Edward Parkes

PREFACE TO THIRD EDITION

Within 30 months of the release of both the first and second editions of Contrast Media: Safety Issues and ESUR Guidelines, the book had sold out, even though more copies were printed than is usual for a radiology book, and at a time when electronic media have increasing impact. There have been changes in the field of contrast media since the second edition, mainly because of increased knowledge about current agents rather than because new agents have been introduced. We therefore decided to update the book and have a new edition, instead of reprinting the second edition. All of the chapters have been updated where appropriate and new chapters have been added. The chapter on non-gadolinium-based contrast agents has been omitted because the manganeseand iron-based agents are currently not marketed. There is a new chapter on the hot topic of off-label use of contrast media. Previously a contrast medium was approved, for example, for intravenous administration for all applications, but now it must also be approved for use in different parts of the body, based on efficacy data. All the currently available agents are not approved for imaging all parts of the body. The radiologist must know whether the agent which is to be used is approved for the particular examination that is to be undertaken. If the agent is not approved, special informed consent must be obtained in some countries. Another new chapter deals with the use of contrast media in pediatrics. Off-label use is often necessary in pediatrics because contrast media are not usually evaluated in children. Also, when administering contrast media to children, it is important to allow for some of the physiological differences between children and adults. A chapter on measurement of the glomerular filtration rate (GFR) has been added. Nowadays, this is an important topic because GFR decides which gadolinium-based agent can be used and whether or not there should be volume expansion before iodine-based contrast media are given. The CKDEPI equation seems to be the best option for estimating GFR. The chapter on Contrast Media Classification and Terminology has been updated with more physicochemical data for the various commercially available agents. The chapter on prevention of acute contrast medium reactions has been rewritten to include the concept that hypersensitivity to contrast media may be allergic or non-allergic, and the increasing recognition of the fact that mild symptoms may follow CT and MR scans even when no contrast medium is given. The importance of recording acute reactions correctly is stressed, so that patients who have mild symptoms not requiring medical treatment are not inappropriately denied contrast medium in future. The chapters on late adverse reactions, contrast-induced nephropathy and nephrogenic systemic fibrosis have been revised. The European Society of Urogenital Radiology Contrast Medium Safety Committee (ESUR CMSC) recently reviewed the literature on these three topics and published update papers in European Radiology based on its conclusions. The conclusions are included in this book, and references to the guideline papers are given in Official publications from the Contrast Medium Safety Committee of the European Society of Urogenital Radiology.