Clinical factors associated with dense and wedge-shaped nephrograms detected 24 h after chemoembolization

Wayne L. Monsky, Anokh Pahwa, Chin-Shang Li, Richard W Katzberg

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

This investigation aimed to evaluate patient characteristics and procedural factors associated with abnormal nephrograms encountered on noncontrast computed axial tomography (CAT) obtained 24-h after transarterial chemoembolization (TACE) for primary and metastatic hepatic malignancies. Sixty hepatic chemoembolization procedures were performed in 29 patients who had a median age of 63 years (range 42-79). The male-to-female ratio was 16:13. Noncontrast CAT scans were obtained approximately 24 h after TACE as part of our institutional protocol and were examined for persistent renal nephrograms. These findings were compared with clinical and procedural parameters to determine whether there was any association with these factors or with the occurrence of acute renal failure (ARF). Abnormally persistent CAT nephrograms were observed 24 h after 28 of 60 (46.7%) TACE procedures, of which 14 (23.3%) were persistent, bilaterally dense, global nephrograms, and 14 (23.3%) were small, wedge-shaped, and focal nephrograms. The change in serum creatinine from baseline to 24 h was significantly greater (p = 0.031) in the global nephrogram group. The presence of cirrhosis, Child-Pugh score, procedure time, baseline renal insufficiency, and lower periprocedural mean arterial blood pressure were also statistically significantly associated with the occurrence of bilateral globally dense nephrograms. The procedure time was statistically significantly associated with the occurrence of wedge-like focally persistent nephrograms. Global, persistently dense nephrograms and wedge-shaped focally persistent nephrograms are not infrequently observed after TACE. Persistent global nephrograms can be an important clinical indicator of ARF. The wedge nephrogram may represent focal renal ischemia. .

Original languageEnglish (US)
Pages (from-to)1193-1201
Number of pages9
JournalCardioVascular and Interventional Radiology
Volume32
Issue number6
DOIs
StatePublished - Nov 2009

Fingerprint

Tomography
Acute Kidney Injury
Arterial Pressure
Kidney
Liver
Renal Insufficiency
Creatinine
Fibrosis
Ischemia
Serum
Neoplasms

Keywords

  • Chemoembolization
  • Interventional radiology
  • Kidney
  • Kidney injury
  • Kidney nephrograms
  • MDCT

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Clinical factors associated with dense and wedge-shaped nephrograms detected 24 h after chemoembolization. / Monsky, Wayne L.; Pahwa, Anokh; Li, Chin-Shang; Katzberg, Richard W.

In: CardioVascular and Interventional Radiology, Vol. 32, No. 6, 11.2009, p. 1193-1201.

Research output: Contribution to journalArticle

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abstract = "This investigation aimed to evaluate patient characteristics and procedural factors associated with abnormal nephrograms encountered on noncontrast computed axial tomography (CAT) obtained 24-h after transarterial chemoembolization (TACE) for primary and metastatic hepatic malignancies. Sixty hepatic chemoembolization procedures were performed in 29 patients who had a median age of 63 years (range 42-79). The male-to-female ratio was 16:13. Noncontrast CAT scans were obtained approximately 24 h after TACE as part of our institutional protocol and were examined for persistent renal nephrograms. These findings were compared with clinical and procedural parameters to determine whether there was any association with these factors or with the occurrence of acute renal failure (ARF). Abnormally persistent CAT nephrograms were observed 24 h after 28 of 60 (46.7{\%}) TACE procedures, of which 14 (23.3{\%}) were persistent, bilaterally dense, global nephrograms, and 14 (23.3{\%}) were small, wedge-shaped, and focal nephrograms. The change in serum creatinine from baseline to 24 h was significantly greater (p = 0.031) in the global nephrogram group. The presence of cirrhosis, Child-Pugh score, procedure time, baseline renal insufficiency, and lower periprocedural mean arterial blood pressure were also statistically significantly associated with the occurrence of bilateral globally dense nephrograms. The procedure time was statistically significantly associated with the occurrence of wedge-like focally persistent nephrograms. Global, persistently dense nephrograms and wedge-shaped focally persistent nephrograms are not infrequently observed after TACE. Persistent global nephrograms can be an important clinical indicator of ARF. The wedge nephrogram may represent focal renal ischemia. .",
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