[Contrast media - Guidelines for practical use].

Area of Science:

• Radiology
• Medical Imaging
• Diagnostic Radiology

Background:

• Contrast agents are essential for diagnostic radiology, particularly in multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI).
• Key contrast agent groups include iodine- and gadolinium-based agents.
• Potential side effects range from rare post-contrast acute kidney injury (PC-AKI) to more common allergic and chemotoxic reactions.

Purpose of the Study:

• To review the current understanding and guidelines for contrast agent use in diagnostic radiology.
• To highlight evolving safety concerns, such as gadolinium deposition in the central nervous system (CNS).
• To provide recommendations for contrast media administration in specific patient populations, including those with reduced renal function.

Main Methods:

• Review of current literature and guidelines on contrast agent administration.
• Analysis of risks and benefits associated with iodine- and gadolinium-based contrast agents.
• Discussion of safety protocols for enhanced MDCT and MRI examinations.

Main Results:

• Nephrogenic fibrosis is no longer reported following guideline implementation.
• Gadolinium deposition in the CNS is an emerging concern.
• Recommendations for patients with reduced renal function include hydration and careful indication review at specific eGFR thresholds (<45 mL/min or <30 mL/min).
• Low kV and dual-energy (DE) scan protocols can reduce iodinated contrast agent dosage in MDCT.
• Only macrocyclic contrast agents are recommended for enhanced MRI examinations.

Conclusions:

• Appropriate use of contrast agents requires continuous knowledge updates.
• Risk-benefit analyses are crucial for enhanced studies in pregnancy, lactation, and pediatric populations.
• Patient information and legal considerations for non-approved indications are integral to clinical practice.