Journal of magnetic resonance imaging : JMRI
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J Magn Reson Imaging · Dec 2009
ReviewRemoval of gadolinium by dialysis: review of different strategies and techniques.
Nephrogenic systemic fibrosis (NSF) has been related to the administration of gadolinium-based contrast agents for magnetic resonance imaging studies in patients with kidney disease. After reviewing the pathophysiology of NSF, we discuss the possible factors contributing to the toxicity of gadolinium in susceptible patients, including the excessive amounts of intravenous iron and erythropoietin as well as the inflammatory states commonly seen in patients treated with hemodialysis. Since free gadolinium is the most accepted risk factor for NSF, we provide some suggestions to improve clearance of both free and chelated gadolinium using different dialysis strategies and techniques. ⋯ Magn. Reson. Imaging 2009;30:1347-1349. (c) 2009 Wiley-Liss, Inc.
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Nephrogenic systemic fibrosis (NSF) is a rare systemic fibrosing disorder that primarily affects the skin and the subcutaneous structures. Also, there are reports of involvement of deeper structures and organs in the human body, but the confirmation of systemic involvement is complicated by overlap of other disease processes that occur in patients with severe renal impairment. The disorder leads to significant disability and is an important contributing factor of death. ⋯ Magn. Reson. Imaging 2009;30:1289-1297. (c) 2009 Wiley-Liss, Inc.
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J Magn Reson Imaging · Dec 2009
ReviewNSF prevention in clinical practice: summary of recommendations and guidelines in the United States, Canada, and Europe.
In this article we summarize recommendations and guidelines for the prevention of NSF from the United States, Canada, and Europe. J. ⋯ Reson. Imaging 2009;30:1357-1363. (c) 2009 Wiley-Liss, Inc.
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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. ⋯ Magn. Reson. Imaging 2009;30:1298-1308. (c) 2009 Wiley-Liss, Inc.
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J Magn Reson Imaging · Dec 2009
ReviewGadolinium-based contrast agents and NSF: evidence from animal experience.
Nephrogenic systemic fibrosis (NSF) is a potentially severe systemic disease typically characterized by fibrosis of the skin and connective tissues. The etiology of NSF is still unknown but is likely to be multifactorial. Specific triggers under scientific evaluation have included surgery and/or the occurrence of thrombosis or other vascular injury, proinflammatory state, the administration of high doses of erythropoietin, and more recently the use of gadolinium-based contrast agents (GBCAs). ⋯ Magn. Reson. Imaging 2009;30:1268-1276. (c) 2009 Wiley-Liss, Inc.