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


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).


CONCLUSIONS
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.
Martin
Diego R
DR
Department of Radiology, Emory University, Atlanta, Georgia, USA. dmartin@emory.edu
Krishnamoorthy
Saravanan K
SK
Kalb
Bobby
B
Salman
Khalil N
KN
Sharma
Puneet
P
Carew
John D
JD
Martin
Phillip A
PA
Chapman
Arlene B
AB
Ray
Gaye L
GL
Larsen
Christian P
CP
Pearson
Thomas C
TC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003287:Contrast Media; D003956:Dialysis / Q000706:statistics & numerical data*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005682:Gadolinium; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D054989:Nephrogenic Fibrosing Dermopathy / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D055815:Young Adult
D003287:Contrast Media; D005682:Gadolinium