Evaluation of kidney function before gadolinium contrast-enhanced magnetic resonance imaging: Concern for nephrogenic systemic fibrosis

MRI: magnetic resonance imaging; eGFR: estimated glomerular filtration rate; CT: computed tomography.
* Refer to other UpToDate content or the American College of Radiology (ACR) Appropriateness Criteria for MRI contrast recommendations based on a specific examination indication.
¶ Alternative imaging options include noncontrast MRI, CT, or ultrasound. If the patient is chronically anuric, an iodinated contrast-enhanced CT can be substituted, depending on the clinical indication for imaging. A discussion with a radiologist will likely be helpful.
Δ Refer to imaging provider (eg, radiology department) if the group of the gadolinium agent to be administered is unknown or needs to be specified, as availability will vary with site. For most examinations at most sites, group II agents are given preferentially. Group III agents are sometimes necessary for specific clinical indications. Group I and III agents are no longer marketed in the United States or Europe. Refer to other UpToDate content for description of the gadolinium contrast groups based on their associated risk of nephrogenic systemic fibrosis.
◊ If gadolinium contrast has to be given and the patient is on hemodialysis, schedule the hemodialysis to follow the imaging as close as possible.