Correspondence
More on Pseudohypocalcemia and Gadolinium-Enhanced MRI
N Engl J Med 2004; 350:87-88January 1, 2004
- Article
To the Editor:
In their letter to the editor, Doorenbos et al. (Aug. 21 issue)1 describe seven cases of severe pseudohypocalcemia after gadolinium-enhanced magnetic resonance angiography with the use of gadodiamide. Their report represents an important warning to all physicians, especially since such laboratory interference can occur after any gadodiamide-enhanced magnetic resonance imaging (MRI) examination. Gadodiamide and gadoversetamide are the two gadolinium chelates known to interfere with the colorimetric methods of measuring serum calcium used in most hospitals.2-5 However, five other gadolinium contrast agents do not show this interference: gadopentetate dimeglumine (Magnevist) and gadoteridol (ProHance), which are widely used in the United States, and gadobenate dimeglumine (MultiHance), gadobutrol (Gadovist), and gadoterate meglumine (Dotarem), which are available in Europe and selected countries elsewhere.
The reported interference with calcium measurements is due not to the gadolinium but rather to these two chelators. The interference can be completely avoided by requesting only those gadolinium contrast agents that are free of this interference. Alternatively, the interference can be eliminated by avoiding colorimetric methods of measuring serum calcium.
Editor's note: Dr. Prince reports having received honorariums and research support from Amersham, Berlex, Schering, Mallinckrodt, and Bracco and patent revenue from Mallinckrodt and Bracco. Dr. Knopp reports having received honorariums and research support from Amersham, Berlex, Schering, Mallinckrodt, and Bracco and patent revenue from Amersham.
5 ReferencesMartin R. Prince, M.D., Ph.D.
Weill Medical College of Cornell University, New York, NY 10021
map2008@med.cornell. edu Peter L. Choyke, M.D.
National Institutes of Health, Bethesda, MD 20892Michael V. Knopp, M.D., Ph.D.
Ohio State University, Columbus, OH 432151
Doorenbos CJ ,Ozyilmaz A ,van Wijnen M . Severe pseudohypocalcemia after gadolinum-enhanced magnetic resonance angiography. N Engl J Med 2003;349:817-818
Full Text | Web of Science | Medline2
Prince MR ,Erel HE ,Lent RW , et al. Gadodiamide administration causes spurious hypocalcemia. Radiology 2003;227:639-646
CrossRef | Web of Science | Medline3
Choyke PL ,Knopp MV . Pseudohypocalcemia with MR imaging contrast agents: a cautionary tale. Radiology 2003;227:627-628
CrossRef | Web of Science | Medline4
Normann PT ,Froysa A ,Svaland M . Interference of gadodiamide injection (OMNISCAN) on the colorimetric determination of serum calcium. Scand J Clin Lab Invest 1995;55:421-426
CrossRef | Web of Science | Medline5
Lin J ,Idee JM ,Port M , et al. Interference of magnetic resonance imaging contrast agents with the serum calcium measurement technique using colorimetric reagents. J Pharm Biomed Anal 1999;21:931-943
CrossRef | Web of Science | Medline
Author/Editor Response
We appreciate the comments of Prince and colleagues. Many clinicians may make mistakes with pseudohypocalcemia because of the interaction between the gadolinium chelate and the colorimetric method used to measure calcium, as Prince and colleagues have described,1 and as we reported in our letter. This problem may be avoided by increasing clinicians' awareness of it; by postponing blood sampling for calcium measurement after the administration of gadolinium, especially in patients with renal failure; by not using the colorimetric method for measuring calcium; or by using a gadolinium preparation that causes no interference.2 The first two solutions are difficult to guarantee, and the third is hard to justify because of the rarity of this problem. Furthermore, measurements of calcium by means of an ion-selective electrode or inductively coupled plasma-atomic emission spectroscopy are not available in most hospitals. Therefore, we prefer the fourth solution: use of a gadolinium preparation that is free from interference,3 as suggested by Prince and colleagues.
3 ReferencesCornelius J. Doorenbos, M.D., Ph.D.
Kenneth Koster, M.D.
Merel van Wijnen, Ph.D.
Deventer Hospital, NL-7415 CM Deventer, the Netherlands
doorenbc@dz.nl 1
Prince MR ,Erel HE ,Lent RW , et al. Gadodiamide administration causes spurious hypocalcemia. Radiology 2003;227:639-646
CrossRef | Web of Science | Medline2
Normann PT ,Froysa A ,Svaland M . Interference of gadodiamide injection (OMNISCAN) on the colorimetric determination of serum calcium. Scand J Clin Lab Invest 1995;55:421-426
CrossRef | Web of Science | Medline3
Lin J ,Idee JM ,Port M , et al. Interference of magnetic resonance imaging contrast agents with the serum calcium measurement technique using colorimetric reagents. J Pharm Biomed Anal 1999;21:931-943
CrossRef | Web of Science | Medline
- Citing Articles (6)
Citing Articles
1
Andrea Löwe, Josy Breuer, Petra Palkowitsch. (2011) Evaluation of the Effect of Two Gadolinium-Containing Contrast-Enhancing Agents, Gadobutrol and Gadoxetate Disodium, on Colorimetric Calcium Determinations in Serum and Plasma. Investigative Radiology 46:6, 366-369
CrossRef2
Jean-Marc Idée, Marc Port, Isabelle Raynal, Michel Schaefer, Soizic Le Greneur, Claire Corot. (2006) Clinical and biological consequences of transmetallation induced by contrast agents for magnetic resonance imaging: a review. Fundamental and Clinical Pharmacology 20:6, 563-576
CrossRef3
Kohkan Shamsi, E Kent Yucel, Paul Chamberlin. (2006) A Summary of Safety of Gadofosveset (MS-325) at 0.03 mmol/kg Body Weight Dose. Investigative Radiology 41:11, 822-830
CrossRef4
Michael V. Knopp, Thomas Balzer, Marc Esser, Franciska K. Kashanian, Predip Paul, Hans P. Niendorf. (2006) Assessment of Utilization and Pharmacovigilance Based on Spontaneous Adverse Event Reporting of Gadopentetate Dimeglumine as a Magnetic Resonance Contrast Agent After 45 Million Administrations and 15 Years of Clinical Use. Investigative Radiology 41:6, 491-499
CrossRef5
Andrea L??we, Thomas Balzer, Uta Hirt. (2005) Interference of Gadolinium-Containing Contrast-Enhancing Agents With Colorimetric Calcium Laboratory Testing. Investigative Radiology 40:8, 521-525
CrossRef6
M. Decupere. (2005) Artifactual hypocalcaemia after intravenous administration of gadodiamide (Omniscan(R)). Nephrology Dialysis Transplantation 20:7, 1516-1517
CrossRef
