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DOI: 10.1148/radiol.2483071863
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(Radiology 2008;248:807-816.)
© RSNA, 2008

Contrast Media

Incidence of Nephrogenic Systemic Fibrosis at Two Large Medical Centers1

Martin R. Prince, MD, PhD, Honglei Zhang, MD, Michael Morris, MD, Jennifer L. MacGregor, MD, Marc E. Grossman, MD, Jeffrey Silberzweig, MD, Robert L. DeLapaz, MD, Henry J. Lee, MD, PhD, Cynthia M. Magro, MD, and Anthony M. Valeri, MD

1 From the Departments of Radiology (M.R.P., H.Z.), Dermatology (H.J.L.), Pathology (C.M.M.), and Nephrology (J.S.), Weill Medical College of Cornell University, New York, NY; and Departments of Radiology (M.M., R.L.D.), Dermatology (J.L.M., M.E.G.), and Nephrology (A.M.V.), Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022. Received October 26, 2007; revision requested December 19; revision received April 11, 2008; accepted April 15; final version accepted May 21. Address correspondence to M.R.P. (e-mail: map2008{at}med.cornell.edu).

Purpose: To determine the incidence and associated risk factors of nephrogenic systemic fibrosis (NSF) in patients who undergo gadolinium-based contrast agent (GBCA)-enhanced magnetic resonance (MR) imaging.

Materials and Methods: Institutional review board approval was obtained for retrospective review of the medical records from two hospitals to identify all cases of biopsy-confirmed NSF and all patients administered a GBCA from January 1, 1997, to June 30, 2007. Informed patient consent was not required. The incidence of NSF was calculated for patients who received a standard dose of GBCA, patients who received a high dose, and subgroups of patients with renal impairment.

Results: Fifteen patients developed NSF after gadolinium-enhanced MR imaging. All of them had an estimated glomerular filtration rate (eGFR) lower than 30 mL/min, and 11 had acute renal failure or acute deterioration of chronic renal failure. The incidence of NSF after gadolinium-enhanced MR imaging without screening for renal function was zero of 74 124 patients with the standard dose of GBCA and 15 (0.17%) of 8997 patients with the high dose (P < .001). The NSF incidence associated with a high dose of GBCA increased to 0.4% in patients in a chronic hemodialysis program and to 8.8% in those who had an eGFR lower than 15 mL/min but were not undergoing hemodialysis (P < .001). The NSF incidence in the patients with acute renal failure who received a high dose when their creatinine level was increasing was 19% (11 of 58 patients) when hemodialysis was delayed for longer than 2 days. More patients with NSF had proinflammatory events, and compared with patients without NSF, these patients had lower pH, younger age, lower eGFR, elevated serum phosphorus levels, and a longer delay between GBCA injection and hemodialysis.

Conclusion: For patients with an eGFR lower than 15 mL/min, hemodialysis helped to prevent NSF. For patients with an eGFR lower than 30 mL/min who received a high dose of GBCA, acute renal failure, delayed hemodialysis after contrast agent injection, proinflammatory events, and hyperphosphatemia were associated with increased risk of NSF.

© RSNA, 2008


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