We at VRI recognize that contrast administered during imaging studies is not without risk. In order to prevent contrast induced nephropathy in CT, nephrogenic systemic fibrosis in MR, and contrast reactions in both CT and MR, we have briefly outlined our protocol below to maximize safety while achieving the highest diagnostic accuracy. Our guidelines are based on the latest American College of Radiology’s Manual on Contrast Media, Version 9.
For CTs with contrast, renal function tests should be obtained within 90 days for patients with an age >60, diabetes, hypertension, a history of renal disease, or that may have possible renal dysfunction.
- for eGFR > 60, a full dose of contrast will be administered.
- for eGFR 30-60, pre-scan IV hydration and the use of the lowest possible dose of contrast for an adequate study will be administered.
- for eGFR < 30, contrast will not be used due to the significant risk of contrast induced nephropathy.
- for patients in chronic renal failure on dialysis and no reasonable expectation of native renal function, contrast may be used.
For MRI with contrast, renal function tests should be obtained within 90 days for patients with an age >60, diabetes, hypertension, a history of renal disease, or that may have possible renal dysfunction.
- eGFR > 60, a full dose Optimark or Magnevist not to exceed 20 cc will be administered
- eGFR 30-60, a ½ dose of Multihance will be administered. Please note Multihance has never had a nonconfounded case of nephrogenic systemic fibrosis.
- eGFR < 30 or on dialysis, needs discussion with referrer if absolutely needed to assess if the benefits outweigh the risks, the lowest possible dose of Multihance will be used and dialysis within 24 hours will be considered.
History of contrast reaction or allergy
No pretreatment needed
- Single, Isolated shellfish allergy not anaphylactic
Premedication needed (50mg Prednisone PO 13, 7 and 1 hour before the injection & 50mg Benadryl PO within 1 hour of injection)
- Existing mild reaction to iodinated contrast i.e. hives, nonanaphylactic reaction
- Allergies to multiple entities
- Anaphylaxis to anything other than iodinated contrast
Cannot give IV contrast
Anaphylaxis to iodinated contrast