Maximum Arterial Contrast Concentrations With Computed Tomography and Left Ventriculography: Implications for Contrast Nephrotoxicity Risk
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Published on: April 18, 2013
Nicholas M Gutierrez1, Jeffrey H Newhouse
1From the Columbia University Medical Center, New York, NY.
Insights
Cardiac angiography leads to higher maximum renal arterial contrast concentration than computed tomography (CT), increasing contrast nephropathy risk. Controlling contrast concentration and its rate of change may reduce this risk.
Area of Science:
- Nephrology
- Radiology
- Cardiology
Background:
- Contrast nephropathy is a known risk following procedures involving iodinated contrast media.
- Cardiac angiography, particularly left ventriculography, is associated with higher rates of contrast nephropathy compared to contrast-enhanced computed tomography (CT).
- The underlying mechanisms for this difference in nephropathy risk are not fully understood.
Purpose of the Study:
- To investigate whether maximum renal arterial contrast concentration is higher after left ventriculography compared to contrast-enhanced CT.
- To assess the rate of change of contrast concentration in the renal arteries for both procedures.
Main Methods:
- Contrast concentration in the abdominal aorta during contrast-enhanced CT was measured using CT densitometry in 100 adults.
- Aortic contrast concentrations for cardiac angiography were calculated based on standard doses, injection rates, and cardiac output.
- Calibration curves were generated using water phantoms with known contrast concentrations.
Main Results:
- Maximum aortic (renal arterial) contrast concentrations were significantly higher after left ventriculography (6.68%-15.90%) than after CT (1.22%-5.80%).
- The rate of change of contrast concentration was also significantly higher after ventriculography due to shorter injection times.
- These findings suggest a higher peak and faster rise in contrast exposure to the kidneys during cardiac angiography.
Conclusions:
- Higher maximum renal arterial contrast concentration following left ventriculography may contribute to the increased risk of contrast nephropathy.
- The rapid increase in contrast concentration during ventriculography might also enhance renal toxicity.
- Understanding and potentially controlling these contrast delivery dynamics could help mitigate nephropathy risk and inform future research.
Purpose:
Contrast nephropathy occurs more frequently after cardiac angiography, which usually includes left ventriculography via direct left ventricular injection, than after contrast-enhanced computed tomography (CT), despite the usually higher intravenous contrast dose used for CT. To determine whether maximum renal arterial contrast concentration is higher after left ventriculography, we assessed this parameter for both procedures.
Materials And Methods:
Contrast concentration in abdominal aortic blood during contrast-enhanced CT was measured by performing CT densitometry of aortic blood before contrast, and in the arterial phase, in 100 adults undergoing abdominal CT. Densities were converted to contrast concentrations by scanning water phantoms containing 20 graded concentrations of contrast and comparing their densities to patient data. Because it was impossible to perform CT densitometry during cardiac angiography, aortic contrast concentrations were calculated from standard contrast doses and injection rates with the range of clinically encountered cardiac output rates, assuming ultimate steady state for blood/contrast mixing and normal data distribution.
Results:
Maximum aortic (and hence renal arterial) concentrations were significantly higher (range, 6.68%-15.90%) after ventriculography than after CT (1.22%-5.80%). Because ventricular injection times are much shorter than published initial-appearance-to-maximum-concentration times after intravenous administration, the rate of change of contrast concentration is also higher after ventriculography than after CT.
Conclusion:
Higher maximum renal arterial contrast concentration may be responsible for the greater risk of nephropathy after cardiac angiography than after doses for CT. The faster rate of change of renal arterial contrast concentration after ventriculography may also increase the likelihood of renal toxicity.
Clinical Relevance/Application:
Maximum renal arterial contrast concentration, and/or the rapidity of change of this parameter, may be partly responsible for the risk of nephropathy. Controlling these factors might permit reduction of nephropathy risk; they also suggest avenues of research into the pathophysiology of contrast nephropathy.
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