Renal Safety of Gadolinium-based Contrast Media in Patients with Chronic Renal Insufficiency

Gadolinium-based contrast medium (CM) has been associated with contrast medium-induced nephropathy (CIN) in patients with advanced renal disease. However, the bio- and physiochemical properties of the gadolinium-chelates responsible for such nephrotoxicity have not been clearly defined.

In a review article in the March issue of Radiology (RSNA.org/radiology), Elena Ledneva, M.D., of Hôpital Pitié-Salpêtrière in Paris, and colleagues survey available clinical studies to clarify the effects of gadolinium-based CM on renal function. The authors specifically discuss:

Gadolinium chelates appear to be nonnephrotoxic as intravenous CM for MR examinations in subjects with normal renal function, as well as those with preexisting RI when used in doses similar to those recommended to MR imaging, Dr. Ledneva and colleagues conclude.

"However, deterioration in renal function may occur in the majority of cases after intraarterial administration of gadolinium-based CM used at doses higher than 0.2 mmol/kg for diagnostic or interventional angiographic procedures in patients with renal insufficiency," they write.

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Schatzker Classification of Tibial Plateau Fractures: CT and MR Imaging Improve Plain Radiographic Assessment

Although the Schatzker classification system for tibial plateau fractures is widely used to assess the initial injury, plan management and predict prognosis, studies have reported that initial Schatzker rankings and surgical plans based on plain radiographic findings were modified after preoperative CT or MR imaging.

Four-part fracture in a 41-year-old woman who was involved in an altercation. (a) Plain radiograph shows a split fracture of the lateral tibial plateau. Initially, the fracture was treated conservatively with absence of weight bearing. MR imaging was performed because of continued pain and swelling and clinical suspicion of a meniscal or ligamentous injury. (b) Sagittal proton-density–weighted MR image shows an unsuspected nondepressed four-part fracture of the tibial plateau. (c) Sagittal T2-weighted MR image shows contour irregularity and abnormal high signal intensity of the medial meniscus (arrow), findings compatible with a tear. (RadioGraphics 2009;29:585–597) © RSNA, 2009. All rights reserved. Printed with permission.

In an article in the March-April issue of RadioGraphics, (RSNA.org/radiographics), B. Keegan Markhardt, M.D., Jonathan M. Gross, M.D., and Johnny U.V. Monu, M.D., from the University of Rochester Medical Center, describe the added benefit of CT and MR imaging for correct characterization of tibial plateau fractures, discuss how fracture management and outcome change with each fracture type and detail the six types of the Schatzker classification system:

"CT and MR imaging are more accurate than plain radiography for Schatzker characterization and classification of tibial plateau fractures and use of cross-sectional imaging can improve surgical planning," the authors conclude.