Wang Lijian, Chen Qinlan, Liu Haipeng, Wang Xiaomi, Qian Qian, Xu Mengxi, Ma Linlin, Wang Xinhong
Department of Radiology, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Nursing Department, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China.
Quant Imaging Med Surg. 2025 Aug 1;15(8):7338-7351. doi: 10.21037/qims-24-2332. Epub 2025 Jul 25.
Contrast media (CM) is widely used in contrast-enhanced computed tomography (CECT) to enhance the visualization of abnormal structures. CM extravasation, a recognized complication, may cause mild swelling or severe injuries (e.g., ulceration, necrosis). Current research on severe extravasation is limited to case reports or lacks large-cohort analyses of risk factors. This study aimed to explore risk factors, validate incidence and outcomes, and compare patient/technique/CM-related factors between mild and severe CM extravasation injuries using large-scale clinical data to aid early recognition and prevention.
This is a retrospective cohort study. A total of 586,812 CM injections were performed during CECT scans at a single institution between November 2012 and December 2023. Among these, 709 cases (334 males, 375 females; age: 62.9±15.2 years) with CM extravasation injuries were included. Extravasation injuries were classified by severity. The frequency and clinical outcomes of different severities of injuries were investigated. Risk factors of serious injuries were evaluated using logistic regression with generalized estimating equation analyses.
CM extravasation occurred in 0.12% (709/586,812) of cases. Of the 709 extravasation injuries, 672 (94.8%) were mild, 32 (4.5%) were moderate, and 5 (0.7%) were severe. Only 5 patients received consultations from dermatologists or burn specialists, and none required surgery. Multivariate analysis underscored the presence of diabetes mellitus [DM, odds ratio (OR) =8.04; P<0.01], injections in the dorsum of the hand (OR =4.86; P<0.01), without saline test (OR =2.58; P=0.02), and large-volume extravasation (OR =5.49; P<0.01) as potential risk factors of moderate or severe CM extravasation injury.
Most CM extravasation injuries are mild and without serious consequences. Multiple modifiable risk factors for serious CM extravasation injury have been identified that could mitigate the severity of the injury.
对比剂（CM）广泛应用于增强计算机断层扫描（CECT）以提高异常结构的可视化程度。CM外渗是一种公认的并发症，可能导致轻度肿胀或严重损伤（如溃疡、坏死）。目前关于严重外渗的研究仅限于病例报告，或缺乏对危险因素的大规模队列分析。本研究旨在探讨危险因素，验证发病率和结局，并使用大规模临床数据比较轻度和重度CM外渗损伤之间的患者/技术/CM相关因素，以帮助早期识别和预防。
这是一项回顾性队列研究。2012年11月至2023年12月期间，在单一机构进行的CECT扫描中共进行了586,812次CM注射。其中，纳入了709例发生CM外渗损伤的病例（男性334例，女性375例；年龄：62.9±15.2岁）。外渗损伤按严重程度分类。调查了不同严重程度损伤的发生率和临床结局。使用广义估计方程分析的逻辑回归评估严重损伤的危险因素。
CM外渗发生在0.12%（709/586,812）的病例中。在709例外渗损伤中，672例（94.8%）为轻度，32例（4.5%）为中度，5例（0.7%）为重度。只有5例患者接受了皮肤科医生或烧伤专家的会诊，无人需要手术。多变量分析强调糖尿病（DM，比值比[OR]=8.04；P<0.01）、手部背部注射（OR=4.86；P<0.01）、未进行生理盐水试验（OR=2.58；P=0.02）和大量外渗（OR=5.49；P<0.01）是中度或重度CM外渗损伤的潜在危险因素。
大多数CM外渗损伤为轻度，无严重后果。已确定多个可改变的严重CM外渗损伤危险因素，这些因素可减轻损伤的严重程度。
