Journal of magnetic resonance imaging : JMRI
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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.
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J Magn Reson Imaging · Dec 2009
Incidence of nephrogenic systemic fibrosis at Chinese PLA General Hospital.
Magnetic resonance imaging (MRI), dermatology, and dermatopathology records were searched to determine the incidence of nephrogenic systemic fibrosis (NSF) at a large military hospital in China. Over the past 3.7 years, gadolinium-based contrast agent (GBCA)-enhanced MRI was performed with Gd-DTPA (n = 28,680) or MultiHance (n = 635) typically at slightly more than a standard dose, as most patients received a unit dose, 15 mL or 20 mL instead of a weight-based dose. This included 118 renal failure patients with estimated glomerular filtration rate (eGFR) less than 30 mL/min and 33 patients on chronic hemodialysis. ⋯ Magn. Reson. Imaging 2009;30:1309-1312. (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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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
Retrospective assessment of prevalence of nephrogenic systemic fibrosis (NSF) after implementation of a new guideline for the use of gadobenate dimeglumine as a sole contrast agent for magnetic resonance examination in renally impaired patients.
From May 2007 to January 2008, patients with Stage 3-5 chronic kidney disease (CKD) undergoing gadobenate dimeglumine (GBD)-enhanced magnetic resonance (MR) examinations were included in the retrospective investigation. The electronic medical records were reviewed to assess the prevalence of nephrogenic systemic fibrosis (NSF) in renally impaired patients underwent GBD-enhanced MR examinations. In all, 250 patients (98 men, mean age 72.6 years) were included: 97% of the patients had Stage 3 CKD (estimated GFR 30-59 mL/min/1.73 m(2)); 37% had been exclusively exposed to GBD. ⋯ Magn. Reson. Imaging 2009;30:1335-1340. (c) 2009 Wiley-Liss, Inc.