Comparative Safety Profiles and Usage Patterns of Iodinated Contrast Media in Medical Imaging

This study aimed to analyze the usage patterns and hypersensitivity reaction (HSR) profiles of six nonionic iodinated contrast media (ICMs) used in computed tomography (CT) to enhance patient safety and inform evidence-based contrast agent selection.

We retrospectively reviewed 248,209 CT scans obtained between January 2020 and December 2022. Six ICMs (iomeprol, iohexol, ioversol, iopromide, iodixanol, and iobitridol) were compared on the basis of their usage rates, HSR incidence, and severity. This study also evaluated the impact of premedication protocol reinforcement and assessed the quarterly HSR rates.

Among the 248,209 CT scans, 1603 (0.65%) were associated with HSRs. Most HSRs were mild (86.2%), with moderate (10.9%) and severe (2.9%) reactions being less common. Four ICMs were used as first-line agents and two ICMs were used as second-line agents. The second-line agents, iobitridol and iodixanol, exhibited 7-8 times higher HSR rates compared to the first-line agents. A modified premedication protocol implemented in mid-2022 significantly reduced the incidence of moderate HSRs (p = 0.0075). The quarterly analysis indicated a trend in higher HSR rates in the first quarter and a statistically significant increase in severe HSRs in the third quarter (p = 0.033).

These findings highlight the importance of tailored premedication protocols and a 7-8 times higher rate of HSR with second-line agents in contrast-enhanced imaging. Future research should focus on elucidating the mechanisms underlying these variations to further refine contrast agent selection and management strategies.