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Are gadolinium contrast media really less nephrotoxic than iodine agents in radiographic examinations? A comparison in relation to their ability to attenuate x-rays in a pig model

Elmståhl, Barbara LU (2006)
Abstract
Purpose: To confront the statement that gadolinium contrast media (Gd-CM) are less nephrotoxic than iodine contrast media (I-CM) when used in x-ray angiographic and computed tomographic (CT) examinations.



Methods: I) For CT measurements (mean density in Hounsfield numbers) 20-mL syringes filled with I- and Gd-CM at 0.01, 0.02, 0.05 and 0.1 mmol attenuating atoms/mL were scanned in air and in a 30 cm polystyrene phantom. For measurements on radiofluoroscopy (RF), X-ray angiography (XA) and direct digital systems (DX) systems (relative contrast values) 20-mL syringes were filled with 0.5M Gd-CM and I-CM at 35, 50, 70, 90, 110 and 140 mg I/mL. The syringes were placed in phantoms equivalent to 13 (thin) and 20 cm (thick)... (More)
Purpose: To confront the statement that gadolinium contrast media (Gd-CM) are less nephrotoxic than iodine contrast media (I-CM) when used in x-ray angiographic and computed tomographic (CT) examinations.



Methods: I) For CT measurements (mean density in Hounsfield numbers) 20-mL syringes filled with I- and Gd-CM at 0.01, 0.02, 0.05 and 0.1 mmol attenuating atoms/mL were scanned in air and in a 30 cm polystyrene phantom. For measurements on radiofluoroscopy (RF), X-ray angiography (XA) and direct digital systems (DX) systems (relative contrast values) 20-mL syringes were filled with 0.5M Gd-CM and I-CM at 35, 50, 70, 90, 110 and 140 mg I/mL. The syringes were placed in phantoms equivalent to 13 (thin) and 20 cm (thick) water. Syringes filled with distilled water served as a constancy reference. II) In a non-crossover design in three separate studies 3 ml of each test solution were injected in 8 pigs/study at a rate of 20 mL/min into the balloon-occluded (10-minutes) right renal artery of left-sided nephrectomized pigs. Test solutions: 1) 0.5M gadopentetate (1.96 Osm/kg H2O), 0.5M gadodiamide (0.78 Osm/kg), 0.5M iohexol (190 mg I/mL; 0.42 Osm/kg), 0.18M iohexol (70 mg I/mL; with an x-ray attenuation equal to that of 0.5M Gd-CM at 80 kVp) and saline; 2) 0.5M gadopentetate, 0.5M gadodiamide, 0.5M iohexol and mannitol solutions iso-osmotic to these CM; 3) 1.0M gadobutrol (1.6 Osm/kg), 0.5M gadodiamide, iodixanol 150 and 320 mg I/mL (290 mOsm/kg) and iopromide 150 mg I/mL (340 mOsm/kg). The plasma half-life elimination time of a GFR-marker were used to compare their effects on glomerular filtration rate 1-3 hours post-injection. III) After the experiments the kidneys were evaluated histomorphologically.



Results: I) In vitro measurements indicate that 0.5M Gd-CM are equal attenuating with 60-80 mg I/mL at commonly used 70-90 kVp for XRA and with 110 mg I/mL at 120 kVp CT using a body phantom. II) Gadopentetate and iso-osmotic mannitol as well as gadobutrol caused severe impairment of renal function. Gadodiamide caused a 90% prolongation of plasma half-life relative to saline, significantly longer than 0.5M iohexol with a 35% prolongation. GFR following injections of iohexol 70, iopromide 150, and iodixanol 150 and 320 were in the same range as that following saline. III) Gd-CM with the highest osmolality caused marked necroses and haemorrhage/congestion correlating with their marked impairment of renal function, while the plasma iso-osmotic I-CM caused no or only minimal changes.



Conclusions: Gd-CM are more nephrotoxic than equal volumes of I-CM resulting in the same or even better attenuation of x-rays. Thus, Gd-CM should not be used as a substitute for I-CM in patients with renal impairment when performing radiographic examinations.



Key words: Angiography; Computed tomography; Contrast media, toxicity; Gadolinium; Glomerular filtration; Iodine; Kidney failure; Nephrotoxicity.



Key words: Angiography; Computed tomography; Contrast media, toxicity; Osmolality; Renal impairment; Gadolinium, Kidney failure; Iodine, nephrotoxicity, equal attenuation, equi-molar, osmotic load, attenuation, half-life, porcine model (Less)
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author
supervisor
opponent
  • Professor Jakobsen, Jarl Å., Bilde- og Intervensjonsklinikken, Rikshospitalet-Radiumhospitalet HF
organization
publishing date
type
Thesis
publication status
published
subject
keywords
Angiography, Computed tomography, toxicity, Contrast media, Glomerular filtration, Gadolinium, Iodine, Kidney failure, Nephrotoxicity., Medicin (människa och djur), radiology, Clinical physics, Medicine (human and vertebrates), tomography, medical instrumentation, Diagnostik, Diagnostics, medicinsk instrumentering, tomografi, radiologi, Klinisk fysiologi
pages
149 pages
publisher
Department of Clinical Sciences, Lund University
defense location
Malmö, UMAS Jubileumsaulan ing 59
defense date
2006-01-27 09:00:00
ISBN
91 - 85481 - 36 - X
language
English
LU publication?
yes
id
a7385a1d-61af-4f4c-9506-68c9612cdbe9 (old id 546102)
date added to LUP
2016-04-01 16:43:12
date last changed
2018-11-21 20:43:40
@phdthesis{a7385a1d-61af-4f4c-9506-68c9612cdbe9,
  abstract     = {Purpose: To confront the statement that gadolinium contrast media (Gd-CM) are less nephrotoxic than iodine contrast media (I-CM) when used in x-ray angiographic and computed tomographic (CT) examinations.<br/><br>
<br/><br>
Methods: I) For CT measurements (mean density in Hounsfield numbers) 20-mL syringes filled with I- and Gd-CM at 0.01, 0.02, 0.05 and 0.1 mmol attenuating atoms/mL were scanned in air and in a 30 cm polystyrene phantom. For measurements on radiofluoroscopy (RF), X-ray angiography (XA) and direct digital systems (DX) systems (relative contrast values) 20-mL syringes were filled with 0.5M Gd-CM and I-CM at 35, 50, 70, 90, 110 and 140 mg I/mL. The syringes were placed in phantoms equivalent to 13 (thin) and 20 cm (thick) water. Syringes filled with distilled water served as a constancy reference. II) In a non-crossover design in three separate studies 3 ml of each test solution were injected in 8 pigs/study at a rate of 20 mL/min into the balloon-occluded (10-minutes) right renal artery of left-sided nephrectomized pigs. Test solutions: 1) 0.5M gadopentetate (1.96 Osm/kg H2O), 0.5M gadodiamide (0.78 Osm/kg), 0.5M iohexol (190 mg I/mL; 0.42 Osm/kg), 0.18M iohexol (70 mg I/mL; with an x-ray attenuation equal to that of 0.5M Gd-CM at 80 kVp) and saline; 2) 0.5M gadopentetate, 0.5M gadodiamide, 0.5M iohexol and mannitol solutions iso-osmotic to these CM; 3) 1.0M gadobutrol (1.6 Osm/kg), 0.5M gadodiamide, iodixanol 150 and 320 mg I/mL (290 mOsm/kg) and iopromide 150 mg I/mL (340 mOsm/kg). The plasma half-life elimination time of a GFR-marker were used to compare their effects on glomerular filtration rate 1-3 hours post-injection. III) After the experiments the kidneys were evaluated histomorphologically.<br/><br>
<br/><br>
Results: I) In vitro measurements indicate that 0.5M Gd-CM are equal attenuating with 60-80 mg I/mL at commonly used 70-90 kVp for XRA and with 110 mg I/mL at 120 kVp CT using a body phantom. II) Gadopentetate and iso-osmotic mannitol as well as gadobutrol caused severe impairment of renal function. Gadodiamide caused a 90% prolongation of plasma half-life relative to saline, significantly longer than 0.5M iohexol with a 35% prolongation. GFR following injections of iohexol 70, iopromide 150, and iodixanol 150 and 320 were in the same range as that following saline. III) Gd-CM with the highest osmolality caused marked necroses and haemorrhage/congestion correlating with their marked impairment of renal function, while the plasma iso-osmotic I-CM caused no or only minimal changes.<br/><br>
<br/><br>
Conclusions: Gd-CM are more nephrotoxic than equal volumes of I-CM resulting in the same or even better attenuation of x-rays. Thus, Gd-CM should not be used as a substitute for I-CM in patients with renal impairment when performing radiographic examinations.<br/><br>
<br/><br>
Key words: Angiography; Computed tomography; Contrast media, toxicity; Gadolinium; Glomerular filtration; Iodine; Kidney failure; Nephrotoxicity.<br/><br>
<br/><br>
Key words: Angiography; Computed tomography; Contrast media, toxicity; Osmolality; Renal impairment; Gadolinium, Kidney failure; Iodine, nephrotoxicity, equal attenuation, equi-molar, osmotic load, attenuation, half-life, porcine model},
  author       = {Elmståhl, Barbara},
  isbn         = {91 - 85481 - 36 - X},
  language     = {eng},
  publisher    = {Department of Clinical Sciences, Lund University},
  school       = {Lund University},
  title        = {Are gadolinium contrast media really less nephrotoxic than iodine agents in radiographic examinations? A comparison in relation to their ability to attenuate x-rays in a pig model},
  url          = {https://lup.lub.lu.se/search/files/4760112/546104.pdf},
  year         = {2006},
}