Contrast agent guidelines help prevent debilitating disorder

A simple blood test may help prevent a serious complication associated with a contrast agent commonly used in MRI exams, according to a study published in the July issue of Radiology.

Within the past five years, use of gadolinium-based (GBCA) has been linked to the development of nephrogenic systemic fibrosis (NSF), a rare disorder mainly affecting patients with severe kidney disease. But since 2008, restrictive GBCA administration guidelines implemented by Massachusetts General Hospital have proven effective in preventing NSF.

"It is important for the public to know that gadolinium products are safe for most patients and the risk of NSF should not deter them from GBCA-enhanced exams, such as MRIs," said the study's lead author Hani H. Abujudeh, M.D., M.B.A., associate professor of radiology at Harvard Medical School in Boston.

NSF is characterized by widespread . Patients with NSF experience an increase of collagen in the tissues, causing thickening and hardening of the skin of the extremities, and often resulting in immobility and tightening or deformity of the joints. NSF can develop rapidly and may result in patients becoming wheelchair-bound within just a few weeks. In some cases, there is involvement of other tissues, including the lungs, heart, diaphragm, esophagus and .

Massachusetts General Hospital began implementing restrictive GBCA guidelines in May 2007 in order to protect patients from possibly developing NSF. The guidelines require that a blood test be done on patients over age 60 or at risk for . The blood test measures how well the kidneys are doing. That number is then converted via a formula to estimate the glomerular filtration rate (eGFR), which measures the rate of through the kidneys. The guidelines stipulate a maximum GBCA dose of 20mL for patients with a low eGFR (below 60 mL/ min/m2). GBCA should not be administered at all to patients currently undergoing or with a very low (below 30 mL/min/ m2).

For the study, Dr. Abujudeh and colleagues reviewed the hospital's medical records during the pre-guideline and transition period (January 2002 through December 2007) and the post-adoption period (January 2008 to March 2010). Prior to adoption of the guidelines and during the transition period, 113,120 contrast-enhanced MRI exams were performed, and 34 cases of NSF were subsequently identified. During the post-guideline period, 52,954 contrast-enhanced MRIs were performed with no new cases of NSF identified.

"The findings prove that these guidelines are effective," Dr. Abujudeh said, "and that strategies can be put into practice to ensure patient safety."

More information: "Incidence of Nephrogenic Systemic Fibrosis after Adoption of Restrictive Gadolinium-based Contrast Agent Guidelines." radiology.rsna.org/

add to favorites email to friend print save as pdf

Related Stories

FDA wants MRI contrast agent warning

May 23, 2007

The U.S. Food and Drug Administration wants a warning printed on the labels of all gadolinium-based magnetic resonance imaging contrast agents.

New study suggests cause of debilitating skin condition

Sep 24, 2007

New findings from researchers at Wake Forest University Baptist Medical Center and colleagues suggest why some people with kidney failure can develop a rare tightening and swelling of the skin and other organs, including ...

FDA warns of deadly side effect with imaging drugs

Sep 09, 2010

(AP) -- Federal health regulators are warning doctors that a class of injectable drugs used in MRI medical imaging scans can cause a rare and sometimes fatal condition in patients with kidney disease.

Recommended for you

Researchers ferret out a flu clue

4 hours ago

Research that provides a new understanding as to why ferrets are similar to humans is set to have major implications for the development of novel drugs and treatment strategies.

In the battle against Ebola, a double-layer solution

7 hours ago

When working with Ebola patients, protective gear works, but removing it can be harrowing. Seeking to protect health care workers from the precarious nature of taking off soiled gloves, Cornell students have ...

User comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.