Hani H. Abujudeh MD, MBA, Presenter: Nothing to Disclose

Rathachai Kaewlai MD, Abstract Co-Author: Nothing to Disclose

Anna Kagan MD, Abstract Co-Author: Nothing to Disclose

Ashwin V. Asrani MD, Abstract Co-Author: Nothing to Disclose

Rosalynn Nazarian MD, Abstract Co-Author: Nothing to Disclose

Jonathan Kay, Abstract Co-Author: Nothing to Disclose

Gadolinium-chelated contrast agents have been associated with the development of nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy (NSF/NFD) in patients with chronic kidney disease. This has been described extensively with gadodiamide, but infrequently with other gadolinium-based agents and not with gadopentetate dimeglumine. At our institution, gadopentetate dimeglumine has been the only contrast agent used for magnetic resonance imaging (MRI) over the past decade. We report the novel association of gadopentetate dimeglumine with NSF/NFD in 24 patients at our institution.

Patients with biopsy-proven NSF/NFD were identified retrospectively by searching medical and pathology records from 2000 to present at our hospital. Records of these patients were NSF/NFD were reviewed for clinical manifestations, dose and timing of gadolinium administration, renal status, comorbid conditions, laboratory findings, and clinical outcome.

Twenty-four patients [mean age 61.5 years; SD 14.4; 14 men, 10 women] had NSF/NFD on clinical and histopathologic examination. All patients had chronic kidney disease (CKD) and had received gadopentetate dimeglumine for magnetic resonance imaging (MRI). Twenty-two patients (92%) had stage 5 CKD and were receiving hemodialysis at the time of gadolinium administration.. Median time from the most recent gadolinium administration to the onset of symptoms was 85 days (range, 9 to 990 days). Each patient received an average of 4 Gd-enhanced MR exams (SD 2.8, range 1 to 12) with an average gadopentetate dimeglumine dose of 37 mL (SD 12.2, range 15 to 60). The average cumulative dose of gadopentetate dimeglumine was 135.5 mL (SD 85.7, range 20 to 338 mL). At the time of MR examination, the majority of patients were hospitalized for various reasons (60/95 exams, 63.2%). Only 2 patients had preexisting acidosis when receiving gadolinium administration. Ten patients (10/24, 41.7%) have died.

NSF/NFD develops in patients with underlying chronic kidney disease following exposure to gadopentetate dimeglumine.

NSF/NFD likely is a class-related complication with gadolinium-containing contrast agents and is not limited to gadodiamide alone.

Abujudeh, H, Kaewlai, R, Kagan, A, Asrani, A, Nazarian, R, Kay, J, Nephrogenic Systemic Fibrosis/Nephrogenic Fibrosing Dermopathy in Patients Receiving Gadopentetate Dimeglumine: A Case Series of 24 Patients.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5012917.html