Abstract

Our case series provides substantial support for the association between gadopentetate dimeglumine exposure and the subsequent development of nephrogenic systemic fibrosis (NSF) in patients with marked renal impairment; this relationship is both dose and time dependent, supporting a contributory role for gadopentetate dimeglumine in the development of NSF.

Purpose

To retrospectively assess the association between gadopentetate dimeglumine exposure at magnetic resonance imaging and the development of nephrogenic systemic fibrosis (NSF).

Materials and Methods

This HIPAA-compliant study had institutional review board approval. Informed consent was waived. A search of medical and pathologic records was performed to identify patients with NSF that was diagnosed between January 1998 and December 2007. Patients with known exposure to gadolinium-based contrast agents other than gadopentetate dimeglumine were excluded. Medical records were then reviewed for gadopentetate dimeglumine exposure, renal status, concomitant diseases, timing of NSF symptom onset, date of NSF diagnosis, and clinical outcome. Skin gadolinium deposition was assessed for those patients with adequate available tissue. Spearman rank correlations were estimated to assess the relationship between the dose of gadopentetate dimeglumine and the time to onset of NSF.

Results

Thirty-six patients (mean age, 62.6 years; range, 30–83 years) had been exposed to gadopentetate dimeglumine prior to NSF onset. All had stage 5 chronic kidney disease and all but one were undergoing dialysis at the time of exposure. NSF developed within 3 months after the last gadopentetate dimeglumine exposure (range, 1–59 months) in 21 (66%) of 32 patients. The patients had been exposed to median cumulative gadopentetate dimeglumine volumes of 35, 40, 85, and 117.5 mL over the 3, 12, and 24 months and up to 11 years preceding the onset of NSF, respectively. Patients who received higher cumulative and total gadopentetate dimeglumine doses had a higher risk of developing NSF than did those who received lower doses (odds ratio = 1.2). Twenty (56%) of 36 patients died, with a median interval of 18 months between NSF symptom onset and death.

Conclusion

NSF develops in patients with renal impairment after exposure to gadopentetate dimeglumine in a dose- and time-dependent manner.

Supplemental material: http://radiology.rsna.org/lookup/suppl/doi:10.1148/radiol.2531082160/-/DC1

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Article History

Received December 10, 2008; revision requested January 29, 2009; revision received March 10; accepted March 20; final version accepted June 11.
Published in print: Oct 2009

Vol. 253, No. 1

Supplemental Material

Abbreviations

Abbreviations:

GBCA	gadolinium-based contrast agent
NSF	nephrogenic systemic fibrosis

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