RESUMEN
In order to promote the rational clinical use of gadolinium-based contrast agents （GBCA） and to provide a reference for physicians to prescribe such contrast agents and for pharmacists to review prescriptions， the consensus working group launched the preparation project of “Consensus on whole-process pharmaceutical care for GBCA” according to domestic and foreign guidelines and consensus. The Zhujiang Hospital of Southern Medical University took the lead and cooperated with clinical experts and pharmaceutical experts from several domestic medical institutions to discuss and summarize the basic pharmacological effect of GBCA， types， pharmacokinetics， pharmacodynamics， indications， contraindications， precautions， usage and dosage， adverse drug reactions， and finally forms the consensus. The main contents of this consensus include an overview of various types of GBCA， rational clinical use of drugs， security management and whole-process pharmaceutical care process， etc.， for reference by physicians and pharmacists in medical institutions at all levels.
RESUMEN
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.
Resumo Objetivo: Avaliar aspectos práticos do uso de agentes de contraste à base de gadolínio (gadolinium-based contrast agents - GBCAs) por médicos especialistas em radiologia. Materiais e Métodos: Dez radiologistas de diferentes regiões do Brasil foram convidados a participar de um painel Delphi com perguntas sobre o uso de GBCAs lineares e macrocíclicos (1,0 e 0,5 M), em termos de dosagem, volume injetado e preocupações relacionadas à segurança. Resultados: A taxa de resposta foi de 100% para todas as perguntas. GBCAs são seguros em relação a reações adversas agudas, e os casos de fibrose nefrogênica sistêmica são raros. O depósito de gadolínio no cérebro e em outros tecidos é uma preocupação de todo o painel. Agentes macrocíclicos são preferíveis aos lineares. Um volume menor que 0,1 mL/kg injetado de contraste macrocíclico 1,0 M poderia oferecer imagem com boa qualidade e benefício adicional em longo prazo, entretanto, não há evidências publicadas que apóiem tal recomendação. A maioria prefere não administrar GBCA em gestantes. Conclusão: É importante considerar as características de deposição e minimizar potenciais riscos ao se escolher um GBCA. Ações de educação médica são necessárias para a conscientização dos potenciais riscos da presença de gadolínio em longo prazo e evitar a sobre-exposição ao agente de contraste.
RESUMEN
Gadolinium-based contrast agents (GBCAs) are widely used in magnetic resonance imaging. Recently, a large amount of evidence indicates that change of magnetic resonance signal in deep brain nuclei is related to repeated injection of GBCAs. Especially in the dentatum and pallidum the gadolinium deposition is most obvious. This paper reviews the research status and policy progress of brain deposition of GBCAs, and introduces the relationship between gadolinium deposition in the brain and the type of GBCAs.