AIM: To assess current practice of United Kingdom cardiologists with respect to patients with reported shellfish/iodine allergy, and in particular the use of iodinated contrast for elective coronary angiography.Moreov...AIM: To assess current practice of United Kingdom cardiologists with respect to patients with reported shellfish/iodine allergy, and in particular the use of iodinated contrast for elective coronary angiography.Moreover we have reviewed the current evidence-base and guidelines available in this area.METHODS: A questionnaire survey was send to 500senior United Kingdom cardiologists(almost 50% cardiologists registered with British Cardiovascular Society)using email and first 100 responses used to analyze practise. We involved cardiologists performing coronary angiograms routinely both at secondary and tertiary centres. Three specific questions relating to allergy were asked:(1) History of shellfish/iodine allergy in pre-angiography assessment;(2) Treatments offeredfor shellfish/iodine allergy individuals; and(3) Any specific treatment protocol for shellfish/iodine allergy cases. We aimed to establish routine practice in United Kingdom for patients undergoing elective coronary angiography. We also performed comprehensive PubMed search for the available evidence of relationship between shellfish/iodine allergy and contrast media.RESULTS: A total of 100 responses were received, representing 20% of all United Kingdom cardiologists. Ninety-three replies were received from consultant cardiologists, 4 from non-consultant grades and 3 from cardiology specialist nurses. Amongst the respondents, 66% routinely asked about a previous history of shellfish/iodine allergy. Fifty-six percent would pre-treat these patients with steroids and anti-histamines. The other 44% do nothing, or do nonspecific testing based on their personal experience as following:(1) Skin test with 1 mL of subcutaneous contrast before intravenous contrast;(2) Test dose 2 mL contrast before coronary injection;(3) Close observation for shellfish allergy patients; and(4) Minimal evidence that the steroid and anti-histamine regime is effective but it makes us feel better.CONCLUSION: There is no evidence that allergy to shellfish alters the risk of reaction to intravenous contrast more than any other allergy and asking about such allergies in pre-angiogram assessment will not provide any additional information except propagating the myth.展开更多
AIM: To evaluate the image quality of hepatic multidetector computed tomography(MDCT) with dynamic contrast enhancement. METHODS: It uses iodixanol 270 mg/m L(Visipaque 270) and 80 kVp acquisitions reconstructed with ...AIM: To evaluate the image quality of hepatic multidetector computed tomography(MDCT) with dynamic contrast enhancement. METHODS: It uses iodixanol 270 mg/m L(Visipaque 270) and 80 kVp acquisitions reconstructed with sinogram affirmed iterative reconstruction(SAFIRE?) in comparison with a standard MDCT protocol. Fiftythree consecutive patients with known or suspected hepatocellular carcinoma underwent 55 CT examinations, with two different four-phase CT protocols. The first group of 30 patients underwent a standard 120 kVp acquisition after injection of Iohexol 350 mg/m L(Accupaque 350~?) and reconstructed with filtered back projection. The second group of 25 patients underwent a dual-energy CT at 80-140 kVp with iodixanol 270. The 80 kVp component of the second group was reconstructed iteratively(SAFIRE?-Siemens). All hyperdense and hypodense hepatic lesions ≥ 5 mm were identified with both protocols. Aorta and portal vessels/liver parenchyma contrast to noise ratio(CNR) in arterial phase, hypervascular lesion/liver parenchyma CNR in arterial phase, hypodense lesion/liver parenchyma CNR in portal and late phase were calculated in both groups.RESULTS: Aorta/liver and focal lesions altogether/liver CNR were higher for the second protocol(P = 0.0078 and 0.0346). Hypervascular lesions/liver CNR was not statistically different(P = 0.86). Hypodense lesion/liver CNR in the portal phase was significantly higher for the second group(P = 0.0107). Hypodense lesion/liver CNR in the late phase was the same for both groups(P = 0.9926).CONCLUSION: MDCT imaging with 80 kVp with iterative reconstruction and iodixanol 270 yields equal or even better image quality.展开更多
文摘AIM: To assess current practice of United Kingdom cardiologists with respect to patients with reported shellfish/iodine allergy, and in particular the use of iodinated contrast for elective coronary angiography.Moreover we have reviewed the current evidence-base and guidelines available in this area.METHODS: A questionnaire survey was send to 500senior United Kingdom cardiologists(almost 50% cardiologists registered with British Cardiovascular Society)using email and first 100 responses used to analyze practise. We involved cardiologists performing coronary angiograms routinely both at secondary and tertiary centres. Three specific questions relating to allergy were asked:(1) History of shellfish/iodine allergy in pre-angiography assessment;(2) Treatments offeredfor shellfish/iodine allergy individuals; and(3) Any specific treatment protocol for shellfish/iodine allergy cases. We aimed to establish routine practice in United Kingdom for patients undergoing elective coronary angiography. We also performed comprehensive PubMed search for the available evidence of relationship between shellfish/iodine allergy and contrast media.RESULTS: A total of 100 responses were received, representing 20% of all United Kingdom cardiologists. Ninety-three replies were received from consultant cardiologists, 4 from non-consultant grades and 3 from cardiology specialist nurses. Amongst the respondents, 66% routinely asked about a previous history of shellfish/iodine allergy. Fifty-six percent would pre-treat these patients with steroids and anti-histamines. The other 44% do nothing, or do nonspecific testing based on their personal experience as following:(1) Skin test with 1 mL of subcutaneous contrast before intravenous contrast;(2) Test dose 2 mL contrast before coronary injection;(3) Close observation for shellfish allergy patients; and(4) Minimal evidence that the steroid and anti-histamine regime is effective but it makes us feel better.CONCLUSION: There is no evidence that allergy to shellfish alters the risk of reaction to intravenous contrast more than any other allergy and asking about such allergies in pre-angiogram assessment will not provide any additional information except propagating the myth.
文摘AIM: To evaluate the image quality of hepatic multidetector computed tomography(MDCT) with dynamic contrast enhancement. METHODS: It uses iodixanol 270 mg/m L(Visipaque 270) and 80 kVp acquisitions reconstructed with sinogram affirmed iterative reconstruction(SAFIRE?) in comparison with a standard MDCT protocol. Fiftythree consecutive patients with known or suspected hepatocellular carcinoma underwent 55 CT examinations, with two different four-phase CT protocols. The first group of 30 patients underwent a standard 120 kVp acquisition after injection of Iohexol 350 mg/m L(Accupaque 350~?) and reconstructed with filtered back projection. The second group of 25 patients underwent a dual-energy CT at 80-140 kVp with iodixanol 270. The 80 kVp component of the second group was reconstructed iteratively(SAFIRE?-Siemens). All hyperdense and hypodense hepatic lesions ≥ 5 mm were identified with both protocols. Aorta and portal vessels/liver parenchyma contrast to noise ratio(CNR) in arterial phase, hypervascular lesion/liver parenchyma CNR in arterial phase, hypodense lesion/liver parenchyma CNR in portal and late phase were calculated in both groups.RESULTS: Aorta/liver and focal lesions altogether/liver CNR were higher for the second protocol(P = 0.0078 and 0.0346). Hypervascular lesions/liver CNR was not statistically different(P = 0.86). Hypodense lesion/liver CNR in the portal phase was significantly higher for the second group(P = 0.0107). Hypodense lesion/liver CNR in the late phase was the same for both groups(P = 0.9926).CONCLUSION: MDCT imaging with 80 kVp with iterative reconstruction and iodixanol 270 yields equal or even better image quality.
