What does the ACR suggest when delivering GBCA to a pregnant patient?

The recommendation to use agents believed to have the lowest risk of nephrogenic system fibrosis (NSF) when delivering gadolinium-based contrast agents (GBCA) to a pregnant patient is based on safety considerations. During pregnancy, both the patient and the developing fetus are at higher risk for complications. Gadolinium is excreted primarily by the kidneys, and in patients with compromised renal function, the likelihood of developing NSF increases due to inefficient clearance of gadolinium from the body.

Using agents with a lower risk of NSF minimizes the potential adverse effects that may arise from the use of GBCA, particularly in vulnerable populations like pregnant women. The American College of Radiology (ACR) emphasizes the importance of weighing the benefits of imaging against the potential risks associated with contrast agents in pregnant patients, leading to the guidance of selecting agents with a better safety profile. This choice is more about ensuring safety for both the mother and the fetus than maximizing the strength or dosage of the contrast agent. Thus, the focus is on minimizing risk while still obtaining necessary diagnostic information.