Effect of iodinated contrast media on renal perfusion: A randomized comparison study in pigs using quantitative contrast-enhanced ultrasound (CEUS)

Abstract

The administration of iodinated contrast media (CM) can cause microcirculatory disorder leading to acute renal dysfunction. In a prospective, randomized investigation two CM (Iodixanol vs Iopromide) were compared in 16 pigs. Each animal received 10 intra-aortal injections (5 ml Iodixanol or 4.32 ml Iopromide). Microcirculation was assessed using contrast-enhanced ultrasound (CEUS) directly on the kidney surface using time-to-peak (TTP) and blood-volume-analysis. Macroscopic observations were documented. Post mortem residual CM distribution in the kidneys was detected using X-ray. TTP was significantly prolonged over the descending vasa recta of the Iopromide group. This coincided with a visible marble-like pattern on the kidney surface occurring in 30 out of 80 Iopromide-injections but in 4 out of 80 Iodixanol-injections (p = 0.007). The blood volume over the entire kidney did not change after Iodixanol-application, but decreased by about 6.1% after Iopromide-application. The regional blood volume in the renal cortex showed a tendency to decrease by about 13.5% (p = 0.094) after Iodixanol-application, and clearly decreased by about 31.7% (p = 0.022) after Iopromide-application. The study revealed a consistent influence of repeated injections of two different CM on the kidney perfusion using three different imaging methods (CEUS analysis, macroscopic observation and X-ray analysis).

Histological and SEM Assessment of Blood Stasis in Kidney Blood Vessels after Repeated Intra-Arterial Application of Radiographic Contrast Media

“…This was in line with another animal study in which could be shown that iodinated CM deteriorate the oxygen tension in the renal cortico-medullary region of pigs [18]. The studies [15,17,18] have been conducted within the same animal cohort of the presented study according to the 3R principle (refinement, reduction, and replacement).…”

“…This had been demonstrated before also in a clinical study [16]. The pig study revealed a transient stasis of the renal microcirculation in different kidney regions, which was more pronounced after administration of Iopromide vs. Iodixanol [17]. This was in line with another animal study in which could be shown that iodinated CM deteriorate the oxygen tension in the renal cortico-medullary region of pigs [18].…”

“…A decrease of perfusion in porcine myocardium has, furthermore, been reported following CM injection into the left coronary artery [22]. Finally, a decrease of perfusion in the renal vasculature following repeated CM injections into the supra-renal aorta has been observed within in the same cohort of animals of the presented study [17]. As a possible reason for the CM-induced impairment of kidney perfusion, a constriction of the medullary vasa recta has been discussed [23], and this could be intensified by the formation of echinocytes [24][25][26][27][28][29][30] or by the buckling of endothelial cells [31].…”

“…This potential mechanism, however, has not been examined to date. Therefore, we investigated the kidneys from those animals that had been examined in vivo in the study reported by Lamby et al [17]. Histological and complementary scanning electron microscopy (SEM) analyses were conducted to determine whether CM are able to induce stasis and/or the formation of thrombi in the renal vasculature following repeated supra-renal intra-aortal injections of two different CM.…”

Contrast enhanced ultrasonography (CEUS) to detect abdominal microcirculatory disorders in severe cases of COVID-19 infection: First experience

“…Although hemodynamic assessment by CCDS remains indispensable, CEUS allows a rapid and clear evaluation of arterial and venous organ perfusion of the liver, kidneys, spleen and mesentery. Small areas of reduced microvascularization or early infarctions of the kidneys are not visible in fundamental B-mode, but clearly detectable using dynamic CEUS [8,17].…”