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Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast - Own Experiences.

Garcarek J, Kurcz J, Guziński M, Banasik M, Miś M, Gołębiowski T - Pol J Radiol (2015)

Bottom Line: Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality.In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. 1.Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3.

View Article: PubMed Central - PubMed

Affiliation: Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland.

ABSTRACT

Background: High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages.

Material/methods: Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1-2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6-8 mL of Iodixanol (320 mg/mL) diluted with saline to 18-24 mL was administered at a speed of 4-5 mL/s.

Results: Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography.

Conclusions: 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site.

No MeSH data available.


Related in: MedlinePlus

Volume rendering (VR) reconstruction of angio-CT scan clearly demonstrating contrast extravasation.
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f4-poljradiol-80-344: Volume rendering (VR) reconstruction of angio-CT scan clearly demonstrating contrast extravasation.

Mentions: The second group of patients consisted of patients with gastrointestinal bleeding with negative arteriography of visceral vessels. Arteriography of bleeding from the small intestine is problematic, as typically increased peristalsis and presence of intestinal gas make it difficult to detect the site of bleeding due to formation of artifacts during DSA [14]. In such cases we take into consideration indirect signs, even after provocation tests. Embolization is risky for a patient under such circumstances. Due to the presence of arterial arcades closing the last distal vessel is a rule. Following indirect signs leads to unintentional embolization or extended embolization, which is related to possible complications, such as necrosis of the intestinal wall. On the other hand, if the procedure is not performed, relapse is frequent and often life-threatening. Application of angio-CT with intraarterial contrast administration enabled precise localization of bleeding source in 6 out of 10 patients, facilitated guidance into the site of interest and allowed for performing safe and effective embolization (Figures 3, 4). We did not find in the available literature any reports of using such a diagnostic method for the gastrointestinal tract. We believe that this method requires further investigation, including use of provocation tests in angio-CT following negative classical arteriography.


Intraarterial CT Angiography Using Ultra Low Volume of Iodine Contrast - Own Experiences.

Garcarek J, Kurcz J, Guziński M, Banasik M, Miś M, Gołębiowski T - Pol J Radiol (2015)

Volume rendering (VR) reconstruction of angio-CT scan clearly demonstrating contrast extravasation.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4497469&req=5

f4-poljradiol-80-344: Volume rendering (VR) reconstruction of angio-CT scan clearly demonstrating contrast extravasation.
Mentions: The second group of patients consisted of patients with gastrointestinal bleeding with negative arteriography of visceral vessels. Arteriography of bleeding from the small intestine is problematic, as typically increased peristalsis and presence of intestinal gas make it difficult to detect the site of bleeding due to formation of artifacts during DSA [14]. In such cases we take into consideration indirect signs, even after provocation tests. Embolization is risky for a patient under such circumstances. Due to the presence of arterial arcades closing the last distal vessel is a rule. Following indirect signs leads to unintentional embolization or extended embolization, which is related to possible complications, such as necrosis of the intestinal wall. On the other hand, if the procedure is not performed, relapse is frequent and often life-threatening. Application of angio-CT with intraarterial contrast administration enabled precise localization of bleeding source in 6 out of 10 patients, facilitated guidance into the site of interest and allowed for performing safe and effective embolization (Figures 3, 4). We did not find in the available literature any reports of using such a diagnostic method for the gastrointestinal tract. We believe that this method requires further investigation, including use of provocation tests in angio-CT following negative classical arteriography.

Bottom Line: Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality.In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography. 1.Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3.

View Article: PubMed Central - PubMed

Affiliation: Department of General Radiology, Interventional Radiology ang Neuroradiology, Wrocław Medical University, Wrocław, Poland.

ABSTRACT

Background: High volume of intravenous contrast in CT-angiography may result in contrast-induced nephropathy. Intraarterial ultra-low volume of contrast medium results in its satisfactory blood concentration with potentially good image quality. The first main purpose was to assess the influence of the method on function of transplanted kidney in patients with impaired graft function. The second main purpose of the study was to evaluate the usefulness of this method for detection of gastrointestinal and head-and-neck haemorrhages.

Material/methods: Between 2010 and 2013 intraarterial CT-angiography was performed in 56 patients, including 28 with chronic kidney disease (CKD). There were three main subgroups: 18 patients after kidney transplantation, 10 patients with gastrointestinal hemorrhage, 8 patients with head-and-neck hemorrhage. Contralateral or ipsilateral inguinal arterial approach was performed. The 4-French vascular sheaths and 4F-catheters were introduced under fluoroscopy. Intraarterial CT was performed using 64-slice scanner. The scanning protocol was as follows: slice thickness 0.625 mm, pitch 1.3, gantry rotation 0.6 sec., scanning delay 1-2 sec. The extent of the study was established on the basis of scout image. In patients with CKD 6-8 mL of Iodixanol (320 mg/mL) diluted with saline to 18-24 mL was administered at a speed of 4-5 mL/s.

Results: Vasculature was properly visualized in all patients. In patients with impaired renal function creatinine/eGFR levels remained stable in all but one case. Traditional arteriography failed and CT-angiography demonstrated the site of bleeding in 3 of 10 patients with symptoms of gastrointestinal bleeding (30%). In 8 patients with head-and-neck bleeding CT-angiography did not prove beneficial when compared to traditional arteriography.

Conclusions: 1. Ultra-low contrast intraarterial CT-angiography does not deteriorate the function of transplanted kidneys in patients with impaired graft function. 2. 3D reconstructions allow for excellent visualization of vascular anatomy of renal transplants. 3. Intraarterial CT-angiography is useful for detection of the bleeding site.

No MeSH data available.


Related in: MedlinePlus