Abstract
ObjectiveTo assess the practical aspects of the use of various gadolinium-based contrast agents (GBCAs) by radiologists.Materials and MethodsTen experienced radiologists from different regions of Brazil participated in a Delphi panel querying their use of various GBCAs, including linear and macrocyclic classes (1.0 and 0.5 M), in terms of the choice of agent, volume and dosage of the agents, and associated safety concerns.ResultsThe response rate was 100% for all questions. GBCAs are safe in terms of acute adverse reactions, and nephrogenic systemic fibrosis is rare. The deposition of gadolinium in the brain and other tissues is a concern among the experts. Macrocyclic agents are preferable to linear agents; an injection volume below 0.1 mL/kg of a 1.0 M agent could result in good-quality images with additional long-term safety, but there is no published evidence to support this recommendation. The majority of experts preferred not to administer GBCAs to pregnant patients.ConclusionWhen choosing a GBCA, it is important to consider the characteristics of the gadolinium deposition in patient tissues and minimize potential risks. Furthermore, medical education programs are needed to increase the awareness of the potential risks of gadolinium deposition and thus avoid instances of overexposure to the contrast agent.
Highlights
Gadolinium-based contrast agents (GBCAs) have been used since 1988, with gadopentate dimeglumine being approved for use in the USA, Germany and Japan[1], and have an excellent overall safety record[2]
When choosing a gadolinium-based contrast agents (GBCAs), it is important to consider the characteristics of the gadolinium deposition in patient tissues and minimize potential risks
To date, there is no evidence of any damage caused by gadolinium deposition in the brain, and there is no evidence to recommend one class of GBCA over another based on this aspect[2]
Summary
Gadolinium-based contrast agents (GBCAs) have been used since 1988, with gadopentate dimeglumine being approved for use in the USA, Germany and Japan[1], and have an excellent overall safety record[2]. Acute adverse events are rare[2,3], and the use of newer GBCAs together with careful screening has drastically decreased the incidence of nephrogenic systemic fibrosis[4]. It has been established that linear GBCAs are less stable and show greater deposition in the human brain than macrocyclic agents; deposition occurs with the latter, albeit to a lesser extent[6]. To date, there is no evidence of any damage caused by gadolinium deposition in the brain, and there is no evidence to recommend one class of GBCA over another based on this aspect[2]
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