Gadolinium dimeglumine: an alternative contrast agent for digital subtraction angiography

The aim of this study was to evaluate gadolinium diethylenetriaminepenta-acetic acid (Gd-DTPA) as an alternative contrast agent for digital subtraction angiography (DSA) in patients with renal insufficiency or previous anaphylactic reaction to iodinated contrast agents. We performed 34 DSAs in 31 patients by use of the commercially available 0.5-M Gd-DTPA solution (Magnevist, Schering, Berlin, Germany). The contrast material was power- or hand-injected at the same rate as iodinated contrast material, without exceeding a total amount of 0.4 mmol/kg body weight. In 18 studies Gd-DTPA was the sole contrast agent. In 9 cases gadolinium injections were combined with carbon dioxide. Restricted non-ionic contrast medium injections were administered to complete the examinations in 7 cases and for comparative purposes in 1 case. Cerebral and carotid arteries, one superior limb, abdominal aorta, renal arteries, renal transplants, iliac arteries and inferior limbs were imaged, and ten endovascular interventional procedures, including three transjugular intrahepatic percutaneous stent shunts, were performed. No side effects were observed. Diagnostic angiographic images were obtained in all cases except in 5 of the 8 distal run-off studies. Gadolinium-based contrast can produce clinically useful angiograms in patients with a contra-indication to iodine who must undergo angiography.