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Advantages and disadvantages of single-source dual-energy whole-body CT angiography with 50% reduced iodine dose at 40 keV reconstruction.
Noda, Y, Nakamura, F, Yasuda, N, Miyoshi, T, Kawai, N, Kawada, H, Hyodo, F, Matsuo, M
The British journal of radiology. 2021;(1121):20201276
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Abstract
OBJECTIVES To assess the feasibility of whole-body dual-energy computed tomographic angiography (DECTA) at 40 keV with 50% reduced iodine dose protocol. METHODS Whole-body CTA was performed in 65 patients; 31 of these patients underwent 120 kVp single-energy computed tomographic angiography (SECTA) with standard iodine dose (600 mgI/kg) and 34 with 40 keV DECTA with 50% reduced iodine dose (300 mgI/kg). SECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (SECTA group), and DECTA data were reconstructed with adaptive statistical iterative reconstruction of 40% (DECTA-40% group) and 80% (DECTA-80% group). CT numbers of the thoracic and abdominal aorta, iliac artery, background noise, signal-to-noise ratio (SNR), and arterial depiction were compared among the three groups. The CT dose index volumes (CTDIvol) for the thorax, abdomen, and pelvis were compared between SECTA and DECTA protocols. RESULTS The vascular CT numbers and background noise were found to be significantly higher in DECTA groups than in the SECTA group (p < 0.001). SNR was significantly higher in the order corresponding to DECTA-80%, SECTA, and DECTA-40% (p < 0.001). The arterial depiction was comparable in almost all arteries; however, intrapelvic arterial depiction was significantly worse in DECTA groups than in the SECTA group (p < 0.0001-0.017). Unlike the pelvic region (p = 0.055), CTDIvol for the thorax (p < 0.0001) and abdomen (p = 0.0031) were significantly higher in the DECTA protocol than in the SECTA protocol. CONCLUSION DECTA at 40 keV with 50% reduced iodine dose provided higher vascular CT numbers and SNR than SECTA, and almost comparable arterial depiction, but had a degraded intrapelvic arterial depiction and required a larger radiation dose. ADVANCES IN KNOWLEDGE DECTA enables 50% reduction of iodine dose while maintaining image quality, arterial depiction in almost all arteries, vascular CT numbers, and SNR; however, it does not allow clear visualization of intrapelvic arteries, requiring a slightly larger radiation dose compared with SECTA with standard iodine dose.
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Intake of seaweed as part of a single sushi meal, iodine excretion and thyroid function in euthyroid subjects: a randomized dinner study.
Noahsen, P, Kleist, I, Larsen, HM, Andersen, S
Journal of endocrinological investigation. 2020;(4):431-438
Abstract
OBJECTIVE Globalisation has extended to the kitchen and the Asian cuisine has gained international popularity with sushi and seaweed now being widespread. We explored the possible acute adverse effects of an iodine load from a single sushi-and-seaweed meal as seaweed iodine may induce thyroid dysfunction. METHODS Nine euthyroid participants were randomized into three groups: Halibut maki roll with either (A) newly harvested Greenlandic seaweed salad, (B) no seaweed salad on the side, or (C) Japanese seaweed salad purchased at a local store. We collected spot urine and blood samples daily for a week for measurement of iodine and creatinine in urine, thyroid stimulating hormone (TSH), and estimated-free T4 (fT4) in serum. RESULTS All participants ingested the full meal and the drop-out was nil. No adverse effects were reported. Pre-meal urinary iodine excretion (UIE) was 75 µg/g. UIE rose (p < 0.001) by 385%, 59% and 43% for groups A, B, and C, peaked in the 6-h spot urine sample at 393, 120, and 109 µg/g, and was down to pre-meal values by day 2. Serum TSH rose (p = 0.012) 150% on day 2 and was down to pre-meal values by day 3. Serum fT4 remained at the same level. No adverse reactions were reported. CONCLUSION A sushi meal increased urinary iodine excretion by 40 µg/g, or 400 µg/g if a newly harvested seaweed salad was added. An ensuing rise in serum TSH was brief, and a single sushi meal with seaweed salad did not cause any adverse events.
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Iodine dose optimization in portal venous phase virtual monochromatic images of the abdomen: Prospective study on rapid kVp switching dual energy CT.
Noda, Y, Goshima, S, Nakashima, Y, Miyoshi, T, Kawai, N, Kambadakone, A, Matsuo, M
European journal of radiology. 2020;:108746
Abstract
PURPOSE To investigate iodine dose concentration required for adequate hepatic parenchymal enhancement on fast-kilovoltage-switching dual-energy computed tomography (DECT) of the abdomen based on patient body weight. MATERIALS AND METHODS The protocol of this prospective study was approved by the local Institutional Review Board and written informed consent for study participation was obtained from all patients. The study cohort of 204 consecutive patients who underwent whole body single-source DECT to screen for tumor metastases and/or recurrence after surgical resection of malignant tumors were randomly assigned to one of three protocols according to the iodine dose (400, 500, and 600 mgI/kg). For each case, two radiologists quantitatively and qualitatively reviewed three energy levels (65, 70, and 75 kilo electron volt [keV]) of the portal venous phase virtual monochromatic images (VMIs). CT numbers of the liver and the qualitative hepatic parenchymal enhancement were compared among the VMIs with the three protocols and three energy levels. RESULTS Hepatic enhancement (ΔHU > 50HU) was achieved at 65 keV with 400, 500, and 600 mgI/kg, at 70 keV with 500 and 600 mgI/kg, and at 75 keV with 600 mgI/kg. The hepatic parenchymal enhancement was graded as sufficient hepatic enhancement in 97%, 100%, and 99% at 65 keV with 400, 500, and 600 mgI/kg, 88% and 97% at 70 keV with 500 and 600 mgI/kg, and 84% at 75 keV with 600 mgI/kg, respectively. CONCLUSION The iodine dose can be reduced to 400 mgI/kg at 65 keV or 500 mgI/kg at 70 keV in DECT without compromising hepatic parenchymal enhancement.
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Chlorhexidine 0.5%/70% Alcohol and Iodine 1%/70% Alcohol Both Reduce Bacterial Load in Clean Foot Surgery: A Randomized, Controlled Trial.
Shadid, MB, Speth, MJGM, Voorn, GP, Wolterbeek, N
The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons. 2019;(2):278-281
Abstract
No consensus exists regarding which cleansing technique, solution, and concentration should be used in orthopedic surgery. The aim of this randomized, controlled trial was to compare the effect of chlorhexidine 0.5%/70% alcohol with iodine 1%/70% alcohol on lowering positive cultures before elective foot surgery and to study any wound complications, infections and allergic reactions. Consecutive patients ≥18 years of age scheduled for a hallux valgus correction or arthrodesis of the first metatarsophalangeal joint were included. Swabs were taken from 2 sites before and twice after preparing the skin and were quantitatively and qualitatively analyzed. The study group consisted of 49 patients with a mean age of 52.3 ± 14.4 (range 22 to 75) years of whom 42 (86%) were female. No significant differences were observed for positive cultures between the chlorhexidine (73%, 2%, and 12%) and iodine (68%, 7%, and 9%) group at any time point. Coagulase-negative staphylococci were the most commonly isolated micro-organisms found after skin preparation. Occasionally, Bacillus spp and Corynebacterium spp were cultured. The complication rate 2 weeks postoperatively was 0% in the chlorhexidine group versus 8.7% (n = 2) in the iodine group (delayed wound healing; p = .215). The complication rate at 6 weeks postoperatively was, respectively, 3.8% (n = 1) versus 4.3% (n = 1; both showed swelling and redness; p > .999). There was no significant difference in postoperative wound problems or infection rates between the 2 skin preparation solutions. Chlorhexidine 0.5%/70% alcohol and iodine 1%/70% alcohol both decreased the amount of positive cultures in elective foot surgery.
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Does the use of an iodine-containing contrast agent to visualise the PICC tip in preterm babies cause hypothyroidism? A randomised controlled trial.
Rath, CP, Thomas, M, Sullivan, D, Kluckow, M
Archives of disease in childhood. Fetal and neonatal edition. 2019;(2):F212-F214
Abstract
AIM: To compare thyroid function tests in preterm neonates (<30 weeks and >48 hour old) exposed to iodine-based contrast with controls and ascertain the certainty of peripherally inserted central catheter (PICC) tip position. METHODS Infants requiring a PICC were randomised to receive 0.3 mL of iodine-containing contrast or normal saline. The primary outcome was the difference in thyroid-stimulating hormone (TSH) levels on day 14 post PICC insertion and on day 28 of life. RESULTS 41 infants were randomised with no significant differences in TSH level (mIU/L) at day 14 post PICC insertion (3.1 vs 2) or on day 28 of life (2.2 vs 1.7). The PICC tip was more easily localised in the contrast group (85% vs 55%). Urinary iodine levels were significantly increased in the contrast-exposed group. CONCLUSION Use of contrast did not suppress subsequent thyroid function and helped visualise the PICC tip with more certainty. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12614000560695, pre-result.
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Impact of Moderate Sodium Restriction and Hydrochlorothiazide on Iodine Excretion in Diabetic Kidney Disease: Data from a Randomized Cross-Over Trial.
Binnenmars, SH, Corpeleijn, E, Kwakernaak, AJ, Touw, DJ, Kema, IP, Laverman, GD, Bakker, SJL, Navis, G
Nutrients. 2019;(9)
Abstract
Sodium restriction may potentially reduce iodine intake. This study aimed to determine the effect of sodium restriction (dietary counseling) on 24-h urinary iodine excretion. Diuretics provide an alternative to sodium restriction and are frequently added to sodium restriction, so the effects of hydrochlorothiazide (50 mg daily) and combined therapy were also studied. We performed a post-hoc analysis of a Dutch multi-center, randomized cross-over trial in 45 patients with diabetic kidney disease with a mean age of 65 ± 9 years, mean eGFR of 65 ± 27 mL/min/1.73 m2, median albuminuria of 648 [230-2008] mg/24 h and 84% were male. During regular sodium intake with placebo, mean 24 h urinary sodium and iodine excretion were 224 ± 76 mmol/24 h and 252 ± 94 ug/24 h, respectively (r = 0.52, p < 0.001). Mean iodine excretion did not change significantly if sodium restriction and hydrochlorothiazide were applied separately; mean difference -8 ug/day (95% CI -38, 22; p = 0.6) and 14 ug/day (95% CI -24, 52; p = 0.5), respectively. Combined therapy induced a significant decrease in mean iodine excretion (-37 ug/day; 95% CI -67, -7; p = 0.02), yet this was not seen to a clinically meaningful level. The number of patients with an estimated intake below recommended daily allowances did not differ significantly between the four treatment periods (p = 0.3). These findings show that sodium restriction is not a risk factor for iodine deficiency.
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Impact of iodine concentration and iodine delivery rate on contrast enhancement in coronary CT angiography: a randomized multicenter trial (CT-CON).
Rengo, M, Dharampal, A, Lubbers, M, Kock, M, Wildberger, JE, Das, M, Niezen, A, van Tilborg, F, Kofflard, M, Laghi, A, et al
European radiology. 2019;(11):6109-6118
Abstract
OBJECTIVE To compare the effect of contrast medium iodine concentration on contrast enhancement, heart rate, and injection pressure when injected at a constant iodine delivery rate in coronary CT angiography (CTA). METHODS One thousand twenty-four patients scheduled for coronary CTA were prospectively randomized to receive one of four contrast media: iopromide 300 mg I/ml, iohexol 350 mg I/ml, iopromide 370 mg I/ml, or iomeprol 400 mg I/ml. Contrast media were delivered at an equivalent iodine delivery rate of 2.0 g I/s. Intracoronary attenuation was measured and compared (per vessel and per segment). Heart rate before and after contrast media injection was documented. Injection pressure was recorded (n = 403) during contrast medium injection and compared between groups. RESULTS Intracoronary attenuation values were similar for the different contrast groups. The mean attenuation over all segments ranged between 384 HU for 350 mg I/ml and 395 HU for 400 mg I/ml (p = 0.079). Dose-length product (p = 0.8424), signal-to-noise ratio (all p > 0.05), time to peak (p = 0.324), and changes in heart rate (p = 0.974) were comparable between groups. The peak pressures differed: 197.4 psi for 300 mg I/ml (viscosity 4.6 mPa s), 229.8 psi for 350 mg I/ml (10.4 mPa s), 216.1 psi for 370 mg I/ml (9.5 mPa s), and 243.7 psi for 400 mg I/ml (12.6 mPa s) (p < 0.0001). CONCLUSION Intravascular attenuation and changes in heart rate are independent of iodine concentration when contrast media are injected at the same iodine delivery rate. Differences in injection pressures are associated with the viscosity of the contrast media. KEY POINTS • The contrast enhancement in coronary CT angiography is independent of the iodine concentration when contrast media are injected at body temperature (37 °C) with the same iodine delivery rate. • Iodine concentration does not influence the change in heart rate when contrast media are injected at identical iodine delivery rates. • For a fixed iodine delivery rate and contrast temperature, the viscosity of the contrast medium affects the injection pressure.
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Adjuvant Effect of Molecular Iodine in Conventional Chemotherapy for Breast Cancer. Randomized Pilot Study.
Moreno-Vega, A, Vega-Riveroll, L, Ayala, T, Peralta, G, Torres-Martel, JM, Rojas, J, Mondragón, P, Domínguez, A, De Obaldía, R, Avecilla-Guerrero, C, et al
Nutrients. 2019;(7)
Abstract
This study analyzes an oral supplement of molecular iodine (I2), alone and in combination with the neoadjuvant therapy 5-fluorouracil/epirubicin/cyclophosphamide or taxotere/epirubicin (FEC/TE) in women with Early (stage II) and Advanced (stage III) breast cancer. In the Early group, 30 women were treated with I2 (5 mg/day) or placebo (colored water) for 7-35 days before surgery. For the Advanced group, 30 patients received I2 or placebo, along with FEC/TE treatment. After surgery, all patients received FEC/TE + I2 for 170 days. I2 supplementation showed a significant attenuation of the side effects and an absence of tumor chemoresistance. The control, I2, FEC/TE, and FEC/TE + I2 groups exhibited response rates of 0, 33%, 73%, and 100%, respectively, and a pathologic complete response of 18%, and 36% in the last two groups. Five-year disease-free survival rate was significantly higher in patients treated with the I2 supplement before and after surgery compared to those receiving the supplement only after surgery (82% versus 46%). I2-treated tumors exhibit less invasive potential, and significant increases in apoptosis, estrogen receptor expression, and immune cell infiltration. Transcriptomic analysis indicated activation of the antitumoral immune response. The results led us to register a phase III clinical trial to analyze chemotherapy + I2 treatment for advanced breast cancer.
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Outcome of pleurodesis using different agents in management prolonged air leakage following lung resection.
Jabłoński, S, Kordiak, J, Wcisło, S, Terlecki, A, Misiak, P, Santorek-Strumiłło, E, Lazarek, J, Kozakiewicz, M
The clinical respiratory journal. 2018;(1):183-192
Abstract
BACKGROUND AND AIMS Prolonged air leaks (PAL) are a common problem after pulmonary resection. PAL can be a source of significant complications. One of the treatment options is chemical pleurodesis. MATERIAL AND METHODS The efficiency of three methods of treatment of PAL after lung resection was evaluated. In Iodine_ group aqueous iodine solution (lat.Tinctura Jodi) was applied intrapleurally (30 patients); in Doxycycline_group (34 patients) 200 mg of Doxycyclin was given and in Drainage_group 35 patients were applied Lidocaine solution only. RESULTS The group investigated was similar with regard to age [F = 0.04, P = 0.96] and the amount of air leakage (approx. 462 mL/min). The shortest drainage time and hospital stay was observed in the Iodine_group [10.57, P < 0.001]. However, this therapy was connected with strongly perceptible chest pain (P < 0.0001]). The number of case of pneumothorax recurrence was low and it was the same was seen in other methods of treatment [F = 0.87, P = 0.42]. Allergic reactions were not observed. The number of episodes of tachycardia, hypotension, dyspnea, pneumonia, subcutaneus empyema, fluid collection, emphysema, pneumothorax recurrence and number of re-thoracotomies were statistically similar in all three methods of treatment. CONCLUSION Iodine pleurodesis can be considered as one of possible treatment methods of PAL after lung resection as it showed favorable results compared with Doxycycline pleurodesis or drainage alone regarding duration of air leakage, hospitalization and pneumothorax recurrence with only slightly increased pleural pain.
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Low-Tube-Voltage CT Urography Using Low-Concentration-Iodine Contrast Media and Iterative Reconstruction: A Multi-Institutional Randomized Controlled Trial for Comparison with Conventional CT Urography.
Kim, SY, Cho, JY, Lee, J, Hwang, SI, Moon, MH, Lee, EJ, Hong, SS, Kim, CK, Kim, KA, Park, SB, et al
Korean journal of radiology. 2018;(6):1119-1129
Abstract
OBJECTIVE To compare the image quality of low-tube-voltage and low-iodine-concentration-contrast-medium (LVLC) computed tomography urography (CTU) with iterative reconstruction (IR) with that of conventional CTU. MATERIALS AND METHODS This prospective, multi-institutional, randomized controlled trial was performed at 16 hospitals using CT scanners from various vendors. Patients were randomly assigned to the following groups: 1) the LVLC-CTU (80 kVp and 240 mgI/mL) with IR group and 2) the conventional CTU (120 kVp and 350 mgI/mL) with filtered-back projection group. The overall diagnostic acceptability, sharpness, and noise were assessed. Additionally, the mean attenuation, signal-to-noise ratio (SNR), contrast-to-noise ratio (CNR), and figure of merit (FOM) in the urinary tract were evaluated. RESULTS The study included 299 patients (LVLC-CTU group: 150 patients; conventional CTU group: 149 patients). The LVLC-CTU group had a significantly lower effective radiation dose (5.73 ± 4.04 vs. 8.43 ± 4.38 mSv) compared to the conventional CTU group. LVLC-CTU showed at least standard diagnostic acceptability (score ≥ 3), but it was non-inferior when compared to conventional CTU. The mean attenuation value, mean SNR, CNR, and FOM in all pre-defined segments of the urinary tract were significantly higher in the LVLC-CTU group than in the conventional CTU group. CONCLUSION The diagnostic acceptability and quantitative image quality of LVLC-CTU with IR are not inferior to those of conventional CTU. Additionally, LVLC-CTU with IR is beneficial because both radiation exposure and total iodine load are reduced.