Journal of magnetic resonance imaging : JMRI
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J Magn Reson Imaging · Dec 2009
Gadolinium-based contrast agents and nephrogenic systemic fibrosis: why did it happen and what have we learned?
This article addresses two questions about gadolinium-based contrast agents (GBCAs) and nephrogenic systemic fibrosis (NSF): "Why did it happen" and "What have we learned"? It reviews the events leading to the discovery of an association between NSF and GBCAs. Various factors are elucidated that contributed to the delay between the time when GBCA came into widespread clinical use and a link was made with NSF, including use in renal-compromised patients, high-dose magnetic resonance angiography (MRA), lack of documentation and adequate databases, policy and regulatory changes, and an absence of scientific evidence. The authors conclude that the overriding cause was lack of awareness. ⋯ Magn. Reson. Imaging 2009;30:1236-1239. (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.