Which study when? Is gadolinium-enhanced MR imaging safer than iodine-enhanced CT?
Which study when? Is gadolinium-enhanced MR imaging safer than iodine-enhanced CT?
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DOI：
10.1148/radiol.2491080075
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发表时间：
2008-10
期刊：
影响因子：
19.7
通讯作者：
J. Weinreb
中科院分区：
文献类型：
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作者：
J. Weinreb
基于钆的造影剂与肾源性系统性纤维化（NSF）（一种罕见的使人衰弱，有时甚至致命的疾病）之间的关联的出现，导致了对造影剂增强CT和造影剂增强MR成像的相对风险的重新评估，特别是在肾功能受损的患者中。现在，连同所有其他风险，必须权衡NSF的潜在危险和相关成本。本文探讨了静脉注射碘化造影剂和钆基造影剂的相关风险，并表明MR增强成像对大多数患者仍然是非常安全的，并且与许多患者相比，MR增强成像具有一些优势。静脉造影剂通常用于计算机断层扫描（CT）和磁共振（MR）成像，以帮助疾病的检测、表征和分期。尽管每年都有数以千万计的手术使用它们，但严重和危及生命的事件相对较少。然而，在CT上使用碘化造影剂（ICAs）和在MR上使用钆基造影剂（gbca）会引起一系列安全问题，特别是在某些高危人群中，放射科医生经常面临两难境地：当ica增强CT或gbca增强MR成像均能提供相关诊断信息时，这是更安全和首选的检查，特别是在肾功能受损的患者中。尽管关于ICAs与不良事件之间的关联有大量的文献，但对于如何将这些信息整合到日常实践中以减轻或消除不良事件，仍然存在很多不确定性(1)。尽管存在这种不确定性，但直到最近，至少有两个原则得到了大多数放射科医生的认可，并且长期以来一直是放射学经典的组成部分：总体而言，与ICAs相比，gbca的不良事件发生率较低；对于肾功能受损的患者，gbca比ICAs更安全。
Jeffrey C. Weinreb, MD The emergence of an association between gadolinium-based contrast agents and nephrogenic systemic fibrosis (NSF), a rare debilitating and sometimes fatal disease, has led to a reassessment of the relative risks of contrast material–enhanced CT and contrast-enhanced MR imaging, particularly in patients with compromised renal function. Now, along with all the other risks, the potential dangers and associated costs of NSF have to be weighed. This article explores the relative risks associated with the use of intravenous iodinated contrast agents and gadolinium-based contrast agents and shows that contrast-enhanced MR imaging is still extremely safe for the majority of patients and has some advantages compared with contrast-enhanced CT for many of them. Intravenous contrast agents are commonly used for both computed tomography (CT) and magnetic resonance (MR) imaging to aid in the detection, characterization, and staging of disease. Despite their use in tens of millions of procedures every year, there are relatively few serious and lifethreatening events. Nevertheless, administration of both the iodinated contrast agents (ICAs) for CT and the gadolinium-based contrast agents (GBCAs) for MR imaging can raise a range of safety concerns, particularly in certain increased-risk population groups, and radiologists are frequently confronted with a dilemma: When either ICA-enhanced CT or GBCA-enhanced MR imaging could provide the relevant diagnostic information, which is the safer and preferred examination, especially in a patient with compromised renal function. Although there is a plethora of literature concerning the association between ICAs and adverse events, there is still much uncertainty about how this information should be integrated into routine practice in an effort to mitigate or eliminate adverse events (1). Despite this uncertainty, until recently there were at least two principles upon which most radiologists agreed and have long been components of the radiology canon: Overall, GBCAs are associated with a lower incidence of adverse events than ICAs, and GBCAs are safer than ICAs in patients with compromised renal function.