Ali Cam1, Murat Canyiğit2, Mete Hıdıroğlu3, Erol Şener3, Halil Arslan2, Alpaslan Altunoğlu4
1Department of Radiology, İskenderun State Hospital, Hatay, Turkey
2Department of Radiology, Ankara City Hospital, Ankara, Turkey
3Department of Cardiovascular Surgery, Ankara City Hospital, Ankara, Turkey
4Department of Nephrology, Ankara City Hospital, Ankara, Turkey
Keywords: Chronic kidney disease, computed tomography angiography, contrast-induced nephropathy, contrast material, endovascular aortic repair
Objectives: In this study, we aimed to evaluate the accuracy of transarterial computed tomography angiography (TA-CTA) in treatment planning and follow-up and to identify the contrast-induced nephropathy (CIN) risk of this procedure in patients with chronic kidney disease (CKD).
Patients and methods: Between November 2012 and November 2013, a total of 14 patients (13 males, 1 female; mean age 73.8Â±7.2 years; range, 58 to 90 years) with CKD and an aortic aneurysm who underwent TA-CTA were included in this study. A flush catheter was placed in the aorta and CTA images were obtained by 64-slice multidetector computed tomography (MDCT). For the thoracoabdominal TA-CTA, a mixture of 16 mL contrast + 84 mL saline was used, while for the abdominal TA-CTA, 8 mL of contrast + 42 mL of saline mixture was used. These mixtures were injected with an automatic injector without delay in time. The image quality scores (IQS) were between 1 and 4. Serum creatinine and estimated glomerular filtration rate (eGFR) values were obtained before the procedure, and on Days 2-5 and at Months 1-3 after the procedure.
Results: None of the patients developed CIN. The mean creatinine levels were as follows: 2.35 mg/dL before the procedure, 2.27 mg/dL on Days 2-5, and 2.28 mg/dL at Months 1-3 (p=0.084 and 0.109, respectively). The mean eGFR values were as follows: 32.2 mL/min/1.73 m2 before the procedure, 34.2 mL/min/1.73 m2 on Days 2-5, and 34.6 mL/min/1.73 m2 at Months 1-3 (p=0.061 and 0.017, respectively). The Hounsfield unit (HU) values were as follows: 184 to 251 HU (mean: 230 HU) on the distal ascending aorta, 104 to 430 HU (mean: 198 HU) on the renal artery level of the abdominal aorta, 104 to 430 HU (mean: 198 HU) at the terminal aorta, 88 to 406 HU (mean: 183 HU) on the common iliac arteries, and 103 to 274 HU (mean: 171 HU) on the common femoral arteries The HU value was measured in a non-enhanced area as 22 to 45 HU (mean: 32 HU). The mean IQS of Observer 1 and Observer 2 was 3.52 and 3.47, respectively. Only one TA-CTA procedure was scored differently. The mean IQS was 3.495 with an intra-observer agreement of 94%.
Conclusion: Despite its invasive nature, diluted, low-contrast enhanced TA-CTA is an easy-to-use and safe method which provides
sufficient anatomical details without causing any nephropathy risk.