Current Status of Gadolinium Toxicity in Patients with Kidney Disease

Perazella, Mark A.

doi:10.2215/cjn.06011108

Cited by 235 publications

(158 citation statements)

References 43 publications

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“…ICD artifacts and the risk of nephrogenic systemic fibrosis present further challenges (5,12). Alternatively, CT has the potential for comprehensive scar evaluation (13), but inconsistent delayed enhancement in chronic infarcts, associated contrast nephropathy, and metal artifacts limit its current application.…”

Section: Anatomic Scar Imagingmentioning

confidence: 99%

Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Tian¹,

Smith²,

Ahmad³

et al. 2012

J Nucl Med

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The integration of myocardial scar models in 3-dimensional (3D) mapping systems may provide a novel way of helping to guide ventricular tachycardia (VT) ablations. This study assessed the value of 201 Tl SPECT perfusion imaging to define ventricular myocardial scar areas and to characterize electrophysiology voltage-derived myocardial substrate categories of scar, border zone (BZ), and normal myocardium regions. Scar and BZ regions have been implicated in the genesis of ventricular arrhythmias. Methods: Ten patients scheduled for VT ablation underwent 201 Tl SPECT before the ablation procedure. 3D left ventricular (LV) scar models were created from the SPECT images. These scar models were registered with the LV voltage maps and analyzed with a 17-segment cardiac model. Scar location and scar burden were compared between the SPECT scar models and voltage maps. In addition, 201 Tl SPECT uptake was quantified using a 68-segment cardiac model and compared among voltage-defined scar, BZ, and normal segments. Results: 3D models of LV myocardium and scar were successfully created from 201 Tl SPECT images and integrated in a clinical mapping system. The surface registration error with the electrophysiology voltage map was 4.4 6 1.0 mm. The 3D scar location from SPECT matched in 72% of the segments with the voltage map findings. All successful ablation sites were located within the SPECTdefined scar or within 1 cm of its border, with 73% of the successful ablation sites within 1 cm of the scar border. Voltage measurements in SPECT-defined scar and normal areas were 1.2 6 1.7 and 3.4 6 2.8 mV, respectively (P , 0.001). The fractional SPECT scar burden area (18.8% 6 5.2%) agreed better with the abnormal (scar plus BZ) voltage area (20.8% 6 15.7%) than with the scar voltage area (5.8% 6 5.8%). Mean normalized 201 Tl uptake was 55% 6 21% in the voltage-defined scar, 63% 6 20% in BZ, and 79% 6 17% in normal myocardial segments (P , 0.05 for scar or BZ vs. normal). Conclusion: 3D SPECT surface models of LV scar were accurately integrated into a clinical mapping system and predicted endocardial voltage-defined scar. These preliminary data support the possible use of widely available 201 Tl SPECT to facilitate substrateguided VT ablations. Pat ients with internal cardiac defibrillators (ICD) may present with frequent shocks for ventricular tachycardia (VT) that are an appropriate response to the arrhythmia. Radiofrequency ablation of VT is required in many of these patients because of the side effects and decreasing longterm efficacy of antiarrhythmic medications. A substrateguided approach is required in 60%-90% of patients because of the multiple morphologies and hemodynamic intolerance of VT (1,2). In these approaches, linear ablation lines are placed across and along the myocardial scar and its border zone (BZ) to interrupt conducting channels of surviving myocardium (1,3,4). The current gold standard of scar delineation consists of voltage mapping, which is limited by catheter contact, mapping density, and inability to ...

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Section: Anatomic Scar Imagingmentioning

confidence: 99%

Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Tian¹,

Smith²,

Ahmad³

et al. 2012

J Nucl Med

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“…The warnings for gadolinium contrast agents have recently been updated and three agents are currently contraindicated in patients with AKI or with chronic renal impairment and a GFR < 30 ml/min. The other agents do not have this contraindication although extensive precautions are still advised [45]. …”

Section: Magnetic Resonance Imagingmentioning

confidence: 99%

Measurement of kidney perfusion in critically ill Patients

2013

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“…Th e warnings for gadolinium contras t agents have recently been updated and three agents are currently contraindicated i n patients with AKI or with chronic renal impairment and a GFR < 30 ml/min. Th e other agents do not have this contraindication although extensive precautions are still advised [45].…”

Section: Contrast-enhanced Mri Mod Alitiesmentioning

confidence: 99%

Measurement of Kidney Perfusion in Critically Ill Patients

Schneider

Goodwin

Bellomo

2013

Annual Update in Intensive Care and Emergency Medicine 2013

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Acute kidney injury (AKI) is a major complication of critical illness [1] occurring in 30 to 40 % of all critically ill patients and in its sev ere form requires renal replacement therapy (RRT), in approximately 5 % of patients [2]. AKI has been s hown to be an independent predictor for mortality [3] and is associated with invasive therapy and substantial costs [4].Despite its impor tance, the pathoph ysiology of AKI is still poorly understood. AKI is most commonly associated with systemic diseases, such as septic shock, major surgery and cardiogenic shock [1], but a specifi c mechanism causing AKI to develop in specifi c patients can rarely be determined. Since the early description of an "acute uremia syndrome" in crush injury victims during World War II [5,6] and its association with histopathological fi ndings similar to those found in experimental renal artery ligation, ischemia or some form of alteration in renal blood fl ow has been thought to play a pivotal role in the pathogenesis of AKI. Th is paradigm that essentially all AKI in critically ill patients is the result of some form or degree of ischemia remains of continuing conceptual dominanc e to this day [7]. Despite such dominance, there are only very limited data supporting this concept. In a recent systematic review, Prowle et al. [8] highlighted the extraordinary fact that renal blood fl ow measurement, irrespective of the technique used, has only been reported in 46 critically ill patients (fi ve studies) within the last sixty years. Th us, our knowledge, understanding, and theoretical constructs regarding global renal perfu sion in critically ill patients with RRT-treated AKI (an estimated 5 % of all ICU admissions for a total of approximately a quarter of a million such patients each year in developed countries alone) is, like an inverted pyramid, based on extremely weak evidence.Furthermore, given the complex and heterogeneous nature of the renal vasculature, evaluating the fl ow in the main renal arteries (macrocirculation) might not provide suffi cient information to adequately understand perfusion alterations in complex diseases, such as septic or cardio genic shock. Indeed, some pathophysiological processes may be associated with increased global renal blood fl ow [9,10] despite loss of f un ction. In such instances, there is experimental evidence that, at least in sepsis, this phenomenon may be caused by intra-renal shunting [11]. Hence, correlation between macroscopic renal blood fl ow and function is far from linear. Th erefore, techniques allowing the study of microcircu latory parameters, such as cortico-med ullary perfusion ratio and regional tissue oxygenation measurement, and assessment of their relative change over time may be more valuable in increasing our understanding of the pathophysiology of AKI.In this state-of-the art review, we discuss the value, challenges, limitations, safety and feasibility of diff erent techniques for the measurement of kidney perfusion in critically ill patients. Th e advantages of each technique wi...

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Current Status of Gadolinium Toxicity in Patients with Kidney Disease

Cited by 235 publications

References 43 publications

Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Integration of 3-Dimensional Scar Models from SPECT to Guide Ventricular Tachycardia Ablation

Measurement of kidney perfusion in critically ill Patients

Measurement of Kidney Perfusion in Critically Ill Patients

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