ACR Manual Version 2016 for Contrast Media: Summary

The ACR Manual on Contrast Media, v10.2 published in June 2016 is now available, providing these revised areas: Post-Contrast Acute Kidney Injury and  Contrast-Induced Nephropathy in Adults  Metformin Contrast Media in Children Adverse Reactions to Gadolinium-Based Contrast Media Administration of Contrast Media to Pregnant or Potentially Pregnant Patient

Full article can be accessed here: 

http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2016_Contrast_Media.pdf

Some of the key updates in this edition include: 

Gadolinium deposition in Brain

"Recently, residual gadolinium has been found within the brain tissue of patients who received multiple doses of GBCAs over their lifetimes. For reasons that remain unclear, gadolinium deposition appears to occur preferentially in certain specific areas of the brain, even in the absence of clinically evident disease and in the setting of an intact blood brain barrier. Such deposition is not expected, and led the FDA to publish a Safety Alert in July of 2015 indicating that they were actively investigating the risk and clinical significance of these gadolinium deposits. To date, no adverse health effects have been uncovered, but the radiology community has initiated a rigorous investigation."

Guidelines for Metformin and Iodinated contrast media have been updated. 

"The Committee recommends that patients taking metformin be classified into one of two categories based on the patient’s renal function (as measured by eGFR)."

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Category I

In patients with no evidence of AKI and with eGFR ≥30 mL / min/1.73m2 , there is no need to discontinue metformin either prior to or following the intravenous administration of iodinated contrast media, nor is there an obligatory need to reassess the patient’s renal function following the test or procedure.

Category II

In patients taking metformin who are known to have acute kidney injury or severe chronic kidney

disease (stage IV or stage V; i.e., eGFR< 30), or are undergoing arterial catheter studies that might result in emboli (atheromatous or other) to the renal arteries, metformin should be temporarily discontinued at the time of or prior to the procedure, and withheld for 48 hours subsequent to the procedure and reinstituted only after renal function has been re-evaluated and found to be normal.

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Recommendations for the use of GBCA-enhanced MRI examinations in pregnant patients

"Because it is unclear how GBCAs will affect the fetus, these agents should be administered with caution to pregnant or potentially pregnant patients. GBCAs should only be used if their usage is considered critical and the potential benefits justify the potential unknown risk to the fetus."