Severe adverse reaction to iv gadopentetate dimeglumine

Role of Contrast in MR Imaging

Magnetic resonance (MR) contrast agents have been widely used over the last 3 decades in routine clinical practice. Paul Lauterbur recognized the presence of these contrast agents, which act as paramagnetic catalysts that accelerate the T1 relaxation process. The first MR contrast agent to be approved for clinical use was in 1988, and since then, it is estimated that 200 million doses have been administered worldwide. These contrast agents have diverse clinical as well as research applications, involving almost all the body organs. This review will cover some existing as well as many new applications that have emerged over the last few decades. MR imaging now has the potential of being used to monitor enzymatic activity, gene expression, metal ion homeostasis, and cell death in vivo. In future, newer contrast agents will develop and become commercially available, expanding the current clinical applications of MR contrast media.

Magnetic resonance imaging of soft-tissue tumors in children

Magnetic resonance imaging (MRI) has become an important diagnostic tool in the detection and characterization and local anatomic staging of soft-tissue tumors in children. This article outlines some of the procedural issues unique to the pediatric population.

Occurrence of adverse reactions to gadolinium-based contrast material and management of patients at increased risk: a survey of the American Society of Neuroradiology Fellowship Directors

RATIONALE AND OBJECTIVES

The authors attempted to determine the frequency and severity of adverse reactions to gadolinium-based magnetic resonance (MR) contrast agents and to identify strategies for management of patients at increased risk.

MATERIALS AND METHODS

American Society of Neuroradiology program directors were surveyed about adverse reactions at their institutions to gadolinium-based contrast agents, the contrast agents responsible, and the management of patients with allergy-like reactions to iodinated or gadolinium-based agents who required MR contrast agent administration.

RESULTS

Fifty-three (50.5%) surveys were received from 105 centers. Of 687,255 gadopentetate dimeglumine injections, 314 (0.046%) nonallergic reactions and 107 (0.016%) mild, 28 (0.004%) moderate, and five (0.001%) severe allergy-like reactions occurred. Of 74,275 gadodiamide injections, 11 (0.015%) nonallergic and 12 (0.016%) mild allergy-like reactions occurred. Of 64,005 gadoteridol administrations, 171 (0.267%) nonallergic reactions and 49 (0.077%) mild, 29 (0.047%) moderate, and 11 (0.017%) severe allergy-like reactions occurred. Twenty-six departments took no precautions for patients with previous allergy-like reactions to iodinated contrast material. Nineteen did not premedicate patients who previously had reactions to gadolinium-based agents before repeat administration of MR contrast agents.

CONCLUSION

Although MR contrast agents are safe, adverse reactions occur. Many centers have not adopted policies for the OFF

Safety of magnetic resonance imaging contrast agents

Many of the MR examinations performed in the world each year are accompanied by administration of one of these frequently used intravenous contrast agents: Magnevist, Omniscan, and ProHance. Accordingly, MR practitioners must understand the basic pharmacokinetics, side effects, and the potential for adverse events for these contrast agents. Additionally, MR practitioners must know how to manage side effects and adverse events that may occur in association with the administration of contrast agents. Notably, the use of MR imaging contrast agents in special patient populations must be understood. This article discusses each of these important issues.

The use of gadolinium in the MR evaluation of soft tissue tumors

MRI has emerged as the preferred modality for the imaging evaluation of musculoskeletal tumors. Although there is general agreement on the value of MR in detection, diagnosis and staging, the use of intravenous contrast in the evaluation of soft-tissue tumors and tumor-like masses remains controversial. The purpose of this review is to highlight these controversies, to put them in perspective, and to make recommendations for the use of gadolinium-enhanced imaging. The following specific areas will be addressed: (1) general considerations in the evaluation of soft tissue tumors, (2) added specificity in diagnosis, (3) response to chemotherapy, (4) evaluation for local recurrence after surgery and/or radiation therapy, and (5) selection of biopsy site.

MRI of the TMJ disc with intravenous administration of gadopentetate dimeglumine

PURPOSE

The purpose of this study was to ascertain whether MR imaging with intravenous administration of gadopenetate dimeglumine (Gd-DTPA) is useful in the demonstration of the temporomandibular joint (TMJ) disc.

METHOD

Sagittal T1-weighted MR images of 50 TMJs (25 patients) were obtained using a 0.5-T system both before and after intravenous injection of Gd-DTPA. The authors depicted the TMJ in which intravenous injection of Gd-DTPA improved visulization of the disc.

RESULTS

Intravenous injection of Gd-DTPA increased intensity in the retrodiscal space, the pterygoid venous plexus, as well as joint effusion by diffused Gd-DTPA. The technique improved visualization of 10 (50%) of 20 normal discs and 20 (67%) of 30 anterior disc displacements in closed-mouth position, and also 23 (74%) of 31 normal discs and 12 (63%) of 19 anterior disc displacements in open-mouth position. There were 12 TMJs (24% of the 50 TMJs) in which equivocal findings became highly diagnostic. The incidence in marked contrast effect was higher in TMJs with severe internal derangement than in those with normal or mild internal derangement (p < 0.005).

CONCLUSION

Using a 0.5-T MR imager, T1-weighted imaging with intravenous injection of Gd-DTPA showed more anatomic details than imaging without the contrast agent.

Systemic gadolinium toxicity in patients with renal insufficiency and renal failure: retrospective analysis of an initial experience

OBJECTIVE

To study the possible deleterious systemic effects of gadolinium in patients with impaired renal function.

DESIGN

We retrospectively analyzed the routine laboratory data and clinical course of patients who had undergone a gadolinium-enhanced magnetic resonance imaging (MRI) examination of the brain and spine and had evidence of impaired glomerular filtration.

MATERIAL AND METHODS

Between October 1988 and October 1992, 15,830 patients underwent gadolinium-enhanced MRI at our institution, 151 of whom had a serum creatinine value of more than 2 mg/dL. The clinical records of these 151 patients were thoroughly examined for the period from 3 days before to 30 days after the gadolinium-enhanced MRI examination. All data were analyzed in an attempt to detect any adverse events that could be related to free gadolinium as a result of dissociation from the chelating agent due to prolonged elimination times (that is, increased serum creatinine concentrations). In addition, we calculated the 90-day mortality rate for both the study group and a matched control population of 80 patients who had undergone MRI of the brain and spine before gadolinium was available.

RESULTS

The overall incidence of adverse events in the study group was 3.6%. No event was severe or life threatening--nausea and rash occurred in two patients each, and seizure and headache occurred in one patient each. These findings were not significantly different from those in previous studies performed in populations with normal elimination times. Moreover, no significant difference was noted in the 90-day mortality rate (14.6% of the study group) in comparison with that in the control group (13.8%).

CONCLUSION

On the basis of this initial retrospective analysis, we were unable to detect any clinical deleterious effects of administration of gadolinium for MRI examination in patients with impaired renal function. Further investigation with prospective studies is needed to confirm these initial retrospective findings.