BACKGROUND: We investigated the effect of iodinated contrast medium concentration on increased neoplastic lesion enhancement and its direct relation to diagnostic efficacy in biphasic spiral computed tomography for detection of hepatocellular carcinoma. METHODS: A pilot, single-center, randomized, double-blind, crossover, comparative study was performed and included 22 participants. Each patient underwent two separate biphasic contrast-enhanced spiral computed tomographic examinations. Scans were performed with iomeprol containing 400 (iomeprol 400) or 300 (iomeprol 300) mg of iodine per milliliter (Iomeron, Bracco Imaging SpA, Milan, Italy) with a 2- to 12-day window scan; patients were given an equal total dose of 45 g of iodine at a fixed injection rate of 4 mL/s. Comparison included assessment of quantitative and qualitative parameters. RESULTS: Lesion density and lesion-to-liver contrast increased more markedly with the higher concentration of contrast medium during the arterial phase (p = 0.0016 and 0.0005, respectively). There was no significant difference in any parameter between the two concentrations during the portal phase. Number of lesions detected during the arterial phase increased from 37 with iomeprol 300 to 42 with iomeprol 400; in the portal phase, the respective numbers were 34 and 36. CONCLUSION: Even though a small number of patients was examined, our study suggests that, in patients with cirrhosis, an increased concentration of iodine improves liver-to-lesion contrast and may improve the detection of hepatocellular carcinoma.

Adult↗

PubMedDate not supplied

CT-fluoroscopy link-up (CTF): potential for special procedures.

Some interventional radiological procedures call for unrestricted axial vision and monoplanar fluoroscopy at different angles. We have mounted a fluoroscopic image intensifier in front of the gantry of a CT scanner to assess whether the combination would be useful. This link-up has been tested in a variety of situations and, even with the shortcomings of makeshift equipment, the combination filled some gaps in our vision of what is going on inside the patient, especially before an invasive procedure. It also proved useful in the planning of multiple procedures in a single session, especially when they had to be performed under general anesthesia in children or in the management of critical cases. We feel that the possibilities afforded by CTF (computed tomography plus fluoroscopy) need further exploration prior to the construction of purpose-built equipment. The interim information supplied suggests that it will be worth developing.

Biopsy↗

PubMedDate not supplied

Continuous infusion with implantable pumps: expanding the radiologist's role.

Drug infusion systems attract increasing attention as biomedical technology offers miniaturized devices for targeted delivery of therapeutic substances on an outpatient basis. We have used a totally implantable, subcutaneous pump, externally programmable by radiofrequency link, learning the technique of implantation and management and using various imaging modalities for the diagnosis and control of complications. The procedure for implanting systems for continuous intrathecal analgesia and systemic intravenous chemotherapy is described. Our experience of the latter is made up of 296 implants in 290 patients. The selected infusion pump proved reliable and acceptable to patients and the quality of life, given the reduced drug toxicity, more than good. The complications were few both in frequency and in severity. The setting-up of a long-term infusion system, when major surgery is not needed, can fall within the interventional radiologist's field, partly because of a good cost-benefit ratio.

Cost-Benefit Analysis↗