From the Guidelines
MRI scans for Kisunla infusion do not typically require contrast unless specifically ordered by your neurologist for other diagnostic purposes. The standard pre-treatment MRI screening for Kisunla therapy is usually performed without contrast to establish a baseline and check for any signs of progressive multifocal leukoencephalopathy (PML) or other contraindications to treatment. According to a study published in Radiologia Medica 1, the routine use of contrast agents when performing whole-body MRI for cancer screening in asymptomatic subjects of the general population is strongly discouraged due to medical and public concerns related to long-term gadolinium deposition in the brain and possible adverse effects in subjects with undisclosed acute kidney injury.
Some key points to consider when deciding on the use of contrast in MRI scans for Kisunla infusion include:
- The need to evaluate for active inflammatory lesions or to better characterize certain findings, which may require contrast-enhanced MRI 1
- The potential risks associated with contrast agent use, such as gadolinium deposition in the brain and nephrogenic systemic fibrosis 1
- The importance of following individual patient factors and institutional guidelines when determining the need for contrast-enhanced MRI 1
In general, the decision to use contrast in MRI scans for Kisunla infusion should be made on a case-by-case basis, taking into account the specific clinical situation and the information needed to safely proceed with treatment.
From the Research
MRI for Kisunla Infusion with Contrast
- The use of gadolinium-based contrast agents (GBCAs) in patients with kidney disease is a topic of controversy, with concerns regarding nephrogenic systemic fibrosis (NSF) 2, 3, 4, 5.
- According to the Canadian Association of Radiologists, the position that GBCAs are absolutely contraindicated in acute kidney injury (AKI), chronic kidney disease (CKD) stage 4 or 5, and dialysis-dependent patients is outdated 3, 5.
- In patients with mild-to-moderate CKD, administration of standard doses of GBCA is safe and no additional precautions are necessary 3, 5.
- For patients with AKI, severe CKD, or on dialysis, administration of GBCAs should be considered individually and alternative imaging modalities utilized whenever possible 3, 5.
- Newer GBCAs may be administered with patient consent, citing an exceedingly low risk of developing NSF 3, 5.
- There is no direct evidence to suggest that MRI for kisunla infusion requires contrast, but the use of GBCAs in patients with kidney disease should be approached with caution and considered on a case-by-case basis 2, 3, 4, 5, 6.
Considerations for GBCA Use
- Screening for renal disease is important, but less critical when using macrocyclic and newer linear GBCAs 3, 5.
- Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCAs is recommended 3, 5.
- Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, stage 4 or 5 CKD, or on dialysis 3, 5.