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Kontrastmittel – Handlungsempfehlungen für die Praxis

Contrast media – Guidelines for practical use

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Zusammenfassung

Kontrastmittel (KM) sind aus der modernen radiologischen Diagnostik nicht mehr wegzudenken. Sie liefern in der Multidetektor-Computertomographie (MDCT) und Magnetresonanztomographie (MRT) essenzielle Informationen u. a. bei vaskulären, entzündlichen und onkologischen Fragestellungen, die sonst nicht beantwortet werden könnten. Die wichtigsten Gruppen sind jodhaltige und gadolinumhaltige Kontrastmittel, welche vorwiegend intravenös eingesetzt werden. Zu den seltenen unerwünschten Wirkungen beider Substanzgruppen gehören die mögliche akute Niereninsuffizienz (AKI), häufiger treten allergische und chemotoxische Reaktionen auf. Die nephrogene Fibrose ist seit der Etablierung von Guidelines nicht mehr nachgewiesen worden. Gadoliniumablagerungen im Zentralnervensystem (ZNS), deren klinische Bedeutung nach wie vor unklar ist, sind seit einigen Jahren ein aktuelles Thema. Ab einem Schwellenwert der Nierenfunktion mit einer eGFR von <45 bzw. <30 ml/min wird eine Hydrierung des Patienten bzw. eine strengere Indikationsstellung empfohlen. Low-kV und DE-Scanprotokolle in der MDCT helfen, die benötigte Kontrastmittelmenge zu reduzieren. In der MRT sollten bis auf zugelassene Indikationen nur makrozyklische Substanzen verwendet werden. Die Anwendung in der Schwangerschaft, während der Laktation und bei Kindern ist immer einer sorgfältigen Nutzen-Risiko-Analyse zu unterziehen und ebenso ein wichtiges Thema dieses Übersichtsartikels. Die adäquate Patientenaufklärung und rechtliche Aspekte bei nichtzugelassenen Anwendungen sind unverzichtbarer Bestandteil im täglichen klinischen Einsatz. Das Wissen um die sachgerechte Anwendung der vielfältigen zugelassenen Kontrastmittel ist ständig zu aktualisieren und zu erweitern.

Abstract

Contrast agents have become an indispensable part of everyday life in diagnostic radiology. In multidetector computed tomography (MDCT) and magnetic resonance imaging (MRI), they provide essential diagnostic information, especially for vascular, inflammatory or oncologic diseases, which otherwise could not be answered. The two most important groups are iodine- and gadolinium-containing contrast agents. Rare side effects include PC-AKI (post-contrast acute kidney injury); more common are allergic and chemotoxic reactions. Since the introduction of guidelines, nephrogenic fibrosis has not been reported anymore, whereas gadolinium deposition in the central nervous system (CNS) has become a new topic. Concerning contrast media use in patients with reduced renal function, at a eGFR threshold of <45 ml/min or <30 ml/min, hydration and a review of indication for enhanced MDCT, depending on the application, is recommended. Low kV and DE-scan protocols with MDCT can help to reduce the amount of iodinated contrast agents. In MRI examinations, only macrocyclic contrast agents should be used for enhanced MRI exams. There has to be a careful risk–benefit analysis with enhanced studies in pregnancy, during lactation and in the pediatric population. Patient information and legal aspects with nonapproved indications are indispensable parts of daily clinical routine. The continuous updating and broadening of knowledge regarding the appropriate use of the various contrast agents has to be an integral part of clinical diagnostic radiology.

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  1. Abteilung für Allgemeine- und Kinderradiologie, Universitätsklinik für Radiologie und Nuklearmedizin, Medizinische Universität Wien, Währinger Gürtel 18–20, 1090, Wien, Österreich

    Christian Krestan MBA

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Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Krestan, C. Kontrastmittel – Handlungsempfehlungen für die Praxis. Radiologe 59, 444–453 (2019). https://doi.org/10.1007/s00117-019-0523-8

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