Patients who underwent CT with or without contrast had similar rates of acute kidney injury, showing contrast use isn’t associated with nephropathy.
Researchers have found similar rates of acute kidney injury among patients who underwent computed tomography with or without contrast material, indicating that the use of contrast was not associated with an increased risk for nephropathy.
“Intravenous contrast material used in a large percentage of [CT] scans is commonly withheld in patients with even mild renal impairment because of the concern for contrast-induced nephropathy,” said Jennifer S. McDonald, PhD, of the Mayo Clinic, Rochester, Minn, author of the new retrospective analysis. “This practice can often result in compromised diagnostic accuracy of the scan.”
According to McDonald, previous studies examined contrast-induced nephropathy, but few included control groups of patients that were not given contrast material. Therefore, these studies could not differentiate between contrast-induced nephropathy and other, contrast-independent causes of renal injury.
“The incidence and severity of contrast-induced nephropathy from intravenous administration of contrast material appear to have been overestimated by prior uncontrolled contrast-induced nephropathy studies,” McDonald told Diagnostic Imaging. “Our findings promote a more liberalized use of contrast material in patients where diagnostically indicated.”
McDonald and colleagues had previously conducted a meta-analysis and systematic review in which they identified 13 controlled contrast induced nephropathy studies. All patients from those studies were included in this study, which was published in Radiology.
A total of 12,508 propensity score-matched patients with contrast-enhanced and unenhanced scans between 2000 and 2010 were included. The researchers stratified the patients according to their baseline estimated glomerular filtration rate (eGFR). They defined acute kidney injury as an increase in serum creatinine of 0.5 mg/dL or greater.
After propensity score matching, the researchers identified a significantly increased incidence of acute kidney injury with a decreasing eGFR in both the contrast enhanced and non-enhanced groups. Patients with an eGFR of 30 mL/min/1.73 m2 or lower had a 14 percent risk for injury; whereas, patients with an eGFR of 90 mL/min/1.73 m2 had a risk of only 1 percent.
No significant difference in risk for acute kidney injury was found between contrast-enhanced and non-enhanced patients for any of the eGFR subgroups:
“If contrast-induced nephropathy exists, it is likely rare and difficult to distinguish from contrast material-independent causes of renal injury,” McDonald said. “Future studies should include control groups of patients not administered contrast material in order to better characterize the true risk of contrast-induced nephropathy.”
A Victory for Radiology: New CMS Proposal Would Provide Coverage of CT Colonography in 2025
July 12th 2024In newly issued proposals addressing changes to coverage for Medicare services in 2025, the Centers for Medicare and Medicaid Services (CMS) announced its intent to provide coverage of computed tomography colonography (CTC) for Medicare beneficiaries in 2025.
The Reading Room: Artificial Intelligence: What RSNA 2020 Offered, and What 2021 Could Bring
December 5th 2020Nina Kottler, M.D., chief medical officer of AI at Radiology Partners, discusses, during RSNA 2020, what new developments the annual meeting provided about these technologies, sessions to access, and what to expect in the coming year.
ACR Collaborative Model Leads to 35 Percent Improvement with Mammography Positioning Criteria
July 1st 2024Noting significant variation with facilities for achieving passing criteria for mammography positioning, researchers found that structured interventions, ranging from weekly auditing of images taken by technologists to mechanisms for feedback from radiologists to technologists, led to significant improvements in a multicenter study.
New Study Shows Non-Radiologists Interpreting 28 Percent of Imaging for Medicare Patients
June 28th 2024While radiologists interpreted approximately 99 percent of all non-cardiac CT, MRI and nuclear medicine studies in hospital and emergency department settings for Medicare beneficiaries, new research shows significantly less radiologist review of cardiac imaging and office-based imaging.