Association of Gadolinium Based Magnetic Resonance Imaging Contrast Agents and Nephrogenic Systemic Fibrosis

Abstract

Purpose To investigate the recently discovered association between gadolinium based MRI contrast agents and the development of nephrogenic systemic fibrosis (NSF) in patients with chronic kidney disease or acute kidney injury. Materials and Methods A systematic review of the PubMed database and publicly available patient databases was performed to characterize NSF and its possible association with exposure to gadolinium based MRI contrast agents. Results Data from case series reports, NSF patient databases, NSF case reporting to the Federal Drug Administration (FDA) after gadolinium contrast agent exposure, and retrospective case-control studies suggest a strong association between the use of gadolinium based MRI contrast agents and the subsequent development of NSF in patients with renal disease. These data also suggest that the risk of NSF depends on the degree of renal dysfunction, dose of contrast agent, gadolinium contrast agent stability, and severity of concomitant illness. Thus, the occurrence of NSF after gadolinium contrast agent exposure may vary from negligible up to 2–5% in select high-risk clinical situations. Conclusions MRI utilizing gadolinium based contrast agents must be undertaken judiciously in patients with renal dysfunction carefully weighing, on a case by case basis, the benefits of MRI and the risk of NSF as well as the disadvantages of undergoing alternative imaging studies or foregoing imaging studies.

Cutaneous Manifestations of ESRD

“…ESRD patients who receive a high dose (.0.2 mmol/kg) or multiple cumulative doses of GBCA (with an overall GBCA volume.0.2 mmol/kg) versus a single standard dose of GBCA (0.1 mmol/kg) and the use of linear or nonionic chelating agents pose the highest risk of NSF (94,101,102). Although no GBCA is risk-free, most cases have been associated with gadodiamide (Omniscan), a linear nonionic agent, which has less in vitro stability than the ionic and macrocylcic GBCAs (94,95,101).…”

Nephrogenic systemic fibrosis: risk factors suggested from Japanese published cases

“…To date, more than 500 NSF cases have been reported worldwide to health authorities [2]. However, several of those cases have not been systematically validated.…”

“…Nephrogenic systemic fibrosis (NSF) is a rare disease that occurs in patients with renal failure; it can be devastating and usually initially appears as skin thickening and hardening, and occasionally progresses to limb contractures, leading to severe disability and even death [1][2][3][4][5][6][7][8][9]. It can be very painful.…”

“…The disease was first diagnosed in 1997 and a report first published in 2000 [10]. A confident diagnosis requires a combination of clinical history, physical examination and pathological assessment of the skin biopsy specimen [1][2][3][4][5][6][7][8][9]. The exact pathophysiology of NSF remains uncertain, but the possible association between gadolinium-based contrast agent (GBCA), which is widely used for MRI, and NSF was proposed in 2006 [7,11].…”

Non-contrast-enhanced MR angiography using time-spin labelling inversion pulse technique for detecting crossing renal vessels in children with symptomatic ureteropelvic junction obstruction: comparison with surgical findings

“…The limitations and disadvantages include radiation exposure and the need for intravenous contrast medium, with potential complications from anaphylaxis and nephrotoxicity. Contrastenhanced MR angiography (CE-MRA) appears to be an accurate technique in the identification of CRV [13,14], but exposes one to nephrogenic systemic fibrosis [15,16] especially in patients with renal impairment.…”