by
Brendon Nafziger, DOTmed News Associate Editor | May 17, 2011
Tough guidelines and a precautionary blood test could help prevent an extremely rare but potentially fatal reaction linked with MRI contrast agents, according to a new study.
In the paper published in the July issue of Radiology, doctors at Massachusetts General Hospital said after instituting restrictive guidelines on using gadolinium-based contrast agents, the number of cases of a possible rare side effect fell to zero, despite the hospital performing tens of thousands of contrast-enhanced MRIs in that period.
"The findings prove that these guidelines are effective," the study's lead author Dr. Hani H. Abujudeh, associate professor of radiology at Harvard Medical School in Boston, said in a statement.
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In 2006, doctors discovered that using GBCA in patients with kidney disease was linked with nephrogenic systemic fibrosis, an extremely uncommon disorder characterized by excess fibrotic tissue building up in the skin, joints and internal organs.
In response, in May 2007, Massachusetts General set up restrictive guidelines for using GBCA. The guidelines require that patients over 60 or at risk for kidney disease must have a blood test before receiving a contrast injection. Patients with a low glomerular filtration rate, which measures kidney function, receive either a low GBCA dose (only 20 mL if the eGFR is below 60 mL/min/m2) or none at all (if the eGFR is below 30 mL/min/m2).
For the study, the doctors compared the NSF rates at the hospital before the guidelines were set up and while they were being deployed (January 2002 to December 2007), to a post-adoption period (January 2008 to March 2010).
The researchers found before the guidelines were adopted, 34 cases of NSF were reported from 113,120 contrast-enhanced MRI exams. After the guidelines took effect, they found no NSF cases among 52,954 contrast-enhanced MRIs.
Last year, the Food and Drug Administration updated the
warning label on GBCAs, cautioning that three brands were associated with greater risk of NSF among kidney-impaired patients. The FDA first slapped boxed warnings on the drugs in 2007.
