MRI findings of iatrogenic extravasation of gadolinium-based contrast agents in patients with cancer

Magnetic resonance imaging (MRI) findings after subcutaneous extravasation of gadolinium-based contrast agent (GBCA) have not been investigated in detail.To present the MRI findings of iatrogenic extravasation and to evaluate the characteristic findings.In this retrospective study of 16,039 patients with cancer, 11 patients had significant extravasation of macrocyclic GBCA, and 7 of the 11 had MRI of the injection site. Characteristic MRI findings as well as symptoms and changes over time were evaluated.The forearms or antecubital fossa felt cold in all seven cases, and 3 (43%) patients felt pain at the injection sites. Fat-suppressed T1-weighted images showed a mosaic pattern of the extravasate with mixed high and low signal in the subcutaneous tissue in 7 (100%) cases. Contrast enhancement of the fascia toward the proximal portion was observed in 3 (43%) cases. There was no subfascial deep extension. On T2-weighted images, GBCAs were observed as low-signal fluid collection on the fascia, with linear spread to the dermis and subcutaneous tissue. Four patients underwent daily MRI scans, all of whom had their contrast disappeared within three days.Macrocyclic GBCA disappears from subcutaneous tissue quickly after extravasation and is unlikely to cause serious sequelae.