title: Revisiting the risks of MRI with Gadolinium based contrast agents-review of literature and guidelines.
abstract: Gadolinium based contrast agents (GBCA) have been linked to the occurrence of nephrogenic systemic fibrosis (NSF) in renal impaired patients. The exact interaction between the various different available formulations and occurrence of NSF is not completely understood, but has been postulated. This association has triggered public health advisory bodies to issue guidelines and best practice recommendations on its use. As a result, the reported incidence of NSF, as well as the published use of GBCA-enhanced magnetic resonance imaging in renal impairment, has seen a decline. Understanding of the events that led to these recommendations can increase clinical awareness and the implications of their usage. We present a review of published literature and a brief overview of practice recommendations, guidelines and manuals on contrast safety to aide everyday imaging practice.
  
  
  CONCLUSIONS
  • Low risk gadolinium based contrast agents should be the choice in renal insufficiency. • Higher doses have been linked to NSF development. Doses should be as low as possible. • Clear documentation of date, dose and type of formulation used should be noted. • Post-scan dialysis should be arranged as soon as possible and feasible. • Pre- existing inflammatory state is a risk factor; liver insufficiency is not a contraindication.
authors.affiliation: Department of Renal Transplant Surgery & Vascular Access, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, West Midlands, UK. aurangzaib.khawaja@nhs.net.
authors.forename: Aurang Z
authors.initials: AZ
authors.lastname: Khawaja
authors.affiliation: Division of Diabetes and Cardiovascular Medicine, University of Dundee, Dundee, DD19SY, UK.
authors.forename: Deirdre B
authors.initials: DB
authors.lastname: Cassidy
authors.affiliation: Department of Renal Transplant Surgery & Vascular Access, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, West Midlands, UK.
authors.forename: Julien
authors.initials: J
authors.lastname: Al Shakarchi
authors.affiliation: Department of Renal Transplant Surgery & Vascular Access, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, West Midlands, UK.
authors.forename: Damian G
authors.initials: DG
authors.lastname: McGrogan
authors.affiliation: Department of Renal Transplant Surgery & Vascular Access, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, West Midlands, UK.
authors.forename: Nicholas G
authors.initials: NG
authors.lastname: Inston
authors.affiliation: Department of Radiology, Queen Elizabeth Hospital, University Hospitals Birmingham, Mindelsohn Way, Birmingham, B15 2GW, West Midlands, UK.
authors.forename: Robert G
authors.initials: RG
authors.lastname: Jones
keywords: Contrast media; Gadolinium/adverse effects; Magnetic resonance imaging; Nephrogenic fibrosing dermopathy; Renal insufficiency