To investigate the effect of low-dose tolvaptan combined with hydration on the incidence of contrast-induced acute kidney injury (CI-AKI) and prognosis in high-risk patients undergoing coronary angiography or intervention.

This single-center, randomized controlled clinical trial (ChiCTR2000028834) enrolled 232 patients scheduled for elective coronary angiography or intervention, randomly assigned to the experimental group (low-dose tolvaptan + standard intravenous hydration) or the control group (standard hydration alone). Multivariate logistic regression analysis was performed to explore factors associated with CI-AKI occurrence. Kaplan-Meier survival curve was plotted with major adverse cardiovascular events (MACEs) to compare six-month survival rates between the two groups.

The incidence of CI-AKI in the tolvaptan group was significantly lower than in the control group (10.3% vs. 23.3%, p = 0.008). Abdominal spectral CT at 24 h postoperatively showed that iodine concentration in the renal medulla was significantly lower in the tolvaptan group than in the control group (p < 0.05). The increases in creatinine and Cys-C levels and the decrease in eGFR were also significantly smaller in the tolvaptan group (p < 0.05). Multivariate logistic regression analysis indicated that tolvaptan use reduced the risk of CI-AKI (p = 0.001), while lower preoperative eGFR and higher AGEF scores were independent risk factors for CI-AKI (p < 0.05). Kaplan-Meier analysis showed no significant difference in MACEs incidence between groups over six months (93.9% vs. 88.6%, p = 0.142).

Low-dose tolvaptan combined with standard hydration reduces the incidence of CI-AKI in high-risk patients undergoing coronary intervention.

Chinese Clinical Trial Registry (ChiCTR2000028834).

Patients with chronic kidney disease (CKD) are considered the primary population at risk for post-contrast acute kidney injury (PC-AKI), yet there are few predictive tools specifically designed for this vulnerable population.

Adult CKD patients undergoing coronary angiography or percutaneous coronary intervention at the Second Xiangya Hospital (2015-2021) were enrolled. The patients were divided into a derivation cohort and a validation cohort based on their admission dates. The primary outcome was the development of PC-AKI. The random forest algorithm was used to identify the most influential predictors of PC-AKI. Six machine learning algorithms were used to construct predictive models for PC-AKI. Model 1 included only preoperative variables, whereas Model 2 included both preoperative and intraoperative variables. The Mehran score was included in the comparison as a classic postoperative predictive model for PC-AKI.

Among the 989 CKD patients enrolled, 125 (12.6%) developed PC-AKI. In the validation cohort, deep neural network (DNN) outperformed other machine learning models with the area under the receiver operating characteristic curve (AUROC) of 0.733 (95% CI 0.654-0.812) for Model 1 and 0.770 (95% CI 0.695-0.845) for Model 2. Furthermore, Model 2 showed better performance compared to the Mehran score (AUROC 0.631, 95% CI 0.538-0.724). The SHapley Additive exPlanations method provided interpretability for the DNN models. A web-based tool was established to help clinicians stratify the risk of PC-AKI (https://xydsbakigroup.streamlit.app/).

The explainable DNN models serve as promising tools for predicting PC-AKI in CKD patients undergoing coronary angiography and intervention, which is crucial for risk stratification and clinical descion-making.

Coronary computed tomography angiography (CCTA)-derived fractional flow reserve (FFRCT) strategy significantly decreases unnecessary invasive coronary angiography and refines the appropriateness of revascularization decision. The present study aimed to evaluate how FFRCT guided - strategy impacts outcomes postrevascularization.

We included patients with suspected obstructive coronary artery disease (OCAD in a registry from 2013 to 2021. FFRCT entered Heart-Team decision from 2017. Propensity score adjusted Cox - and logistic - regression analyzed FFRCT's impact on post- revascularization major adverse cardiovascular events (MACE) and myocardial injury (PMI).

Among 7541 patients, 1601 had suspected OCAD. 559 patients underwent revascularization: 69.0 % PCI, 29.7 % CABG and 1.2 % both. 252(45.1 %) patients underwent FFRCT. Over 4.4 ± 2.2 years, 137(24.5 %) patients experienced MACE. FFRCT was associated with a trend toward reduced MACE (HR 0.736, 95 % CI 0.513-1.055, p = 0.095) and significantly reduced all-cause mortality (HR 0.476, 95 % CI 0.230-0.985, p = 0.046). In the post-2017 cohort (413 patients, follow-up 3.7 ± 1.5 years), FFRCT significantly reduced MACE (HR 0.610, 95 % CI 0.390-0.954, P = 0.030) and all-cause mortality (HR 0.285, 95 % CI 0.104-0.779, P = 0.014). In CABG patients, FFRCT was associated with lower PMI incidence (5.3 % vs. 15.6 %, p = 0.044). Multivariable analysis revealed no significant association between FFRCT use and PMI.

Revascularization decision-making with FFRCT translates into better post-revascularization outcomes, primarily by reducing MACE through lower mortality. There was no clear impact on PMI. These findings suggests that FFRCT's value lies indeed in improving patient selection for revascularization, but warrants further confirmation in randomized clinical trials.

Stress-induced hyperglycemia (SIH) is a common phenomenon in acute myocardial infarction and is associated with poor prognosis. The relationship between glycemic gap (GG), a marker of SIH, and ST-segment elevation myocardial infarction (STEMI)-associated acute kidney injury (STAAKI) remains unclear. This study aims to explore the predictive value of GG for the risk of STAAKI after percutaneous coronary intervention (PCI) in STEMI patients.

This study retrospectively selected patients diagnosed with STEMI who underwent primary PCI. Logistic regression analysis was used to identify the risk factors associated with STAAKI. To examine the dose-response relationship between GG and STAAKI, restricted cubic splines (RCS) were employed. The predictive accuracy of the models was assessed using Delong test, net reclassification index (NRI) and integrated discrimination improvement (IDI).

This study included 595 patients, the incidence of STAAKI was 9.2%. Multivariate logistic regression showed LVEF (OR per 1% increase = 0.931, 95% CI: 0.895 ~ 0.969), NT-proBNP (OR per 1 pg/mL increase = 1.579, 95% CI: 1.212 ~ 2.057), and GG (OR per 1 mmol/L increase = 1.379, 95% CI: 1.223 ~ 1.554) as independent predictors of STAAKI. RCS analysis indicated a linear dose-response relationship between GG and STAAKI. After integrating GG, the new model could significantly improve the risk model for STAAKI (Z = 2.77, NRI = 0.780, and IDI = 0.095; All P < 0.05).

GG is an independent risk factor for the occurrence of STAAKI after PCI in STEMI patients, and integrating GG can significantly improve risk modeling regarding STAAKI.

Not applicable.

The use of radiological imaging has gained increasing importance in thoracic surgery, due to the development of new modalities. In particular, computed tomography (CT) not only offers significant diagnostic value but has also become essential for preoperative planning and postoperative follow-up in thoracic surgery. This review is intended to serve as a practical reference and guide for the indication, planning, and interpretation of thoracic CT imaging. It not only explains diagnostic aspects, such as the evaluation of specific conditions in CT imaging, but also provides practical guidance on how to formulate specific clinical questions. The appropriate indication for contrast-enhanced CT versus non-contrast imaging is evaluated. Additionally, the various contrast phases in CT imaging and their diagnostic relevance are discussed using specific thoracic surgery cases. The goal is to provide a structured guide for the application and assessment of radiological diagnostics in thoracic surgery.

Numerous kidney functions exhibit substantial circadian oscillations, such as renal blood flow, glomerular filtration rate, tubular reabsorption function, and erythropoietin production. The onset and the injury of acute kidney injury caused by ischemia or drugs also have a circadian rhythmicity. Contrast media are widely used in clinical diagnosis and treatment; however, whether contrast-induced kidney injury exhibits a time-of-day dependence is unknown. We retrospectively analyzed 33 patients who underwent percutaneous coronary angiography and found that contrast induced the increase of serum neutrophil gelatinase-associated lipocalin (NGAL) was more obvious in the group who underwent operation during 6:00 ~ 13:00 than the group who underwent operation between 13:00 ~ 20:00. In addition, C57BL/6J mice were injected with iohexol at different times. The kidney injury of mice injected with iohexol at ZT12 was more severe than that at ZT0, which was manifested in the increase of urinary KIM1 and NGAL, enhanced renal tubular lipid peroxidation, and increased tubular ferroptosis. Inhibition of ferroptosis could alleviate kidney injury induced by iohexol at ZT12. Mechanistically, we found that nuclear factor erythrocyte 2-associated factor 2 (NRF2) expression has a 24-h circadian rhythm and is directly regulated by CLOCK. Administration of 4-Octyl itaconate at ZT12 to increase NRF2 expression could attenuate iohexol-induced tubular ferroptosis. These findings provide a new insight into the pathology of contrast medium-induced kidney injury, in which oscillatory NRF2 expression regulated by CLOCK contributes to the susceptibility of contrast-induced kidney injury in a time-of-day-specific fashion.

More than half of ST-segment elevation myocardial infarction (STEMI) patients have coronary microcirculatory dysfunction (CMD) after percutaneous coronary intervention (PCI). This study aimed to explore the role of CMD in the occurrence of contrast-induced acute kidney injury (CI-AKI) in patients with STEMI.

This was a single-centre retrospective clinical observational study. Coronary angiography-derived index of microcirculatory resistance (caIMR) was measured and used to assess CMD. Regression analysis was used to identify risk factors for CI-AKI. Restricted cubic splines (RCS) was employed to examine the dose-response relationship between caIMR and CI-AKI. The predictive accuracy of the models was assessed with net reclassification index (NRI), and integrated discrimination improvement (IDI).

This study included 745 patients, the incidence of CI-AKI was 10.6% (79/745). Multivariate logistic regression identified caIMR (OR = 1.072, 95% CI: 1.051-1.094) as an independent predictor of CI-AKI. RCS analysis indicated a linear dose-response relationship between caIMR and CI-AKI. Receiver operating characteristic (ROC) analysis demonstrated that the areas under the curve for caIMR was 0.725, the optimal cutoff value was 25.95 U. Integration of caIMR could significantly improve the risk model for CI-AKI in STEMI patients (NRI = 0.721, IDI = 0.102, P < 0.001).

Elevated caIMR is an independent risk factor for the development of CI-AKI after PCI in STEMI patients. Integrating caIMR significantly improves the risk model for CI-AKI.

Epicardial adipose tissue (EAT) affects the kidneys by secreting various bioactive molecules. Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) patients. The relationship between EAT and CI-AKI remains unclear. This study aims to explore the relationship between EAT and the incidence of CI-AKI after PCI in STEMI patients.

Patients diagnosed with STEMI were continuously included, all patients underwent PCI within 12 hours of onset. EAT volume was measured and obtained by chest CT. Logistic regression analysis was used to analyze possible risk factors for CI-AKI. Restricted cubic splines (RCS) were utilized to explore the dose-response relationship involving EAT and CI-AKI.

The incidence of CI-AKI was 8.9% (57/638). Compared with the Non-CI-AKI group, the EAT volume was significantly higher (p<0.005). After adjusting for confounding factors, multivariate regression analysis showed FBG, NT-proBNP, LVEF, and EAT volume were the independent predictors for CI-AKI. RCS analysis indicated a linear dose-response relationship between EAT volume and CI-AKI. The integration of EAT volume could significantly improve ability of the model for CI-AKI (NRI 0.4071, 95% CI 0.231 ~ 0.583, p < 0.001; IDI 0.1356, 95% CI 0.091 ~ 0.180, p < 0.001).

Higher EAT volume was an independent risk factor for CI-AKI in STEMI patients. Integration of EAT volume could significantly improve the risk model for CI-AKI.

AimTo investigate the prognostic implication (mortality at 3 months) of acute kidney injury (AKI) in acute ischemic stroke treated with mechanical thrombectomy (MT).Material and MethodsA literature search was performed using PubMed/OVID/Cochran's CENTRAL database (time frame: inception to January 2023). Study characteristics, patient status, clinical outcomes, AKI incidence, and sample size were recorded. The exclusion criteria were non-English literature, no human subjects, and <10 patients as the sample size. Studies were assessed using the MINORS/GRADE system. Meta-analysis and meta-regression with a random-effects model were performed.Results3314 studies were retrieved. After applying the exclusion criteria, the final population included of 18/3314 studies (0.5%). Among them, only 6/18 (33.3%) studies reported results in two separate groups (AKI vs non-AKI), allowing for inference statistics for a total population of 3229 (538.6 ± 403.7). The I^2 was 34.6 and Q's Cochrane was 7.80. The pooled odds ratio (OR) for mortality at 3 months in patients with AKI was 5.8 (95% confidence interval [95% CI] 95% CI 3.62 to 9.52). Leave-one-out meta-analysis showed no significant sources of heterogeneity. In the meta-regression, diabetes prevalence was associated with a higher mortality rate (OR 1.14, 95% CI 1.03 to 1.28), and lower age and a small amount of contrast media were negatively correlated (0.91 [95% CI 0.83 to 0.99] and OR 0.97 [95% CI 0.94 to 1.00], respectively).ConclusionAKI was significantly associated with the mortality rate in MT-treated stroke patients (OR 5.8 [95% CI 3.62 to 9.36]).

To assess the potential of virtual monoenergetic images (VMIs) on a photon-counting computed tomography (PCCT) for reducing the amount of injected iodine contrast media compared to an energy-integrating CT (EICT).

A multienergy phantom was scanned with a PCCT and EICT at 11 mGy with abdomen-pelvis examination parameters. VMIs were generated at 40 keV, 50 keV, 60 keV, and 70 keV. For all VMIs, the contrast-to-noise ratio (CNR) of iodine inserts with concentrations of 1 mg/mL, 2 mg/mL, 5 mg/mL, 10 mg/mL, and 15 mg/mL was calculated by dividing the signal difference between HU in iodine inserts versus solid water by the noise value assessed on solid water. The potential reduction in iodine media was calculated by the rate of reduction in iodine concentration with PCCT while maintaining the same CNR obtained with EICT for the reference concentration.

Significantly higher CNR values were found with PCCT at all VMI energy levels for iodine concentrations above 1 mg/mL. The highest reduction was observed at 40 keV, with a value of 48.9 ± 1.6% (mean ± standard deviation). It decreased as the energy level increased, by 38.5 ± 0.5%, and 30.8 ± 0.8% for 50 and 60 keV, respectively. For 70 keV, the potential reduction of 24.4 ± 1.1% was found for iodine concentrations above 1 mg/mL. This reduction reached 57 ± 2.3% at 40 keV with PCCT compared to 60 keV with EICT.

For abdomen-pelvis protocols, the use of VMIs with PCCT significantly improved the CNR of iodine, offering the potential to reduce the required contrast medium.

The use of VMIs with PCCT may reduce the quantity of iodine contrast medium to be injected compared with EICT, limiting costs, the risk of adverse effects, and the amount of contrast agent released into the wastewater.

PCCT improves the image quality of VMIs. PCCT offers the potential for reducing the amount of injected contrast medium. PCCT potential for reducing the injected contrast medium depends on energy level.

Contrast-induced nephropathy (CIN) represents a significant complication associated with the use of iodinated contrast media (ICM), especially in individuals with preexisting renal impairment. The pathophysiology of CIN encompasses oxidative stress, inflammation, endothelial dysfunction, and hemodynamic disturbances, resulting in acute kidney injury (AKI). Early detection is essential for effective management; however, conventional markers like serum creatinine (sCr) and estimated glomerular filtration rate (eGFR) exhibit limitations in sensitivity and timeliness. This review emphasizes the increasing significance of novel biomarkers in enhancing early detection and risk stratification of contrast-induced nephropathy (CIN). Recent advancements in artificial intelligence and computational analytics have improved the predictive capabilities of these biomarkers, enabling personalized risk assessment and precision medicine strategies. Additionally, we discuss mitigation strategies, including hydration protocols, pharmacological interventions, and procedural modifications, aimed at reducing CIN incidence. Incorporating biomarker-driven assessments into clinical decision-making can enhance patient management and outcomes. Future research must prioritize the standardization of biomarker assays, the validation of predictive models across diverse patient populations, and the exploration of novel therapeutic targets. Utilizing advancements in biomarkers and risk mitigation strategies allows clinicians to improve the safety of contrast-enhanced imaging and reduce the likelihood of renal injury.

Contrast-induced acute kidney injury (CI-AKI) is a common complication in patients with ST-segment elevation myocardial infarction (STEMI) and is associated with an inflammatory response. Inflammatory burden index (IBI) is a novel inflammatory marker, and the relationship between IBI and CI-AKI in STEMI patients is currently unknown. The aim of this study was to investigate the effect of IBI on CI-AKI after percutaneous coronary intervention (PCI) in STEMI patients.

This was a single-center retrospective observational study consecutively enrolling patients diagnosed with STEMI and successful PCI between August 2022 and December 2024. Logistic regression analysis was used to identify risk factors associated with CI-AKI. Restricted cubic spline (RCS) was used to explore the dose-response relationship between IBI and CI-AKI. The predictive effectiveness of the models was assessed by the net reclassification index (NRI) and the integrated discriminant improvement index (IDI).

A total of 647 patients were included in this study and the incidence of CI-AKI during hospitalization was 78 (12.1%). After adjusting for possible confounding factors, the result showed that IBI > 18.89 (OR = 2.418, 95% CI: 1.331-4.392) was an independent factor for CI-AKI in STEMI patients. RCS results suggested that there was a non-linear dose-response relationship between IBI and CI-AKI. After integrating IBI, the ability of the new model to predict CI-AKI in STEMI patients was significantly improved (NRI = 0.315, IDI = 0.019, P < 0.05).

Elevated IBI is an independent risk factor for CI-AKI after PCI in STEMI patients, and there is a non-linear dose-response relationship between IBI and CI-AKI. Integrating IBI can improve the risk stratification of STEMI patients regarding CI-AKI.

Background/Objectives: To evaluate the feasibility of reducing contrast volume in oncologic body imaging using dual-energy CT (DECT) by (1) identifying the optimal virtual monochromatic imaging (VMI) reconstruction using DECT and (2) comparing DECT performed with reduced iodinated contrast media (ICM) volume to single-energy CT (SECT) performed with standard ICM volume. Methods: In this retrospective study, we quantitatively and qualitatively compared the image quality of 35 thoracoabdominopelvic DECT across 9 different virtual monoenergetic image (VMI) levels (from 40 to 80 keV) using a reduced volume of ICM (0.3 gI/kg of body weight) to determine the optimal keV reconstruction level. Out of these 35 patients, 20 had previously performed SECT with standard ICM volume (0.3 gI/kg of body weight + 9 gI), enabling protocol comparison. The qualitative analysis included overall image quality, noise, and contrast enhancement by two radiologists. Quantitative analysis included contrast enhancement measurements, contrast-to-noise ratio, and signal-to-noise ratio of the liver parenchyma and the portal vein. ANOVA was used to identify the optimal VMI level reconstruction, while t-tests and paired t-tests were used to compare both protocols. Results: VMI60 keV provided the highest overall image quality score. DECT with reduced ICM volume demonstrated higher contrast enhancement and lower noise than SECT with standard ICM volume (p < 0.001). No statistical difference was found in the overall image quality between the two protocols (p = 0.290). Conclusions: VMI60 keV with reduced contrast volume provides higher contrast and lower noise than SECT at a standard contrast volume. DECT using a reduced ICM volume is the technique of choice for oncologic body CT.

Renal function varies among liver transplantation (LT) candidates with the same Model for End-Stage Liver Disease (MELD)3.0 score. The impact of marginal grafts on post-LT renal function and prognosis varies based on the pre-LT renal function. We explored the effects of matching recipients with low renal function to marginal donors on graft survival (GS) and post-LT kidney function.

We analyzed data from the Scientific Registry of Transplant Recipients (SRTR), categorizing pre-LT renal function by estimated glomerular filtration rate (eGFR) into low (<30 mL/min/1.73 m2) and high (≥30 mL/min/1.73 m2). Marginal donors were defined by criteria including donation after cardiac death, age ≥ 65, severe macrosteatosis (≥30%), or body mass index ≥ 40 kg/m2. The primary outcome was to compare 3-year post-LT GS between patients with low and high pre-LT renal function. Additionally, we examined post-LT eGFR 1-3 months post-LT.

Of 13 279 LT recipients, 12 851 had high pre-LT eGFR and 428 had low pre-LT eGFR. Kaplan-Meier survival analysis showed that recipients with low pre-LT eGFR had significantly lower 3-year GS compared to those with high eGFR (p < 0.01). Recipients of organs from marginal donors also exhibited a significant reduction in 3-year GS (p < 0.01). This adverse effect persisted within the same MELD3.0 category. Additionally, lower pre-LT eGFR was associated with an increased risk of post-LT kidney function deterioration, especially among those receiving grafts from marginal donors. Multivariable logistic regression identified recipient age > 65 as a significant risk factor for post-LT kidney function decline (OR 3.34 [1.05-10.7]; p = 0.03).

GS was notably worse in recipients with low pre-LT eGFR, particularly when matched with marginal donors. A recipient age > 65 is a risk indicator for post-LT kidney function deterioration with marginal donors, underscoring the importance of careful donor-recipient matching, especially with compromised pre-LT kidney function.

To assess the viability of using ultra-low radiation and contrast medium (CM) dosage in aortic computed tomography angiography (CTA) through the application of low tube voltage (60kVp) and a novel deep learning image reconstruction algorithm (ClearInfinity, DLIR-CI).

Iodine attenuation curves obtained from a phantom study informed the administration of CM protocols. Non-obese participants undergoing aortic CTA were prospectively allocated into two groups and then obtained three reconstruction groups. The conventional group (100kVp-CV group) underwent imaging at 100kVp and received 210 mg iodine/kg in combination with a hybrid iterative reconstruction algorithm (ClearView, HIR-CV). The experimental group was imaged at 60kVp with 105 mg iodine/kg, while images were reconstructed with HIR-CV (60kVp-CV group) and with DLIR-CI (60kVp-CI group). Student's t-test was used to compare differences in CM protocol and radiation dose. One-way ANOVA compared CT attenuation, image noise, SNR, and CNR among the three reconstruction groups, while the Kruskal-Wallis H test assessed subjective image quality scores. Post hoc analysis was performed with Bonferroni correction for multiple comparisons, and consistency analysis conducted in subjective image quality assessment was measured using Cohen's kappa.

The radiation dose (1.12 ± 0.23mSv vs. 2.03 ± 0.82mSv) and CM dosage (19.04 ± 3.03mL vs. 38.11 ± 6.47mL) provided the reduction of 45% and 50% in the experimental group compared to the conventional group. The CT attenuation, SNR, and CNR of 60kVp-CI were superior to or equal to those of 100kVp-CV. Compared to the 60kVp-CV group, images in 60kVp-CI showed higher SNR and CNR (all P < 0.001). There was no difference between the 60kVp-CI and 100kVp-CV group in terms of the subjective image quality of the aorta in various locations (all P > 0.05), with 60kVp-CI images were deemed diagnostically sufficient across all vascular segments.

For non-obese patients, the combined use of 60kVp and DLIR-CI algorithm can be preserving image quality while enabling radiation dose and contrast medium savings for aortic CTA compared to 100kVp using HIR-CV.

To compare image quality and iodine attenuation intra-individually in portal venous phase photon-counting detector CT (PCD-CT) scans using protocols with different contrast medium (CM) volume.

A prospectively acquired patient cohort between 04/2021 and 11/2023 was retrospectively screened if patients had the following combination of portal venous phase thoracoabdominal CT scans: (a) PCD-CT with 120 mL CM volume (PCD-CT120 mL), (b) PCD-CT with 100 mL CM volume (PCD-CT100 mL), and (c) prior energy-integrating detector CT (EID-CT) with 120 mL CM volume. On PCD-CT, virtual monoenergetic image (VMI) reconstructions at 70 keV were applied for both groups as well as additional VMI at 60 keV for PCD‑CT100 mL. Quantitative analyses including signal-to-noise (SNR) and contrast-to-noise ratios (CNR) and qualitative analyses were performed using a mixed linear effects model.

The final study cohort comprised 49 patients (mean age 67 [31-86] years, 12 female). Comparison to EID-CT was available in 33 patients. In standard 70 keV VMI reconstructions, PCD-CT100 mL was non-inferior to PCD-CT120 mL as well as to EID-CT120 mL for CNR in abdominal organs (all p > 0.050). The mixed linear effects model revealed significant differences between contrast volume groups for both contrast enhancement and image quality ratings. PCD-CT100 mL/70 keV demonstrated the smallest deviation from optimal contrast enhancement (-0.306, p < 0.001).

In portal venous phase thoracoabdominal PCD-CT, a nearly 17% reduction in CM was achievable while maintaining subjective and objective image quality compared to prior higher CM volume PCD-CT scans within the same patients and still surpassing image quality of previous exams on an EID-CT system.

Question How do image quality and iodine attenuation intra-individually compare in portal venous phase photon-counting detector CT (PCD-CT) scans using protocols with different contrast medium volume. Findings PCD-CT scans exhibit superior quantitative and qualitative image quality compared to energy-integrating detector-CT acquisitions and are not negatively affected by contrast volume reductions up to 17%. Clinical relevance This study provides further evidence that PCD-CT enables a considerable reduction in iodine dose for portal venous phase acquisition, benefiting both patients and healthcare system costs.

Contrast-induced acute kidney injury (CI-AKI) is a common complication after percutaneous coronary intervention (PCI) in patients with ST-segment elevation myocardial infarction (STEMI). Soluble suppression of tumorigenicity 2 (sST2) is associated with AKI. However, the relationship between sST2 and CI-AKI is unclear. This study aimed to investigate the relationship between sST2 and CI-AKI in patients with STEMI.

This was a single-center retrospective observational study. Patients diagnosed with STEMI in the Yichun People's Hospital from February 2020 to May 2024 were continuously included. CI-AKI was defined as an increase in serum creatinine of at least 50% or 0.3 mg/dL from baseline within 48-72 h after contrast exposure.

The incidence of CI-AKI after PCI was 12.4% (98/791). Univariate analysis showed that age, fasting plasma glucose, diabetes mellitus, Killip class, left ventricular ejection fraction, estimated glomerular filtration rate, high sensitivity troponin T, N-terminal pro-B-type natriuretic peptide, and sST2 were associated with CI-AKI. The above factors were included in a multivariate analysis, which showed that sST2 was an independent factor for CI-AKI after PCI. The restricted cubic splines showed a nonlinear dose-response relationship between sST2 and CI-AKI (P < 0.001). The integration of the sST2 could significantly improve the ability of the model to identify CI-AKI (NRI 0.681, 95% CI 0.474-0.887; IDI 0.063, 95% CI 0.038-0.099).

Elevated sST2 is an independent risk factor for CI-AKI after PCI in patients with STEMI. Integration of sST2 can significantly improve the risk model for CI-AKI.

Contrast media are essential agents that enhance the diagnostic capabilities of imaging studies, such as computed tomography and magnetic resonance imaging. However, concerns regarding the risk of adverse events have led to cautious use in patients with chronic kidney disease. A multidisciplinary review by nephrologists, cardiologists, and radiologists at National Taiwan University Hospital examined evidence linking iodinated contrast media and gadolinium-based contrast agents with acute kidney injury and nephrogenic systemic fibrosis. The consensus is that the risk of iodinated contrast-induced acute kidney injury is minimal in patients with an estimated glomerular filtration rate greater than 30 mL/min/1.73 m2. Preventive strategies, including hydration with 0.9% saline and limiting contrast volume, may further reduce acute kidney injury risk in susceptible individuals. For nephrogenic systemic fibrosis, the risk is negligible with group II gadolinium-based contrast agents, even in patients with advanced chronic kidney disease or those on dialysis. The panel concludes that the use of iodinated contrast media or group II gadolinium-based contrast agents should not be postponed in chronic kidney disease patients when clinically significant imaging studies are required.

The clinical availability of photon-counting computed tomography (PCCT) has ushered in a new era of CT imaging. Spectral imaging coupled with superior contrast resolution, and ultrahigh spatial resolution (200 μm) offered by PCCT has the potential to revolutionize value-driven imaging. The potential of multicolor PCCT has generated excitement, and renewed interest, in novel contrast agent development for comprehensive disease interrogation, prediction and monitoring of treatment outcomes. Nanoparticles provide a versatile and powerful platform for the development of next generation contrast agents for spectral PCCT. In this article, we review recent developments and use of nanoparticle contrast agents for PCCT. We also discuss future research and translational opportunities for nanoparticle-based CT contrast agents enabled by the advent of PCCT and describe key considerations for their clinical translation.

There has been growing interest in using quantitative magnetic resonance imaging (MRI) to describe and understand the pathophysiology of acute kidney injury (AKI). The ability to assess kidney blood flow, perfusion, oxygenation, and changes in tissue microstructure at repeated timepoints is hugely appealing, as this offers new possibilities to describe nature and severity of AKI, track the time-course to recovery or progression to chronic kidney disease (CKD), and may ultimately provide a method to noninvasively assess response to new therapies. This could have significant clinical implications considering that AKI is common (affecting more than 13 million people globally every year), harmful (associated with short and long-term morbidity and mortality), and currently lacks specific treatments. However, this is also a challenging area to study. After the kidney has been affected by an initial insult that leads to AKI, complex coexisting processes ensue, which may recover or can progress to CKD. There are various preclinical models of AKI (from which most of our current understanding derives), and these differ from each other but more importantly from clinical AKI. These aspects are fundamental to interpreting the results of the different AKI studies in which renal MRI has been used, which encompass different settings of AKI and a variety of MRI measures acquired at different timepoints. This review aims to provide a comprehensive description and interpretation of current studies (both preclinical and clinical) in which MRI has been used to assess AKI, and discuss future directions in the field. LEVEL OF EVIDENCE: 1 TECHNICAL EFFICACY: Stage 3.

Reports of large series of hybrid iliofemoral revascularization for chronic lower limb ischemia are scarce. The aims of this study were to evaluate outcomes for staged and nonstaged procedures, and to evaluate risk factors for outcomes at 90 days.

Patients were consecutively included between 2013 and 2023. Surgical site infection (SSI) was defined by the ASEPSIS criteria and major adverse limb events (MALE) as onset of acute or continuing or worsening chronic limb ischemia or major amputation. Factors associated with outcomes were tested in a multivariable logistic regression analysis and expressed in odds ratios (ORs) with 95% confidence intervals (CIs).

Patients undergoing nonstaged procedures (n = 124) had higher Trans-Atlantic Inter-Society Consensus (TASC) class representing anatomical occlusive complexity, more often through-and through femoral guidewire access, more endoprosthesis, more covered stents, longer procedure time with open groin wounds, and less contralateral femoral access, than those undergoing staged procedures (n = 31). The median time interval between the staged procedures was 1 day, and iliac stenting was done first in 77%. The median in-hospital stay was nonsignificantly longer in staged procedure (8 vs. 6 days, P = 0.053). The overall SSI and MALE rates were 25.8% and 20.0%, respectively, without differences between groups. Diabetes mellitus (OR 3.7, 95% CI 1.2-7.2]) and presence of a foot ulcer (OR 3.7, 95% CI [1.5-9.4]) were independently associated with MALE at 90 days. Postoperative hyperglycemia was nonsignificantly associated with SSI (OR 2.1 (95% CI 1.0-4.5), P = 0.066) in multivariable analysis.

The risks of SSI and MALE after elective hybrid iliofemoral revascularization were high. There appears to be no benefit in performing staged as opposed to nonstaged procedures. The extent of iliofemoral occlusive disease according to the TASC classification had little influence on outcomes whereas diabetes mellitus and presence of a foot ulcer had greater impact on MALE.

Optical coherence tomography (OCT) has gained increasing popularity in coronary artery intervention due to its high resolution and excellent tissue correlation as a novel intravascular imaging modality. However, the current use of OCT requires contrast agent injection for imaging, and excessive use of contrast agents may adversely affect renal function, exacerbate cardiac burden, and even lead to contrast agent-induced nephropathy and heart failure. In recent years, several researchers have proposed the use of low molecular weight dextran (LMWD) as a substitute for contrast agents in OCT imaging because of its low toxicity, low cost, and wide availability. However, the inclusion of lesions in these studies is relatively simple, and the image quality criteria remain to be optimized.

This study included 26 patients with coronary artery disease who were scheduled for OCT imaging in a real-world clinical practice involving various complex lesions. All patients underwent two OCT examinations at the same vascular site, one each using contrast agent and LMWD. Both contrast media and LMWDs were infused by an autoinjector. The primary endpoint of the study was the average image quality score. Secondary endpoints included clear image length, clear image segments, minimum lumen area, average lumen area, and contrast-induced nephropathy, among others.

In terms of image clarity, the average image quality score was similar when comparing contrast media with LMWD (3.912 ± 0.175 vs. 3.769 ± 0.392, P = 0.071). The lengths of the clear images and the segments of the clear images were also similar between the two groups (50.97 ± 16.25 mm vs. 49.12 ± 18.15 mm, P = 0.110; 255.5 ± 81.29 vs. 250.5 ± 89.83, P = 0.095). Additionally, strong correlations were noted between the two flushing solutions regarding the minimum lumen area and mean lumen area. During their hospital stay, none of the patient exhibited deterioration in renal function, and no patient experienced any major adverse cardiovascular events.

The quality of coronary artery OCT imaging using LMWD may be comparable to that achieved with traditional contrast agents, even in real-world clinical practice involving various complex lesions. For high-risk patients, LMWD may serve as an excellent substitute for contrast agents in OCT examinations.

To gauge the utility of multiparametric MRI in characterizing pathologic changes after iodinated contrast-induced acute kidney injury (CI-AKI) in rats.

We randomly grouped 24 rats injected with 8 g iodine/kg of body weight (n = 6 each) and 6 rats injected with saline as controls. All rats underwent T1, T2 mapping and diffusion kurtosis imaging (DKI) after contrast injection at 0 (control), 1, 3, 7, 13 days. T1, T2, and mean kurtosis (MK) values were performed in renal outer/inner stripes of outer medulla (OSOM and ISOM) and cortex (CO), and their diagnosis performance for CI-AKI also been evaluated. Serum creatinine (SCr), insulin-like growth factor-binding protein 7 (IGFBP7), tissue inhibitor metalloproteinase 2 (TIMP-2), aquaporin-1 (AQP1), α-smooth muscle actin (α-SMA), and histologic indices were examined.

Compared with controls, urinary concentrations of both TIMP-2 and IGFBP7 were obviously elevated from Day 1 to Day 13 (all p < 0.05). T2 values were significantly higher than control group for Days 1 and 3, and T1 and MK increased were more remarkable at all time points (Days 1-13) in CI-AKI (all p < 0.05) than control group. Changes in T1 and MK strongly correlated with renal injury scores of all anatomical compartments and with expression levels of AQP1 and moderately correlated with α-SMA. Changes in T2 values correlating moderately with renal scores of CO, ISOM and OSOM and AQP1. The MK obtained the highest area under the receiver operating characteristic (ROC) curve of 0.846 with a sensitivity of 70.8 % and specificity of 88.9 %.

Combined use of multiparametric MRI could be a valid noninvasive method for comprehensive monitoring of CI-AKI. Among these parameters, MK may achieve the best diagnostic performance for CI-AKI.

This study employs bibliometric methods to explore the global research dynamics of iodine contrast agents in medical imaging. Through the visualization of knowledge maps, it presents research progress and reveals the research directions, hotspots, trends, and frontiers in this field.

Using Web of Science Core Collection database, CiteSpace and VOSviewer were employed to conduct a visual analysis of the global application of iodine contrast agents in medical imaging over the past four decades. The analysis focused on annual publication volume, collaboration networks, citation characteristics, and keywords.

A total of 3,775 studies on the application of iodine contrast agents in medical imaging were included. The earliest paper was published in 1977, with a slight increase in publications from 1991 to 2004, followed by a significant rise after 2005. The United States emerged as the leading country in publication volume. Harvard University was identified as a globally influential institution with 126 publications. Although a large author collaboration cluster and several smaller ones were formed, most collaborations between authors were relatively weak, with no high-density integrated academic network yet established. Pietsch Hubertus was the most prolific author, while Bae KT was the most highly co-cited author. The most highly cited journal was Radiology, with 2,384 citations. Co-occurrence analysis revealed that the top three keywords by frequency were "agent," "CT," and "image quality." Keyword clustering analysis showed that the top three clusters were "gadolinium," "gold nanoparticles," and "image quality." The timeline analysis indicated that clusters such as "gadolinium," "gold nanoparticles," "image quality," and "material decomposition" exhibited strong temporal continuity, while the keyword with the highest burst value was "digital subtraction angiography" (19.38). Burst term trend analysis suggested that recent research has been focusing on areas like "deep learning," "risk," "radiation dosage," and "iodine quantification."

This study is the first to systematically reveal the global trends, hotspots, frontiers, and development dynamics of iodine contrast agents in medical imaging through the use of CiteSpace and VOSviewer. It provides a novel perspective for understanding the role of iodine contrast agents in imaging and offers valuable insights for advancing global research in medical imaging.

Renal artery stenosis (RAS) is associated with poor outcome in patients with ischemic heart disease. In this study, we investigated the development of coronary collateral in RAS patients and possible association of RAS with a 5-year outcome after chronic total occlusion-percutaneous coronary intervention (CTO PCI).

Consecutive 58 patients with CTO PCI were enrolled prospectively, including 21 RAS patients (15 unilateral RAS and 6 bilateral RAS) and 37 non-RAS patients. RAS was diagnosed by renal duplex. Coronary collaterals were appraised by CC classification and Rentrop classification.

Development of left anterior descending artery coronary collateral by Rentrop classification was significantly worse in RAS patients than non-RAS patients. Kaplan-Meier curve of survival was significantly worse in RAS patients than non-RAS patients (p = 0.027). By univariate COX proportional hazard regression analysis, collateral development by CC classification was a significant predictor for 5-year survival. When age, RAS, and collateral development by CC classification were included in multivariate COX proportional hazard regression analysis, only age (hazard ratio: 1.349; 95% confidential interval: 1.058-1.720; p = 0.016) and RAS (hazard ratio: 6.680; 95% confidential interval: 1.322-33.747; p = 0.022) were significant predictors for 5-year survival.

We concluded that survival in RAS patients after CTO PCI is significantly worse than non-RAS patients, and RAS is a significant predictor for survival after CTO PCI. It seems that injured collateral development might partly explain increased all cause death in RAS patients.

To update the French recommendations for the management of kidney cancer.

A systematic review of the literature was conducted for the period from 2014 to 2024. The most relevant articles concerning the diagnosis, classification, surgical treatment, medical treatment, and follow-up of kidney cancer were selected and incorporated into the recommendations. The recommendations have been updated specifying the level of evidence (strong or weak).

Kidney cancer following prolonged occupational exposure to trichloroethylene should be considered an occupational disease. The reference examination for the diagnosis and staging of kidney cancer is the contrast-enhanced thoraco-abdominal CT scan. PET scans are not indicated in the staging of kidney cancer. Percutaneous biopsy is recommended in situations where its results will influence therapeutic decisions. It should be used to reduce the number of surgeries for benign tumors, particularly avoiding unnecessary radical nephrectomies. Kidney tumors should be classified according to the pTNM 2017 classification, the WHO 2022 classification, and the ISUP nucleolar grade. Metastatic kidney cancers should be classified according to IMDC criteria. Surveillance of tumors smaller than 2cm should be prioritized and can be offered regardless of patient age. Robot-assisted laparoscopic partial nephrectomy is the reference surgical treatment for T1 tumors. Ablative therapies and surveillance are options for elderly patients with comorbidities for tumors larger than 2cm. Stereotactic radiotherapy is an option to discuss for treating localized kidney tumors in patients not eligible for other treatments. Radical nephrectomy is the first-line treatment for locally advanced localized cancers. Pembrolizumab is recommended for patients at high risk of recurrence after surgery for localized kidney cancer. In metastatic patients, cytoreductive nephrectomy can be immediate in cases of good prognosis, delayed in cases of intermediate or poor prognosis for patients stabilized by medical treatment, or as "consolidation" in patients with complete or major partial response at metastatic sites after systemic treatment. Surgical or local treatment of metastases can be proposed for single lesions or oligometastases. Recommended first-line drugs for metastatic clear cell renal carcinoma are combinations of axitinib/pembrolizumab, nivolumab/ipilimumab, nivolumab/cabozantinib, and lenvatinib/pembrolizumab. Patients with non-clear cell metastatic kidney cancer should be presented to the CARARE Network and prioritized for inclusion in clinical trials.

These updated recommendations are a reference that will enable French and French-speaking practitioners to optimize their management of kidney cancer.

Recent guidelines recommend direct patient observation, pressure monitoring, and sensor devices to prevent extravasation during contrast media (CM) injection. However, it is impractical in terms of time and cost to install sensors for all patients.

To identify risk factors for CM extravasations during contrast-enhanced computed tomography (CECT) in a large population and to establish criteria for placing the sensor device on patients.

This retrospective study included 143,556 patients who underwent CECT at our hospital between April 2012 and July 2022. We performed multivariable logistic regression analysis between patients with (n = 350) and randomly selected patients without CM extravasation (n = 350). We investigated the percentage of patients with sensor devices and their sensitivity for detecting extravasation using receiver operating characteristic curve analysis.

The extravasation rate was 0.27%. Multivariable logistic regression analysis showed that the injection rate (adjusted odds ratio [AOR] = 1.61, 95% confidence interval [CI] = 1.33-1.95: P <0.001), catheter gauge (AOR = 3.86, 95% CI = 1.92-7.76; P <0.001), the use of anticancer drugs (AOR = 1.81, 95% CI = 1.32-2.50; P <0.001), and existing catheters (AOR = 1.52, 95% CI = 1.10-2.11; P = 0.009) were significantly associated with extravasation. To achieve a sensitivity of 90%, 80%, 70%, 60%, and 50%, 80%, 65%, 50%, 40%, and 28% of all patients required the placement of a sensor device, respectively.

Sensitivity analysis established criteria for effective placing sensor devices.

Coronary computed tomography angiography (CCTA) offers non-invasive diagnostics of the coronary arteries. Vessel evaluation requires the administration of intravenous contrast. The purpose of this study was to evaluate the utility of gadolinium-based contrast agent (GBCA) as an alternative to iodinated contrast for CCTA on a first-generation clinical dual-source photon-counting-detector (PCD)-CT system.

A dynamic circulating phantom containing a three-dimensional-printed model of the thoracic aorta and the coronary arteries were used to evaluate injection protocols using gadopentetate dimeglumine at 50%, 100%, 150%, and 200% of the maximum approved clinical dose (0.3 mmol/kg). Virtual monoenergetic image (VMI) reconstructions ranging from 40 keV to 100 keV with 5 keV increments were generated on a PCD-CT. Contrast-to-noise ratio (CNR) was calculated from attenuations measured in the aorta and coronary arteries and noise measured in the background tissue. Attenuation of at least 350 HU was deemed as diagnostic.

The highest coronary attenuation (441 ± 23 HU, mean ± standard deviation) and CNR (29.5 ± 1.5) was achieved at 40 keV and at the highest GBCA dose (200%). There was a systematic decline of attenuation and CNR with higher keV reconstructions and lower GBCA doses. Only reconstructions at 40 and 45 keV at 200% and 40 keV at 150% GBCA dose demonstrated sufficient attenuation above 350 HU.

Current PCD-CT protocols and settings are unsuitable for the use of GBCA for CCTA at clinically approved doses. Future advances to the PCD-CT system including a 4-threshold mode, as well as multi-material decomposition may add new opportunities for k-edge imaging of GBCA.

Patients allergic to iodine-based contrast media and the future of multicontrast CT examinations would benefit greatly from alternative contrast media, but the utility of GBCA for coronary photon-counting-dector-CT angiography remains limited without further optimization of protocols and scanner settings.

GBCA-enhanced coronary PCD-CT angiography is not feasible at clinically approved doses. GBCAs have potential applications for the visualization of larger vessels, such as the aorta, on PCD-CT angiography. Higher GBCA doses and lower keV reconstructions achieved higher attenuation values and CNR.

Contrast-induced acute kidney injury (CI-AKI) refers to the acute renal dysfunction caused by the injection of contrast agents. CI-AKI is currently a common complication after percutaneous coronary intervention (PCI).

To investigate the predictive value of the combined systemic inflammatory index (SII) and urate/high-density lipoprotein cholesterol ratio (UHR) for CI-AKI after PCI in patients with AMI.

A total of 1222 patients with AMI who underwent PCI were randomly divided into a training group and a validation group in an 8:2 ratio. According to the definition of CI-AKI diagnostic criteria, the training group was divided into CI-AKI group and non-CI-AKI group. Collect patient's blood and biochemical data, then calculate SII and UHR. The risk factors for CI-AKI were identified using LASSO and multivariate logistic regression analyses. A predictive column was created by using R language.Evaluate the predictive value of SII, UHR and their combination for CI-AKI after PCI using the area under the ROC curve (AUC).

Diabetes, Cystatin C, Diuretics, UHR, and LnSII were independent risk factors for CI-AKI in AMI patients after PCI. The ROC curve showed that the AUC of UHR and SII combined for predicting CI-AKI in AMI patients after PCI was 0.761 (95% CI: 0.709-0.812), with a sensitivity of 65.20% and a specificity of 76.70%, which was better than the prediction by either factor alone.

High SII and high UHR are risk factors for AMI, and their combination can improve the accuracy of predicting CI-AKI in AMI patients after PCI.The prognosis of CI-AKI in AMI patients is worse than in the general population.

Although sodium-glucose transport protein-2 (SGLT2) inhibitors (SGLT2i) do not increase the risk of acute kidney injury (AKI) in general, they may pose a risk in patients undergoing angiography. This prospective cohort study aimed to evaluate the safety and efficacy of SGLT2i for post-contrast AKI (PC-AKI) in patients with type 2 diabetes mellitus (T2DM). Following screening, 306 patients with T2DM selected to undergo coronary arterial angiography with or without percutaneous intervention were enrolled. Patients were divided into the SGLT2i exposure and non-exposure groups. The primary outcome was PC-AKI, defined as an increase in serum creatinine levels > 0.5 mg/dL (44.2 µmol/L), or 25% above the baseline, within 48-72 h after exposure to contrast medium. The incidence of PC-AKI in the overall T2DM population was 5.2% (16/306). Following 1:1 propensity score matching, the incidence of PC-AKI was significantly higher in the SGLT2i group than in the non-SGLT2i group (10.7% vs. 2.9%; P = 0.027), with an odds ratio of 4.5 (95% confidence interval: 1.0-20.2; P = 0.047). Furthermore, PC-AKI occurred at a higher rate among short-term users of SGLT2i than long-term users (20.5% vs. 3.4%, P = 0.018). Thus, our findings suggest an increased risk of PC-AKI associated with short-term SGLT2i therapy in patients with T2DM.

The incidence of post-contrast acute kidney injury (PC-AKI) is low with the new low- or iso-osmolar non-ionic iodinated contrast agents. The only proven form of prophylaxis for PC-AKI is hydration, preferably intravenous, although oral hydration is equally effective. In this article we define PC-AKI and its risk factors, propose a prophylaxis protocol and respond to the most common doubts that arise around prophylaxis. We also update the fasting guidelines to be followed prior to contrast testing. In general, fasting of solids is not necessary before injecting iodinated contrast or gadolinium except in tests in which it is necessary to specifically study the upper digestive tract and bile duct. Even in these cases, fasting clear liquids is not required, which is of great help for oral hydration and for reducing the incidence of PC-AKI.

Previous studies have reported a high occurrence of contrast-associated acute kidney injury (CA-AKI) in myocardial infarction (MI) patients undergoing primary percutaneous coronary intervention (PCI). However, the data on CA-AKI in MI patients who underwent elective PCI are limited. To evaluate the incidence of CA-AKI in MI patients undergoing elective PCI. The data were sourced from the Iodixanol-AKI Registry of MI patients scheduled to undergo elective PCI in 8 medical centers from May 2020 to November 2021. The participants were divided into three groups: acute, prior, and multiple MI. The outcomes measured were CA-AKI and the composite endpoint of major adverse renal and cardiovascular events (MARCE). The incidence of CA-AKI was 4.46% (37/830) in the MI patients, 4.40% (7/159) in the acute MI patients, 4.41% (22/499) in the prior MI patients, and 4.65% (8/172) in the multiple MI patients. Of note, 36 patients (97.30%) at AKI stage 1, and only 1 patient at AKI stage 2. There was no difference in the incidence of CA-AKI (P = 0.991) among the three groups. Multivariate regression analysis revealed that the independent risk factors for CA-AKI were diabetes and an estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2. MARCE occurred in 3.4% (28/830) of the total patients and was not associated with either any subgroup of patients with MI or AKI. The incidence of CA-AKI was low and mainly limited to mildly impaired renal function in MI patients undergoing elective PCI.

This study aimed to explore the incidence of and potential risk factors for adverse drug reactions (ADRs) after non-ionic iodinated contrast media (NICM) administration for CT exams in out-patient settings in China.

A total of 473,482 out-patients who underwent intravenous NICM between January 1st, 2017, and Dec 31st, 2021, were retrospectively enrolled from three institutions. The occurrence of ADRs and clinical information were recorded. Chi-square test, Poisson regression, and logistic regression analyses were used to evaluate potential ADR risk factors and correlation with demographics, season, and NICM type.

Among the 473,482 patients (mean age 55.22 ± 14.85; 253,499 male) who received intravenous NICM, the overall ADR incidence was 0.110% (522 of 473,482), with 0.099% acute-related drug reactions (469 of 473,482) and 0.0004% serious ADRs (two of 473,482). Iopromide was associated with a higher risk of acute ADRs. Late ADRs were more frequently observed with iodixanol 320. Multi-level logistic regression of patients with acute ADRs and a control group (matched 1:1 for age, gender, NICM, prescriber department, and institution) showed that summer (adjusted OR = 1.579; p = 0.035) and autumn (adjusted OR = 1.925; p < 0.001) were risk factors of acute ADRs. However, underlying disease and scanned body area were not related to a higher ADR incidence.

The use of NICM for out-patients is in general safe with a low ADR incidence. The type of contrast medium (iopromide) and the seasons (summer and autumn) were associated with a higher risk of acute ADRs. Late ADRs were more often observed with iodixanol.

In comparison to in-patients, out-patients may be exposed to higher risk due to a lack of extensive risk screening, less nursing care, and higher throughput pressure. Safety data about NICM from a large population may complement guidelines and avoid ambiguity.

• The incidence and risk factors for adverse events after using non-ionic iodinated contrast media are complex in out-patients. • Non-ionic iodinated contrast media are safe for out-patients and the overall incidence of adverse drug reactions was 0.110%. • There is a higher risk of acute adverse drug reactions in summer and autumn.

Background/Objectives: Carbon dioxide digital-subtraction angiography (CO2-DSA) is an increasingly adopted technique in endovascular aortic repair (EVAR) and fenestrated/branched EVAR (F/B-EVAR); it is used to reduce the amount of iodinate contrast medium (ICM) and prevent postoperative renal function worsening (PO-RFW). Our aim is to report results from the literature on EVAR and F/B-EVAR procedures using CO2-DSA, together with wider applications in aortic endovascular treatment. Methods: We performed a literature review by searching electronic databases for published data on CO2-DSA during EVAR and F/B-EVAR procedures. The endpoints were postoperative renal function worsening (PO-RFW) and efficacy of intraoperative arterial visualization. Further, applications of CO2 for thoracic endovascular aortic repair (TEVAR) were described. Results: Seventeen studies reporting results on CO2-DSA in EVAR (644 patients) were retrieved. Overall, 372 (58%) procedures were performed with CO2 alone, and 272 (42%) were performed with CO2+ICM. Eight studies analyzed the effect of CO2-DSA angiography on PO-RFW; four studies showed a significantly lower rate of PO-RFW compared to ICM. Five studies (153 patients) analyzed intraoperative arterial visualization with CO2-DSA; renal and hypogastric arteries were effectively visualized in 69% and 99% of cases, respectively. The use of CO2-DSA in F/B-EVAR has not been widely investigated. The largest series reported that PO-RFW was lower in the CO2 vs. ICM group. Conclusions: Carbon dioxide is widely applied in modern aortic endovascular treatment. CO2-DSA for EVAR and F/B-EVAR is an efficient technique for reducing PO-RFW while allowing acceptable arterial intraoperative visualization.

The risk of acute renal failure (ARF) following iodinated contrast media injection has long been overestimated because of the previous use of more toxic ICPs and uncontrolled studies. Nowadays, this concept is being questioned. Patients with severe renal failure and/or ARF are the only group still considered at risk. In these patients, it is necessary to discuss an alternative without an iodinated contrast agent. Contrast-enhanced ultrasound, MRI, spectral CT or PET-CT scan can be used instead of contrast-enhanced CT. Preventive measures should be applied when appropriate substitute to CT is not available or not diagnosed (minimum necessary dose of ICP, interruption of some treatments and prior hydration). These recommendations formalized by the European Society of Urogenital Radiology (ESUR) in 2018 address most situations faced by clinicians. In complex situations, an opinion from a nephrologist remains necessary after asking the radiologist about the availability of acceptable substitutes.

This study aimed to assess the feasibility of GPT-4 for answering questions related to contrast media with and without the context of the European Society of Urogenital Radiology (ESUR) guideline on contrast agents. The overarching goal was to determine whether contextual enrichment by providing guideline information improves answers of GPT-4 for clinical decision-making in radiology.

A set of 64 questions, based on the ESUR guideline on contrast agents mirroring pertinent sections, was developed and posed to GPT-4 both directly and after providing the guideline using a plugin. Responses were graded by experienced radiologists for quality of information and accuracy in pinpointing information from the guideline as well as by radiology residents for utility, using Likert-scales.

GPT-4's performance improved significantly with the guideline. Without the guideline, average quality rating was 3.98, which increased to 4.33 with the guideline (p = 0036). In terms of accuracy, 82.3% of answers matched the information from the guideline. Utility scores also reflected a significant improvement with the guideline, with average scores of 4.1 (without) and 4.4 (with) (p = 0.008) with a Fleiss´ Kappa of 0.44.

GPT-4, when contextually enriched with a guideline, demonstrates enhanced capability in providing guideline-backed recommendations. This approach holds promise for real-time clinical decision-support, making guidelines more actionable. However, further refinements are necessary to maximize the potential of large language models (LLMs). Inherent limitations need to be addressed.