This entity may manifest overlapping symptomatology with ALI and should be excluded clinically before consideration of imaging modalities. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Sudden Onset of Cold, Painful Leg Linear gadolinium-based agents used in contrast-enhanced MRI have previously been associated with nephrogenic systemic fibrosis (NSF) in patients with underlying renal dysfunction. However, in patients with acute kidney injury or stage 4/5 chronic kidney disease with current generation macrocyclic and linear agents (group II, ie, gadobenate dimeglumine, gadobutrol, gadoterate meglumine, gadoteridol, gadoxetic acid disodium) the risk of NSF is suggested to be so low that the potential harm of delaying or withholding contrast is likely to outweigh the risk of NSF in most clinical situations [5]. Group III agents (ie, gadoxetic acid disodium) have thus far demonstrated no unconfounded cases of NSF, although evidence is still limited. Of note, there is increasing evidence that gadolinium deposition occurs within the brain parenchyma, namely, within the dentate nuclei and globus pallidus, although with unknown clinical significance; this remains a topic of interest within MRI contrast safety [6]. Contrast-enhanced ultrasound (US) using microbubble-based intravenous (IV) contrast is being applied to a growing number of scenarios to demonstrate findings typically seen on contrast-enhanced CT and MRI. Early evidence has suggested the potential use of contrast-enhanced 3-D US to create targeted volumetric mapping of patent lower extremity arteries [7].
Sudden Onset of Cold Painful Leg. This entity may manifest overlapping symptomatology with ALI and should be excluded clinically before consideration of imaging modalities. The American College of Radiology seeks and encourages collaboration with other organizations on the development of the ACR Appropriateness Criteria through representation of such organizations on expert panels. Participation on the expert panel does not necessarily imply endorsement of the final document by individual contributors or their respective organization. Reprint requests to: publications@acr.org Sudden Onset of Cold, Painful Leg Linear gadolinium-based agents used in contrast-enhanced MRI have previously been associated with nephrogenic systemic fibrosis (NSF) in patients with underlying renal dysfunction. However, in patients with acute kidney injury or stage 4/5 chronic kidney disease with current generation macrocyclic and linear agents (group II, ie, gadobenate dimeglumine, gadobutrol, gadoterate meglumine, gadoteridol, gadoxetic acid disodium) the risk of NSF is suggested to be so low that the potential harm of delaying or withholding contrast is likely to outweigh the risk of NSF in most clinical situations [5]. Group III agents (ie, gadoxetic acid disodium) have thus far demonstrated no unconfounded cases of NSF, although evidence is still limited. Of note, there is increasing evidence that gadolinium deposition occurs within the brain parenchyma, namely, within the dentate nuclei and globus pallidus, although with unknown clinical significance; this remains a topic of interest within MRI contrast safety [6]. Contrast-enhanced ultrasound (US) using microbubble-based intravenous (IV) contrast is being applied to a growing number of scenarios to demonstrate findings typically seen on contrast-enhanced CT and MRI. Early evidence has suggested the potential use of contrast-enhanced 3-D US to create targeted volumetric mapping of patent lower extremity arteries [7].