MRI Protocols in Neuroradiology, Clinical Practice Guidelines (SFNR, 2020)

French Society of Neuroradiology (SFNR)

This is a quick summary of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

November 17, 2020

In November 2020, the French Society of Neuroradiology (SFNR) published clinical practice guidelines on the use of gadolinium-based contrast agents and related MRI protocols in neuroradiology.[1]

Gadolinium-based contrast agents (GBCAs) associated with a high risk of nephrogenic systemic fibrosis (NSF) are strictly not to be used in neuroradiology: gadodiamide, gadoversetamide, and gadopentetate dimeglumine.

GBCAs with an intermediate risk of NSF are strictly not to be used in neuroradiology: gadobenate demeglumine and gadoxetate disodium.

GBCAs with a low risk of NSF should be used for neuroimaging: gadoterate meglumine, gadobutrol, and gadoteridol.

The standard GBCA dose for neuroimaging is 0.1 mmol/kg body weight (BW).

In patients with no residual renal function (anuric), enhanced CT is preferred to enhanced MRI if diagnostic performances are similar.

When repeat GBCA injections are required, a minimum of 4 hr between injections is recommended, and this should be extended to 7 days in patients with an estimated glomerular filtration rate (eGFR) <30 ml/min/1.73m2, as well as to newborns and infants younger than 1 yr.

In pregnant women, GBCA injection should be used only when it is considered clinically necessary and cannot be postponed until after the pregnancy.

In lactating women, GBCA injection should be used only when it is considered clinically necessary and cannot be postponed until after the lactation period.

GBCA injection and intracranial vascular imaging are systematic in the workup of patients with intracranial hemorrhage to look for underlying etiologies, except in patients who strictly meet the criteria for hypertensive microangiopathy (deep hemorrhage, >65 yr, hypertension, and other hypertension end-organ stigmata).

In patients with chronic headache, GBCA is not recommended unless other sequences show evidence of a pathology requiring contrast enhancement.

In patients with intracranial infection, GBCA injection is recommended to search for parenchymal and meningeal enhancement, brain injury, and related complications.

In patients with intra-axial tumors, GBCAs are systematic for diagnosis and follow-up.

GBCA injection is systematic for the initial workup of vestibular schwannomas.

GBCA injection is required for diagnosis of pituitary microadenoma.

For more information, go to Magnetic Resonance Imaging in Acute Stroke and Brain Magnetic Resonance Imaging.

For more Clinical Practice Guidelines, go to Guidelines.

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