Saturday, February 09, 2008

A rare complication of MRIs

I had an MRI last year as a screening test for breast cancer. MRI scanning with a contrast material called gadolinium is the best screen currently available for the cancer, and I received my negative results with a deep sense of satisfaction that, for the moment, I was free and clear.

While I have an internist's enthusiasm for ingested substances*, I have an abiding distaste for things injected. I will think long and hard about getting another MRI--I didn't mind the noise, no problem with the confined space, and I don't really mind IVs, it's the thought of another IV injection that stops me cold. And now, here's news of a new disease, rare but icky, we've created with gadolinium imaging technology.

Nephrogenic systemic fibrosis (NSF) was first described in 1997. Case series confirmed that NSF was confined to patients with renal insufficiency (diminished kidney function), and later determined to affect only those kidney patients who had undergone radiological imaging with gadolinium in the several months prior to developing hardened leathery skin. The fibrosis or connective tissue thickening and scarring associated with NSF binds up joints, lungs, heart, and diaphragm as well as the skin. The systemic involvement can be fatal.

By the time your kidney function is low enough to be at risk for NSF, you have already come to the attention of a specialist. Hopefully, no cases of NSF will appear in people not known to be at risk. This emerging syndrome reminds me, however, that there's no such thing as diagnoses for nothing' and MRIs for free**.
*Coupled with a coming-of-age-in-the-'60s mentality
**Sorry Dire Straits!


JeanMac said...

Another informative post - I had an MRI & no one mentioned this - I guess I'd have gone ahead anyway!

Ruth said...

We have had 2 patients in a year with this diagnosis on our rehab unit. The one young woman had chronic renal failure and was on dialysis when she had a contrast MRI. The other middle aged man had a strep infection in his finger and went into multi-organ failure. He had an MRI when in short term kidney failure. His MRI was done 1 month prior to a warning bulletin being published about NSF. Both patients have severely sclerosed muscles and no independent mobility. Needless to say, there is a class action law suit out there. People now know about this risk but for a few years a lot of people were exposed unknowingly.

Mauigirl said...

Oh great - I don't know what I get when I have the MRIs for my tongue/neck lymph nodes (I do get the IV so assume it's this substance) but I hope I don't get this! On the plus side, I do get a full blood chemistry done by the oncologist before he assigns me to go to get an MRI once a year so I'm assuming my kidney values are coming back normal.