three sympatric ecomorphs ofAnolislizards. J Exp Biol 2001; 204:4141-55. [PMID: 11809788 DOI: 10.1242/jeb.204.23.4141] [Citation(s) in RCA: 68] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
SUMMARYAlthough the maximal speeds of straight-ahead running are well-documented for many species of Anolis and other lizards, no previous study has experimentally determined the effects of turning on the locomotor performance of a lizard. Anolis lizards are a diverse group of arboreal species, and the discrete paths created by networks of perches in arboreal environments often force animals to turn in their natural habitats. For three species of Anolis with similar overall body size but different shape, we quantified the escape locomotor performance for arboreal locomotion on 4.8 cm diameter perches that were straight (0°) or had turning angles of 30° and 90°. The turning angle had widespread significant effects that were often species-dependent. This was shown by measuring the average gross velocity (including the times while the lizards paused) of the three species covering the middle 30 cm of a racetrack with either 30° or 90° turns. The results were expressed as a percentage of the gross velocity over the same distance on a straight racetrack. The values obtained for A. grahami (99 % for 30° turns and 79 % for 90° turns) showed a smaller effect of turning angle than for A. lineatopus (79 % for 30° turns and 50 % for 90° turns) and A. valencienni (74 % for 30° turns and 48 % for 90° turns). Consequently, the rank order of species based on speed depended on the angle of the turn. Some of the magnitudes of decreased locomotor speed associated with turning exceeded those reported previously for the effects of decreasing perch diameter for these species. For all species, more pausing occurred with increased turning angle, with the twig ecomorph (A. valencienni) pausing the most. Approximately half the individuals of each species jumped to traverse the 90° turn, but some of the potential benefits of jumping for increasing speed were offset by pauses associated with preparing to jump or recovering balance immediately after a jump. The tail of Anolis lizards may facilitate the substantial rotation (>60°) of the body that often occurred in the airborne phase of the jumps.
Collapse
Affiliation(s)
- T E Higham
- Department of Biological Sciences, University of Cincinnati, PO Box 210006, Cincinnati, OH 45221-0006, USA.
| | | | | |
Collapse
|
7
|
Abstract
The use of prophylactic antibiotics in reduction mammoplasty has been random and its efficacy unproven. This study reviewed 106 consecutive inferior pedicle technique reduction mammoplasties. Two groups were identified; 47 patients received prophylactic antibiotics and 59 patients did not. The decision of who received prophylactic antibiotics was random based on resident rotation and resident preoperative orders. The demographics were equal between the antibiotic group and the control group. The wound infection rate and the rate of delayed healing were examined in both groups. There were no statistically significant differences in the infection rate or the rate of delayed wound healing in either the antibiotic group or the control group. Individual risk factors were also studied in each group. These risk factors included obesity, older age, smoking history, and large reductions. The use of prophylactic antibiotics did not reduce the infection rate in any of these high-risk groups. Comparing the individual risk factors for the remainder of the patient population showed that the infection rate was higher in obese patients but was unaffected by prophylactic antibiotics. Delayed healing was also higher in larger reductions but also was unaffected by the use of prophylactic antibiotics. We conclude that the use of prophylactic antibiotics in reduction mammoplasty is not efficacious in reducing the rate of wound infection or delayed healing.
Collapse
Affiliation(s)
- J M Serletti
- Department of Surgery, University of Rochester School of Medicine and Dentistry, NY
| | | | | | | |
Collapse
|