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Conservative gadolinium administration to patients with Duchenne muscular dystrophy: decreasing exposure, cost, and time, without change in medical management

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Abstract

Cardiac MR (CMR) is increasingly used to assess for cardiac involvement in patients with Duchenne muscular dystrophy (DMD). The frequent use of gadolinium based contrast agents (GBCAs) has been called into question with reports of intracranial gadolinium deposition in patients receiving multiple administrations. We adopted a conservative GBCA administration policy, limiting the frequency of GBCA exposure in patients with previously documented late gadolinium enhancement. The aim of our study was to evaluate the clinical effects of this policy change. Data were retrospectively reviewed on 405 consecutive patients with DMD who underwent CMR evaluation. Patients were grouped into conservative GBCA administration or historical control. CMR reports were evaluated and clinical reports were reviewed to determine actionable changes. Ohio Medicaid reimbursements were used to estimate costs. A total of 187 patients comprised the conservative GBCA group and 218 patients the historical cohort. The conservative GBCA group had lower contrast administration rates (84% vs. 99%, p < 0.0001), shorter scan times (35.2 vs. 39.0 min, p < 0.0001), and lower estimated medical costs ($339 vs. $351/study). There was no change regarding the initial presence of first-time late gadolinium enhancement, and no difference in actionable change. Contrast administration substantially decreased 7 months post-policy change (65%) compared to the initial 7 months (96%, p < 0.0001). In the current era with unclear concern for intracranial gadolinium deposition, thoughtful GBCA administration is warranted in patients anticipated to undergo multiple CMRs. Our updated approach has resulted in fewer patients receiving contrast, shorter scan times, and less medical costs, without appreciable changes to patient management.

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Data availability

The data that support the findings of this study are available on request from the corresponding author [SML]. The data are not publicly available due to records which may contain information that could compromise patient confidentiality.

Abbreviations

CMR:

Cardiac magnetic resonance

DMD:

Duchenne muscular dystrophy

GBCA:

Gadolinium based contrast agent

LGE:

Late gadolinium enhancement

SSFP:

Steady-state free precession

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Authors and Affiliations

  1. Heart Institute, Cincinnati Children’s Hospital Medical Center, 3333 Burnet Avenue, MLC 2003, Cincinnati, OH, 45229, USA

    Sean M. Lang, Tarek Alsaied, Ryan A. Moore, Thomas D. Ryan & Michael D. Taylor

  2. Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA

    Sean M. Lang, Tarek Alsaied, Ryan A. Moore, Thomas D. Ryan & Michael D. Taylor

  3. Department of Radiology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, 45229, USA

    Mantosh Rattan

  4. Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, 45229, USA

    Mantosh Rattan

Authors
  1. Sean M. Lang
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  2. Tarek Alsaied
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Correspondence to Sean M. Lang.

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The authors declare that they have no competing interests or funds to disclose.

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This study was approved by the Institutional Review Board at Cincinnati Children’s Hospital Medical Center.

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The requirement for informed consent was waived due to the retrospective nature of the study.

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Lang, S.M., Alsaied, T., Moore, R.A. et al. Conservative gadolinium administration to patients with Duchenne muscular dystrophy: decreasing exposure, cost, and time, without change in medical management. Int J Cardiovasc Imaging 35, 2213–2219 (2019). https://doi.org/10.1007/s10554-019-01670-1

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  • DOI: https://doi.org/10.1007/s10554-019-01670-1

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