Implementation of a New MRI Contrast Policy at a Large Hospital System: Access to Contrast-Enhanced MRI and...

To evaluate access to contrast-enhanced MRI among patients with acute or chronic renal failure after implementation of a more permissive contrast policy and determine whether any patients developed nephrogenic systemic fibrosis (NSF).

This retrospective study included all patients who had an order for contrast-enhanced MRI in our healthcare system between July 1st, 2023 and June 30th, 2025. Each exam was categorized as completed or cancelled, and multivariable analysis was performed to identify factors associated with exam cancellation. Potential diagnoses of NSF were identified by searching the problem list and encounter diagnoses using ICD-10 codes.

Of 207,091 orders placed for contrast-enhanced MRI, 2911 (1.4%) were placed in patients with AKI/dialysis. Of these, 1440 (49.5%) were completed and 1459 (50.1%) were canceled. Over the two-year study period, with a median of 1.09 years (IQR: 0.56, 1.57) of clinical follow-up, there were no cases of NSF. Most orders in patients with AKI/dialysis occurred in the inpatient setting (91.3%, N=2658) and at an academic facility (95.4%, N=2798). Although AKI/dialysis was significantly associated with a higher cancellation rate (OR of 8.0; 95% CI: 7.4, 8.6), the effect was much less pronounced in multivariable analysis (adjusted OR of 1.3; 95% CI: 1.2, 1.4), attributable to the high frequency of inpatient orders among patients with AKI/dialysis and high rate of canceled exams among inpatients.

Implementation of a more permissive contrast policy allowing for administration of GBCA in patients with acute or chronic renal failure did not result in any diagnoses of NSF.