Lauren M. Burke

Self-reported gadolinium toxicity: A survey of patients with chronic symptoms

PURPOSE This study aims to describe the self-reporting symptoms experienced by individuals with self-reported normal renal function after gadolinium based contrast agent (GBCA) administration. MATERIALS AND METHODS This HIPAA-compliant, IRB-approved study consisted of an anonymous online survey of patients who believe that they suffer from gadolinium toxicity. 50 respondents completed the nine-question survey. RESULTS Fifty (100%) of the subjects ascribed their complaints to gadolinium exposure. Thirty-three (66%) described the onset immediately following GBCA administration and 16 (32%) within 6weeks. The most common symptoms included bone/joint pain and head/neck symptoms including headache, vision change, and hearing change (77.6% each). Other symptoms occurred with lesser incidence. CONCLUSIONS This survey represents an initial description of patients with normal renal function who self-described toxicity related to GBCA administration. Bone and joint complaints and skin changes are two of the most common complaints.

Magnetic resonance imaging of acute appendicitis in pregnancy: a 5-year multiinstitutional study

OBJECTIVE The purpose of this study was to determine the diagnostic performance of magnetic resonance imaging (MRI) in the diagnosis of acute appendicitis during pregnancy in a multiinstitutional study. STUDY DESIGN In this multicenter retrospective study, the cases of pregnant women who underwent MRI evaluation of abdominal or pelvic pain and who had clinical suspicion of acute appendicitis between June 1, 2009, and July 31, 2014, were reviewed. All MRI examinations with positive findings for acute appendicitis were confirmed with surgical pathologic information. Sensitivity, specificity, negative predictive values, and positive predictive values were calculated. Receiver operating characteristic curves were generated, and area under the curve analysis was performed for each participating institution. RESULTS Of the cases that were evaluated, 9.3% (66/709) had MRI findings of acute appendicitis. Sensitivity, specificity, accuracy, positive predictive value, and negative predictive values were 96.8%, 99.2%, 99.0%, 92.4%, and 99.7%, respectively. There was no statistically significant difference between centers that were included in the study (pair-wise probability values ranged from 0.12-0.99). CONCLUSION MRI is useful and reproducible in the diagnosis of suspected acute appendicitis during pregnancy.

Gadolinium deposition disease: Initial description of a disease that has been around for a while

PURPOSE To describe the clinical manifestations of presumed gadolinium toxicity in patients with normal renal function. MATERIALS AND METHODS Participants were recruited from two online gadolinium toxicity support groups. The survey was anonymous and individuals were instructed to respond to the survey only if they had evidence of normal renal function, evidence of gadolinium in their system beyond 30days of this MRI, and no pre-existent clinical symptoms and/or signs of this type. RESULTS 42 subjects responded to the survey (age: 28-69, mean 49.1±22.4years). The most common findings were: central pain (n=15), peripheral pain (n=26), headache (n=28), and bone pain (n=26). Only subjects with distal leg and arm distribution described skin thickening (n=22). Clouded mentation and headache were the symptoms described as persistent beyond 3months in 29 subjects. Residual disease was present in all patients. Twenty-eight patients described symptoms following administration of one brand of Gadolinium-Based Contrast Agent (GBCA), 21 after a single GBCA administration and 7 after multiple GBCA administrations, including: gadopentetate dimeglumine, n=9; gadodiamide, n=4; gadoversetamide, n=4; gadobenate dimeglumine, n=4; gadobutrol, n=1; gadoteridol, n=2; and unknown, n=4. CONCLUSIONS Gadolinium toxicity appears to arise following GBCA administration, which appears to contain clinical features seen in Nephrogenic Systemic Fibrosis, but also features not observed in that condition.

Presumed Gadolinium Toxicity in Subjects With Normal Renal Function: A Report of 4 Cases.

ObjectiveThe aim of this study was to examine and report 4 patients who developed symptomatology shortly after gadolinium-based contrast agent (GBCA) administration. Materials and MethodsHistory taking and targeted physical examination were performed on 4 subjects who reported development of new disease features within hours to 4 weeks of having received an intravenous administration of GBCA. ResultsTwo subjects were assessed at 2 months (patient P2mo) and at 3 months (patient P3mo) after GBCA administration (early stage), and 2 subjects were assessed at 7 years (patient P7yr) and 8 years (patient P8yr) after having received GBCA administration (late stage). Clinical features were similar between subjects, and included central torso pain (all), peripheral arm and leg pain (all), clouded mentation (n = 2), and distal arm and leg skin thickening and rubbery subcutaneous tissue (one early and both late subjects). Gadolinium was detected as follows: in a 24-hour urine specimen, 1 month after disease development (18 &mgr;g/24 hours and 82 &mgr;g/24 hours in patients P2mo and P3mo, respectively); hair (0.0007 &mgr;g/g) and urine (0.0644 &mgr;g/g) samples, 7 years after disease development (late stage, patient P7yr); and saphenous vein sample, 8 years after disease development (0.27 ± 0.007 ng/62 mg sample) (late stage, patient P8yr). ConclusionsGadolinium toxicity may occur in subjects with normal renal function. Central torso and peripheral arm and leg distribution pain were common features. Distal arm and leg skin thickening and rubbery subcutaneous tissue were seen in late stages. Clouded mentation is also common. Vigilance to identify additional cases and investigate strategies for prevention and treatment is warranted to increase even further the safety of a very safe diagnostic procedure, GBCA-enhanced magnetic resonance imaging.

Liver imaging reporting and data system category 4 observations in MRI: Risk factors predicting upgrade to category 5.

To identify demographic and imaging features in magnetic resonance imaging (MRI) that are associated with upgrade of Liver Imaging Reporting and Data System (LI‐RADS) category 4 (LR‐4) observations to category 5 (LR‐5), and to assess their effects on risk of upgrade and time to upgrade.

Trends in Diagnostic CT Among Fee-For-Service Enrollees, 2000-2011

OBJECTIVES To examine trends in the use of diagnostic CT in aggregate and for 4 major body regions (abdomen/pelvis, head/neck, chest, and spine) in an 11-year US nationwide analysis. METHODS We summarize records from a large, mostly fee-for-service insurance claims database from 2000 to 2011. RESULTS Rates of diagnostic CT have increased substantially from 2000 to 2011; however, changes in rates are disparate for different age groups and body regions. As others have shown, there has been a notable increase in use of diagnostic CT from 2000 to 2011. However, from 2009 to 2011, diagnostic CT studies of the chest, abdomen/pelvis, and head/neck have leveled off or decreased, whereas CTs of the spine show a continued increase in many groups. CONCLUSIONS In general, the increase in the rate of CT study performance has slowed, whereas spine CT continued to escalate. Future research should consider whether the increase in use of spine CT leads to a benefit that outweighs the risk associated with the increased population-level cancer risk.

Realce por contraste de lesões hepáticas em pacientes com cirrose: estudo cruzado comparativo de dois agentes de contraste para RM realizado em uma única instituição. Resultados preliminares

OBJECTIVE: To prospectively compare full dose gadopentetate dimeglumine (Gd-DTPA) with full dose gadobenate dimeglumine (Gd-BOPTA) in the detection of focal hepatic lesions in patients with chronic liver disease on MRI. MATERIALS AND METHODS: Eight patients with hepatic cirrhosis and a strong suspicion for small hepatocellular carcinoma based on prior MRI underwent contrast-enhanced MR examinations, one with full dose Gd-DTPA and one with full dose Gd-BOPTA. The exams were performed from 72-108 hours apart. Two blinded and independent radiologists evaluated images for lesion number, characterization, enhancement, and subjective preference. RESULTS: There was no statistically significant difference between the two studies for lesion detection or characterization. There was 18% increased lesion enhancement for Gd-BOPTA, compared to Gd-DTPA, of the dominant lesion. Both blinded readers subjectively preferred the images using Gd-BOPTA over Gd-DTPA in the majority of cases, based on greater lesion enhancement and better edge definition. CONCLUSION: At equivalent full doses, Gd-BOPTA compared similarly with Gd-DTPA in the detection and characterization of focal hepatic lesions in patients with chronic liver disease. However, Gd-BOPTA was superior for increased lesion enhancement and subjective preference of the reader.

Comparison of the incidence of pancreatic abnormalities between high risk and control patients: Prospective pilot study with 3 tesla MR imaging

To compare the incidence of pancreatic abnormalities detected by MR imaging between high‐risk patients and control patients.

Utility of Pelvic Computed Tomography Angiography Prior to Prostatic Artery Embolization.

Pelvic computed tomography angiography (CTA) prior to prostatic artery embolization is a beneficial tool for preprocedural planning to increase the likelihood of success during what can be a challenging procedure. Additionally, the same CTA images can be used for calculating the baseline prostate volume as well as for intraprocedural anatomic guidance, adding to the value of the scan. This article discusses the technique used for pelvic CTA and its role in preprocedural assessment of the pelvic vasculature prior to prostatic artery embolization.

Health care reform in the USA: Recommendations from USA and non-USA radiologists

AIM To compare the opinions and recommendations of imaging specialists from United States (USA) and non-USA developed nations for USA health care reform. METHODS A survey was emailed out to 18 imaging specialists from 17 non-USA developed nation countries and 14 radiologists within the USA regarding health care reform. The questionnaire contained the following questions: what are the strengths of your health care system, what problems are present in your nations health care system, and what recommendations do you have for health care reform in the USA. USA and non-USA radiologists received the same questionnaire. RESULTS Strengths of the USA health care system include high quality care, autonomy, and access to timely care. Twelve of 14 (86%) USA radiologists identified medicolegal action as a major problem in their health care system and felt that medicolegal reform was a critical aspect of health care reform. None of the non-USA radiologists identified medicolegal aspects as a problem in their own country nor identified it as a subject for USA health care reform. Eleven of 14 (79%) USA radiologists and 16/18 (89%) non-USA radiologists identified universal health care coverage as an important recommendation for reform. CONCLUSION Without full universal coverage, meaningful health care reform will likely require medicolegal reform as an early and important aspect of improved and efficient health care.