Ces radiol. 2007, 61(4):431-437

Digital subtraction angiography with gadolinium contrast media and review of literatureCase report

Filip Cihlář¹, Milouš Derner¹, Milan Řehořek¹, Vladimír Pavlov¹, Josef Smetana², Martin Sauer²

¹ Radiologické oddělení, Masarykova nemocnice, Ústí nad Labem

² Chirurgická klinika IPVZ, Masarykova nemocnice, Ústí nad Labem

Aim: Patients with a history of severe allergic reaction to iodinated contrast media or a history of renal insufficiency present serious dilemma to the interventional radiologist when diagnostic angiographic or interventional procedures are planned. Of the contrast media investigated to date, only carbon dioxide (CO₂) and gadolinium chelates have been shown to be viable alternatives for digital subtraction angiography (DSA) examinations. The aim of this report was to evaluate gadolinium contrast media as an alternative contrast agents for DSA in patients with a history of severe allergic reaction to iodinated contrast media or a history of renal insuficiency.

Method: In the present report, gadolinium was used as the contrast agent for diagnostic and interventional DSA in two patients with severe allergic reaction to iodinated contrast media. A literature review was performed and the advantages and drawbacks were discussed.

Results: DSA with a gadolinium chelate as contrast medium can provide image of suitable quality for diagnosis and intervention. The overall safety profile of gadolinium contrast agents is excellent in intravenous application. Gadolinium-based contrast media are well tolerated in patiens when administered intraarterially in doses of less than 0.3-0.4 mmol/kg. Several studies have reported the nephrotoxic potential of gadolinium-based contrast agents in doses of more than 0.3 mmol/kg in patients with renal insufficiency. To our knowledge, there is no evidence indicating that the use of gadolinium-based contrast agents for DSA instead of iodinated contrast media in equi-attenuating doses, decreases incidence of contrast induced nephropathy in patients with renal insufficiency.

Conclusion: Gadolinium-based contrast media are useful alternative in selected high risk patients with a history of severe allergic reaction to iodinated contrast media. In our opinion the use of gadolinium-based contrast agents for DSA is controversial in patients with renal insufficiency.

Keywords: digital subtraction angiography, contrast media, gadolinium

Accepted: May 30, 2007; Published: December 1, 2007  Show citation