Safe use of contrast media in myasthenia gravis: systematic review and updated European Society of Urogenital Radiology Contrast Media Safety Committee guidelines

Remy W F Geenen; Giles Roditi; Marie-France Bellin; Michele Bertolotto; Torkel Brismar; Jean-Michel Correas; Ilona A Dekkers; Gertraud Heinz-Peer; Andreas H Mahnken; Aart J van der Molen; Carlo C Quattrocchi; Alexander Radbuch; Peter Reimer; Maria Sebastià; Fulvio Stacul; Laura Romanini; Olivier Clément; Contrast Media Safety Committee

doi:10.1007/s00330-023-10463-z

Safe use of contrast media in myasthenia gravis: systematic review and updated European Society of Urogenital Radiology Contrast Media Safety Committee guidelines

Eur Radiol. 2023 Dec 14. doi: 10.1007/s00330-023-10463-z. Online ahead of print.

Authors

Remy W F Geenen¹, Giles Roditi², Marie-France Bellin³, Michele Bertolotto⁴, Torkel Brismar^{5

6}, Jean-Michel Correas⁷, Ilona A Dekkers⁸, Gertraud Heinz-Peer⁹, Andreas H Mahnken¹⁰, Aart J van der Molen⁸, Carlo C Quattrocchi¹¹, Alexander Radbuch^{12

13}, Peter Reimer¹⁴, Maria Sebastià¹⁵, Fulvio Stacul¹⁶, Laura Romanini¹⁷, Olivier Clément¹⁸; Contrast Media Safety Committee

Affiliations

¹ Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands.
² Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK.
³ BioMaps, Service de Radiologie, University Hospital Bicêtre, AP-HP, University Paris-Saclay, Le Kremlin-Bicêtre, France.
⁴ Department of Radiology, University Hospital Trieste, Trieste, Italy.
⁵ Unit of Radiology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden.
⁶ Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden.
⁷ Service de Radiologie, DMU Imagina, Groupe Hospitalier Necker, AP-HP, Université de Paris-Cité, Paris, France.
⁸ Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
⁹ Department of Radiology, Landesklinikum St Pölten, St Pölten, Austria.
¹⁰ Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany.
¹¹ Centre for Medical Sciences-CISMed, University of Trento, Via S. Maria Maddalena 1, 38122, Trento, Italy.
¹² Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, Bonn, Germany.
¹³ German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany.
¹⁴ Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany.
¹⁵ Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain.
¹⁶ Department of Radiology, Ospedale Maggiore, Trieste, Italy.
¹⁷ Department of Radiology, ASST Cremona, Cremona, Italy.
¹⁸ Service de Radiologie, DMU Imagina, Hôpital Européen Georges Pompidou, AP-HP, Université Paris-Cité, 20 Rue LeBlanc, 75015, Paris, France. olivier.clement@aphp.fr.

PMID: 38092951
DOI: 10.1007/s00330-023-10463-z

Abstract

Objectives: It is uncertain whether modern iodine-based or gadolinium-based contrast media (CM) administration can lead to increased symptoms in patients with myasthenia gravis.

Methods: A systematic search in Medline was conducted for studies describing the symptomatology of myasthenia gravis patients before and after receiving intravenous (IV) CM and having a matched control group of myasthenia gravis patients who did not receive IV CM.

Results: Three retrospective studies were selected with a total of 374 myasthenia gravis patients who received iodine-based CM and a total of 313 myasthenia gravis patients who underwent unenhanced CT and served as controls. Pooling of the data from the three retrospective studies showed that in 23 of 374 patients, increased symptoms after iodine-based CM administration were described (6.1%). Increased symptomatology also occurred in 11 of 313 patients after unenhanced CT (3.5%). When looking more deeply into the data of the three studies, conflicting results were found, as two articles did not find any relationship between CM and myasthenia gravis symptoms. The remaining study only found a significant increase in symptomatology within 1 day after CT scanning: seven patients (6.3%) in the contrast-enhanced CT group and one patient (0.6%) in the unenhanced CT group (p = 0.01).

Conclusions: There is limited evidence on the relationship between CM and myasthenia gravis symptoms. In the vast majority of myasthenia gravis patients, CM are safe. Probably, in less than 5% of the patients, iodine-based CM administration may lead to increased severity of the symptoms within the first 24 h after administration.

Clinical relevance statement: Be aware that intravenous administration of iodine-based contrast media can lead to an increase of symptoms in patients with myasthenia gravis within the first 24 h. This can probably happen in less than 5% of the patients.

Key points: • It is unclear whether modern contrast media can lead to increased symptoms in myasthenia gravis patients after intravenous administration. • There seems to be a small risk of increased myasthenia gravis symptoms within 24 h after intravenous administration of iodine-based contrast media, probably in less than 5% of the administrations. • Gadolinium-based contrast media are safe for patients with myasthenia gravis.

Keywords: Contrast media; Multidetector computed tomography; Myasthenia gravis.