Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
Eur Radiol. 2010 Mar;20(3):595-603. doi: 10.1007/s00330-009-1586-0. Epub 2009 Sep 16.
The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors.
This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated.
Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 +/- 15.5 ml (range 15-60 ml) or 0.24 + 0.12 mmol/kg (range 0.1-0.53 mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60 ml/min/1.73 m(2)). Mean eGFR pre-angiography was 26 ml/min/1.73 m(2) and 33 ml/min/1.73 m(2) post-angiography. The mean follow-up period covers 28 months, range 1-84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF.
Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO(2) angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients.
回顾性分析 27 例肾功能不全患者采用钆对比剂（GDBCA）行常规血管造影检查的临床资料，评估其发生肾源性系统性纤维化（NSF）的情况及相关潜在危险因素。
本 HIPAA 合规研究获得了机构审查委员会的批准，并豁免了知情同意。对所有可用的实验室和临床数据（包括皮肤科报告）进行了统计分析。记录血管造影和其他适用的 MRI 研究中使用的 GDBCA 的类型和剂量。记录血管造影前后的血清肌酐水平（SCr），并计算估算肾小球滤过率（eGFR）。
共纳入 10 例女性和 17 例男性患者，接受 GDBCA 血管造影检查。GDBCA 的平均给药剂量为 44±15.5ml（范围 15-60ml）或 0.24±0.12mmol/kg（范围 0.1-0.53mmol/kg）。血管造影时所有患者均存在肾功能不全（eGFR＜60ml/min/1.73m2）。血管造影前 eGFR 平均为 26ml/min/1.73m2，血管造影后为 33ml/min/1.73m2。平均随访时间为 28 个月，范围为 1-84 个月。15 例患者行 GDBCA 辅助 MRI 检查。1 例有典型皮肤病变的患者发生了经活检证实的 NSF。
肾功能不全患者行 GDBCA 常规动脉血管造影检查可能会导致 NSF 的发生。在这些患者中，应考虑使用替代对比剂，如 CO2 血管造影或低剂量碘对比剂。
