Gadolinium-based Contrast Agents as an Alternative at Vena Cavography in Patients with Renal Insufficiency—Early Experience1
John A. Kaufman, MD,
Stuart C. Geller, MD,
Hasan Bazari, MD and
Arthur C. Waltman, MD
1 From the Division of Vascular Radiology (J.A.K., S.C.G., A.C.W.) and the Department of Medicine, Division of Nephrology (H.B.), Harvard Medical School, Massachusetts General Hospital, GRB 290, 55 Fruit St, Boston, MA 02114. Received April 30, 1998; revision requested July 6; revision received August 18; accepted December 15. Address reprint requests to J.A.K. (e-mail: kaufmanfamily@sprintmail.com).
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Figure 1a. Patient 5. IVC filter placement in an 86-year-old woman with deep venous thrombosis and a closed head injury, with use of diluted gadodiamide (GADO INJ) as a contrast agent. LT = left. (a) Digital subtraction inferior vena cavogram was obtained prior to (PRE FILTER) filter placement after injection of gadodiamide diluted 2:1 with normal saline solution at a rate of 15 mL/sec for 2 seconds through a 5-F pigtail catheter positioned at the confluence of the iliac veins. Contrast agent density is adequate. The renal veins (arrows) are readily identified. (b) Digital subtraction inferior vena cavogram was obtained through the filter delivery sheath with the same contrast agent and injection rates after placement (S/P FILTER) of the filter (arrow).
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Figure 1b. Patient 5. IVC filter placement in an 86-year-old woman with deep venous thrombosis and a closed head injury, with use of diluted gadodiamide (GADO INJ) as a contrast agent. LT = left. (a) Digital subtraction inferior vena cavogram was obtained prior to (PRE FILTER) filter placement after injection of gadodiamide diluted 2:1 with normal saline solution at a rate of 15 mL/sec for 2 seconds through a 5-F pigtail catheter positioned at the confluence of the iliac veins. Contrast agent density is adequate. The renal veins (arrows) are readily identified. (b) Digital subtraction inferior vena cavogram was obtained through the filter delivery sheath with the same contrast agent and injection rates after placement (S/P FILTER) of the filter (arrow).
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Figure 2a. Patient 13. IVC thrombolysis in a 49-year-old man with IVC thrombosis. (a) Digital subtraction inferior vena cavogram was obtained at 48 hours after thrombolysis by means of hand injection of 40 mL of CO2 through a 5-F pigtail catheter. A poorly defined mural filling defect (arrow) is depicted in the region of the right renal vein orifice. (b) Repeat digital subtraction inferior vena cavogram through the same catheter was obtained with undiluted gadodiamide at 20 mL/sec for 2 seconds. The residual thrombus (arrow) in the region of the right renal vein (a posterior structure) is better defined with the gadodiamide, which mixes with blood rather than displacing it. Note the apparent difference in caliber of the suprarenal IVC when compared with a as a result of anterior layering of CO2.
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Figure 2b. Patient 13. IVC thrombolysis in a 49-year-old man with IVC thrombosis. (a) Digital subtraction inferior vena cavogram was obtained at 48 hours after thrombolysis by means of hand injection of 40 mL of CO2 through a 5-F pigtail catheter. A poorly defined mural filling defect (arrow) is depicted in the region of the right renal vein orifice. (b) Repeat digital subtraction inferior vena cavogram through the same catheter was obtained with undiluted gadodiamide at 20 mL/sec for 2 seconds. The residual thrombus (arrow) in the region of the right renal vein (a posterior structure) is better defined with the gadodiamide, which mixes with blood rather than displacing it. Note the apparent difference in caliber of the suprarenal IVC when compared with a as a result of anterior layering of CO2.
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Copyright © 1999 by the Radiological Society of North America.
