Original Research

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

  1. Diego R. Martin MD, PhD1,*,
  2. Saravanan K. Krishnamoorthy MD1,
  3. Bobby Kalb MD1,
  4. Khalil N. Salman MD1,
  5. Puneet Sharma MD1,
  6. John D. Carew PhD2,
  7. Phillip A. Martin MS3,
  8. Arlene B. Chapman MD4,
  9. Gaye L. Ray MS, NP-C1,
  10. Christian P. Larsen MD, PhD5,
  11. Thomas C. Pearson MD, PhD5

Article first published online: 23 JAN 2010

DOI: 10.1002/jmri.22024

Issue

Journal of Magnetic Resonance Imaging

Journal of Magnetic Resonance Imaging

Volume 31, Issue 2, pages 440–446, February 2010

Additional Information

How to Cite

Martin, D. R., Krishnamoorthy, S. K., Kalb, B., Salman, K. N., Sharma, P., Carew, J. D., Martin, P. A., Chapman, A. B., Ray, G. L., Larsen, C. P. and Pearson, T. C. (2010), Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols. J. Magn. Reson. Imaging, 31: 440–446. doi: 10.1002/jmri.22024

Author Information

  1. 1

    Department of Radiology, Emory University, Atlanta, Georgia, USA

  2. 2

    Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA

  3. 3

    University of West Georgia, Carrollton, Georgia, USA

  4. 4

    Department of Medicine, Emory University, Atlanta, Georgia, USA

  5. 5

    Department of Surgery, Emory University, Atlanta, Georgia, USA

*Director of MRI and the Clinically Applied Research Body MRI Program, Emory University School of Medicine, 1365 Clifton Road, NE, Clinic Building A–AT622, Atlanta, GA 30322

Publication History

  1. Issue published online: 23 JAN 2010
  2. Article first published online: 23 JAN 2010
  3. Manuscript Accepted: 19 OCT 2009
  4. Manuscript Received: 30 JUN 2009

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Keywords:

  • NSF;
  • ESRD;
  • dialysis;
  • gadolinium;
  • MRI

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. J. Magn. Reson. Imaging 2010; 31: 440–446. © 2010 Wiley-Liss, Inc.

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