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. 2009 Nov;32(6):1193-1201.
doi: 10.1007/s00270-009-9692-6.

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

Wayne L Monsky  1 , Anokh Pahwa, Chin-Shang Li, Richard W Katzberg
Affiliations

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

Wayne L Monsky et al. Cardiovasc Intervent Radiol. 2009 Nov.

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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Figures

Fig. 1
Fig. 1
Noncontrast CAT image at baseline and at 24 h after TACE in a 76-year-old woman with hepatocellular carcinoma and cirrhosis. A Baseline preprocedural noncontrast abdominal CAT having attenuation values of 33.8 HU for the right renal parenchyma and 33.9 HU for the left renal parenchyma. B Noncontrast CAT image in the same patient 24 h after TACE shows globally dense bilateral nephrograms. There is distinct demarcation of dense cortex and medulla as well as vicarious excretion of contrast material in the gallbladder (small white arrows). Right kidney cortical attenuation (black ROI) is 211.2 HU and medullary attenuation (white ROI is 88.9 HU. Left kidney cortical attenuation (black ROI) is 215.5 HU and medullary attenuation (white ROI) is 87.9 HU
Fig. 2
Fig. 2
Noncontrast CAT scan 24 h after TACE in a 54-year-old man with insulinoma metastatic to the liver. Coronal (A) and axial (B) CAT images showing a focally dense, wedge-shaped nephrogram (arrows in both figures) in the lower pole of the right kidney
Fig. 3
Fig. 3
Graph depicting baseline and 24-h renal attenuation (in HU) for the combined versus the globally dense nephrogram groups. There is no difference in renal parenchyma attenuation at baseline; however, there is much greater cortical and medullary attenuation (p < 0.0001 for each) at 24 h compared with parenchymal attenuation in the combined group. Values shown are the means and SEMs
Fig. 4
Fig. 4
Graph depicting changes in SCr from baseline (before TACE) to 24- and 48-h after TACE in the globally dense nephrogram versus combined nephrogram groups. The increase in SCr for the globally dense group at 24 h after TACE was significantly greater (p = 0.031) than for the combined group. There was also a near statistical difference at 48 h after TACE. Values shown are means and SEMs
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