Abstract:
RATIONALE AND OBJECTIVES:The authors analyze the origins of the "clotting issue," the controversy that began in the 1980s when contrast media, once perceived as good flushing agents for catheters because of their assumed anticoagulant properties, came under attack for allegedly causing thromboembolism. Laboratory studies as well as a number of clinical reports seemed to substantiate this charge. Nonionic agents in particular were accused by some clinicians of being more likely to cause clots to form in syringes contaminated with blood than were ionic agents. The authors wanted to determine whether some lapse in operator technique rather than a fault in the contrast agent might be to blame. The theory that the syringe and catheter materials, and not the contrast agent itself, could be the source of thromboembolic problems in angiography also is examined. METHODS:The authors reviewed studies and reports on both sides of the issue and conducted laboratory and clinical studies of their own. For the syringe materials analysis, they used a fibrinopeptide A (FpA) enzyme-linked immunosorbent assay (ELISA) test to monitor levels as a marker of activation of coagulation. They tested catheter materials using the same technique. RESULTS:Clots were found only in nonionic agents, but under nonclinically relevant circumstances. If the anticoagulant effect of the nonionic contrast agent was maximized by mixing rather than layering blood and agent, clots did not form. In their materials analysis, the authors demonstrated that glass syringes are thrombogenic, causing vigorous contact activation, and that plastic is less so. Polyurethane catheters are more thrombogenic, polyethylene less so. One survey conducted in the 1970s on the clinical incidence of thromboembolism in coronary angiography suggested that the single most important factor in the etiology is poor angiographic technique. The authors' studies supported their thesis. CONCLUSIONS:In terms of the findings from laboratory studies, misinterpretation of data by nonclinicians is one problem. No evidence suggests that nonionic contrast agents are in any way prothrombotic or thrombogenic. On the contrary, in line with their greater inertness, nonionic agents have weaker effects. Ionic contrast media may cause more endothelial injury and associated localized platelet deposition than nonionic contrast media, and more anticoagulant contrast agents are more toxic. If anticoagulation is required, therefore, it should be achieved by such procedures as carefully controlled systemic heparinization rather than by resorting to more toxic materials. The activation of coagulation is caused by endothelial injury and by prolonged contact between blood and foreign surfaces such as syringes or catheters, but is inhibited by the contrast agent. Because a thrombus may form inside the catheter, whatever contrast agent is used, flushing is important. The authors agree with the findings of one study that the incidence of thromboembolism in coronary angiography, and probably in other catheter procedures, is markedly operator dependent. The materials of the syringes and catheters used, as well as the state of the patient's intrinsic clotting, are more important factors than the contrast agent. The authors conclude that materials other than the contrast agents are the cause of thromboembolic problems; and that, being anticoagulant, contrast agents are entirely helpful, if variably so, in angiographic procedures.
journal_name
Invest Radioljournal_title
Investigative radiologyauthors
Dawson P,Cousins C,Bradshaw Asubject
Has Abstractpub_date
1993-11-01 00:00:00pages
S31-6; discussion S37-8eissn
0020-9996issn
1536-0210journal_volume
28 Suppl 5pub_type
杂志文章,评审abstract::Using cardiac-gated fast acquisition with multiple excitation (FAME), time curves of the cerebral aqueduct signals were derived in 19 healthy volunteers and 14 patients. A mean curve of the normal subjects was determined during systole. A relatively stable point of time was found at 270 msec after the R-wave supposed ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198911000-00004
更新日期:1989-11-01 00:00:00
abstract::An isotopic radiation source 125I was investigated for use in soft tissue radiaography, with particular attention to possible use in mammography for mass screening. Film sensitivities, exposure rates, absorbed doeses, contrast and resolution were determined, and compared to conventional x-ray units. It was found that ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-197509000-00007
更新日期:1975-09-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to compare the prognostic utility of a staging system using magnetic resonance imaging (MRI) with the seventh American Joint Committee on Cancer (AJCC) staging system in patients with hepatocellular carcinoma (HCC) who underwent hepatic resection. MATERIALS AND METHODS:A total of 1...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0b013e3182630e8d
更新日期:2012-11-01 00:00:00
abstract:OBJECTIVE:Dynamic ventilation (3)He-MRI is a new method to assess pulmonary gas inflow. As differing airway diameters throughout the ventilatory cycle can influence gas inflow this study intends to investigate the influence of volume and timing of a He gas bolus with respect to the beginning of the tidal volume on insp...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0b013e3181690111
更新日期:2008-06-01 00:00:00
abstract:OBJECTIVES:This clinical study investigated the pharmacokinetics and safety of gadobutrol, a magnetic resonance (MR) imaging extracellular contrast agent, in pediatric patients aged 2 to 17 years. MATERIALS AND METHODS:In this open-label, multicenter study, patients scheduled for routine contrast-enhanced MR imaging o...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0b013e3181bfe2d2
更新日期:2009-12-01 00:00:00
abstract::A patient, suffering a severe anaphylactoid reaction to contrast material injected for an intravenous pyelogram, developed a consumption coagulopathy and evidence of complement activation. Precontrast complement values suggested that the patient had been processing complement via the classical pathway, perhaps as a co...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198011001-00004
更新日期:1980-11-01 00:00:00
abstract::Recent publications of the magnetic resonance safety profile of neurostimulators, cardiac pacemakers, and other implanted devices imply that these devices are no longer a contraindication for magnetic resonance imaging. It is very promising that patients who have these implanted devices may in the future no longer be ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/01.rli.0000185898.59140.91
更新日期:2005-12-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:The authors conduct technical feasibility and performance studies on a new 0.009-inch nitinol microguidewire for potential neuroendovascular applications. METHODS:In vivo microcatheterizations of brachiocephalic arteries were performed in four pigs using the 0.009-inch nitinol microguidewire w...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-199704000-00008
更新日期:1997-04-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:Echogenic antibody-conjugated anionic liposomes have been developed that allow directed tissue targeting and acoustic enhancement. These are not efficient for gene delivery. A cationic formulation that allows directed gene delivery while retaining acoustic properties may provide more efficient ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-200012000-00007
更新日期:2000-12-01 00:00:00
abstract:RATIONALE AND OBJECTIVE:The authors performed a retrospective study in ultrasound to investigate new aspects in the sonomorphology of lymph node metastases of the neck. In this study, it could be demonstrated the first time that the histologic characteristics of the metastases determine the sonographic appearance. In a...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-199609000-00001
更新日期:1996-09-01 00:00:00
abstract:OBJECTIVES:The aim of this study was to investigate the impact of impaired renal function on gadolinium (Gd) retention in various organs after Gd-based contrast agent injection. MATERIALS AND METHODS:After local animal care and review committee approval, 23 normal mice and 26 with renal failure were divided into 4 tre...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0000000000000295
更新日期:2016-10-01 00:00:00
abstract::The effect of three iodinated contrast media (CM) on human plasma butyrylcholinesterase (BuChE) activity was studied during the intravenous pyelography (i.v.P). BuChE is an enzyme that participates in the metabolism of acetylcholine and hydrolyzes food esters and drugs such as nondepolarizing muscle relaxants and loca...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-199805000-00008
更新日期:1998-05-01 00:00:00
abstract:OBJECTIVE:To investigate the efficacy of true fast imaging with steady state precession (true-FISP) compared with T2-weighted fast spin echo (T2W-FSE) in monitoring changes in cyst volume and renal expansion in an ischemia reperfusion (IR) injured PKD1 knockout (IKO) mouse model. MATERIALS AND METHODS:The animal study...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0b013e3181be3501
更新日期:2010-01-01 00:00:00
abstract::We studied 60 male patients who had concurrent chest films (CXR), computed tomography scans (CT) and pulmonary function tests (PFT) to assess the sensitivity of CT and conventional films in detecting emphysema compared with PFT. We also sought to determine whether emphysema could be diagnosed by CT in patients with no...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198804000-00004
更新日期:1988-04-01 00:00:00
abstract:PURPOSE:The relaxivities of 3 macrocyclic gadolinium-based contrast agents (GBCAs) were determined in human plasma and blood under standardized and clinically relevant laboratory conditions. METHODS:The T1 relaxivity, r1, was determined in human plasma at 1.5, 3, and 7 T, and in human blood at 3 T at 37°C in phantoms ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0000000000000577
更新日期:2019-09-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:This study assesses the ability of a cardiac-gated phase-contrast magnetic resonance imaging (MRI) technique to measure renal blood flow (RBF) noninvasively in humans. METHODS:In nine normal volunteers, total RBF in the renal arteries and in the left renal vein was estimated by MRI and correla...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-199206000-00012
更新日期:1992-06-01 00:00:00
abstract::The authors evaluated double-blind comparative and open-label clinical trials in 1,186 patients who received ioversol to evaluate the safety and efficacy of ioversol, a new nonionic low-osmolality contrast medium, at iodine concentrations of 32%, 24%, and 16%. The results indicate that ioversol was well tolerated in a...
journal_title:Investigative radiology
pub_type: 临床试验,杂志文章
doi:10.1097/00004424-198906001-00020
更新日期:1989-06-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:The authors studied the incidence and distribution of orthopedic injuries sustained in Operation Desert Shield and Desert Storm by evaluating whether existing diagnostic imaging modalities were sufficient to diagnose the types of musculoskeletal injuries incurred. The authors also sought to det...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-199703000-00006
更新日期:1997-03-01 00:00:00
abstract:RATIONAL AND OBJECTIVES:The purpose of this study was to evaluate the effects of variation in design parameters on the resultant radial force. We evaluated the influence of wire gauge, leg length, and number of bends on the radial force produced by z stents and compared these with radial forces produced by commercial s...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-200109000-00004
更新日期:2001-09-01 00:00:00
abstract::The results of an in vitro mixed hemadsorption (MHA) assay predicted the success of in vivo tumor localization using a radioiodinated, monoclonal, IgG1 antibody (A2) with reactivity to the human bladder carcinoma cell line RT4. In vitro, murine monoclonal antibodies A2 and G6, demonstrated reactivity to RT4 with titer...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198411000-00011
更新日期:1984-11-01 00:00:00
abstract::Experimental pulmonary arteritis was produced in rabbits by intravenous injection of alveolar macrophages from donor rabbits. These animals, along with matched controls, were studied with pulmonary angiography to test the hypothesis that angiography could detect the vasculitic process in life. The animals were then sa...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198007000-00005
更新日期:1980-07-01 00:00:00
abstract:OBJECTIVE:As an imaging modality for follow-up during continuous or repeated hepatic arterial infusion chemotherapy using a hepatic intra-arterial indwelling catheter, the usefulness of CT while infusing contrast through the indwelling catheter (reservoir port) was examined. METHODS:Using reservoir ports implanted in ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-199912000-00003
更新日期:1999-12-01 00:00:00
abstract::A battery of tests for toxicity assessment of new contrast media is reviewed. Cell toxicity in a protozoan culture (Blepharisma americanum); lethal dose determination in mice; EEG Spectral analysis following cisternography in rabbits; ED50 and LD50 determination by intra- and pericerebral injection in rats; intraciste...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198011001-00053
更新日期:1980-11-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:The authors differentiate acute tubular necrosis from transplant rejection in patients with delayed kidney graft function using gadolinium (Gd)-DTPA enhanced magnetic resonance (MR) imaging. METHODS:Twenty-four patients after renal transplantation (10 with normal graft function, 14 with delaye...
journal_title:Investigative radiology
pub_type: 临床试验,杂志文章
doi:10.1097/00004424-199606000-00009
更新日期:1996-06-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:The vasoconstriction of the renal arteries is frequently considered as a crucial factor for radiocontrast-induced nephropathy. A direct effect of iodinated radiographic contrast medium (RCM) on vascular smooth muscle is supposed to be one component of the vascular response. We studied the effec...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-200208000-00005
更新日期:2002-08-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:To test noninvasive inductive heating of implanted vascular stents as an alternative approach for reduction or prevention of neointimal hyperplasia. METHODS:Calorimetric pretests were performed to get an orientation on the different parameters of influence for inductive heating of stents. The ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/01.rli.0000117881.42422.72
更新日期:2004-05-01 00:00:00
abstract:OBJECTIVES:To test the feasibility of combining inner-volume imaging (IVI) techniques with conventional multishot periodically rotated overlapping parallel lines with enhanced reconstruction (PROPELLER) techniques for targeted-PROPELLER magnetic resonance imaging. MATERIALS AND METHODS:Perpendicular section-selective ...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0b013e3181a8b015
更新日期:2009-08-01 00:00:00
abstract:PURPOSE:To determine whether liver metastases conspicuity is improved at 80 kVp when compared with weighted average (WA) simulated 120 kVp data using dual source dual energy CT. METHODS:A total of 11 patients with 44 hypo-vascular liver metastases underwent contrast enhanced Dual Energy CT (DECT). In all cases the sub...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/RLI.0b013e3181dfda78
更新日期:2010-07-01 00:00:00
abstract:RATIONALE AND OBJECTIVES:Dynamic contrast enhanced (DCE) MR mammography (MRM) uses tumor capillary density differences for prognosis. The heterogeneous response of permeability-surface area products (PS = Kp<-->t) was examined in mammary tumors, as a function of contrast agent size, to determine what effect ROI size mi...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-200204000-00003
更新日期:2002-04-01 00:00:00
abstract::An ultrasound phantom was constructed simulating fetal femurs in amniotic fluid. Bones of 26, 36, 50, 58, and 70 mm, representative of gestational ages ranging from 17 to 36 weeks, were scanned with mechanical sector, phased sector, and linear array systems (ATL, Diasonics, Acuson, and GE). Measurements were made with...
journal_title:Investigative radiology
pub_type: 杂志文章
doi:10.1097/00004424-198505000-00016
更新日期:1985-05-01 00:00:00