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 (M R) 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 ag ents 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 reactio ns and 107 (0.016%) mild, 28 (0.004%) moderate, and five (0.001%) severe al lergy-like reactions occurred. Of 74,275 gadodiamide injections, 11 (0.015% ) nonallergic and 12 (0.016%) mild allergy-like reactions occurred, Of 64,0 05 gadoteridol administrations. 171(0.267%) nonallergic reactions and 49 (0 .077%) mild, 29 (0.047%) moderate, and Il (0.017%) severe allergy-like reac tions occurred. Twenty-six departments took no precautions for patients wit h previous allergy-like reactions to iodinated contrast material, Nineteen did not premedicate patients who previously had reactions to gadolinium-bas ed 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 management of patients at in creased risk.