Multi-modal CT in acute stroke: wait for a serum creatinine before giving intravenous contrast? No!

Int J Stroke. 2015 Oct;10(7):1014-7. doi: 10.1111/ijs.12605. Epub 2015 Aug 26.


Background: Multi-modal CT (MMCT) to guide decision making for reperfusion treatment is increasingly used, but there remains a perceived risk of contrast-induced nephropathy (CIN). At our center, MMCT is used empirically without waiting for serum-creatinine (sCR) or renal profiling.

Aims: To determine the incidence of CIN, examine the risk factors predisposing to its development, and investigate its effects on clinical outcome in the acute stroke population.

Methods: An institution-wide protocol was implemented for acute stroke presentations to have MMCT (100-150 ml nonionic tri-iodinated contrast, perfusion CT and CT angiography) without waiting for serum-creatinine to minimize delays. Intravenous saline is routinely infused (80-125 ml/h) for at least 24-h after MMCT. Serial creatinine levels were measured at baseline, risk period, and follow-up. Renal profiles and clinical progress were reviewed up to 90 days.

Results: We analyzed 735 consecutive patients who had MMCT for the evaluation of acute ischemic or hemorrhagic stroke during the last five-years. A total of 623 patients met the inclusion criteria for analysis: 16 cases (2·6%) biochemically qualified as CIN; however, the risk period serum-creatinine for 15 of these cases was confounded by dehydration, urinary tract infection, or medications. None of the group had progression to chronic kidney disease or required dialysis.

Conclusions: The incidence of CIN is low when MMCT is used routinely to assess acute stroke patients. In this population, CIN was a biochemical phenomenon that did not have clinical manifestations, cause chronic kidney disease, require dialysis, or negatively impact on 90-day mRS outcomes. Renal profiling and waiting for a baseline serum-creatinine are an unnecessary delay to emergency reperfusion treatment.

Keywords: CT angiography; acute stroke imaging; contrast nephropathy; multimodal CT perfusion; renal failure; stroke.

MeSH terms

  • Administration, Intravenous
  • Aged
  • Aged, 80 and over
  • Brain / diagnostic imaging
  • Contrast Media / administration & dosage
  • Creatinine / blood*
  • Decision Making*
  • Female
  • Glomerular Filtration Rate
  • Humans
  • Incidence
  • Kidney Diseases / epidemiology
  • Kidney Diseases / etiology
  • Male
  • Middle Aged
  • Radiography
  • Risk Factors
  • Stroke / blood*
  • Stroke / diagnostic imaging*
  • Stroke / epidemiology
  • Tomography Scanners, X-Ray Computed*


  • Contrast Media
  • Creatinine