著者

対馬 義人

出版者

日本小児放射線学会

雑誌

日本小児放射線学会雑誌 (ISSN:09188487)

巻号頁・発行日

vol.33, no.2, pp.91-96, 2017 (Released:2018-04-11)

参考文献数

24

---

Gadolinium (Gd)-based contrast agents (GBCA) are commonly used in magnetic resonance imaging (MRI), and are safe for the majority of patients. Adverse reactions to GBCA are classified into: 1) acute adverse reaction, which occurs within one hour of contrast medium injection, 2) late adverse reaction, which is defined as a reaction which occurs one hour to one week after contrast medium injection, and 3) very late adverse reaction, which is nephrogenic systemic fibrosis (NSF). The risk factors of acute adverse reaction include a history of acute reaction to GBCA, asthma, and atopy requiring medical treatment. The risk factors of NSF include dialysis, eGFR < 30 ml/min/1.73 m2, acute renal failure, and use of unstable linear-chelate GBCA. In recent studies, tissue retention of Gd after GBCA administration has been reported even in patients without renal dysfunction. Brain retention of Gd is able to be detected as an increased signal intensity of the brain tissue on T1-weighted images. Moreover, Gd retention has been detected in the skin, liver, kidney, lung, heart, and bones more often with linear-chelate GBCA than macrocyclic GBCA. In a study using pregnant mice, Gd was confirmed to be transferred to pups and was retained in their brain, leading to impaired brain development.

著者

対馬 義人

出版者

日本磁気共鳴医学会

雑誌

日本磁気共鳴医学会雑誌 (ISSN:09149457)

巻号頁・発行日

vol.40, no.2, pp.55-61, 2020-05-15 (Released:2020-06-15)

参考文献数

27

---

In the European Society of Urogenital Radiology (ESUR) guidelines 10.0, the usefulness of premedication, such as steroids, which is widely used for patients with risk factors for acute (immediate) adverse effects, has been disproved, and the recommendation of premedication has been scrapped. Certainly, there is no evidence that premedication is effective for preventing the occurrence of adverse effects or reducing the severity. How this change would be applied in the actual clinical setting is controversial. There is no major change in management of acute adverse effects. For this point, however, recommendation no. 3 laid down by the Japan Medical Safety Research Organization in 2019 should be referred to. If anaphylaxis is suspected, 0.3 mg of adrenaline should be administered in the anterolateral thigh muscle without hesitation. Even if you are not convinced of anaphylaxis, an intramuscular injection of adrenaline must be given immediately. Moreover, adverse effects of intramuscular injections of 0.3 mg of adrenaline are not a cause for concern, as the injection route is not intravenous. The knowledge of nephrogenic systemic fibrosis (NSF) is already well established. This disease was first described in the 2018 edition of the Japanese National Examination Standard for Doctors. The use of linear gadolinium-based contrast agents with low chelate stability (except EOB Primovist) is extremely limited, and occurrence probability of NSF is extremely low as long as macrocyclic gadolinium-based contrast agents are used. Patient-related risk factors are eGFR <15 mL/min/1.73 m3 and dialysis. Gadolinium accumulation (retention) in the body and environmental diffusion have recently been described. Although the accumulation of gadolinium in the body is widely known, its clinical significance is unknown. Since gadolinium is an element, once it diffuses in the environment, it is almost impossible to recover it. However, its effect on humans is unknown.

著者

関 優子 清水 立矢 藍原 正憲 山口 玲 相島 薫 好本 裕平 安藤 雅 須藤 高行 対馬 義人

出版者

特定非営利活動法人 日本脳神経血管内治療学会

雑誌

脳血管内治療 (ISSN:24239119)

巻号頁・発行日

pp.oa.2021-0018, (Released:2021-09-17)

参考文献数

13

---

【目的】血管内治療のアクセスルートとなる大動脈弓部の形態がアプローチ時間に与える影響を検討する.評価に際して,単純 CT の 2D 画像から,造影 3DCTA と同等の大動脈弓部の情報を取得できるか検討する.【方法】2017 年から 2019 年に大腿動脈経由で脳血管内治療を施行した連続症例のうち,大動脈弓部を含む CTA を行った 65 名を対象とした.目的血管と大動脈弓(頂部もしくは下縁)のなす角度,大動脈弓頂部から目的血管分岐までの距離を 2D 画像および 3D 画像で計測し,年齢,性別,穿刺部位,アプローチ時間(穿刺時刻からガイディングカテーテル留置後の目的血管造影までの時間),治療方法,疾患名,検査時間,治療部位との関連を後方視的に検討した.【結果】アプローチ時間は平均 24 分であった.2D と 3D の計測では,大動脈弓下縁と分岐血管の角度(r=0.721)と大動脈弓頂部からの距離(r=0.858)で強い相関を認めた.2D 計測にてアプローチ時間と大動脈弓頂部から分岐までの距離においては正の相関を認めた(r=0.478).また,大動脈弓と目的血管分岐がなす角度には負の相関(r=−0.197)を認め,大動脈弓下縁との分岐角(r=−0.298)がより相関が強かった.【結論】2D での簡便な計測でも,3D と同等の情報を得ることができる.大動脈弓頂部から目的血管分岐までの距離が長い,または目的血管と大動脈弓下縁のなす角度が鋭角なほどアプローチ時間は長くなる.

著者

茂木 孝夫 石坂 浩 堀越 浩幸 久保田 潤 櫻井 美奈子 対馬 義人 佐藤 典子 松本 満臣 城下 尚 モテキ タカオ イシザカ ヒロシ ホリコシ ヒロユキ クボタ ジュン サクライ ミナコ ツシマ ヨシト サトウ ノリコ マツモト ミツオミ ジョウシタ タカシ Moteki Takao Ishizaka Hiroshi Horikoshi Hiroyuki Kubota Jun Sakurai Minako Tsushima Yoshito Satou Noriko Matsumoto Mituomi Joshita Takashi

出版者

日本医学放射線学会

雑誌

日本医学放射線学会雑誌 (ISSN:00480428)

巻号頁・発行日

vol.55, no.3, pp.145-149, 1995-02-25