CT contrast reaction raises MRI contrast risk

Date:
February 22, 2022
Source:
Radiological Society of North America
Summary:
People with a history of allergic-like reactions to iodinated
contrast media, which is used in a variety of X-ray-based
procedures, such as CT and angiography, are susceptible to similar
reactions from commonly used MRI contrast agents, according to a
large, eight-year study. The study also found that premedication
or switching to a different MRI contrast agent may reduce risk in
patients who have had previous contrast agent reactions.



FULL STORY ========================================================================== People with a history of allergic-like reactions to iodinated contrast
media, which is used in a variety of X-ray-based procedures, such as CT
and angiography, are susceptible to similar reactions from commonly used
MRI contrast agents, according to a large, eight-year study published
in the journal Radiology. The study also found that premedication or
switching to a different MRI contrast agent may reduce risk in patients
who have had previous contrast agent reactions.


========================================================================== Gadolinium-based contrast agents (GBCA) have long been used to improve visualization of organs, tissues and blood vessels on MRI and provide a
more accurate depiction of disease. Although GBCA are relatively safe,
recent studies have reported several adverse reactions related to their
use, including allergic-like hypersensitivity reactions, such as rash
and flushing.

The incidence of these reactions is increasing with the widespread
use of GBCA, prompting an urgent need for research into risk factors,
according to the study's senior author Hye-Ryun Kang, M.D., Ph.D.,
from the Department of Internal Medicine at Seoul National University
College of Medicine in Seoul, Korea.

Dr. Kang and colleagues recently analyzed more than 330,000 cases of
GBCA exposure in 154,539 patients over an eight-year period at the Seoul National University Hospital. There were 1,304 cases of allergic-like hypersensitivity reactions, for a rate of 0.4%. In patients who had a
previous GBCE reaction, the average recurrence rate was 15%.

Acute allergic-like hypersensitivity reactions, or those that occur
within one hour of contrast administration, accounted for 1,178 cases,
while a far smaller number of 126 cases were delayed allergic-like hypersensitivity reactions, or those that occur beyond the first hour
and mostly within one week after exposure.

The risk of allergic-like hypersensitivity reactions to GBCAs was higher
in those with a history of similar reactions to iodinated contrast media.

Traditionally, a history of iodinated contrast media hypersensitivity
was not considered as a risk factor for hypersensitivity to GBCAs and
vice versa, owing to the structural and compositional differences between
the two.



==========================================================================
"The results of our study challenge this idea," Dr. Kang said.

The increased risk may be the result of an underlying predisposition
to drug allergies in susceptible patients, Dr. Kang said, rather than
any cross- reactivity associated with structural similarities between
iodinated contrast media and GBCA. In fact, the risk of hypersensitivity reactions to iodinated contrast media was also higher in those who
previously experienced a similar reaction to GBCA.

"Thus, physicians should be aware that patients with a history of hypersensitivity to one of iodinated contrast media or GBCA are at greater
risk of developing hypersensitivity reactions to the other," she said.

Analysis of the data showed that premedication, typically with steroids
and antihistamines, and changing the GBCA showed preventive effects
in patients with a history of acute allergic-like hypersensitivity
reactions. Patients who received premedication and before MRI or were
switched to a different GBCA showed the lowest rate of recurrence. Only premedication significantly reduced the incidence of reactions in patients
with a history of delayed reactions.

"As the most important preventive measure is avoidance of the culprit
agent, a precise record of previously used GBCA should be kept for all patients," Dr.

Kang said. "Physicians should discuss appropriate premedication strategies
with their patients prior to MRI procedures." Dr. Kang emphasized that contrast-enhanced MRI examinations are invaluable in the diagnosis and follow-up of various diseases, and the overall risk remains low.

"As most of these reactions are mild, we believe the benefits of MRI
outweigh the potential risks associated with GBCA use," she said.

Dr. Kang advises that in all patients receiving an MRI with GBCA exposure,
a detailed history of previous hypersensitivity allergic reactions be conducted, and when necessary, appropriate prevention measures such
as using premedication and switching to different types of GBCA should
be implemented.

The researchers hope to conduct future studies with larger populations
to identify possible risk factors and effective preventive strategies
for delayed hypersensitivity reactions to GBCA.

========================================================================== Story Source: Materials provided by
Radiological_Society_of_North_America. Note: Content may be edited for
style and length.


========================================================================== Journal Reference:
1. Yoon Hae Ahn, Dong Yoon Kang, Soo-Been Park, Hyun Hwa Kim, Hyun
Jee Kim,
Ga-Yoon Park, Soon-Ho Yoon, Young-Hun Choi, Suh Young Lee,
Hye-Ryun Kang.

Allergic-like Hypersensitivity Reactions to Gadolinium-based
Contrast Agents: An 8-year Cohort Study of 154 539
Patients. Radiology, 2022; DOI: 10.1148/radiol.210545 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2022/02/220222102423.htm

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