Nephrogenic Systemic Fibrosis

Abstract

NSF is a potentially lethal disorder that occurs in patients with reduced kidney function. Current evidence suggests a strong association with gadolinium-based contrast agents--mostly used in MRI--in this patient group. This has urged the radiology community to emphasize careful screening for the presence of renal dysfunction among patients for whom gadolinium-enhanced MRI is contemplated. Appropriate selection of gadolinium-based contrast agent type, avoidance of nonstandard dosage, patient education, and informed consent have been recommended by authorities.

Assessment of Elastin Deficit in a Marfan Mouse Aneurysm Model Using an Elastin-Specific Magnetic Resonance Imaging Contrast Agent

“…Moreover, DOTA has been reported to have slower kinetics of dissociation, greater specificity than DTPA for gadolinium, 12 and less nephrotoxicity in patients with renal dysfunction. 12,20 As noted, this method has translational potential for humans. Aortic elastin content could be assessed noninvasively, and the information used as a diagnostic and prognostic tool.…”

Brain gadolinium deposition after administration of gadolinium-based contrast agents

“…Approximately 75 % of NSF was associated with gadodiamide (linear non-ionic GBCA), around 23 % with gadopentate dimeglumine (linear ionic GBCA) and only a few cases with other GBCAs. Most cases of NSF were associated with linear chelate GBCAs, with instability of the chelate compound implicated as the factor inducing NSF [25][26][27][28][29][30]. The European Society of Urogenital Radiology (ESUR) [29] and European Medicines Agency (EMA) [24] classified the NSF risk of GBCAs into three groups (high risk, intermediate risk, low risk), and recommended that high risk GBCAs not be administered to patients on hemodialysis, with eGFR (estimated glomerular filtration rate) under 30, or acute renal dysfunction.…”

“…The American College of Radiology (ACR) [30] identified the GBCAs associated with the greatest apparent NSF-associated risk (gadodiamide, gadopentetate dimeglumine and gadoversetamide), and recommended that their administration be avoided in such patients. Until now, no definitive treatment for NSF has been devised and radiologists play an essential role in preventing its occurrence [24][25][26][27][28][29][30]. …”

Molecular Imaging of the Cardiac Extracellular Matrix

“…This approach may prove particularly useful in patients with stage 4 or 5 kidney disease who are not candidates for receiving gadolinium contrast due to concerns regarding nephrogenic systemic fibrosis. 38 Native T1 mapping gives investigators a general idea of the state of extracellular space, but is not equally as quantitative as the methods to measure ECV as described below. Measuring ECV is performed by mapping T1 before and after either a bolus injection or equilibrium infusion of gadolinium.…”