Can these patients receive Magnetic Resonance Imaging (MRI) with intravenous (IV) contrast?

From the Guidelines

Patients can generally receive MRI with IV contrast unless they have specific contraindications, such as severe kidney dysfunction, pregnancy, known allergy to gadolinium contrast agents, or acute kidney injury, as stated in the most recent study 1. The main contraindication for MRI with IV contrast is severe kidney dysfunction (eGFR < 30 ml/min/1.73m²) due to the risk of nephrogenic systemic fibrosis, a rare but highly morbid condition associated with fibrosis of the skin, joints, eyes, and organs 1. Some key points to consider when administering MRI with IV contrast include:

• Patients with moderate kidney impairment (eGFR 30-60 ml/min/1.73m²) may receive contrast with caution 1.
• Other contraindications include pregnancy (first trimester), known allergy to gadolinium contrast agents, and acute kidney injury 1.
• Before administering contrast, patients should be screened for these conditions with recent kidney function tests 1.
• Standard gadolinium contrast doses range from 0.1-0.2 mmol/kg depending on the specific agent and indication 1.
• Patients should be well-hydrated before and after the procedure to help eliminate the contrast 1. The use of MRI with IV contrast has been shown to improve image quality and provide better visualization of abnormal tissues, inflammation, tumors, and vascular structures that might otherwise be difficult to distinguish from surrounding tissues 1. It is worth noting that the incidence of nephrogenic systemic fibrosis has dropped significantly with the increasing use of macrocyclic rather than linear gadolinium-based contrast material, and routine screening for chronic kidney disease is no longer recommended 1. In terms of specific patient populations, MRI with IV contrast has been shown to be useful in a variety of clinical scenarios, including the evaluation of liver lesions 1 and the imaging of malignant pleural mesothelioma 1. Overall, the decision to administer MRI with IV contrast should be made on a case-by-case basis, taking into account the individual patient's medical history, kidney function, and other relevant factors 1.

From the FDA Drug Label

Gadoterate Meglumine Injection is a gadolinium-based contrast agent indicated for intravenous use with magnetic resonance imaging (MRI) in brain (intracranial), spine and associated tissues in adult and pediatric patients (including term neonates) to detect and visualize areas with disruption of the blood brain barrier (BBB) and/or abnormal vascularity.

for intravenous use with magnetic resonance imaging (MRI) in brain (intracranial), spine and associated tissues in adult and pediatric patients (including term neonates) to detect and visualize areas with disruption of the blood brain barrier (BBB) and/or abnormal vascularity ( 1)

for intravenous use with magnetic resonance imaging (MRI) in brain (intracranial), spine and associated tissues in adult and pediatric patients (including term neonates) to detect and visualize areas with disruption of the blood brain barrier (BBB) and/or abnormal vascularity. ( 1)

Yes, these patients can receive Magnetic Resonance Imaging (MRI) with intravenous (IV) contrast, as indicated by the drug labels for gadoterate meglumine (IV) 2, 2, and 2. The primary use of this contrast agent is for intravenous use with MRI in adult and pediatric patients. Key points include:

• Indications: Detection and visualization of areas with disruption of the blood brain barrier and/or abnormal vascularity in brain, spine, and associated tissues.
• Patient population: Adult and pediatric patients, including term neonates.
• Administration: Intravenous bolus injection.

From the Research

Patient Eligibility for MRI with IV Contrast

The decision to administer Magnetic Resonance Imaging (MRI) with intravenous (IV) contrast to patients, particularly those with kidney disease, is guided by several factors including the type of contrast agent used, the patient's renal function, and the presence of conditions such as acute kidney injury (AKI) or chronic kidney disease (CKD).

Considerations for Patients with Kidney Disease

• For patients with mild-to-moderate CKD (eGFR ≥30 and <60 mL/min/1.73 m^2), the administration of standard doses of gadolinium-based contrast agents (GBCAs) is considered safe, with no additional precautions necessary 3, 4.
• In patients with AKI, severe CKD (eGFR <30 mL/min/1.73 m^2), or those on dialysis, the use of GBCAs should be considered on an individual basis, with alternative imaging modalities preferred whenever possible 3, 4, 5.
• Newer GBCAs may be administered to these high-risk patients with informed consent, citing a very low risk of developing nephrogenic systemic fibrosis (NSF) 3, 4, 6.
• Certain GBCAs, such as gadopentetate dimeglumine, gadodiamide, and gadoversetamide, are contraindicated in patients with AKI, stage 4 or 5 CKD, or those on dialysis 3, 4.

Recommendations for GBCA Administration

• Standard dosing of GBCAs is recommended; half or quarter dosing is not advised, and repeat injections should be avoided 3, 4.
• For dialysis-dependent patients, receiving dialysis is recommended, but initiating dialysis or switching modalities solely to reduce NSF risk is not proven to be beneficial 3, 4, 5.
• The use of macrocyclic ionic instead of macrocyclic nonionic GBCAs or macrocyclic instead of newer linear GBCAs to prevent NSF is not supported by evidence 3, 4.
• Screening for renal disease is important but less critical when using macrocyclic and newer linear GBCAs 3, 4.

Recent Consensus and Guidelines

• Consensus statements from the American College of Radiology and the National Kidney Foundation suggest that the risk of NSF from certain GBCAs in patients with advanced kidney disease is very low, and the potential harms of delaying or withholding these agents should be balanced against the risk of NSF 6.
• These guidelines aim to standardize care and improve outcomes for patients with kidney disease who require MRI with IV contrast.