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Are gadolinium-based contrast media really safer than iodinated media for digital subtraction angiography in patients with azotemia?

Nyman, Ulf LU ; Elmståhl, Barbara LU ; Leander, Peter LU ; Nilsson, Mats LU ; Golman, Klaes LU and Almén, Torsten LU (2002) In Radiology 223(2). p.311-318
Abstract
Gadolinium chelates, intended as intravenous contrast media for magnetic resonance imaging, have been regarded as nonnephrotoxic and recommended to replace iodinated contrast media in patients with azotemia who are undergoing digital subtraction angiography (DSA). High intraarterial doses (up to 220 mmol of gadodiamide) have been used, with a 40% incidence of nephropathy. The authors discourage the use of gadolinium for DSA for several reasons. (a) There exist no randomized studies comparing the nephrotoxic effects of gadolinium-based and iodinated media at equal-attenuating concentrations and doses. (b) Gadolinium-based media are hypertonic, a pathogenetic factor in contrast medium-induced nephropathy after renal angiography, with an... (More)
Gadolinium chelates, intended as intravenous contrast media for magnetic resonance imaging, have been regarded as nonnephrotoxic and recommended to replace iodinated contrast media in patients with azotemia who are undergoing digital subtraction angiography (DSA). High intraarterial doses (up to 220 mmol of gadodiamide) have been used, with a 40% incidence of nephropathy. The authors discourage the use of gadolinium for DSA for several reasons. (a) There exist no randomized studies comparing the nephrotoxic effects of gadolinium-based and iodinated media at equal-attenuating concentrations and doses. (b) Gadolinium-based media are hypertonic, a pathogenetic factor in contrast medium-induced nephropathy after renal angiography, with an osmolality two to seven times that of plasma. Iodinated media in concentrations that are equally attenuating with gadolinium-based media can be made isotonic. (c) In vitro measurements indicate that 0.5 mol/L gadolinium chelates are equally attenuating with 60-80 mg iodine per milliliter at the commonly used 70-90-kV range used for DSA. Thus, 50 mL of 0.5 mol/L gadolinium chelate ( approximately 0.3 mmol/kg in an 80-kg person) would be equally attenuating with a dose of 3-4 g of iodine in an iodinated medium (eg, 50 mL iohexol at 60-80 mg I/mL or 10-13 mL at 300 mg I/mL). (d) By combining these data on attenuation and results of toxicity studies in mice, the general toxicity of gadolinium chelates may be six to 25 times higher than that of equal-attenuating doses of iodinated media at 70-kV DSA. Thus, the authors believe that at equal-attenuating doses for DSA, modern iodinated contrast media should result in a lower toxic load on the body than with presently available gadolinium chelates. (Less)
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keywords
Triiodobenzoic Acids : chemistry, Triiodobenzoic Acids : adverse effects, Radiology, Interventional, Kidney Diseases : chemically induced, Human, Gadolinium DTPA : diagnostic use, Gadolinium DTPA : chemistry, Gadolinium DTPA : adverse effects, Contrast Media : adverse effects, Contrast Media : chemistry, Triiodobenzoic Acids : diagnostic use, Uremia : complications, Chelating Agents : diagnostic use, Chelating Agents : chemistry, Chelating Agents : adverse effects, Digital Subtraction, Angiography
in
Radiology
volume
223
issue
2
pages
311 - 318
publisher
Radiological Society of North America
external identifiers
  • wos:000175270000005
  • scopus:0036237985
ISSN
1527-1315
DOI
10.1148/radiol.2232010221
language
English
LU publication?
yes
id
edf3376d-7753-4f7e-b7ff-7e212beb4b11 (old id 108042)
date added to LUP
2007-07-27 12:32:16
date last changed
2017-02-12 04:06:01
@article{edf3376d-7753-4f7e-b7ff-7e212beb4b11,
  abstract     = {Gadolinium chelates, intended as intravenous contrast media for magnetic resonance imaging, have been regarded as nonnephrotoxic and recommended to replace iodinated contrast media in patients with azotemia who are undergoing digital subtraction angiography (DSA). High intraarterial doses (up to 220 mmol of gadodiamide) have been used, with a 40% incidence of nephropathy. The authors discourage the use of gadolinium for DSA for several reasons. (a) There exist no randomized studies comparing the nephrotoxic effects of gadolinium-based and iodinated media at equal-attenuating concentrations and doses. (b) Gadolinium-based media are hypertonic, a pathogenetic factor in contrast medium-induced nephropathy after renal angiography, with an osmolality two to seven times that of plasma. Iodinated media in concentrations that are equally attenuating with gadolinium-based media can be made isotonic. (c) In vitro measurements indicate that 0.5 mol/L gadolinium chelates are equally attenuating with 60-80 mg iodine per milliliter at the commonly used 70-90-kV range used for DSA. Thus, 50 mL of 0.5 mol/L gadolinium chelate ( approximately 0.3 mmol/kg in an 80-kg person) would be equally attenuating with a dose of 3-4 g of iodine in an iodinated medium (eg, 50 mL iohexol at 60-80 mg I/mL or 10-13 mL at 300 mg I/mL). (d) By combining these data on attenuation and results of toxicity studies in mice, the general toxicity of gadolinium chelates may be six to 25 times higher than that of equal-attenuating doses of iodinated media at 70-kV DSA. Thus, the authors believe that at equal-attenuating doses for DSA, modern iodinated contrast media should result in a lower toxic load on the body than with presently available gadolinium chelates.},
  author       = {Nyman, Ulf and Elmståhl, Barbara and Leander, Peter and Nilsson, Mats and Golman, Klaes and Almén, Torsten},
  issn         = {1527-1315},
  keyword      = {Triiodobenzoic Acids : chemistry,Triiodobenzoic Acids : adverse effects,Radiology,Interventional,Kidney Diseases : chemically induced,Human,Gadolinium DTPA : diagnostic use,Gadolinium DTPA : chemistry,Gadolinium DTPA : adverse effects,Contrast Media : adverse effects,Contrast Media : chemistry,Triiodobenzoic Acids : diagnostic use,Uremia : complications,Chelating Agents : diagnostic use,Chelating Agents : chemistry,Chelating Agents : adverse effects,Digital Subtraction,Angiography},
  language     = {eng},
  number       = {2},
  pages        = {311--318},
  publisher    = {Radiological Society of North America},
  series       = {Radiology},
  title        = {Are gadolinium-based contrast media really safer than iodinated media for digital subtraction angiography in patients with azotemia?},
  url          = {http://dx.doi.org/10.1148/radiol.2232010221},
  volume       = {223},
  year         = {2002},
}