Nephrogenic Systemic Fibrosis and Gadolinium-Containing Radiological Contrast Agents: An Update

Abstract

Nephrogenic systemic fibrosis (NSF), originally described as “scleromyxedema‐like cutaneous disease,” is an entity that has emerged recently in patients with renal dysfunction.1 NSF is a rare but severely disabling disease that manifests as fibrosis of skin and viscera. Numerous reports have highlighted an association between NSF and gadolinium (Gd)‐based contrast agents (GBCAs) used for magnetic resonance imaging. The exact mechanisms underlying this association are still under investigation.2,3 There were apparently no reports of NSF prior to 1997, when the first cases were described.1 Clinical Pharmacology & Therapeutics (2011) 89 6, 920–923. doi:

Pulmonary Arterial Hypertension: MR Imaging-derived First-Pass Bolus Kinetic Parameters Are Biomarkers for Pulmonary Hemodynamics, Cardiac Function, and Ventricular Remodeling

“…A third limitation is the need for gadolinium-containing contrast agents that have potential adverse effects, including hypersensitivity reactions and nephrogenic systemic fibrosis. However, nephrogenic systemic fibrosis occurs only in patients with advanced kidney disease (35), which was not present in any of these participants. In addition, the doses of injected contrast material were small, which may have further reduced the risk of nephrogenic systemic fibrosis.…”

Real-Time Monitoring of Arsenic Trioxide Release and Delivery by Activatable T1 Imaging

“…[37][38] To increase the safety of MRI contrast agents, much emphasis is now being placed on alternative approaches based on non-lanthanide metals, in particular manganese ions (Mn 2+ ). Mn 2+ is a typical T 1 contrast agent with high spin number, long electronic relaxation time, and labile water exchange.…”

One‐step analysis of brain perfusion and function for acute stroke patients after reperfusion: A resting‐state fMRI study

“…Dynamic susceptibility contrast perfusion‐weighted imaging (DSC‐PWI) is the most commonly used imaging technique in clinical practice. However, recent studies have sparked awareness of gadolinium (Gd) deposition in the brain and Gd contrast, which was found to have a positive association with the development of nephrogenic systemic fibrosis (NSF) . The severe potential side effects of contrast agents limit the number of repeated scans one patient may undergo and demand noncontrast alternatives.…”

“…However, recent studies have sparked awareness of gadolinium (Gd) deposition in the brain and Gd contrast, which was found to have a positive association with the development of nephrogenic systemic fibrosis (NSF). 6,7 The severe potential side effects of contrast agents limit the number of repeated scans one patient may undergo and demand noncontrast alternatives. Arterial spin labeling (ASL) uses magnetically labeled water in the blood as an endogenous tracer, and thus requires no exogenous contrast administration to noninvasively measure brain perfusion at the tissue level.…”