Interventional uroradiologic procedures performed using gadodiamide as an alternative to iodinated contrast material

Exploring Gadolinium-Based Contrast Media for Retrograde Pyelography in the Context of Iodine Allergy

Iodinated contrast media can rarely cause severe allergic reactions during nonvascular urologic imaging procedures. Alternatives like gadolinium-based contrast may help mitigate this risk in susceptible patients. A 66-year-old woman with a documented iodine allergy presented with an obstructing stone in the right ureter. To avoid the risk of an allergic reaction, the decision was made to use an alternative non-iodinated contrast agent for retrograde pyelography prior to ureteral stent placement. Gadobenate dimeglumine, an MRI contrast agent, was diluted 50:50 with saline and utilized successfully to provide adequate opacification for safe stent placement without adverse reaction. The patient underwent repeat pyelography with gadobenate dimeglumine one month later during ureteroscopy without complication. This case demonstrates that diluted gadobenate can serve as an effective alternative to iodinated contrast media in patients at high risk of reaction to iodine-containing agents. While severe reactions to iodinated contrast are uncommon in nonvascular urologic procedures, they can still occur even with premedication. Gadolinium-based agents have been reported to provide sufficient opacification for most urologic interventions, though inferior radiographically to iodinated contrast. Further study on gadolinium efficacy and safety in this setting is warranted. However the present case supports gadobenate dimeglumine as a viable option for retrograde pyelography when allergy risk precludes iodinated contrast use.

[Use of gadolinium as contrast agent in endoscopic retrograde cholangiopancreatography in patients with iodine allergy]

INTRODUCTION

Radiologic contrasts are required during endoscopic retrograde cholangiopancreatography (ERCP). The most frequently used are iodine-based contrast media. Controversy still surrounds the optimal strategy in patients with previous adverse reactions to iodine contrasts that need to undergo an ERCP.

OBJECTIVE

To evaluate the safety and efficacy of a gadolinium-derived contrast medium in patients with previous reactions to iodine-derived agents during ERCP.

MATERIAL AND METHODS

Thirteen ERCP were performed in 11 patients with well-established adverse reactions to iodine compounds. ERCP was carried out with gadobutrol, a non-ionic gadolinium compound and without prophylaxis.

RESULTS

In all patients, ERCP were satisfactorily completed. Thirteen cholangiograms and one pancreatogram were obtained. All procedures were technically successful, allowing diagnosis and endotherapy. The quality of the images was good, similar to those obtained with standard contrast media, and did not represent a limitation. No contrast-related adverse events were observed, and there were no post-ERCP complications.

CONCLUSIONS

Gadolinium-derived agents are a safe and effective alternative in iodine-allergic patients.

Gadolinium-based contrast agents in angiography and interventional radiology

Gadolinium is useful as an alternative contrast agent for diagnostic angiographic and interventional procedures in patients with renal insufficiency or a history of a severe reaction to iodinated contrast material. Gadolinium usually is used as a "problem solver" to answer specific diagnostic questions or guide interventional procedures that cannot adequately be defined with CO2 angiography. Because of dose limitations with Gd, careful planning is required prior to its use with angiography or interventional procedures.

Percutaneous carotid angioplasty and stenting with the use of gadolinium in lieu of iodinated contrast medium: technical case report and review of the literature

OBJECTIVE AND IMPORTANCE

We describe a patient who underwent percutaneous transluminal carotid angioplasty and stent placement with the use of intra-arterial gadolinium (Gd-DTPA) instead of iodinated contrast medium. This represents one of the first published reports of the use of Gd-DTPA as an angiographic contrast agent for an interventional neuroradiological procedure.

CLINICAL PRESENTATION

A 75-year-old man with renal insufficiency and multiple comorbidities developed amaurosis fugax. Doppler examination revealed high-grade stenosis of the right internal carotid artery.

INTERVENTION

The patient underwent percutaneous transluminal balloon angioplasty with endovascular stent placement for 95% narrowing of the proximal right internal carotid artery. Because of his impaired renal function, the procedure was performed with the use of Gd-DTPA as the sole contrast agent. Approximately 60 ml of contrast medium (twice the volume typically used for a magnetic resonance imaging study) was used. There were no neurological, renal, or other complications.

CONCLUSION

Intra-arterially administered Gd-DTPA may be substituted for iodinated contrast agents in complex neuroendovascular procedures. This capacity expands the armamentarium for interventional neuroradiological procedures.

Gadolinium contrast agents: their role in vascular and nonvascular diagnostic angiography and interventions

Gadolinium-based contrast agents can be used for diagnostic and interventional angiographic procedures to reduce contrast-related nephrotoxicity or in patients with a history of severe allergic reaction to iodine-containing contrast material. These agents are best used in conjunction with CO(2) to complete nondiagnostic CO(2) angiograms and to monitor the progress of a percutaneous intervention. However, the total volume of gadolinium that can be administered, the reduced quality of gadolinium digital subtraction angiography images, and the increased cost of the gadolinium-based agents can limit their use.