Paramagnetic contrast agents


Gadolinium chelates used as contrast agents for magnetic resonance (MR) imaging are considered to be relatively safe.
 
Gadopentetate dimeglumine, gadoteridol, gadoterate meglumine.
 
Incidence
Gadopentetate dimeglumine.
 
Adverse reactions 2.4% (rash: 0.09%, urticaria: 0.07%, anaphylactic shock:3/million.
 
Adverse reactions in asthmatic patients: 3.7%.
 
Adverse reactions in allergic patients: 3.7%.
 
Adverse reactions in patients with a history of reaction to MR imaging contrast agent: 21.3%
 
Adverse reactions to iodinated contrast agent: 6.3%
 
Deaths reported.
 
Risk factors
Asthma, allergy, previous reaction to MR imaging contrast agent, previous reaction to iodinated contrast agent.
 
Rapid injection is not an adverse reaction risk factor.
 
Clinical manifestations
Anaphylactic shock
 
Bronchospasm.
 
Pruritus, facial and lingual edema, urticaria, maculopapular exanthema.
 
Diagnostic methods
None.
 
Mechanisms
Paramagnetic contrast agents are ionic or non-ionic.
 
Although not yet fully understood, the same mechanisms as iodinated contrast agents could be involved.
 
Management
No premedication data published.

References

  1. Nelson K.L, Gifford L.M, Lauber-Huber C, Gross C.A, Lasser T.A, "Clinical safety of gadopentetate dimeglumine", Radiology., 1995; 196 (2): 439-43
  2. Witte R.J, Anzai L.L, "Life-threatening anaphylactoid reaction after intravenous gadoteridol administration in a patient who had previously received gadopentetate dimeglumine", Am. J. Neuroradiol., 1994; 15 (3): 523-4
  3. Shellock F.G, Hahn H.P, Mink J.H, Itskovich E, "Adverse reaction to intravenous gadoteridol (see comments)", Radiology., 1993; 189 (1): 151-2
  4. Baxter A.B, Lazarus S.C, Brasch R.C, "In vitro histamine release induced by magnetic resonance imaging and iodinated contrast media", Invest. Radiol., 1993; 28 (4): 308-12
  5. Niendorf H.P, Dinger J.C, Haustein J, Cornelius I, Alhassan A, Clauss W, "Tolerance data of Gd-DTPA: a review", Eur. J. Radiol., 1991; 13 (1): 15-20

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.