Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration.
Persistent renal enhancement after intra-arterial versus intravenous iodixanol administration.
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DOI：
10.1016/j.ejrad.2011.02.044
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发表时间：
2011-11
影响因子：
3.3
通讯作者：
Yeh, Benjamin M.
中科院分区：
文献类型：
--
作者：
Chou, Shinn-Huey;Wang, Zhen J.;Kuo, Jonathan;Cabarrus, Miguel;Fu, Yanjun;Aslam, Rizwan;Yee, Judy;Zimmet, Jeffrey M.;Shunk, Kendrick;Elicker, Brett;Yeh, Benjamin M.
目的：探讨碘黄醇治疗后肾脏持续性强化的临床意义。我们对166名连续接受腹盆腔CT平扫的患者进行了回顾性研究，这些患者在接受动脉注射(n=99)或静脉注射(n=67)碘后7天内进行了腹盆腔CT平扫。每一次平扫CT扫描均测量肾脏密度。持续性肾脏强化定义为CT衰减>；55Hounsfield单位(HU)。造影剂肾病(CIN)定义为造影剂注射后5天内血肌酐≥升高0.5 mg/dL。动脉注射(平均CT密度为73.7HU，99例患者中54例，占55%)后肾脏持续性强化的强度和频率高于静脉注射造影剂(51.8HU，67例中21例，占31%，P<；0.005)，但多因素回归模型显示，持续肾脏强化的独立预测因素是较短的时间间隔(p<；0.001)、较高的对比剂剂量(p<；0.001)、较高的基线血肌酐(p<；0.001)；和高龄(p<；0.05)。在该模型中，造影剂注射途径并不是持续性肾脏强化的预测指标。接受动脉内注射的患者中有9例(9%)出现造影剂诱导的肾病，而静脉注射碘化醇的患者中有3例(4%)，而且在肾脏持续性强化的患者中更常见(p<；0.01)。随访期非增强CT的持续性肾脏强化提示造影剂诱发肾病的风险更大，但在接受动脉内造影剂而不是静脉造影剂的患者中，肾脏显著强化的频率增加也反映了此类患者的造影剂剂量更大，后续CT扫描的时间更短。
To examine the clinical significance of persistent renal enhancement after iodixanol administration. We retrospectively studied 166 consecutive patients who underwent non-enhanced abdominopelvic CT within 7 days after receiving intra-arterial (n=99) or intravenous (n=67) iodixanol. Renal attenuation was measured for each non-enhanced CT scan. Persistent renal enhancement was defined as CT attenuation > 55 Hounsfield units (HU). Contrast-induced nephropathy (CIN) was defined as a rise in serum creatinine ≥ 0.5mg/dL within 5 days after contrast administration. While the intensity and frequency of persistent renal enhancement was higher after intra-arterial (mean CT attenuation of 73.7HU, seen in 54 of 99 patients, or 55%) than intravenous contrast material administration (51.8HU, seen in 21 of 67, or 31% p < 0.005), a multivariate regression model showed that the independent predictors of persistent renal enhancement were a shorter time interval until the subsequent non-enhanced CT (p<0.001); higher contrast dose (p<0.001); higher baseline serum creatinine (p<0.01); and older age (p<0.05). The route of contrast administration was not a predictor of persistent renal enhancement in this model. Contrast-induced nephropathy was noted in 9 patients who received intra-arterial (9%) versus 3 who received intravenous iodixanol (4%), and was more common in patients with persistent renal enhancement (p<0.01). Persistent renal enhancement at follow-up non-contrast CT suggests a greater risk for contrast-induced nephropathy, but the increased frequency of striking renal enhancement in patients who received intra-arterial rather than intravenous contrast material also reflects the larger doses of contrast and shorter time to subsequent follow-up CT scanning for such patients.
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