ASNR Statement on Gadolinium-Based Contrast Agent Use in Patients with Chronic Kidney Disease

Kirk M Welker; David Joyner; Anthony W Kam; David S Liebeskind; Amit M Saindane; Colin Segovis; Noushin Yahyavi-Firouz-Abadi; John E Jordan

doi:10.3174/ajnr.A8501

ASNR Statement on Gadolinium-Based Contrast Agent Use in Patients with Chronic Kidney Disease

AJNR Am J Neuroradiol. 2024 Sep 16:ajnr.A8501. doi: 10.3174/ajnr.A8501. Online ahead of print.

Authors

Kirk M Welker¹, David Joyner¹, Anthony W Kam¹, David S Liebeskind¹, Amit M Saindane¹, Colin Segovis¹, Noushin Yahyavi-Firouz-Abadi¹, John E Jordan¹

Affiliation

¹ From the Department of Radiology, Mayo Clinic, Rochester MN, USA (K.M.W), Department of Radiology and Medical Imaging, University of Virginia, Charlottesville, VA, USA (D.J.), Department of Radiology, Loyola University Medical Center, Maywood, IL, USA (A.W.K), Department of Neurology, University of California Los Angeles, Los Angeles, CA, USA (D.S.L.), Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, GA, USA (A.M.S., C.S), Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, MD, USA (N.Y.), and Department of Radiology, Providence Little Company of Mary Medical Center, Torrance, CA, USA (J.E.J.).

PMID: 39284636
DOI: 10.3174/ajnr.A8501

Abstract

Background: Beginning in 2006, neuroradiologists became increasingly aware of the risk of nephrogenic system fibrosis (NSF) when patients suffering from chronic kidney disease (CKD) received gadolinium-based contrast agents (GBCAs) in conjunction with MRI scans. Radiology practices began withholding GBCAs from MRI patients with substantial CKD and instated a variety of safety measures to ensure that these individuals did not inadvertently receive GBCAs. As a result, the worldwide incidence of NSF was dramatically reduced. Since that time, a wealth of research on NSF and its etiology has found few unconfounded cases associated with those GBCAs categorized as Group II agents by the American College of Radiology.

Methods: In 2023 and 2024, members of the American Society of Neuroradiology (ASNR) Standards and Guidelines Committee reviewed new research evidence on GBCA safety and its relevance to current MRI contrast administration guidelines for patients with CKD. This focused on systematic reviews and meta-analyses conducted during the past five years. Upon consideration of this literature, recommendations for administration of GBCAs to patients with CKD were formulated.

Key message: For neuroimaging applications, the ASNR recommends that Group II GBCAs no longer be withheld in patients with CKD when these agents are medically indicated for diagnosis. Moreover, if Group II GBCAs are exclusively used in an MRI practice, other safety measures such as checking renal function or querying patients about chronic kidney disease can be discontinued.

Abbreviations: ACR = American College of Radiology; ASNR = American Society of Neuroradiology; CKD = chronic kidney disease; GBCA = gadolinium-based contrast agent; NSF = nephrogenic systemic fibrosis.