![]() ![]() Its safety profile appears similar to that of the gadolinium chelates that preceded it in approval. Gadobenate dimeglumine is approved in most of Europe at this time, and approval is pending in the United States and the Far East. ![]() Weak protein binding may make this agent superior in MR angiography and possibly also in conventional MR imaging of the CNS. It has a major advantage over the currently available gadolinium chelates in liver imaging, due to its dual renal and hepatobiliary clearance. This agent will likely be marketed for whole-body and MR angiographic applications, with clinical trials having been conducted for imaging of the central nervous system (CNS), liver, and MR angiography. The agent farthest along in the approval process is gadobenate dimeglumine (Gd-BOPTA or MultiHance, Bracco Diagnostics) ( 1, 2). At least the first will also soon gain widespread approval. Two other agents deserve brief mention, as they have recently been approved in a limited number of countries. ![]() This paper focuses on safety issues regarding the six agents with widespread use. Of the gadolinium agents, the first three (gadopentetate dimeglumine, gadoteridol, and gadodiamide) have the greatest market share (in part because gadoterate meglumine is not available in the United States). Of these, the first four (the gadolinium chelates) easily dominate the market. However, these six are the most common used today in clinical practice. Because of market size and commercial reasons, not all are available in every country. These include four gadolinium chelates (gadopentetate dimeglumine, gadoteridol, gadodiamide, and gadoterate meglumine), one manganese chelate (mangafodipir trisodium), and one iron particle (superparamagnetic iron oxide). SIX MR CONTRAST AGENTS for intravenous administration currently enjoy widespread approval and use. This review discusses the safety issues involved with administration of intravenous contrast media in MR imaging, focusing on the six agents (four gadolinium chelates, one manganese chelate, and the last a large iron particle) with widespread use world-wide. These latter two agents are considered to be very safe but have a higher percentage of associated adverse reactions (7%–17% with mangafodipir trisodium and 15% with ferumoxides). Far fewer patients have been examined to date with the two other agents that have widespread approval, mangafodipir trisodium and ferumoxides. The four gadolinium chelates currently available worldwide, gadopentetate dimeglumine, gadoteridol, gadodiamide, and gadoterate meglumine, cannot be differentiated on the basis of adverse reactions. Health care personnel should be aware of the (extremely uncommon) potential for severe anaphylactoid reactions in association with the use of MR contrast media and be prepared should complications arise. Minor adverse reactions, including nausea (1%–2% for all agents) and hives (<1% for all agents), occur in a very low percent of cases. Unlike x-ray agents, the gadolinium chelates are not nephrotoxic. These agents are thought to be safer than nonionic iodinated contrast agents. The gadolinium chelates constitute the largest group of MR contrast media and are considered to be very safe. Contrast media provide critical additional diagnostic information in many instances. In the last 10 years, the use of intravenous contrast media in magnetic resonance (MR) has become well-established clinical practice. ![]()
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