Evaluation of Visibility of Celiac and Renal Arteries on Digital Subtraction Angiography Using Iodine, Gadolinium and Carbon dioxide Contrast Agents: A Porcine Experimental Study

Purpose: To examine the differences in visibility of celiac, renal arteries and nephrogram on digital subtraction angiography (DSA) among 3 different contrast agents in a porcine model. Methods: Six swine underwent percutaneous catheterization and DSA. Celiac and bilateral renal DSA angiograms with iodine, gadolinium and CO2 were obtained by the same injection protocols for each swine. The arterial diameter, contrast enhancement and renal density were measured using the Image-J software. Assessment of visual quality of iodine, gadolinium and CO2 images was done by 3 observers using a four-point grading scale. The Wilcoxon test was used to analyze among 3 contrast agents. Results: The diameters of the main celiac/renal arteries were the largest on iodine-DSA (4.60 ± 0.65 mm/5.08 ± 0.77 mm), and larger on gadolinium-DSA (4.26 ± 0.54 mm/4.76 ± 0.71 mm) than CO2-DSA (3.33 ± 0.37 mm/3.48 ± 0.77 mm). The arterial enhancement of the main celiac/renal arteries was the highest on iodine-DSA(332 ± 59/353 ± 68) and higher on gadolinium-DSA (113 ± 21/122 ± 31) than CO2-DSA (39 ± 14/37 ± 14). The nephrogram was denser on iodine-DSA (139 ± 13) than gadolinium-DSA (29 ± 5). Although visual quality was diagnostic on all DSA, iodine-DSA (mean celiac renal artery scores: 1.27 and 1.33) was the best, and gadolinium-DSA (mean celiac and renal artery scores: 1.83 and 1.71) was better than CO2-DSA (mean celiac and renal artery scores: 2.88 and 2.95). These differences were all significant (P < 0.05). Conclusion: Although gadolinium and CO2 can be used as an alternative to iodine, the differences in image quality among them should be kept in mind when the diameters of visceral arteries, enhancement and nephrogram are assessed for diagnosis and therapeutic intervention.