Intravenous Imaging Contrast Media Complications: The Basics That Every Clinician Needs to Know.

Intravenous contrast is commonly used in noninvasive imaging procedures such as magnetic resonance imaging and computed tomography and can evaluate blood vessels and better characterize soft-tissue lesions. Although the incidence of adverse events after administration of contrast is low, it is important that clinicians and radiologists minimize risks and respond quickly and effectively when reactions occur. We will discuss a range of adverse events to iodinated and gadolinium-based contrast agents, including allergic-like reactions, nephrotoxicity, extravasation, and nephrogenic systemic fibrosis. We will review risk stratification for patients, as well as premedication and treatment of adverse events.

[1]  L. Talner,et al.  Pretreatment with corticosteroids to alleviate reactions to intravenous contrast material. , 1987, The New England journal of medicine.

[2]  B. Barrett,et al.  Metaanalysis of the relative nephrotoxicity of high- and low-osmolality iodinated contrast media. , 1993, Radiology.

[3]  E. Kanal,et al.  Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis. , 2007, Radiology.

[4]  Lone Skov,et al.  Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. , 2006, Journal of the American Society of Nephrology : JASN.

[5]  Antonio Colombo,et al.  Contrast agent--associated nephrotoxicity. , 2003, Progress in cardiovascular diseases.

[6]  G. Dangas,et al.  Acute renal failure requiring dialysis after percutaneous coronary interventions , 2001, Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions.

[7]  W. Bautz,et al.  Nephrotoxicity of iso-osmolar iodixanol compared with nonionic low-osmolar contrast media: meta-analysis of randomized controlled trials. , 2009, Radiology.

[8]  N. Hosten,et al.  No Increased Risk for Contrast-Induced Nephropathy after Multiple CT Perfusion Studies of the Brain with a Nonionic, Dimeric, Iso-Osmolal Contrast Medium , 2008, American Journal of Neuroradiology.

[9]  S. Adusumilli,et al.  Frequency, management, and outcome of extravasation of nonionic iodinated contrast medium in 69,657 intravenous injections. , 2007, Radiology.

[10]  G. Dangas,et al.  Sodium bicarbonate for the prevention of contrast induced-acute kidney injury: a systematic review and meta-analysis. , 2009, Clinical journal of the American Society of Nephrology : CJASN.

[11]  B. Williamson,et al.  Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. , 1994, AJR. American journal of roentgenology.

[12]  C. Becker,et al.  Strategies to reduce the risk of contrast-induced nephropathy. , 2006, The American journal of cardiology.

[13]  T. Kozuka,et al.  Adverse reactions to ionic and nonionic contrast media. A report from the Japanese Committee on the Safety of Contrast Media. , 1990, Radiology.

[14]  K. Davis,et al.  Contrast-induced nephropathy in elderly trauma patients. , 2010, The Journal of trauma.

[15]  Carol C Wu,et al.  Pulmonary 64-MDCT angiography with 30 mL of IV contrast material: vascular enhancement and image quality. , 2012, AJR. American journal of roentgenology.

[16]  A. Levey,et al.  A More Accurate Method To Estimate Glomerular Filtration Rate from Serum Creatinine: A New Prediction Equation , 1999, Annals of Internal Medicine.

[17]  D. O’Connell,et al.  Failure to demonstrate contrast nephrotoxicity , 1991, The Medical journal of Australia.

[18]  B. Thiers Gadodiamide-Associated Nephrogenic Systemic Fibrosis: Why Radiologists Should Be Concerned , 2008 .

[19]  D. Lang,et al.  Increased risk for anaphylactoid reaction from contrast media in patients on beta-adrenergic blockers or with asthma. , 1991, Annals of internal medicine.

[20]  G. D'Amato,et al.  Strategies for the prevention of asthmatic, anaphylactic and anaphylactoid reactions during the administration of anesthetics and/or contrast media. , 2008, Journal of investigational allergology & clinical immunology.

[21]  M. Johnston,et al.  M AN US CR IP T AC CE PT ED ACCEPTED MANUSCRIPT , 2014 .

[22]  J. Fine,et al.  Background fluctuation of kidney function versus contrast-induced nephrotoxicity. , 2009, AJR. American journal of roentgenology.

[23]  E. Bröcker,et al.  Anaphylaxis to iodinated contrast material: nonallergic hypersensitivity or IgE-mediated allergy? , 2008, AJR. American journal of roentgenology.

[24]  J. D'Elia,et al.  Effects of saline, mannitol, and furosemide on acute decreases in renal function induced by radiocontrast agents. , 1994, The New England journal of medicine.

[25]  T. Risler,et al.  What is the best hydration regimen to prevent contrast media-induced nephrotoxicity? , 2004, Clinical nephrology.

[26]  Act Investigators Acetylcysteine for Prevention of Renal Outcomes in Patients Undergoing Coronary and Peripheral Vascular Angiography: Main Results From the Randomized Acetylcysteine for Contrast-Induced Nephropathy Trial (ACT) , 2011, Circulation.

[27]  D. Panicek,et al.  Iodine allergy: an oyster without a pearl? , 1997, AJR. American journal of roentgenology.

[28]  H. Thomsen,et al.  Contrast medium extravasation injury: guidelines for prevention and management , 2002, European Radiology.

[29]  I. Pedrosa,et al.  Incidence of contrast-induced nephropathy in patients with multiple myeloma undergoing contrast-enhanced CT. , 2011, AJR. American journal of roentgenology.

[30]  A. Elster Frequency, Management, and Outcome of Extravasation of Nonionic Iodinated Contrast Medium in 69 657 Intravenous Injections , 2008 .

[31]  H. Maibach,et al.  Current Understanding of Contrast Media Reactions and Implications for Clinical Management , 2006, Drug safety.

[32]  R. Cohan,et al.  Intravascular contrast media: adverse reactions. , 1987, AJR. American journal of roentgenology.

[33]  Peter Reimer,et al.  Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines , 2013, European Radiology.

[34]  U. Schoepf,et al.  Is Contrast Medium Osmolality a Causal Factor for Contrast-Induced Nephropathy? , 2014, BioMed research international.

[35]  K. Furie,et al.  Functional Contrast-Enhanced CT for Evaluation of Acute Ischemic Stroke Does Not Increase the Risk of Contrast-Induced Nephropathy , 2010, American Journal of Neuroradiology.

[36]  J. Weinreb,et al.  IV contrast administration for CT: a survey of practices for the screening and prevention of contrast nephropathy. , 2006, AJR. American journal of roentgenology.

[37]  J P Kriss,et al.  Limitations of creatinine as a filtration marker in glomerulopathic patients. , 1985, Kidney international.

[38]  E. Fischler,et al.  Early effects of corticosteroids on basophils, leukocyte histamine, and tissue histamine. , 1979, The Journal of allergy and clinical immunology.

[39]  M. Tonelli,et al.  Prophylaxis strategies for contrast-induced nephropathy. , 2006, JAMA.

[40]  A. Djamali,et al.  Nephrogenic systemic fibrosis: risk factors and incidence estimation. , 2007, Radiology.

[41]  D. DeLong,et al.  Breakthrough adverse reactions to low-osmolar contrast media after steroid premedication. , 2001, AJR. American journal of roentgenology.

[42]  K. Shojania,et al.  Is acetylcysteine effective in preventing contrast-related nephropathy? A meta-analysis. , 2004, The American journal of medicine.

[43]  J. Kaude,et al.  Dialysis is not indicated immediately after administration of nonionic contrast agents in patients with end-stage renal disease treated by maintenance dialysis. , 1994, AJR. American journal of roentgenology.

[44]  M. Sendeski Pathophysiology of renal tissue damage by iodinated contrast media , 2011, Clinical and experimental pharmacology & physiology.

[45]  Samin K. Sharma,et al.  Cardiac Angiography in Renally Impaired Patients (CARE) Study: A Randomized Double-Blind Trial of Contrast-Induced Nephropathy in Patients With Chronic Kidney Disease , 2007, Circulation.

[46]  H. Hussain,et al.  Nephrogenic systemic fibrosis: a report of 29 cases. , 2008, AJR. American journal of roentgenology.

[47]  G. Dangas,et al.  Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function. , 2003, Reviews in cardiovascular medicine.

[48]  K. Bailey,et al.  For estimating creatinine clearance measuring muscle mass gives better results than those based on demographics. , 2009, Kidney international.

[49]  R. Hartman,et al.  Use of IV epinephrine for treatment of patients with contrast reactions: lessons learned from a 5-year experience. , 2009, AJR. American journal of roentgenology.

[50]  G. Rozycki,et al.  Risk and benefit of intravenous contrast in trauma patients with an elevated serum creatinine. , 2005, The Journal of trauma.

[51]  D. Swanson,et al.  Acute reactions to intravascular contrast media: types, risk factors, recognition, and specific treatment. , 1991, AJR. American journal of roentgenology.

[52]  M. Jardine,et al.  Systematic Review: Sodium Bicarbonate Treatment Regimens for the Prevention of Contrast-Induced Nephropathy , 2009, Annals of Internal Medicine.

[53]  M. Brezis,et al.  Potential deleterious effect of furosemide in radiocontrast nephropathy. , 1992, Nephron.

[54]  J. Sayre,et al.  Trends in adverse events after IV administration of contrast media. , 2001, AJR. American journal of roentgenology.

[55]  Christopher M. Thompson,et al.  Optimal timing of hydration to erase contrast-associated nephropathy: the OTHER CAN study. , 2003, The Journal of invasive cardiology.

[56]  F. Keller,et al.  Prophylaxis of Contrast-Induced Nephrotoxicity , 2014, BioMed research international.

[57]  H. Thomsen Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide , 2006, European Radiology.

[58]  Eric E. Smith,et al.  CT Angiography for Intracerebral Hemorrhage Does Not Increase Risk of Acute Nephropathy , 2009, Stroke.

[59]  R. Hartman,et al.  Intravenous contrast material exposure is not an independent risk factor for dialysis or mortality. , 2014, Radiology.