Clinical Factors Associated with Dense and Wedge-Shaped Nephrograms Detected 24 h After Chemoembolization

Abstract

This investigation aimed to evaluate patient characteristics and procedural factors associated with abnormal nephrograms encountered on noncontrast computed axial tomography (CAT) obtained 24-h after transarterial chemoembolization (TACE) for primary and metastatic hepatic malignancies. Sixty hepatic chemoembolization procedures were performed in 29 patients who had a median age of 63 years (range 42-79). The male-tofemale ratio was 16:13. Noncontrast CAT scans were obtained approximately 24 h after TACE as part of our institutional protocol and were examined for persistent renal nephrograms. These findings were compared with clinical and procedural parameters to determine whether there was any association with these factors or with the occurrence of acute renal failure (ARF). Abnormally persistent CAT nephrograms were observed 24 h after 28 of 60 (46.7%) TACE procedures, of which 14 (23.3%) were persistent, bilaterally dense, global nephrograms, and 14 (23.3%) were small, wedge-shaped, and focal nephrograms. The change in serum creatinine from baseline to 24 h was significantly greater (p = 0.031) in the global nephrogram group. The presence of cirrhosis, Child-Pugh score, procedure time, baseline renal insufficiency, and lower periprocedural mean arterial blood pressure were also statistically significantly associated with the occurrence of bilateral globally dense nephrograms. The procedure time was statistically significantly associated with the occurrence of wedge-like focally persistent nephrograms. Global, persistently dense nephrograms and wedge-shaped focally persistent nephrograms are not infrequently observed after TACE. Persistent global nephrograms can be an important clinical indicator of ARF. The wedge nephrogram may represent focal renal ischemia.

Persistent CT nephrograms following cardiac catheterisation and intervention: initial observations

“…On the other hand, Jakobsen et al [ 24 ] demonstrated persistence of the cortical nephrogram by sequentially timed delayed CT scans and postulated that retention of CM occurred in the proximal tubular cells and was greater for the nonionic dimer, iodixanol, in comparison with nonionic monomers. The HU levels we have observed and those reported by Yamazaki et al [ 11 ] and Monsky et al [ 12 ] are generally much higher. More than 98% of the iodixanol administered should be excreted within the first 24 h.…”

“…Monsky et al [ 12 ] described wedge-shaped or linear peripheral nephrograms in 24-h delayed CT scans in 23.3% (14/60) of patients having undergone TACE and found a statistically significant ( P = 0.029) relationship with procedure time. These authors postulated that these foci represent segmental ischemia and trapped CM in the tubular lumen.…”

“…(No focal CT nephrograms reported) ↑SCr, Cr Cl and urinary biomarkers LOCM, LOCM ionic dimer Yamazaki et al (2001) [ 11 ] Delayed CT cortical enhancement 16–21 h after TACE in 81/180 (45%) and nephropathy in 11/180 (6%) of treatments. Minimal cortical retention >50 HU and severe retention >100 HU ↑SCr ≥44 μmol/l or ≥25% HOCM, LOCM, LOCM ionic dimer Monsky et al (2009) [ 12 ] CT renal nephrograms 24 h post TACE in 14/60 (23.3%) treatments. Global nephrograms associated with significant ( p = 0.031) change in SCr at 24 h. (Delayed segmental nephrograms associated with procedural factors) ↑SCr at 24 h and 24 h from baseline pre-TACE values IOCM and LOCM ↑SCr increase in serum creatinine, μmol/l micromol per liter, CrCl creatinine clearance, HOCM high osmolar contrast media, LOCM low osmolar contrast media, IOCM iso-osmolar contrast media, HU Hounsfield units, CECT contrast-enhanced CT, TACE transarterial chemoembolisation …”

“…Focal, segmental nephrograms on delayed CT scans have been uncommonly reported, but are believed to be a possible indication of AKI, related to focal renal ischemia. Yamazaki et al [ 11 ] and Monsky et al [ 12 ] observed segmental, wedge-shaped nephrograms, as well as global nephrograms on delayed CT scans following transarterial chemoembolisation (TACE), with the global nephrograms being associated with AKI. Monsky et al [ 12 ] postulated that the delayed CT segmental nephrograms could represent foci of renal injury secondary to renal emboli related to the catheterisation procedure itself.…”

A Short Review of Some Medicinal Plants And Phytocompounds With Hypotensive And Hypoglycemic Activities

“…Extracts of leaves and stems of Petiveria alleaceae showed over 60% reduction in blood glucose concentration one hour after oral administration in male Balb/c mice which had been fasted for 48 hours [21,31,32].…”