title: Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast - Own Experiences.
abstract: BACKGROUND
  High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages.
  
  
  METHODS
  Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1-2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6-8 mL of Iodixanol (320 mg/mL) diluted with saline to 18-24 mL was administered at a speed of 4-5 mL/s.
  
  
  RESULTS
  Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography.
  
  
  CONCLUSIONS
  1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site.
authors.affiliation: Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Jerzy
authors.initials: J
authors.lastname: Garcarek
authors.affiliation: Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Kurcz
authors.affiliation: Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Maciej
authors.initials: M
authors.lastname: Guziński
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland.
authors.forename: Mirosław
authors.initials: M
authors.lastname: Banasik
authors.affiliation: Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland.
authors.forename: Marcin
authors.initials: M
authors.lastname: Miś
authors.affiliation: Department of Nephrology and Transplantation Medicine, Wrocław Medical University, Wrocław, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Gołębiowski
keywords: Angiography, Digital Subtraction; Contrast Media; Gastrointestinal Hemorrhage; Infusions, Intra-Arterial; Kidney Transplantation; Multidetector Computed Tomography