Use of a mixture of gadolinium and iodinated contrast for angiography

The purpose of this study was to determine if the image quality of gadolinium digital subtraction angiography (DSA) can be improved by the addition of small quantities of iodinated contrast to gadolinium. The optical density (OD) of a mixture of four parts gadolinium-based contrast to one part iodinated contrast was measured through a phantom study and compared to that of full-strength gadolinium, full strength iodinated contrast, and a 20% solution of iodinated contrast. We also compared the clinical image quality of the mixture of gadolinium-based contrast and iodinated contrast relative to full-strength gadolinium and full strength iodinated contrast during DSA. The DSA image quality of the gadolinium-iodinated contrast mixture was significantly improved relative to images obtained with full-strength gadolinium and compared favorably to that obtained with full-strength iodinated contrast. The phantom data showed that the OD of the gadolinium-iodinated contrast mixture was much greater than that of full strength gadolinium and the 20% iodinated contrast solution. The increase in OD was greater than that expected from a simple additive effect of the OD of the contrast agents. Adding a small amount of iodinated contrast to gadolinium results in a significant improvement in the radiographic density and DSA image quality of gadolinium. This simple technique appears to overcome one of the major limitations of gadolinium-based angiography-poor radiographic density-while continuing to minimize the volume of administered iodinated contrast.