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- Aspelin, P., et al.
(author)
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Cost-effectiveness of iodixanol in patients at high risk of contrast-induced nephropathy
- 2005
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In: American Heart Journal. - : Elsevier BV. - 0002-8703 .- 1097-6744. ; 149:2, s. 298-303
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Research review (peer-reviewed)abstract
- Background: Acute renal failure after contrast-induced nephropathy is a clinically important and costly complication after the use of iodine-based contrast media. We investigated the cost and cost-effectiveness of 2 contrast media in patients at high risk of contrast-induced nephropathy. Methods: The analyses were based on a randomized, prospective, multinational clinical study comparing the nephrotoxic effects of an isosmolar nonionic contrast medium, iodixanol, with those of a low-osmolar nonionic contrast medium, iohexol. Resource utilization data were obtained from the study and from a retrospective review of patients' hospital records. Swedish, German, and French unit prices were applied to resources used. Between-group differences in average costs were analyzed using a nonparametric bootstrap method. Results: Resource utilization data for 125 patients were analyzed. Seven contrast media-related serious adverse reactions, of which 6 were acute renal failures, were noted in 6 patients receiving iohexol. Two patients in the iodixanol group had 1 nonserious reaction each. The mean hospitalization cost per patient was €489, €573, and €393 lower after iodixanol than after iohexol using Swedish, German, and French unit prices, respectively. The mean per-patient costs of treating adverse drug reactions were €371, €399, and €445 lower after iodixanol than after iohexol, using the respective unit prices (P = 0.01). Iodixanol was cost-effective compared with iohexol, with both lower costs and better effects related to fewer adverse drug reactions. Conclusions: The isosmolar contrast medium iodixanol appears to be cost-effective when compared with a low-osmolar contrast medium, iohexol, in diabetic patients with renal impairment undergoing angiography. © 2005, Elsevier Inc. All rights reserved.
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| 4. |
- Aspelin, P, et al.
(author)
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Nephrotoxic effects in high-risk patients undergoing angiography
- 2003
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In: New England Journal of Medicine. - 0028-4793 .- 1533-4406. ; 348:6, s. 491-499
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Journal article (peer-reviewed)abstract
- BACKGROUND: The use of iodinated contrast medium can result in nephropathy. Whether iso-osmolar contrast medium is less nephrotoxic than low-osmolar contrast medium in high-risk patients is uncertain. METHODS: We conducted a randomized, double-blind, prospective, multicenter study comparing the nephrotoxic effects of an iso-osmolar, dimeric, nonionic contrast medium, iodixanol, with those of a low-osmolar, nonionic, monomeric contrast medium, iohexol. The study involved 129 patients with diabetes with serum creatinine concentrations of 1.5 to 3.5 mg per deciliter who underwent coronary or aortofemoral angiography. The primary end point was the peak increase from base line in the creatinine concentration during the three days after angiography. Other end points were an increase in the creatinine concentration of 0.5 mg per deciliter or more, an increase of 1.0 mg per deciliter or more, and a change in the creatinine concentration from day 0 to day 7. RESULTS: The creatinine concentration increased significantly less in patients who received iodixanol. From day 0 to day 3, the mean peak increase in creatinine was 0.13 mg per deciliter in the iodixanol group and 0.55 mg per deciliter in the iohexol group (P=0.001, the increase with iodixanol minus the increase with iohexol, -0.42 mg per deciliter [95 percent confidence interval, -0.73 to -0.22]). Two of the 64 patients in the iodixanol group (3 percent) had an increase in the creatinine concentration of 0.5 mg per deciliter or more, as compared with 17 of the 65 patients in the iohexol group (26 percent) (P=0.002, odds ratio for such an increase in the iodixanol group, 0.09 [95 percent confidence interval, 0.02 to 0.41]). No patient receiving iodixanol had an increase of 1.0 mg per deciliter or more, but 10 patients in the iohexol group (15 percent) did. The mean change in the creatinine concentration from day 0 to day 7 was 0.07 mg per deciliter in the iodixanol group and 0.24 mg per deciliter in the iohexol group (P=0.003, value in the iodixanol group minus the value in the iohexol group, -0.17 mg per deciliter [95 percent confidence interval, -0.34 to -0.07]). CONCLUSIONS: Nephropathy induced by contrast medium may be less likely to develop in high-risk patients when iodixanol is used rather than a low-osmolar, nonionic contrast medium.
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- Thomsen, HS, et al.
(author)
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Metformin and contrast media
- 2010
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In: Radiology. - : Radiological Society of North America (RSNA). - 1527-1315 .- 0033-8419. ; 256:2, s. 672-673
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Journal article (other academic/artistic)
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| 17. |
- Udén, P, et al.
(author)
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Preoperative localization in unilateral parathyroid surgery. A cost-benefit study on ultrasound, computed tomography and scintigraphy
- 1990
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In: Acta Chirurgica Scandinavica. - 0001-5482. ; 156:1, s. 29-35
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Journal article (peer-reviewed)abstract
- In 50 patients with primary hyperparathyroidism, investigation before initial neck exploration included ultrasonography, computed tomography and 99technetium-201thallium subtraction scintigraphy. The sensitivity for correct preoperative localization was 50%, 54% and 56%, respectively. There was marked inter-observer variation in assessment of ultrasonography and computed tomography, while scintigrams were evaluated by only one person. The scintigraphic sensitivity increased with size of the glands. In cases where correct preoperative localization permitted unilateral parathyroidectomy, the time for surgery and anesthesia was significantly reduced. A cost-benefit analysis, however, revealed that the financial saving from this time reduction was outweighed by the cost of the localization procedures. The authors conclude that investigations for definition of enlarged parathyroid glands are not indicated prior to unilateral parathyroidectomy.
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| 20. |
- Agren, B, et al.
(author)
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Dynamic scintigraphy of bone and bone marrow in multiple myeloma patients with bone-marrow transplants
- 1997
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 38:44 Pt 1, s. 533-538
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Journal article (peer-reviewed)abstract
- Purpose: To determine whether dynamic registration at bone and bone-marrow scintigraphy produces additional information compared to subsequent static registrations of bone-marrow transplants in multiple myeloma patients. Material and Methods: In a prospective study, 8 dynamic bone and 6 dynamic bone-marrow scintigraphies were performed in 10 patients. The dynamic scintigraphies were compared with conventional radiography, MR images, and static scintigraphies of bone and bone marrow. Results: No additional information was revealed by the dynamic registration method; on the contrary, 4 of the 8 known lesions were not discerned at dynamic registration. An incidental observation was that the time-activity curves of both radiopharmaceuticals had a specific pattern. Conclusion: Dynamic registration at bone and bone-marrow scintigraphy was not useful for detecting disease in multiple myeloma lesions.
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| 22. |
- Agren, B, et al.
(author)
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MR imaging of multiple myeloma patients with bone-marrow transplants
- 1998
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 39:1, s. 36-42
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Journal article (peer-reviewed)abstract
- Purpose: to evaluate the role of MR imaging in the examination of multiple myeloma (MM) patients with bone-marrow transplants Material and Methods: A total of 40 MR examinations were made of 20 patients: 33 examinations of the spine and pelvis in 20/20 patients; and 7 examinations of the femora in 5/20 patients. the 40 examinations were evaluated and the results compared with those found at radiography. Altogether 13/20 patients were re-examined: 10 after 1 year (1 patient twice); and 3 after 2 years. Five sequences were tested, 3 of them first without and then with i.v. contrast enhancement Results: in 24/33 examinations, active MM lesions were shown by MR. in 16/33 examinations, MR showed greater spread and detectability than radiography. in the 5/20 femoral patients, 3 had a peripheral red bone-marrow extension in the femora. in the 13 re-examinations, the lesions had spread in 4 patients, were unchanged in 7, and had decreased in 2. the lesions were easier to detect with the turbo inversion recovery (TIR) technique and with fat saturation than with the conventional spin-echo sequences. Contrast enhancement made the lesions more conspicuous in 8/17 examinations Conclusion: MR has the potential to be a useful routine examination with T1-weighted and TIR sequences of selected areas, and without the use of contrast enhancement. However, further longitudinal studies are necessary in order to evaluate its possible predictive value
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| 23. |
- Agren, B, et al.
(author)
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Radiography and bone scintigraphy in bone marrow transplant multiple myeloma patients
- 1997
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 38:1, s. 144-150
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Journal article (peer-reviewed)abstract
- Purpose: To compare conventional radiography and bone scintigraphy in relation to clinical outcome in bone marrow transplant multiple myeloma patients. Material and Methods: A total of 70 radiographies and 70 bone scintigraphies were compared in 35 patients. Results: The skull, the extremities, the iliac and pubic bones were better assessed with radiography. For new vertebral lesions and for lesions in the ribs and sternum, bone scintigraphy proved superior. For the sacrum, the methods were equal. When bone scintigraphy was used as a complement to radiography, 4% more pathological sites were found. No patient had both a normal radiography and a pathological bone scintigraphy, but 5 patients had both a normal bone scintigraphy and a pathological radiography. The results of the radiological examinations did not always correlate with the clinician's grading of the patient's disease. The radiological examinations had no prognostic value for the 7 patients examined on several occasions. Conclusion: The ability of conventional radiography and bone scintigraphy to disclose myeloma lesions varies, depending on location and size of the lesions. Radiography should remain the primary examination modality also for bone marrow transplant multiple myeloma patients. Bone scintigrapy can serve as a complement for investigating unexplained pain, e.g. caused by lesions in vertebrae or ribs.
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| 24. |
- Alvfeldt, G, et al.
(author)
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Radiology reporting in rectal cancer using MRI: adherence to national template for structured reporting
- 2022
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 63:12, s. 1603-1612
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Journal article (peer-reviewed)abstract
- In 2014, a national workshop program was initiated and a reporting template and manual for rectal cancer primary staging using magnetic resonance imaging (MRI) was introduced and made available by the national Swedish Colorectal Cancer Registry. Purpose To evaluate the effect of the national template program by identify if there was a gap between the content in Swedish MRI reports from 2016 and the national reporting template from 2014. The aim was to explore and compare differences in content in reporting practice in different hospitals in relation to the national reporting template, with focus on: (i) identifying any implementational differences in reporting styles; and (ii) evaluating if reporting completeness vary based on such implementational differences. Material and Methods A total of 250 MRI reports from 10 hospitals in four healthcare regions in Sweden were collected. Reports were analyzed using qualitative content analysis with a deductive thematic coding scheme based on the national reporting template. Results Three different implemented reporting styles were identified with variations of content coverage in relation to the template: (i) standardized and structured protocol (reporting style A); (ii) standardized semi-structured free-text (reporting style B); and (iii) regular free-text (reporting style C). The relative completeness of reporting practice of rectal cancer staging in relation to the national reporting template were 92.9% for reporting style A, 77.5% for reporting style B, and 63.9% for reporting style C. Conclusion The implementation of template-based reporting according to reporting style A is a key factor to conform to evidence-based practice for rectal cancer reporting using MRI.
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| 25. |
- Alvfeldt, G, et al.
(author)
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Rectal cancer staging using MRI: adherence in reporting to evidence-based practice
- 2020
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 61:11, s. 1463-1472
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Journal article (peer-reviewed)abstract
- Magnetic resonance imaging (MRI) is the first-line imaging modality for local staging of rectal cancer. The radiology report should deliver all relevant available imaging information to guide treatment. Purpose To explore and describe if there was a gap between the contents in MRI reports for primary staging of rectal cancer in Sweden in 2010 compared to evidence-based practice. Material and Methods A total of 243 primary MRI staging reports from 2010, collected from 10 hospitals in four healthcare regions in Sweden, were analyzed using content analysis with a deductive thematic coding scheme based on evidence-based practice. Focus was on: (i) most frequently reported findings; (ii) correlation to key prognostic findings; and (iii) identifying if any findings being reported were beyond the information defined in evidence-based practice. Results Most frequently reported findings were spread through the bowel wall or not, local lymph node description, tumor length, and distance of tumor from anal verge. These items accounted for 35% of the reporting content. Of all reported content, 86% correlated with the evidence-based practice. However, these included more information than was generally found in the reports. When adjusting for omitted information, 48% of the reported content were accounted for. Of the reported content, 20% correlated to key pathological prognostic findings. Six types of findings were reported beyond the evidence-based practice, representing 14% of the total reporting content. Conclusion There was a gap between everyday practice and evidence-based practice in 2010. This indicates a need for national harmonization and implementation of standardized structured reporting templates.
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| 39. |
- Aspelin, P, et al.
(author)
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Obituary for Prof. Torsten Almén
- 2016
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In: European radiology. - : Springer Science and Business Media LLC. - 1432-1084 .- 0938-7994. ; 26:5, s. 1219-1220
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Journal article (other academic/artistic)
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- Axelsson, R, et al.
(author)
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Role of scintigraphy with technetium-99m depreotide in the diagnosis and management of patients with suspected lung cancer
- 2008
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 1600-0455 .- 0284-1851. ; 49:3, s. 295-302
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Journal article (peer-reviewed)abstract
- Background: In Sweden, there are over 3000 new lung cancer cases every year. There are still numerous patients with undetermined lesions after routine diagnostic evaluation by clinical examination, chest radiography, computed tomography (CT) of the thorax, and bronchoscopy. An appropriate method for further diagnostic workup is therefore needed. Purpose: To evaluate the diagnostic value of the somatostatin analogue depreotide in patients with suspected lung cancer, and to determine in which clinical settings it would be beneficial to use 99mTc-depreotide scintigraphy. Material and Methods: We included 99 consecutive patients referred to our hospital with suspected lung cancer. A clinical examination, bronchoscopy, chest radiography, CT of the thorax and upper abdomen, and scintigraphy were done. Scintigraphy was performed after injection of 740 MBq 99mTc depreotide with tomographical imaging of the thorax and whole-body scanning. The diagnostic outcome of the scintigrams was compared to CT, using morphology or clinical outcome as the endpoint. Results:99mTc-depreotide uptake was found in 62 out of 66 malignancies, including 57 of 58 primary lung cancer cases. Two cases of lung metastasis (one from a colon cancer and one from an adenoid cystic carcinoma originating in the palate) and one rib chondrosarcoma did not show depreotide uptake. There were 33 patients with benign lesions, of whom 16 displayed false-positive 99mTc-depreotide uptake, whereof 11 were pneumonias. Tc-99m-depreotide uptake was absent in 17 patients with benign lesions, including all 10 hamartomas. The sensitivity in detecting malignancy was 94%, and in detecting lung cancer 98%. The specificity was calculated based on two sets of data. When all cases were used, the specificity was 52%. If the 12 pneumonias are excluded, the specificity was 77%. Conclusion:99mTc-depreotide scintigraphy has a high sensitivity in detecting lung cancer. The method is useful in decision-making with respect to surgery.
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| 49. |
- Bone, B, et al.
(author)
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Contrast-enhanced MR imaging as a prognostic indicator of breast cancer
- 1998
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In: Acta radiologica (Stockholm, Sweden : 1987). - : SAGE Publications. - 0284-1851 .- 1600-0455. ; 39:3, s. 279-284
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Journal article (peer-reviewed)abstract
- Background: Using contrast-enhanced MR imaging in the diagnosis of breast cancer may provide additional information not only on tumor extension but also on the biological behavior of tumors. Thus certain characteristics such as tumor angiogenesis and the proliferating activity of the tumor, which have been shown to correlate significantly with prognosis, are both potentially amenable to analysis by MR imaging Material and Methods: We compared contrast enhancement in 50 malignant breast tumors at MR imaging to several prognostic factors, such as tumor size, lymph-node status, histological grade of malignancy, tumor angiogenesis, and proliferating activity as shown by the mitotic count and PCNA immunoreactivity Results: There was significant correlation between contrast enhancement at MR imaging of breast cancer and both tumor angiogenesis and proliferative cellular activity as shown by PCNA immunoreactivity. Furthermore, there was a correlation between contrast enhancement and tumor malignancy grade as well as tumor invasiveness Conclusion: These observations suggest that contrast enhancement at MR imaging may be influenced by factors that have prognostic value. If this assumption is correct, contrast-enhanced MR imaging may become a valuable prognostic tool in the pre-operative evaluation of breast cancers
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