Diagnostic imaging matters


Fulvio Stacul MD


Chairman of the Department of Radiology, Ospedale Maggiore, Azienda Ospedaliero-Universitaria “Ospedali Riuniti di Trieste”, Trieste, Italy


Over the past decade, hundreds of papers dealing with contrast-induced nephropathy (CIN) have been published, adding new information to this complex field. While the clinical importance of the condition is clear, significant uncertainty remains about the best definition for CIN, its pathogenesis and the strategies for its prevention. Vacuolisation has been discussed extensively in the literature in connection with CIN for many years, but now appears to be poorly related to renal toxicity. Furthermore, significant differences between contrast media viscosities do not appear to be correlated with differences in renal toxicity. There is no question that preclinical studies are important; however, as argued in this issue of Diagnostic Imaging Matters, the best way to measure the nephrotoxicity of any given contrast medium is in a well designed clinical trial in humans. It is here that the radiological community needs to concentrate its efforts. Finally, as a clinical radiologist, I am convinced that we need to focus less on slight serum creatinine changes, which can represent physiological fluctuations of this parameter, as trial endpoints and more on serious clinical outcomes, especially long-term clinical outcomes, such as the need for renal replacement therapy.


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