title: Nephrogenic systemic fibrosis after gadopentetate dimeglumine exposure: case series of 36 patients.
abstract: OBJECTIVE
  To retrospectively assess the association between gadopentetate dimeglumine exposure at magnetic resonance imaging and the development of nephrogenic systemic fibrosis (NSF).
  
  
  METHODS
  This HIPAA-compliant study had institutional review board approval. Informed consent was waived. A search of medical and pathologic records was performed to identify patients with NSF that was diagnosed between January 1998 and December 2007. Patients with known exposure to gadolinium-based contrast agents other than gadopentetate dimeglumine were excluded. Medical records were then reviewed for gadopentetate dimeglumine exposure, renal status, concomitant diseases, timing of NSF symptom onset, date of NSF diagnosis, and clinical outcome. Skin gadolinium deposition was assessed for those patients with adequate available tissue. Spearman rank correlations were estimated to assess the relationship between the dose of gadopentetate dimeglumine and the time to onset of NSF.
  
  
  RESULTS
  Thirty-six patients (mean age, 62.6 years; range, 30-83 years) had been exposed to gadopentetate dimeglumine prior to NSF onset. All had stage 5 chronic kidney disease and all but one were undergoing dialysis at the time of exposure. NSF developed within 3 months after the last gadopentetate dimeglumine exposure (range, 1-59 months) in 21 (66%) of 32 patients. The patients had been exposed to median cumulative gadopentetate dimeglumine volumes of 35, 40, 85, and 117.5 mL over the 3, 12, and 24 months and up to 11 years preceding the onset of NSF, respectively. Patients who received higher cumulative and total gadopentetate dimeglumine doses had a higher risk of developing NSF than did those who received lower doses (odds ratio = 1.2). Twenty (56%) of 36 patients died, with a median interval of 18 months between NSF symptom onset and death.
  
  
  CONCLUSIONS
  NSF develops in patients with renal impairment after exposure to gadopentetate dimeglumine in a dose- and time-dependent manner.
  
  
  BACKGROUND
  http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082160/-/DC1.
authors.affiliation: Department of Radiology and Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA 02114, USA. habujudeh@partners.org
authors.forename: Hani H
authors.initials: HH
authors.lastname: Abujudeh
authors.forename: Rathachai
authors.initials: R
authors.lastname: Kaewlai
authors.forename: Anna
authors.initials: A
authors.lastname: Kagan
authors.forename: Lori B
authors.initials: LB
authors.lastname: Chibnik
authors.forename: Rosalynn M
authors.initials: RM
authors.lastname: Nazarian
authors.forename: Whitney A
authors.initials: WA
authors.lastname: High
authors.forename: Jonathan
authors.initials: J
authors.lastname: Kay
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D003287:Contrast Media / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D005260:Female; D019786:Gadolinium DTPA / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000453:epidemiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D003287:Contrast Media; D019786:Gadolinium DTPA