All patients underwent both pre- and standard iodine enhanced CT scans when they were initially admitted to our institution before any treatment. CT exams were performed either on a 16-detector CT scanner or on a 64-detector CT scanner (Sensation 16; SOMATOM Definition Flash 64; Siemens Medical Solutions, Forchheim, Germany). For the 16-detector scanner, the parameters were 120 kV and 100 effective mA. For the 64-detector scanner, the parameters were 120 kV and 110 effective mA. Dose modulation was used in both scanners. Images were reconstructed with a section thickness of 5 mm and a gap of 1 mm. Post-contrast scanning started 38–48 s after intravenous administration 100 mL of loversol injection (Optiray, Guerbet, Villepinte, France) at a rate of 2.8 mL/sec by using a power injector.
Optiray
Manufactured by Guerbet
Sourced in France
Optiray is a contrast agent used in medical imaging procedures. It is an iodine-based solution that enhances the visibility of internal structures during imaging scans, such as computed tomography (CT) or angiography. Optiray is designed to be administered intravenously or by other routes as prescribed by a healthcare professional.
Automatically generated - may contain errors
Lab products found in correlation
Dotarem, by Guerbet (2 mentions)
Sensation 16, by Siemens (1 mentions)
Ultravist, by Bayer (1 mentions)
Omnipaque, by GE Healthcare (1 mentions)
Iqon spectral ct, by Philips (1 mentions)
Synapse vincent software program, by Fujifilm (1 mentions)
Methylene blue, by Merck Group (1 mentions)
Ingenuity ct, by Philips (1 mentions)
Propofol, by Fresenius (1 mentions)
8 protocols using optiray
1
Iodine-Enhanced CT Scanning Protocol
2
Dual-Energy Chest CT Imaging Protocol
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CT scan was performed in two steps: all patients underwent ECG-gated coronary calcium-scoring CT first and then underwent non-ECG-gated contrast-enhanced dual-energy chest CT (Figure 2 ).
All CT scans in this study were performed with a 256-slice CT scanner (Revolution, GE healthcare, Waukesha, Wisconsin, USA). All patients were scanned twice at the end of inspiration, in a supine position; from the aortic arch to the cardiac base by calcium score CT and from the thoracic inlet to the middle of the kidney by enhanced chest DECT.
The ECG-gated coronary calcium-scoring CT was performed with a 16cm axial volume scan and the parameters were as follows: tube voltage = 120 kVp; tube rotation time = 0.28 s; and slice thickness = 2.5 mm.
The enhanced chest DECT scans were performed using a fast kVp switching technology and an 8 cm helical scan mode with the following parameters: tube voltage = 140 kVp and 80 kVp; tube rotation time = 0.28 s; pitch = 1.531 and slice thickness = 1.25 mm. The images were acquired after a 60s administration of contrast medium (350 mg iodine = patient’s weight * 1.2 mL, limited up to 100 mL of Optiray® (ioversol): Guerbet, Raleigh, NC, USA; Ultravist® (Iopromide): Bayer Schering, Berlin, Germany; or Pamiray® (iopamidol): Dongkook Lifescience, Seoul, Korea) and a 10s saline flush using a power injector (Nemoto Kyorindo Co., Ltd., Tokyo, Japan) (Table 1 ).
All CT scans in this study were performed with a 256-slice CT scanner (Revolution, GE healthcare, Waukesha, Wisconsin, USA). All patients were scanned twice at the end of inspiration, in a supine position; from the aortic arch to the cardiac base by calcium score CT and from the thoracic inlet to the middle of the kidney by enhanced chest DECT.
The ECG-gated coronary calcium-scoring CT was performed with a 16cm axial volume scan and the parameters were as follows: tube voltage = 120 kVp; tube rotation time = 0.28 s; and slice thickness = 2.5 mm.
The enhanced chest DECT scans were performed using a fast kVp switching technology and an 8 cm helical scan mode with the following parameters: tube voltage = 140 kVp and 80 kVp; tube rotation time = 0.28 s; pitch = 1.531 and slice thickness = 1.25 mm. The images were acquired after a 60s administration of contrast medium (350 mg iodine = patient’s weight * 1.2 mL, limited up to 100 mL of Optiray® (ioversol): Guerbet, Raleigh, NC, USA; Ultravist® (Iopromide): Bayer Schering, Berlin, Germany; or Pamiray® (iopamidol): Dongkook Lifescience, Seoul, Korea) and a 10s saline flush using a power injector (Nemoto Kyorindo Co., Ltd., Tokyo, Japan) (
3
Comparison of Ultrasound and Anatomical Landmark-Guided Retrolaminar Injections in Canine Cadavers
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This study was granted an exemption from full ethical review by the Animal Research Ethics Committee of University College Dublin (AREC-E-20-28-Huuskonen).
The cadavers of ten adult greyhound dogs, that had been euthanised for reasons unrelated to the present study, frozen, and subsequently thawed at ambient temperature for 72–96 h, were used. Cadavers with spinal abnormalities that could have hindered the identification of the anatomical or ultrasonographic target landmarks were excluded from the study. All cadavers were randomly assigned to receive an anatomical landmark-guided retrolaminar injection in one hemithorax (group B, n = 10) and an ultrasound-guided in the other (group U, n = 10) using a random sequence generator (www.randomizer.org , accessed on 26 August 2023). A total volume of 0.6 mL/kg iodinated contrast (ioversol) (Optiray®, 300 mg I/mL, Guerbet, Villepinte, France) was injected per site. In all cadavers, the ultrasound-guided injection was performed first, immediately followed by the anatomical landmark-guided retrolaminar injection. The distribution of the injectate was evaluated using computed tomography (CT) immediately after the injections were performed.
The cadavers of ten adult greyhound dogs, that had been euthanised for reasons unrelated to the present study, frozen, and subsequently thawed at ambient temperature for 72–96 h, were used. Cadavers with spinal abnormalities that could have hindered the identification of the anatomical or ultrasonographic target landmarks were excluded from the study. All cadavers were randomly assigned to receive an anatomical landmark-guided retrolaminar injection in one hemithorax (group B, n = 10) and an ultrasound-guided in the other (group U, n = 10) using a random sequence generator (
4
Multislice CT Contrast Imaging Protocol
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CT examinations were performed using a 64-row multislice CT system (IQon Spectral CT, Philips Healthcare, Eindhoven, The Netherlands) and a 320-row multislice CT system (Aquilion ONE Genesis Edition, Tokyo, Japan). After the acquisition of precontrast scans, each subject was injected with a properly selected iodinated contrast agent of one of four brands (Omnipaque, GE Healthcare, Boston, MA; Optiray, Guerbet, Paris, France; Iomeron, Eisai, Tokyo, Japan; or Iopromide, Fujifilm, Tokyo, Japan), using a Dual Shot GX7 power injector (Nemoto, Tokyo, Japan). The injection dose was 600 mg of iodine per kg of body weight, and the duration was fixed at 30 seconds; hence, the injection rate depended on the patient's body weight. Triple-phasiccontrast-enhanced scans through the abdomen were performed without a bolus tracking program. Equilibrium-phase images were obtained 180 seconds after injection. The slice thickness for the contrast-enhanced images was 2 mm. The images were saved in DICOM format and transferred to an image workstation using the SYNAPSE VINCENT software program (Fujifilm).
5
Retrolaminar Injection Spread Analysis
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Eight frozen adult greyhound cadavers, five males and three females, euthanised for reasons unrelated to this study, were used after being thawed at ambient temperature for 72–96 h. The number of cadavers was chosen according to previous, similar studies. Any cadavers with spinal abnormalities that could have affected the identification of the anatomical landmarks were excluded from the study. Three cadavers were randomly allocated to receive a unilateral right or left retrolaminar injection to evaluate the potential spread into the contralateral paravertebral space (two right and one left injection), while the remaining five cadavers received bilateral injections. The thirteen injections were further randomised into either 10 mL (low-volume injection group, LV, n = 5) or 20 mL (high-volume injection group, HV, n = 8) of a 1:20 mixture of Methylene blue (Methylene blue, 1%, Merck, Germany) and iodinated contrast (ioversol) (Optiray®, 300 mg I/mL, Guerbet, France), respectively. Both randomisations were achieved via the removal of a ballot from an opaque envelope containing eight and thirteen ballots, respectively. All thirteen retrolaminar injections were performed at the level of the 12th thoracic spinal vertebra (T12). The distribution of the injectate was evaluated using computed tomography in all cadavers and transverse anatomical dissection in two cadavers.
6
Contrast-enhanced CT Imaging Protocol
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The CTAs were performed on a 128-slice scanner CT (Philips Ingenuity CT, Philips Healthcare). The main CT imaging parameters were as follows: collimation/increment: 0.625/0.3 mm; tube current: 120 mAs; field of view: 210 mm; matrix size: 512 × × 512. All groups of patients received intravenous administration of contrast material at a dose of 1 mL/kg (standard dose). A non-ionic contrast medium (CM) containing 350 mg of iodine per mL was used (Jowersol 741 mg/mL, Optiray ® , Guerbet, France). CT data acquisition was triggered using a real-time bolus-tracking technique (Philips Healthcare) with the region of interest placed in the ascending aorta. The CM was intravenously injected using a power injector at a flow rate of 5 mL/s. This was immediately followed by the injection of 40 mL of saline solution at the same flow rate. Following the injection of CM and saline, image acquisition was started automatically with a 2-s delay when the attenuation trigger value reached a threshold of 120 Hounsfield units (HU). Scanning was performed in the caudocranial direction.
7
Contrast Media Comparison in Cats
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The cats were divided into four groups based on the type of contrast media received. One group received only medication for maintenance of general anaesthesia without the use of a contrast medium and served as the control group (ctr). Another group received the non-ionic iodated agent, ioversol (Optiray; Guerbet) (group ioversol [iov]). The third group received gadoteric acid (Dotarem; Guerbet) for the MRI (group gadoteric acid [gad]). A fourth group underwent both modalities and received both contrast media (group ioversol and gadoteric acid [iov + gad]). The radiologist in charge decided, in agreement with the anaesthesiologist monitoring the cat's clinical state, whether the administration of a contrast medium was necessary. This decision was made completely independently of the authors (Figure 1).
Open in a separate window Figure 1 Decision tree for contrast media administration in the patient presented for diagnostic imaging. CM = contrast media; gad = group gadoteric acid; iov = group ioversol; iov+gad = group ioversol+gadoteric acid; ctr = control group
Open in a separate window Figure 1 Decision tree for contrast media administration in the patient presented for diagnostic imaging. CM = contrast media; gad = group gadoteric acid; iov = group ioversol; iov+gad = group ioversol+gadoteric acid; ctr = control group
8
Standardized Feline Anaesthesia Protocol
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The anaesthesia protocol for CT or MRI was standardised as follows. For premedication, butorphanol (Alvegesic; Virbac, 0.2 mg/kg body weight [BW]), midazolam (Dormicum; Cheplapharm, 0.2 mg/kg BW) and ketamine (Ketamidor; Richter Pharma, 1 mg/kg BW) were applied via an IV or intramuscular (IM) injection. For induction, Propofol (Propofol; Fresenius, 1-3 mg/kg) or alfaxalon (Alfaxan Multidose; Jurox [UK], 1-2 mg/kg) was administered IV. After orotracheal intubation, anaesthesia was maintained with isoflurane (CT) or sevoflurane (MRI) in oxygen (fraction of inspired oxygen = 1.0). In 12/53 cats, slightly modified protocols were used. For the CT contrast study, ioversol (Optiray; Guerbet) was injected at a dose of 2 ml/kg BW via an injection pump at a flow rate of 0.7 ml/s. For the MRI contrast study, gadoteric acid (Dotarem; Guerbet) was administered manually at a dose of 0.2 ml/kg. During anaesthesia, each cat was infused with isotone IV fluids (Sterofundin; Braun) at a dosage of 3-5 ml/kg/h. During the CT examination, the cats were warmed with forced hot air (Bair Hugger); during the MRI examination, the cats were kept warm with blankets.
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