title: Iodine contrast iso-attenuating with diagnostic gadolinium doses in CTA and angiography results in ultra-low iodine doses. A way to avoid both CIN and NSF in azotemic patients?
abstract: OBJECTIVE
  To establish iodine (I) contrast medium (CM) doses iso-attenuating with gadolinium (Gd) CM doses regarded diagnostic in CTA and percutaneous catheter-angiography/vascular interventions (PCA/PVI) in azotemic patients.
  
  
  METHODS
  CT Hounsfield units (HU) were measured in 20-mL syringes containing 0.01/0.02,/0.05/0.1 mmol/mL of iodine or gadolinium atoms and placed in phantoms. Relative contrast were measured in 20-mL syringes filled with iohexol at 35/50/70/90/110/140 mg I/mL and 0.5 M gadodiamide using radiofluoroscopy (RF), digital radiography (DX) and x-ray angiography (XA) systems. Clinical doses of Gd-CM at CTA/PCA/PVI were reviewed.
  
  
  RESULTS
  At CT 91-116 and 104-125 mg I/mL in the chest and abdominal phantoms, respectively, were iso-attenuating with 0.5 M Gd at 80-140 kVp. At RF/DX/XA systems 35-90 mg I/mL were iso-attenuating with 0.5 M gadodiamide at 60-115 kVp. Clinically, 60 mL 91-125 mg I/mL (5.5-7.5 gram-iodine) at 80-140 kVp CTA and 60 mL of 35-90 mg I/mL (2.1-5.4 gram-iodine) at 60-115 kVp PCA/PVI would be iso-attenuating with 60 mL 0.5 M Gd-CM (=0.4 mmol Gd/kg in a 75-kg person).
  
  
  CONCLUSIONS
  Meticulous examination technique and judicious use of ultra-low I-CM doses iso-attenuating with diagnostic Gd-CM doses in CTA and PCA/PVI may minimise the risk of nephrotoxicity in azotemic patients, while there is no risk of NSF.
authors.affiliation: Department of Diagnostic Radiology, Lasarettet Trelleborg, University of Lund, Trelleborg, Sweden. ulf.nyman@skane.se
authors.forename: Ulf
authors.initials: U
authors.lastname: Nyman
authors.forename: Barbara
authors.initials: B
authors.lastname: Elmståhl
authors.forename: Håkan
authors.initials: H
authors.lastname: Geijer
authors.forename: Peter
authors.initials: P
authors.lastname: Leander
authors.forename: Torsten
authors.initials: T
authors.lastname: Almén
authors.forename: Mats
authors.initials: M
authors.lastname: Nilsson
mesh_terms: D053099:Azotemia / Q000150:complications / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage; D004305:Dose-Response Relationship, Drug; D019786:Gadolinium DTPA / Q000008:administration & dosage* / Q000009:adverse effects; D006801:Humans; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced / Q000517:prevention & control*; D019047:Phantoms, Imaging; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed / Q000009:adverse effects* / Q000295:instrumentation
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
references.citation: Radiology. 1998 Jun;207(3):657-62
references.pmid: 9609887
references.citation: J Interv Cardiol. 2005 Oct;18(5):379-83
references.pmid: 16202115
references.citation: Med Phys. 1993 Jan-Feb;20(1):15-31
references.pmid: 8455493
references.citation: J Comput Assist Tomogr. 1999 Nov-Dec;23(6):939-40
references.pmid: 10589571
references.citation: Radiology. 2008 Apr;247(1):88-97
references.pmid: 18292474
references.citation: Radiol Clin North Am. 2009 Sep;47(5):871-5, vii
references.pmid: 19744601
references.citation: Radiology. 2007 Feb;242(2):425-34
references.pmid: 17179401
references.citation: J Vasc Surg. 2003 Feb;37(2):346-52
references.pmid: 12563205
references.citation: J Am Coll Cardiol. 2004 Oct 6;44(7):1393-9
references.pmid: 15464318
references.citation: AJR Am J Roentgenol. 2001 May;176(5):1305-11
references.pmid: 11312200
references.citation: Heart Vessels. 2006 May;21(3):141-5
references.pmid: 16715187
references.citation: Invest Radiol. 1997 Nov;32(11):690-5
references.pmid: 9387057
references.citation: Radiology. 1999 Mar;210(3):829-34
references.pmid: 10207488
references.citation: Int J Clin Pract. 2008 Jul;62(7):1113-8
references.pmid: 18218006
references.citation: Radiology. 2009 Mar;250(3):618-28
references.pmid: 19244037
references.citation: Acad Radiol. 2006 Jul;13(7):840-9
references.pmid: 16777558
references.citation: Radiology. 2006 Mar;238(3):1022-35
references.pmid: 16505397
references.citation: Am J Kidney Dis. 2003 Jan;41(1):1-12
references.pmid: 12500213
references.citation: Acta Radiol. 2009 Nov;50(9):965-7
references.pmid: 19863403
references.citation: Catheter Cardiovasc Interv. 2004 Nov;63(3):319-22
references.pmid: 15505847
references.citation: Eur Radiol. 2010 Jun;20(6):1321-30
references.pmid: 20033693
references.citation: Nephrol Dial Transplant. 2002 May;17(5):824-8
references.pmid: 11981070
references.citation: Acad Radiol. 2006 Aug;13(8):979-85
references.pmid: 16843850
references.citation: J Comput Assist Tomogr. 1994 Jul-Aug;18(4):634-6
references.pmid: 8040451
references.citation: Emerg Radiol. 2007 Feb;13(5):243-9
references.pmid: 17136378
references.citation: AJR Am J Roentgenol. 1999 Jun;172(6):1613-4
references.pmid: 10350300
references.citation: J Vasc Interv Radiol. 2004 Sep;15(9):947-54
references.pmid: 15361562
references.citation: J Intern Med. 2001 Nov;250(5):429-34
references.pmid: 11887978
references.citation: Invest Radiol. 2008 Mar;43(3):170-8
references.pmid: 18301313
references.citation: Nephrol Dial Transplant. 2008 Apr;23(4):1233-40
references.pmid: 18256017
references.citation: Invest Radiol. 1995 Nov;30(11):644-9
references.pmid: 8557505
references.citation: Br J Radiol. 2000 Aug;73(872):878-82
references.pmid: 11026864
references.citation: Acad Radiol. 2004 Nov;11(11):1219-28
references.pmid: 15561568
references.citation: J Radiol. 2009 Mar;90(3 Pt 1):287-98
references.pmid: 19421113
references.citation: Cardiovasc Intervent Radiol. 2002 Jan-Feb;25(1):49-52
references.pmid: 11907774
references.citation: J Magn Reson Imaging. 1996 Jan-Feb;6(1):162-6
references.pmid: 8851422
references.citation: Am J Cardiol. 2006 Sep 18;98(6A):27K-36K
references.pmid: 16949378
references.citation: Br J Anaesth. 2005 Nov;95(5):603-10
references.pmid: 16155037
references.citation: Eur Radiol. 2006 May;16(5):1111-6
references.pmid: 16607499
references.citation: AJR Am J Roentgenol. 2005 Jun;184(6):1821-8
references.pmid: 15908537
references.citation: Clin J Am Soc Nephrol. 2008 Sep;3(5):1274-81
references.pmid: 18463172
references.citation: Rofo. 1993 Mar;158(3):255-9
references.pmid: 8453080
references.citation: Radiology. 2002 May;223(2):319-25; discussion 326-7
references.pmid: 11997531
references.citation: Radiology. 2002 May;223(2):311-8; discussion 328-9
references.pmid: 11997530
references.citation: Radiology. 2005 Aug;236(2):677-84
references.pmid: 15972332
references.citation: Eur Radiol. 2004 Jun;14(6):1055-62
references.pmid: 14872279
references.citation: J Endovasc Ther. 2004 Oct;11(5):553-9
references.pmid: 15482029
references.citation: Catheter Cardiovasc Interv. 2003 Mar;58(3):358-61
references.pmid: 12594702
references.citation: Eur Radiol. 2007 Sep;17(9):2394-400
references.pmid: 17285280
references.citation: AJNR Am J Neuroradiol. 2000 May;21(5):964-7
references.pmid: 10815678
references.citation: Radiol Clin North Am. 2009 Sep;47(5):827-31, vi
references.pmid: 19744597
references.citation: Am J Cardiol. 2003 Apr 15;91(8):974-5, A4
references.pmid: 12686340
references.citation: Eur Radiol. 2010 Mar;20(3):595-603
references.pmid: 19760239
references.citation: Radiol Clin North Am. 2002 Jul;40(4):693-710
references.pmid: 12171180
references.citation: Neurosurgery. 2001 Nov;49(5):1262-5; discussion 1265-6
references.pmid: 11846923
references.citation: J Vasc Interv Radiol. 2000 Jan;11(1):35-43
references.pmid: 10693711
references.citation: Radiology. 1996 Feb;198(2):579-81
references.pmid: 8596869
references.citation: Circulation. 2003 Oct 28;108(17):2154-69
references.pmid: 14581387
references.citation: Kidney Int Suppl. 2006 Apr;(100):S11-5
references.pmid: 16612394