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

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).