From the Guidelines
Contraindications for MRI renal with and without contrast include severe kidney dysfunction, acute kidney injury, dialysis dependence, known allergies to gadolinium contrast, and certain implanted devices, as these conditions can increase the risk of nephrogenic systemic fibrosis or other adverse reactions. When considering MRI renal with and without contrast, it is essential to evaluate the patient's kidney function, as severe kidney dysfunction (estimated glomerular filtration rate below 30 mL/min/1.73m²) is a significant contraindication due to the risk of nephrogenic systemic fibrosis associated with gadolinium-based contrast agents 1. Patients with acute kidney injury, dialysis dependence, or known allergies to gadolinium contrast should avoid contrast-enhanced MRI, while those with moderate kidney dysfunction (eGFR 30-60 mL/min/1.73m²) may benefit from macrocyclic gadolinium agents, which carry a lower risk 1. Other contraindications for any MRI include certain implanted devices like non-MRI compatible pacemakers, cochlear implants, certain aneurysm clips, and ferromagnetic foreign bodies, particularly in the eyes or brain, as well as claustrophobia, which may prevent completion of the scan unless sedation is provided, and large body habitus exceeding the scanner's weight limit or bore size 1. Pregnancy is a relative contraindication, especially in the first trimester, though non-contrast MRI may be performed if benefits outweigh risks. Recent laboratory tests (within 30 days) assessing kidney function should be obtained before administering contrast to ensure patient safety. Key considerations for MRI renal with and without contrast include:
- Severe kidney dysfunction
- Acute kidney injury
- Dialysis dependence
- Known allergies to gadolinium contrast
- Certain implanted devices
- Claustrophobia
- Large body habitus
- Pregnancy It is crucial to weigh the benefits and risks of MRI renal with and without contrast for each patient, taking into account their individual medical history and current condition, to ensure the best possible outcome in terms of morbidity, mortality, and quality of life.
From the FDA Drug Label
The following serious adverse reactions are discussed in greater detail in other sections of the prescribing information: Nephrogenic systemic fibrosis [see Boxed Warning and Warnings and Precautions ( 5.2)] . Hypersensitivity reactions [see Contraindications ( 4) and Warnings and Precautions (5.3)].
The contraindications for MRI renal with and without contrast are:
- Hypersensitivity reactions: Patients with a history of hypersensitivity reactions or a history of asthma or other allergic disorders should be cautious.
- Nephrogenic systemic fibrosis (NSF): Patients with impaired renal function are at risk of NSF.
- Acute kidney injury: Patients with chronically reduced renal function are at risk of acute kidney injury. No direct contraindications for MRI renal with and without contrast are explicitly stated in the label, but caution is advised in certain patient populations, such as those with impaired renal function or a history of hypersensitivity reactions 2.
From the Research
Contraindications for MRI Renal with and without Contrast
- The use of iodinated contrast media or group II gadolinium-based contrast agents should not be postponed in chronic kidney disease patients when clinically significant imaging studies are required 3.
- Patients with an estimated glomerular filtration rate greater than 30 mL/min/1.73 m2 have a minimal risk of iodinated contrast-induced acute kidney injury 3.
- Preventive strategies, including hydration with 0.9% saline and limiting contrast volume, may further reduce acute kidney injury risk in susceptible individuals 3.
- The risk of nephrogenic systemic fibrosis is negligible with group II gadolinium-based contrast agents, even in patients with advanced chronic kidney disease or those on dialysis 3, 4.
- Risk stratification prior to contrast media use in patients with pre-existing renal dysfunction should be based on eGFR-determination, and patients with an eGFR ≥ 30 ml/min require an individual risk assessment 5.
- In patients with advanced renal insufficiency, ensuring euvolemia is crucial, and there is no evidence for any other preventive approach 5.
- Current MRI techniques, such as diffusion-weighted imaging, longitudinal relaxation time (T1) mapping, and blood oxygen-level-dependent MRI, can noninvasively assess the structure and function of the kidney in a single MRI scan session 6, 7.
Specific Contraindications
- Severe chronic kidney disease (CKD) may be a contraindication for the use of gadolinium-based contrast agents (GBCAs), although the risk of nephrogenic systemic fibrosis is negligible with group II GBCAs 4.
- Acute kidney injury requires a patient individual decision regarding the use of contrast media 5.
- End-stage renal disease may require timing of contrast media injection and dialysis sessions after MRI contrast media use 5.