Bibliometric analysis of the top 100 cited articles on contrast media complications: Influence of agent class and structure.

Abstract

Contrast media complications have shaped radiologic practice through successive safety concerns over iodinated and gadolinium-based agents. This study aimed to characterize the intellectual structure and dominant clinical themes of the 100 most-cited articles on contrast media complications, specifically evaluating agent class and gadolinium chelate structure (linear vs. macrocyclic). The Web of Science Core Collection was searched in January 2026. The 100 most-cited publications primarily focused on contrast-related complications were analyzed. Extracted variables included citation metrics, study design, complication category, contrast agent class, and gadolinium chelate structure. Citation density was calculated, and associations were assessed using chi-square and non-parametric tests. Published between 1989 and 2021, the 100 citation classics had a median of 310.5 total citations and a median citation density of 16.9. Renal complications, notably contrast-induced acute kidney injury, predominated (49%), followed by nephrogenic systemic fibrosis and gadolinium deposition. Studies on iodinated agents were most frequent overall, while gadolinium-focused classics primarily addressed fibrosis and tissue retention. A significant temporal shift was observed (p = 0.004), with post-2010 literature increasingly focused on gadolinium deposition. Eighty-one percent of articles appeared in Q1 journals. Industry involvement was more common in gadolinium-related studies (p < 0.001). Highly cited contrast media research reflects successive safety crises, evolving from renal injury to fibrosis and gadolinium retention. While severe adverse events dominate this influential literature, other clinically relevant complications remain comparatively underrepresented, underscoring the need for broader, proactive safety research.