A rare and serious condition that causes fibrosis of the skin, joints, eyes and internal organs, can be prevented by carefully restricting the use of a contrast dye commonly used in magnetic resonance imaging (MRI), a new study shows.
Researchers at Massachusetts General Hospital led by Dr. Ozden Narin presented their findings at the American Roentgen Ray Society meeting being held this week in Chicago. Narin’s team showed that careful restriction of the use of gadolinium-based contrast agents (GBCAs) before MRIs eliminated all new cases of nephrogenic systemic fibrosis (NSF)
"Now, we only use GBCAs in patients with decreased kidney function in emergent cases," Narin said in a prepared statement, “and we have procedures in place to pay special attention to those patients and to take all the necessary precautions."
Nephrogenic systemic fibrosis (NSF) is a mysterious condition in which patients develop large patches of hardened skin, and fibrosis of joints, eyes and internal organs. The earliest cases of NSF occurred in 1997. It was first noticed that it occurred most often in patients with kidney disease, and has since been linked to gadolinium-containing contrast agents. In 2006, researchers correlated the development of NSF with the increasing use of gadolinium-based MRI contrast agents in patients with kidney disease. The International Society for Magnetic Resonance in Medicine says more than 250 cases of NSF have been traced to gadolinium-containing contrast dye worldwide.
In the study, Narin’s team reviewed 52,954 contrast-enhanced MRIs at Massachusetts General Hospital between January 2008 and September 2010. These were done after the hospital implemented a restrictive protocol calling for screening all patients scheduled for an MRI with GBCA in May 2007. All used the contrast dye Gadopentetate Dimeglumine (MultiHance®).
Administration of the dye was prohibited in patients with impaired kidney function defined as an estimated glomerular filtration rate (eGFR) of less than 30 milliliters per Liter per meter squared (30 mL/min/m2) except in the case of emergency. Patients with borderline kidney disease defined as a eGFR of 30 to 60 mL/min/m2 were restricted to a low-dose GBCA before MRI.
The analysis showed that of the 52,954 contrast-enhanced MRIs 13,867 (26.2 percent) were not screened, 6,490 patients (12.26 percent) had an eGFR greater than 30 and less than 60 mL/min/m2, and just 38 patients (0.07 percent) had an eGFR of less than 30 mL/min/m2.
Significantly, there was no record of a single case of NSF, leading the researchers to conclude that strict adherence to the protocol could likely eliminate the incidence of NSF in the future.
The Gadopentetate Dimeglumine (MultiHance®) used in the study is the first paramagnetic resonance imaging contrast agent, meaning it takes on magnetic properties only in the presence of an externally applied magnetic field. It is especially useful in MRI angiography and in imaging blood vessels and inflamed or diseased tissues with “leaky” blood vessels.
Four of the seven gadolinium contrast agents approved by the U.S. FDA have been principally implicated in NSF, including Omniscan, Multihance, Magnevist, and OptiMARK.
As a result, gadolinium-containing contrast is now considered contraindicated in patients with an eGFR under 60 mL/min/m2 and in particular for patients under 30 mL/min/m2.
By Michael O’Leary, contributing writer, Health Imaging Hub