ADVERSE REACTIONS TO GADOLINIUM CONTRAST-MEDIA - A REVIEW OF 36 CASES

OBJECTIVE. We investigated the frequency, manifestations, and severity of reactions to gadolinium contrast media in patients who underwent M R imaging at a single institution. MATERIALS AND METHODS. We reviewed the quality assurance records of 21,000 patients to whom gadolinium co ntrast media were administered at our institution between January 1990 and October 1994. Of these patients, 36 had adverse reactions. All 36 patients were evaluated by a radiologist at the time of the adverse r eaction, and a written report of the findings was completed immediatel y. RESULTS. We classified adverse reactions into four groups: mild non allergic reactions (15 patients with nausea or vomiting), mild reactio ns resembling allergy (12 patients with hives, diffuse erythema, or sk in irritation), moderate reactions resembling allergy (seven patients with respiratory symptoms), and life-threatening reactions resembling allergy (two patients with severe chest tightness, respiratory distres s, and periorbital edema). Eleven of these 36 patients who had adverse reactions also had an unusual local reaction of skin discomfort in th e extremity through which gadolinium was injected. Four of the 36 pati ents with adverse reactions had histories of adverse reactions to iodi nated contrast media. All four of these patients and one of the remain ing 32 patients with adverse reactions required treatment. No patients with adverse reactions died. CONCLUSION. Although gadolinium contrast media are safe, we found that patients had adverse reactions at a fre quency greater than we expected. Severe anaphylactoid reactions occurr ed in two patients (0.01%). This rate exceeds the rate of 0.0003% repo rted in the literature. The indexes of suspicion for the occurrence of reactions to gadolinium, and both the documentation and the managemen t of adverse reactions, must be as rigorous for reactions associated w ith MR imaging contrast agents as they are for reactions associated wi th iodinated contrast media.