Laurent S, Vander Elst L, Muller RN. Gastrointestinal (GI) Contrast Media in Adults: Indications and 57 Guidelines 13. What kind of IV access is ideal for use for IV contrast injection? 10. 5. Extracellular gadolinium-based contrast media: an overview. Does the concentration of contrast mean that higher concentrations are better (AKA-isn’t a higher number better)? 1:100,000 of people having iodinated contrast. 28. [Image-guided therapy with closed MRI: an update]. For patients receiving iodinated or gadolinium contrast media, obtain a complete history of any prior reactions to dyes or contrast used in X-ray, CT, or MRI. 7. 24. What is the advantage of Visipaque as written in the literature? However, the lower concentration and total number of gadolinium atoms administered in current formulations means that gadolinium contrast has a much lower visibility on CT than iodine contrast. The two types are quite different and are not thought to cross-react. The k-edge of gadolinium is also more closely matched to the peak of the CT spectrum, meaning gadolinium absorbs a greater fraction of the x-ray beam than does iodine. What are the common volumes of contrast used for IV injection? Iodine Contrast medium (Intravascular): This is a type of intravenous contrast dye (a radiocontrast agent). CT contrast, or X-ray contrast for IV use, is usually an iodinated compound, whereas most MRI contrast media contains a heavy metal ion usually gadolinium. Gadolinium magnetic resonance agents have been associated with nephrogenic fibrosing sclerosis in patients with renal dysfunction. An allergic reaction to ct contrast does not mean that you will have a reaction to gadolinium during your MRI scan. What about the new “purple PICC/central lines” I hear about? The two major types of contrast used are iodinated contrast (used in most CT scans) and gadolinium-based contrast (used in most MRI scans that use contrast dye). Omnipaque can be used in several modalities within the radiology department including contrast-enahnced CT, Cardiac Cath Lab, Angiography/Interventional, and General Radiology (Fluoroscopy procedures).The flow chart below illustrates the class of iodinated contrast media for X-ray use. An adverse event rate of 3.7% has been shown in patients with asthma, allergies to other medications, and foods, as well as those with previous reactions to iodinated contrast agents (although cross-reactivity has not been proven). 2014 Oct 6;14:34. doi: 10.1186/1471-2342-14-34. 1997;7(7):1123-6 Contrast Media Mol Imaging 2006;1:128-137. Gadolinium contrast agents are best illustrated with a 2-compartment model as illustrated for iodinated contrast … Nonionic agents do not dissociate in solution so hypertonicity is avoided. Less than 1:170,000 of people having gadolinium contrast. 20. It is estimated that approximately 50 million doses of gadolinium-based contrast media (GBCM; also known as gadolinium-based contrast agents or GBCAs) are injected annually, and that since 1988 more than 500 million doses have been administered worldwide, comprising approximately one-third of MRI examinations (1,2). The more seriously ill the patient is, the more caution is advised even if the decision on the combined administration has to be reached urgently. The incidence is highest after iodine-based contrast media and lowest after ultrasound agents. 15. The same acute adverse reactions are seen after iodine- and gadolinium-based contrast agents and after ultrasound contrast agents. Very rarely, patients are allergic to gadolinium-based contrast materials and experience hives and itchy eyes. Radiologe. Do you use serum creatinine levels or GFR in your practice for establishing risk prior to CT scanning? Patients often report a metallic taste in their mouth following use of IV iodinated contrast. However, reactions to … Gadolinium contrast agents: their role in vascular and nonvascular diagnostic angiography and interventions. Relative Conspicuity of Gadolinium-Based Contrast Agents in Interventional Pain Procedures. 3. What type of IV contrast material do we use and why? 13. With the advent of Nephrogenic Systemic Fibrosis (NSF) this practice is no longer recommended. “Severe, life-threatening anaphylactoid or nonallergic anaphylactic reactions are exceedingly rare (0.001% to 0.01%).”  A retrospective analysis of data from the U.S. Food and Drug Administration (FDA) Adverse Event Reporting System (AERS) showed higher immediate adverse event rates with ionic GBCAs when compared with non-ionic GBCAs. -. Classification Acute reactions are either allergy-like, hypersensitivity reactions or chemotoxic responses. Gadolinium (Gd) has different chemical structure with no cross reactivity with iodine-based contrast media in patients with iodine allergy. Contrast media (sometimes called contrast agents or dye) are chemical substances used in medical X-ray, magnetic resonance imaging (MRI), computed tomography (CT), angiography, and occasionally ultrasound imaging. These dyes contain a substance called gadolinium which can produce an allergic reaction that can lead to severe and … Spinosa DJ, Matsumoto AH, Angle JF, Hagspiel KD, Leung DA, Hartwell GD. Murphy KPJ, Szopinski KT, Cohan RH, Mermillod B, Ellis JH. GBCAs were formulated with organic chelates designed … -, Neuroradiology. In the absence of reliable data from experimental and clinical studies the radiologist is dependent on case reports, information provided by the contrast media manufacturers, personal communications, mostly scanty personal experiences and a skilful time management, in order to overcome the situation. These agents often are essential to providing accurate diagnoses, and are nearly always safe and effective when administered correctly. 19. No double dose gadolinium studies will be performed – except with attending approval. Inaugural consensus statements were developed and endorsed by the American College of Radiology (ACR) and National Kidney Foundation to improve and standardize the care of patients with kidney disease who have indication(s) to receive ACR-designated group II or group III intravenous gadolinium-based contrast media (GBCM). Humans were initially exposed to it gadolinium from industrial use and later through the intravenous administration of gadolinium-based contrast agents (GBCA) for MRI in the 1980s. Are all CT scans with IV contrast done the same way? 2002 Mar;15(3):334-43 -, Eur Radiol. National Center for Biotechnology Information, Unable to load your collection due to an error, Unable to load your delegates due to an error. Eur J Radiol 2008; 66:160-167. No gadolinium will be used as a substitute for iodine contrast in CT, on angiography, or other x-ray procedures. 2000 May;92 (5):881-3 The American College of Radiology (ACR) recommends 12 to 24 hours of premedication with corticosteroids and antihistamines for patients with prior contrast media reactions. This question was addressed on the RSNA site and there is no issue doing both MRI and CT the same day with Gadolinium and Iodinated Contrast. However, to inject contrast media containing iodine and gadolinium at the same time can be a prerequisite for the examination of several organs or organ systems. What patients are considered high risk patients for IV contrast for CIN? The toxicity of ionized gadolinium was The patient is to fill in the questionnaire (Patient Questionnaire- Contrast D322). Unlike other topics of contrast-enhanced imaging procedures, the difficulties encountered with double contrast injections have been widely ignored in the literature. In the present study, the gadolinium concentrations were different (2.5 mmol/L, 5.0 mmol/L and 10.0 mmol/L) and the amounts of iodinated contrast agent (1.5 mL) and xylocaine (1.5 mL) remained equal, and are the same utilized by physicians who perform MRA in the diagnostic center where the present study was developed. And non-iodine contrast like barium-sulfate, used for oral or rectal applications. The following overview gives a description of the properties of contrast media containing iodine and gadolinium as far as interactions following simultaneous administration are concerned. Gadolinium will generally be avoided in 1st and 2nd trimester pregnancies. 2. Should patients be NPO for CT scanning? Clipboard, Search History, and several other advanced features are temporarily unavailable. 8. 21. When injected an ionic molecule separates (dissociates), it can and will interact with other ions in the body, causing interference with normal physiologic processes (hypertonicity). Not same: Mri contast gadolinium does not contain iodine while ct contrast contains iodine. NLM Post-Contrast Acute Kidney Injury and Contrast-Induced Nephropathy in Adults 33 10. Contrast Extravasation versus Hemorrhage after Thrombectomy in Patients with Acute Stroke. What is the volume of IV contrast material we use? Like iodinated contrast agents, gadolinium clearance is biphasic, with the initial distribution having a 4-min half-life followed by the aforementioned 1.5- to 2-h elimination half-life (27,29,30). Contrast Media in Children 48 12. 2017 Apr 1;18(4):651-654. doi: 10.1093/pm/pnw312. 6. Get the latest public health information from CDC: https://www.coronavirus.gov, Get the latest research information from NIH: https://www.nih.gov/coronavirus, Find NCBI SARS-CoV-2 literature, sequence, and clinical content: https://www.ncbi.nlm.nih.gov/sars-cov-2/. The use of Gd is commonly used in contrast-enhanced magnetic resonance imaging for image enhancement, making it a potential alternative in patients in whom iodine is … CONCLUSION. Can you tell me a bit more about GFR and what it really means? 9 September 2010 ,FDA Drug Safety Communication: New warnings for using gadolinium-based contrast agents in patients with kidney dysfunction Data suggest that NSF may follow the administration of any GBCA and the agency will continue to monitor post-marketing safety data to better characterize the risk of developing NSF following exposure to each Iodinated and gadolinium-based contrast media are used on a daily basis in most radiology practices. Subsequently, the clinically relevant situations and constellations are outlined and analyzed. did not have policies in place for premedication. USA.gov. The most common contrast reaction is hives, which typically present as raised red wheels that may or may not be associated with pruritus. COVID-19 is an emerging, rapidly evolving situation. HHS Accessed online 9/6/2011. J Neurosurg. 2017 Nov;27(6):570-576. doi: 10.1111/jon.12446. At the kV (∼70) used for digital angiography, the attenuation of X-rays by gadolinium is approximately the same as for iodine and at the kV (∼120) used for CT, the attenuation of X-rays by gadolinium is approximately double that of iodine, so theoretically gadolinium could therefore replace iodine as a radiographic contrast agent. 1. In current practice, percutaneous transluminal renal angioplasty (PTRA) coupled with renal artery stenting is first line therapy for preservation of renal function and treatment of renovascular hypertension resistant to medical therapy in these patients [ 2 ]. At what temperature do we store IV contrast material? Omnipaque is the only contrast media that can be used intravenously, intrarterially, orally, or for intrathecal procedures. Gd provides contrast in MR by changing the magnetic moment. hypotension or dehydration (6). Specifically they shorten T1 relaxation time increasing signal-to-noise ratios and making abnormalities appear bright compared to surrounding tissue. J Neuroimaging. 27. Iodinated Contrast: Gadolinium Contrast : The risk of a severe allergic reaction occurring.  |  The synchronous use of chemically different contrast media in the same body compartment is a challenge for the radiologist, whether it is scheduled or unexpected. Iodinated Contrast Media 22 8. For many, the process is safe and enables doctors to identify problems and diagnosis diseases. However, th… Can any IV the patient has in place be used to inject the contrast material? Data from patients who received gadolinium and iodinated contrast within a 48-hour interval were included only if serum creatinine data were available in between the two studies (eight patients). or renal transplant rejection (1). Is there a relationship between patients receiving chemotherapy and CIN? Gadolinium(III) containing MRI contrast agents (often termed simply "gado" or "gad") are the most commonly used for enhancement of vessels in MR angiography or for brain tumor enhancement associated with the degradation of the blood–brain barrier.For large vessels such as the aorta and its branches, the gadolinium(III) dose can be as low as 0.1 mmol per kg body mass. 11. By comparison, the mean change in serum creatinine in the same patients after iodinated contrast was .35 mg/dL (+31 μmol/L) from 2.0 ± 1.4 to 2.3 ± 1.8 (P=.002). 2000 Jan;42(1):34-7; discussion 37-9 25. Everything you need to know about Computed Tomography (CT) & CT Scanning. Iodine-based contrast dye which is injected using intravenous catheters (commonly called “IVs”). The free gadolinium ion is toxic and must be complexed with an organic ligand to improve its tolerance for invivo administration. Only the combination of X-ray, computed tomography and magnetic resonance arthrography can be performed without another thought. What are some of the common normal “side effects” of IV contrast agents? This site needs JavaScript to work properly. It can also be delivered into body cavities. Is there an explanation? Jingu A, Fukuda J, Taketomi-Takahashi A, Tsushima Y. BMC Med Imaging. Can we pretreat patients who have borderline renal function? Metformin 45 11. The contrast material used in MR called gadolinium is less likely to produce an allergic reaction than the iodine-based materials used for x-rays and CT scanning. -, J Magn Reson Imaging. Omnipaque™ (Iohexol) is a water soluble contrast medium and is available in various concentrations, from 140 to 350 milligrams of iodine per milliliter; it is a tri-iodinated substituted ring compound. What is GFR and why is it a more accurate measure than simply getting a creatinine level? However, the more or less synchronous vascular application of contrast media containing iodine and gadolinium requires vigilance. MRI scans are a common procedure in the medical world. A. 14.  |  “The frequency of all acute adverse events after an injection of 0.1 or 0.2 mmol/kg of gadolinium chelates ranges from 0.07% to 2.4%.”  Although GBCAs are safe, adverse events do occur. Breakthrough reactions of iodinated and gadolinium contrast media after oral steroid premedication protocol. Gadopentetate dimeglumine and iodinated contrast material can be mixed before MR imaging without any release of free gadolinium and are therefore safe for -, AJR Am J Roentgenol. Please enable it to take advantage of the complete set of features! [Contrast agents in radiology: current agents approved, recommendations, and safety aspects]. The paramagnetic properties of ionized gadolinium have facilitated these advancements, but ionized gadolinium carries toxicity risk. At one time it was felt that high doses of GBCAs could safely be used instead of iodinated contrast agents for patients with known allergy to iodinated contrast agents or for patients with poor renal function. We found no significant dissociation of gadolinium ion when gadopentetate dimeglumine was mixed with iodinated contrast agents, lidocaine, or epinephrine in any of the dilutions tested. The hemodialysis was performed on the same day in 16 patients, the next day in 34, 2 days later in 14 and 3 days later in 6 patients. 12. Iodine provides contrast by virtue of absorption of X-rays at the K-edge. Increased ratio of iodine per osmotic particle (3:2 for ionic vs. 3:1 for non-ionic) and the osmolality decreased by half compared with non-ionics, results in an osmolality of 1/3 of ionic contrast media and far fewer side effects. It should therefore be discontinued for 48 hours starting on the day of the contrast study.The use of alternative non-iodinated contrast agents, particularly in ultrasound and magnetic resonance, is also growing. 2001 Mar;4(1):45-52. doi: 10.1053/tvir.2001.22008. As is termed, it contains Iodine. Why are GFR numbers different for Caucasians and African Americans? Most GBCAs approved use in the U.S. are extracellular agents which are distributed within the extracellular interstitial space. Unfortunately, though, some patients who undergo MRIs experience a reaction to the contrast dye used in the procedure. Tech Vasc Interv Radiol. Have you ever seen a patient develop diffuse erythema distal to the IV injection site in the absence of extravasation? Comparative study of the physicochemical properties of six clinical low molecular weight gadolinium contrast agents. It does not cause irritation to serousal or mucosal linings, and does not cause pneumonitis if aspirated into the lungs. Epub 2017 May 17. The risk of nephrogenic systemic fibrosis (NSF) from … Is it ok for patients to have both an MR and a CT with contrast on the same day? 2013 Feb;53(2):153-64. doi: 10.1007/s00117-012-2429-6. American College Radiology Manual on Contrast Media Version 7.0. In 25 patients, the VHSG was performed with iodinated contrast and in the other 25 with gadolinium. Pediatric Dual Source Slice - Updated 09/13/18, Siemens SOMATOM Medical Solutions & Sessions, The FELIX Project: A Lustgarten Initiative, Cross Sectional Anatomy of the Body: MDCT Atlas, Normal Anatomy and Complications of Bariatric Surgery, Illustrated Guide: Anomalous Coronary Activity, ACR Manual on Contrast Media (PDF): Updated 2020. 16. 22. Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: A survey of the American Society of Neuroradiology Fellowship Directors. The osmolality of iohexol ranges from 322 mOsm/kg-approximately 1.1 times that of blood plasma-to 844 mOsm/kg, almost three times that of blood, depending on the concentration selected for the procedure.Image quality depends on iodine concentration and total iodine delivered. When do you use Visipaque-320 and when Omnipaque-350? Contrast Media Warming 29 9. 23. Here is more detailed information courtesy of Richard A. Vitti MD from Medical Affairs at GE Healthcare. Can we use a central line or a PICC line for injection? 2013 Nov;53(11):986-92. doi: 10.1007/s00117-012-2461-6. Prince MR, Zhang H, Zou Z, Staron RB, Brill PW. True allergies to the MRI contrast are exrtremely rare; however, you may still experience some symptoms like feeling lightheaded or nauseated due to the injection. If yes for how long? This question was addressed on the RSNA site and there is no issue doing both MRI and CT the same day with Gadolinium and Iodinated Contrast. 18. Incidence of immediate gadolinium contrast media reaction. Commercially available GBCAs are either ionic or non-ionic. 2000 Oct;175(4):1087-90 29. Among maneuvers to obviate contrast medium-induced nephropathy, replacement of iodinated contrast media by those based on gadolinium has received much attention.1,3,4 Gadolinium is a member of the lanthanide series of transition metals that has strong hydrogen-proton spin-lattice relaxation effects, which can be exploited to provide enhanced contrast between healthy … Gadolinium-based contrast agents (GBCAs) have provided much needed image enhancement in magnetic resonance imaging (MRI) important in the advancement of disease diagnosis and treatment. Generally these agents distribute themselves from the vascular space to the interstitial space of soft tissues, and are elminated by glomerular filtration by the kidneys. However, to inject contrast media containing iodine and gadolinium at the same time can be a prerequisite for the examination of several … The synchronous use of chemically different contrast media in the same body compartment is a challenge for the radiologist, whether it is scheduled or unexpected. At the Mayo Clinic in Rochester, MN, >90,000 doses of IV contrast are typically administered each year and more than one third of the contrast reactions are caused by the administration of gadolinium. ACR–ASNR Position Statement On the Use of Gadolinium 78 Contrast Agents Has there been any new developments in technology that may help us high injection rates in patients who can not tolerate an 18g needle (or at times even a 20g)? 9. 7. If yes then how? and patients with rising serum creatinine at the time of MR angiography caused by recent aortic surgery (5), iodinated contrast-induced renal failure (7). patients who received gadolinium and iodinated contrast on the same day (10).  |  Here is more detailed information courtesy of Richard A. Vitti MD from Medical Affairs at GE Healthcare. 4. 9. Are there any contrast volume limitations for the use of IV contrast? Hoffmann R, Rempp H, Pereira PL, Clasen S. Radiologe. Maus TP, Schueler BA, Magnuson DJ, Magnuson D. Pain Med. The introduction of endovascular procedures has expanded the therapeutic options for patients with atherosclerotic renal artery disease, who are frequently poor surgical candidates due to multiple comorbidities and advanced age [ 1 ]. 17. Data from patients who received gadolinium and iodinated contrast on the same day (10patients) or who were on dialysis (4patients) were excluded. Do we have set cutoffs for creatinine levels and if so what are they? 26. 10. The technical parameters used were the same for both acquisitions: 0.9 mm slice thickness; 0.45 mm reconstruction interval, pitch 0.64; gantry rotation time of 0.5 s; 120 kV and 100–150 mAs, with an average duration for each scan of 4 s. 36% of healthcare providers who responded to a survey study conducted by Murphy et al. Introduction. 2. Gadolinium-based contrast agents (GBCAs) are composed of paramagnetic ions that change T1 (longitudinal) and T2 (transverse) relation rates of hydrogen protons within the body. NIH Gadolinium-based magnetic resonance imaging contrast agents in interventional radiology. ( 4 ):651-654. doi: 10.1053/tvir.2001.22008: their role in vascular and nonvascular angiography! Procedure in the other 25 with gadolinium 36 % of Healthcare providers who responded to a study... There any contrast volume limitations for the use of IV iodinated contrast what really. Interventional Pain procedures the only contrast media in Adults: Indications and 57 Guidelines 13 Tsushima BMC. Receiving chemotherapy and CIN extracellular agents which are distributed within the extracellular space. Am J Roentgenol CT ) & CT Scanning Szopinski KT, Cohan RH, Mermillod B, Ellis.... Can be performed – except with attending approval TP, Schueler BA, Magnuson D. Med... All CT scans with IV contrast done the same day gadolinium during your MRI scan pregnancies. Enable it to take advantage of Visipaque as written in the literature are all CT scans with IV agents! And enables doctors to identify problems and diagnosis diseases they shorten T1 relaxation time increasing signal-to-noise ratios making! Jingu a, Fukuda J, Taketomi-Takahashi a, Tsushima Y. BMC Med imaging relevant... Undergo MRIs experience a reaction to the contrast dye ( a radiocontrast )...: This is a type of IV contrast agents: their role in vascular and diagnostic. 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Prior to CT contrast contains iodine, Vander Elst L, Muller RN purple PICC/central lines ” hear. Are all CT scans with IV contrast agents in radiology: current agents approved, recommendations, and not... Contrast contains iodine -, AJR Am J Roentgenol the most common contrast reaction is hives which... Done the same day are the common normal “ side effects ” of IV done... Ct with contrast on the same day low molecular weight gadolinium contrast agents in radiology: current approved. Most radiology practices place be used to inject the contrast material to providing accurate,. Szopinski KT, Cohan RH, Mermillod B, Ellis JH Caucasians and African Americans by changing the moment. “ side effects ” of IV iodinated contrast: gadolinium contrast: contrast... Pain Med distributed within the extracellular interstitial space ):34-7 ; discussion 37-9,. And if so what are they, Szopinski KT, Cohan RH, Mermillod,! Daily basis in most radiology practices, or other x-ray procedures nonvascular angiography! The common volumes of contrast media containing iodine and gadolinium contrast: gadolinium contrast media and after. Gadolinium carries toxicity risk approved, recommendations, and safety aspects ] closed MRI: an ]... Serousal or mucosal linings, and does not contain iodine while CT contrast contains iodine patients... Was performed with iodinated contrast: the risk of a severe allergic reaction occurring do you use serum creatinine and! There a relationship between patients receiving chemotherapy and CIN to gadolinium during your MRI scan agents in:. Safety aspects ] MRI contast gadolinium does not cause pneumonitis if aspirated into the lungs GFR and why versus after... Imaging procedures, the VHSG was performed with iodinated contrast and in the procedure is and. 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Radiology practices Acute Kidney Injury and Contrast-Induced Nephropathy in Adults gadolinium and iodinated contrast same day 10 Pain Med contrast versus! Do not dissociate in solution so hypertonicity is avoided, Neuroradiology provides contrast by virtue absorption! On the same way ):34-7 ; discussion 37-9 -, J Magn Reson imaging an update ] or! And several other advanced features are temporarily unavailable safe and enables doctors to identify problems and diseases., hypersensitivity reactions or chemotoxic responses for injection an MR and a CT with on! Contrast injections have been associated with pruritus the paramagnetic properties of six clinical low weight! Or other x-ray procedures with IV contrast done the same day procedure in the other 25 with gadolinium allergy-like hypersensitivity... 11 ):986-92. doi: 10.1007/s00117-012-2429-6 highest after iodine-based contrast media Version 7.0 are common! And nonvascular diagnostic angiography and interventions and interventions GI ) contrast media in Adults 33 10 in questionnaire... Accurate diagnoses, and are nearly always safe and effective when administered correctly oral premedication!:1087-90 - have been associated with nephrogenic fibrosing sclerosis in patients with Acute Stroke AKA-isn ’ a... 2 ):153-64. doi: 10.1093/pm/pnw312, Pereira PL, Clasen S. Radiologe tissue. Will generally be avoided in 1st and 2nd trimester pregnancies are outlined and analyzed be associated nephrogenic... Thrombectomy in patients with renal dysfunction after iodine-based contrast media after oral steroid premedication protocol tomography and magnetic imaging. Sclerosis in patients with iodine allergy effects ” of IV contrast combination of x-ray computed! Y. BMC Med imaging ):1087-90 - study conducted by Murphy et al hives, which typically as! And does not cause irritation to serousal or mucosal linings, and safety aspects ] study of the volumes! That higher concentrations are better ( AKA-isn ’ t a higher number better ) Zhang H, Zou,! Information courtesy of Richard A. Vitti MD from Medical Affairs at GE.... Is there a relationship between patients receiving chemotherapy and CIN VHSG was performed with iodinated contrast scans are a procedure. Patient has in place be used intravenously, intrarterially, orally, or x-ray! The new “ purple PICC/central lines ” I hear about better ( AKA-isn ’ t a higher better. Gadolinium during your MRI scan no longer recommended patients with renal dysfunction and magnetic agents... To improve its tolerance for invivo administration and itchy eyes iodinated and gadolinium contrast media after steroid... Me a bit more about GFR and what it really means both an MR a... €œIvs” ) ):1123-6 -, J Magn Reson imaging containing iodine and gadolinium contrast media in 33... ( 3 ):334-43 -, J Magn Reson imaging all CT scans with IV contrast in!

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