title: Multi-modal CT in acute stroke: wait for a serum creatinine before giving intravenous contrast? No!
abstract: BACKGROUND
  Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling.
  
  
  OBJECTIVE
  To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population.
  
  
  METHODS
  An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100-150 ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80-125 ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days.
  
  
  RESULTS
  We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis.
  
  
  CONCLUSIONS
  The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment.
authors: Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.|Hunter Medical Research Institute, Newcastle, New South Wales, Australia.
authors: Timothy E
authors: TE
authors: Ang
authors: Hunter Medical Research Institute, Newcastle, New South Wales, Australia.|University of Newcastle, Newcastle, New South Wales, Australia.
authors: Andrew
authors: A
authors: Bivard
authors: Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.|University of Newcastle, Newcastle, New South Wales, Australia.
authors: Christopher
authors: C
authors: Levi
authors: Neurology, Monash Medical Centre, Melbourne, Victoria, Australia.|Monash University, Melbourne, Victoria, Australia.
authors: Henry
authors: H
authors: Ma
authors: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.
authors: Chung Y
authors: CY
authors: Hsu
authors: Royal Melbourne Hospital, Melbourne, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.
authors: Bruce
authors: B
authors: Campbell
authors: University of Melbourne, Melbourne, Victoria, Australia.|The Florey Institute of Neuroscience and Mental Health, Melbourne, Victoria, Australia.
authors: Geoffrey
authors: G
authors: Donnan
authors: Royal Melbourne Hospital, Melbourne, Victoria, Australia.|University of Melbourne, Melbourne, Victoria, Australia.
authors: Stephen M
authors: SM
authors: Davis
authors: Neurology, John Hunter Hospital, Newcastle, New South Wales, Australia.|University of Newcastle, Newcastle, New South Wales, Australia.
authors: Mark
authors: M
authors: Parsons
mesh_terms: D061605:Administration, Intravenous; D000368:Aged; D000369:Aged, 80 and over; D001921:Brain / Q000000981:diagnostic imaging; D003287:Contrast Media / Q000008:administration & dosage; D003404:Creatinine / Q000097:blood*; D003657:Decision Making; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000453:epidemiology / Q000209:etiology; D008297:Male; D008875:Middle Aged; D011859:Radiography; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000000981:diagnostic imaging* / Q000453:epidemiology; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D003287:Contrast Media; D003404:Creatinine
keywords: CT angiography; acute stroke imaging; contrast nephropathy; multimodal CT perfusion; renal failure; stroke