While gadolinium-based contrast agents (GBCAs) are essential to performing breast MR imaging, guidance from the US Food and Drug Administration (FDA) and the American College of Radiology (ACR) includes the recommendation of limiting a patient's gadolinium exposure. Gadopiclenol injection, a macrocyclic, high-relaxivity GBCA can address this recommendation by providing high-quality images with half the gadolinium dose as compared to other conventional GBCAs.

This educational program features Dr. Margarita Zuley’s clinical expertise and practice experience. Through case study examples she will share the indications for abbreviated breast MRI and the clinical rationale for implementing optimal imaging protocols using a lower gadolinium dose and clinical examples of the management of MRI detected findings.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Explain the clinical benefits of abbreviated breast MRI for patients with dense breast and/or high-risk factors.
• Implement lower gadolinium dosing protocols for patients who may experience repeat breast MRI scans.
• Understand the clinical paradigms and indications for breast MRI as it relates to other imaging modalities.

This program is made possible through an unrestricted educational grant from Bracco Diagnostics Inc.

Prior to 2023, six extracellular fluid magnetic resonance imaging (MRI) contrast agents were available in the US: ProHance® (gadoteridol), Gadavist® (gadobutrol), Dotarem® (gadoterate meglumine; Clariscan™ (gadoterate meglumine); Omniscan™ (gadodiamide); and MultiHance® (gadobenate dimeglumine). These gadolinium-based contrast agents (GBCAs) vary with respect to chelate structure (ionic vs nonionic; macrocyclic vs linear), molar concentration (the number of Gd molecules per mL), and relaxivity.

With decades of use, these agents were demonstrated to be quite safe; however, since 2006, concerns about the safety of GBCAs have come to light, particularly with regard to the less stable (linear, nonionic) agents. Specifically, nephrogenic systemic fibrosis (NSF) and Gd retention were seen more readily with the use of these less-stable agents. It became apparent that a macrocyclic, high-relaxivity GBCA would be ideal, optimizing patient safety without compromising image quality.

In 2023, the US Food and Drug Administration approved Vueway™ (gadopiclenol) injection, a macrocyclic, high relaxivity agent that represents a significant advancement in terms of efficacy and safety. This paper compares the properties, mechanism-of-action, dosing, efficacy, and safety of the currently available GBCAs to the new agent Vueway.

This program has been supported through an educational grant from Bracco Diagnostics, Inc

Gadolinium-based contrast agents (GBCAs) continue to advance the diagnostic value of magnetic resonance imaging (MRI). Given that children may undergo repeat exams over their lifetime, weighing the benefits of contrast with its associated risks is crucial.

In this CE-accredited program, Shreyas Vasanawala, MD, PhD, division chief of pediatric radiology at Stanford, shares his clinical experience and discusses considerations for selecting and utilizing GBCAs in pediatric MRI. With special focus on structure and relaxivity, Dr Vasanawala presents case studies that demonstrate the clinical impact of the newest GBCA, gadopiclenol.

Educational Objectives:
At the completion of this activity, participants should be able to:

• Describe the history of GBCA use in contrast-enhanced MRI, with focus on pediatric imaging.
• Identify key physicochemical properties that can guide the selection and use of GBCAs in children.
• Discuss the use of gadopiclenol in pediatric clinical scenarios and its impact on patient management.

Made possible through an unrestricted educational grant from Bracco Diagnostics, Inc.

This program compares the physicochemical properties of the current FDA approved gadolinium-based MR contrast agents (GBCAs). This includes the molecular design as well as properties such as ionicity, molar concentration, relaxivity, biodistribution and excretion. Dosing considerations based on relaxivity are presented along with data from peer-reviewed publications. Stability metrics are defined and compared. Adverse events including acute, physiologic events as well as the chronic adverse reaction, NSF are discussed along with the most recent information regarding gadolinium deposition and retention.

Gadopiclenol solution for injection, 485.1 mg.mL, was approved by the FDA in Sept 2022. For a presentation about the Practical Considerations for Use of this product, please choose the online course "Gadopiclenol Injection | Practical Considerations for Use" from the list of RADU accredited programs.

Educational Objectives

At the completion of this program, participants will be able to:

• Describe the difference between linear and macrocyclic molecules
• Cite the least stable type of GBCA
• Define relaxivity
• Describe how to calculate volume of administration based on molar concentration
• Define thermodynamic and kinetic stability
• Cite the agents currently contraindicated in patients with eGFR below 30
• Identify agents associated with retention of gadolinium

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

The goals of Acute Stroke Imaging are to differentiate acute ischemic stroke from intracranial hemorrhage, confirm the diagnosis so patients are not treated unnecessarily, identify brain tissue that is still viable, and locate the vascular occlusion. In this education program, Dr. John Karis increases awareness of the importance of a quick, determinate diagnosis when assessing acute stoke injury. A review of the evolution of stroke treatments and clinical outcomes which are supported by the appropriate imaging modality (CT vs MRI) is discussed. When speed and accuracy are necessary, MR imaging in the ED can assist in making the diagnosis and quickly moving the patient to the appropriate treatment for improved outcomes. The recommendation of establishing an emergency room MR imaging protocol for Acute Stroke imaging is presented.

Educational Objectives

At the completion of this program, participants will be able to:

• Understand the evolution of stroke treatments
• Explain how to assess clinical outcomes of stroke patients
• Discuss the clinical studies supporting interventional treatments & management of acute stroke
• Appreciate the goals of Acute Stoke Imaging: CT vs MRI
• Establish ED imaging recommendations for Acute Stroke and Transient Ischemic Attack patients

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

This accredited program provides a comprehensive overview of MRI safety considerations for passive / active implants, and devices.

When considering patient safety during MR imaging, it is critical to assess the patient’s history and have a clear understanding of any passive and or active implants and/or devices. The ACR Manual on MR Safety states that the Radiologist is responsible for the safety of the patient undergoing the MRI Exam. They are also responsible for implementing MR Safety policies and procedures and ensuring that the facilities’ personnel adhere to them at all time. Regarding implants and devices, regular reviews and updates to the MRI safety policy should be completed.

With more than 35 years of experience in the field of MRI, the author of the best-selling textbook series, the Reference Manual for Magnetic Resonance Safety, Implants and Devices, and the creator of the internationally popular website, www.MRIsafety.com, Dr. Frank G. Shellock is uniquely qualified to present this important MRI Safety information designed for MRI Imaging professionals.

Educational Objectives

• Name and describe the current labeling terminology for implants & devices.
• Safely image patients with passive and active, MR Conditional implants and devices.
• Establish a comprehensive MRI Safety protocol for imaging implants & devices.

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

When considering body MRI, the use of GBCAs are foundational and are used in most protocols. The importance of GBCAs is documented in multiple applications for body MRI imaging. Documentation of the need for GBCA administration, sample approval, selection and processes as well as the pros and cons of various agents are considered. Case studies of GBCA choices in liver MR imaging and potential pitfalls are reviewed. Kevin Chang, MD and a panel of MRI experts discuss the clinical benefits, protocols and use of GBCAs in body MRI applications.

Educational Objectives

• List MR body protocols that require the use of GBCA to make a complete diagnosis
• Discuss how the need for GBCA in body imaging can be documented and justified
• Compare and contrast the GBCA choices in liver imaging

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

When considering the choice of a gadolinium-based contrast agents (GBCAs) for neuro MRI, multiple factors should be reviewed as part of the selection process. Patient history, the reasons for the scan, and the clinical risks vs benefits to receiving an MR contrast are important factors. The fact that high relaxivity linear agents can potentially improve the image quality should be considered when imaging certain neurological pathologies. In this accredited program Max Wintermark, MD and a panel of MR imaging experts discuss the clinical challenges and associated imaging considerations, as well as emerging techniques impacting neuro MRI. (i.e. AI, MR contrast dose reduction & non-contrasted imaging protocols).

Educational Objectives

• Assess practice trends impacting GBCA selection for Neuro MRI
• Identify the clinical and patient considerations in terms of risks vs benefits of GBCA utilization
• List the benefits of using a high relaxivity linear GBCA in neuro MRI studies
• Discuss new and emerging techniques in the use of GBCAs in neuro MRI

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.

In MR Imaging, a careful review of the safety criteria for the selection of a Gadolinium-based Contrast Agents (GBCAs) should be considered for pediatric and neonatal patients. The program will provide a comprehensive review of the supporting research that addresses Gadolinium selection in this special patient population. Both chronic and long-term effects of GBCAs will be discussed.

As a Pediatric Neuroradiologist, Dr. Shah is uniquely qualified to share his experience which includes a discussion of risk vs benefits, supported by practical protocols for the administration of MR contrast; including limiting the amount of contrast given to patients that may receive several lifetime doses.

Educational Objectives

• Explain the differences between available MR contrast agents and any associated adverse events.
• Improve clinical management decisions about when to administer MR contrast (risk vs benefit).
• Apply FDA guidelines regarding MRI contrast agents to clinical practice.

Supported through an unrestricted educational grant from Bracco Diagnostics, Inc.