Application of extracellular gadolinium-based MRI contrast agents and the risk of nephrogenic systemic fibrosis.
Nephrogenic systemic fibrosis (NSF) is a serious, sometimes fatal disease. Findings in recent years have shown that a causal association between gadolinium containing contrast media and NSF is most likely. Therefore, the regulatory authorities have issued guidelines on the use of gadolinium-containing contrast media which have reduced the number of new cases of NSF to almost zero. However, it is for precisely this reason that the greatest care must still be taken to ensure that these guidelines are complied with. The most important factors are renal function, the quantity of gadolinium administered and coexisting diseases such as inflammation. All of these factors crucially influence the quantity of gadolinium released from the chelat in the body. This free gadolinium is thought to be the trigger for NSF. Other important factors are the stability of the gadolinium complex and furthermore the route of its elimination from the body. Partial elimination via the liver might be an additional protective mechanism. In conclusion, despite the NSF risk, contrast-enhanced MRI is a safe diagnostic procedure which can be used reliably and safely even in patients with severe renal failure, and does not necessarily have to be replaced by other methods.
University Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital Bern, Bern.
J T
JT
Heverhagen
Diagnostic and Interventional Radiology, University Hospital Giessen, Justus Liebig University Giessen, Gießen.
G A
GA
Krombach
Department for Neuroradiology, Innsbruck Medical University, Innsbruck.
E
E
Gizewski
D003287:Contrast Media / Q000009:adverse effects; D019317:Evidence-Based Medicine; D005682:Gadolinium / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects* / Q000592:standards*; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000175:diagnosis / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D012307:Risk Factors
D003287:Contrast Media; D005682:Gadolinium