Nephrogene systemische Fibrose (NSF): Wie hoch ist das Risiko und wie können wir es vermeiden?

Zusammenfassung: Das Krankheitsbild der nephrogenen systemischen Fibrose, das nach Durchführung einer Gadolinium unterstützen Magnetresonanztomographie/-angiographie bei Patienten mit schwerer Niereninsuffizienz auftreten kann, hat zu einer massiven Verunsicherung in der Anwendung dieser wertvollen Untersuchungstechnik geführt. Das Ziel der vorliegenden Arbeit ist es, neben der Diskussion des Krankheitskonzepts, der zugrundeliegenden Pathophysiologie, der Klinik und der therapeutischen Optionen, die Risikofaktoren zu beleuchten und Konzepte der Prävention aufzuzeige

Three-dimensional dynamic MR-hysterosalpingography; a new, low invasive, radiation-free and less painful radiological approach to female infertility

BACKGROUND: The purpose of this study was to propose a new method for imaging the uterine cavity and Fallopian tube patency by three-dimensional dynamic magnetic resonance hysterosalpingography (3D dMR-HSG) and to analyse if, by using a higher viscosity contrast solution, direct visualization of the Fallopian tubes may be achieved by this new technique. METHODS: 10 consecutive infertile women underwent 3D dMR-HSG and conventional HSG as gold standard. 3D dMR-HSG consisted of injection of 20 ml of a gadolinium-polyvidone solution into the uterine cavity while acquiring five consecutive three-dimensional (3D) T1-weighted MR-sequences. RESULTS: In three patients the catheter became dislodged during 3D dMR-HSG. However, in one of these patients the examination was still partially diagnostic. Imaging findings of 3D dMR-HSG showed good correlation with conventional hysterosalpingography and allowed 3D imaging of the uterine cavity and of Fallopian tube patency in 8/10 patients and direct visualization of the Fallopian tubes in 5/7 patients. CONCLUSION: 3D dMR-HSG represents a new and promising imaging approach to female infertility causing less pain and avoiding exposure of the ovaries to ionizing radiation. By using a higher viscosity MR-contrast agent it allows not only visualization of uterine cavity and Fallopian tube patency but also direct visualization of Fallopian tube

Total-body contrast-enhanced MRA on a short, wide-bore 1.5-T system: intra-individual comparison of Gd-BOPTA and Gd-DOTA

Total-body contrast-enhanced MRA (CE-MRA) provides information of the entire vascular system according to a one-stop-shop approach. Short, wide-bore scanners have not yet been used for total-body CE-MRA, probably due to their restricted field of view in the z-direction. The purpose of this feasibility study is to introduce an image protocol for total-body MRA on a short, wide-bore system. The protocol includes five to six table-moving steps and two injection runs. Two pharmacologically different contrast materials (CM) were applied in ten healthy volunteers in view of possible CM-dependent influences on the protocol outcome (Gd-Bopta, Gd-Dota). Differences consisted of significantly higher CNR with Gd-Bopta with a mean of 73.8 ± 38.7 versus 69.1 ± 34.3 (p = 0.008), significantly better arterial visualization values with Gd-Dota with a mean of 1.26 ± 0.44 versus 1.53 ± 0.73 (p = 0.003) and a tendency to less venous overlay with Gd-Dota, mean 1.19 ± 0.44 and 1.34 ± 0.72, respectively (p = 0.065) (two-tailed Wilcoxon matched-pairs test). Overall 94% of the steps were valued as qualitatively excellent or good. The good results with both CM suggest a transfer to further patient evaluatio

Low-dose intra-arterial contrast-enhanced MR aortography in patients based on a theoretically derived injection protocol

Multiple intra-arterial contrast agent injections are necessary during MR-guided endovascular interventions. In respect to the approved limits of maximum daily gadolinium dose, a low-dose injection protocol is mandatory. The objective of this study was to derive and apply a low-dose injection protocol for intra-arterial 3D contrast-enhanced MR aortography in patients. Injection rate (Qinj), concentration of injected gadolinium [Gd]inj and aortal blood flow rate (Qblood) were included for the theoretical evaluation of signal intensity (SI) of the arterial lumen. SI simulations were carried out at Qinj=2 versus 4ml/s in the [Gd]inj range between 0-500mM. Qinj and [Gd]inj with SI above the 75% threshold of the maximal SI were regarded as optimal injection parameters. [Gd]inj=50mM and Qinj=4ml/s were considered as optimal and were administered in five patients for 3D MR aortography. All images revealed clear delineation of the abdominal aorta and its major branches. Mean±SD of contrast-to-noise ratios of the abdominal aorta, common iliac and renal artery were 70.2±15.2, 58.6±12.3 and 67.4±12.3. Approximately seven intra-aortal injections would be permissible in patients during MR-guided interventions without exceeding the maximal dose of gadoliniu

Cycle-finite module categories

We describe the structure of module categories of finite dimensional algebras over an algebraically closed field for which the cycles of nonzero nonisomorphisms between indecomposable finite dimensional modules are finite (do not belong to the infinite Jacobson radical of the module category). Moreover, geometric and homological properties of these module categories are exhibited

Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines

Objectives: The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. Areas covered in part 2: Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium. Key points: \u2022 In CKD, hydration reduces the PC-AKI risk \u2022 Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis \u2022 No drugs have been consistently shown to reduce the risk of PC-AKI \u2022 Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m2 \u2022 Dialysis schedules need not change when intravascular contrast medium is given

Degenerate flag varieties: moment graphs and Schr\"oder numbers

We study geometric and combinatorial properties of the degenerate flag varieties of type A. These varieties are acted upon by the automorphism group of a certain representation of a type A quiver, containing a maximal torus T. Using the group action, we describe the moment graphs, encoding the zero- and one-dimensional T-orbits. We also study the smooth and singular loci of the degenerate flag varieties. We show that the Euler characteristic of the smooth locus is equal to the large Schr\"oder number and the Poincar\'e polynomial is given by a natural statistics counting the number of diagonal steps in a Schr\"oder path. As an application we obtain a new combinatorial description of the large and small Schr\"oder numbers and their q-analogues.Comment: 25 page

Post-contrast acute kidney injury \u2013 Part 1: Definition, clinical features, incidence, role of contrast medium and risk factors: Recommendations for updated ESUR Contrast Medium Safety Committee guidelines

Purpose: The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers. Areas covered in part 1: Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs. Key Points: \u2022 PC-AKI is the preferred term for renal function deterioration after contrast medium. \u2022 PC-AKI has many possible causes. \u2022 The risk of AKI caused by intravascular contrast medium has been overstated. \u2022 Important patient risk factors for PC-AKI are CKD and dehydration

Categorification of skew-symmetrizable cluster algebras

We propose a new framework for categorifying skew-symmetrizable cluster algebras. Starting from an exact stably 2-Calabi-Yau category C endowed with the action of a finite group G, we construct a G-equivariant mutation on the set of maximal rigid G-invariant objects of C. Using an appropriate cluster character, we can then attach to these data an explicit skew-symmetrizable cluster algebra. As an application we prove the linear independence of the cluster monomials in this setting. Finally, we illustrate our construction with examples associated with partial flag varieties and unipotent subgroups of Kac-Moody groups, generalizing to the non simply-laced case several results of Gei\ss-Leclerc-Schr\"oer.Comment: 64 page