Článek shrnuje současné poznatky o hypersenzitivních reakcích na jodové i gadoliniové kontrastní látky široce používané v radiodiagnostice. Alergologické vyšetření významně přispívá k upřesnění typu hypersenzitivity, účasti imunologického mechanismu, výběru vhodné kontrastní látky a dalších opatření pro budoucí použití.
The review summarizes current knowledge on hypersensitive reactions to iodinated contrast media and contrast media containing gadolinium, which both are widely used in radiology. Allergy work-up contributes to the correct assessment of hypersensitivity type, involvement of immune mechanism, selection of suitable contrast media and other measures for future use.
- MeSH
- Medical History Taking MeSH
- Basophils immunology MeSH
- Hypersensitivity, Immediate MeSH
- Gadolinium administration & dosage adverse effects therapeutic use MeSH
- Immunologic Techniques MeSH
- Iodine administration & dosage adverse effects therapeutic use MeSH
- Contrast Media * administration & dosage adverse effects MeSH
- Skin Tests MeSH
- Drug Hypersensitivity * diagnosis etiology MeSH
- Humans MeSH
- Hypersensitivity, Delayed MeSH
- Prednisone administration & dosage adverse effects therapeutic use MeSH
- Premedication standards MeSH
- Radiography * MeSH
- Tryptases blood MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
BACKGROUND: Delayed-release dimethyl fumarate (DMF) has demonstrated efficacy and a favorable benefit-risk profile in phase 2 and 3 studies that enrolled predominantly white patients with relapsing-remitting multiple sclerosis (RRMS). In this study (APEX, Part I), we evaluated the efficacy/safety outcomes of DMF in a predominantly East Asian population of patients with RRMS. METHODS: In this 24-week, randomized, double-blind, placebo-controlled phase 3 study, 225 patients, 142 of which were East Asian (63.4%), were enrolled: Japan (n = 114), South Korea (n = 20), Taiwan (n = 8), the Czech Republic (n = 42), and Poland (n = 40). Key exclusion criteria included diagnosis of neuromyelitis optica spectrum disorder. Stratified by country, patients were randomized 1:1 to receive DMF 240 mg twice daily or placebo. Clinical assessments, including neurological examination and EDSS scoring, were conducted at baseline and at weeks 12 and 24. RESULTS: A total of 213 patients (95.1%) completed the study. From weeks 12 - 24, the total number of new gadolinium-enhancing (Gd+) lesions was reduced by 84% (p < 0.0001) in DMF compared with placebo. For the secondary endpoint, from baseline to week 24, the total number of new Gd+ lesions was reduced by 75% and the mean number of new/newly enlarging T2 hyperintense lesions was reduced by 63% (both p < 0.0001). Flushing and flushing-related symptoms, and gastrointestinal events were adverse events related to DMF treatment. Efficacy and safety results in the Japanese subgroup and the East Asian subgroup (which included patients from Japan, Taiwan, and South Korea) were consistent with the overall study population. CONCLUSION: The strong efficacy and favorable benefit-risk profile of DMF extends to Japanese, and more broadly, East Asian patients with RRMS. TRIAL REGISTRATION: This trial is registered on ClinicalTrials.gov (identifier: NCT01838668 ), April 20, 2013 (retrospectively registered). The registration can be found at the following URL: https://clinicaltrials.gov/ct2/show/NCT01838668.
- MeSH
- Dimethyl Fumarate administration & dosage MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Gadolinium administration & dosage MeSH
- Immunosuppressive Agents therapeutic use MeSH
- Delayed-Action Preparations MeSH
- Middle Aged MeSH
- Humans MeSH
- Multiple Sclerosis, Relapsing-Remitting drug therapy MeSH
- Treatment Outcome MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Clinical Trial, Phase III MeSH
- Randomized Controlled Trial MeSH
- Geographicals
- Czech Republic MeSH
- Asia, Eastern MeSH
- Poland MeSH
BACKGROUND AND PURPOSE: In the SELECT study, treatment with daclizumab high-yield process (DAC HYP) versus placebo reduced the frequency of gadolinium-enhancing (Gd(+) ) lesions in patients with relapsing-remitting multiple sclerosis (RRMS). The objective of this post hoc analysis of SELECT was to evaluate the effect of DAC HYP on the evolution of new Gd(+) lesions to T1 hypointense lesions (T1 black holes). METHODS: SELECT was a randomized double-blind study of subcutaneous DAC HYP 150 or 300 mg or placebo every 4 weeks. Magnetic resonance imaging (MRI) scans were performed at baseline and weeks 24, 36 and 52 in all patients and monthly between weeks 4 and 20 in a subset of patients. MRI scans were evaluated for new Gd(+) lesions that evolved to T1 black holes at week 52. Data for the DAC HYP groups were pooled for analysis. RESULTS: Daclizumab high-yield process reduced the number of new Gd(+) lesions present at week 24 (P = 0.005) or between weeks 4 and 20 (P = 0.014) that evolved into T1 black holes at week 52 versus placebo. DAC HYP treatment also reduced the percentage of patients with Gd(+) lesions evolving to T1 black holes versus placebo. CONCLUSIONS: Treatment with DAC HYP reduced the evolution of Gd(+) lesions to T1 black holes versus placebo, suggesting that inflammatory lesions that evolved during DAC HYP treatment are less destructive than those evolving during placebo treatment.
- MeSH
- Adult MeSH
- Double-Blind Method MeSH
- Gadolinium administration & dosage pharmacology MeSH
- Outcome Assessment, Health Care * MeSH
- Antibodies, Monoclonal, Humanized pharmacology MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Multiple Sclerosis, Relapsing-Remitting drug therapy pathology MeSH
- Image Enhancement MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
- MeSH
- Gadolinium DTPA administration & dosage adverse effects MeSH
- Gadolinium * administration & dosage adverse effects MeSH
- Contrast Media * administration & dosage adverse effects MeSH
- Humans MeSH
- Magnetic Resonance Imaging adverse effects MeSH
- Nephrogenic Fibrosing Dermopathy * chemically induced MeSH
- Brain Diseases metabolism pathology MeSH
- Renal Insufficiency complications MeSH
- Check Tag
- Humans MeSH
- Publication type
- Letter MeSH
BACKGROUND AND PURPOSE: Gadobutrol (Gadavist) and gadoteridol (ProHance) have similar macrocyclic molecular structures, but gadobutrol is formulated at a 2-fold higher (1 mol/L versus 0.5 mol/L) concentration. We sought to determine whether this difference impacts morphologic contrast-enhanced MR imaging. MATERIALS AND METHODS: Two hundred twenty-nine adult patients with suspected or known brain tumors underwent two 1.5T MR imaging examinations with gadoteridol or gadobutrol administered in randomized order at a dose of 0.1 mmol/kg of body weight. Imaging sequences and T1 postinjection timing were identical for both examinations. Three blinded readers evaluated images qualitatively and quantitatively for lesion detection and for accuracy in characterization of histologically confirmed brain tumors. Data were analyzed by using the Wilcoxon signed rank test, the McNemar test, and a mixed model. RESULTS: Two hundred nine patients successfully completed both examinations. No reader noted a significant qualitative or quantitative difference in lesion enhancement, extent, delineation, or internal morphology (P values = .69-1.00). One hundred thirty-nine patients had at least 1 histologically confirmed brain lesion. Two readers found no difference in the detection of patients with lesions (133/139 versus 135/139, P = .317; 137/139 versus 136/139, P = .564), while 1 reader found minimal differences in favor of gadoteridol (136/139 versus 132/139, P = .046). Similar findings were noted for the number of lesions detected and characterization of tumors (malignant/benign). Three-reader agreement for characterization was similar for gadobutrol (66.4% [κ = 0.43]) versus gadoteridol (70.3% [κ = 0.45]). There were no significant differences in the incidence of adverse events (P = .199). CONCLUSIONS: Gadoteridol and gadobutrol at 0.1 mmol/kg of body weight provide similar information for visualization and diagnosis of brain lesions. The 2-fold higher gadolinium concentration of gadobutrol provides no benefit for routine morphologic imaging.
- MeSH
- Adult MeSH
- Gadolinium administration & dosage MeSH
- Heterocyclic Compounds administration & dosage MeSH
- Cross-Over Studies MeSH
- Contrast Media administration & dosage MeSH
- Middle Aged MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Brain Neoplasms diagnosis MeSH
- Neuroimaging methods MeSH
- Organometallic Compounds administration & dosage MeSH
- Aged MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Research Support, Non-U.S. Gov't MeSH
- Randomized Controlled Trial MeSH
Cíl. Zhodnotit a optimalizovat protokol magnetické rezonance hrudníku pro zobrazení bronchogenního karcinomu, který v sobě zahrnoval aplikaci intravaskulární kontrastní látky gadofosvesetu. Materiál a metoda. Osmnáct nemocných s konzervativně léčeným, morfologicky ověřeným pokročilým bronchogenním karcinomem podstoupilo zobrazení hrudníku magnetickou rezonancí. Jednalo se o soubor 7 žen a 11 mužů, průměrný věk byl 63,3. Ve 4 případech šlo o malobuněčný karcinom ve stadiu ED (extensive disease), ve 14 případech o nemalobuněčný karcinom v klinickém stadiu IIIB nebo I V. Vyšetřovací protokol v sobě zahrnoval T2 vážená zobrazení sekvencí HASTE ve třech ortogonálních rovinách, dále axiální zobrazení T2 váženými obrazy STIR. V průběhu dynamické akvizice dat sekvencí 3D FLASH VIBE byla aplikována kontrastní látka gadofosveset, dynamická studie v sobě zahrnovala celkem šest cyklů včetně nativního zobrazení v prvním cyklu. Pro zobrazení plicních cév i vaskularizace nádorové tkáně byla provedena dále zobrazení v době ustálené intravaskulární distribuce pomocí sekvence odvozené z kontrastní MR angiografie-ceMRA. Byla hodnocena kvalita jednotlivých zobrazovacích sekvencí a diagnostická hodnota jednotlivých orientací zobrazovacích rovin. Výsledky. Hodnotitelné vyšetření bylo provedeno u všech nemocných. Optimální kvalita zobrazení nádorové tkáně byla dosažena pomocí T2 vážené sekvence STIR a dále v průběhu dynamického zobrazení pomocí 3D FLASH VIBE sekvence. Hodnocení plicních cév i vaskularizace nádorové tkáně bylo možné v době ustálené intravaskulární distribuce gadofosvesetu sekvencí kontrastní MR angiografie-ceMRA. Závěr. Pomocí optimalizovaného protokolu magnetické rezonance je možné získat zobrazení hrudníku, které je schopné se stát alternativou k zobrazení CT či PET/CT.
Aim. To evaluate and optimize the feasible imaging protocol used in thoracic magnetic resonance imaging of bronchogenic carcinoma (BrCa) including application of blood-pool contrast agent gadofosveset. Material and method. 18 patients underwent thoracic magnetic resonance within 18 months (7 females, 11 males, mean age 63.3 y) Tere were four small-cell BrCa in clinical stage of extensive disease and 14 non-small-cell BrCa in clinical stage IIIB or I V. Imaging protocol contained T2 w. HASTE in three orthogonal planes; T2 w. STIR in axial plane before application of gadofosveset. Gadofosveset was injected during dynamic acquisition of 3D FLASH VIBE sequence with six cycles of data acquisition including first non-enhanced. Te images of pulmonary vasculature were performed in steady-state of intravascular distribution of gadofosveset. Te image quality optimal timing and orientation of sequences were evaluated. Results. Te valuable examination was performed in all 18 cases. Optimal image quality of the tumorous tissue was reached in T2 STIR sequence and during dynamic data acquisition afer application of gadofosveset. Te pulmonary vasculature and also the vas-cularity of the tumorous tissue were enabled to be assessed when we used the steady-state ceMRA imaging sequence. Conclusion. Using optimized imaging protocol, the magnetic resonance of the chest is able to become an alternative imaging method to the computed tomography or PET/CT.
- MeSH
- Carcinoma, Bronchogenic diagnosis MeSH
- Gadolinium administration & dosage diagnostic use MeSH
- Magnetic Resonance Imaging methods instrumentation utilization MeSH
- Organometallic Compounds administration & dosage diagnostic use MeSH
- Tomography, X-Ray Computed history methods utilization MeSH
- Neoplasm Staging methods instrumentation utilization MeSH
- Tomography, Spiral Computed methods utilization MeSH
- Imaging, Three-Dimensional methods instrumentation utilization MeSH
- MeSH
- Gadolinium administration & dosage diagnostic use MeSH
- Contrast Media poisoning MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Hypertension, Portal diagnosis MeSH
- Portal System physiology physiopathology MeSH
- Portography methods MeSH
- Data Display MeSH
- Check Tag
- Humans MeSH
- Publication type
- Comparative Study MeSH
- MeSH
- Gadolinium administration & dosage diagnostic use MeSH
- Contrast Media administration & dosage chemical synthesis MeSH
- Humans MeSH
- Magnetic Resonance Imaging methods MeSH
- Manganese diagnostic use MeSH
- Liver Diseases MeSH
- Oxides diagnostic use MeSH
- Iron diagnostic use MeSH
- Check Tag
- Humans MeSH
- Publication type
- Review MeSH
