Contrast Medium Reactions Guidelines

Updated: Jul 22, 2017
  • Author: Nasir H Siddiqi, MD; Chief Editor: Eugene C Lin, MD  more...
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Guidelines Summary

The ACR Committee on Drugs and Contrast Media has created a guide for radiologists to promote safe and effective practices concerning the use of contrast media, including patient screening, premedication, adverse reactions, and emergency-related treatment of adverse reactions. [1]

The ACR Committee published the following recommendations for imaging patients at risk for NSF [1] :

Group II agents (gadobenate dimeglumine, gadobutrol, gadoterate acid, gadoteridol) are strongly preferred in patients at risk for NSF (nephrogenic systemic fibrosis). Given the very low, if any, risk of NSF development with group II agents, regardless of renal function or dialysis status, informed consent is not recommended prior to GBCA (gadolinium-based contrast agent) group II injection, but deference is made to local practice preferences.

If use of a group I agent (gadodiamide, gadopentetate dimeglumine, gadoversetamide) or group III agent (gadoxetate disodium) is being considered in a patient with a risk of NSF, the potential benefits of a GBCA-enhanced MRI exam are felt to outweigh the risk of NSF in an individual patient, and there is no suitable alternative, the referring physician and patient should be informed of the risks of GBCA administration, and both should agree with the decision to proceed with GBCA injection. Group I agents, the GBCAs that have been most often associated with NSF, have been contraindicated by the FDA for use in these patients.

The lowest dose of GBCA required to obtain the needed clinical information should be used in at-risk patients, and it should generally not exceed the recommended single dose.