Radiology: Strict gadolinium policies reduce NSF cases

Following the switch from gadodiamide to gadobenate dimeglumine and gadopentetate dimeglumine, and the adoption of restrictive gadolinium-based contrast agent policies, no nephrogenic systemic fibrosis (NSF) cases were observed at two university health centers, according to a study in the October issue of Radiology.

Ersan Altun, MD, from the department of radiology at the University of North Carolina at Chapel Hill and colleagues sought to determine the incidence of NSF in tertiary care centers of two U.S. universities, following the switch from the use of gadodiamide to gadobenate dimeglumine and gadopentetate dimeglumine, and the adoption of restrictive gadolinium-based contrast agent policies.

The researchers identified NSF patients between January 2000 and December 2006 at Center A and between October 2003 and February 2007 at Center B (pre-adoption periods); and from June 2007 to June 2008 at both centers (post-adoption period). They also identified the numbers of patients who underwent gadolinium-enhanced MRI at each center, patients at risk for NSF at Center A, and dialysis patients at Center B in the pre- and post-adoption periods.

The authors noted gadodiamide was the only agent used in the pre-adoption period. Gadobenate dimeglumine and gadopentetate dimeglumine were the agents used in the post-adoption period.

The study institutions adopted a restrictive gadolinium-based contrast agent policy that limits the use and dose of gadolinium-based contrast agents in patients with risk factors in the post-adoption period. Follow-up lasted nine months from July 2008 to March 2009.

According to the researchers, respective total benchmark incidence of NSF at both centers, at-risk incidence of NSF at Center A, and dialysis incidence of NSF at Center B were 37 of 65,240, 28 of 925, and nine of 312 in the pre-adoption period and zero of 25,167, zero of 147 and zero of 402 in the post-adoption period.

All three incidences demonstrated significant differences between the pre- and post-adoption periods, the authors wrote.

Altun and colleagues concluded that their findings support the hypothesis that particular gadolinium-based contrast agents may have different frequencies of association with NSF and that stable gadolinium-based contrast agents may have a low or nearly nonexistent frequency of association with NSF, depending on the type of gadolinium-based contrast agent.

They wrote that they “believe that the use of restrictive gadolinium-based contrast agent policies also contributed substantially to the decrease in the incidence of NSF.”