Association Of Gadolinium Based Magnetic Resonance Imaging Contrast Agents And Nephrogenic Systemic Fibrosis

Main Category: Urology / Nephrology
Also Included In: MRI / PET / Ultrasound
Article Date: 17 Oct 2008 - 5:00 PDT

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UroToday.com - Every physician who orders MRI scans for his or her patients should read this article.

While nephrogenic systemic fibrosis (NSF) following exposure to gadolinium based MRI contrast agents (GBMCA) is a rare disorder, its long-term effects are devastating to patients with renal insufficiency. As a consequence, this study is now refused by radiologists for patients who have even moderate renal insufficiency (60< GFR >30). This review demonstrates that NSF from GBMCA has never been reported in patients whose GFR is > 30 ml/min. Therefore, it appears that only patients with severe renal insufficiency are at risk for GBMCA induced in NSF.

The symptoms of NSF usually develop within weeks to months after exposure to GBMCA. However, there can be a 1 to 2 years latency period, which therefore mandates close follow-up of any patient who has renal insufficiency and has received gadolinium in the past few years. The authors suggest an algorithm for imaging patients for renal insufficiency. For patients with a GFR > 30 ml/min MRI with low dose, stable contrast agent or CT with IVP contrast and prophylactic maneuvers - such as hydration and N-acetylcysteine - should be considered acceptable. In patients with CKD (GFR < 30 ml/min) or acute kidney injuries, no contrast agents should be utilized. Patients with ESRD should be imaged only with CT and IV contrast and dialyzed immediately following the study if necessary.

Further research needs to be directed to finding agents that will stabilize gadolinium and make MRI imaging safe even in patients with CKD.

G. Bhave, J. B. Lewis and S.S. Chang
J.Urol. 2008; 180: 830-835
doi:10.1016/j.juro.2008.05.005

Written by UroToday.com Contributing Editor Elspeth M. McDougall, MD, FRCSC, MHPE

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