Multi-detector row CT angiography of pulmonary circulation with gadolinium-based contrast agents: prospective evaluation in 60 patients.
OBJECTIVE
To prospectively evaluate gadolinium dose safety and effectiveness for 16-detector pulmonary computed tomographic (CT) angiography.


METHODS
Ethics committee approval and informed consent were obtained. Sixty patients with contraindications to iodine underwent CT of the pulmonary circulation with 0.5 mmol/L gadolinium chelate given at either 0.3 (n = 29, group A) or 0.4 (n = 31, group B) mmol/kg; clinical and biologic tolerances were evaluated. Enhancement of central and segmental pulmonary arteries was measured (poor enhancement, <100 HU; good, 100-150 HU; excellent, >150 HU). Subsegmental artery enhancement was assessed as similar or inferior to that of segmental arteries. Confidence in analysis of the pulmonary arterial bed was graded according to arterial enhancement: Grades 1-3, diagnostic images; grade 4, nondiagnostic. The main effectiveness parameter for comparison between groups A and B was diagnostic value of CT angiograms. Nonparametric statistics were used to analyze results.


RESULTS
The mean (+/- standard deviation) contrast material volume was 50.09 mL +/- 8.45 (all patients: range, 30-64 mL; group A: 46.54 mL +/- 8.59; group B: 53.42 mL +/- 6.92). Diagnostic images were obtained in 55 (92%) patients, and confident analysis of pulmonary arteries to the subsegmental level was achieved in 26 (grade 1, 44%) and to the segmental level, in 21 (grade 2, 35%). Mean attenuation was higher in group B than in group A in central (180.61 HU +/- 53.85 vs 148.14 HU +/- 52.61; P = .04) and segmental (201.59 HU +/- 54.70 vs 164.73 HU +/- 59.26; P = .03) arteries. Number of diagnostic CT angiograms was higher (P = .02) in group B (n = 31 [100%]) than in group A (n = 24 [83%]). In both groups, mean enhancement of pulmonary arteries was significantly higher at 80 or 100 kV than at 120 kV. Renal function was impaired in two group A patients.


CONCLUSIONS
Gadolinium chelates may be used as an alternative CT contrast agent in patients who cannot receive iodine.
Remy-Jardin
Martine
M
Departmentsof Radiology, Calmette Hospital, University Center of Lille, France. mremy-jardin@chru-lille.fr
Bahepar
Julbert
J
Lafitte
Jean-Jacques
JJ
Dequiedt
Philippe
P
Ertzbischoff
Olivier
O
Bruzzi
John
J
Delannoy-Deken
Valérie
V
Duhamel
Alain
A
Remy
Jacques
J
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000792:Angiography / Q000379:methods*; D016009:Chi-Square Distribution; D003287:Contrast Media / Q000008:administration & dosage* / Q000009:adverse effects; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010865:Pilot Projects; D011446:Prospective Studies; D011652:Pulmonary Circulation / Q000502:physiology*; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed
D003287:Contrast Media; D019786:Gadolinium DTPA