Editor's Commentary

Alert: MRI Contrast Agent Use in Patients with Renal Failure

Beginning in the mid-1990s, a rare, idiopathic disorder was recognized and reported, called nephrogenic fibrosing dermopathy. It primarily was encountered in patients in chronic renal failure and most were undergoing dialysis. More recently it has been recognized that other organ systems besides the skin are involved. Accordingly, the name has now been changed to nephrogenic systemic fibrosis (NSF). Several recent articles that have appeared in 2006 from the nephrology, rheumatology, and dermatology literature have raised the question of an association between gadodiamide and NSF when used in patients with chronic renal failure.

This disease primarily affects the skin, resulting in thickening and induration, leading ultimately to fibrosis and contractures of the joints. As more patients have been recognized with NSF, multiorgan involvement has been detected. There currently is no effective therapy for this disorder.

In a study by Broome et al. 1 from Loma Linda University, which will be published in the printed issue of the February 2007 issue of AJR, and available in advance online, the strong association of NSF with the administration of gadodiamide to patients either in acute or chronic renal failure gains further support. Two thirds of the patients reported in this study were in dialysis-dependent chronic renal insufficiency, and a third of the patients manifested an acute hepatorenal syndrome.

The conclusions of the authors are supported by strong statistical data, which appear to invoke gadodiamide as a causative agent. Based on slowly accumulating evidence, the beginning of the occurrence of NSF appears to coincide with the use of higher doses of gadodiamide for MR angiography in patients with renal insufficiency.

Because of the need to alert all who might be intending to use this MR contrast agent intravenously in patients who are in renal insufficiency, this prepublication emergency alert is being posted on our society Web site. Although gadodiamide is approved by the FDA for use in MRI, its use should be strictly avoided in patients on dialysis or with end-stage renal disease or acute hepatorenal syndrome.

NOTE: As of 1/22/2007 this article is freely available at www.ajronline.org

Robert J. Stanley, M.D.
Editor in Chief
American Journal of Roentgenology

Reference
1. Broome DR, Girguis M, Baron P, Cottrell A, Kjellin I, Kirk G. Gadodiamide-associated nephrogenic systemic fibrosis: why radiologists should be concerned. AJR 2007; DOI: 10.2214/AJR.06.1094