Subsequent MRI of pediatric patients after an adverse reaction to Gadolinium-based contrast agents

Abstract

BackgroundGadolinium-based contrast agent (GBCA)-enhanced magnetic resonance imaging (MRI) scans often must be used repeatedly in pediatric oncologic patients. Although GBCAs are usually well tolerated, severe and life-threatening allergic reactions might occur, which can result in overly cautions adherence to special precautions in patients. PurposeTo evaluate the management of the reported GBCA-associated adverse reactions in subsequent contrast-enhanced MRIs in pediatric patients, distinguishing non-allergic and allergic reactions. Materials and methodsIn this retrospective, cross-sectional study, consecutive pediatric neurooncological patients who underwent GBCA-enhanced MRI at our university hospital, between 2007 and 2016, were eligible. The patients' history was evaluated with regard to any adverse events after GBCA administration. In a subset of patients with reported adverse reactions, the institutional premedication regime or an allergy work-up in clinical practice were performed, using either skin-prick tests or intravenous provocation tests in a double-blind procedure. ResultsIncluded were 8156 contrast-enhanced MRI scans in 2109 patients. Nineteen acute adverse events (19/8156; 0.23%) in 17 patients (17/2109; 0.81%) were reported. Despite a premedication regime in 14 patients, three patients (3/14; 21.4%) reported a breakthrough reaction. None of the 12 patients who underwent skin-prick tests or intravenous provocation tests showed allergic reactions. At least one well-tolerated GBCA was identified in almost every tested patient.

Hypersensitivity to Gadolinium-Based Contrast Media

“… * Positivity criteria according to ENDA's guidelines . The rest of the studies do not specify the positivity criteria, except ( 26 ) that follow the European Society of Contact Dermatitis recommendations . …”

“…Doses for DPTS ranged from 1 to 10 mL ( 3 , 29 , 36 ), with increasing doses at 1-h intervals ( 29 , 36 ). In some of them, patients tolerated another GBCA than those they were sensitized to ( 3 , 7 , 18 , 21 , 26 , 27 , 29 , 36 ).…”

“…They found no difference in the rate of reactions when comparing macrocyclic with linear-ionic GBCAs ( 40 ). Other studies have also found no utility of premedication to prevent future reactions with GBCAs ( 26 , 41 – 43 ).…”

“…Hojreh et al ( 26 ) did a retrospective study on 17 children who had presented a reaction with GBCAs. Twenty-one DPTs were performed in ten patients for at least two substances—either gadoterate meglumine, gadobutrol, or gadobenate dimeglumine.…”

Anwendung von Kontrastmitteln in der Kinderradiologie

“…Die Erkenntnis über eine Schilddrüsenvorerkrankung, KM-Anamnese und eventuell eine bereits durchgeführte Allergietestung mit der Kenntnis über ein gut verträgliches KM können helfen, eine erneute Reaktion zu vermeiden [3]. Unter Berücksichtigung der Medikamentenanamnese können auch Wechselwirkungen vermieden werden [1].…”