SESSION TYPE: Non Pulmonary Critical Care Posters
PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM
PURPOSE: Introduction: Renal function is an established prognostic factor that influences survival in patients with end stage liver disease. Given the potential risk of contrast nephropathy associated with intravenous iodinated CT contrast, alternate contrast modalities for abdominal imaging in advanced cirrhosis need to be examined. Aim: The purpose of this study was to examine the renal safety of MRI with gadolinium during abdominal imaging in patients with advanced liver disease.
METHODS: The study involved a retrospective analysis of 260 cases of abdominal MRI with gadolinium in patients with end stage liver disease and without renal replacement therapy, at a single academic center during the period 2007 to 2010. For each case, a serum creatinine was noted prior to, and within a week after the MRI. The serum creatinine values before and after the MRI were compared for each case using a paired t-test. In addition, the cases were analyzed for sub-acute complications of nephrogenic systemic fibrosis (NSF), a reported complication of gadolinium in end stage renal disease.
RESULTS: The age of the patients ranged from 37 to 77 years, with 38% being female. The MELD score ranged from 7 to 33 (average MELD 15). The pre- MRI serum creatinine values ranged from 0.5 to 3.8 mg/dl, with 49 cases (19%) having values ≥ 1.5 mg/dl. A comparison of the pre and post MRI serum creatinine values did not demonstrate a statistically significant difference, including those cases with a pre-MRI serum creatinine > 1.5 mg/ dl. In addition, no cases of NSF were noted.
CONCLUSIONS: These observations suggest that MRI with gadolinium is a non-nephrotoxic imaging modality in end stage liver disease. Importantly, the renal safety of this modality extends to cases of advanced cirrhosis with concomitant renal insufficiency, in which contrast enhanced CT may be contraindicated due to the risk of CT contrast nephropathy.
CLINICAL IMPLICATIONS: Since renal function is an established prognostic factor that influences outcome in advanced cirrhosis, the renal safety of gadolinium as a contrast agent in cirrhosis may establish MRI as the preferred imaging modality in end stage liver disease.
DISCLOSURE: The following authors have nothing to disclose: Karl Langberg, Mohammad Asfari, Ram Subramanian
No Product/Research Disclosure InformationEmory University, Atlanta, GA