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Risk of nephrogenic systemic fibrosis in patients with impaired renal function undergoing fixed-dose gadoxetic acid-enhanced magnetic resonance imaging

  • Hepatobiliary
  • Published:
Abdominal Radiology Aims and scope Submit manuscript

Abstract

Purpose

To assess the risk of nephrogenic systemic fibrosis (NSF) in patients with renal impairment undergoing gadoxetic acid-enhanced magnetic resonance imaging.

Methods

This retrospective study included patients who had an estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2 or had undergone dialysis around the time of gadoxetic acid exposure from January 2010 to November 2019. All patients received at least one intravenous injection of gadoxetic acid at a fixed dose of 2.5 mmol. The primary endpoint was the development of NSF after exposure to gadoxetic acid based on Girardi’s clinicopathological scoring system.

Results

A total of 204 patients with renal impairment received 424 injections of gadoxetic acid, of which 131 and 54 had an eGFR of 30–59 and < 30 mL/min per 1.73 m2, respectively, and 19 had undergone hemodialysis. Eighty-two patients received multiple injections, with 23 receiving five or more injections. The dose of each exposure ranged from 0.02 to 0.07 mmol/kg and the cumulative doses ranged from 0.02 to 0.45 mmol/kg. Thirty-three patients had concomitant Child–Pugh class B or C cirrhosis. No NSF was detected during follow-up (median 20 months; range 6 days to 111 months). The upper bound of the 95% confidence interval for NSF risk was 2.2% and 1.1% per patient and examination, respectively.

Conclusion

No NSF was detected in this study. However, it is premature to ascertain the risk of NSF using gadoxetic acid in patients with renal impairment and further studies are warranted.

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Author notes

  1. Ti-Yung Tseng and Jeng-Hwei Tseng contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5, Fu-Hsing Street, Gueishan, Taoyuan, 333, Taiwan

    Ti-Yung Tseng, Jeng-Hwei Tseng, Shen-Yen Lin, Gigin Lin & Ying-Chieh Lai

  2. Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan

    Ti-Yung Tseng, Jeng-Hwei Tseng, Shen-Yen Lin, Gigin Lin & Ying-Chieh Lai

  3. Department of Radiation Oncology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, Taoyuan, Taiwan

    Bing-Shen Huang

  4. Department of Dermatology, Drug Hypersensitivity Clinical and Research Center, Chang Gung Memorial Hospital at Linkou, Taipei, and Keelung, Taoyuan, Taiwan

    Chun-Bing Chen

  5. Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan

    Yi-Wen Fang

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Tseng, TY., Tseng, JH., Huang, BS. et al. Risk of nephrogenic systemic fibrosis in patients with impaired renal function undergoing fixed-dose gadoxetic acid-enhanced magnetic resonance imaging. Abdom Radiol 46, 3995–4001 (2021). https://doi.org/10.1007/s00261-021-03045-4

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