Comparative assessment of image quality for coronary CT angiography with iobitridol and two contrast agents with higher iodine concentrations: iopromide and iomeprol. A multicentre randomized double-blind trial
Achenbach S.,Friedrich - Alexander - University, Erlangen - Nuremberg |
Paul J.-F.,Center Chirurgical Marie Lannelongue |
Laurent F.,University of Bordeaux 1 |
Laurent F.,Bordeaux University Hospital Center |
And 15 more authors.
European Radiology | Year: 2016
Objectives: To demonstrate non-inferiority of iobitridol 350 for coronary CT angiography (CTA) compared to higher iodine content contrast media regarding rate of patients evaluable for the presence of coronary artery stenoses. Methods: In this multicentre trial, 452 patients were randomized to receive iobitridol 350, iopromide 370 or iomeprol 400 and underwent coronary CTA using CT systems with 64-detector rows or more. Two core lab readers assessed 18 coronary segments per patient regarding image quality (score 0 = non diagnostic to 4 = excellent quality), vascular attenuation, signal and contrast to noise ratio (SNR, CNR). Patients were considered evaluable if no segment had a score of 0. Results: Per-patient, the rate of fully evaluable CT scans was 92.1, 95.4 and 94.6 % for iobitridol, iopromide and iomeprol, respectively. Non-inferiority of iobitridol over the best comparator was demonstrated with a 95 % CI of the difference of [-8.8 to 2.1], with a pre-specified non-inferiority margin of -10 %. Although average attenuation increased with higher iodine concentrations, average SNR and CNR did not differ between groups. Conclusions: With current CT technology, iobitridol 350 mg iodine/ml is not inferior to contrast media with higher iodine concentrations in terms of image quality for coronary stenosis assessment. Key Points: • Iodine concentration is an important parameter for image quality in coronary CTA.• Contrast enhancement must be balanced against the amount of iodine injected.• Iobitridol 350 is non-inferior compared to CM with higher iodine concentrations.• Higher attenuation with higher iodine concentrations, but no SNR or CNR differences. © 2016 The Author(s) Source
Pratola C.,University of Ferrara |
Notarstefano P.,University of Ferrara |
Toselli T.,University of Ferrara |
Artale P.,University of Ferrara |
And 4 more authors.
PACE - Pacing and Clinical Electrophysiology | Year: 2010
Introduction: Not all candidates for cardiac resynchronization therapy (CRT) are responders at follow-up. Echocardiographic parameters of dyssynchrony do not predict the response. Analysis of electrical properties of left ventricle (LV) by noncontact mapping (NCM) could be useful to better identify candidates for CRT. Methods and Results: We studied nine consecutive patients undergoing CRT. An NCM was positioned in the LV via atrial transeptal puncture. LV activation was recorded during sinus rhythm (SR), pacing from RV, from different LV epicardial locations, and in biventricular (BIV) pacing. The corresponding invasive pressure was determined. Heparin, administered during NCM, was reversed and CRT implant was completed. An offline analysis of the data was performed in order to measure transeptal and total LV activation time, to evaluate the site of earliest and latest LV activation, and the pattern of activation. No complications occurred. Mean time of total NCM procedures was 24 ± 7 minutes. During SR, RV, LV, and BIV pacing, respectively, a "U"-shaped LV activation pattern was found in three, seven, four, and and two patients; mean LV activation time was 58.1 ± 7.0, 81.7 ± 15.8, 71.1 ± 12.4, and 65.6 ± 7.7 ms; and mean systolic LV peak pressure was 114 ± 21, 97 ± 18, 103 ± 17 and 110 ± 15 mmHg, respectively. LV activation was influenced by a slow conduction area at the pacing site and by the duration of transeptal time. Conclusion: An NCM during CRT is safe and feasible. It provides an additional information on electrical activation in SR and in various modality of pacing. Further studies with larger populations are needed in order to correlate electrical to clinical outcomes. (PACE 2010; 74-84) © 2009 Wiley Periodicals, Inc. Source
Ballardini P.,Ospedale del Delta |
Marri I.,Ospedale del Delta |
Margutti G.,Ospedale del Delta |
Aliberti C.,Ospedale del Delta |
And 2 more authors.
Tumori | Year: 2010
Effective and safe systemic treatment for advanced hepatocellular carcinoma (HCC) with severe underlying cirrhosis is not yet available. Sorafenib, an oral multikinase inhibitor, has proved to be effective in the treatment of patients affected by HCC with Child-Pugh class A liver function. For patients with cirrhosis-associated HCC having Child-Pugh class B and C liver function, no systemic treatments of documented efficacy and safety exist. We report a case of metastatic HCC associated with Child-Pugh class B cirrhosis that was treated with low, "metronomic" doses of capecitabine (1000 mg/day continuously). This treatment was effective and well tolerated and the response was maintained for 18 months. Metronomic capecitabine may represent a possible alternative in the treatment of those patients with advanced cirrhosis-associated HCC who cannot be treated with sorafenib. Free full text available at www.tumorionline.it. Source