High-dose contrast-enhanced computed tomography (CECT) with iopamidol in the detection of cerebral metastases

Leonardi, Marco; Lavaroni, A.; Biasizzo, E.; Fabris, G.; Penco, T.; Zappoli, Franco A.

doi:10.1007/bf00698843

Cited by 10 publications

(3 citation statements)

References 24 publications

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“…Computer tomography (CT) and Magnetic Resonance Imaging (MRI) scans can identify CNS metastases at a relatively early stage [6][7][8][9]. However, these tools are used only if there is clinical evidence of CNS involvement, because routine screening with CT/MRI scans and neurologic examinations of asymptomatic patients have proved to be of limited value [10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Neuron-specific enolase as a marker of brain metastasis in patients with small-cell lung carcinoma

et al. 1994

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Neuron-specific enolase (NSE) is one of the iso-forms of enolase, a glycolytic enzyme found in the neuroendocrine system. NSE is one of the most widely used tumor markers in small-cell lung carcinoma (SCLC). To assess the value of NSE in discriminating between the sites of metastases in SCLC-patients with and without cerebral involvement, serial NSE determinations were performed. Serum NSE was elevated in 76% of the patients at initial diagnosis. The value did not discriminate between the extent of disease nor between the sites of extrathoracic disease. NSE levels declined significantly at restaging. A persistent, significant rise occurred in patients with relapse of their disease, regardless of the site of relapse. In patients with brain metastases with and without extracranial disease at relapse, the NSE increase was significantly smaller than in patients without intracranial involvement. These findings indicate that serial determination of serum NSE in SCLC-patients may be useful in monitoring tumor activity but not in predicting the site of metastatic disease.

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Section: Introductionmentioning

confidence: 99%

Neuron-specific enolase as a marker of brain metastasis in patients with small-cell lung carcinoma

et al. 1994

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“…1,2 When patients with such tumors are treated by stereotactic radiotherapy, a major issue is tumor registration at the time of treatment. Because the latest radiotherapy machines are equipped with kilovoltage cone-beam computed tomography (kV CBCT) units, 3 it may be possible to detect normally invisible tumors by contrast medium administration immediately before stereotactic treatment.…”

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confidence: 99%

Contrast medium-assisted stereotactic image-guided radiotherapy using kilovoltage cone-beam computed tomography

et al. 2008

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Iodized contrast media have been widely used to detect tumors such as brain metastases and hepatocellular carcinomas. 1,2 When patients with such tumors are treated by stereotactic radiotherapy, a major issue is tumor registration at the time of treatment. Because the latest radiotherapy machines are equipped with kilovoltage cone-beam computed tomography (kV CBCT) units, 3 it may be possible to detect normally invisible tumors by contrast medium administration immediately before stereotactic treatment. We have therefore investigated the feasibility of kV CBCT-based direct tumor registration for the two types of tumors mentioned above after contrast medium administration.Iodized oil (Lipiodol) 3.5 ml was administered via the left hepatic artery under fl uoroscopic monitoring. Radiotherapy planning was performed 3 days after the iodized oil administration by Pinnacle (Philips Medical Systems, Eindhoven, The Netherlands) based on CT images taken by a large-bore CT (Aquilion/LB; Toshiba Medical Systems, Tokyo, Japan). Elekta Synergy (Elekta, Crawley, UK) was used for radiotherapy 4 days after the iodized oil administration, with the on-board CBCT image obtained immediately before treatment. The Elekta Stereotactic Body Frame was used for body immobilization.The initial attempt at tumor registration was performed by built-in bone-matching software because of its quick calculation. In other words, tumor registration was performed using bone anatomy with the assumption that the spatial relation between the bone anatomy and the tumor remained the same at the planning and treatment times. Subsequently, the tumor position in the CBCT image and the isocenter imported from the treatment planning system were displayed for further manual adjustment. The contrast-enhanced tumor position was also verifi ed during treatment by employing a previously reported in-treatment CBCT procedure. 4 All the CBCT images shown in this article were acquired with standard parameters provided by the manufacturer; in other words, we did not increase X-ray dose for this study. Figure 1a depicts an axial planning CT image of the patient with hepatocellular carcinoma. Figure 1b shows a kV CBCT image after the above-mentioned bonematching registration, which was performed immediately before treatment. The crossed lines indicate the isocenter position. In this case, no further manual adjustment was required. Although signifi cant ring artifacts were observed possibly due to breathing, it was shown that the artifact did not degrade the accuracy of visual verifi cation. It was also confi rmed that the tumor remained in the same position during (Fig. 1c) and immediately after (Fig. 1d) treatment. Figure 1e shows a brain metastasis image acquired by the planning CT, and Fig. 1f depicts a kV CBCT image after each intravenous bolus administration of iodized contrast medium (Iopamiron 300, 100 ml; Schering, Germany). The planning CT image (2-mm slice) was acquired immediately after the fi rst administration on a treatment planning day, and the CBCT image (c...

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“…Recently the issue of the most efficacious dose has emerged. In the case of computed tomography (CT), double doses of iodinated contrast agents have shown strong tolerability [1] and increased diagnostic accuracy in MS patients when compared to the conventional dose [2]. Mushlin and colleagues [3] found noncontrast MRI to be superior to double-dose CT in detecting MS. MRI performed with intravenous contrast agents (gadolinium [Gd]) has further been shown to provide better results when compared to noncontrast MRI [ 4].…”

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confidence: 99%

Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients

Wolansky¹,

Bardini²,

Cook

et al. 1994

Journal of Neuroimaging

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Nine patients with multiple sclerosis underwent brain magnetic resonance imaging (MRI) to evaluate the contrast enhancement of individual lesions after a single dose and a triple dose of gadolinium. A single dose (0.1 mmol/kg) of gadoteridol was administered and after a delay, axial T1-weighted images were obtained. After an additional 0.2-mmol/kg dose, the same T1-weighted sequence was repeated. An unblinded reader simultaneously viewed the images from both doses, and utilizing a computer console to rule out flow artifacts, created a gold standard of "definite" enhancing lesions. Using this system, he determined that there was a total of 12 definite enhancing lesions among the patients. This reader also evaluated lesion conspicuity. The contrast-noise ratio was calculated for each lesion. A second reader, blinded to the dose used, then evaluated the number of enhancing lesions at both doses. The unblinded reader noted increased lesions at both doses. The unblinded reader noted increased lesion conspicuity after the triple dose. Contrast-noise ratios were significantly (p < 0.001) higher after the triple dose (mean, 9.19) than after the single dose (mean, 2.97). The blinded reader detected 11 of the 12 definite lesions on MRIs after the triple dose (sensitivity, 92%) but saw only 6 on MRIs after the single dose (sensitivity, 50%). The difference was significant (p < 0.001). Subjective analysis of the films revealed an increase in "ghosting artifacts" at the high dose. Administration of triple-dose gadolinium provides increased lesion conspicuity and an improved lesion detection rate when compared to single-dose gadolinium in patients with multiple sclerosis.

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High-dose contrast-enhanced computed tomography (CECT) with iopamidol in the detection of cerebral metastases

Cited by 10 publications

References 24 publications

Neuron-specific enolase as a marker of brain metastasis in patients with small-cell lung carcinoma

Neuron-specific enolase as a marker of brain metastasis in patients with small-cell lung carcinoma

Contrast medium-assisted stereotactic image-guided radiotherapy using kilovoltage cone-beam computed tomography

Triple‐Dose Versus Single‐Dose Gadoteridol in Multiple Sclerosis Patients

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