Christine Uang-Chin Lee MD, PhD, Presenter: Nothing to Disclose

Gina Kay Hesley MD, Abstract Co-Author: Nothing to Disclose

Robert Perry Hartman MD, Abstract Co-Author: Committee member, American Medical Systems

Jeffrey Thomas Lund MD, Abstract Co-Author: Nothing to Disclose

Mellena Davis Bridges MD, Abstract Co-Author: Nothing to Disclose

Eric E. Williamson MD, Abstract Co-Author: Consultant, General Electric Company

Alvin C. Silva MD, Abstract Co-Author: Nothing to Disclose

David DiCaudo MD, Abstract Co-Author: Nothing to Disclose

Mark Pittelkow, Abstract Co-Author: Nothing to Disclose

Nelson Leung, Abstract Co-Author: Nothing to Disclose

Terri Jo Vrtiska MD, Abstract Co-Author: Nothing to Disclose

James F. Glockner MD, PhD, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

et al, Abstract Co-Author: Nothing to Disclose

(1) To retrospectively review nephrogenic systemic fibrosis (NSF) cases from all three Mayo Clinic sites with particular attention to relative renal disease, gadolinium (Gd) agent, dose, and route of administration. (2) To focus on Mayo Clinic Rochester dialysis and transplant patients over the past 5 years and derive an accurate NSF incidence in this well-characterized patient population.

Multidisciplinary, multi-site databases from the Departments of Radiology, Nephrology, and Dermatology were merged to identify cases of NSF. 5-year dialysis and renal transplant databases at Mayo Rochester were reviewed. Detailed retrospective chart review and data evaluation were performed.

A total of 49 cases of NSF were identified at Mayo Rochester (36), Scottsdale (7), and Jacksonville (6). 27/49 patients had documented antecedent exposure to Gd. Multiple Gd-based agents, doses, and routes of administration were identified. Several patients who developed NSF after Gd administration were in acute renal or hepatorenal failure. Between 2001-2006, 125,584 doses of Gd were administered at Mayo Clinic Rochester. During this time period, 751/2453 (31%) dialysis(D) patients had at least one Gd-enhanced MR study with 116 of these patients receiving more than one Gd administration. 12/751 D-Gd patients developed NSF, for an incidence of 1.6%. During the same period, 560/1446 (39%) renal transplant(T) patients had at least one Gd-enhanced MR study and 4/560 T-Gd patients developed NSF, for an incidence of 0.7%. Despite thorough chart review, no documented antecendent Gd exposure was identified in 9 NSF patients on dialysis and 1 NSF transplant patient on dialysis.

(1) The role of gadolinium in NSF patients still remains to be determined. (2) It is difficult to verify antecedent gadolinium exposure in nearly 50% of patients with NSF, likely due to our tertiary referral practice. (3) The overall incidence of NSF in dialysis and transplant patients exposed to gadolinium remains very low.

Collaborative data on a large number of NSF patients from multiple sites may provide the basis for practical guidelines for risk factor assessment and gadolinium administration.

Lee, C, Hesley, G, Hartman, R, Lund, J, Bridges, M, Williamson, E, Silva, A, DiCaudo, D, Pittelkow, M, Leung, N, Vrtiska, T, Glockner, J, et al, , et al, , Multidisciplinary, Multisite, Retrospective Review of Nephrogenic Systemic Fibrosis Relative to Gadolinium-based Contrast Exposure at the Mayo Clinic: A Collaborative Effort from Mayo Rochester, Mayo Scottsdale, and Mayo Jacksonville.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5008455.html