Nephrogenic systemic fibrosis: Clinical spectrum of disease

Mayr, Michael; Burkhalter, Felix; Bongartz, Georg

doi:10.1002/jmri.21975

Cited by 25 publications

(14 citation statements)

References 68 publications

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“…This might facilitate clinical translation compared to other pH imaging agents, where toxic effects can arise from Gd 3+ -chelates in patients with renal insufficiency29 or from preparations of hyperpolarized caesium bicarbonate, where toxic caesium30 is used to increase the bicarbonate concentration.…”

Section: Discussionmentioning

confidence: 99%

Imaging of pH in vivo using hyperpolarized 13C-labelled zymonic acid

et al. 2017

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Natural pH regulatory mechanisms can be overruled during several pathologies such as cancer, inflammation and ischaemia, leading to local pH changes in the human body. Here we demonstrate that 13C-labelled zymonic acid (ZA) can be used as hyperpolarized magnetic resonance pH imaging sensor. ZA is synthesized from [1-13C]pyruvic acid and its 13C resonance frequencies shift up to 3.0 p.p.m. per pH unit in the physiological pH range. The long lifetime of the hyperpolarized signal enhancement enables monitoring of pH, independent of concentration, temperature, ionic strength and protein concentration. We show in vivo pH maps within rat kidneys and subcutaneously inoculated tumours derived from a mammary adenocarcinoma cell line and characterize ZA as non-toxic compound predominantly present in the extracellular space. We suggest that ZA represents a reliable and non-invasive extracellular imaging sensor to localize and quantify pH, with the potential to improve understanding, diagnosis and therapy of diseases characterized by aberrant acid-base balance.

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Section: Discussionmentioning

confidence: 99%

Imaging of pH in vivo using hyperpolarized 13C-labelled zymonic acid

et al. 2017

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“…The natural history of NSF is variable [19]. As the condition progresses, the skin may take on a woody texture.…”

Section: How Serious a Problem Is Nsf?mentioning

confidence: 99%

Gadolinium and nephrogenic systemic fibrosis: an update

2013

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Nephrogenic systemic fibrosis (NSF) is a multisystem disease seen exclusively in patients with renal impairment. It can be severely debilitating and sometimes fatal. There is a strong association with gadolinium-based contrast agents used in magnetic resonance imaging (MRI). Risk factors include renal impairment and proinflammatory conditions, e.g. major surgery and vascular events. Although there is no single effective treatment for NSF, the most successful outcomes are seen following restoration of renal function, either following recovery from acute kidney injury or following renal transplantation. There have been ten biopsy-proved pediatric cases of NSF, with no convincing evidence that children have a significantly altered risk compared with the adult population. After implementation of guidelines restricting the use of gadolinium-based contrast agents in at-risk patients, there has been a sharp reduction in new cases and no new reports in children. Continued vigilance is recommended: screening for renal impairment, use of more stable gadolinium chelates, consideration of non-contrast-enhanced MRI or alternative imaging modalities where appropriate.

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“…In the vast majority of patients, gadolinium contrast agents are safe—safer than iodine-based contrast. However, in patients with an estimated glomerular filtration rate of <30 mL/min, only cyclic gadolinium-based contrast agents should be used, and then only after risk-benefit analysis and at the minimum dose because of the possibility of the severe condition, nephrogenic systemic fibrosis (NSF) [10]. …”

Section: Cmr Safetymentioning

confidence: 99%