New research has shown a possible association between a popular magnetic resonance imaging (MRI) contrast agent and the incidence of a rare disease called nephrogenic systemic fibrosis (NSF) in patients with kidney disease, according to an editorial appearing 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, M.D., Ph.D., assistant clinical professor of diagnostic radiology at Yale University School of Medicine in New Haven, Conn. "At this point, the data clearly show the vast majority of NSF cases are associated with the use of gadodiamide."
NSF, an emerging systemic disorder characterized by widespread tissue fibrosis, has been diagnosed in patients who were previously administered gadodiamide (Omniscan) and other gadolinium-based MRI contrast agents. While the precise cause of NSF is unknown, the disorder has only been observed in patients with kidney disease, especially those requiring dialysis.
"So far, NSF has only been reported in patients with renal failure," Dr. 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 of the extremities and often resulting in immobility and tightening or deformity of the joints. NSF can develop rapidly and may result in patients becoming wheelchair-bound within just a few weeks. In some cases, there is involvement of other tissues, including the lungs, heart, diaphragm, esophagus and skeletal muscle. No consistently effective therapy exists.
Approximately 400 cases of NSF have been reported worldwide. While gadolinium-based agents have not been definitively shown to cause NSF, as many as 90 percent of known NSF patients had previously received gadodiamide, and a recent survey of approximately 100 NSF patients revealed that more than 95 percent were exposed to a gadolinium agent within two to three months prior to disease onset. Other evidence linking gadolinium with NSF includes residual gadolinium in a skin biopsy of an NSF patient 11 months after the contrast agent was administered.