Gadolinium contrast media

In the patients with ALPE, plain CT of the kidney (delayed CT) a few hours, 24 h, and 48 h after the administration of 40 ml contrast medium showed wedge-shaped contrast enhancement. When physicians hesitate to administer a contrast medium, patchy accumulation can be sometimes detected by magnetic resonance imaging (MRI) with gadolinium-diethylenetriaminopentoacetic acid (Gd-DTPA), bone scan with MDP, or ultrasonography with Levovist. 

To protect residual renal function, use doses under 0.3 mmol/kg of gadolinium-based contrast agents Referto ESUR guidelines to avoid contrast medium-induced renal damage (hydration, use small doses of low-osmolar contrast media)... 

In stable and cooperative patients, the diagnostic arteriography is performed under local anesthesia via a transfemoral access and in the classical Seldinger technique. Celiac trunk and the superior mesenteric artery (SMA) are catheterized with preshaped single-use 4- or 5-F catheters of the Cobra or side-winder type. lodinated nonionic iso-osmolar contrast medium (25-35 ml at a rate of 4-6 ml/s) is injected by a power injector into the celiac trunk and SMA. In patients with renal insufficiency, contrast allergy or hyperthyroidism gadolinium chelates (MRI contrast medium) have been suggested as a substitute for iodinated contrast medium [53], but reports on its use in the visceral arteries are still awaited. 

Thomsen HS, Morcos SK, Ahnen T, Beilin MF, Bertolotto M, Bongartz G, et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol February 2013 23(2) 307-18. 

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