Model for predicting the impact of gadolinium on plasma calcium measured by the o-cresolphthalein method

Background: Gadolinium formulations, which are administered as contrast agents in magnetic resonance imaging examinations, interfere with colorimetric serum calcium determinations. Methods: We performed an in vitro study to determine the extent to which three gadolinium formulations -gadodiamide (Omniscan), gadopentetate dimeglumine (Magnevist), and gadoversetamide (OptiMARK) - affect measurements by two methods that use o-cresolphthalein (Dade Behring, Inc. and Roche Diagnostics) and one that uses arsenazo dye (Equal Diagnostics). We also compared values from the o-cresolphthalein methods for 116 samples from patients administered gadodiamide. Results: Magnevist did not affect any of the methods evaluated, whereas Omniscan and OptiMARK were identical in their effects. For the Dade method, the differences from the control sample were ≤4.0 and 7.0 mg/L at 0.25 and 0.5 mmol/L gadolinium, respectively. For the Roche method, the differences were 19, 9.0, and 5.0 mg/L at 0.5, 0.25, and 0.125 mmol/L gadolinium, respectively. Falsely increased calcium values were seen when samples were measured by the arsenazo-based method: differences were 6.0 and 3.0 mg/L at 1.0 and 0.5 mmol/L gadolinium. Using patient data collected at our institution, we were able to generate a model for predicting, from a patient's glomerular filtration rate and the time elapsed since administration, the impact of Omniscan on calcium measurements by the o-cresolphthalein method from Roche Diagnostics. Conclusions: The predictive model can be used to calculate, in patients who have received gadodiamide, the minimum length of time to wait before blood collection to avoid pseudohypocalcemia when the Roche o-cresolphthalein method is used.