Risk of NSF for contrast agents in MRI

The European Medicines Agency has published a report in which they concluded that contrast agents that have a linear molecular structure pose the greatest risk of NSF, while those that have a cyclic molecular structure pose the least.  The types of contrast agents that they included in the report were:

Linear                     Cyclic

Omniscan             ProHance

OptiMARK            Gadovist

Magnevist             Dotarem

MultiHance

Primovist

Vasovist

What MRI contrast agents are associated with NSF?

There are five FDA approved gadolinium contrast agents; however, only three of these contrast agents have been credibly implicated in cases of nephrogenic systemic fibrosis. These three gadolinium MRI contrast agents are Omniscan (GE Healthcare), Optimark (Covidien/Mallinckrodt), and Magnevist (Bayer Healthcare). All three of these contrast agents share a common linear design for their chelator that is intended to bind the gadolinium. Other contrast agents use a safer chelator design that builds a "cage" around the gadolinium. These "macrocyclic" contrast agents have not been linked to cases of NSF. In fact, the only proven cause of NSF is exposure to one of these three contrast agents with the linear design.

Five gadolinium-based contrast agents are approved by the FDA for use during an MRI. The trade names for these products are:

• Omniscan
• OptiMARK
• Magnevist
• ProHance
• MultiHance

None of these agents are approved by the FDA for MRA. The dose of gadolinium-based contrast agent given to patients undergoing an MRA is often higher (up to three times) than the approved dose for MRI.

gadodiamide (OmniScan)*

gadopentetate dimeglumine (Magnevist)*

gadoversetamide (OptiMARK)*

gadobenate dimeglumine (MultiHance)

gadoteridol (ProHance)

* these agents have shown a higher risk association with NSF

Less stable contrast gadolinium agents have shown to have a higher association with NSF. Gadodiamide (OmniScan) is one of the least stable agents. The higher the thermodynamic stability constant for the contrast agent the higher the stability.

- Gadoversetaminde (OptiMARK) 16.6

- Gadodiamide (Omnisan) 16.9

- Gadobutrol (Gadovist) 21.8

- Gd-DTPA (Magnevist) 22.1

- Gadobenate (Multihance) 22.6

- Gadoteridol (Prohance) 23.8

- Gd-DOTA (Dotarem) 25.8