Angioscanographie thoracique au gadolinium  en TDM multicoupe du thorax : analyse rétrospective de la qualité image et de la tolérance chez 45 patients évalués antérieurement à la description de la fibrose systémique néphrogénique

• Published in: Journal de radiologie 2009-03, Vol.90 (3), p.287-298
• Main Authors: Smadja, L, Rémy-Jardin, M, Dupuis, P, Deken-Delannoy, V, Devos, P, Duhamel, A, Laffitte, JJ, Dequiedt, P, Rémy, J
• Format: Article
• Language: fre
• Subjects: Angioscanographie; Artères Pulmonaires; CTA; Gadolinium; Insuffisance rénale; Multidetector-row CT; Nephrologie. Maladies des voies urinaires; Néphropathies. Pathologie vasculaire rénale. Insuffisance rénale; Pulmonary arteries; Sciences biologiques et medicales; Sciences medicales; TDM multidétecteur; Techniques d'exploration et de diagnostic (generalites)
• ISSN: 0221-0363
• DOI: 10.1016/S0221-0363(09)72507-7

To assess the accuracy and torerability of gadolinium-enhanced thoracic CTA using a 64 MDCT compared to a 16 MDCT. Because this study was started prior to the description of NSF, particular attention was paid to long-term follow-up of the patient population. The study protocol was approved by the ethics committee of our institution and informed consent was obtained from all patients. Fourteen patients (Group 1) (9 males and 5 females; mean age: 64.3 years) with contraindication to the administration of iodinated contrast material underwent thoracic CTA (collimation: 32 × 2 × 0.6 mm; pitch: 1.2) with gadolinium administration (0.5 mml/ml) at 0.4 mmol/kg injected at 6 ml/sec with evaluation of clinical and biological tolerability of the gadolinium based contrast agent. Results from this patient population were compared to results from a population of 31 patients (21 males; 10 females; mean age: 63.2 years) (Group 2) imaged on a 16 MDCT. All patients were folloowed-up for a mean time of 22.6 months. Using a mean contrast volume (standard deviation) that was not significantly different (Group 1: 54.8±11 ml; Group 2: 53.4±6.9 ml) (p=0.94), patients in Group 1 underwent complete thoracic CTA whereas patients in Group 2 underwent CTA of only the middle third of the thoracic region. All CTA examinations were diagnostic for Group 1 and Group 2 patients; however, evaluation of subsegmental vessels was possible in a significantly larger proportion of patients in Group 1 (10/14; 72%) compared to Group 2 (6/31; 19%) (p=0.003). Mean attenuation values within pulmonary arterial branches were similar for Groups 1 and 2 (central arteries: 194.5±51.3 HU vs 180.6±53.8 HU; p=0.38) (lobar arteries: 208.5±52.5 HU vs 189.9±60.1 HU; p=0.33) (segmental arteries: 220.4±50.4 HU vs 201.5±54.7 HU; p=0.42). Transient alteration of renal function was recorded in one patient from Group 1 with severe pre-existing chronic renal failure. No change in renal function was observed for Group 2 patients. No case of NSF was reported in patients with pre-existing renal failure at the time of enrollment. The use of a gadolinium-based contrast agent for thoracic CTA using a 64 MDCT provides diagnostic quality examinations in all patients with improved image quality compared to a 16 MDCT. No complication other than transient alteration of renal function was observed. Because the likelihood of developing NSF may vary with the type of gadolinium-based contrast agent used, the least toxic agent should b