MRI NSF: Understanding What Causes Nephrogenic Systemic Fibrosis

Philadelphia, PAScientists studying MRI contrast side effects may be closer to understanding what causes MRI contrast agent side effects. Specifically, they may now understand what causes people who are given an MRI contrast agent that contains gadolinium to develop Nephrogenic Systemic Fibrosis (NSF).

Nephrogenic Systemic Fibrosis affects patients with renal failure who are given gadolinium-based contrast agents for an MRI. The disease involves a thickening of the skin around the joints and can affect the internal organs, including the heart and lungs.

Two studies conducted by researchers at the Jefferson Institute of Molecular Medicine of Thomas Jefferson University were published in the November issue of Annals of Rheumatic Diseases and cited online by Jefferson University Hospitals (jeffersonhospital.org 10/19/10).

Gadolinium is excreted from the body through the kidneys. In people with renal insufficiency, the gadolinium remains in the system longer than it should, which can result in the development of NSF. Researchers found that in patients who develop NSF, cells affected by the disease produce excessive amounts of collagen. Furthermore, a different protein, actin, which exists in smooth muscle, was also contained in cells affected by NSF.

These changes occurred even in multiple generations of cell division, suggesting that the NSF-related changes affected the cells' genetic material.

The second study conducted by the researchers found that gadolinium-based contrast agents cause a change in the activation of chemicals and proteins that regulate a person's immune response.

Nephrogenic Systemic Fibrosis is a potentially fatal disease with no effective treatment. Patients who develop it experience decreased mobility, often requiring use of a wheelchair or walker to get around. According to an editorial that accompanied the studies in the Annals of Rheumatic Diseases, "The presence of skin changes of NSF [including tightening and hyperpigmentation] has been associated with a nearly threefold increased risk of death within 24 months."

The FDA recently issued new warnings about the risk of gadolinium-based contrast agents in patients with renal insufficiency. The new warning label for those products recommends that three contrast agents—Magnevist, Omniscan and Optimark—not be used in patients with AKI (acute kidney injury) or chronic, severe kidney disease, and that patients be screened prior to administration of a gadolinium-based contrast agent to determine whether or not they have kidney insufficiency.

Symptoms of NSF include hardening, tightening or scaling of the skin, changes in pigmentation, including red or dark patches, and stiffness.