NSF: WHAT WE KNOW AND WHAT WE NEED TO KNOW: Nephrogenic Systemic Fibrosis: Non‐Gadolinium Options for the Imaging of CKD/ESRD Patients

Dawson, Peter; Punwani, Shonit

doi:10.1111/j.1525-139x.2007.00401.x

Cited by 22 publications

(22 citation statements)

References 43 publications

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“…The role of microbubble contrast ultrasound in detecting microvascular and macrovascular lesions has been described in liver, carotid, and cardiac imaging. However, the potential risks of these agents are incompletely understood, and they are at present not licensed in pregnancy and children [86]. A range of nonenhanced MRI techniques are now available to depict vascular anatomy [87] and includes a technique of inverting the magnetic vector in a specific volume of tissue, then allowing time (0.5-2 s) for noninverted blood to enter this volume and finally acquire the images, which will then predominantly comprise signal from the intravascular spaces.…”

Section: Alternative Imaging Strategies In Childrenmentioning

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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Section: Alternative Imaging Strategies In Childrenmentioning

confidence: 99%

Gadolinium and nephrogenic systemic fibrosis: an update

2013

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“…These include Magnetic Resonance Imaging (MRI) without GBC-enhancement, where options such as 3D time-of-flight MRA, phase-contrast angiography, and arterial spin labeling-MR provide excellent information about blood vessels and blood flow. 31 MRI with ultra-small paramagnetic iron oxide particles may offer a future alternative in those that need a contrast-based scan for diagnosis. 32 However, since contrast enhanced MRI/MRA studies remain extremely important imaging modalities, their use may be required in some high risk individuals.…”

Section: Alternative Radiologic Imaging Modalities To Gbc Enhanced Mamentioning

confidence: 99%

Nephrogenic systemic fibrosis: What the hospitalist needs to know

Fine

Perazella

2010

Journal of Hospital Medicine

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Nephrogenic systemic fibrosis (NSF) has now been linked to gadolinium‐based contrast (GBC) exposure in those with compromised kidney function, particularly those with end‐stage renal disease (ESRD). When ESRD is present, symptoms can be quite devastating for the patient including severe pain and immobility and even death. For those at risk, avoidance of GBC exposure, whenever possible, is absolutely essential to prevent this potentially devastating complication. Identifying those at risk depends in some circumstances on appropriate recognition of renal dysfunction and understanding appropriate use of glomerular filtration rate (GFR) estimation formulas. Although hemodialysis (but not peritoneal dialysis) removes gadolinium, the availability of dialysis should never be used as a justification for GBC use in this high‐risk population. Unfortunately there is a lack of a universally effective therapy. Resolution of acute kidney injury (AKI) appears to attenuate disease in most cases, while kidney transplantation has been associated with variable success. Journal of Hospital Medicine 2010;5:46–50. © 2010 Society of Hospital Medicine.

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“…In particular, when it comes to the central nervous system (CNS), the spine, and osteoarticular pathology, MRI is superior (3). Also, within the abdomen, enhanced MRI has some advantages compared to enhanced CT.…”

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confidence: 99%