Imaging Pearls ❯ Contrast ❯ Myasthenia Gravis
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- Myasthenia Gravis: There is a questionable relationship between IV iodinated contrast medium and exacerbations of myasthenic symptoms in patients with myasthenia gravis. While one retrospective study showed no immediate increase in myasthenic symptoms following the administration of iodinated or gadolinium-based contrast medium [13], another that searched for myasthenic exacerbations occurring up to 45 days after a CT scan found that IV non-ionic iodinated contrast medium was associated with an acute (within 1 day of contrast administration) myasthenic exacerbation in approximately 6% of patients (compared to a 1% acute exacerbation rate in patients who had undergone noncontrast CT, p=0.01) [14]. However, that study was retrospective, and the number of events was small. Premedication is not recommended solely on the basis of a history of myasthenia gravis. It is controversial whether iodinated contrast medium should be considered a relative contraindication in patients with myasthenia gravis.
ACR Manual On Contrast Media 2023
- “ Intravenous administration of low-osmolality contrast material is significantly associated with exacerbation of myasthenia gravis-related symptoms. Exacerbations most commonly manifest as new or progressive acute respiratory comprimise.”
Effect of Intravenous Low-Osmolality Iodinated Contrast Media on Patients with Myasthenia Gravis
Somashekar CK et al.
Radiology 2013; 267:727-734 - “ Intravenous administration of low-osmolality contrast material should be considered among the list of medications known to exacerbate myasthenic symptoms, with an estimated risk of acute symptoms deterioration of approximately 5-6% above baseline.”
Effect of Intravenous Low-Osmolality Iodinated Contrast Media on Patients with Myasthenia Gravis
Somashekar CK et al.
Radiology 2013; 267:727-734