MIR Guidelines Regarding Pre-Treatment of Patients Undergoing Contrast-Enhanced MRI
1. At the time of scheduling, it should be determined if the patient has had a prior reaction to either
gadolinium-based (MR) or iodinated contrast agents.
a. If there is no history of a prior reaction, then no pre-treatment is needed. b. If the patient has had a prior reaction to an MR contrast agent, it should be determined
whether the reaction required treatment from a nurse or physician, either at the scanner or
i. If it was a mild reaction that did not require treatment, no pre-treatment is
i . If the previous reaction required treatment of any type:
-The patient should be pretreated with corticosteroids prior to undergoing a
-A different MR contrast agent should be used, provided the original offending
agent is known. In addition, gadobenate dimeglumine (Multihance) should be
c. If the patient has had a prior reaction to an iodinated contrast agent, no premedication is
necessary. While there are studies that have shown that patients with an allergy to iodinated
contrast agents have an increased risk of reactions to gadolinium based contrast agents,
there is no proven cross reactivity between iodinated and gadolinium based contrast agents.
Furthermore, patients with asthma and various other allergies, including to medications and
foods, are also at similar and greater risk. Thus, the increased incidence of reactions to
gadolinium based agents in patients with iodinated contrast allergies may be related to
increased atopy in these patients, and is not known to be related to a link between iodinated
and gadolinium based contrast agents, per se. The ACR Manual on Contrast Media1 does not
recommend premedicating patients who are to receive gadolinium based contrast agents
who have a previous al ergy to iodinated based contrast agents. In addition, Murphy et al.2
found that only 3 of 56 centers they surveyed premedicated patients for contrast enhanced
MR exams who had an allergy to iodinated contrast. Finally, our communications with other
academic centers have shown that the overwhelming majority of centers do not premedicate
patients with iodinated contrast allergies prior to receiving MR contrast agents.
2. Any patient with a history of asthma should be instructed to bring an inhaler with them to their
MR examination. These patients do not require corticosteroids, special scheduling, or special
a. Oral regimen: Prednisone 50 mg PO QID beginning the day before the scheduled MR
examination and continuing up to the time of the examination. Diphenhydramine (Benedryl)
50 mg PO can also be administered at the discretion of the referring physician or responsible
radiologist one hour before the MR examination. If diphenhydramine is administered to
outpatients, there should be someone available to drive them home after the examination.
b. Intravenous regimen: Hydrocortisone (Solu Cortef) 250 mg IV stat injected over 30-60 sec.
The MR examination should be conducted no less than one hour and no more than four hours
after the initiation of IV Hydrocortisone. Diphenhydramine 50 mg IV can also be administered
one hour before the examination if time permits. The IV regimen should only replace the oral
regimen in rare circumstances and should not be used in the evenings or on weekends. It
should be used at the discretion of the responsible radiologist for patients who would be
greatly inconvenienced by rescheduling of the MR examination (e.g., patients who live a great
distance from the hospital). Potential risk/benefit should be discussed with the referring
physician and patient by a radiologist prior to administration. If Benadryl is administered to
outpatients, there should be someone available to drive them home after the examination.
4. Radiologist responsibilities:
If a patient arrives for an MRI exam and a history of allergy to gadolinium contrast agents is
elicited, if premedication has not been arranged, then a radiology consultation will be
triggered. A radiologist will discuss with the patient the risk/benefit of rescheduling and/or
premedication, and will also discuss this with the referring physician. If the referring
physician is not available for consultation at the time of the radiology exam (i.e. after hours
and weekends), then the physician’s office wil be contacted the next business day.
1. ACR Manual on Contrast Media. Version 8. (2012) ACR Committee on Drugs and Contrast
2. Murphy KP, Szopinski K, Cohan R, et al. Occurrence of Adverse Reactions to Gadolinium-based
Contrast Material and Management of Patients at Increased Risk. Acad Radiol 1999; 6: 656-
3. Prince MR, Zhang H, Zhitong Z, et al. Incidence of Immediate Gadolinium Contrast Media
Functional Diagnostic Nutrition® and the BioHealth Laboratory’s BH101 Metabolic Assessment Profile The Utility of Urine Testing for Indican, Lipid Peroxides and Urinary Bile Acid Sulfates in Functional Assessments of Patients with Common Health Complaints Related to the Chronic Stress Response Reed Davis, Clinical Advisor BH Laboratory Introduction In functional
Rehabilitation Institute of Texas RIT Patient Initial Visit Information Sheet Patient Name: ____________________________ Age: _______ Gender: M FReferring Physician: _______________________ Primary Care Physician: ___________________ Reason for the visit: _______________________________________________________________ 1. When did your present problem start? _____________________