NSF after Gadovist exposure: a case report and hypothesis of NSF development

Abstract

So far no cases of nephrogenic systemic fibrosis (NSF) have been published on macrocyclical gadolinium-based contrast media (Gd-CM), assumed as low NSF risk CM due to their complex stability. In our haemodialysis-dependent patient, the first symptoms indicating NSF appeared about 16 months after the exposure to Gadovist, a macrocyclical Gd-CM, and 1 month after x-ray angiography with iodinated CM (Ultravist). This indicates that in addition to excretory renal failure and Gd-CM exposure, the loss of biosynthetic renal function could be essential for NSF development. A hypothesis of possible pathways involved in the development of NSF is presented.

Does Higher Gadolinium Concentration Play a Role in the Morphologic Assessment of Brain Tumors? Results of a Multicenter Intraindividual Crossover Comparison of Gadobutrol versus Gadobenate Dimeglumine (the MERIT Study)

“…In this regard, although gadobutrol is a macrocyclic agent and thus widely considered one of the "safer" GBCAs, cases of NSF following its sole injection have been reported. 23,24 Our study suggests that gadobutrol, though reported to have slightly higher relaxivity compared with established standard relaxivity agents, 11,25 provides little or no benefit over other GBCAs for brain tumor imaging when compared specifically with the imaging performance achieved with 0.1 mmol/kg of gadobenate dimeglumine. In support of this conclusion, the package insert for gadobutrol describes an as yet unpublished comparison of gadobutrol and gadoteridol and states that "performances of Gadavist and gadoteridol for visualization parameters were similar.…”

Stability and Toxicity of Contrast Agents

“…So far, it appears that NSF has not been unequivocally confirmed in patients who have a clear medical record of only having received macrocyclic contrast agents (unconfounded) [288,302]. There is one case study report of a patient with end stage renal failure who developed NSF like symptoms 16 months after receiving Gadovist (Gadobutrol) [303]. However, debates have continued as to whether this was indeed a true case of NSF [304].…”

Speciation of Metal Complexes of Medicinal Interest: Relationship between Solution Equilibria and Pharmaceutical Properties

“…where BMA = bis-(methylamide)) and far fewer diseases have been reported in patients treated with Magnevist (Gd(DTPA)), and only a few cases have been observed after the use of macrocyclic agents [160,164,[170][171][172][173][174].…”