AJR InPractice
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Figures Only
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Gandhi, M. J.
Right arrow Articles by Scott, M. G.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Gandhi, M. J.
Right arrow Articles by Scott, M. G.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati  
What's this?
Hotlight (NEW!)
Right arrow
What's Hotlight?
DOI:10.2214/AJR.07.2923
AJR 2008; 190:W213-W217
© American Roentgen Ray Society

Original Research

Clinical and Economic Impact of Falsely Decreased Calcium Values Caused by Gadoversetamide Interference

Manish J. Gandhi1, Vamsidhar R. Narra2, Jeffrey J. Brown2, Amy Guo3, Daniel S. Grosu3, Curtis A. Parvin1 and Mitchell G. Scott1

1 Department of Pathology and Immunology, Washington University School of Medicine, 660 S Euclid Ave., Box 8118, St. Louis, MO 63110.
2 Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, MO.
3 Bayer HealthCare Pharmaceuticals, Wayne, NJ.

OBJECTIVE. Gadolinium is administered as a contrast agent in MRI procedures. Two gadolinium-based contrast agents, gadodiamide and gadoversetamide, interfere with colorimetric total serum calcium methods. The purpose of this prospective observational study was to examine the incidence of calcium interference after gadoversetamide procedures, associated clinical outcomes, and costs 20 months after implementation of quality assurance and physician education programs.

MATERIALS AND METHODS. Records of patients who received gadoversetamide from June 24, 2006, to October 7, 2006, were reviewed to determine if a routine calcium test had been performed after the injection. Calcium values were repeated with an alternate method that is less susceptible to gadoversetamide interference. If the difference was ≥ 2.0 mg/dL or if the initial test value was ≤7.0 mg/dL, patient charts were reviewed for any related treatment. Costs associated with this algorithm were tracked.

RESULTS. The initial calcium test was performed after gadoversetamide in 766 of 3,439 instances. The alternate test was performed in 633 of 766. One hundred twenty-five of 633 (20%) showed a difference in calcium values that was ≥ 0.7 mg/dL, with 16 showing differences of ≥ 1.6 mg/dL. Chart review for 56 instances revealed that calcium supplements were administered in 22 of 56 around the time of gadoversetamide injection. However, none appeared to be related to the spurious hypocalcemia. The total additional cost (reagent and technologist) for following this algorithm for just over 3 months was $6,807.

CONCLUSION. Approximately 20% of patients receiving gadoversetamide exhibited spurious hypocalcemia. No patients were identified who received inappropriate calcium because of this interference. This may be attributable to the quality assurance and physician education programs.

Keywords: calcium • gadolinium • interference


Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati    What's this?




HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 2008 by the American Roentgen Ray Society.