Reddan Donal, Fishman Elliot K
University College Galway Hospitals, Unit 7, Merlin Park Hospital, Galway, Ireland.
Eur J Radiol. 2008 May;66(2):235-45. doi: 10.1016/j.ejrad.2007.05.012. Epub 2007 Aug 28.
The past decade has seen a proliferation in the number of CT procedures. As increasing numbers of elderly patients with multiple comorbidities undergo contrast media (CM)-enhanced procedures, more patients are at risk for contrast-induced nephropathy (CIN).
To understand whether radiologists are sufficiently aware of the incidence, impact and risk factors of CIN, and whether they are taking sufficient measures to prevent CIN among patients undergoing CT.
A telephone or online survey was conducted in 2005 with 509 radiologists from 10 European countries. Participants had a minimum of 3 years' experience and performed at least 50 CT scans per week.
Most (88%) radiologists believed that CIN is an important issue. While 45% identify that a patient is experiencing CIN when the serum creatinine level increases >25% (0.5mg/dL) from baseline within 48h, the remainder used criteria that might lead to significant under-diagnosis. Most (72%) radiologists believed that CIN is associated with increased morbidity; 56% did not believe that it is associated with increased mortality. Most respondents agreed that pre-existing renal impairment (97%), dehydration (90%) and diabetes (89%) were risk factors for CIN; however, 26%, 30% and 46%, respectively, did not identify advanced age, CM dose or congestive cardiac failure as risk factors. Only 7% of radiologists thought they were always made aware of CIN associated with their cases and 28% never consulted a nephrologist to discuss patients at risk of CIN or who had developed CIN.
There is highly variable awareness of the definition, impact and risk factors for CIN among European radiologists. Data regarding the importance of CIN in CT are limited. Improved efforts are required to better educate radiologists and referring physicians and to institute appropriate protocols to identify at-risk patients and prevent CIN.
在过去十年中，CT检查的数量激增。随着越来越多患有多种合并症的老年患者接受造影剂（CM）增强检查，更多患者面临造影剂肾病（CIN）的风险。
了解放射科医生是否充分认识到CIN的发病率、影响及危险因素，以及他们是否正在采取足够措施预防接受CT检查的患者发生CIN。
2005年对来自10个欧洲国家的509名放射科医生进行了电话或在线调查。参与者至少有3年工作经验，每周至少进行50次CT扫描。
大多数（88%）放射科医生认为CIN是一个重要问题。虽然45%的医生认为当血清肌酐水平在48小时内较基线水平升高>25%（0.5mg/dL）时患者出现了CIN，但其余医生使用的标准可能导致严重漏诊。大多数（72%）放射科医生认为CIN与发病率增加有关；56%的医生不认为它与死亡率增加有关。大多数受访者同意，既往肾功能损害（97%）、脱水（90%）和糖尿病（89%）是CIN的危险因素；然而，分别有26%、30%和46%的医生未将高龄、CM剂量或充血性心力衰竭视为危险因素。只有7%的放射科医生认为他们总是了解与其病例相关的CIN情况，28%的医生从未咨询肾病科医生以讨论有CIN风险或已发生CIN的患者。
欧洲放射科医生对CIN的定义、影响及危险因素的认识差异很大。关于CIN在CT检查中的重要性的数据有限。需要加大力度更好地教育放射科医生和转诊医生，并制定适当方案以识别高危患者并预防CIN。
