MRI Contrast Administration Algorithm
1. Any contraindication to GBCA administration?    
2. Is the patient pregnant?  
3. Does patient have known nephrogenic systemic fibrosis (NSF)?  
4. Does patient have known renal disease or diabetes?  
5. Are the lab values for GFR, BUN, and creatinine older than 30 days?  
   
If NO to all of above. Yes to any of above.
   
  1. Perform non-contrast.    
  2. Consent pregnant patients and do non contrast.
  3. Obtain fresh labs.      
 
 
         
Normal renal function to      
mild renal impairment (GFR > 59 mL/min)    
1. Order specifically states need for    
contrast in script for MRI/MRA.    
2. Give 0.1 mmol/kg GBCA. Doses    
≥ 0.2 mmol/kg must be approved by radiologist.    
3. No consent needed        
 
Moderate renal impairment (GFR 30-59 mL/min)  
1. Radiologist to determine if GBCA is needed.    
2. Perform non-contrast study if possible.    
3. Give 0.1 mmol/kg GBCA. Doses    
≥ 0.2 mmol/kg must be approved by radiologist.    
4. No consent needed.        
 
Severe renal impairment (GFR < 30 mL/min)    
1. Radiologist risk/benefit assessment.    
2. Radiologist must give written order including:    
gadolinium type, dose, route, rate, and sign  
date and time order.        
3. Obtain informed consent.      
4. Interpretation report to include risk/benefit        
discussion.            
     
NOT on dialysis and dialysis NOT needed:        
1. Use Multihance 0.05-1 mmol/kg.        
2. Follow-up with referring physician 2-4 weeks.        
     
Not on dialysis and dialysis needed:          
1. Cancel study.        
2. Have HD catheter placed.        
3. Perform with Multihance.        
4. Schedule HD within 2 hours        
of GBCA administration.      
5. Consider 2nd HD within 24 hours.      
6. Follow-up with referring physician 2-4 weeks.      
   
Dialysis dependent:          
1. Nephrology consultation.      
2. Use Multihance.      
3. Immediate HD.        
4. Consider repeat HD in 24 hours.  
5. Follow-up with nephrologist/referring physician
in 2-4 weeks.      
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