Use of gadolinium-based contrast agents and MRI protocols: SFNR Guidelines
Written By : Medha Baranwal
Medically Reviewed By : Dr. Kamal Kant Kohli
Published On 2021-01-22 12:30 GMT | Update On 2021-01-23 06:49 GMT
- For cerebral venous thrombosis, GBCA is systematic with the standard dose. Phase-contrast MR-venography can be an alternative in patients with strong contra-indication for GBCAs or refusing injections (pregnancy, lactation, other).
- In patients with multiple sclerosis, GBCA administration is recommended in the following situations: (A) at the time of diagnosis to evaluate diagnostic criteria and highlight the temporal dissemination; (B) if a previous MRI is not available to assess lesion burden progression; (C) when a new treatment is started and six months thereafter; (D) in case of a clinical or FLAIR relapse; and (E) when progressive multifocal leukoencephalopathy (PML) is suspected.
- In patients with multiple sclerosis, GBCA injection is not recommended in the absence of imaging, clinical, or treatment modification.
- In patients with chronic headache, GBCA administration is not recommended, except when other sequences show evidence of a pathological process requiring contrast-enhanced characterization.
- In patients with intracranial infection, GBCA injection is recommended to search for parenchymal and meningeal enhancement, brain injury, and related complications.
- For patients with intra-axial tumors, GBCAs are systematic for the diagnosis, as well as during follow-up under or after treatment.
- GBCA injection is systematic for the screening for meningioma under or after treatment with cyproterone acetate.
- GBCA injection is systematic for the initial diagnosis of extra-axial tumors, but can be waived on a case-by-case basis for stable benign processes.
- GBCA injection is systematic for the postoperative assessment of extra-axial tumors.
- GBCAs injection is systematic for the initial workup of vestibular schwannomas.
- GBCA injection can be waived in patients with stable followed-up or treated schwannoma, evaluated with high-resolution T2-W sequences.
- The diagnosis of pituitary microadenoma requires GBCA injection.
- A non-operated macroadenoma may be followed with unenhanced sequences.
"Consensus Guidelines of the French Society of Neuroradiology (SFNR) on the use of Gadolinium-Based Contrast agents (GBCAs) and related MRI protocols in Neuroradiology," is published in the Journal of Neuroradiology.
DOI: https://www.sciencedirect.com/science/article/pii/S0150986120301978
Login or Register to read the full article
France: The French Society of Neuroradiology (SFNR) has released recent guideline on the use of gadolinium-based contrast agents and related MRI protocols in neuroradiology.
Gadolinium-based contrast agents (GBCAs) are used in up to 35% of magnetic resonance imaging (MRI) examinations and are associated with an excellent safety profile. Nevertheless, two main issues have arisen in the last two decades: the risk of nephrogenic systemic fibrosis and the risk of gadolinium deposition and retention.
The consensus guideline, published in the Journal of Neuroradiology, reviews the different categories of GBCAs available in neuroradiology, their issues, and provides updates regarding the use of these agents in routine daily practice.
Key recommendations include:
- High nephrogenic systemic fibrosis (NSF) risk GBCAs are strictly not to be used in Neuroradiology.
- Intermediate NSF risk GBCAs are strictly not to be used in Neuroradiology.
- Low NSF risk GBCAs, namely Gadoterate meglumine, Gadobutrol, and Gadoteridol should be used for neuroimaging.
- Standard GBCA dose for neuroimaging is 0.1 mmol/kg body weight (BW).
- EGFR assessment is not mandatory before GBCA injection.
- In patients with no residual renal function (anuric), enhanced computed tomography (CT) is preferred to enhanced MRI if diagnostic performances are similar.
- When repeat GBCA injections are mandated by an acute clinical context, a minimum of 4 hours between injections is recommended, extended to 7 days in patients with an eGFR < 30 ml/min/1.73m2, and to the newborn and infant under 1 year of age.
- In pregnant women, GBCAs injection should be used only when deemed clinically necessary and non-postponable to after the pregnancy.
- In lactating women, GBCA injection should be used only when deemed clinically necessary and non-postponable to after the lactation period.
- In the context of acute ischemic stroke, GBCA use is not systematic and should be reserved for penumbral imaging using perfusion-weighted sequences, and for the pre-therapeutic evaluation of revascularization strategies on a case-by-case approach.
- Non-contrast MR-Time of Flight Angiography should be favored for the evaluation of intracranial arterial occlusion.
- Supra-aortic trunk MR-Angiography with GBCA injection can be performed as part as the initial MR exam in patients with a suspectedtransient ischemic attack.
- GBCA injection and intracranial vascular imaging are systematic in the work-up of a patient with ICH to search for an underlying etiology, except when the patient strictly meets criteria for hypertensive microangiopathy (deep hemorrhage, > 65 y.o., hypertension, and other hypertension end-organ stigmata).
Our comments section is governed by our Comments Policy . By posting comments at Medical Dialogues you automatically agree with our Comments Policy , Terms And Conditions and Privacy Policy .
Disclaimer: This site is primarily intended for healthcare professionals. Any content/information on this website does not replace the advice of medical and/or health professionals and should not be construed as medical/diagnostic advice/endorsement/treatment or prescription. Use of this site is subject to our terms of use, privacy policy, advertisement policy. © 2024 Minerva Medical Treatment Pvt Ltd