From the Research
Patients who have undergone bone marrow transplantation, stem cell therapy, or received chemotherapy and radiation for neoplasia can generally receive MRI with IV contrast, but certain precautions should be considered, as indicated by the most recent guidelines 1. The primary concern is kidney function, as many contrast agents (gadolinium-based) are eliminated through the kidneys. Before administering contrast, healthcare providers should assess the patient's renal function through blood tests (BUN and creatinine) since these patients may have compromised kidney function due to their treatments. Some key points to consider include:
- If kidney function is adequate (typically GFR >30 mL/min), contrast can usually be safely administered, according to recent studies 1.
- For patients with severely impaired kidney function, macrocyclic gadolinium agents like gadoterate meglumine (Dotarem), gadobutrol (Gadavist), or gadoteridol (ProHance) are preferred as they have lower risk of nephrogenic systemic fibrosis, as noted in previous research 2.
- The standard dose is typically 0.1 mmol/kg body weight.
- Additionally, patients should be well-hydrated before and after the procedure to help eliminate the contrast agent.
- The timing of MRI with contrast relative to chemotherapy or radiation treatments is not usually a concern, though scheduling the imaging between treatment cycles when the patient is feeling better may improve tolerance, as suggested by studies on stem cell therapy and bone marrow transplant 3. It is essential to weigh the benefits and risks of MRI with IV contrast in these patients, considering their complex medical history and potential for compromised kidney function, as discussed in the context of total body irradiation and hematopoietic stem cell transplant 4.