rentradВестник рентгенологии и радиологииJournal of radiology and nuclear medicine0042-46762619-0478Limited Liability Company "LUCHEVAYA DIAGNOSTIKA", Russian Association of Radiologists10.20862/0042-4676-2023-104-6-363-384rentrad-845Research ArticleМЕТОДИЧЕСКИЕ РЕКОМЕНДАЦИИGUIDELINESБезопасное использование контрастных средств в рентгенологии (методическое руководство Российского общества рентгенологов и радиологов)Safe Use of Contrast Media in Radiology (Clinical Guidelines)https://orcid.org/0000-0002-5649-2193СиницынВ. Е.SinitsynV. E.

Синицын Валентин Евгеньевич, д. м. н., заведующий кафедрой лучевой диагностики и лучевой терапии факультета фундаментальноймедицины, заведующий отделом лучевой диагностики Медицинского научно-образовательного центра

Ломоносовский пр-т, 27, корп. 10, Москва, 119991

Valentin Е. Sinitsyn, Dr. Med. Sc., Professor, Chief of Chair of Radiology, Faculty of Fundamental Medicine, Head of Department of Radiology, Medical Scientific and Educational Center

Lomonosovskiy prospekt, 27, corp. 10, Moscow, 119991

https://orcid.org/0000-0003-0558-4079ТюринИ. Е.TyurinI. E.

Тюрин Игорь Евгеньевич, д. м. н., профессор, заведующий кафедрой рентгенологии и радиологии

ул. Баррикадная, 2, стр. 1, Москва, 123995

Igor Е. Tyurin, Dr. Med. Sc., Professor, Chief of Chair of Radiology

ul. Barrikadnaya, 2, str. 1, Moscow, 123995

https://orcid.org/0000-0001-8887-4420ШимановскийН. Л.ShimanovskiyN. L.

Шимановский Николай Львович, д. м. н., профессор, чл.-кор. РАН, заведующий кафедрой молекулярной фармакологии и радиобиологии им. академика П.В. Сергеева

ул. Островитянова, 1, Москва, 117997

Nikolay L. Shimanovskiy, Dr. Med. Sc., Professor, Corresponding Member of RAS, Chief of Chair of Molecular Pharmacology and Radiobiology named after Academician P.V. Sergeev

ul. Ostrovityanova, 1, Moscow, 117997

КармазановскийГ. Г.KarmazanovskiyG. G.

Кармазановский Григорий Григорьевич, д. м. н., профессор, чл.-кор. РАН, профессор кафедры лучевой диагностики и терапии; заведующий отделом лучевых методов диагностики и лечения

ул. Островитянова, 1, Москва, 117997; ул. Большая Серпуховская, 27, Москва, 117997

Grigoriy G. Karmazanovskiy, Dr. Med. Sc., Professor, Corresponding Member of RAS, Professor, Chair of Radiation Diagnostics and Therapy; Head of Department of Radiation Diagnostics and Treatment

ul. Ostrovityanova, 1, Moscow, 117997; ul. Bolshaya Serpukhovskaya, 27, Moscow, 117997

https://orcid.org/0000-0002-1459-4124БыченкоВ. Г.BychenkoV. G.

Быченко Владимир Геннадьевич, врач-рентгенолог, заведующий отделением лучевой диагностики 

ул. Aкадемика Опарина, 4, Москва, 117997

Vladimir G. Bychenko, Radiologist, Head of Department of Radiation Diagnostics

ul. Akademika Oparina, 4, Moscow, 117997

https://orcid.org/0000-0001-8378-4338РубцоваН. А.RubtsovaN. A.

Рубцова Наталья Алефтиновна, д. м. н., руководитель отдела лучевой диагностики

2-й Боткинский пр-д, 3, Москва, 125284

Natalia А.  Rubtsova, Dr. Med. Sc., Head of Department of Radiation Diagnostics

Vtoroy Botkinskiy proezd, 3, Moscow, 125284

https://orcid.org/0000-0002-0894-1994ФилатоваД. А.FilatovaD. A.

Филатова Дарья Андреевна, врач-рентгенолог, аспирант кафедры лучевой диагностики и лучевой терапии

Ломоносовский пр-т, 27, корп. 10, Москва, 119991

Daria А. Filatova, Radiologist, Postgraduate, Chair of Radiology, Faculty of Fundamental Medicine

Lomonosovskiy prospekt, 27, corp. 10, Moscow, 119991

dariafilatova.msu@mail.ruФГБОУ ВО «Московский государственный университет им. М.В. Ломоносова»РоссияLomonosov Moscow State UniversityRussian FederationФГБОУ ДПО «Российская медицинская академия непрерывного профессионального образования» Минздрава РоссииРоссияRussian Medical Academy of Continuing Professional EducationRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава РоссииРоссияPirogov Russian National Research Medical UniversityRussian FederationФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России; ФГБУ «Национальный медицинский исследовательский центр хирургии им. А.В. Вишневского» Минздрава РоссииРоссияPirogov Russian National Research Medical University; Vishnevsky National Medical Research Center of SurgeryRussian FederationФГБУ «Национальный медицинский исследовательский центр акушерства, гинекологии и перинатологии им. В.И. Кулакова» Минздрава РоссииРоссияKulakov National Medical Research Center of Obstetrics, Gynecology and PerinatologyRussian FederationМосковский научно-исследовательский онкологический институт им. П.А. Герцена – филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииРоссияHerzen Moscow Scientific Research Oncological Institute – branch of National Medical Research Center for RadiologyRussian Federation2023260520241046363384Copyright © Синицын В.Е., Тюрин И.Е., Шимановский Н.Л., Кармазановский Г.Г., Быченко В.Г., Рубцова Н.А., Филатова Д.А., 20242024Синицын В.Е., Тюрин И.Е., Шимановский Н.Л., Кармазановский Г.Г., Быченко В.Г., Рубцова Н.А., Филатова Д.А.Sinitsyn V.E., Tyurin I.E., Shimanovskiy N.L., Karmazanovskiy G.G., Bychenko V.G., Rubtsova N.A., Filatova D.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.russianradiology.ru/jour/article/view/845

В последние годы значительно возросла частота выполнения лучевых исследований с введением контрастных средств (КС), и вопросы их выбора и рационального использования не теряют своей актуальности. Настоящее методическое руководство представлеяет в краткой форме рекомендации по применению КС в лучевой диагностике. Описаны виды используемых в настоящее время КС при проведении компьютерной томографии, магнитно-резонансной томографии, а также ультразвукового исследования. Систематизированы правила техники безопасности при введении каждого из видов КС, объяснены принципы дозирования препаратов и их возможные побочные эффекты. Кроме того, важным представляется освещение проблем лекарственного взаимодействия между КС и другими препаратами, которые принимает пациент, в частности возможное ухудшение функции почек при использовании КС у пациентов с сахарным диабетом, принимающих метформин. Следует отметить, что многие положения, рассматриваемые в данном руководстве, в последние годы претерпели значительные изменения. Также в приложениях приведены шаблоны опросников для пациентов перед проведением исследования с контрастированием. Методическое руководство составлено на основании данных современных публикаций международных экспертов по применению КС в лучевой диагностике, а также данных двух главных руководств: Руководства по КС Американской коллегии радиологов (ACR) от 2023 г. и Рекомендаций по безопасности КС Европейского общества урогенитальной радиологии (ESUR) от 2018 г. (версия 10). Таким образом, представленная информация является проверенной и современной, что дает основания для ее использования в реальной клинической практике. Руководство будет обновляться по мере появления новых научных данных, однако на сегодняшний день данная версия наиболее актуальна. 

In recent years, the frequency of contrast-enhanced radiological studies has increased significantly, and the issues of their selection and rational use do not lose their relevance. These methodological recommendations represent a complete up-to-date guide for using contrast agents (CA) in radiology. Types of currently used CA in computed tomography, magnetic resonance imaging, and ultrasound examinations are described. Safety rules for injection of each CA type are systematized, the principles of dosing and possible side effects are explained. In addition, it is important to highlight the issues of interactions between CA and other drugs that patient might take, in particular, the possible deterioration of renal function when using CA in diabetes mellitus patients taking metformin. It should be noted that these recommendations have undergone significant changes in recent years. Also questionnaire templates for patients prior to the contrast-enhanced study are given in the supplements. The methodological guidelines are based on current publications of international experts on CA use in radiology as well as on the data of two major guidelines: American College of Radiologists (ACR) Guidelines (2023) and European Society of Urogenital Radiology (ESUR) Safety Recommendations (2018, version 10). Thus, the information presented is validated, which provides grounds for its application in real clinical practice. The guidelines will be actualized as new scientific evidence becomes available, but to date they appear to be the most relevant.

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The authors declare that there are no conflicts of interest present.