Contrast media safety: what do we know and how do we know it?
Use of an intravenous injection of a water-soluble iodine compound (sodium iodide) for visualizing the urinary tract was first described by Osborne in 1923. However, sodium iodide was accompanied by a high incidence of side effects and the image quality was not good. As newer, improved contrast agents were introduced, a number of investigators reported on the incidence of death and side effects incurred by their use. In 1975, the first large-scale, multicenter, prospective study on the incidence of fatal and nonfatal reactions was reported by Shehadi. In this series, the overall incidence of adverse reactions was 5.65%, of which 3.77% were mild, 1.77% were moderate, 0.02% were severe, and 0.0007% were fatal. Shehadi also noted that a history of allergy doubled the risk of adverse reaction and a history of a previous adverse reaction to contrast material trebled the risk; also, the risk of a reaction to an intraarterial injection was half that of the risk associated with an intravenous injection. With the introduction of low osmolar nonionic agents, other large-scale studies were performed because these agents appeared to cause significantly fewer adverse reactions. However, they were from 10 to 15 times more expensive than their predecessors. In 1987, Lasser reported on the increased safety of ionic agents when patients were pretreated with steroids. Palmer in Australia and Katayama in Japan collected 120,000 and 335,000 patients, respectively, and compared the incidence of adverse reactions of the ionic versus the nonionic agents. Wolf recently reported a study that included a direct comparison of ionic agents with pretreatment with steroids versus nonionic agents.(ABSTRACT TRUNCATED AT 250 WORDS)
Mishkin
M M
MM
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
D003287:Contrast Media / Q000009:adverse effects* / Q000737:chemistry; D006801:Humans; D007477:Ions; D012449:Safety
D003287:Contrast Media; D007477:Ions