Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study

Kristiansson, M; Holmquist, F.; Nyman, Ulf

doi:10.1007/s00330-009-1691-0

Cited by 39 publications

(29 citation statements)

References 43 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…CM dosing should be performed according to body weight, so at least low-weight patients do not get unnecessarily high doses [39,40]. CT angiography may be performed with half the ordinary CM dose or even lower by decreasing the X-ray tube potential from 120 to 80 peak kilovoltage (kVp) [41,42]. This requires a substantial increase in X-ray tube loading (mAs) so as not to deteriorate image noise and to keep the contrast-to-noise ratio at an acceptable level.…”

Section: Safety First!mentioning

confidence: 99%

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

et al. 2012

Self Cite

View full text Add to dashboard Cite

We oppose the opinion that the intra-arterial administration of iodine-based contrast media (CM) appears to pose a greater risk of contrast medium-induced nephropathy (CIN) than intravenous administration since 1) in intra-arterial coronary procedures and most other intra-arterial angiographic examinations, CM injections are also intravenous relative to the kidneys, 2) there is a lack of comparative trials studying the risk of CIN between intra-arterial and intravenous procedures with matched risk factors and CM doses, 3) a bias selection of patients with fewer risk factors may explain the seemingly lower rate of CIN after CT in comparison with coronary interventions, 4) the rate of CIN following intra-arterial coronary procedures may also be exaggerated owing to other causes of acute kidney failure, such as haemodynamic instability and microembolisation, 5) roughly the same gramiodine/GFR ratio (≈1:1) as a limit of relatively safe CM doses has preliminarily been found for both intravenous CT and intra-arterial coronary procedures and 6) the substantially higher injected intravenous CM dose rate during CT relative to an intra-arterial coronary procedure might actually pose a higher risk of CIN following CT. Key Points• Most intra-arterial injections of contrast media are intravenous relative to the kidneys.• No evidence that intravenous CM injections should be less nephrotoxic than intra-arterial.• Considerably higher dose rates of CM are used for CT relative to intra-arterial procedures. • Higher dose rates may pose higher nephrotoxic risk for intravenous based CT studies.

show abstract

Section: Safety First!mentioning

confidence: 99%

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

et al. 2012

Self Cite

View full text Add to dashboard Cite

show abstract

“…The catheter was placed in the central portion of the renal vein, and its position was verified by venography with ultra-low doses (5-15 mg I/kg) of iohexol (Omnipaque Ò 300 mg I/ml; GE Healthcare, Stockholm, Sweden) [22]. Using the renal vein catheter, RBF was measured by continuous retrograde thermodilution [23,24].…”

Section: Measurements Of Renal Variablementioning

confidence: 99%

Effects of norepinephrine on renal perfusion, filtration and oxygenation in vasodilatory shock and acute kidney injury

et al. 2010

View full text Add to dashboard Cite

show abstract

“…17,20 Some studies on body weight-adapted CM protocols for CTPA in selective, low-weight patient groups have been published: Holmquist et al used an 80-kV protocol with TIL of around 13 g in a low-weight patient group, and Kristiansson et al reduced the TIL in a similar patient group even further to 9.6 g. However, 8-12% of the examinations were regarded as suboptimal. 21,22 In coronary CTA, a smaller standard deviation of intracoronary attenuation was reported when using a body weight-adapted injection protocol, indicating a smaller variation in attenuation values between individual patients. 17,20 In CTPA, the lower HU limit is important as CM attenuation is typically even lower in the more peripheral arteries.…”

Section: Discussionmentioning

confidence: 99%

Individually tailored contrast enhancement in CT pulmonary angiography

Hendriks

Kok

Mihl

et al. 2016

BJR

View full text Add to dashboard Cite

Objective: The purpose was to evaluate individually shaped contrast media (CM) delivery in CT pulmonary angiography (CTPA) for suspected pulmonary embolism (PE). Methods: 100 consecutive emergency patients with clinical suspicion of PE were evaluated. High-pitch CTPA was performed on a second-generation dual-source CT using the following parameters: 100 kV, 200-250 mAsref, rotation time 0.28 s, 128 3 0.6 mm col. and image reconstruction 1.0/0.8 mm (B30f). Group 1 (n 5 50) then received a fixed CM bolus (300 5 mgI ml 21, volume 5 90 ml and flow rate 5 6 ml s 21 ); Group 2 (n 5 50) received a body weightadapted CM bolus determined by dedicated contrast injection software. For analysis, groups were further subdivided into low-weight (40-75 kg) and high-weight (76-117 kg) groups. Technical image quality was graded using a four-point Likert scale (1 5 non-diagnostic; 2 5 diagnostic; 3 5 good and 4 5 excellent image quality) at the level of the pulmonary trunk and pulmonary arteries. Objective image quality analysis was performed by measuring contrast enhancement in Hounsfield units (HU) at the same levels. Attenuation levels . 180 HU were considered diagnostic. Results: All examinations were graded as diagnostic at each level. The individual minimum pulmonary attenuation was 184 and 270 HU for Group 1 and 2, respectively. Mean attenuation was as follows: Group 1: 475 6 105 HU (40-75 kg) and 402 6 115 HU (76-117 kg), p , 0.03. Group 2: 424 6 76 HU (40-75 kg) and 418 6 100 HU (76-117 kg), p 5 0.8. For Group 2, CM volumes were: 55 6 5 ml (40-75 kg) and 66 6 5 ml (76-117 kg), leading to 16-51% CM reduction. Conclusion: Even under emergency conditions, individualized CM protocols can provide diagnostic and robust image quality in CTPA for PE with a substantial reduction of CM volume for lower weight patients, compared with a fixed CM protocol. Advances in knowledge: CM volume can substantially be reduced by using individualized CM protocols in CT angiography for PE without compromising the diagnostic image quality.

show abstract

Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study

Abstract: 80-kVp MDCT combined with individualised ultralow CM doses may provide satisfactory diagnostic quality, which should be to the benefit of patients at risk of contrast medium-induced nephropathy.

Cited by 39 publications

References 43 publications

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Are intravenous injections of contrast media really less nephrotoxic than intra-arterial injections?

Effects of norepinephrine on renal perfusion, filtration and oxygenation in vasodilatory shock and acute kidney injury

Individually tailored contrast enhancement in CT pulmonary angiography

Contact Info

Product

Resources

About