Risk factors for NSF: A literature review

Abstract

Emerging evidence linking gadolinium-based contrast agents (GBCAs) to nephrogenic systemic fibrosis (NSF) has changed medical practice patterns toward forgoing GBCA-enhanced magnetic resonance imaging (MRI) or substituting other imaging methods, which are potentially less accurate and often radiation-based. This shift has been based on reports of high NSF incidence at sites where a confluence of risk factors occurred in patients with severe renal dysfunction. This review article explores the factors that affect NSF risk, compares risks of alternative imaging procedures, and demonstrates how risk can be managed by careful selection of GBCA dose, timing of injection with respect to dialysis, and other factors. Nearly half of NSF cases are a milder form that does not cause contractures or reduce mobility. It appears that eliminating even a single risk factor can reduce NSF incidence/risk at least 10-fold. Elimination of multiple risk factors by using single-dose GBCA, dialyzing dialysis patients quickly following GBCA administration, avoiding GBCA in acute renal failure while serum creatinine is rising, and avoiding nonionic linear GBCA in renal failure patients may reduce NSF risk more than a thousand-fold, thereby allowing safe GBCA-enhanced MRI in virtually all patients.

Histogram Analysis of Intravoxel Incoherent Motion for Differentiating Recurrent Tumor from Treatment Effect in Patients with Glioblastoma: Initial Clinical Experience

“…This is particularly relevant in patients with compromised renal function or severe allergies and those who cannot be given intravenous, gadolinium-based contrast media. 18 Last, the IVIM method can provide standardized values if the same modeling was used; therefore this method has potential to be used in multicenter clinical trials.…”

Safety of Gadopentetate Dimeglumine after 120 Million Administrations over 25 Years of Clinical Use

“…Interestingly, in Japan, the reason for the low incidence of NSF cases in Japan may be related to the dosing of Gd-DTPA. In a study by Prince and associates 24 of 182 reported cases of NSF for which data on GBCA dose was available, 90z of patients had received a dose greater than the standard 0.1 mmol/ kg. Therefore, it is possible that administration of high doses of GD-DTPA may be very rare in Japan due to the severe restrictions on dosing by reimbursement guidelines from health insurance providers.…”

Quantification of renal perfusion: Comparison of arterial spin labeling and dynamic contrast‐enhanced MRI

“…An advantage of not involving contrast injection is eliminating the risk of nephrogenic systemic fibrosis (NSF) in patients with compromised kidney function (11). Although principally employed for cerebral blood flow quantification, ASL has begun to see applications outside of the brain, with the kidney being one of the first and most popular sites.…”