Waiting times between examinations with intravascularly administered contrast media: a review of contrast media pharmacokinetics and updated ESUR Contrast Media Safety Committee guidelines

Abstract

The pharmacokinetics of contrast media (CM) will determine how long safe waiting intervals between successive CT or MRI examinations should be. The Contrast Media Safety Committee has reviewed the data on pharmacokinetics of contrast media to suggest safe waiting intervals between successive contrast-enhanced imaging studies in relation to the renal function of the patient. Clinical relevance statement Consider a waiting time between elective contrast-enhanced CT and (coronary) angiography with successive iodine-based contrast media administrations in patients with normal renal function (eGFR > 60 mL/min/1.73 m2) of optimally 12 h (near complete clearance of the previously administered iodine-based contrast media) and minimally 4 h (if clinical indication requires rapid follow-up). Key Points • Pharmacokinetics of contrast media will guide safe waiting times between successive administrations. • Safe waiting times increase with increasing renal insufficiency. • Iodine-based contrast media influence MRI signal intensities and gadolinium-based contrast agents influence CT attenuation.

Ten years of gadolinium retention and deposition: ESMRMB-GREC looks backward and forward

“…Hepatobiliary GBCA has additional intracellular transient uptake and hepatic excretion into the biliary tree. In patients with severely reduced renal function (estimated glomerular filtration rate (eGFR) < 30 ml/min/1.73 m 2 ) this early elimination half-life can increase up to 30h [ 9 ], which can increase the likelihood of transmetallation. A review of pharmacokinetic data showed the presence of a deep compartment of distribution with long-lasting residual excretion.…”

The use of intravascular contrast media in patients with impaired kidney function – joint clinical practice position statement of the Polish Society of Nephrology and the Polish Medical Society of Radiology

“…The pharmacokinetics of ICM should determine the waiting intervals between successive CT or MRI examinations [ 59 ]. In patients with normal or moderately impaired renal function (eGFR > 30 ml/min/1.73 m 2 ), 75% of ICM is excreted within 4 hours of administration.…”

Iodine-based contrast media in contrast-enhanced mammography and dedicated breast computed tomography: is it necessary to assess renal function in all outpatients to prevent contrast-induced acute kidney injury?

“…A potential risk of contrast-enhanced imaging by using ICM is the occurrence of contrast-induced acute kidney injury (CI-AKI), characterized by a swift deterioration in renal function within days after intravascular exposure to ICM [5]. To minimize the potential for CI-AKI in CEM and dBCT, radiologists commonly utilize screening methods in line with those employed for any contrastenhanced CT examination, given the absence of specific guidelines for breast imaging.…”

“…To minimize the potential for CI-AKI in CEM and dBCT, radiologists commonly utilize screening methods in line with those employed for any contrastenhanced CT examination, given the absence of specific guidelines for breast imaging. Evaluating serum creatinine in all outpatients is recommended practice to determine the estimated glomerular filtration rate (eGFR) in Italian and Dutch guidelines and an alternative imaging technique without ICM is frequently advised when the eGFR value is ≤ 30 mL/min/1.73 m 2 [5,6]. These recommendations are largely expert-based and driven by practical, logistical reasons within hospital environments.…”

“…Current guidelines in Europe may have different recommendations for CI-AKI risk screening in outpatients. While the Radiological Society of the Netherlands [5] and the Italian College of Radiology [6] recommend assessing eGFR for all patients receiving intravascular ICM, the ESUR includes the option to assess eGFR before administering intravascular ICM only for those with a history of renal disease, kidney surgery, proteinuria, hypertension, hyperuricemia, and diabetes mellitus [12,15].…”