Evaluating the safety of intravenous gadolinium-based contrast agents in patients with sickle cell disease: A prospective study

Introduction: Sickle cell disease (SCD) affects nearly 300,000 individuals annually, with sickle cell anemia being the most severe form, associated with vaso-occlusive crises and chronic anemia. The safety of gadolinium-based contrast media (GBCMs) in SCD remains uncertain due to limited prospective evidence. This study investigates GBCM safety in pediatric and adult SCD patients undergoing MRI. Materials and Methods: This 5-year prospective observational study (January 2020–December 2024) was conducted at a single center. Patients with confirmed SCD (excluding sickle cell trait) undergoing MRI were included in the study. A total of 62 patients underwent 88 contrast-enhanced magnetic resonance imaging (CE-MRI) scans, whereas 89 patients underwent 93 unenhanced MRI scans. Patients were stratified by disease severity and MRI type. Adverse events were monitored for 1 week post-MRI. Results: In the CE-MRI group, eight adverse events occurred (five mild, three moderate), whereas the unenhanced group reported six events (three mild and three moderate). No statistically significant difference in adverse event rates was found between the groups. Discussion: MRI is vital for evaluating SCD complications. GBCMs enhance imaging quality without increasing the risk of vaso-occlusive or hemolytic events. Findings support the 2024 ACR guidelines, indicating minimal GBCM risk in SCD. However, the small sample size limits the generalizability and necessitates larger studies to confirm safety and reduce the risk of type II error. Conclusion: GBCM use in SCD patients does not increase the risk of adverse events during CE-MRI compared to unenhanced MRI. Larger studies are warranted to reinforce these findings.