Radiologists should avoid using three types of common gadolinium based contrast agents when administering MRIs to patients with chronic or acute kidney disease, according to an advisory from the American College of Radiology.
That's because these three types—gadodiamide or Omniscan by GE Healthcare, gadopentetate dimeglumine or Magnevist by Bayer Healthcare Pharmaceuticals, and Gadoversetamide by OptiMARK by Covidien—are linked with a greater number of nephrogenic systemic fibrosis cases, and make up Group I, according to the ACR.
According to the U.S. Food and Drug Administration, as of December 2009, NSF disease has been documented in 382 patients who received gadodiamide, out of 13 million doses; in 195 patients who received gadopentetate dimeglumine, out of 23 million doses; And in 35 patients who received gadoversetamide, out of 4.7 million doses.
The condition is extremely rare, but problematic and as yet incurable, says Richard Cohan, MD, professor of abdominal radiology at the University of Michigan. Cohan is chairman of one of two committees that helped write the guidance paper under Section 11: Nephrogenic Systemic Fibrosis.
"If you look at all the patients who have chronic or acute kidney disease, more than 90%—if they get gadolinium with an MRI—will not develop NSF," but for those who do, the condition manifests as a persistent hardening or stiffening of the skin, muscles, and joints.
Also, he says, because of prior warnings by the FDA, the manufacturers, and others about the dangers, "people are taking precautions and there is good news. This has pretty much gone away."
Cohan says that one important ACR recommendation suggests doctors should get renal tests or eGFR function tests on their patients at least six weeks before performing an MRI that requires contrast injection.
"Frankly, nowadays it's easier than ever to get measurements of renal function," he says.