Iodine-based contrast media may be given to pregnant patients in extraordinary conditions, but thyroid function should be checked in the neonate during the first week following the exam. When iodine-based agents are given to lactating mothers, breastfeeding may be continued normally (Thomsen et al. 2016).

In patients with renal impairment (eGFR less 45 mL/min/1.73 m2 for intravenous administration), an alternative imaging method without iodine-based contrast media should be considered. However, if it is really needed, volume expansion should be done. According to the ESUR guidelines, intravenous normal saline, 1.0–1.5 mL/kg/h, for at least 6 h before and after contrast medium administration is recommended. An alternative suitable protocol is intravenous sodium bicarbonate (154 mEq/L in dextrose 5% water), 3 mL/kg/h for 1 h before contrast medium administration and 1 mL/kg/h for 6 h after contrast medium administration. Moreover, the lowest dose of a low or iso-osmolar contrast medium should be used (Thomsen et al. 2016).

Finally, some recommendations should be followed in patients taking metformin due to the risk of lactic acidosis after IV iodine-based contrast exposure when significant renal impairment is present. Patients with an eGFR between 30 and 44 mL/min/1.73 m2 (CKD 3) should stop metformin 48 h before contrast medium injection and should only restart it 48 h after the examination if renal function has not deteriorated. In patients with eGFR less than 30 mL/ min/1.73 m2 (CKD 4 and 5), iodine-based contrast media should be avoided (Beckett et al. 2015; Thomsen et al. 2016).

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