Another Nephrogenic Systemic Fibrosis (NSF) study has tied the debilitating condition to Gadolinium contrast agents used in Magnetic Resonance Imaging (MRI). This latest NSF research was conducted by the Centers for Disease Control (CDC), which examined a cluster of NSF patients at one unidentified St. Louis Missouri Hospital. The CDC found that the exposure to Gadolinium contrast dyes during MRI was independently associated with the development of NSF.
NSF (sometimes called Nephrogenic Fibrosing Dermopathy or NFD) was first seen in patients in 1997, and it wasn’t mentioned in medical literature until 2000. NSF leads to excessive formation of connective tissue in the skin and internal organs. It is characterized by high blood pressure, burning, itching, swelling and hardening of the skin. Other symptoms include red or dark patches on the skin; pain deep in the hip bones or ribs and muscle weakness. NSF can progress to the point of causing severe stiffness in joints, and it can lead to death.
There is currently no cure for NSF and no one understands its specific cause. However, the evidence that Gadolinium MRI contrast agents play a role in its development is fast becoming irrefutable. Researchers at Yale University have reported that 95-percent of those with NSF had an MRI that involved a Gadolinium MRI contrast dye two to three months before their symptoms appeared. Researchers at Massachusetts General Hospital also have found that kidney patients who had undergone MRIs with Gadolinium MRI contrast dyes were 10 times more likely to develop NSF than patient who had not been exposed to such agents.
Gadolinium contrast dyes are used in MRI because they make it far easier for a diagnostician to differentiate between normal and abnormal tissue. While the tests can be done without the Gadolinium based contrast agent, they are nowhere near as effective. The FDA has warned that patients with kidney problems not be given Gadolinium based MRI contrast dyes unless it is absolutely necessary because of their association with NSF. Unfortunately, there are not yet any alternatives to gadolinium based MRI contrast agents.
The CDC study of the St. Louis NSF cases only reinforces the link between NSF and Gadolinium. According to the CDC, in May 2006, nephrologists at the St. Louis hospital reported a cluster of NFS among patients treated in their dialysis units. The CDC conducted an investigation to determine the number of affected patients and identify risk factors for NFS. Of the 19 patients eventually included in the study, only five had no identified gadolinium exposure within 1 year preceding NFS diagnosis. However, of these, four had gadolinium exposure from 16 to 68 months preceding diagnosis. Thirteen patients had multiple gadolinium-containing contrast exposures during the preceding year.
According to the CDC, the study indicated that exposure to Gadolinium-containing contrast agents during MRI studies was linked with the development of NFS. The CDC cautioned that clinicians should be aware of the potential for NFS, and when possible, should avoid use of Gadolinium-containing contrast agents in patients with advanced kidney disease.