Frequency and risk factors of contrast media extravasation in 378,082 intravenous contrast-enhanced CT scans

Lijian Wang; Qinlan Chen; Haipeng Liu; Xiaoming Wang; Qian Qian; Mengxi Xu; Linlin Ma; Xinhong Wang

doi:10.1016/j.ejrad.2025.111992

Frequency and risk factors of contrast media extravasation in 378,082 intravenous contrast-enhanced CT scans

Lijian Wang
, Qinlan Chen
, Haipeng Liu
, Xiaoming Wang
, Qian Qian
, Mengxi Xu
, Linlin Ma
, Xinhong Wang

The Second Affiliated Hospital Zhejiang University

Research output: Contribution to journal › Article › peer-review

4 Citations (Scopus)

3 Downloads (Pure)

Abstract

Purpose
To determine the occurrence and risk factors of contrast media extravasation (CME) during contrast-enhanced computed tomography (CECT).
Methods
This is an observational retrospective study. 378,082 cases who underwent CECT scans between January 2017 and December 2023 were initially included. The total and annual incidence of CME were examined. Subsequently, 155,547 cases with sufficient information were finally included for risk analysis. Risk factors of CME were investigated using logistic regression with generalized estimating equation analyses. Besides, risk factors of large-volume (≥50 ml) CME were also surveyed.
Results
The incidence of CME decreased steadily from 0.18 % in 2017 to 0.07 % in 2023, with an overall rate of 0.11 % (431/378,082). Multivariate analysis revealed that female [odds ratio (OR) = 1.683; P < 0.001], age (OR = 1.017; P < 0.001), BMI < 18.5 (OR = 2.083; P < 0.001), emergency patient (OR = 1.950; P < 0.001), diabetes mellitus (OR = 2.650; P = 0.001), iohexol injection (OR = 1.721; P = 0.006), iopamidol injection (OR = 1.640; P = 0.006), and without saline flush (OR = 3.336; P < 0.001) were the risk factors of CME. 24 ≤ BMI < 28 (OR = 0.686; P = 0.002) was a protective factor for CME. In addition, male, BMI ≥ 28, 18-gauge injection, elbow fossa injection, and upper-arm injection were the risk factors for large-volume CME.
Conclusions
CME was uncommon during CECT. Several risk factors identified for CME and large-volume CME may have the potential to reduce the occurrence and severity of CME.

Original language	English
Article number	111992
Number of pages	7
Journal	European Journal of Radiology
Volume	184
Early online date	7 Feb 2025
DOIs	https://doi.org/10.1016/j.ejrad.2025.111992
Publication status	Published - Mar 2025

Bibliographical note

© 2025 Elsevier

Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders.

This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

Funding

The authors thank the Medical Health Science and Technology Project of Zhejiang Provincial Health Commission (Grant No. 2024KY1036, 2023KY106). We are also grateful to the statistician, Dr Z.C., for meticulously checking our methodology.

Funders	Funder number
Medical Health Science and Technology Project of Zhejiang Provincial Health Commission	2024KY1036, 2023KY106

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Computed tomography
Contrast media
Extravasation of diagnostic and therapeutic materials
Injection site reactions
Risk Factors

ASJC Scopus subject areas

Radiology Nuclear Medicine and imaging

Access to Document

10.1016/j.ejrad.2025.111992

Liu2025AAMAccepted author manuscript, 549 KBLicence: CC BY-NC-ND

Cite this

@article{b96fc9a165cc41448367c975858cfb0f,

title = "Frequency and risk factors of contrast media extravasation in 378,082 intravenous contrast-enhanced CT scans",

abstract = "Purpose To determine the occurrence and risk factors of contrast media extravasation (CME) during contrast-enhanced computed tomography (CECT). Methods This is an observational retrospective study. 378,082 cases who underwent CECT scans between January 2017 and December 2023 were initially included. The total and annual incidence of CME were examined. Subsequently, 155,547 cases with sufficient information were finally included for risk analysis. Risk factors of CME were investigated using logistic regression with generalized estimating equation analyses. Besides, risk factors of large-volume (≥50 ml) CME were also surveyed. Results The incidence of CME decreased steadily from 0.18 \% in 2017 to 0.07 \% in 2023, with an overall rate of 0.11 \% (431/378,082). Multivariate analysis revealed that female [odds ratio (OR) = 1.683; P < 0.001], age (OR = 1.017; P < 0.001), BMI < 18.5 (OR = 2.083; P < 0.001), emergency patient (OR = 1.950; P < 0.001), diabetes mellitus (OR = 2.650; P = 0.001), iohexol injection (OR = 1.721; P = 0.006), iopamidol injection (OR = 1.640; P = 0.006), and without saline flush (OR = 3.336; P < 0.001) were the risk factors of CME. 24 ≤ BMI < 28 (OR = 0.686; P = 0.002) was a protective factor for CME. In addition, male, BMI ≥ 28, 18-gauge injection, elbow fossa injection, and upper-arm injection were the risk factors for large-volume CME. Conclusions CME was uncommon during CECT. Several risk factors identified for CME and large-volume CME may have the potential to reduce the occurrence and severity of CME.",

keywords = "Computed tomography, Contrast media, Extravasation of diagnostic and therapeutic materials, Injection site reactions, Risk Factors",

author = "Lijian Wang and Qinlan Chen and Haipeng Liu and Xiaoming Wang and Qian Qian and Mengxi Xu and Linlin Ma and Xinhong Wang",

note = "{\textcopyright} 2025 Elsevier Copyright {\textcopyright} and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author{\textquoteright}s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it. ",

year = "2025",

month = mar,

doi = "10.1016/j.ejrad.2025.111992",

language = "English",

volume = "184",

journal = "European Journal of Radiology",

issn = "1872-7727",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Frequency and risk factors of contrast media extravasation in 378,082 intravenous contrast-enhanced CT scans

AU - Wang, Lijian

AU - Chen, Qinlan

AU - Liu, Haipeng

AU - Wang, Xiaoming

AU - Qian, Qian

AU - Xu, Mengxi

AU - Ma, Linlin

AU - Wang, Xinhong

N1 - © 2025 Elsevier Copyright © and Moral Rights are retained by the author(s) and/ or other copyright owners. A copy can be downloaded for personal non-commercial research or study, without prior permission or charge. This item cannot be reproduced or quoted extensively from without first obtaining permission in writing from the copyright holder(s). The content must not be changed in any way or sold commercially in any format or medium without the formal permission of the copyright holders. This document is the author’s post-print version, incorporating any revisions agreed during the peer-review process. Some differences between the published version and this version may remain and you are advised to consult the published version if you wish to cite from it.

PY - 2025/3

Y1 - 2025/3

N2 - Purpose To determine the occurrence and risk factors of contrast media extravasation (CME) during contrast-enhanced computed tomography (CECT). Methods This is an observational retrospective study. 378,082 cases who underwent CECT scans between January 2017 and December 2023 were initially included. The total and annual incidence of CME were examined. Subsequently, 155,547 cases with sufficient information were finally included for risk analysis. Risk factors of CME were investigated using logistic regression with generalized estimating equation analyses. Besides, risk factors of large-volume (≥50 ml) CME were also surveyed. Results The incidence of CME decreased steadily from 0.18 % in 2017 to 0.07 % in 2023, with an overall rate of 0.11 % (431/378,082). Multivariate analysis revealed that female [odds ratio (OR) = 1.683; P < 0.001], age (OR = 1.017; P < 0.001), BMI < 18.5 (OR = 2.083; P < 0.001), emergency patient (OR = 1.950; P < 0.001), diabetes mellitus (OR = 2.650; P = 0.001), iohexol injection (OR = 1.721; P = 0.006), iopamidol injection (OR = 1.640; P = 0.006), and without saline flush (OR = 3.336; P < 0.001) were the risk factors of CME. 24 ≤ BMI < 28 (OR = 0.686; P = 0.002) was a protective factor for CME. In addition, male, BMI ≥ 28, 18-gauge injection, elbow fossa injection, and upper-arm injection were the risk factors for large-volume CME. Conclusions CME was uncommon during CECT. Several risk factors identified for CME and large-volume CME may have the potential to reduce the occurrence and severity of CME.

AB - Purpose To determine the occurrence and risk factors of contrast media extravasation (CME) during contrast-enhanced computed tomography (CECT). Methods This is an observational retrospective study. 378,082 cases who underwent CECT scans between January 2017 and December 2023 were initially included. The total and annual incidence of CME were examined. Subsequently, 155,547 cases with sufficient information were finally included for risk analysis. Risk factors of CME were investigated using logistic regression with generalized estimating equation analyses. Besides, risk factors of large-volume (≥50 ml) CME were also surveyed. Results The incidence of CME decreased steadily from 0.18 % in 2017 to 0.07 % in 2023, with an overall rate of 0.11 % (431/378,082). Multivariate analysis revealed that female [odds ratio (OR) = 1.683; P < 0.001], age (OR = 1.017; P < 0.001), BMI < 18.5 (OR = 2.083; P < 0.001), emergency patient (OR = 1.950; P < 0.001), diabetes mellitus (OR = 2.650; P = 0.001), iohexol injection (OR = 1.721; P = 0.006), iopamidol injection (OR = 1.640; P = 0.006), and without saline flush (OR = 3.336; P < 0.001) were the risk factors of CME. 24 ≤ BMI < 28 (OR = 0.686; P = 0.002) was a protective factor for CME. In addition, male, BMI ≥ 28, 18-gauge injection, elbow fossa injection, and upper-arm injection were the risk factors for large-volume CME. Conclusions CME was uncommon during CECT. Several risk factors identified for CME and large-volume CME may have the potential to reduce the occurrence and severity of CME.

KW - Computed tomography

KW - Contrast media

KW - Extravasation of diagnostic and therapeutic materials

KW - Injection site reactions

KW - Risk Factors

UR - https://www.scopus.com/pages/publications/85217704438

U2 - 10.1016/j.ejrad.2025.111992

DO - 10.1016/j.ejrad.2025.111992

M3 - Article

SN - 1872-7727

VL - 184

JO - European Journal of Radiology

JF - European Journal of Radiology

M1 - 111992

ER -

Frequency and risk factors of contrast media extravasation in 378,082 intravenous contrast-enhanced CT scans

Abstract

Bibliographical note

Funding

UN SDGs

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this