Ronaldo Hueb Baroni1, Tufik Bauab2, Leonardo Kayat Bittencourt3, Giuseppe D'Ippolito4, Suzan Menasce Goldman4, Guilherme Hohgraefe Neto5, Adonis Manzella6, Antonio José Rocha7, Luis Augusto Sonoda8, Fabio Seichi Takeda9. 1. Instituto Israelita de Ensino e Pesquisa Albert Einstein, Hospital Israelita Albert Einstein, São Paulo, SP, Brazil. 2. Faculdade de Medicina de São José do Rio Preto (Famerp), São José do Rio Preto, SP, Brazil. 3. Universidade Federal Fluminense (UFF), Niterói, RJ, Grupo DASA, Rio de Janeiro, RJ, Brazil. 4. Escola Paulista de Medicina da Universidade Federal de São Paulo (EPM-Unifesp), São Paulo, SP, Brazil. 5. Hospital Moinhos de Vento, Porto Alegre, RS, Brazil. 6. Hospital da Restauração, Recife, PE, Centro Diagnóstico Lucilo Ávila Junior, Recife, PE, Brazil. 7. Faculdade de Ciências Médicas da Santa Casa de São Paulo, São Paulo, SP, Grupo DASA, São Paulo, SP, Brazil. 8. Instituto de Gastroenterologia de São Paulo (Igesp), São Paulo, SP, Hospital Nipo Brasileiro, São Paulo, SP, Brazil. 9. Ultramed Medical Services, Londrina, PR, Medvia Diagnósticos, Porto Alegre, RS, Brazil.
Abstract
OBJECTIVE: To assess the practical aspects of the use of various gadolinium-based contrast agents (GBCAs) by radiologists. MATERIALS AND METHODS: Ten experienced radiologists from different regions of Brazil participated in a Delphi panel querying their use of various GBCAs, including linear and macrocyclic classes (1.0 and 0.5 M), in terms of the choice of agent, volume and dosage of the agents, and associated safety concerns. RESULTS: The response rate was 100% for all questions. GBCAs are safe in terms of acute adverse reactions, and nephrogenic systemic fibrosis is rare. The deposition of gadolinium in the brain and other tissues is a concern among the experts. Macrocyclic agents are preferable to linear agents; an injection volume below 0.1 mL/kg of a 1.0 M agent could result in good-quality images with additional long-term safety, but there is no published evidence to support this recommendation. The majority of experts preferred not to administer GBCAs to pregnant patients. CONCLUSION: When choosing a GBCA, it is important to consider the characteristics of the gadolinium deposition in patient tissues and minimize potential risks. Furthermore, medical education programs are needed to increase the awareness of the potential risks of gadolinium deposition and thus avoid instances of overexposure to the contrast agent.
OBJECTIVE: To assess the practical aspects of the use of various gadolinium-based contrast agents (GBCAs) by radiologists. MATERIALS AND METHODS: Ten experienced radiologists from different regions of Brazil participated in a Delphi panel querying their use of various GBCAs, including linear and macrocyclic classes (1.0 and 0.5 M), in terms of the choice of agent, volume and dosage of the agents, and associated safety concerns. RESULTS: The response rate was 100% for all questions. GBCAs are safe in terms of acute adverse reactions, and nephrogenic systemic fibrosis is rare. The deposition of gadolinium in the brain and other tissues is a concern among the experts. Macrocyclic agents are preferable to linear agents; an injection volume below 0.1 mL/kg of a 1.0 M agent could result in good-quality images with additional long-term safety, but there is no published evidence to support this recommendation. The majority of experts preferred not to administer GBCAs to pregnant patients. CONCLUSION: When choosing a GBCA, it is important to consider the characteristics of the gadolinium deposition in patient tissues and minimize potential risks. Furthermore, medical education programs are needed to increase the awareness of the potential risks of gadolinium deposition and thus avoid instances of overexposure to the contrast agent.
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