Emergency Radiology

, Volume 12, Issue 5, pp 210–215 | Cite as

Adverse reactions to intravenous iodinated contrast media: a primer for radiologists

  • Saravanan NamasivayamEmail author
  • Mannudeep K. Kalra
  • William E. Torres
  • William C. Small
Review Article


Adverse reactions to intravenous iodinated contrast media may be classified as general and organ-specific, such as contrast-induced nephrotoxicity. General adverse reactions may be subclassified into acute and delayed types. Acute general adverse reactions can range from transient minor reactions to life-threatening severe reactions. Non-ionic contrast media have lower risk of mild and moderate adverse reactions. However, the risk of fatal reactions is similar for ionic and non-ionic contrast media. Adequate preprocedure evaluation should be performed to identify predisposing risk factors. Prompt recognition and treatment of acute adverse reactions is crucial. Risk of contrast induced nephrotoxicity can be reduced by use of non-ionic contrast media, less volume of contrast, and adequate hydration. The radiologist can play a pivotal role by being aware of predisposing factors, clinical presentation, and management of adverse reactions to contrast media.


Iodinated contrast media Contrast media Complications Radiocontrast nephropathy Radiology and radiologists Iatrogenic injury 


  1. 1.
    Solomon R (2006) How large a problem is contrast-induced nephropathy? Decisions in imaging economics, November 2005. Available at:, accessed on February 15
  2. 2.
    Webb JAW, Stacul F, Thomsen HS, Morcos SK (2003) Late adverse reactions to intravascular iodinated contrast media. Eur Radiol 13:181–184PubMedCrossRefGoogle Scholar
  3. 3.
    ACR’s manual of contrast media, 5th edn. June 2004Google Scholar
  4. 4.
    Morcos SK, Thomsen HS (2001) Adverse reactions to iodinated contrast media. Eur Radiol 11:1267–1275PubMedCrossRefGoogle Scholar
  5. 5.
    Thomsen HS, Bush WH (1998) Adverse effects of contrast media: incidence, prevention and management. Drug Safety 19:313–324PubMedCrossRefGoogle Scholar
  6. 6.
    Thomsen HS, Dorph S (1993) High-osmolar and low-osmolar contrast media. An update on frequency of adverse drug reactions. Acta Radiol 3:205–209CrossRefGoogle Scholar
  7. 7.
    Wysowski DK, Nourjah P (2006) Deaths attributed to X-ray contrast media on U.S. death certificates. AJR Am J Roentgenol 186:613–615PubMedCrossRefGoogle Scholar
  8. 8.
    Fischer H, Doust V (1992) An evaluation of pretesting in the problem of serious and fatal reactions to excretory urography. Radiology 103:497–501Google Scholar
  9. 9.
    Witten D (1975) Reactions to urographic contrast media. JAMA 231:974–977PubMedCrossRefGoogle Scholar
  10. 10.
    Siegle R (1993) Rates of idiosyncratic reactions. Ionic versus nonionic contrast media. Invest Radiol 28:S95–S98PubMedCrossRefGoogle Scholar
  11. 11.
    Siegle R, Halvorsen R, Dillon J et al (1991) The use of iohexol in patients with previous reactions to ionic contrast material. Invest Radiol 26:411–416PubMedCrossRefGoogle Scholar
  12. 12.
    Lang D, Allpern M, Visintainer P et al (1991) Increased risk for anaphylactoid reaction from contrast media in patients on beta-adrenergic blockers or with asthma. Ann Intern Med 115:270–276PubMedGoogle Scholar
  13. 13.
    Greenberger P, Meyers S, Kramer B (1997) Effects of beta-adrenergic and calcium antagonists on the development of anaphylactoid reactions from radiographic contrast media during cardiac angiography. J Allergy Clin Immunol 80:698–702CrossRefGoogle Scholar
  14. 14.
    Lasser EC, Berry CC, Mishkin MM et al (1994) Pretreatment with corticosteroids to prevent adverse reactions to nonionic contrast media. AJR Am J Roentgenol 162:523–526PubMedGoogle Scholar
  15. 15.
    Greenberger PA, Paterson R. The prevention of immediate generalized reactions to radiocontrast media in high-risk patients. J Allergy Clin Immunol 87:867–872Google Scholar
  16. 16.
    Lasser EC, Berry CC, Talner LB et al (1988) Protective effects of corticosteroids in contrast material anaphylaxis. Invest Radiol 23:S193–S194PubMedCrossRefGoogle Scholar
  17. 17.
    Lasser EC, Berry CC, Talner LB et al (1987) Pretreatment with corticosteroids to alleviate reactions to intravascular contrast media. N Engl J Med 317:845–849PubMedCrossRefGoogle Scholar
  18. 18.
    Dawson P, Sidhu PS (1993) Is there a role for corticosteroid prophylaxis in patients at increased risk of adverse reactions to invascular contrast agents? Clin Radiol 48:225–226PubMedCrossRefGoogle Scholar
  19. 19.
    Kelly JF, Patterson R, Lieberman P et al (1978) Radiographic contrast media studies in high-risk patients. J Allergy Clin Immunol 62:181–184PubMedCrossRefGoogle Scholar
  20. 20.
    Davies P, Roberts MB, Roylance J (1975) Acute reactions to urographic contrast media. BMJ 2:434–437CrossRefPubMedGoogle Scholar
  21. 21.
    Hartman GW, Hattery RR, Witten DM et al (1982) Mortality during excretory urography: Mayo clinic experience. AJR Am J Roentgenol 139:919–922PubMedGoogle Scholar
  22. 22.
    Almen T (1994) The etiology of contrast medium reactions. Invest Radiol 29:S37–S45, (Suppl)PubMedCrossRefGoogle Scholar
  23. 23.
    Katayama H (1996) Retrospective survey of iotrolan-280-induced late adverse reactions. Eur Radiol 6(Suppl 3):S11Google Scholar
  24. 24.
    Cohan RH, Ellis JH, Garner WL (1996) Extravasation of radiographic contrast material: recognition, prevention, and treatment. Radiology 200:593–604PubMedGoogle Scholar
  25. 25.
    Lin J, Bonventre JV (2005) Prevention of radiocontrast nephropathy. Curr Opin Nephrol Hypertens 14:105–110PubMedCrossRefGoogle Scholar
  26. 26.
    Tippins RB, Torres WE, Baumgartner BR, Baumgarten DA (2000) Are screening serum creatinine levels necessary before outpatient CT examinations? Radiology 216:481–484PubMedGoogle Scholar
  27. 27.
    Levey AS, Bosch JP, Lewis JB, Greene T, Rogers N, Roth D (1999) A more accurate method to estimate glomerular filtration rate from serum creatinine: a new prediction equation. Ann Intern Med 130:461–470PubMedGoogle Scholar
  28. 28.
    Namasivayam S, Kalra MK, Ritchie JC et al (2005) Role of reagent strip based rapid creatinine meter in patients undergoing contrast enhanced radiological studies. Presented as a hot topic in the Radiologic Society of North America Annual MeetingGoogle Scholar

Copyright information

© Am Soc Emergency Radiol 2006

Authors and Affiliations

  • Saravanan Namasivayam
    • 1
    Email author
  • Mannudeep K. Kalra
    • 1
  • William E. Torres
    • 1
  • William C. Small
    • 1
  1. 1.Division of Abdominal Imaging, Department of RadiologyEmory University School of MedicineAtlantaUSA

Personalised recommendations