Acute Adverse Reactions to Nonionic Iodinated Contrast Media: A Meta-Analysis

Young Joo Suh, Soon Ho Yoon, Hyunsook Hong, Seokyung Hahn, Dong Yoon Kang, Hye Ryun Kang, Young Hun Choi, Whal Lee

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Objectives We aimed to meta-analytically compare the incidence of acute adverse reactions (AARs) to nonionic iodinated contrast media (ICM) according to the type of ICM in patients who underwent radiologic examinations with administration of ICM via intravascular route. Materials and Methods A systematic literature search identified studies evaluating the incidence of AARs to 7 nonionic ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, ioversol, and iodixanol) with extractable outcomes. These outcomes were pooled using a random-effects model, and the effect of ICM type on the incidence of overall and severe AARs was evaluated using meta-regression analysis. Results Thirty studies with 1,360,488 exposures to ICM were included. The pooled incidences of overall and severe AARs to nonionic ICM were 1.03% (95% confidence interval [CI], 0.81%-1.30%; I2 = 0.99) and 0.0141% (95% CI, 0.0108%-0.0183%; I2 = 0.56), respectively. Iomeprol had the highest overall AAR incidence (1.74%; 95% CI, 0.79%-3.76%; I2 = 0.99), followed by iohexol (1.21%; 95% CI, 0.67%-2.17%; I2 = 0.99), iopamidol (1.10%; 95% CI, 0.60%-2.03%; I2 = 0.99), ioversol (0.88%; 95% CI, 0.43%-1.83%; I2 = 0.96), iodixanol (0.85%; 95% CI, 0.36%-1.95%; I2 = 0.99), iopromide (0.82%; 95% CI, 0.43%-1.55%; I2 = 0.99), and iobitridol (0.77%; 95% CI, 0.36%-1.62%; I2 = 0.99). Multivariable meta-regression analysis revealed that study design (P = 0.0014) and premedication (P = 0.0230) were statistically significant determinants affecting the incidence of overall AARs. Iodinated contrast media type did not affect the incidence of overall and severe AARs (P = 0.1453 and 0.4265, each). Conclusions The varying pooled incidences of overall and severe AARs to specific types of nonionic ICM do not remain as significant after adjusting confounders. Our results may support nonrestriction of certain types of nonionic ICM in the context of AAR avoidance.

Original languageEnglish
Pages (from-to)589-599
Number of pages11
JournalInvestigative Radiology
Issue number9
StatePublished - 1 Sep 2019


  • acute adverse reaction
  • iodinated contrast media
  • meta-analysis
  • outcomes
  • systematic literature search

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