Question

A Group II gadolinium-based contrast agent (per ACR/RCR guidance, lowest risk of nephrogenic systemic fibrosis) can be safely administered in which of the following patients?

• A. A patient with GFR <50 mL/min/1.73m²
• B. A 30-year-old with no renal function test done
• C. A 60-year-old with no renal function test done
• D. A patient with normal renal function tests

Hint:

The whole point of Group II macrocyclic agents — negligible NSF risk, so usable even with low GFR.

Answer 1

The Correct Option is A

Step 1: Recall the gadolinium agent groups.
Gadolinium-based contrast agents (GBCAs) are stratified by nephrogenic systemic fibrosis (NSF) risk: Group I = highest risk (linear, e.g. gadodiamide); Group II = very low/negligible risk (macrocyclic, e.g. gadoterate, gadobutrol, gadoteridol); Group III = limited data.

Step 2: Identify the unique property of Group II.
Because Group II agents have negligible NSF risk, guidance allows their use even in patients with impaired renal function, and routine pre-contrast eGFR screening is not mandatory for them. The scenario that specifically tests this is a patient with a documented low GFR.

Step 3: Evaluate the options.
• GFR <50 — a Group II macrocyclic agent remains safe here owing to negligible NSF risk; this is the intended answer because it highlights safe use despite renal impairment.
• The two "no RFT" options concern screening, not the agent's intrinsic safety in renal disease.
• A patient with normal RFT can of course receive any GBCA, but this does not demonstrate the special advantage of Group II.

Step 4: Conclusion.
Group II GBCAs may be given even when GFR is reduced. Key fact: macrocyclic (Group II) gadolinium agents carry negligible NSF risk and are safe in renal impairment, including GFR <50, without mandatory eGFR screening.