MRI Safety guidelines regarding risk of NSF from contrast agents

The American College of Radiology (ACR) issued an update to their 2004 guidelines on MRI safety, called the ACR Guidance Document for Safe MR Practices.  A section of the document is devoted to discussing the risk of Nephrogenic Systemic Fibrosis (NSF), also known as Nephrogenic Fibrosing Dermopathy (NFD) which has been linked to the use of gadiolinium MRI contrast agents in patients with kidney insufficiencies.

>>INFORMATION: MRI Contrast Problems for Kidney Patients

NSF is a progressive disease which is severely disabling.  It is associated with the development of areas of thick and tight skin, which can limit mobility of the joints.  The tissue scarring, known as fibrosis, usually develops on the extremities, but  it can also involve other internal parts of the body, such as the diaphragm, heart, lung, pulmonary vasculature or skeletal muscles.  There is no known cure for NSF.

>>INFORMATION: NSF Symptoms 

The ACR has issued the following recommendations and guidelines for MRI safety to reduce the risk of Nephrogenic Sytemic Fibrosis, including:

• Those who are undergoing an enhanced MRI or MRA should be prescreened, with an additional question asking about the presence of a history of kidney disease or dialysis
• With moderate or end-stage kidney disease (stage 3, 4 or 5), consider refraining from use of gadolinium contrast unless the benefit of doing so clearly outweighs the NSF risk
• There are five different gadolinium-based MRI contrasts which are used, but three in particular should be avoided for those with moderate or end-stage kidney disease; Omniscan contrast, Magnevist contrast and OptiMARK contrast.  
• Those with any level of kidney disease should not receive Omniscan contrast, as that particular gadolinium agent is associated with the development of NSF at rates which greatly exceed its market share.   
• If the contrast is necessary for those with stage 3 renal disease or higher, the lowest dose possible that will provide the diagnostic benefit should be administered.  For these individuals, a half-dose should be considered the standard dose if they are receiving the MR contrast.
• Consider postponing the enhanced MRI or MRA until renal function has been improved, if that is feasible
• Those receiving the MRI contrast agents who have stage three to five kidney disease should be informed of all of the risks and benefits and consent to the use of the gadolinium-based agent.
• For those already on hemodialysis, arrangements should be made to immediately transport them to demodialysis following the imaging examination.  Hemodialysis should be intiated no later than two hours after the use of a gadolinium contrast, and additional hemodialysis should be considered within 24 hours.
• For peritoneal dialysis patients, the lowest dose possible should be used (if any) because of the near-total apparent ineffectiveness of peritoneal dialysis at clearing gadolinium from the body.  It should be considered whether initiation of hemodialysis in peritoneal dialysis patients is necessary if the contrast agent is used
• All gadolinium based MRI/MRA contrast agents should only be administered by radiologists, to avoid the risk that non-radiologists may be unaware of the risk of Nephrogenic Systemic Fibrosis.
• If a gadolinium contrast is to be given to someone with moderate to end-stage renal disease, a radiologist should write the order after approving the use.  The contrast should not be administered based only on a referring doctor’s order or from a protocol standing order.
• For those who have already been diagnosed with NSF/NFD, consider avoiding any administration of further gadolinium contrasts.

>>LINK: ACR MRI Safety Guidelines

MRI CONTRAST LAWSUITS

The MRI contrast lawyers at Saiontz & Kirk, P.A. represent individuals who have been diagnosed with Nephrogenic Systemic Fibrosis/Nephrogenic Fibrosing Dermopathy.  Lawsuits are being pursued nationwide to obtain compensation for those who were not warned of the potential problems or given the opportunity to avoid this devastating condition.

If you, a friend or family member have been diagnosed with NSF/NFD, or experienced any symptoms of the disease, request a free consultation and claim evaluation to help determine if you may be eligible for a claim.  There are no fees or expenses unless a recovery is obtained.

>>REQUEST A NEPHROGENIC SYSTEMIC FIBROSIS LAWSUIT EVALUATION<<