Perhaps the most clinically impactful property of GBCAs relates to their stability and potential for dechelation ie, release of the Gd ion from the chelate structure. 20 (Table 1) GBCA Stability and Dechelation 4-11 Although contrast extravasation is an indirect safety issue associated with GBCAs, potentially causing pain and swelling at the injection site, this can be limited with GBCAs that have lower viscosity and osmolality that enable greater ease of injection. 21 Importantly, the rates and types of AEs are comparable across agents. Serious AEs and allergic reactions requiring hospitalization are extremely rare, occurring in about 0.008% of GBCA administrations.

(Table 1) Acute Adverse Eventsīased on data provided in package inserts, most AEs associated with GBCAs are mild and non-serious. GBCAs vary with respect to their structure, stability, ionicity, osmolality, and viscosity, all of which can contribute to the severity and likelihood of harm. Real risk is evidence-based and determined by the severity and likelihood of harm. Risks vs Benefits of GBCA UseĪlthough the risks associated with GBCA use can be viewed as the probability of harm, the focus should center on evaluating real risk vs perceived risk. We also address two fundamental issues: 1) when is contrast necessary, and 2) what are the best practices for its use in selected applications, specifically neuroradiology/stroke imaging, breast screening, and abdominal imaging? Finally, we discuss practical administrative and cost considerations related to contrast use in MRI. The primary goal of the forum was to explore the real and perceived risks associated with GBCA use and to elucidate the radiologist’s role in performing the necessary risk–benefit assessment when considering contrast-enhanced MRI for specific indications. In this article, we present a summary of discussions from a recent Expert Panel Forum on Advancing Clinical Practice in MR Imaging. These include the identification of nephrogenic systemic fibrosis (NSF) as a serious potential adverse event (AE), 15 and an appreciation that gadolinium (Gd) is retained in brain, bone, and soft-tissue organs, 16-19 with unknown long-term clinical consequences.

8 Unfortunately, several events have occurred since 2006 that have altered the perception that all GBCAs are equally safe. 13,14 Today only one GBCA, ProHance, retains a triple-dose (0.3 mmol/kg) indication for MRI of the CNS in adults. Double or even triple doses of some agents were routinely used for MR angiography and for specific central nervous system (CNS) applications. Because substantial evidence demonstrated that higher doses provided additional diagnostic yield with few associated safety concerns, doses were frequently higher than the standard (approved) 0.1 mmol/kg dose. Moreover, their safety profiles were considered comparable. Until approximately 2006, GBCAs were deemed safe for patients, particularly those with renal impairment. 4-10 (Tables 1, 2) OptiMARK and Magnevist were removed from the market in 20, respectively, while GE introduced Clariscan™ (gadoterate meglumine), a generic version of Dotarem, in 2019. 2,3 Until recently, available general-use GBCAs consisted of the conventional-relaxivity simple linear agents Magnevist ® (gadopentetate dimeglumine), Omniscan™ (gadodiamide), and OptiMARK™ (gadoversetamide) the high-relaxivity substituted linear GBCA MultiHance ® (gadobenate dimeglumine), and three macrocyclic agents: ProHance ® (gadoteridol), Gadavist ® (gadobutrol), and Dotarem ® (gadoterate meglumine). 1 Since then, GBCA use has greatly expanded, and GBCAs are now used routinely in approximately 45% of MRI exams in the United States.

Gadolinium-based contrast agents (GBCAs) were first approved for magnetic resonance imaging (MRI) in 1988 based on their ability to improve soft-tissue contrast relative to noncontrast exams. The entire text of this supplement, learning objectives, and the posttest are available at. This article confers 1.0 ARRT Category A Continuing Education credit, which will be awarded upon completion of an online post test.

Mr contrast agents radiology