Erratum to “Hair and fingernail gadolinium ICP-MS contents in an overdose case associated with nephrogenic systemic fibrosis” [Forensic Sci. Int. (in press)]

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.

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Risk factors for NSF: A literature review

Prince

Zhang

Roditi

et al. 2009

Magnetic Resonance Imaging

108

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Nephrogenic systemic fibrosis in liver disease: A systematic review

Mazhar

Shiehmorteza

Kohl

et al. 2009

Magnetic Resonance Imaging

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Nephrogenic systemic fibrosis (NSF) may develop in patients with liver disease, a fact highlighted by Food and Drug Administration (FDA) announcements cautioning against the use of gadolinium‐based contrast agents (GBCAs) in select liver disease patients. The purpose of this systematic literature review is to characterize the risk of NSF in patients with liver disease. All published articles on NSF from September 2000 through August 2008, were identified via PubMed searches and examination of articles' reference lists. Two reviewers independently read each article and identified unique patients with biopsy‐proven or suspected NSF. Data on demographics, liver status, renal status, and GBCA exposure were collected. A total of 324 articles were reviewed, with 108 articles containing case descriptions of 335 unique NSF patients. After excluding the 95/335 (28%) patients in whom the presence or absence of liver disease was uncertain, liver disease was confirmed present in 41/239 (17%) patients. Renal insufficiency could be assessed in 35 of the liver disease patients; severe renal insufficiency, defined as a glomerular filtration rate (GFR) or estimated GFR (eGFR) <30 mL/min/1.73 m2 or dialysis requirement, was present in 34/35 (97%) patients. The lone patient who developed NSF with mild/moderate renal insufficiency was atypical and received a total gadodiamide load of 0.76 mmol/kg over a 10‐week period periliver transplantation. The published medical literature demonstrates that patients with liver disease who develop NSF also have severe renal insufficiency, suggesting that liver disease does not confer a risk for NSF beyond that of the underlying renal insufficiency. J. Magn. Reson. Imaging 2009;30:1313–1322. © 2009 Wiley‐Liss, Inc.

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Possible involvement of gadolinium chelates in the pathophysiology of nephrogenic systemic fibrosis: A critical review

et al. 2008

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Erratum to “Hair and fingernail gadolinium ICP-MS contents in an overdose case associated with nephrogenic systemic fibrosis” [Forensic Sci. Int. (in press)]

Cited by 3 publications

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Risk factors for NSF: A literature review

Risk factors for NSF: A literature review

Nephrogenic systemic fibrosis in liver disease: A systematic review

Possible involvement of gadolinium chelates in the pathophysiology of nephrogenic systemic fibrosis: A critical review

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