To Gad, Or Not To Gad...

Eric M. Baumel, MD

Digital Imaging Diagnostics

CT Brain

No contrast for Bleed

C- for Sinuses, Facial Bones

C+ for Orbits (except trauma)

CT Chest

No Need for Without and With

C+ to Evaluate for Mass (esp. for mediastinal and hilar adenopathy)

C+ for CTA Dissection, CTPA, CCTA

C- for Follow/Up of Nodules, ILD

CT Abdomen and Pelvis

Renal Stone Protocol - No IV or Oral

Oral and IV for Just About Everything Else (and you don’t need C- unless stones are a consideration)

Remember Abdomen stops at Iliac Crest -- Pelvis goes to Symphysis

MRI Extremities

No Gd unless evaluating a mass

MRI Spine

Gd for Lumbar Spines with Prior Surgery

Gd for All Spines for Tumor, Infection, Demyelinating Disease

MRI Brain without and with Gad

Mass

Infection

Demyelinating Disease

Acute / Subacute CVA

MRI without and with Gad

IAC’s

Pituitary

Orbits (ex. r/o Optic Neuritis)

Gad Enhanced MRACircle of Willis

Cervical Carotids

Aortogram and Runoff

(Can do CoW and Carotids w/o if necessary)

No Gd for MRCP

MRI Abdomen

Gd for Mass Evaluation

NSF (Nephrogenic Systemic Fibrosis)

GFR <30 == Contraindication

GFR >60 == No Problem

GRF 30 - 60 == Use Medical Judgement

Thank You!

Eric M. Baumel, M.D.

Digitalrads.com