title: Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols.
abstract: 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.
authors.affiliation: Department of Radiology, Emory University, Atlanta, Georgia, USA. dmartin@emory.edu
authors.forename: Diego R
authors.initials: DR
authors.lastname: Martin
authors.forename: Saravanan K
authors.initials: SK
authors.lastname: Krishnamoorthy
authors.forename: Bobby
authors.initials: B
authors.lastname: Kalb
authors.forename: Khalil N
authors.initials: KN
authors.lastname: Salman
authors.forename: Puneet
authors.initials: P
authors.lastname: Sharma
authors.forename: John D
authors.initials: JD
authors.lastname: Carew
authors.forename: Phillip A
authors.initials: PA
authors.lastname: Martin
authors.forename: Arlene B
authors.initials: AB
authors.lastname: Chapman
authors.forename: Gaye L
authors.initials: GL
authors.lastname: Ray
authors.forename: Christian P
authors.initials: CP
authors.lastname: Larsen
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Pearson
mesh_terms: 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
chemical_list: D003287:Contrast Media; D005682:Gadolinium