ESUR Guidelinesの改訂と最近の話題

抄録

　In the European Society of Urogenital Radiology (ESUR) guidelines 10.0, the usefulness of premedication, such as steroids, which is widely used for patients with risk factors for acute (immediate) adverse effects, has been disproved, and the recommendation of premedication has been scrapped. Certainly, there is no evidence that premedication is effective for preventing the occurrence of adverse effects or reducing the severity. How this change would be applied in the actual clinical setting is controversial.

　There is no major change in management of acute adverse effects. For this point, however, recommendation no. 3 laid down by the Japan Medical Safety Research Organization in 2019 should be referred to. If anaphylaxis is suspected, 0.3 mg of adrenaline should be administered in the anterolateral thigh muscle without hesitation. Even if you are not convinced of anaphylaxis, an intramuscular injection of adrenaline must be given immediately. Moreover, adverse effects of intramuscular injections of 0.3 mg of adrenaline are not a cause for concern, as the injection route is not intravenous.

　The knowledge of nephrogenic systemic fibrosis (NSF) is already well established. This disease was first described in the 2018 edition of the Japanese National Examination Standard for Doctors. The use of linear gadolinium-based contrast agents with low chelate stability (except EOB Primovist) is extremely limited, and occurrence probability of NSF is extremely low as long as macrocyclic gadolinium-based contrast agents are used. Patient-related risk factors are eGFR <15 mL/min/1.73 m³ and dialysis.

　Gadolinium accumulation (retention) in the body and environmental diffusion have recently been described. Although the accumulation of gadolinium in the body is widely known, its clinical significance is unknown.

　Since gadolinium is an element, once it diffuses in the environment, it is almost impossible to recover it. However, its effect on humans is unknown.