Patient evaluation before magnetic resonance imaging: Concern for acute reaction to gadolinium contrast

MRI: magnetic resonance imaging; CT: computed tomography.
* Refer to other UpToDate content or the American College of Radiology (ACR) Appropriateness Criteria for MRI contrast recommendations based on a specific exam indication.
¶ Acute adverse reactions to gadolinium contrast have been defined as those that occur within one hour of contrast administration. No cross-reactivity between gadolinium and iodinated contrast has been identified.
Δ Alternative imaging options include noncontrast, MRI, CT, or ultrasound. A discussion with a radiologist will likely be helpful.
◊ If a gadolinium contrast agent different from the one that caused the index reaction is available, it should be given preferentially. However, there is no evidence that this decreases the likelihood of a recurrent reaction.
§ There is no evidence that premedication decreases the likelihood of a recurrent reaction.
¥ The most severe symptom predominates. If allergic-like and physiologic symptoms are mixed or cannot be determined (eg, cardiopulmonary collapse), reaction should be presumed allergic-like.