Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols

Diego R. Martin, Saravanan K. Krishnamoorthy, Bobby Kalb, Khalil N. Salman, Puneet Sharma, John D. Carew, Phillip A. Martin, Arlene B. Chapman, Gaye L. Ray, Christian P. Larsen, Thomas C. Pearson

Research output: Contribution to journalArticlepeer-review

93 Scopus citations


Purpose: To retrospectively determine the incidence of nephrogenic systemic fibrosis (NSF) in patients on dialysis administered either a lower dose high-relaxivity linear gadolinium-chelate, gadobenate dimeglumine (Multi-Hance, MH), compared to a standard dose linear gadolinium chelate, gadodiamide (Omniscan, OM). Materials and Methods: This study was Health Insurance Portability and Accountability Act (HIPAA)-compliant and Institutional Review Board (IRB)-approved. As per institution standardized contrast-enhanced magnetic resonance imaging (MRI) protocols, patients on dialysis were imaged using either MH, between 2/2007 to 9/2008, or OM between 10/2003 and 1/2007. Rates of NSF were compared using 95% score-based confidence intervals (CI). The Wilcoxon rank sum test was used to test similarity/ difference between contrast doses given to each patient group. Results: Overall, 312 patients on dialysis received OM and eight (2.6%) developed NSF (95% CI: 1.30%-4.98%). In all, 784 patients on dialysis received MH at a mean cumulative dose of 0.11 mmol/kg (0.05-0.75 mmol/kg) and no cases of NSF were identified (upper 95% confidence bound of 0.45%). The mean cumulative dose of OM was 0.16 mmol/kg (0.1-0.9 mmol/kg) for all patients and 0.28 mmol/kg (0.1-0.8 mmol/kg) for the patients with NSF. The median OM dose was greater in patients who developed NSF (P = 0.03), and was greater than the median MH dose (P < 0.005).

Original languageEnglish (US)
Pages (from-to)440-446
Number of pages7
JournalJournal of Magnetic Resonance Imaging
Issue number2
StatePublished - Feb 2010


  • Dialysis
  • ESRD
  • Gadolinium
  • MRI
  • NSF

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging


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