What are the contrast (Contrast Agent) side effects?

From the Guidelines

Contrast side effects can be minimized by proper hydration and screening for risk factors, and the use of macrocyclic agents is recommended over linear agents due to the risk of gadolinium deposition in the brain and body. The most common contrast side effects include nausea, vomiting, headache, itching, rash, and a warm sensation during injection. More serious reactions may include difficulty breathing, swelling of the face or throat, hives, and in rare cases, anaphylaxis which is a life-threatening allergic reaction. Patients with a history of allergies, asthma, or previous contrast reactions are at higher risk. Kidney problems can also occur with iodinated contrast (contrast-induced nephropathy), particularly in patients with pre-existing kidney disease, diabetes, or dehydration. According to the study by 1, administration of N-acetyl-L-cysteine is not useful for the prevention of contrast-induced AKI.

Risk Factors and Prevention

• Patients with pre-existing kidney disease, diabetes, or dehydration are at higher risk of kidney problems
• Proper hydration is essential to minimize the risk of contrast-induced nephropathy
• Screening for risk factors before administering contrast is crucial
• Premedication with antihistamines or corticosteroids may be considered for high-risk patients

Contrast Agents

• Macrocyclic agents are recommended over linear agents due to the risk of gadolinium deposition in the brain and body, as stated in the study by 1
• The European Medicines Agency recommended suspension of the marketing authorization for 4 linear gadolinium contrast agents, including Omniscan, Optimark, Magnevist, and MultiHance, due to convincing evidence of gadolinium deposition in the brain months after injection.
• The use of alternative imaging methods and/or contrast agents should be considered whenever possible, especially for patients with severe renal insufficiency, as mentioned in the study by 1.

Management of Reactions

• Prompt recognition and treatment of reactions are essential
• Management ranges from antihistamines for mild reactions to epinephrine and emergency support for severe reactions
• The benefit of enhanced diagnostic imaging must be weighed against the potential risks of contrast agents.

From the Research

Contrast Side Effects

• The use of iodinated and gadolinium-based contrast media can cause reactions, including life-threatening ones, although they are generally safe and effective when administered correctly 2.
• Nephrogenic systemic fibrosis, a skin disease, is an adverse reaction related to the use of some gadolinium-based contrast agents in patients with chronic renal failure 2, 3, 4.
• Gadolinium deposition in the brain and other organs has been recognized, although no data show any adverse biologic or clinical effects from this deposition, even with normal kidney function 3, 4, 5.
• Other side effects of contrast media include acute allergic-like reactions, post-contrast acute kidney injury (PC-AKI), and chemotoxic reactions 3, 5, 6.
• The risk of contrast-induced acute kidney injury (CI-AKI) can be minimized by calculating the maximal allowable contrast dose (MACD) and limiting contrast volume 6.

Specific Contrast Agents

• Iodine-containing contrast agents can cause rare side effects, including PC-AKI, and more common allergic and chemotoxic reactions 5.
• Gadolinium-containing contrast agents have been associated with nephrogenic systemic fibrosis and gadolinium deposition in the brain and other organs 2, 3, 4, 5.
• Macrocyclic contrast agents are considered lower risk for nephrogenic systemic fibrosis and are recommended for use in enhanced MRI exams 5.

Patient Considerations

• Patients with reduced renal function require careful consideration, including hydration and review of indication for enhanced MDCT, depending on the application 5.
• Enhanced studies in pregnancy, during lactation, and in the pediatric population require careful risk-benefit analysis 5.
• Patient information and legal aspects with nonapproved indications are essential parts of daily clinical routine 5.