Frequency, outcome, and risk factors of contrast media extravasation
in 142,651 intravenous contrast-enhanced CT scans
Eui Jin Hwang
Young Hun Choi
Chang Min Park
Received: 23 January 2018 / Revised: 16 April 2018 / Accepted: 19 April 2018
European Society of Radiology 2018
Objective To evaluate the frequency, outcome, and risk factors of intravenous contrast media (CM) extravasation during contrast-
enhanced CT scans in a large population.
Methods After institutional review board approval, 142,651 patients (72,976 males and 69,675 females; mean age, 59.9 ± 13.0
years) who underwent contrast-enhanced CT scans with intravenous CM between January 2015 and April 2017 were retrospec-
tively included. The frequency of CM extravasations and their clinical outcomes were investigated. Risk factors of CM extrav-
asation were evaluated using logistic regression with generalized estimating equation analyses. In addition, the frequency and risk
factors of large-volume (≥100 ml) CM extravasation were also investigated.
Results CM extravasation occurred in 0.23% (321/142,651) of patients, all of which were of mild degree and resolved without
any sequelae through conservative management. Multivariate analysis revealed that female gender [odds ratio (OR) = 1.61; p <
0.001], 60 < age ≤ 70 years (OR = 1.71; p = 0.004) or age > 70 years (OR = 2.49; p < 0.001), patients in general wards (OR =
2.71; p <0.001)orICUs(OR=4.76;p < 0.001), 9.4 < CM viscosity ≤ 10.0 (OR = 1.65; p = 0.015), 10.0 < CM viscosity ≤ 10.6
(OR = 1.60; p =0.002),andCMviscosity>16.0(OR=2.55,p < 0.001) were independent risk factors for CM extravasation.
Conclusion CM extravasation during contrast-enhanced CT scans was uncommon with no substantial clinical consequences.
Several risk factors that may have the potential to reduce the occurrence of CM extravasation were identified.
• The observed frequency of contrast media extravasation during contrast-enhanced CT scans was 0.23% (321/142,651).
• Significant risk factors for contrast media extravasation were female gender, age older than 60 years, patients in general wards
or ICUs, and the viscosity of contrast media greater than 9.4 mPa∙s.
• The main preventive action for contrast media extravasation would be to lower the viscosity of contrast media.
Keywords Contrast media
Extravasation of diagnostic and therapeutic materials
Injection site reaction
CI Confidence interval
CM Contrast media
EEV Estimated extravasated volume
ICU Intensive care unit
OR Odds ratio
Subcutaneous extravasation is a well-known complication af-
ter intravenous administration of iodinated contrast media
(CM) during contrast-enhanced CT scans. Previous studies
have reported its frequency to range between 0.1%-1.2%
[1–7]. Fortunately, most extravasation injuries were reported
to involve small volumes of CM and to resolve rapidly
through conservative management such as elevation of the
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s00330-018-5507-y) contains supplementary
material, which is available to authorized users.
* Chang Min Park
Department of Radiology, Seoul National University College of
Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Korea
Institute of Radiation Medicine, Seoul National University Medical
Research Center, Seoul, Korea