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. 2010 Feb;31(2):440-6.
doi: 10.1002/jmri.22024.

Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols

Diego R Martin  1 , Saravanan K Krishnamoorthy, Bobby Kalb, Khalil N Salman, Puneet Sharma, John D Carew, Phillip A Martin, Arlene B Chapman, Gaye L Ray, Christian P Larsen, Thomas C Pearson
Affiliations

Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols

Diego R Martin et al. J Magn Reson Imaging. 2010 Feb.

Abstract

Purpose: To retrospectively determine the incidence of nephrogenic systemic fibrosis (NSF) in patients on dialysis administered either a lower dose high-relaxivity linear gadolinium-chelate, gadobenate dimeglumine (MultiHance, MH), compared to a standard dose linear gadolinium chelate, gadodiamide (Omniscan, OM).

Materials and methods: This study was Health Insurance Portability and Accountability Act (HIPAA)-compliant and Institutional Review Board (IRB)-approved. As per institution standardized contrast-enhanced magnetic resonance imaging (MRI) protocols, patients on dialysis were imaged using either MH, between 2/2007 to 9/2008, or OM between 10/2003 and 1/2007. Rates of NSF were compared using 95% score-based confidence intervals (CI). The Wilcoxon rank sum test was used to test similarity/difference between contrast doses given to each patient group.

Results: Overall, 312 patients on dialysis received OM and eight (2.6%) developed NSF (95% CI: 1.30%-4.98%). In all, 784 patients on dialysis received MH at a mean cumulative dose of 0.11 mmol/kg (0.05-0.75 mmol/kg) and no cases of NSF were identified (upper 95% confidence bound of 0.45%). The mean cumulative dose of OM was 0.16 mmol/kg (0.1-0.9 mmol/kg) for all patients and 0.28 mmol/kg (0.1-0.8 mmol/kg) for the patients with NSF. The median OM dose was greater in patients who developed NSF (P = 0.03), and was greater than the median MH dose (P < 0.005).

Conclusion: NSF incidence in at-risk patients receiving contrast-enhanced MRI can be reduced after changing contrast administration protocols that includes changing the type and dose of contrast agent.

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Figures

Figure 1
Figure 1
Distribution of cumulative doses in the gadodia-mide (OM) group with NSF.
Figure 2
Figure 2
Distribution of cumulative doses by type of gadolinium agent, either gadodiamide (OM) or gadobenate dime-glumine (MH).
Figure 3
Figure 3
Incidence of NSF in patients with endstage chronic kidney disease on dialysis versus type of gadolinium agent and number of contrast-enhanced MRI exams performed, using either gadodiamide (OM) or gadobenate dimeglumine (MH). The 95% confidence limits are shown.
See this image and copyright information in PMC

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