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.

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.

MR imaging of the abdomen and pelvis is performed to evaluate organs of the abdomen, such as the liver, biliary tract, kidneys, spleen, bowel, pancreas, and adrenal glands, organs of the pelvis, including the bladder and the reproductive organs; uterus and ovaries in females, and the prostate gland in males, blood vessels (including MR Angiography), and lymph nodes. MRI helps diagnose or monitor treatment for conditions such as, tumors of the abdomen or pelvis, diseases of the liver, such as cirrhosis, and abnormalities of the bile ducts and pancreas, inflammatory bowel disease such as Crohn's disease and ulcerative colitis, abnormal blood vessels and inflamed vessels (vasculitis) and a fetus in the womb of a pregnant woman.

In this educational program, Dr. Porter will focus on Intravenous Gadolinium Based Contrast Utilization in the Abdomen & Pelvis by providing a review of the ACR Appropriateness Criteria of the GI, Urological and Women’s Imaging. The clinical benefits of GBCA MRI are demonstrated by case study review. Further discussion includes a risk to benefits relationship of contrast administration and potential diagnostic alternatives.

Educational Objectives

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

• Recognize when GBCA MRI is appropriate and indicated in the Abdomen & Pelvis
• Understand the benefits of GBCA utilization in the Abdomen & Pelvis
• Describe the risk-to-benefit relationship of contrast administration and potential, diagnostic alternatives
• State the ACR Appropriateness Criteria of GI, Urological and Women’s imaging in MR of Abdomen & Pelvis

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

This two-part, on-demand webinar and accompanying digital monograph has been developed to increase overall understanding of the properties, clinical benefits, and safety considerations of iodinated and gadolinium-based contrast agents (GBCAs). The goal of this program is to fully prepare pharmacy personnel to make informed decisions regarding contrast media selection.

The complete online program has been approved for up to 2.5 Category A ARRT continuing educational credits.

This program was supported through an educational grant from Bracco Diagnostics, Inc.

With the recent FDA approval of gadopiclenol injection, radiologists now have the choice of a macrocyclic gadolinium-based contrast agent (GBCA) with 2 – 3 times higher relaxivity at a lower standard dose as compared to other gadolinium-based contrast agents on the market.

Therefore, and because gadopiclenlol is different than other currently available GBCAs, a review of the clinical benefits of using a higher relaxivity GBCA at a lower administered dose is important. A clear understanding of relaxivity and calculation of the volume to be administered based on dosing considerations, is necessary.

In this accredited webinar, Mr. Faulkner will provide insights into the differences of the current FDA-approved GBCAs and how these differences apply to MR imaging. Following the presentation, questions from the audience were addressed during a live Q&A.

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

• Identify the properties that distinguish gadopiclenol injection from the other high relaxivity and conventional gadolinium-based contrast agents (GBCAs).
• Employ the FDA-approved indications and clinical applications for gadopiclenol injection.
• Calculate and administer the proper volume dose of gadopiclenol, as compared to other conventional GBCAs.
• Apply clinical considerations and dosing options for gadopiclenol to vulnerable patient populations who may experience repeat dosing of GBCA.

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

Since the 1990’s, multi-patient contrast administration has been available in the form of the Pharmacy Bulk Package (PBP), which is still offered by several contrast vendors. The FDA required that all related Prescribing Information (PI) sheets for the PBP include specific directions for the dispensing of the contrast from the PBP container. The PI language describes withdrawing the contrast from the bottle in a suitable work area, specifically “a laminar flow hood, using aseptic techniques”. However, this method is not possible in most CT Suites, as laminar flow hoods are generally located in the Pharmacy, not the CT suite.

Therefore, during the last decade, regulators have begun to have concerns about the use of PBP. In 2009, The Joint Commission began citing imaging providers who were using PBP to fill power injector syringes in what they considered an unsuitable work area, as described in the manufacturer’s PBP guidelines for the dispensing of contrast.

This Expert Forum will review the steps taken by the contrast media industry and the FDA to develop a safe and compliant solution for multi-patent contrast administration in CT. This solution is now available as the Imaging Bulk Package (IBP) which is approved for use in the CT Suite. This panel will also share their comprehensive process for incorporating IBP into their clinical practice.

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

• Implement Joint Commission guidelines for multi-patient contrast administration.
• Describe the differences between Pharmacy Bulk Package (PBP) and Imaging Bulk Package (IBP) and define which is FDA approved for multi-patient use.
• Discuss the clinical and economic benefits of multi-patient contrast administration using Imaging Bulk Package (IBP).

This program has been supported through an 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.

This accredited program provides a comprehensive overview of MRI safety including the radiologist's responsibilities and liabilities, MRI staff education and patient safety. It is designed specifically for practicing radiologists, fellows, residents, and healthcare professionals who oversee MRI services and will provide practical guidance from two respected MRI safety educators who present information on accepted safety standards of care based on the 2020 ACR Manual on MR Safety, the 2021 FDA Guidance Document, and a review of the literature.

Program Considerations: It is critical to have established MRI safety protocols and to have a clear understanding of the basics of MRI Safety. 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. These MRI safety policies should be reviewed and updated annually in order to prevent patient injury.

Educational Objectives

• Describe the difference between Level 1 & Level 2 MR personnel.
• Differentiate and identify the ACR-designated Safety Zones.
• Implement safety considerations for the static magnetic field, time-varying gradient magnetic fields, and radiofrequency fields.
• Employ procedures and protocols to prevent RF-related burns and methods to manage SAR levels.
• Manage acute and chronic gadolinium-based contrast agent adverse events.

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

Autoimmune encephalitis is a difficult clinical diagnosis due to the similarities in the clinical, imaging and laboratory findings of many forms of autoimmune and infectious encephalitis.¹ Many cases have no imaging findings, especially early in the course of the disease. MRI with contrast is considered the most sensitive imaging modality, and findings are present in over half of individuals.²

In this program, Dr. Maklinzak discusses the diagnosis of Autoimmune Encephalotomies using CE MR and explains how this modality can help guide acute treatment and antibody testing procedures.

1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4712273/
2. Radiopaedia.org Autoimmune encephalitis Dr Francis Fortin and Radswiki et al.

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

• Review MRI contrast considerations and imaging protocols relating to Pediatric Neuro MRI in the diagnosis of Autoimmune Encephalotomies
• Understand the clinical imaging patterns of ADEM (acute disseminated encephalomyelitis), optic neuritis & transverse myelitis, limbic encephalitis, and MS
• Describe the movement toward antibody diagnoses with improved prognostic value and targeted therapy
• State how MRI findings can guide acute treatment and antibody testing

Supported 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