Spinosa D J, Matsumoto A H, Angle J F, Hagspiel K D, Isaacs R B, McCullough C S, Lobo P I
Department of Radiology, University of Virginia Health Sciences Center, Charlottesville 22908, USA.
J Vasc Interv Radiol. 1998 Nov-Dec;9(6):909-16. doi: 10.1016/s1051-0443(98)70421-x.
To evaluate the utility and potential nephrotoxicity of gadolinium-based contrast angiography when used with carbon dioxide angiography in renal transplant patients with suspected vascular causes of renal insufficiency and/or accelerated hypertension.
Thirteen consecutive renal transplant patients with suspected vascular causes of renal insufficiency and/or accelerated hypertension were evaluated with gadolinium-based contrast and CO2 angiography with use of digital subtraction techniques. Stenotic lesions were treated with angioplasty with/or without stent placement. No iodinated contrast agents were used. Serum creatinine levels were obtained before and at 24 and 48 hours after the procedure. An increase in creatinine levels greater than 0.5 mg/dL (44 micromol/L) was considered significant.
Nine patients were studied for renal insufficiency, two for accelerated hypertension, and two for both. All 13 studies were considered diagnostic. Significant stenoses were treated in four patients with angioplasty with or without stent placement. Two patients had progression of their renal insufficiency. One of these patients underwent biopsy and was found to have both acute and chronic rejection. The other patient underwent cardiac catheterization 2 days after a transplant renal artery angioplasty. In the remaining nine patients with renal insufficiency (creatinine range, 1.8-3.9 mg/dL [159-345 micromol/L]; mean, 2.7 mg/dL [239 micromol/L]), renal function improved or did not worsen.
Based on this limited study, gadolinium-based contrast angiography appears to be a promising supplement to CO2 angiography for the diagnosis and treatment of vascular lesions in patients with renal transplant insufficiency and/or accelerated hypertension. Further study is necessary to determine safety, optimal gadolinium dosage, and imaging parameters.
评估钆基对比剂血管造影与二氧化碳血管造影联合用于怀疑因血管原因导致肾功能不全和/或急进性高血压的肾移植患者时的效用及潜在肾毒性。
连续13例怀疑因血管原因导致肾功能不全和/或急进性高血压的肾移植患者接受了钆基对比剂和二氧化碳血管造影检查，并采用数字减法技术。狭窄病变采用血管成形术治疗，必要时放置支架。未使用碘化对比剂。在检查前、检查后24小时和48小时测定血清肌酐水平。肌酐水平升高超过0.5mg/dL（44μmol/L）被认为具有临床意义。
9例患者因肾功能不全接受检查，2例因急进性高血压接受检查，2例因两者均有接受检查。所有13例检查均被认为具有诊断价值。4例患者的显著狭窄病变接受了血管成形术治疗，必要时放置支架。2例患者肾功能恶化。其中1例患者接受了活检，发现有急性和慢性排斥反应。另1例患者在移植肾动脉血管成形术后2天接受了心导管检查。其余9例肾功能不全患者（肌酐范围为1.8 - 3.9mg/dL[159 - 345μmol/L]；平均为2.7mg/dL[239μmol/L]），肾功能改善或未恶化。
基于这项有限的研究，钆基对比剂血管造影似乎是二氧化碳血管造影的一种有前景的补充手段，可用于诊断和治疗肾移植功能不全和/或急进性高血压患者的血管病变。有必要进一步研究以确定安全性、最佳钆剂量和成像参数。
