Spurious hypocalcemia after Omniscan- or OptiMARK-enhanced magnetic resonance imaging: an algorithm for minimizing a false-positive laboratory value.

Abstract

Contrast-enhanced magnetic resonance imaging has become a routine diagnostic imaging procedure. Reports in the literature document that 2 of the 4 available gadolinium-based magnetic resonance imaging contrast agents, gadodiamide (Omniscan) and gadoversetamide (OptiMARK), are less stable and readily undergo dechelation. In vitro, this dechelation can result in interference with the most common laboratory methods used to measure total plasma or serum calcium. The result of total calcium measurement soon after contrast-enhanced magnetic resonance imaging with these interfering contrast agents is a spurious lowering of the total calcium level. This low calcium measurement may result in a value consistent with hypocalcemia and can persist in patients with renal insufficiency and in patients receiving higher doses of contrast agent. Alternatively, a clinically significant elevated calcium level may be overlooked because of the artificially lowered value. Two of the available gadolinium-based contrast agents, gadoteridol (ProHance) and gadopentetate dimeglumine (Magnevist), have not been to shown to interfere with total calcium measurement. A clinical practice algorithm for the laboratorian, the radiologist, and the clinician is presented to minimize the occurrence and consequences of a spuriously lowered total calcium level due to Omniscan- or OptiMARK-enhanced magnetic resonance imaging.