MRI contrast agent could increase incidence of rare disease

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A widely used magnetic resonance imaging (MRI) contrast agent could be associated with incidences of a rare disease called nephrogenic systemic fibrosis (NSF) in patients with kidney disease, according to an editorial to be published in the March issue of Radiology.

"We recommend avoiding the use of gadodiamide in patients with any degree of renal disease," said Phillip H. Kuo, MD, PhD, assistant clinical professor of diagnostic radiology at Yale University School of Medicine. "At this point, the data clearly show the vast majority of NSF cases are associated with the use of gadodiamide."

NSF is a systemic disorder that involves widespread tissue fibrosis that has been diagnosed in patients who were previously administered gadodiamide (Omniscan) and other gadolinium-based MRI contrast agents.

"So far, NSF has only been reported in patients with renal failure," Kuo said. "Gadolinium contrast agents do not appear to cause NSF in patients with normal kidney function."

Patients with NSF experience an increase of collagen in the tissues, causing thickening and hardening of the skin. NSF can develop rapidly and may result in patients becoming wheelchair-bound within just a few weeks, according to the study authors.

About 400 cases of NSF have been reported worldwide. Gadolinium-based agents have not been definitively shown to provoke NSF, yet 90 percent of documented NSF patients had previously received gadodiamide. Also survey of some 100 NSF patients showed that more than 95 percent were exposed to a gadolinium agent within two to three months prior to disease onset, according to an RSNA release.

Studies investigating the relationship between NSF and gadolinium are currently underway at Yale, as well as the Centers for Disease Control, the FDA and EU medical regulatory agencies. FDA has advised caution regarding the use of gadolinium-based contrast agents in patients with moderate to advanced renal disease.

Kuo and colleagues recommend not using gadodiamide in patients with kidney disease, but he pointed out that there are circumstances where the benefits of other gadolinium-based agents outweigh the risks.

"MRI with contrast is simply the best exam in many situations," Kuo said. "One has to wonder if excluding large numbers of patients with moderate renal failure from the best exam would do more harm than good."