Supplemental Content - Annals of Internal Medicine

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From the Publishers of
A Trip to the Hardware Store:
Is an MRI Safe?
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Case
 70 yo man, AAA, needs imaging
 Diabetic, Creatinine 1.8
 Contrast allergy
 Mechanical valve
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Risk Factors for Contrast Nephropathy
 Serum Cr > 1.5
 Estimated GFR < 60 ml/min per 1.73 m2
 Diabetic nephropathy with renal insufficiency
 Advanced heart failure
 Hypovolemia
 Percutaneous coronary intervention (risk of
emboli)
 High total dose of contrast agent
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St. Jude Aortic Valve
St. Jude Aortic Valve
Edwards MB, Taylor KM, Shellock, FG. Prosthetic heart valves: Evaluation of
magnetic field interactions, heating, and artifacts at 1.5 T. J. Magn. Reson. Imaging.
2000; 12: 363-369.
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How about his renal insufficiency and Gadolinium
MR contrast ?
 Gadolinium may cause nephrotoxicity in
high risk azotemic patients
 Case reports of nephrogenic systemic
fibrosis when GFR < 30 mL/min
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Nephrogenic systemic fibrosis
 Skin
 Symmetrical induration
 Initially ankles to knees
 Anywhere but head
 Internal organs
 Fibrosis
 Muscle induration
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The Guys replies
 MRI for this patient
 The mechanical valve is not metal
 Low risk for gadolinium nephrotoxicity,
nephrogenic systemic fibrosis
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