Clinical Pearl: Gadolinium in EM: Follow the Evidence : Emergency Medicine News

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Clinical Pearl

Gadolinium in EM: Follow the Evidence

doi: 10.1097/01.EEM.0000898228.58073.16
    gadolinium, contrast agents, nephrogenic systemic fibrosis


    Gadolinium-based contrast agents (GBCA) are divided into three groups based on molecular structure and charge. Group 1 GBCAs are associated with the greatest number of reported cases of nephrogenic systemic fibrosis (NSF), a potentially debilitating and fatal fibrosing condition that most often affects the skin but can involve multiple organs.

    Group 2 GBCAs have an exceedingly low to nonexistent risk for inducing NSF and should be used whenever possible. Group 3 GBCAs are associated with few if any cases of NSF, but limited data are available. Group 3 GBCAs are used primarily for hepatobiliary imaging.

    GBCAs are not generally associated with postcontrast acute kidney injury, especially in patients with normal renal function. The American College of Radiology and the National Kidney Foundation state that routine evaluation of renal function is not mandatory for any Group 2 GBCA, but it is for Group 3 GBCAs. (Tex Heart Inst J. 2022;49[3]:e217680;; Radiology. 2021;298[1]:28;

    Patients on hemodialysis can undergo an MRI with GBCA, and the next hemodialysis session should be performed as soon as possible after the MRI, preferably within a few hours. (Tex Heart Inst J. 2022;49[3]:e217680;; Radiology. 2021;298[1]:28;

    Despite theoretical concerns about the safety of GBCA administration during pregnancy, no harm has yet been attributed during any trimester, but studies are lacking. The most recent recommendations state that Group 2 GBCAs should be used during pregnancy only if the potential benefits justify the unknown risk to the fetus. (Tex Heart Inst J. 2022;49[3]:e217680;

    The expected systemic dose absorbed by breastfeeding infants is less than 0.0004 percent of the intravascular dose given to the mother. The likelihood of an adverse effect from such a small amount of GBCA absorbed from breast milk is remote and suggests that no breastfeeding interruption is required after GBCA administration. (Tex Heart Inst J. 2022;49[3]:e217680;; Obstet Gynecol. 2017;130[4]:e210.)

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