Acute adverse events following gadolinium-based contrast agent administration: A single-center retrospective study of 281 945 injections

Jennifer S McDonald, Christopher Hunt, Amy B. Kolbe, John J. Schmitz, Robert P. Hartman, Daniel E. Maddox, David F Kallmes, Robert McDonald

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Acute allergic-like and physiologic reactions occur following administration of gadolinium-based contrast agents (GBCAs) for MRI examinations. Because these reactions are uncommon, it is challenging to compare reaction rates between GBCAs and to determine risk factors. Purpose: To compare reaction rates between the four GBCAs gadodiamide, gadobutrol, gadobenate dimeglumine, and gadoterate meglumine, and to determine potential risk factors for reactions. Materials and Methods: This retrospective study identified all intravenous GBCA injections for MRI examinations performed at a single institution from June 1, 2009, to May 9, 2017. Reactions were identified by reviewing records from the MRI technologist, MRI nursing staff, radiologist, emergency department, and provider. Reactions were classified as allergic-like or physiologic and as mild, moderate, or severe by using American College of Radiology criteria. GBCA reaction rates and other potential risk factors were examined by using multivariable regression models with generalized estimating equations. Results: Analysis included a total of 158 100 patients (median age, 55 years [interquartile range, 40-67 years], 51% women) who received a total of 281 945 GBCA injections (140 645 gadodiamide, 94 109 gadobutrol, 39 138 gadobenate, and 8053 gadoterate). At multivariate analysis, gadobenate or gadobutrol had higher rates of allergic-like reactions compared with gadodiamide (gadobenate: Odds ratio [OR], 3.9 [95% confidence interval {CI}: 3.0, 5.1]; P , .001; gadobutrol: OR, 2.3 [95% CI: 1.8, 2.9]; P , .001) or gadoterate (gadobenate: OR, 4.8 [95% CI: 1.0, 23]; P = .049; gadobutrol: OR, 2.8 [95% CI: 0.6, 14]; P = .20). Physiologic reactions were more frequently observed with gadoterate (OR, 7.7 [95% CI: 2.3, 25; P = .001), gadobenate (OR, 1.8 [95% CI: 1.3, 2.5; P , .001), and gadobutrol (OR, 1.6 [95% CI: 1.3, 2.1; P , .001) administration compared with gadodiamide. Six severe allergic-like reactions (three gadobutrol, three gadobenate) occurred requiring hospitalization. Patient age (P values .025 to , .001), sex (P , .001), location (P = .006), and MRI type (P = .003 and P = .006) were associated with acute reactions. Conclusion: Gadobenate and gadobutrol are associated with higher rates of allergic-like reactions compared with gadodiamide or gadoterate, and gadoterate, gadobenate, and gadobutrol are associated with higher rates of physiologic reactions compared with gadodiamide. Patient sex, age, location, and MRI type correlate with acute reaction rates.

Original languageEnglish (US)
Pages (from-to)620-627
Number of pages8
JournalRadiology
Volume292
Issue number3
DOIs
StatePublished - Jan 1 2019

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gadodiamide
Gadolinium
Contrast Media
Retrospective Studies
Injections
Odds Ratio
Confidence Intervals
Hypersensitivity
gadobutrol
Nursing Staff
Radiology
Hospital Emergency Service
Hospitalization
Multivariate Analysis
gadolinium 1,4,7,10-tetraazacyclododecane-N,N',N'',N'''-tetraacetate

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

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Acute adverse events following gadolinium-based contrast agent administration : A single-center retrospective study of 281 945 injections. / McDonald, Jennifer S; Hunt, Christopher; Kolbe, Amy B.; Schmitz, John J.; Hartman, Robert P.; Maddox, Daniel E.; Kallmes, David F; McDonald, Robert.

In: Radiology, Vol. 292, No. 3, 01.01.2019, p. 620-627.

Research output: Contribution to journalArticle

McDonald, Jennifer S ; Hunt, Christopher ; Kolbe, Amy B. ; Schmitz, John J. ; Hartman, Robert P. ; Maddox, Daniel E. ; Kallmes, David F ; McDonald, Robert. / Acute adverse events following gadolinium-based contrast agent administration : A single-center retrospective study of 281 945 injections. In: Radiology. 2019 ; Vol. 292, No. 3. pp. 620-627.
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title = "Acute adverse events following gadolinium-based contrast agent administration: A single-center retrospective study of 281 945 injections",
abstract = "Background: Acute allergic-like and physiologic reactions occur following administration of gadolinium-based contrast agents (GBCAs) for MRI examinations. Because these reactions are uncommon, it is challenging to compare reaction rates between GBCAs and to determine risk factors. Purpose: To compare reaction rates between the four GBCAs gadodiamide, gadobutrol, gadobenate dimeglumine, and gadoterate meglumine, and to determine potential risk factors for reactions. Materials and Methods: This retrospective study identified all intravenous GBCA injections for MRI examinations performed at a single institution from June 1, 2009, to May 9, 2017. Reactions were identified by reviewing records from the MRI technologist, MRI nursing staff, radiologist, emergency department, and provider. Reactions were classified as allergic-like or physiologic and as mild, moderate, or severe by using American College of Radiology criteria. GBCA reaction rates and other potential risk factors were examined by using multivariable regression models with generalized estimating equations. Results: Analysis included a total of 158 100 patients (median age, 55 years [interquartile range, 40-67 years], 51{\%} women) who received a total of 281 945 GBCA injections (140 645 gadodiamide, 94 109 gadobutrol, 39 138 gadobenate, and 8053 gadoterate). At multivariate analysis, gadobenate or gadobutrol had higher rates of allergic-like reactions compared with gadodiamide (gadobenate: Odds ratio [OR], 3.9 [95{\%} confidence interval {CI}: 3.0, 5.1]; P , .001; gadobutrol: OR, 2.3 [95{\%} CI: 1.8, 2.9]; P , .001) or gadoterate (gadobenate: OR, 4.8 [95{\%} CI: 1.0, 23]; P = .049; gadobutrol: OR, 2.8 [95{\%} CI: 0.6, 14]; P = .20). Physiologic reactions were more frequently observed with gadoterate (OR, 7.7 [95{\%} CI: 2.3, 25; P = .001), gadobenate (OR, 1.8 [95{\%} CI: 1.3, 2.5; P , .001), and gadobutrol (OR, 1.6 [95{\%} CI: 1.3, 2.1; P , .001) administration compared with gadodiamide. Six severe allergic-like reactions (three gadobutrol, three gadobenate) occurred requiring hospitalization. Patient age (P values .025 to , .001), sex (P , .001), location (P = .006), and MRI type (P = .003 and P = .006) were associated with acute reactions. Conclusion: Gadobenate and gadobutrol are associated with higher rates of allergic-like reactions compared with gadodiamide or gadoterate, and gadoterate, gadobenate, and gadobutrol are associated with higher rates of physiologic reactions compared with gadodiamide. Patient sex, age, location, and MRI type correlate with acute reaction rates.",
author = "McDonald, {Jennifer S} and Christopher Hunt and Kolbe, {Amy B.} and Schmitz, {John J.} and Hartman, {Robert P.} and Maddox, {Daniel E.} and Kallmes, {David F} and Robert McDonald",
year = "2019",
month = "1",
day = "1",
doi = "10.1148/radiol.2019182834",
language = "English (US)",
volume = "292",
pages = "620--627",
journal = "Radiology",
issn = "0033-8419",
publisher = "Radiological Society of North America Inc.",
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TY - JOUR

T1 - Acute adverse events following gadolinium-based contrast agent administration

T2 - A single-center retrospective study of 281 945 injections

AU - McDonald, Jennifer S

AU - Hunt, Christopher

AU - Kolbe, Amy B.

AU - Schmitz, John J.

AU - Hartman, Robert P.

AU - Maddox, Daniel E.

AU - Kallmes, David F

AU - McDonald, Robert

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Acute allergic-like and physiologic reactions occur following administration of gadolinium-based contrast agents (GBCAs) for MRI examinations. Because these reactions are uncommon, it is challenging to compare reaction rates between GBCAs and to determine risk factors. Purpose: To compare reaction rates between the four GBCAs gadodiamide, gadobutrol, gadobenate dimeglumine, and gadoterate meglumine, and to determine potential risk factors for reactions. Materials and Methods: This retrospective study identified all intravenous GBCA injections for MRI examinations performed at a single institution from June 1, 2009, to May 9, 2017. Reactions were identified by reviewing records from the MRI technologist, MRI nursing staff, radiologist, emergency department, and provider. Reactions were classified as allergic-like or physiologic and as mild, moderate, or severe by using American College of Radiology criteria. GBCA reaction rates and other potential risk factors were examined by using multivariable regression models with generalized estimating equations. Results: Analysis included a total of 158 100 patients (median age, 55 years [interquartile range, 40-67 years], 51% women) who received a total of 281 945 GBCA injections (140 645 gadodiamide, 94 109 gadobutrol, 39 138 gadobenate, and 8053 gadoterate). At multivariate analysis, gadobenate or gadobutrol had higher rates of allergic-like reactions compared with gadodiamide (gadobenate: Odds ratio [OR], 3.9 [95% confidence interval {CI}: 3.0, 5.1]; P , .001; gadobutrol: OR, 2.3 [95% CI: 1.8, 2.9]; P , .001) or gadoterate (gadobenate: OR, 4.8 [95% CI: 1.0, 23]; P = .049; gadobutrol: OR, 2.8 [95% CI: 0.6, 14]; P = .20). Physiologic reactions were more frequently observed with gadoterate (OR, 7.7 [95% CI: 2.3, 25; P = .001), gadobenate (OR, 1.8 [95% CI: 1.3, 2.5; P , .001), and gadobutrol (OR, 1.6 [95% CI: 1.3, 2.1; P , .001) administration compared with gadodiamide. Six severe allergic-like reactions (three gadobutrol, three gadobenate) occurred requiring hospitalization. Patient age (P values .025 to , .001), sex (P , .001), location (P = .006), and MRI type (P = .003 and P = .006) were associated with acute reactions. Conclusion: Gadobenate and gadobutrol are associated with higher rates of allergic-like reactions compared with gadodiamide or gadoterate, and gadoterate, gadobenate, and gadobutrol are associated with higher rates of physiologic reactions compared with gadodiamide. Patient sex, age, location, and MRI type correlate with acute reaction rates.

AB - Background: Acute allergic-like and physiologic reactions occur following administration of gadolinium-based contrast agents (GBCAs) for MRI examinations. Because these reactions are uncommon, it is challenging to compare reaction rates between GBCAs and to determine risk factors. Purpose: To compare reaction rates between the four GBCAs gadodiamide, gadobutrol, gadobenate dimeglumine, and gadoterate meglumine, and to determine potential risk factors for reactions. Materials and Methods: This retrospective study identified all intravenous GBCA injections for MRI examinations performed at a single institution from June 1, 2009, to May 9, 2017. Reactions were identified by reviewing records from the MRI technologist, MRI nursing staff, radiologist, emergency department, and provider. Reactions were classified as allergic-like or physiologic and as mild, moderate, or severe by using American College of Radiology criteria. GBCA reaction rates and other potential risk factors were examined by using multivariable regression models with generalized estimating equations. Results: Analysis included a total of 158 100 patients (median age, 55 years [interquartile range, 40-67 years], 51% women) who received a total of 281 945 GBCA injections (140 645 gadodiamide, 94 109 gadobutrol, 39 138 gadobenate, and 8053 gadoterate). At multivariate analysis, gadobenate or gadobutrol had higher rates of allergic-like reactions compared with gadodiamide (gadobenate: Odds ratio [OR], 3.9 [95% confidence interval {CI}: 3.0, 5.1]; P , .001; gadobutrol: OR, 2.3 [95% CI: 1.8, 2.9]; P , .001) or gadoterate (gadobenate: OR, 4.8 [95% CI: 1.0, 23]; P = .049; gadobutrol: OR, 2.8 [95% CI: 0.6, 14]; P = .20). Physiologic reactions were more frequently observed with gadoterate (OR, 7.7 [95% CI: 2.3, 25; P = .001), gadobenate (OR, 1.8 [95% CI: 1.3, 2.5; P , .001), and gadobutrol (OR, 1.6 [95% CI: 1.3, 2.1; P , .001) administration compared with gadodiamide. Six severe allergic-like reactions (three gadobutrol, three gadobenate) occurred requiring hospitalization. Patient age (P values .025 to , .001), sex (P , .001), location (P = .006), and MRI type (P = .003 and P = .006) were associated with acute reactions. Conclusion: Gadobenate and gadobutrol are associated with higher rates of allergic-like reactions compared with gadodiamide or gadoterate, and gadoterate, gadobenate, and gadobutrol are associated with higher rates of physiologic reactions compared with gadodiamide. Patient sex, age, location, and MRI type correlate with acute reaction rates.

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