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?
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.
Nyman
Ulf
U
Department of Diagnostic Radiology, Lasarettet Trelleborg, University of Lund, Trelleborg, Sweden. ulf.nyman@skane.se
Elmståhl
Barbara
B
Geijer
Håkan
H
Leander
Peter
P
Almén
Torsten
T
Nilsson
Mats
M
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
D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
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