Nephrogenic Systemic Fibrosis Disappeared After Restrictive Use of Gadolinium?

According to a large (50 000+) retrospective cohort of patients who underwent contrast-enhanced MR examinations at a single academic institution pre- and post-adoption of strict gadolinium guidelines:-

• No new cases of nephrogenic systemic fibrosis (NSF) were diagnosed
• During the pre-guidelines adoption and transitional period, the incidence of NSF was 3 cases per 10,000 contrast-enhanced MRI
• After the adoption of guidelines, the incidence was 0 per all examinations

The Guidelines for Imaging Adult Patients

• Based on renal disease severity
• eGFR 60 or greater - GBCA can be administered as indicated
• eGFR 30-59 - weight-based dose of GBCA (0.2 mL/kg) can be administered with maximal dose of 20 mL allowed within 24 hours
• eGFR less than 30 - GBCA cannot be administered except in cases of medical necessity; informed consent required; nephrology consultation required; hemodialysis should be considered
• Very rarely that any patients with eGFR less than 30 would get contrast-enhanced MR exams (36 in 52 954 exams; 0.07%)

eGFR = estimated glomerular filtration rate; GBCA = gadolinium-based contrast agent

Reference:

Wang Y, Alkasab TK, Narin O, et al. Incidence of nephrogenic systemic fibrosis after adoption of restrictive gadolinium-based contrast agent guidelines. Radiology 2011; 260:105-111.