Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast‐enhanced MRI protocols |
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| Authors: | Diego R Martin MD PhD Saravanan K Krishnamoorthy MD Bobby Kalb MD Khalil N Salman MD Puneet Sharma MD John D Carew PhD Phillip A Martin MS Arlene B Chapman MD Gaye L Ray MS NP‐C Christian P Larsen MD PhD Thomas C Pearson MD PhD |
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| Institution: | 1. Department of Radiology, Emory University, Atlanta, Georgia, USA;2. Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, USA;3. University of West Georgia, Carrollton, Georgia, USA;4. Department of Medicine, Emory University, Atlanta, Georgia, USA;5. Department of Surgery, Emory University, Atlanta, Georgia, USA |
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| 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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| Keywords: | NSF ESRD dialysis gadolinium MRI |
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