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Critical Care |

The Renal Safety of MRI With Gadolinium in Critical Care

Karl Langberg*, BS; Ram Subramanian, MD
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Emory University, Atlanta, GA


Chest. 2012;142(4_MeetingAbstracts):391A. doi:10.1378/chest.1388926
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Abstract

SESSION TYPE: Non Pulmonary Critical Care Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Introduction: Intravenous contrast enhanced imaging enhances the detection of pathology in critical illness. Given the risk of contrast nephropathy associated with iodinated CT contrast, alternate contrast modalities need to be examined, particularly in the setting of renal insufficiency. Aim: The purpose of this study was to examine the renal safety of MRI with gadolinium in critically ill patients.

METHODS: The study involved a retrospective analysis of 222 ICU patients at a single academic center during 2007 and 2008, who received an MRI imaging study with gadolinium in the absence of renal replacement therapy. For each case, a serum creatinine was recorded prior to, and 48 and 72 hours after the MRI. The serum creatinine values before and after the MRI were compared for each case. In addition, the cases were analyzed for sub-acute complications of nephrogenic systemic fibrosis (NSF), a reported complication of gadolinium in end stage renal disease.

RESULTS: The age of the patients ranged from 16 to 97 years, with 51% being female. The pre- MRI serum creatinine values ranged from 0.3 to 4.5 mg/dl, with 51 cases (25%) having values ≥ 1.5 mg/dl. A comparison of the pre and post MRI serum creatinine values did not demonstrate a statistically significant difference (P<0.05), including those cases with a pre MRI serum creatinine ≥ 1.5 mg/ dl. In addition, no cases of NSF were noted.

CONCLUSIONS: These observations suggest that MRI with gadolinium is a non-nephrotoxic imaging modality in critically ill patients. Importantly, the renal safety of this modality extends to cases of renal insufficiency, where contrast enhanced CT may be contraindicated due to the risk of CT contrast nephropathy.

CLINICAL IMPLICATIONS: These findings suggest that MRI with gadolinium can be a useful contrast enhanced imaging modality in critical care, especially in the setting of renal insufficiency.

DISCLOSURE: The following authors have nothing to disclose: Karl Langberg, Ram Subramanian

No Product/Research Disclosure Information

Emory University, Atlanta, GA

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