van der Molen Aart J, van de Ven Annick A J M, Vega Francisco, Dekkers Ilona A, Laguna José J
Department of Radiology, C-2S, Leiden University Medical Center, Leiden, The Netherlands.
Department of Internal Medicine, Division of Allergology, University Medical Center Groningen, Groningen, The Netherlands.
Eur J Radiol. 2025 Feb;183:111908. doi: 10.1016/j.ejrad.2024.111908. Epub 2024 Dec 31.
The risk of developing a severe delayed cutaneous reaction (SCAR) is very low following iodine-based contrast medium (ICM) administration and extremely low following gadolinium-based contrast agent (GBCA) administration. However, SCAR can be very severe and potentially life-threatening. It is crucial for the imaging physician to recognize danger signals: bullous skin eruption, skin erosion and detachment, mucosal involvement, systemic symptoms, and laboratory abnormalities. Patients suspected of having a SCAR should be urgently referred to a drug allergy specialist or dermatologist. To prevent recurrence, consider exploring alternative imaging modalities and avoid administering the same type of contrast medium involved: if the culprit is a ICM, avoid all ICM and if the culprit is a GBCA, avoid all GBCA. In an allergy centre with experience in SCAR evaluation a careful allergologic analysis may be performed safely several months after the patient has recovered from SCAR. However, allergologic analysis is challenging due to the lack of reliable in vitro diagnostic tests and the risks of in vivo diagnostic tests, particularly drug provocation tests.
使用碘基造影剂（ICM）后发生严重迟发性皮肤反应（SCAR）的风险非常低，而使用钆基造影剂（GBCA）后该风险极低。然而，SCAR可能非常严重，甚至有潜在的生命危险。对于影像科医生来说，识别危险信号至关重要：大疱性皮疹、皮肤糜烂和脱落、黏膜受累、全身症状以及实验室检查异常。疑似患有SCAR的患者应紧急转诊至药物过敏专科医生或皮肤科医生处。为防止复发，可考虑探索其他成像方式，并避免使用涉及的同类型造影剂：如果罪魁祸首是ICM，则避免使用所有ICM；如果是GBCA，则避免使用所有GBCA。在有SCAR评估经验的过敏中心，患者从SCAR恢复数月后可安全地进行仔细的过敏学分析。然而，由于缺乏可靠的体外诊断测试以及体内诊断测试的风险，尤其是药物激发试验，过敏学分析具有挑战性。
