From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.).
Radiology. 2017 Aug;284(2):530-540. doi: 10.1148/radiol.2017160895. Epub 2017 Apr 6.
Purpose To assess the effect of intravenous contrast media on renal function in neonates. Materials and Methods Institutional review board approval was obtained with waiver of consent. Electronic health records from January 2011 to April 2013 were reviewed retrospectively. Measures of renal function were obtained in inpatient neonates who underwent magnetic resonance (MR) imaging or computed tomography (CT) and for whom serum creatinine (Cr) levels were obtained within 72 hours before imaging and at least one time after imaging (>1 day after administration of contrast material). A total of 140 neonates who received contrast material (59 who underwent CT with iohexol or iodixanol and 81 who underwent MR imaging with gadopentetate dimeglumine) were identified. These neonates were frequency matched according to sex, gestational and postnatal age, and preimaging serum Cr levels with neonates who underwent unenhanced MR imaging or CT. Cr levels and glomerular filtration rates (GFRs) were grouped according to when they were obtained (before imaging, 1-2 days after imaging, 3-5 days after imaging, 6-9 days after imaging, 10-45 days after imaging, and more than 45 days after imaging). Serum Cr levels and GFRs for each time period were compared between groups by using hierarchic regressions or χ or Fisher exact tests and with repeated-measures analysis of variance to compare groups on the rate of change in serum Cr levels and GFRs from before to after imaging. Results Cr levels decreased and GFRs increased in both groups from before to after imaging (CT group, P ≤ .01; MR imaging group, P ≤ .01). The neonates who underwent contrast material-enhanced imaging and the neonates who underwent unenhanced imaging showed similar serum Cr levels at all examined time periods. Groups also did not differ in the proportion of neonates with serum Cr levels higher than the reference range (>0.4 mg/dL) at any time point (iodine- [P > .12] or gadolinium-based [P > .13] contrast material). Similar findings were observed for GFRs. None of the neonates developed nephrogenic systemic fibrosis. Conclusion In the absence of known renal failure, neonates receiving standard inpatient care do not appear to be at increased risk for developing renal toxicity due to administration of intravenous iodine- and gadolinium-based contrast material. RSNA, 2017.
评估静脉内造影剂对新生儿肾功能的影响。
本研究获得了机构审查委员会的批准，并豁免了知情同意。回顾性分析了 2011 年 1 月至 2013 年 4 月的电子健康记录。对接受磁共振成像（MR）或计算机断层扫描（CT）且在成像前 72 小时内和成像后至少一次（造影剂给药后 1 天以上）获得血清肌酐（Cr）水平的住院新生儿进行了肾功能测量。共确定了 140 名接受造影剂的新生儿（59 名接受碘海醇或碘昔醇 CT，81 名接受钆喷酸二甲葡胺 MR 成像）。根据性别、胎龄和生后年龄以及成像前血清 Cr 水平，按频率将这些新生儿与接受未增强 MR 成像或 CT 的新生儿相匹配。根据获得 Cr 水平的时间（成像前、成像后 1-2 天、成像后 3-5 天、成像后 6-9 天、成像后 10-45 天及之后 45 天）将 Cr 水平和肾小球滤过率（GFR）分组。使用层次回归或 χ 或 Fisher 确切检验以及重复测量方差分析比较组间各时间点的 Cr 水平和 GFR，比较成像前后 Cr 水平和 GFR 变化率的组间差异。
两组 Cr 水平在成像前后均降低，GFR 均升高（CT 组，P≤0.01；MR 成像组，P≤0.01）。行造影增强成像的新生儿与行未增强成像的新生儿在所有检查时间点的血清 Cr 水平均相似。两组在任何时间点 Cr 水平高于参考范围（>0.4mg/dL）的新生儿比例也无差异（碘[P>0.12]或钆[P>0.13]造影剂）。GFR 也有类似发现。无新生儿发生肾源性系统性纤维化。
在不存在已知肾功能衰竭的情况下，接受标准住院治疗的新生儿因静脉内使用碘和钆造影剂而发生肾毒性的风险似乎并未增加。RSNA，2017。
