Consensus Report from Oncology Advisory Board Meeting

16 • Strategies for Prevention and Management of CI-AKI and the Role of Contrast in Oncology CT Settings y y Treatment with derivatives of metformin should be stopped for 48 hours following the injection of iodinated contrast medium (ICM). However, stopping the treatment 48 hours before the examination is based on the eGFR, and y y An interval of at least 3 days, up to 5 days if possible, between two injections of ICM is advised. Route of Contrast Administration and Risk of CI-AKI Contrary to previous belief, a recent study (published in 2016) suggested that intra-arterial administration of contrast material during cardiac catheterization had a similar risk of AKI as compared with that of CT scanning involving IV administration in a cohort of patients who underwent both procedures [9]. References 1. Geyer LL, et al ; State of the Art: Iterative CT Reconstruction Techniques; Radiology . 2015; Volume 276, Issue 2. 2. Schindera ST, Nelson RC, Mukundan S Jr, et al . Hypervascular liver tumors: low tube voltage, high tube current multi-detector row CT for enhanced detection-phantom study. Radiology . 2008;246(1):125-132. 3. Faggioni L, Gabelloni M; Iodine Concentration and Optimization in Computed Tomography Angiography Current Issues; Invest Radiol. 2016. 4. McCullough P, Capasso P. Patient Discomfort Associated with the Use of Intra-arterial Iodinated Contrast Media: AMeta-Analysis of Comparative Randomized Controlled Trials. BMC Med Imaging . 2011;11(1):12. 5. Maestro LD, Laghi A, Ronco C. Methods to Address Computed Tomography-Related Risk Factors in Oncology Patients: An Expert Opinion Based on Current Evidence. Blood Purif . 2018;46:56–69. 6. Davenport MS, et al ; Rate of Contrast Material Extravasations and Allergic-like Reactions: Effect of Extrinsic Warming of Low-Osmolality Iodinated CTContrast Material to 37°C. Radiology . 2012;262(2):475–484. 7. Basu A. Contrast-Induced Nephropathy Treatment & Management. Available at https://emedicine.medscape.com/article/246751-treatment# d10. Accessed on 14/05/18. 8. Adapted from-The Royal Australian and New Zealand College of Radiologists. Iodinated Contrast Media Guideline. Sydney: RANZCR; 2018. 9. McDonald JS, Leake CB, McDonald RJ, Gulati R, Katzberg RW, Williamson EE, Kallmes DF. Acute Kidney Injury After Intravenous Versus Intra-Arterial Contrast Material Administration in a Paired Cohort. Invest Radiol . 2016;51(12):804–809. Summary When a patient with malignancy who is at risk for CI-AKI requires an imaging study, the first determination that should be made is whether the desired clinical information can be obtained without use of intravascular contrast. Low osmolar or iso-osmolar contrast agent should be used in conjunction with an IV saline hydration regimen. Use the lowest dose of CM. Low dose contrast-enhanced MRI examination should be performed using a low-risk agent as it has a clearer safety margin. Multi-detector CT has dramatically short image acquisition time. Bolus duration should mimic the scanning duration. Long injection leads to a waste of CM because CM administered after acquisition of data does not contribute to data acquisition. Contrast medium should be at body temperature. At room temperature, in most radiology units, viscosity is high. High viscosity makes the patient more prone to AKI, contrast-induced side effects, as well increased extravasation of the contrast.