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Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents

Hoppe, Hanno ; Spagnuolo, Sara ; Froehlich, Johannes ; Nievergelt, Helga ; Dinkel, Hans-Peter ; Gretener, Silvia ; Thoeny, Harriet

In: European Radiology, 2010, vol. 20, no. 3, p. 595-603

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    Title
    • Retrospective analysis of patients for development of nephrogenic systemic fibrosis following conventional angiography using gadolinium-based contrast agents
    Author
    • Hoppe, Hanno. Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Spagnuolo, Sara. Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Froehlich, Johannes. Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
    • Nievergelt, Helga. Clinic of Dermatology, University Hospital Bern, Bern, Switzerland
    • Dinkel, Hans-Peter. Institute of Diagnostic and Interventional Radiology, Hospital Landshut, Landshut, Germany
    • Gretener, Silvia. Division of Vascular Medicine, Swiss Cardiovascular Center, University Hospital of Bern, Bern, Switzerland
    • Thoeny, Harriet. Institute of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University Hospital Bern, Freiburgstrasse 10, 3010, Bern, Switzerland
    Document Type
    • Postprint
    OAI-PMH Identifier
    • oai:doc.rero.ch:310063
    Summary
    Purpose: The purpose was to retrospectively review the data of 27 patients with renal insufficiency who underwent conventional angiography with gadolinium-based contrast agents (GDBCA) as alternative contrast agents and assess the occurrence of nephrogenic systemic fibrosis (NSF) together with associated potential risk factors. Methods: This HIPAA-compliant study had institutional review board approval, and informed consent was waived. Statistical analysis was performed for all available laboratory and clinical data, including dermatology reports. Type and amount of the GDBCA used were recorded for angiography and additional MRI studies, if applicable. Serum creatinine levels (SCr) pre- and post-angiography were recorded, and estimated glomerular filtration rates (eGFR) were calculated. Results: Ten female and 17 male patients who underwent angiography with GDBCA were included. The mean amount of GDBCA administered was 44 ± 15.5ml (range 15-60ml) or 0.24 + 0.12mmol/kg (range 0.1-0.53mmol/kg). At the time of angiography all patients had renal insufficiency (eGFR <60ml/min/1.73m2). Mean eGFR pre-angiography was 26ml/min/1.73m2 and 33ml/min/1.73m2 post-angiography. The mean follow-up period covers 28months, range 1-84months. Additional MRI studies with GDBCA administration were performed in 15 patients. One patient with typical skin lesions had developed biopsy-confirmed NSF. Conclusion: Conventional arterial angiography with GDBCA may play a role in the development of NSF in patients with renal insufficiency. Alternative contrast agents, such as CO2 angiography or rather the use of low doses of iodinated contrast agents, should be considered in these patients