Reactions To Contrast Media Research Articles

Acute iodinate contrast medium reaction: look at the CT images!

Acute iodinate contrast medium reaction: look at the CT images!

Management of Severe Allergic-Like Contrast Media Reactions: Pitfalls and Strategies, From the AJR Special Series on Contrast Media.

Adverse reactions to contrast media, although uncommon, are often high-acuity events and potentially life-threatening. Nonetheless, these events are treatable, and radiologists may be called on to manage a contrast media reaction. However, because these events are infrequent, they are prone to management errors. This Special Series Review highlights common pitfalls and practical tips for the management of acute contrast media reactions in children and adults. Recognition of frequent management errors and implementation of the mitigation strategies presented can ameliorate risk and improve patient outcomes. These measures include proper training regarding reaction management and medication administration, the prompt use of intramuscular epinephrine autoinjectors whenever a severe allergic-like reaction is suspected, the use of visual aids for quick reference in the setting of a reaction, and the recognition of adverse events that are not allergic-like reactions, which commonly require only supportive care.

Bullous Drug Eruption.

A 63-year-old woman presented at our emergency department with a disseminated dermatosis that developed after undergoing a cardiac catheterization procedure. Her past medical history included an end-stage renal disease undergoing hemodialysis. Clinical examination revealed erosions and hemorrhagic crusts located on her lips and along the arteriovenous fistula. Additionally, we observed five hyperpigmented macules on her left hand's dorsum and palm and multiple hypopigmented macules in the genital area. Upon medical record review, we discovered the occurrence of prior bullous eruptions following contrast administration. A fixed drug eruption (FDE) due to radiocontrast was diagnosed based on clinical history, clinical examination, eruption timeframe, and positive drug provocation test. Intravenous contrast media reactions can be immediate or delayed, with delayed hypersensitivity reactions (DHR) occurring one hour to seven days post-administration. DHRs often present as maculopapular rashes. FDEs are rare. Skin tests are used to identify culprit agents. Ideally, intradermal tests, with delayed readings, and patch tests are combined for optimal sensitivity. Despite lacking standardized protocols, premedication with corticosteroids may mitigate reaction severity.

Let go of the myth: safety of indocyanine green for sentinel lymph node mapping in endometrial cancer

ObjectiveSentinel lymph node mapping by intracervical indocyanine green injection is the preferred method for surgical staging in endometrial cancer. Adverse reactions to indocyanine green are extremely rare, and information about...

Exploring the implementation of role extension for Namibian radiographers: Perspectives on intravenous injection of contrast media

IntroductionRole extension to include intravenous (IV) injection of contrast media has been formally embraced by radiographers and their regulatory bodies in developed countries. The revised scope of practice, in our Namibian context, has formalised IV injection as an extended role for radiographers. This study aimed to explore the perspectives of radiographers regarding this new role of IV injection of contrast media. MethodsA qualitative design with a descriptive phenomenological approach was employed to collect data from 15 radiographers working in both public and private radiology facilities. Participants were purposively selected to participate in focus group discussions and individual interviews. An interview guide was used to facilitate the discussions and interviews, and a voice recorder was used for recording. Data were transcribed verbatim and analysed using Tesch's 8-step method. ResultsFrom the 15 participants, three themes were developed: enhanced service delivery with two subthemes (improved departmental workflow and patient care), training needs with two subthemes (inadequate contrast media reaction training and standardised training requirement), and medical-legal issues with two subthemes (regulatory blurriness and role conflict distress). ConclusionThe participants expressed mixed perceptions towards the IV injection role of radiographers, emphasising the benefits for the department and patients while raising concerns regarding standardisation of training and associated medico-legal issues. Furthermore, a large-scale evaluation is necessary to uncover the challenges and barriers to the successful adoption of this new role. Implications for practiceThe role extension for radiographers to include IV injections is a long-awaited development, but it should be accompanied by the necessary training and guidelines to fully realise its benefits.

Hypersensitivity Reaction Incidence Patterns and Risk Factors of Iodinated Contrast Media

The subjects of this study were 2,798 patients who experienced hypersensitivity reaction of contrast media among 72,910 who had had iodinated contrast media administered intravenously and CT examination at our hospital. Retrospective survey was conducted with these subjects. Their age, gender, hypersensitivity reaction symptoms, prepare methods for the patients who had previous hypersensitivity reaction of contrast media, and contrast media administered were analyzed. When it came to the hypersensitivity reaction incidence of contrast media, women and patients aged less than 60 had the high risk of the reaction. Even if patients had previous contrast media hypersensitivity reaction, their hypersensitivity reaction incidence risk was reduced as they had an appropriate premedication drug administered and contrast media were changed. Regarding the hypersensitivity reaction incidence rate by contrast media, Iopromide’s hypersensitivity reaction incidence rate was significantly high, whereas Iohexol and Ioversol had low incidence rates. In order to prevent contrast media hypersensitivity reaction recurrence, it is preferentially necessary to change a contrast media to a different one without reuse of causative contrast media, rather than to use a premedication drug only. Along with that, it is necessary to administer a premedication drug.

Adverse reactions of high-osmolar and low-osmolar radiographic contrast media in clinical practice

Introduction . Adverse drug reactions (ADR) to administration of radiographic contrast media (RCM) are observed in 10–20 % of patients. Individual tolerability of drugs is affected by RCM properties (ionicity, osmolarity). Aim . Evaluation of ADR in patients during diagnostic studies using high- and low-osmolar RCM. Methods . Analysis of 52 reports of adverse reactions to RCM registered in medical organizations of Voronezh region in 2014–2021 was performed. Group 1 included 21 patients with ADR to high-osmolar RCM (sodium amidotrizoate, yoxitalamic acid), group 2–31 patients with ADR to low-osmolar drugs (yogexol, yopromide, yopamidol, yoversol). Results . Age of patients is 6–82 years, median 48.5 years, children — 8 persons (15.4 %), women — 31 patients (59.6 %), serious reactions — 28 (53.8 %). Since 2017 there has been an increase in the number of ADRs with constant frequency of serious reactions. In 2020–2021 ADRs to low-osmolar drugs were mainly registered. Life-threatening conditions (anaphylactic shock, arterial hypotension, arrhythmia) were observed in 70.2 % of group 2, in 28.6 % of group 1 (p=0.007). One patient with initial renal dysfunction and comorbid pathology was reported to develop nephrotoxicity to yogexol. Pharmacological correction was performed in 92.3 % of cases. In 57.7 % of the patients ADR ended in recovery, in the other cases — state improvement. Conclusion . Side effects of high-osmolar and low-osmolar RCM mainly had form of hyperergic reactions of immediate type and were reversible. High frequency of serious reactions to lowosmolar RCM against an increase in their use requires a more careful selection of patients for X-ray contrast studies.

A Comprehensive Analysis of Nursing Care Management in Radiology Departments: Challenges and Innovations

This article presents a thorough examination of nursing care management within radiology departments, highlighting the challenges and innovative practices that have emerged in this specialized field. The evolution of nursing roles in radiology is explored, from traditional responsibilities to the more complex, multifaceted roles they play in contemporary healthcare settings. Significant challenges are identified, including patient safety, management of radiological emergencies, handling of contrast media reactions, and ethical and legal considerations. The article emphasizes the critical skills and competencies required for radiology nurses, along with the importance of continuous training and professional development. It also explores the use of advanced technology in patient care, the implementation of patient-centered care approaches, and the significance of collaborative practices among interdisciplinary teams. Quality and safety measures within radiology nursing are examined, along with an overview of the current trends and future directions in the field. The article aims to provide insights into the integral role of nursing in radiology departments and to offer recommendations for enhancing patient care and safety in these settings.

Complex Regional Pain Syndrome Type II After Cervical Interlaminar Epidural Injection

BACKGROUND: Complex regional pain syndrome (CRPS) is a pain condition associated with autonomic and inflammatory features and is characterized by pain that is disproportionate in magnitude to the typical pain after similar injuries. The pathophysiology of CRPS is poorly understood, and many events have been implicated as causative factors. CASE REPORT: There are 2 previously documented case reports of CRPS after epidural steroid injections (ESI). This case report details the development of CRPS symptoms in a patient after receiving a cervical ESI. The precipitating event could have been trauma to a nerve root, nerve root irritation from the injectate, or contrast media reaction. Treatment focused on physical therapy and early intervention with a stellate ganglion block. The patient had complete resolution of her symptoms after 10 months. CONCLUSIONS: Although rare, CRPS due to direct nerve root injury or nerve root irritation can develop after an ESI; early diagnosis and treatment may result in a better outcome. KEY WORDS: Complex regional pain syndrome, CRPS, epidural steroid injections, TFESI, ILESI

Frequency of Acute and Late Reaction of Non-Ionic Iodinated Contrast Media in Contrast Enhanced Computed Tomography

Introduction: A contrast agent is a substance used to increase the contrast of structures or fluids within the body in medical imaging. Contrast agents absorb or alter external electromagnetism or ultrasound, and enhance the radio density in a target tissue or structure. Contrast agents are commonly used to improve the visibility of blood vessels and the gastrointestinal tract. Several types of contrast agent are in use in medical imaging and they can roughly be classified based on the imaging modalities where they are used and the purposes of this study to find out the frequency of adverse reactions of non-ionic iodinated contrast media in contrast enhanced Computed Tomography. Material Methods: It was cross-sectional observational study conducted on 133 patients who visited Al-Razi healthcare hospital, Lahore for a CT (computed Tomography) scan. 36 of them got adverse reactions to the non-ionic contrast media. The frequency of adverse reactions happening with the non-ionic contrast usage was determined Results: In this study, one hundred and thirty-three patients who fulfilled the criteria were included in the study. 36 of the patients had adverse reactions to the non-ionic contrast media which included shivering, fatigue, headache, nausea and rashes. All of the patients had no previous history of allergies or contrast reactions. The mean age of patients ranged from 51.49 ± 16.19years. Conclusion: In conclusion, the use of non-ionic contrast media as a CT contrast agent has a safety profile. It is concluded that a non-ionic iodinated contrast media reaction rarely results in long-term sequelae as it is less severe and easily treatable. Keywords: Non-Ionic Iodine Contrast Media, Computed Tomography, Adverse Reactions DOI: 10.7176/JHMN/88-05 Publication date: April 30 th 2021

Comparative Analysis of Death-Related Iodide Contrast Media due to Adverse Reactions of Contrast Media in Computed Tomography

Comparative Analysis of Death-Related Iodide Contrast Media due to Adverse Reactions of Contrast Media in Computed Tomography

Emergent Premedication for Contrast Allergy Prior to Endovascular Treatment of Acute Ischemic Stroke.

Management of contrast media allergies may lead to treatment delays in patients with acute ischemic stroke undergoing endovascular therapy. The optimal premedication strategy remains unclear. The aim of this report was to analyze our experience with emergent administration of premedication regimens before endovascular therapy. We retrospectively reviewed prospective data for all patients undergoing endovascular therapy from 2012 to 2019 at an academic comprehensive stroke center. Records of patients with documented contrast allergy were reviewed and analyzed. Data collected included stroke risk factors and characteristics, historical contrast reaction details, premedication regimens administered, and signs or symptoms of allergic reaction developing post-endovascular therapy. Hospital arrival time to endovascular therapy was compared with that in those who did not have a history of contrast allergy. We analyzed 1521 patients undergoing endovascular therapy; 60 (4%) had documented contrast allergies and constituted the study cohort. The median age was 73 years (interquartile range, 66-81 years), and 65% were women. The median time from premedication to contrast was 24 minutes (interquartile range, 0-36 minutes). Forty-three patients (72%) proceeded directly to endovascular therapy; in 17 patients, the first contrast exposure was CTA. Time from hospital arrival to endovascular therapy was not slower for patients with documented allergies (96 versus 134 minutes, P = .32). No patients experienced a contrast media reaction. In a single-institution cohort study of 60 consecutive patients with documented contrast allergies undergoing endovascular therapy with emergent premedication en route to (or in) the neuroangiography suite, no patients experienced allergic symptoms. This pragmatic approach may be safe for patients who have documented contrast media allergies.

Anaphylaxis in the Radiology Suite

Contrast media are crucial for modern medical imaging. Contrast agents are generally well tolerated. However, patients may present with adverse reactions, which can be divided into pharmacological effects or hypersensitivity reactions. We present a vignette of a patient with a past history of urticaria after radiocontrast media exposure for coronary angiography. He returns for evaluation for radiocontrast media because he needs another coronary angiography. There are no validated methods for predicting such reactions yet. Mechanisms behind adverse contrast media reactions are still not well understood. Because of unknown contrast agent, the patient was successfully pretreated with corticosteroids and an H1 antihistamine.

A prospective observational study on adverse drug reactions of iohexol contrast media in computed tomography imaging studies

Background: Iohexol is widely used radiocontrast media in the radiology departments for the diagnostic imaging purpose. As very few studies are carried out focusing on safety profiles of this contrast media. This study was conducted to know the profile of adverse drug reactions (ADRs) induced by Iohexol in patients who are undergoing the contrast-enhanced computed tomography (CECT) examination.Methods: Total 106 patients from CT unit of radiology department were observed for adverse drug reactions from Iohexol contrast media in 2 months duration. Acute ADRs were recorded immediately after contrast media administration by observation and personal interviews and delayed ADRs are recorded by follow up after 24hrs.Results: Total 23 out of 106 patients who had undergone CT imaging investigations by Iohexol contrast media had developed ADRs. Total 29 ADRs were developed in 23 patients. Out of these, 22 ADRs were acute and 7 ADRs were delayed reactions. All acute ADRs were of “probable” category and all delayed ADRs were of “possible” category according to WHO-UMC and Naranjo’s causality assessment scales. All ADRs were at Level-1 according to Modified Hartwig and Siegel severity scale. Preventability assessment of ADRs using Modified Schumock and Thornton preventability scale showed that all the ADRs were of “not preventable” class. All 29 ADRs were of TYPE U (Unclassified) as per the Wills and Brown method.Conclusions: All reactions are physiologic and are mild in nature. No life-threatening reactions are observed during the entire study period. Development of ADRs in female patients seen higher than male patients. So, this population requires a special attention for any serious contrast media reactions.

Application of comprehensive nursing care in enhanced CT scan

Objective To explore the effects of comprehensive nursing care on adverse reactions of contrast media in enhanced CT scan. Methods From November to December 2016, we selected 4 413 patients with enhanced CT scan in Cancer Hospital of Peking Union Medical College. All of the patients were divided into control group and observation group with the random number table. There were 2 010 cases in control group with routine nursing, while there were 2 403 patients in observation group with comprehensive nursing. We observed the adverse reactions and satisfaction with nursing among patients with enhanced CT scan between two groups. Results The incidence of adverse reactions of observation group was lower than that of control group; the patients' satisfaction with nursing of observation group was higher than that of control group; the differences were all statistical (P<0.05) . Conclusions Comprehensive nursing care can reduce the incidence of adverse reactions of contrast media and improve satisfaction with nursing among patients with enhanced CT scan. Key words: Nursing care; Adverse reactions; Enhanced CT scan; Contrast media; Nursing satisfaction

Difference in Total Serum Immunoglobulin E Level Among Patients With and Without Intravenous Contrast Media Adverse Reaction on Computed Tomography Scan Examination

The adverse reaction (AR) to intravenous contrast media (ICM) are relatively common. Various opinions pro-posed in the mechanism of the incidence of ICM AR. Suspected that the role of Immunoglobulin E (IgE) me-diates allergic conditions that are part of the AR. Objective:To determine the difference in total serum IgE level among subjects with and without ICM AR on computed tomography (CT) scan examination. To ob-serve difference in total serum IgE levels in subjects undergoing ICM adverse reaction based on the degree of severity. Method: An analytical study with cross-sectional design of 104 subjects undergoing CT scans with ICM, examined IgE levels before and after ICM was administered, then measured the severity of adverse re-actions of contrast media. Result: In this study, subjects undergoing adverse reactions, prior to administration Iopamidol had a higher mean IgE 1270.79 mg / dl compared with those who having AR 1174.90 mg / dl and after administration of Iopamidol a mean of Ig E is still higher in subjects having AR 1507.96 mg/dl com-pared with those having negative AR that is 1325.88 mg/dl, p = 0.696, statistically, not significant. Mild reac-tions in 40 subjects (38.5%) with cough, nausea, dizziness, itching, and sweating. Conclusion: Increase in total IgE levels in subjects with positive adverse reactions are independent(p=0.696).

High-Fidelity Simulation Training for the Diagnosis and Management of Adverse Contrast Media Reactions.

Adverse reactions to contrast media are potentially life-threatening events that require prompt recognition and management by radiologists who may have little experience with them. The objectives of this project were to develop and assess a simulation-based program that would equip radiology trainees with appropriate knowledge and skills to recognize and manage adverse contrast media reactions. Fifteen adverse contrast media reaction scenarios were developed to run on high-fidelity adult and pediatric mannequins in a simulation center. Ninety-six radiology trainees (postgraduate year 2-6) participated in the program, which consisted of two didactic lectures and a simulation session. For each simulation session, seven scenarios were chosen. Objective quizzes assessing knowledge and subjective questionnaires assessing comfort were completed both before and after the simulation. A survey assessing the overall program was also completed. All 96 radiology trainees viewed the didactic lectures, attended a simulation session, and completed the pre- and postsimulation quizzes and questionnaires. Mean scores increased from 69% to 82% (p < 0.001) and from 3.1 to 4.5 out of 5 (p < 0.001) on the objective and subjective tests, respectively. Statistically significant improvement was also seen when participants were separated according to level of training. On the final program evaluation survey, scores ranged from 4.5 to 4.7 out of 5. We describe the development of a high-fidelity simulation program with a larger variety of scenarios than in prior studies that can provide radiologists the knowledge and skills needed to recognize and manage adverse contrast media reactions. We saw a statistically significant improvement in knowledge and comfort levels across all levels of training.

Allergic-like contrast media reaction management in children.

The use of contrast materials as part of imaging examinations is common in children of all ages, as these compounds increase image contrast, lesion detection and lesion characterization. Though modern iodinated, gadolinium-based and ultrasound microbubble contrast materials generally are quite safe, acute physiological and allergic-like reactions are possible. The majority of acute contrast reactions in children are mild and self-limited; however, life-threatening reactions can occur. It is our obligation as radiologists to recognize and manage these adverse reactions. The objective of this article is to review the frequency, manifestations and appropriate treatment of acute contrast reactions in the pediatric population.

Benefit of a Visual Aid in the Management of Moderate-Severity Contrast Media Reactions

The purpose of this study was to compare management of moderate-severity reactions with and without a visual aid or flowchart in contrast medium reaction simulations. All attending radiologists and trainees were requested to participate in a contrast medium reaction simulation program, including a moderate-severity reaction scenario, and were randomized to groups having or not having a visual aid. The time to administer intramuscular (IM) epinephrine via automated injector and errors in administration were recorded. After the simulation, all participants completed a survey assessing their comfort in treating reactions to contrast media with and without a visual aid. A total of 138 participants were divided into 21 sessions in the program, with 68 participants in the moderate-severity reaction scenario. Eleven groups were provided a visual aid; 10 groups were not. Errors in management occurred in 18.2% (2 of 11) of groups with visual aids versus 40% (4 of 10) in groups without (p = 0.35), with epinephrine self-administration reflecting the most common error. Excluding the groups with errors, the mean time to administration of IM epinephrine was 97 seconds with versus 152 seconds without the visual aid (p = 0.04). Of the 138 participants, 97.8% agreed that the poster would aid in medication administration, and 87% agreed that it would help decrease time to administer medications. A visual aid increased the subjective confidence of radiologists in the dose and route of medication administration in the contrast medium reaction simulation and led to faster administration of epinephrine. Self-administration IM epinephrine errors were common and seen in both groups.

Safety and Diagnostic Image Quality of Ultravist&amp;lt;sup&amp;gt;&amp;#174;&amp;lt;/sup&amp;gt; in an Unselected Sub-Set of Chinese Patients: Data Analyses from a Previous Post Marketing Surveillance

Background: Iopromide (Ultravist&reg) has been shown to be a very safe CM agent in previous post-marketing surveillance studies on Western and Asian populations. Our study aimed to analyse data pertaining to the safety, tolerability and diagnostic image quality of Iopromide in an unselected sub-set of the Chinese population. Methods: we analysed data for Chinese ambulatory and in-patients who received Iopromide for an imaging procedure (in accordance with the local package insert and routine clinical practice), as part of an international post-marketing surveillance study. Use of premedication was at the discretion of the attending physician. Patient demographics, clinical history, type of examination, contrast quality and tolerability, including pre-specified adverse drug reactions, were recorded. All statistical analyses were descriptive. Results: case report forms for 20,000 Chinese patients (61.3% men) were analysed, of whom 153 patients (0.77%) had risk factors for idiosyncratic contrast media reactions (at-risk group). Use of premedication, most commonly corticosteroids, was recorded for 5658 patients (28.3%) and 86 at-risk patients (56.2% of the at-risk group), respectively. The mean (±standard deviation) dose of iodine administered was 29 ± 5.5 g. During the physician’s evaluation of image parameters, contrast quality was considered to be “good” (64.7%) or “excellent” (29.3%) in the majority of patients. 571 patients (2.9%) experienced at least one adverse drug reaction [most frequently nausea (0.70%) and dysgeusia (0.62%)], which were typically transient and of mild intensity. Two serious adverse drug reactions were reported [edema (n = 1), decreased blood pressure and dyspnea (n = 1)]. The incidence of adverse drug reactions was increased in the at-risk group versus the overall patient population, and tended to reduce with premedication (mainly corticosteroids). Conclusions: Iopromide was well tolerated and proved to be an efficient contrast agent in a large, non-selected sub-set of Chinese patients undergoing different types of diagnostic imaging procedures.