Use of gadolinium-based contrast agents and MRI protocols: SFNR Guidelines

• 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