Life-threatening anaphylactoid reaction after intravenous gadoteridol administration in a patient who had previously received gadopentetate dimeglumine.

We report a case of a life-threatening anaphylactoid reaction to gadoteridol. The reaction resulted in hospitalization but did respond to medical treatment. Resuscitation equipment and properly trained personnel should be available if these agents are being administered.     

Adverse allergic reaction to 131I MIBG

No adverse allergic reactions to iodine-131-metaiodobenzylguanidine (¹³¹I MIBG) at a diagnostic dose have been reported in the English literature. This report of a skin eruption in a 35-year-old man after an intravenous injection of ¹³¹I MIBG strongly suggests an adverse allergic reaction, and is the first to address such a side effect of ¹³¹I MIBG at a diagnostic dose. Erythematous maculopapular eruptions, some of which were contiguous, were seen in a symmetric disposition on the patient’s chest walls, elbows, neck and face 18 h after the ¹³¹I MIBG injection. Antiallergic treatment resolved the lesions completely. There were no possible causes of the exanthema other than the ¹³¹I MIBG injection. Urticaria related to the ¹³¹I MIBG injection and caused by type I allergic reaction was suspected, and these findings point to the possible risk of a hitherto unreported allergic skin reaction to ¹³¹I MIBG. We would like to draw the attention of nuclear physicians to this possible drawback of ¹³¹I MIBG.     

Adverse reactions to intravenous iodinated contrast media: an update

Assessment of patients before intravenous contrast injection can help in detecting predisposing risk factors for adverse reactions to contrast media. Early recognition and treatment of acute adverse reactions can prevent morbidity and mortality (rare).     

Adverse allergic reaction to technetium-99m methylene diphosphonate

Adverse allergic reactions to radiopharmaceuticals are rare but have been documented in the literature. This report presents data consistent with a definite adverse reaction to the radiopharmaceutical [99mTc]MDP.     

Adverse reactions to intravenous iodinated contrast media: a primer for radiologists

Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be subclassified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. Non-ionic contrast media have lower risk of mild and moderate adverse reactions. However, the risk of fatal reactions is similar for ionic and non-ionic contrast media. Adequate preprocedure evaluation should be performed to identify predisposing risk factors. Prompt recognition and treatment of acute adverse reactions is crucial. Risk of contrast induced nephrotoxicity can be reduced by use of non-ionic contrast media, less volume of contrast, and adequate hydration. The radiologist can play a pivotal role by being aware of predisposing factors, clinical presentation, and management of adverse reactions to contrast media.     

Adverse reactions during intravenous urography: are these due to histamine release?

The effects of four different radiographic contrast media (Urovison 58%, Hexabrix 320, Iopamiro 370 and Omnipaque 300) have been examined with respect to histamine release, cardiovascular changes and adverse drug reaction (ADR) in a group of 200 patients undergoing intravenous urography. Each patient received only one of the four agents, which were allocated on a random basis. Urovison produced the greatest number of ADRs. Iopamiro caused the least. No significant correlation between the magnitude of the change in plasma histamine following injection of radiographic contrast medium and the production of a particular ADR could be demonstrated. Heart rate increased significantly following the administration of Urovison, Hexabrix and Iopamiro in the absence of any appreciable change in blood pressure. These results and our earlier findings would favour the use of the low-osmolality contrast media in intravenous urography to minimize ADRs, histamine release and patient discomfort.     

High-dose gadoteridol in MR imaging of intracranial neoplasms.

Twelve patients with a high suspicion of brain metastases by previous clinical or radiologic examinations were studied in a phase III investigation with magnetic resonance (MR) imaging at 1.5 T after a bolus intravenous injection of 0.1 mmol/kg gadoteridol followed at 30 minutes by a second bolus injection of 0.2 mmol/kg gadoteridol. All lesions were best demonstrated (showed greatest enhancement) at the 0.3-mmol/kg (cumulative) dose, with image analysis confirming signal intensity enhancement in the majority of cases after the second gadoteridol injection. More lesions were detected with the 0.3-mmol/kg dose than with the 0.1-mmol/kg dose, and more lesions were detected with the 0.1-mmol/kg dose than on precontrast images. In this limited clinical trial, high-dose gadoteridol injection (0.3-mmol/kg cumulative dose) provided improved lesion detection on MR images specifically in intracranial metastatic disease.     

Adverse reactions to iotroxate at intravenous cholangiography. A prospective clinical investigation and review of the literature

The number and type of adverse reactions to meglumine iotroxate at intravenous infusion cholangiography, performed one day prior to elective cholecystectomy, were recorded in a prospective investigation of 196 asymptomatic, anicteric patients. One hundred ml (50 mg I/ml) of contrast medium was infused over a period of 30 minutes. Only 2 minor (1%) and no severe or fatal reactions were noted. A review of the literature on the use of iotroxate in 2492 patients, including those in the present investigation, revealed a complication rate of 3.5 per cent (3.0% minor, 0.3% moderate and 0.2% severe reactions) at infusion of iotroxate (5.0-8.0 g I) over a period of 30 to 120 minutes. This compared favourably with the 5 per cent complication rate (4% minor, 0.5% moderate and 0.5% severe reactions) at infusion of iodoxamate and the 9 per cent complication rate (5% minor, 1% moderate and 3% severe reactions) at infusion of ioglycamide. Irrespective of the contrast agent used, the frequency of adverse reactions at infusion was found to be 3 times lower than when equal amounts (5.0-5.6 g I) of the same medium were injected. It is concluded that, at present, infusion of iotroxate in an amount which approximates to the transportation maximum of the liver is the least toxic way of performing intravenous cholangiography with an optimum filling of the bile ducts.     

Efficacy evaluation of gadoteridol for MR angiography of intracranial vascular lesions

A phase III multicenter study was conducted in 89 patients with known intracranial vascular lesions to evaluate an extracellular gadolinium contrast agent, gadoteridol, for intracranial magnetic resonance (MR) angiography. The pre- and postcontrast MR angiograms of 82 patients were evaluated by the unblinded investigators and by two blinded readers (A and B) for visualization of lesions; arterial and venous anatomy; extent, size, and number of lesions; and disease classification. The unblinded readers indicated that lesions were visualized better on postcontrast images in the following categories: venous anatomy, 87 (81%) of 107 lesions; arterial anatomy, 43 lesions (40%); and extent or size of lesions, 38 lesions (36%). In 29 (35%) of 82 patients, the unblinded readers determined that enhanced MR angiography provided more diagnostic information than unenhanced MR angiography. The blinded readers determined that enhanced MR angiography provided more information for visualization of vascular anatomy in more than 60% of cases. The additional information provided with gadoteridol would have changed the diagnosis in nine (8%) of 107 lesions seen by the unblinded readers, 11 (12%) of 90 lesions seen by reader A, and three (3%) of 93 lesions seen by reader B. The results confirm that the use of gadoteridol improves the visualization of intracranial vascular lesions with MR angiography. The authors conclude that development of new postprocessing algorithms will improve the utility of contrast-enhanced MR angiography.     

Diffusion into human intervertebral disks studied with MR and gadoteridol.

PURPOSETo determine the feasibility of measuring diffusion into human intervertebral disks by means of MR imaging with an intravenous nonionic gadolinium complex (gadoteridol).METHODSIn 18 patients undergoing lumbar spine MR imaging, signal intensity was measured in the intervertebral disks after a dose of 0.1 mmol/kg and after a supplemental dose of 0.2 mmol/kg.RESULTSSignal intensity in the intervertebral disks increased with both gadoteridol doses. A greater increase was consistently achieved with the 0.3 mmol/kg (total) dose than with the 0.1 mmol/kg dose. The increase was greater near the endplates than in the midportion of the disk.CONCLUSIONDiffusion into human intervertebral disks can be detected with MR imaging after intravenous administration of gadoteridol. MR imaging with a paramagnetic contrast medium can be used to study diffusion into disk cartilage in vivo and noninvasively.     

High-resolution 3D-MRI of postmortem brain specimens fixed by formalin and gadoteridol

PurposeThe purpose of this investigation was to compare magnetization-prepared rapid gradient echo (MP-RAGE) images with T1-weighted images (T1WI) and T2-weighted images (T1W2) of postmortem brain tissue fixed by admixtures of formalin and gadoteridol. We additionally sought to explore the feasibility of using fixed brain magnetic resonance imaging (MRIs) in forensic practices.MethodsSpecimens included in the study were eight whole brains that had been removed during forensic autopsy. Brain specimens were randomly divided into three groups and MRIs were performed either (A) the day of autopsy (n = 2) on unfixed tissue, (B) after immersion fixation in 20% formalin (n = 3), or (C) after immersion fixation in 20% formalin mixed with 4 mL/L ProHance® (gadoteridol) (n = 3). T1WI, T2WI, and MP-RAGE images of all group samples were acquired with a 3T clinical MR scanner. Gray and white matter contrasts of the cortex and basal nucleus in every fixation group and image sequence were then visually compared.ResultsGray/white matter contrasts of the cortex were good in all images obtained by MP-RAGE, and T1WIs of specimens fixed by formalin and gadoteridol-mixed formalin. Additionally, gray/white matter contrast in the basal nucleus was sufficient in the MP-RAGE sequence of specimens fixed by gadoteridol-mixed formalin.ConclusionsMRI of brains immersion-fixed in formalin and gadolinium could serve as a promising tool for neuropathological assessment in forensic practices.     

Safety of gadoteridol injection: U.S. clinical trial experience

As part of the clinical evaluation of gadoteridol injection, intravenous doses ranging from 0.05 to 0.3 mmol/kg were administered to 1,709 patients and volunteers. Safety monitoring included pre- and postdose physical examinations, vital signs, and clinical laboratory values. Adverse event recording included occurrence, duration, severity, relationship to injection, and clinical importance. No clinically important changes in physical examination results, electrocardiograms, or vital signs were attributed to gadoteridol injection except for one case of hypotension. Four clinically important changes in laboratory values possibly or definitely related to the contrast agent were noted in two patients (0.1%). Adverse events were recorded in 118 subjects (6.9%), including nausea in 24 subjects (1.4%) and taste perversion in 22 subjects (1.3%). All other adverse events occurred with a frequency of less than 1%. Adverse events related to contrast agent administration occurred in 79 subjects (4.6%). Gadoteridol injection demonstrated excellent clinical safety and patient tolerance at various doses and injection rates.     

MR Imaging detection of cerebral metastases with a single injection of high-dose gadoteridol

The utility of a single high-dose (0.3 mmol/kg) injection of gadoteridol, a gadolinium chelate, in the detection of brain metastases on magnetic resonance images was studied. Patients (n = 29) with a high suspicion for brain metastases at clinical examination and by history were imaged on two occasions–separated by more than 24 hours and less than 7 days–with a 0.1 mmol/kg contrast agent dose used for the first study and a 0.3 mmol/kg dose for the second. In patients (n = 15) with confirmed brain metastases by clinical, radiologic, and/or histologic criteria, 40 lesions were detected at the 0.3 mmol/kg dose by a single reader blinded to contrast agent dose, compared with 33 lesions at 0.1 mmol/kg, a 21% increase. Three of 15 patients (20%) demonstrated an increase in the number of lesions detected at the higher dose. Region-of-interest analysis of signal intensity measurements showed that lesion contrast (relative to normal brain) improved from 54% at 0.1 mmol/kg to 92% at 0.3 mmol/kg. A 0.3 mmol/kg dose of gadoteridol, administered in a single injection, permits identification of brain metastases not detected at 0.1 mmol/kg. Such information can influence the choice of therapy.