Nephrogenic Systemic Fibrosis Associated With Gadolinium‐containing Contrast Media Administration in Patients With Reduced Glomerular Filtration Rate

Hedley, Adam J; Molan, M; Hare, David; Anavekar, Nagesh S.; Ierino, Francesco L.

doi:10.1111/j.1440-1797.2006.00751.x

Cited by 17 publications

(9 citation statements)

References 2 publications

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“…For example, at the 2008 European Congress of Radiology (58) it was reported that no cases of NSF were observed in almost 250 patients with renal insufficiency who underwent Gd‐containing MRI in nine separate centers in France. Similar negative results are reported in 141 patients with 198 gadoteridol (ProHance) exposures in the USA (59), and 97 dialysis patients undergoing 146 Gd‐enhanced scans in Australia (60).…”

Section: Resultssupporting

confidence: 73%

Gadolinium‐enhanced magnetic resonance imaging for renovascular disease and nephrogenic systemic fibrosis: Critical review of the literature and UK experience

Chrysochou

Buckley

Dark

et al. 2009

Magnetic Resonance Imaging

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Purpose:To examine the positive reporting bias regarding the link with gadolinium (Gd) exposure and nephrogenic systemic fibrosis (NSF) in patients with renal impairment. This link has impacted strongly the international radiology safety guidelines. We believe that positive reporting bias has prevailed in the literature and that very few patients with a glomerular filtration rate (GFR) 15-29 mL/min (stage 4 chronic kidney disease [CKD]) should be regarded as high risk. Materials and Methods:To examine this, we conducted the following steps: 1. A critical literature search on NSF. 2. An analysis of our centers magnetic resonance angiography (MRA) experience since 1999. 3. A survey of participating centers of the multicenter ASTRAL trial to assess whether any patients screened or enrolled into ASTRAL had developed NSF. Results:The vast majority (90%) of NSF cases reported in the literature have occurred in patients with endstage renal disease treated with dialysis; very have had stable stage 4 or 5 (nondialysis) CKD. In all, 562 patients were followed up at our center: 30.4% were CKD4, 14.4% CKD5, 5.3% on dialysis, and 0.2% had renal transplants when imaged. No patients developed any symptoms or signs of NSF. In all, 347 patients were enrolled into ASTRAL on the basis of MRA (32% CKD4/5). One patient out of 45 centers (CKD5, received two Gd scans) developed NSF. Approximately 5 times as many patients were screened as were entered into ASTRAL. Conclusion:No cases of NSF were observed at our center. By extrapolation, 1/1735 patients screened for the AS-TRAL trial developed NSF, giving a crude incidence rate of 0.06%. We would argue that patients with CKD4 can safely undergo Gd-MRA, albeit using a minimal dose of a macrocyclic agent and avoiding repeat doses.

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Section: Resultssupporting

confidence: 73%

Gadolinium‐enhanced magnetic resonance imaging for renovascular disease and nephrogenic systemic fibrosis: Critical review of the literature and UK experience

Chrysochou

Buckley

Dark

et al. 2009

Magnetic Resonance Imaging

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“…In this article we present additional results using the TWIST sequence (10, 11) for time‐resolved imaging during the administration of a small contrast bolus of only 1 mL. The TWIST sequence is combined with parallel imaging GRAPPA (generalized autocalibrating partially parallel acquisition) to further improve the temporal resolution of the sequence (12). The tradeoff in using parallel imaging is a corresponding loss in signal‐to‐noise ratio (SNR).…”

mentioning

confidence: 99%

“…There is a strong association between the administration of high‐dose gadolinium‐based paramagnetic contrast medium in patients with advanced renal failure and the recently reported complication of nephrogenic systemic fibrosis (NSF) (10, 12). Therefore, contrast agent doses as small as 0.03–0.07 mmol/kg body weight have been used successfully for TR‐CEMRA at 1.5T (11, 13, 14) and 3T (15).…”

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confidence: 99%

Low‐dose 3D time‐resolved magnetic resonance angiography (MRA) of the supraaortic arteries: Correlation with high spatial resolution 3D contrast‐enhanced MRA

Lee

Laub

Jung

et al. 2010

Magnetic Resonance Imaging

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Purpose: To evaluate the feasibility of low-dose, 3D timeresolved contrast-enhanced magnetic resonance angiography (TR-CEMRA) in the assessment of the supraaortic vessel, and to compare the results with high-resolution contrast-enhanced MRA (HR-CEMRA). Materials and Methods:This was an Institutional Review Board-approved retrospective study. Forty-five consecutive patients underwent contrast-enhanced 3D TR-CEMRA and 3D HR-CEMRA for evaluation of neurovascular disease at 3.0 T. Gadobutrol was administered at a constant dose of 1 mL for TR-CEMRA (independent of patient weight), and 0.1 mmol/kg for HR-CEMRA. Two readers evaluated image quality using a four-point scale (from 0 ¼ excellent to 3 ¼ nondiagnostic), and subsequently graded each stenosis into clinically relevant categories: normal (0%), mild stenosis (<50%), moderate to severe (>50%), and occlusion. Results:The overall image quality for low-dose TR-CEMRA was in the diagnostic range (median 0, range 0-3). On the grading of stenosis, TR-CEMRA using the TWIST sequence correlated with HR-CEMRA (r ¼ 0.668, P < 0.001). In terms of the comparison of TR-CEMRA with HR-CEMRA, of the 675 supraaortic arterial segments evaluated for stenosis or occlusion, agreement occurred in 611 of 675 (90.5%), overestimation in 41 of 675 (6.1%), and underestimation 23 of 675 (3.4%).Conclusion: TR-CEMRA achieved by administration of a small contrast dose (1 cc) yields rapid and important functional and anatomical information in the evaluation of supraaortic arteries. Due to limited spatial resolution, TR-CEMRA at the current parameters has a tendency to overestimate the stenosis of smaller intracranial arteries compared to HR-CEMRA.

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“…Because of the excellent safety record of gadoliniumbased agents, there has been little prior emphasis on dose minimization strategies, other than for cost containment. Past reports linking gadolinium to nephrogenic systemic fibrosis in renal failure patients (10,(21)(22)(23) has focused attention on the potential importance of minimizing dose in appropriate patient subgroups. It has been suggested that in renal failure patients, a factor contributing to the risk of nephrogenic systemic fibrosis is prolonged exposure to gadolinium in the blood pool (21).…”

Section: Discussionmentioning

confidence: 99%

High-Spatial-Resolution Lower Extremity MR Angiography at 3.0 T: Contrast Agent Dose Comparison Study

Habibi

Krishnam²,

Lohan³

et al. 2008

Radiology

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Nephrogenic Systemic Fibrosis Associated With Gadolinium‐containing Contrast Media Administration in Patients With Reduced Glomerular Filtration Rate

Cited by 17 publications

References 2 publications

Gadolinium‐enhanced magnetic resonance imaging for renovascular disease and nephrogenic systemic fibrosis: Critical review of the literature and UK experience

Gadolinium‐enhanced magnetic resonance imaging for renovascular disease and nephrogenic systemic fibrosis: Critical review of the literature and UK experience

Low‐dose 3D time‐resolved magnetic resonance angiography (MRA) of the supraaortic arteries: Correlation with high spatial resolution 3D contrast‐enhanced MRA

High-Spatial-Resolution Lower Extremity MR Angiography at 3.0 T: Contrast Agent Dose Comparison Study

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