Gadolinium-containing contrast media for radiographic examinations: a position paper

Thomsen, Henrik S.; Almén, Torsten; Morcos, Sameh K.

doi:10.1007/s00330-002-1628-3

Cited by 130 publications

(40 citation statements)

References 27 publications

(29 reference statements)

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“…These agents have similar biodistributions, pharmacokinetics and half-lives [1][2][3][4][5]. The biologic elimination of half-life of these agents is approximately 1.5 h; the plasma half-life increases in relation to the degree of renal insufficiency.…”

Section: Gadolinium Preparations and Pharmacokineticsmentioning

confidence: 96%

Actual clinical use of gadolinium-chelates for non-MRI applications

Strunk

Schild

2004

European Radiology

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For many years, alternatives to iodinated X-ray contrast media have been sought. Of the contrast media investigated to date, only CO(2) and the gadolinium-chelates have been shown to be viable alternatives for selected X-ray examinations. Therefore, we have reviewed the general literature and that specific for gadopentetate (Magnevist) in particular, since this agent has been studied the most. This review indicates that diagnostic CT examinations can be achieved following the intravenous administration of gadolinium-containing contrast media (CM) for evaluation of aortic abnormalities. Gadolinium-containing CM at the dose approved for MR imaging are not useful for CT evaluation of the abdominal parenchymal organs. Intravenous/intraarterial injections have also been used in a variety of angiographic and interventional procedures. Image quality, however, is generally inferior to iodinated contrast media. Gadolinium-containing CM require no special handling and can be administered by hand injection or via conventional angiographic automated injectors with the same flow rates and pressures as are used with iodinated contrast media. For CT, a peripheral bolus injection of a diluted gadolinium agent (1:1 with saline) of 60-90 ml at 3-5 ml/s is usually performed. Similar to all other gadolinium-chelates, the non-MRI use of gadopentetate (Magnevist) is not approved by regulatory agencies. However, the literature suggests that a dose of 0.3-0.4 mmol/kg b.w. has been safely administered for CT as well as for angiography and interventional procedures intravenously and intraarterially. Even at this dose, though, this results in a relatively small overall volume to be injected, which limits utility somewhat.

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Section: Gadolinium Preparations and Pharmacokineticsmentioning

confidence: 96%

Actual clinical use of gadolinium-chelates for non-MRI applications

Strunk

Schild

2004

European Radiology

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“…However, it was a previous misconception that the use of GDBCA was safe in patients with underlying renal insufficiency [2]. The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) did not approve GDBCA for radiographic examinations [3]. It was stated that GDBCA should not be used for radiographic examinations in patients with renal impairment and that these contrast agents are more nephrotoxic than iodinated contrast in equivalent radiographic attenuating doses.…”

Section: Discussionmentioning

confidence: 99%

“…In the past, gadolinium-based contrast agents (GDBCA) were used as alternative contrast agents for conventional angiography in patients with renal insufficiency on an off-label basis, although the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) did not approve GDBCA for radiographic examinations [2,3]. In a previous study, it was concluded that angiography and percutaneous treatment of renal artery stenosis in patients with chronic renal insufficiency and suspected ischaemic nephropathy can be performed safely using intra-arterial injections of GDBCA as contrast media without an increased risk of complications.…”

Section: Introductionmentioning

confidence: 99%

Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents

et al. 2009

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Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents Abstract Purpose: The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors. Methods: This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre-and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated. Results: Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44± 15.5 ml (range 15-60 ml) or 0.24+ 0.12 mmol/kg (range 0.1-0.53 mmol/ kg). At the time of angiography all patients had renal insufficiency (eGFR <60 ml/min/1.73 m 2 ). Mean eGFR pre-angiography was 26 ml/ min/1.73 m 2 and 33 ml/min/1.73 m 2 post-angiography. The mean followup period covers 28 months, range 1-84 months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF. Conclusion: Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO 2 angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients.

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“…In the 1990s, it was widely believed that the gadolinium based contrast media used for Magnetic resonance imaging (MRI) were not nephrotoxic and they were used for conventional angiography and some CT studies to protect the poorly functioning kidney from the nephrotoxicity of iodine based contrast media [11,12]. However, the nephrotoxic potential of the gadolinium based agents is now recognized [13,14].…”

Section: Contrast Induced Nephropathy (Cin))mentioning

confidence: 99%