Radyolojide Kontrast Madde Güvenliği: Güncel Yaklaşımlar
Synopsis
This chapter reviews current approaches to the safety of iodinated, gadolinium-based and ultrasound contrast agents in radiology, based on guidelines published between 2020 and 2026, primarily those of the ACR and ESUR. Hypersensitivity reactions, renal safety, nephrogenic systemic fibrosis (NSF), gadolinium retention, extravasation, pregnancy and lactation, thyroid function, ultrasound contrast agents and safe intervals between consecutive administrations are discussed. In 2025, the ACR-AAAAI, CAR-CSACI and ESUR guidelines independently concluded that routine premedication is not recommended for patients with a history of mild reactions and that switching agents should be preferred whenever possible. Distinguishing contrast-associated from contrast-induced acute kidney injury has shown that nephrotoxic risk was overestimated in the past; prophylactic hydration is now limited to selected patients with acute kidney injury or an eGFR <30 mL/min/1.73 m². NSF risk has become extremely low with group II gadolinium-based agents, while judicious use and high-relaxivity agents such as gadopiclenol, usable at half dose, have gained prominence regarding retention. Surgical consultation for extravasation is now based on clinical severity rather than volume, and interrupting breastfeeding is no longer recommended. In conclusion, standardized protocols are being replaced by evidence-based, individualized approaches, and institutional protocols should be updated regularly.
References
American College of Radiology (ACR). ACR Manual on Contrast Media. Reston, VA: American College of Radiology; updated 2025. Accessed September 6, 2026.
van der Molen AJ, van de Ven AAJM, Vega F, Dekkers IA, Geenen RWF, Bellin MF, et al. Hypersensitivity Reactions to Contrast Media: Part 1. Management of Immediate and Non-immediate Hypersensitivity Reactions in Adults. Updated Guidelines by the ESUR Contrast Media Safety Committee. Eur Radiol. 2025;35(11):6798-810. doi:10.1007/s00330-025-11675-1.
Wang C, Ramsey A, Lang D, Copaescu AM, Krishnan P, Kuruvilla M, et al. Management and Prevention of Hypersensitivity Reactions to Radiocontrast Media: A Consensus Statement From the American College of Radiology and the American Academy of Allergy, Asthma & Immunology. Radiology. 2025;315(2):e240100. doi:10.1148/radiol.240100.
Byrne A, Macdonald DB, Kirkpatrick IDC, Pham M, Green CR, Copaescu AM, McInnes MDF, Ling L, Ellis A, Costa AF. CAR/CSACI Practice Guidance for Contrast Media Hypersensitivity. Can Assoc Radiol J. 2025;76(3):400-16. doi:10.1177/08465371241311253.
van der Molen AJ, van de Ven AAJM, Vega F, Dekkers IA, et al. Hypersensitivity Reactions to Contrast Media: Part 2. Prevention of Recurrent Hypersensitivity Reactions in Adults. Updated Guidelines by the ESUR Contrast Media Safety Committee. Eur Radiol. 2025;35(11):6811-25. doi:10.1007/s00330-025-11676-0.
McDonald JS, McDonald RJ. Risk of Acute Kidney Injury Following IV Iodinated Contrast Media Exposure: 2023 Update, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol. 2024;223(1):e2330037.
Davenport MS, Perazella MA, Yee J, Dillman JR, Fine D, McDonald RJ, et al. Use of Intravenous Iodinated Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology. 2020;294(3):660-668.
McDonald RJ, McDonald JS. Iodinated Contrast and Nephropathy: Does It Exist and What Is the Actual Evidence? Radiol Clin North Am. 2024;62(6):959-69.
Nijssen EC, Rennenberg RJ, Nelemans PJ, Essers BAB, Janssen MMJ, Vermeeren MAJ, et al. Prophylactic Hydration to Protect Renal Function from Intravascular Iodinated Contrast Material in Patients at High Risk of Contrast-Induced Nephropathy (AMACING): A Prospective, Randomised, Phase 3, Controlled, Open-Label, Non-Inferiority Trial. Lancet. 2017;389(10076):1312-22.
Macdonald DB, Hurrell CD, Costa AF, McInnes MDF, O'Malley M, Barrett B, et al. Canadian Association of Radiologists Guidance on Contrast-Associated Acute Kidney Injury. Can J Kidney Health Dis. 2022;9:20543581221097455.
Mallepally A, Kidd JM, Grizzard JD, Syed HJ, Chetla N, Carucci LR, et al. Nephrogenic Systemic Fibrosis in Patients with Advanced Renal Dysfunction Following Gadolinium-based Contrast Agents. Radiology. 2025;317(3):e251794.
Starekova J, Pirasteh A, Reeder SB. Update on Gadolinium-Based Contrast Agent Safety, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol. 2024;223(3):e2330036.
U.S. Food and Drug Administration (FDA). FDA Drug Safety Communication: FDA Warns That Gadolinium-Based Contrast Agents (GBCAs) Are Retained in the Body; Requires New Class Warnings. Silver Spring (MD): FDA; 2017 (updated 2018).
Loevner LA, Kolumban B, Hutóczki G, Dziadziuszko K, Bereczki D, Bago A, et al. Efficacy and Safety of Gadopiclenol for Contrast-Enhanced MRI of the Central Nervous System: The PICTURE Randomized Clinical Trial. Invest Radiol. 2023;58(5):307-13. doi:10.1097/RLI.0000000000000944.
Kuhl C, Csőszi T, Piskorski W, Miszalski T, Lee JM, Otto PM. Efficacy and Safety of Half-Dose Gadopiclenol versus Full-Dose Gadobutrol for Contrast-enhanced Body MRI. Radiology. 2023;308(1):e222612. doi:10.1148/radiol.222612.
Ouyang M, Bao L. Gadolinium Contrast Agent Deposition in Children. J Magn Reson Imaging. 2025;61(1):70-82. doi:10.1002/jmri.29389.
Roditi G, Khan N, van der Molen AJ, Bellin MF, Bertolotto M, Brismar T, et al. Intravenous Contrast Medium Extravasation: Systematic Review and Updated ESUR Contrast Media Safety Committee Guidelines. Eur Radiol. 2022;32(5):3056-66.
European Society of Urogenital Radiology (ESUR) Contrast Media Safety Committee. ESUR Guidelines on Contrast Agents, v. 2025. Available from: https://www.esur.org/esur-guidelines-2025/. Accessed September 6, 2026.
Bookwalter CA, McDonald RJ, Packard AT, Little JT, McDonald JS, Watson RE. Contrast Media in Pregnant and Lactating Patients, From the AJR Special Series on Contrast Media. AJR Am J Roentgenol. 2025;224(4):e2431415. doi:10.2214/AJR.24.31415.
Bednarczuk T, Brix TH, Schima W, Zettinig G, Kahaly GJ. 2021 European Thyroid Association Guidelines for the Management of Iodine-Based Contrast Media-Induced Thyroid Dysfunction. Eur Thyroid J. 2021;10(4):269-84. doi:10.1159/000517175.
Dillman JR, Forbes-Amrhein MM, Wang CL, Asch D, Cavallo J, Ellis JH, et al. ACR Statement on Use of Iodinated Contrast Material for Medical Imaging in Young Children and Need for Thyroid Monitoring. J Am Coll Radiol. 2022;19(7):849-53. doi:10.1016/j.jacr.2022.05.014.
Van der Molen AJ, Dekkers IA, Geenen RWF, Bellin MF, Bertolotto M, Brismar TB, et al. Waiting Times Between Examinations with Intravascularly Administered Contrast Media: A Review of Contrast Media Pharmacokinetics and Updated ESUR Contrast Media Safety Committee Guidelines. Eur Radiol. 2024;34(4):2512-23. doi:10.1007/s00330-023-10085-5.
