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Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study

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Abstract

Objectives

To analyse 80-kVp 16-MDCT in patients with clinically suspected pulmonary embolism (PE) and diminished renal function after a reduction in dose of contrast medium (CM) from 200 to 150 mg I/kg.

Methods

Fifty patients with suspected PE and glomerular filtration rate (GFR) less than 50 mL/min underwent 80-kVp 16-MDCT with 150 mg I/kg. Mean density/image noise (1 standard deviation) was measured in a region of interest in the left pulmonary artery (LPA) and a lower lobe segmental artery (LLSA), and the contrast-to-noise ratio (CNR) was calculated. The values of LPA and LLSA were averaged.

Results

Median values/2.5–97.5 percentiles were: age 84/67–96 years, weight 65/43–84 kg, GFR 36/21–45 mL/min, CM dose 9.6/6.4–12 g of iodine, PA density 353/164–495 HU and CNR 11/4.4–20. PE incidence was 16%, and 8% and 12% of the examinations were regarded suboptimal by observer 1 and 2, respectively. Density/CNR values were within ranges reported for common 120-kVp MDCT protocols. None of 32 patients with plasma-creatinine follow-up within 1 week experienced a rise of more than 44.2 μmol/L and none of 50 patients had oliguria/anuria or dialysis. None of 40 patients with a negative CT/no anticoagulation had thromboembolism during follow-up.

Conclusion

80-kVp MDCT combined with individualised ultralow CM doses may provide satisfactory diagnostic quality, which should be to the benefit of patients at risk of contrast medium-induced nephropathy.

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Acknowledgements

Radiographers Lars Nilsson, Staffan Wettemark and Anna Johansson for supervising the performance of the computed tomography examinations. Jonas Björk, Ph.D., Competence Centre for Clinical Research, University of Lund, University Hospital, Lund, Sweden, for statistical advice. Librarian Elisabeth Sassersson, Lasarettet Trelleborg, for excellent service regarding literature references.

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Authors and Affiliations

  1. Department of Diagnostic Radiology, Lasarettet Trelleborg, University of Lund, 231 85, Trelleborg, Sweden

    Mattias Kristiansson & Ulf Nyman

  2. Department of Diagnostic Radiology, Malmö University Hospital, University of Lund, 205 02, Malmö, Sweden

    Fredrik Holmquist

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  1. Mattias Kristiansson
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  3. Ulf Nyman
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Correspondence to Ulf Nyman.

Additional information

Ulf Nyman was part of an expert group of The Swedish Council on Technology Assessment of Health Care and The National Board of Health and Welfare establishing evidenced-based national guidelines regarding diagnosis of pulmonary embolism.

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Kristiansson, M., Holmquist, F. & Nyman, U. Ultralow contrast medium doses at CT to diagnose pulmonary embolism in patients with moderate to severe renal impairment: a feasibility study. Eur Radiol 20, 1321–1330 (2010). https://doi.org/10.1007/s00330-009-1691-0

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