Cardiac computed tomography with gadolinium: An alternative to iodinated contrast agents?

Abstract

Noninvasive cardiac imaging using multislice computed tomography (MSCT) has become a real alternative to invasive angiography in selected patient populations with rising procedural volume because of its noninvasive character and ease of use. Although computed tomography angiography (CTA) is in general a safe procedure, risks of the test include X-ray exposure and the need to administer iodinated contrast agents. Although radiation remains the most important current point of critique, 1 Einstein A.J. Henzlova M.J. Rajagopalan S. Estimating risk of cancer associated with radiation exposure from 64-slice computed tomography coronary angiography. JAMA. 2007; 298: 317-323 Crossref PubMed Scopus (1217) Google Scholar contrast media complications are also of potential concern. Typically, cardiac CTA requires approximately 80 to 100 mL of iodinated contrast medium, 2 Leber A.W. Becker A. Knez A. von Ziegler F. Sirol M. Nikolaou K. Ohnesorge B. Fayad Z.A. Becker C.R. Reiser M. Steinbeck G. Boekstegers P. Accuracy of 64-slice computed tomography to classify and quantify plaque volumes in the proximal coronary system: a comparative study using intravascular ultrasound. J Am Coll Cardiol. 2006; 47: 672-677 Abstract Full Text Full Text PDF PubMed Scopus (661) Google Scholar , 3 Kopp A.F. Heuschmid M. Reimann A. Kuettner A. Beck T. Ohmer M. Burgstahler C. Brodoefel H. Claussen C.D. Schroeder S. Evaluation of cardiac function and myocardial viability with 16- and 64-slice multidetector computed tomography. Eur Radiol. 2005; 15: D15-D20 Crossref PubMed Scopus (24) Google Scholar with possible side effects including allergic reactions, hyperthyroidism, and acute renal failure. In particular, contrast-induced nephropathy is a feared complication that is associated with substantial rates of morbidity and mortality and furthermore may limit the application of CTA to otherwise eligible patients with abnormal renal function. Risk factors for contrast-associated nephropathy include contrast volume, contrast osmolality, chronic kidney disease, diabetes, and congestive heart failure. 4 Barrett B.J. Parfrey P.S. Clinical practice Preventing nephropathy induced by contrast medium. N Engl J Med. 2006; 354: 379-386 Crossref PubMed Scopus (513) Google Scholar