Lowering iodinated contrast concentration in infrainguinal endovascular interventions: a three-armed randomized
Sjoerd Jens1, Sanne M Schreuder2, Diederik W De Boo2
1Department of Radiology, Academic Medical Center, Room G1-229, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. s.jens@amc.uva.nl.
Insights
Lowering iodinated contrast concentration to 140 mgI/mL for endovascular interventions in peripheral arterial disease (PAD) patients does not reduce radiologist confidence or image quality. This approach significantly reduces iodine load and procedural costs.
Area of Science:
- Radiology
- Vascular Interventions
- Medical Imaging
Background:
- Symptomatic peripheral arterial disease (PAD) often requires endovascular interventions.
- Iodinated contrast agents are crucial for diagnosis and treatment guidance.
- Optimizing contrast concentration is essential to balance image quality, patient safety, and procedural efficiency.
Purpose of the Study:
- To evaluate the impact of reduced iodinated contrast concentration on interventional radiologists' confidence in diagnosing and treating PAD lesions.
- To assess the effect of lower contrast concentrations on procedural iodine load and image quality during endovascular interventions.
Main Methods:
- A randomized controlled non-inferiority trial involving 60 patients with symptomatic PAD.
- Interventions were performed using contrast concentrations of 300 mgI/mL (standard), 240 mgI/mL, or 140 mgI/mL.
- Primary outcome: radiologist confidence scores (0-100%). Secondary outcomes: procedural iodine load and image quality.
Main Results:
- Confidence scores for diagnosing and treating lesions remained high (median 100%) across all contrast groups (300, 240, and 140 mgI/mL), with no statistically significant differences.
- Procedural iodine load was significantly reduced in the 240 mgI/mL (p=0.022) and 140 mgI/mL (p<0.001) groups compared to the standard 300 mgI/mL group.
- Image quality was consistently rated as diagnostic across all tested contrast concentrations.
Conclusions:
- Lowering iodinated contrast concentration to 140 mgI/mL for endovascular interventions in PAD patients significantly reduces iodine load without compromising diagnostic image quality or radiologist confidence.
- The findings support the implementation of lower contrast concentrations to decrease patient iodine exposure and potentially reduce procedure costs.
- Further adoption of reduced iodine contrast protocols is recommended for PAD interventions.
Objectives:
To determine the influence of lowering iodinated contrast concentration on confidence of interventional radiologists in diagnosing and treating lesions during endovascular interventions in patients with symptomatic peripheral arterial disease (PAD).
Methods:
A randomized controlled non-inferiority trial was performed in 60 patients. Intervention was performed with contrast concentrations (in mg of iodine per mL, mgI/mL) of 300 (standard), 240, or 140 mgI/mL. Primary outcome was confidence (score 0-100 %) of radiologists in diagnosing and treating arterial lesions. Secondary outcomes were procedural iodine load and image quality (i.e. non-diagnostic, limited, diagnostic, exemplary).
Results:
Median confidence scores in diagnosing lesions were 100 % (range 81-100 %) for the 300 group (n = 21), 100 % (range 82-100 %) for the 240 group (n = 19), and 100 % (range 91-100 %) for the 140 group (n = 20) (both p = 1.00 compared to the 300 group). Median scores for treating lesions in the 240 and 140 groups, 100 % (range 79-100 %, p = 0.40), and 100 % (range 63-100 %, p = 0.25), respectively, were not lower compared to the 300 group (median 100 %, range 78-100 %). Procedural iodine load was lower in the 240 (24.3 ± 7.6 g, p = 0.022) and 140 groups (17.8 ± 5.6 g, p < 0.001) compared to the 300 group (29.7 ± 6.3 g). Image quality was diagnostic for all groups.
Conclusion:
Using iodine contrast of 140 mgI/mL for diagnosis and interventions in PAD patients significantly reduces administered iodine load without compromising image quality. Future use of lower iodine dose is recommended.
Key Points:
• Lower iodinated contrast concentration during endovascular intervention does not decrease radiologist's confidence. • Image quality of standardized angiographies remains diagnostic using 140 mgI/mL iodinated contrast concentration. • Iodine load during intervention can be decreased by >40 % when using 140 mgI/mL. • Implementing the use of a lower iodinated contrast concentration will reduce the costs of the procedure.
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