Neuropathologists are always reviewing brain MRIs that use gadolinium contrast. I never thought much about the potential toxic effect of gadolinium. However, the illustrious Dr. Brajesh Argawal, resident in the Southern Illinois University School of Medicine neurology program, informed me yesterday of the risk of the use of gadolinium-based MRI contrast agents in patients with chronic renal failure. There is an emerging disorder, known as nephrogenic systemic fibrosis (NSF), that can arise in these patients. NSF involves the deposition of collagen in the skin and other organs in patients either on dialysis or with a glomerular filtration rate of less than 15 cc/min. According to an article on the topic by Philip Kuo et al. in the journal Radiology (2007;242:647-649), “NSF may develop rapidly and can sometimes result in patients becoming confined to a wheelchair within a few weeks… While NSF sometimes stabilizes, it rarely spontaneously remits.” Malpractice lawyers are, of course, all over NSF. For instance:
http://www.mri-contrast-lawsuit.com/
Radiologists now make it a practice to have patients sign a consent form which mentions the possibility of the development of NSF in those with renal insufficiency. Here’s a link to the FDA alert concerning gadolinium:
http://www.hpcbd.com/FDA%20Gadolinium%20Alert.pdf
Thanks for the information, Dr. Argawal!
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2 comments:
This is very interesting to hear. The last time I was shadowing the radiologist that I have followed since I was in high school, a lawyer dropped by to discuss this very topic. I know that at that hospital, a consent form is used that mentions this condition to avoid a lawsuit. Later in the day, we had a discussion about different contrast materials that do not use Gad and the potential benefits and downfalls of these newer MR contrasts.
No medical procedure is without risk. However, the risk with gadolinium is much less than with iodinated contrast given for CT scans.
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