PurposeThe Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.Areas covered in part 1Topics reviewed include the terminology used, the best way to measure eGFR, the definition of PC-AKI, and the risk factors for PC-AKI, including whether the risk with intravenous and intra-arterial contrast medium differs.Key Points• PC-AKI is the preferred term for renal function deterioration after contrast medium.• PC-AKI has many possible causes.• The risk of AKI caused by intravascular contrast medium has been overstated.• Important patient risk factors for PC-AKI are CKD and dehydration.

Topics reviewed include the history, clinical features and prevalence of nephrogenic systemic fibrosis and the current understanding of its pathophysiology. The risk factors for NSF are discussed and prophylactic measures are recommended. The stability of the different gadolinium-based contrast media and the potential long-term effects of gadolinium in the body have also been reviewed.

ObjectivesThe Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 2011 guidelines on the prevention of post-contrast acute kidney injury (PC-AKI). The results of the literature review and the recommendations based on it, which were used to prepare the new guidelines, are presented in two papers.Areas covered in part 2Topics reviewed include stratification of PC-AKI risk, the need to withdraw nephrotoxic medication, PC-AKI prophylaxis with hydration or drugs, the use of metformin in diabetic patients receiving contrast medium and the need to alter dialysis schedules in patients receiving contrast medium.Key points • In CKD, hydration reduces the PC-AKI risk • Intravenous normal saline and intravenous sodium bicarbonate provide equally effective prophylaxis • No drugs have been consistently shown to reduce the risk of PC-AKI • Stop metformin from the time of contrast medium administration if eGFR < 30 ml/min/1.73 m 2 • Dialysis schedules need not change when intravascular contrast medium is given

The results of this meta-analysis suggest that a low-dose CT protocol can be used as the initial imaging technique in the workup of patients with suspected urolithiasis.

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Coronary artery MDCT can reveal important findings and disease in extracardiac structures. Thus, the entire examination should be reconstructed with the maximum field of view and should be reviewed by a qualified radiologist.

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The purpose of this study was to evaluate the usefulness of morphological criteria in differentiating between benign and malignant lesions on MR-mammography. Fifty-three women (18-82 years) with 62 lesions scheduled for excisional biopsy underwent dynamic contrast-enhanced MR-mammography using fast 3D Gradient-Echo sequences in coronal orientation (axial orientation in seven patients). Histology revealed 44 malignant and 18 benign lesions. For each lesion, five radiologists evaluated four morphological features: lesion shape, irregularity of contour, homogeneity of contrast enhancement and presence of ring enhancement. For each feature a receiver operating characteristic (ROC) curve was generated with calculation of the area under the curve (AUC). Interobserver variability was evaluated by the kappa-coefficient. The most reliable morphological feature indicating malignancy was an irregular lesion contour with a sensitivity/specificity/AUC of 83%/76%/0.9 followed by inhomogeneous contrast enhancement (85%/42%/0.7) and the presence of ring enhancement (71%/53%/0.64). The average interobserver agreement for the different features ranged between 0.35 and 0.4. Morphological criteria are useful features in MR-mammography for differentiating between benign and malignant lesions. However, due to the relatively high interobserver variability, standardization of terminology is important.