Safety of Contrast Agents in Magnetic Resonance Imaging for Allergic Patients: Evaluation and Therapeutic Choices

Abstract

The use of contrast agents in magnetic resonance imaging (MRI) is a key element in enhancing diagnostic quality, allowing for more detailed visualization of anatomical structures and pathologies. However, in patients with a history of allergic reactions to contrast agents, the use of these agents can pose significant risks, ranging from mild skin reactions to severe episodes of anaphylaxis. The clinical challenge lies in balancing the need to improve diagnostic imaging with patient safety, particularly in high-risk populations. This study aims to evaluate the effectiveness of allergic prophylaxis strategies, comparing the safety of macrocyclic contrast agents with linear ones, the two main categories of agents used in MRI. The work includes a review of existing guidelines and a critical analysis of the scientific literature, focusing on studies that have examined the incidence of adverse reactions and the effectiveness of pharmacological prophylaxis. Particular attention was given to macrocyclic contrast agents, which, due to their more stable chemical structure, show a lower risk of free gadolinium release and consequently a lower incidence of adverse reactions. The article also explores the importance of detailed pre-procedural evaluation and post-procedural clinical monitoring, identifying best practices for managing patients with a high risk of allergic reactions. The results indicate that adopting a well-planned allergic prophylaxis, along with choosing contrast agents with a superior safety profile, can significantly reduce the risk of adverse reactions. In particular, macrocyclic contrast agents, such as gadoterate meglumine, have been shown to be safer compared to their linear counterparts. This study provides practical recommendations for radiologists and multidisciplinary teams, aiming to improve patient safety and the effectiveness of MRI procedures in allergic patients.