Choice of gadolinium-containing contrast medium

The ACR recognizes three categories of gadolinium-containing contrast media with respect to risk of nephrogenic systemic fibrosis. These are listed below. For simplicity, only those agents approved for use in the United States by the FDA are included:

• Agents associated with the greatest number of NSF cases
  • Gadodiamide (Omniscan)
  • Gadopentetate dimeglumine (Magnevist)
  • Gadoversetamide (OptiMARK)
• Agents associated with few, if any, unconfounded cases of NSF
  • Gadobenate dimeglumine (MultiHance)
  • Gadoteridol (ProHance)
• Agents which have only recently appeared on the market in the US
  • Gadofosveset (Ablavar)
  • Gadoxetic acid (Eovist)

This categorization suggests that gadobenate dimeglumine (MultiHance) or gadoteridol (ProHance) are preferable agents for patients at high risk for nephrogenic systemic fibrosis (i.e., eGFR < 30), and gadobenate dimeglumine (MultiHance) is available at UCSF for use in such selected patients, but should only be used when there is a compelling clinical indication and should only be given as a single dose. It should be noted that the FDA does not differentiate between gadolinium containing contrast media with respect to the risk of NSF, regarding the evidence as insufficient to make a definitive determination². Based on the FDA approach and our departmental experience, we continue to use gadopentetate dimeglumine (Magnevist) as our routine gadolinium containing contrast medium.

-->

Key point: Gadopentetate dimeglumine (Magnevist) is the routine gadolinium containing contrast medium used in our department. Gadobenate dimeglumine (MultiHance) is available for use in patients at high risk for nephrogenic systemic fibrosis (i.e., eGFR < 30).