How young radiologists use contrast media and manage adverse reactions: an international survey.

OBJECTIVES: To collect real-world data about the knowledge and self-perception of young radiologists concerning the use of contrast media (CM) and the management of adverse drug reactions (ADR). METHODS: A survey (29 questions) was distributed to residents and board-certified radiologists younger than 40 years to investigate the current international situation in young radiology community regarding CM and ADRs. Descriptive statistics analysis was performed. RESULTS: Out of 454 respondents from 48 countries (mean age: 31.7 ± 4 years, range 25-39), 271 (59.7%) were radiology residents and 183 (40.3%) were board-certified radiologists. The majority (349, 76.5%) felt they were adequately informed regarding the use of CM. However, only 141 (31.1%) received specific training on the use of CM and 82 (18.1%) about management ADR during their residency. Although 266 (58.6%) knew safety protocols for handling ADR, 69.6% (316) lacked confidence in their ability to manage CM-induced ADRs and 95.8% (435) expressed a desire to enhance their understanding of CM use and handling of CM-induced ADRs. Nearly 300 respondents (297; 65.4%) were aware of the benefits of contrast-enhanced ultrasound, but 249 (54.8%) of participants did not perform it. The preferred CM injection strategy in CT parenchymal examination and CT angiography examination was based on patient's lean body weight in 318 (70.0%) and 160 (35.2%), a predeterminate fixed amount in 79 (17.4%) and 116 (25.6%), iodine delivery rate in 26 (5.7%) and 122 (26.9%), and scan time in 31 (6.8%) and 56 (12.3%), respectively. CONCLUSION: Training in CM use and management ADR should be implemented in the training of radiology residents. CRITICAL RELEVANCE STATEMENT: We highlight the need for improvement in the education of young radiologists regarding contrast media; more attention from residency programs and scientific societies should be focused on training about contrast media use and the management of adverse drug reactions. KEY POINTS: • This survey investigated training of young radiologists about use of contrast media and management adverse reactions. • Most young radiologists claimed they did not receive dedicated training. • An extreme heterogeneity of responses was observed about contrast media indications/contraindications and injection strategy.

Mesoscopic Assessment of Microstructure in Glioblastomas and Metastases by Merging Advanced Diffusion Imaging with Immunohistopathology.

BACKGROUND AND PURPOSE: Glioblastomas and metastases are the most common malignant intra-axial brain tumors in adults and can be difficult to distinguish on conventional MR imaging due to similar imaging features. We used advanced diffusion techniques and structural histopathology to distinguish these tumor entities on the basis of microstructural axonal and fibrillar signatures in the contrast-enhancing tumor component. MATERIALS AND METHODS: Contrast-enhancing tumor components were analyzed in 22 glioblastomas and 21 brain metastases on 3T MR imaging using DTI-fractional anisotropy, neurite orientation dispersion and density imaging-orientation dispersion, and diffusion microstructural imaging-micro-fractional anisotropy. Available histopathologic specimens (10 glioblastomas and 9 metastases) were assessed for the presence of axonal structures and scored using 4-level scales for Bielschowsky staining (0: no axonal structures, 1: minimal axonal fragments preserved, 2: decreased axonal density, 3: no axonal loss) and glial fibrillary acid protein expression (0: no glial fibrillary acid protein positivity, 1: limited expression, 2: equivalent to surrounding parenchyma, 3: increased expression). RESULTS: When we compared glioblastomas and metastases, fractional anisotropy was significantly increased and orientation dispersion was decreased in glioblastomas (each P < .001), with a significant shift toward increased glial fibrillary acid protein and Bielschowsky scores. Positive associations of fractional anisotropy and negative associations of orientation dispersion with glial fibrillary acid protein and Bielschowsky scores were revealed, whereas no association between micro-fractional anisotropy with glial fibrillary acid protein and Bielschowsky scores was detected. Receiver operating characteristic curves revealed high predictive values of both fractional anisotropy (area under the curve = 0.8463) and orientation dispersion (area under the curve = 0.8398) regarding the presence of a glioblastoma. CONCLUSIONS: Diffusion imaging fractional anisotropy and orientation dispersion metrics correlated with histopathologic markers of directionality and may serve as imaging biomarkers in contrast-enhancing tumor components.

Comparison of the Fractured and Non-Fractured Orbit Before and After Surgery Using a Titanium Implant or a Resorbable Poly-d,l-lactic Acid (PDLLA) Implant: A Study from a Single Center in Nis, Serbia of 58 Patients with Unilateral Orbital Floor Fracture Using Volumetric Measurement.

BACKGROUND A fracture of the orbital floor can lead to complications such as enophthalmos, impaired eye motility, or diplopia, which is why it is necessary to reconstruct the bony walls of the orbit. This study from a single center in Nis, Serbia, included 58 patients with unilateral orbital floor fracture and aimed to use volumetric measurement to compare the fractured and non-fractured orbit before and after surgery using a titanium implant or a resorbable poly-d, l-lactic acid (PDLLA) implant. MATERIAL AND METHODS From 2018 to 2022, a total of 58 patients with unilateral orbital floor fractures were treated at the Clinic of Dental Medicine, Nis. Computed tomography examination was used for volumetric measurement of the fractured and non-fractured (contralateral) orbit before and after the surgical procedure. A titanium implant was used in 31 patients, and a PDLLA implant was used in 27 patients. RESULTS Orbital volume ratio did not differ statistically significantly in relation to the type of implant (P=0.591). The postoperative volume did not differ statistically significantly from the volume of the contralateral side (titanium, P=0.212; PDLLA, P=0.232). There was a significant correlation between orbital volume and enophthalmos both before and after surgery (P=0.012, P=0.018, respectively). CONCLUSIONS Measuring the preoperative volume of the injured orbit is sufficient data for an indication because reconstruction depends primarily on the correlation between the volume and enophthalmos. The findings from this study showed that preoperative orbital volumetry using computed tomography evaluated enophthalmos and provide data to assist orbital floor reconstruction.