• The Korean Journal of Pain
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• 제29권4호
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• pp.255-261
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• 2016

Background: Thoracic epidural anesthesia is frequently used to maintain intraoperative and postoperative analgesia. Frequently, 3 ml of local anesthetic is used as a test dose, or for intermittent epidural injection. We assessed the extent of the spread of 3 ml of contrast medium in the thoracic epidural space and attempted to identify any correlating factors affecting the epidurography. Methods: A total of 70 patients were enrolled in the study, and thoracic epidural catheterizations were performed under fluoroscopic guidance. Using 3 ml of contrast medium, epidurography was evaluated to confirm the number of spinal segments covered by the contrast medium. Correlation analysis was performed between patient characteristics (sex, age, body mass index, weight, height, and location of catheter tip) and the extent of the contrast spread. Results: The mean number of vertebral segments evaluated by contrast medium was $7.9{\pm}2.2$ using 3 ml of contrast medium. The contrast spread in the cranial direction showed more extensive distribution than that in the caudal direction, with statistical significance (P < 0.01). Patient height demonstrated a negative correlation with the extent of distribution of contrast medium (r = -0.311, P < 0.05). Conclusions: Thoracic epidurography using 3 ml of contrast medium results in coverage of a mean of $7.9{\pm}2.2$ spinal segments, with more extensive cranial spread, and patient height showed a weak negative correlation with the distribution of contrast medium.

• 약학회지
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• 제53권6호
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• pp.328-333
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• 2009

Contrast media are substances that are used to enhance the contrast of structures or fluids within the body in medical imaging. Those are commonly used to enhance the visibility of blood vessels and the gastrointestinal tract. The aim of this study is to evaluate patients who got injected iopamidol, developed as one of contrast medium regarding changes in cardiovascular system and especially, adverse drug reactions. This study were performed on randomly selected a total of 51 patients (range of 15~85 years old) who got injected contrast medium, Iopamidol at a P hospital in Gyeonggi province from September 22nd, 2008 to January 24th, 2009. Data were collected by questionnaire though person to person. We analyzed the data by SPSS (Version 12. for windows). Methods of analysis were frequency and cross analysis. In results, 19.6% (n=10) were founded for adverse drug reactions of contrast medium. 25.0% (n=4) of 10 patients who had adverse drug reactions of contrast medium had took abdomen contrast test. 2 patients of those took contrast test for chest. Also, 3.9% (n=2) patients felt vomiting and nausea after injection of contrast medium. In conclusion, 19.6% patients experienced adverse drug reaction of contrast medium. Therefore, when taking radiation test, we should make efforts to minimize adverse drug reactions to achieve suitable and effective treatment.

• Journal of Veterinary Science
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• 제21권4호
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• pp.55.1-55.11
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• 2020

Background: Computed tomography urography (CTU), based on the excretion of contrast medium after its injection, allows visualization of the renal parenchyma and the renal collecting system. Objectives: To determine the optimal contrast medium dose allocation ratio to apply in split-bolus CTU in dogs. Methods: This prospective, experimental, exploratory study used 8 beagles. In 3-phase CTU, unenhanced-, nephrographic-, and excretory-phase images were obtained with a single injection of 600 mg iodine/kg iohexol. In split-bolus CTU, two different contrast medium allocation ratios (30% and 70% for split CTU 1; 50% and 50% for split CTU 2) were used. Unenhanced phase image and a synchronous nephrographic-excretory phase image were acquired. Results: Although the attenuation of the renal parenchyma was significantly lower when using both split CTUs than the 3-phase CTU, based on qualitative evaluation, the visualization score of the renal parenchyma of split CTU 1 was as high as that of the 3-phase CTU, whereas the split CTU 2 score was significantly lower than those of the two others. Artifacts were not apparent, regardless of CTU protocol. The diameter and opacification of the ureter in both split CTUs were not significantly different from those using 3-phase CTU. Conclusions: Split-bolus CTU with a contrast medium allocation ratio of 30% and 70% is feasible for evaluating the urinary system and allows sufficient enhancement of the renal parenchyma and appropriate distention and opacification of the ureter, with similar image quality to 3-phase CTU in healthy dogs. Split-bolus CTU has the advantages of reducing radiation exposure and the number of CT images needed for interpretation.

• 대한정형외과 초음파학회지
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• 제5권1호
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• pp.9-14
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• 2012

목적: 유착성 관절낭염 환자에서 초음파를 이용한 관절와 상완 관절강 내 스테로이드 주사를 시행한 후 주사요법의 정확성이 임상적 결과에 미치는 영향을 평가하고자 하였다. 대상 및 방법: 임상적으로 유착성 관절낭염으로 진단받은 환자들 중 외상이 없고, 약물 치료 및 물리 치료를 받았으나 만족할 만한 호전을 보이지 않은 환자를 대상으로 하였다. 환자들은 총 33명으로 남자 15명, 여자 18명으로 평균 연령은 55.1세(42~72세)였다. 이를 대상으로 견봉 쇄골 접근법을 통해 스테로이드 칵테일 10 ml(triamcinolone 1 ml(40 mg/ml), lidocaine 4 ml(2%), normal saline 5 ml)와 조영제 5 ml ($Telebrix^{(R)}$, Guerbet, France)를 주입하였으며, 이후 바로 방사선 촬영을 시행하여 주사의 견관절 관절강 내 주입 여부를 확인하였다. 또한 조영제가 관절강내로 정확히 들어간 경우, 부분적으로 들어간 경우 그리고 조영제가 관절강 바깥으로 들어간 경우로 3군으로 분류하여 각각의 군에서 주사요법 전, 후 수동적 운동범위 및 VAS score를 이용한 통증 완화 정도를 분석하였다. 결과: 총 33례 중 25례(76%)에서 조영제가 정확히 관절강 내로 주입되었음을 확인하였다. 6례(18%)에서는 관절강에 부분적으로 조영제가 관찰되었고, 2례(6%)에서는 조영제가 관절강 바깥에서 관찰되었다. 조영제가 관절강내로 정확히 들어간 군은 시행 전 굴곡은 평균 111도(80~140도), 외회전은 48도(0~90도)였고, 시술 후 굴곡은 평균 134도(90~150도), 외회전은 70도(30~90도)로 호전되었다(p<0.01). 그리고 조영제가 관절강내로 부분적으로 들어간 군은 시행 전 굴곡은 평균 120도(90~150도), 외회전은 70도(10~90도)였고, 시술 후 굴곡은 평균 139(135~140도)도, 외회전은 78도(50~90도)로 호전된 결과가 관찰되었다(p<0.01). 조영제가 관절강 바깥으로 들어간 군은 환자수의 부족으로 통계적으로 의미를 갖지 않았다. 시술 전, 후 VAS 점수의 변화는 조영제가 관절강 내로 정확히 들어간 군은 7.1점(3~9점)에서 2.6점(0~5점)으로 호전되었고(p<0.01), 부분적으로 들어간 군은 7.5점(7~9점)에서 3.3점(2~4점)으로 호전되었고(p<0.01), 관절강 바깥으로 들어간 군은 7.5점에서 2점으로 호전되었다. 또한 당뇨 환자군과 비 당뇨 환자군을 비교한 결과 임상적 결과에 통계적으로 유의한 차이가 없이 모두 호전되었다. 결론: 유착성 관절낭염 환자에서 초음파 하에 견봉 쇄골 접근법을 통한 견관절 관절강 내 스테로이드 주사는 기존의 방법들보다 좋은 정확도(94%)를 보고하였으며, 이 중 관절강 바깥으로 새어나간 군과 새어나가지 않은 군 간에는 임상적으로 유의한 차이가 발견되지 않았다.

• Journal of Yeungnam Medical Science
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• 제36권2호
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• pp.109-114
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• 2019

Background: Transforaminal epidural block (TFEB) is an effective treatment option for radicular pain. To reduce complications from intravascular injection during TFEB, use of imaging modalities such as real-time fluoroscopy (RTF) or digital subtraction angiography (DSA) has been recommended. In this study, we investigated whether DSA improved the detection of intravascular injection during TFEB at the whole spine level compared to RTF. Methods: We prospectively examined 316 patients who underwent TFEB. After confirmation of final needle position using biplanar fluoroscopy, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under RTF; 30 s later, 2 mL of nonionic contrast medium was injected at a rate of 0.5 mL/s under DSA. Results: Thirty-six intravascular injections were detected for an overall rate of 11.4% using RTF, with 45 detected for a rate of 14.2% using DSA. The detection rate using DSA was statistically different from that using RTF (p=0.004). DSA detected a significantly higher proportion of intravascular injections at the cervical level than at the thoracic (p=0.009) and lumbar (p=0.011) levels. Conclusion: During TFEB at the whole spine level, DSA was better than RTF for the detection of intravascular injection. Special attention is advised for cervical TFEB, because of a significantly higher intravascular injection rate at this level than at other levels.

• Korean Journal of Radiology
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• 제21권11호
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• pp.1230-1238
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• 2020

Objective: We aimed to assess the effects of remote ischemic pre-conditioning (RIPC) on the incidence of contrast-induced nephropathy (CIN) after an intravenous (IV) or intra-arterial injection of contrast medium (CM) in patient and control groups. Materials and Methods: This prospective, randomized, single-blinded, controlled trial included 26 patients who were hospitalized for the evaluation of the feasibility of transcatheter aortic valve implantation and underwent investigations including contrast-enhanced computed tomography (CT), with Mehran risk scores greater than or equal to six. All the patients underwent four cycles of five minute-blood pressure cuff inflation followed by five minutes of total deflation. In the RIPC group (n = 13), the cuff was inflated to 50 mm Hg above the patient's systolic blood pressure (SBP); in the control group (n = 13), it was inflated to 10 mm Hg below the patient's SBP. The primary endpoint was the occurrence of CIN. Additionally, variation in the serum levels of cystatin C was assessed. Results: One case of CIN was observed in the control group, whereas no cases were detected in the RIPC group (p = 0.48, analysis of 25 patients). Mean creatinine values at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 88 ± 32 μmol/L, 91 ± 28 μmol/L and 82 ± 29 μmol/L, respectively (p = 0.73) in the RIPC group, whereas in the control group, they were 100 ± 36 μmol/L, 110 ± 36 μmol/L, and 105 ± 34 μmol/L, respectively (p = 0.78). Cystatin C values (median [Q1, Q3]) at the baseline, 24 hours after injection of CM, and 48 hours after injection of CM were 1.10 [1.08, 1.18] mg/L, 1.17 [0.97, 1.35] mg/L, and 1.12 [0.99, 1.24] mg/L, respectively (p = 0.88) in the RIPC group, whereas they were 1.11 [0.97, 1.28] mg/L, 1.13 [1.08, 1.25] mg/L, and 1.16 [1.03, 1.31] mg/L, respectively (p = 0.93), in the control group. Conclusion: The risk of CIN after an IV injection of CM is very low in patients with Mehran risk score greater than or equal to six and even in the patients who are unable to receive preventive hyperhydration. Hence, the Mehran risk score may not be an appropriate method for the estimation of the risk of CIN after IV CM injection.

• 한국콘텐츠학회논문지
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• 제19권11호
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• pp.445-450
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• 2019

본 연구는 자기공명영상 동적검사 시 자동주입기의 사용에 따라 조영제 역류로 인한 생리식염수의 오염 현상을 실험적으로 증명함으로써, 오염된 실린지 재사용 문제의 심각성을 인식시키고자 하였다. 연구방법은 조영제 주입 전 생리식염수와 주입 후 생리식염수를 각각 채취한 다음, T1 강조영상을 획득하여 신호강도를 측정하여 비교하였다. 생리식염수의 주입 후 신호강도가 주입 전에 비해 523.43% 통계적으로 높게 나타났다(p<0.05). 이는 조영제 주입에 따른 압력에 의해 조영제가 관을 통해 역류하여 압력이 낮은 반대쪽 생리식염수를 오염시킨 것으로 분석되었다. 결론적으로 조영제 주입 시 사용하는 실린지는 조영제 역류로 인해 교차오염이 발생하므로 정량적 분석을 위한 검사 시 동일한 환자의 검사라도 검사순서를 변경하거나 실린지를 교체하여 오류를 방지해야 한다.

• 대한방사선기술학회지:방사선기술과학
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• 제41권2호
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• pp.123-128
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• 2018

Recently, the use of contrast agents has been increasing as a broader range of tests and dynamic tests have become common due to the development of equipment and imaging techniques such as Multi-Detector CT. However, the side effects of using contrast agents have been reduced by the development of non-ionic contrast agents, but they are still occurring often. The purpose of this study was to propose a method to minimize the side effect of contrast agent by using the amount of contrast agent injected to the brain angiography test to suppress excessive use of contrast agent and analyze the amount of contrast agent. Patients who were prescribed Brain Angiography due to cerebrovascular disease, According to the results of the comparison of the results obtained by dividing into 4 groups of 10ml each according to the amount of contrast medium injected with contrast agent according to the BMI of the patient, BA and SNR were not different between groups, and even if the amount of contrast injection was reduced, there was no problem in the evaluation of CT angiography through 3D reconstruction. This result shows that even if the contrast medium is injected into the blood vessels of the patient first and then the contrast medium is used as the physiological saline solution, the contrast medium is reduced by 40% it can be expected to minimize.

• 한국콘텐츠학회논문지
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• 제12권9호
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• pp.270-279
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• 2012

토끼 뇌에 대장균을 주입하여 CT 소견을 알아보고, 시간에 따른 동맥혈의 하운스필드 값의 변화를 알아보고자 하였다. 토끼 두개관에 천두공(burr hole)을 뚫고 2~3 mm 깊이에 대장균 $1{\times}10^7$ CFU/ml, 0.1 ml을 주입하여 뇌염증 모델을 제작하고, 조영 증강 CT와 동적 CT, 그리고 동맥혈의 CT영상을 얻었다.조영 증강 CT에서 뇌농양, 뇌실염 그리고 뇌막염등 다양한 뇌염증 소견이 보였다. 뇌농양은 중앙부가 거의 조영되지 않고 주변부가 강하게 조영되는 전형적인 양상을 보였고, 뇌실염은 측뇌실 벽을 따라 강하게 조영되는 소견을 보였으며, 뇌막염은 종뇌와 간뇌의 접히는 부위 뇌막이 강하게 조영되었다. 동적 CT영상에서 염증 중앙부의 조영제 주입 전 HU 값은 $31.01{\pm}3.55$였고, 주입 후 10분까지 $40.36{\pm}3.76$으로 서서히 증가하였다. 그리고 염증 가장자리구역에서 HU 값은 조영제 주입 전에 $47.23{\pm}3.12$였고, 조영제 주입 후 약 45초에 $63.59{\pm}3.31$로 가장 많이 증가 하였으나 이후 20분까지 약간 떨어졌다. 또한 균 주입 반대쪽 정상 뇌조직에서 측정한 HU 값은 조영제 주입 전에 $39.01{\pm}3.24$이었고, 조영제 주입 후 약 30초에 $49.01{\pm}4.29$로 가장 많이 조영되었고, 이후 서서히 낮아졌다. 동맥 혈액 CT에서 조영제 주입 전 HU 값은 $87.78{\pm}6.88$이었고, 조영제 주입 후 10초부터 30초까지 급격히 증가하여 $749.13{\pm}98.48$로 최대값을 보이고, 30초부터 45초까지 $467.85{\pm}62.98$로 급격히 감소하며, 45초에서 60초까지는 정체기(plateau)를 보였으며, 이후 20분까지 $188.28{\pm}25.03$으로 감소되었다. 결과적으로 대장균으로 뇌염증 모델을 만들 수 있고, 조영 증강 CT를 통하여 뇌염증의 특징적인 소견을 잘 알 수 있었으며, 동적 CT를 통해 염증 중앙부와 가장자리구역의 조영 양상을 알 수 있고, 동맥혈은 조영제 주입 후 10초부터 30초 까지 급격히 증가하다 정체기를 거쳐 서서히 감소하는 것으로 나타났다.

• 한국임상수의학회지
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• 제35권6호
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• pp.299-301
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• 2018

A 7-year-old intact female Shih-Tzu with chylothorax was presented. Percutaneous popliteal computed tomographic lymphangiography was performed to evaluate the thoracic duct and seek any potential cause of chylothorax. Despite two attempts, visualization of the thoracic duct failed and perianal subcutaneous computed tomographic lymphangiography with injection of iodinated, nonionic water-soluble contrast medium (0.6 ml/kg) was performed. A single branch of intact thoracic duct and dilated and tortuous lymphatics were detected. It was diagnosed as idiopathic chylothorax. Perianal subcutaneous lymphangiography is considered a less-invasive, easy and reliable method to visualize lymphatics in patients with chylothorax.