From the Department of Radiology, Weill Cornell Medical Center, 416 E 55th St, New York, NY 10022 (B.A.H., Z.F., M.R.P.); Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY (M.R.P.); and Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY (Y.Z.).
Radiology. 2018 Feb;286(2):471-482. doi: 10.1148/radiol.2017162740. Epub 2017 Aug 25.
Purpose To perform a systematic review and meta-analysis to determine if there are differences in rates of immediate allergic events between classes of gadolinium-based contrast agents (GBCAs). Materials and Methods PubMed and Google Scholar databases were searched for studies in which rates of immediate adverse events to GBCAs were reported. The American College of Radiology classification system was used to characterize allergic-like events as mild, moderate, or severe, and the total number of administrations of each GBCA was recorded. Where necessary, authors of studies were contacted to clarify data and eliminate physiologic reactions. Relative risks of GBCA types were estimated by using the Mantel-Haenszel type method. Results Nine studies in which immediate reactions to GBCA were recorded from a total of 716 978 administrations of GBCA met the criteria for inclusion and exclusion. The overall rate of patients who had immediate allergic-like reactions was 9.2 per 10 000 administrations and the overall rate of severe immediate allergic-like reactions was 0.52 per 10 000 administrations.. The nonionic linear chelate gadodiamide had the lowest rate of reactions, at 1.5 (95% confidence interval [CI]: 0.74, 2.4) per 10 000 administrations, which was significantly less than that of linear ionic GBCAs at 8.3 (95% CI: 7.5, 9.2) per 10 000 administrations (relative risk, 0.19 [95% CI: 0.099, 0.36]; P < .00001) and less than that for nonionic macrocyclic GBCAs at 16 (95% CI: 14, 19) per 10 000 administrations (relative risk, 0.12 [95% CI: 0.05, 0.31]; P < .001). GBCAs known to be associated with protein binding had a higher rate of reactions, at 17 (95% CI: 15, 20) per 10 000 administrations compared with the same chelate classification without protein binding, at 5.2 (95% CI: 4.5, 6.0) per 10 000 administrations (relative risk, 3.1 [95% CI: 2.4, 3.8]; P < .0001). Conclusion These data show the lowest rate of immediate allergic adverse events with use of the nonionic linear GBCA gadodiamide in comparison with those of ionic linear or nonionic macrocyclic GBCAs. A higher rate of immediate allergic adverse events was associated with ionicity, protein binding, and macrocyclic structure. RSNA, 2017 An earlier incorrect version of this article appeared online. This article was corrected on August 31, 2017.
进行系统回顾和荟萃分析，以确定不同类型的钆基对比剂（GBCA）之间是否存在即刻过敏反应发生率的差异。
检索了报告 GBCA 即刻不良事件发生率的研究。使用美国放射学院（ACR）分类系统将类似过敏的事件特征化为轻度、中度或重度，并记录了每种 GBCA 的总给药次数。必要时，与研究作者联系以澄清数据并消除生理反应。使用 Mantel-Haenszel 类型方法估计 GBCA 类型的相对风险。
共有 9 项研究记录了 GBCA 的即刻反应，总计 716978 次 GBCA 给药符合纳入和排除标准。即刻发生类似过敏反应的患者总体发生率为 9.2/10000 次给药，即刻发生严重类似过敏反应的总体发生率为 0.52/10000 次给药。非离子线性螯合物钆喷酸葡胺的反应发生率最低，为 1.5/10000 次给药（95%置信区间[CI]：0.74，2.4），明显低于线性离子 GBCA 的 8.3/10000 次给药（95%CI：7.5，9.2）（相对风险，0.19[95%CI：0.099，0.36]；P<.00001），也低于非离子大环 GBCA 的 16/10000 次给药（相对风险，0.12[95%CI：0.05，0.31]；P<.001）。与没有蛋白结合的同类螯合物相比，已知与蛋白结合的 GBCA 的反应发生率更高，为 17/10000 次给药（95%CI：15，20），而没有蛋白结合的相同螯合物分类为 5.2/10000 次给药（95%CI：4.5，6.0）（相对风险，3.1[95%CI：2.4，3.8]；P<.0001）。
与离子线性或非离子大环 GBCA 相比，使用非离子线性 GBCA 钆喷酸葡胺的即刻过敏不良事件发生率最低。即刻过敏不良事件发生率与离子性、蛋白结合和大环结构有关。
RSNA，2017
