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Coelho DH, Tang Y, Suddarth B, Mamdani M. MRI surveillance of vestibular schwannomas without contrast enhancement: Clinical and economic evaluation. Laryngoscope 2017; 128:202-209. [DOI: 10.1002/lary.26589] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2017] [Indexed: 11/12/2022]
Affiliation(s)
- Daniel H. Coelho
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University School of Medicine; Richmond Virginia U.S.A
| | - Yang Tang
- Department of Radiology; Virginia Commonwealth University School of Medicine; Richmond Virginia U.S.A
| | - Brian Suddarth
- Department of Radiology; Virginia Commonwealth University School of Medicine; Richmond Virginia U.S.A
| | - Mohammed Mamdani
- Department of Otolaryngology-Head and Neck Surgery; Virginia Commonwealth University School of Medicine; Richmond Virginia U.S.A
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Weller A, Barber JL, Olsen OE. Gadolinium and nephrogenic systemic fibrosis: an update. Pediatr Nephrol 2014; 29:1927-37. [PMID: 24146299 DOI: 10.1007/s00467-013-2636-z] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 08/28/2013] [Accepted: 09/09/2013] [Indexed: 01/22/2023]
Abstract
Nephrogenic systemic fibrosis (NSF) is a multisystem disease seen exclusively in patients with renal impairment. It can be severely debilitating and sometimes fatal. There is a strong association with gadolinium-based contrast agents used in magnetic resonance imaging (MRI). Risk factors include renal impairment and proinflammatory conditions, e.g. major surgery and vascular events. Although there is no single effective treatment for NSF, the most successful outcomes are seen following restoration of renal function, either following recovery from acute kidney injury or following renal transplantation. There have been ten biopsy-proved pediatric cases of NSF, with no convincing evidence that children have a significantly altered risk compared with the adult population. After implementation of guidelines restricting the use of gadolinium-based contrast agents in at-risk patients, there has been a sharp reduction in new cases and no new reports in children. Continued vigilance is recommended: screening for renal impairment, use of more stable gadolinium chelates, consideration of non-contrast-enhanced MRI or alternative imaging modalities where appropriate.
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Affiliation(s)
- Alex Weller
- Department of Radiology, St George's Hospital NHS Trust, Blackshaw Road, London, SW17 0QT, UK,
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Affiliation(s)
- Henrik S Thomsen
- Department of Diagnostic Radiology, Copenhagen University Hospital Herlev, Herlev, Denmark
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Perazella MA. Magnetic resonance imaging in ESRD patients: what are the options? Semin Dial 2014; 27:610-3. [PMID: 25039646 DOI: 10.1111/sdi.12271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Mark A Perazella
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, New Haven, Connecticut
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Zou Z, Zhang HL, Roditi GH, Leiner T, Kucharczyk W, Prince MR. Nephrogenic systemic fibrosis: review of 370 biopsy-confirmed cases. JACC Cardiovasc Imaging 2012; 4:1206-16. [PMID: 22093272 DOI: 10.1016/j.jcmg.2011.08.013] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 08/23/2011] [Accepted: 08/23/2011] [Indexed: 10/15/2022]
Abstract
Discovery of an association between gadolinium-based contrast agents (GBCAs) and nephrogenic systemic fibrosis (NSF) has led to less use of GBCA-enhanced magnetic resonance imaging in dialysis patients and patients with severe renal failure at risk of NSF, and the virtual elimination of new cases of NSF. But shifting patients with renal failure to alternative imaging methods may subject patients to other risks (e.g., ionizing radiation or iodinated contrast). This review paper examines 370 NSF cases reported in 98 articles to analyze NSF risk factors. Eliminating multiple risk factors by limiting GBCA dose to a maximum of 0.1 mmol/kg, dialyzing patients undergoing dialysis quickly following GBCA administration, delaying GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in patients with renal failure especially when there are proinflammatory conditions may substantially reduce the risk of NSF.
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Affiliation(s)
- Zhitong Zou
- Department of Radiology, Weill Medical College of Cornell University, New York, New York, USA
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Abstract
Nephrogenic systemic fibrosis is a new disease whose incidence has peaked and receded over the past decade. It occurs in the presence of significant renal impairment, either acute or chronic (MDRD creatinine clearance of <30 mL/min/1.73 m(2)), and is associated with the administration of gadolinium-based contrast (GBC). Since 2006, the incidence of this disease has decreased markedly in patients with renal impairment, mainly owing to protocols that have not administered GBC to patients with creatinine clearances of less than 30 mL/min/1.73 m(2), and in some cases with the use of less toxic and lower doses of GBC. The purpose of this article is to review the current status of GBC use for imaging in patients with kidney disease.
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Perazella MA, Reilly RF. Imaging patients with kidney disease: how do we approach contrast-related toxicity? Am J Med Sci 2011; 341:215-21. [PMID: 21139495 DOI: 10.1097/maj.0b013e3181f016e6] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The approach to imaging patients with kidney disease with iodinated radiocontrast and gadolinium-based contrast has changed dramatically in recent times. The complications of these contrast agents, radiocontrast nephropathy and nephrogenic systemic fibrosis, respectively, underlie the changes in the imaging practice used in these patients. Rather than to completely avoid the use of these contrast agents, one must remain judicious in the choice of imaging modality in this group of patients. A prudent approach would be to (1) identify patients at high risk to develop contrast-related complications, (2) use noncontrast-based imaging techniques in these patients, as long as they are suitably diagnostic and safe and (3) if the risk:benefit ratio of the imaging information favors a contrast-based study, then appropriate prophylactic steps and use of contrast agents with the lowest risk of complication should be used after obtaining informed consent. This will allow one to maximize the diagnostic efficiency while also limiting the adverse effects.
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Affiliation(s)
- Mark A Perazella
- Section of Nephrology, Department of Medicine, Yale University School of Medicine, VA Connecticut Health Care System, New Haven, 06520-8029, USA.
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Gauden AJ, Phal PM, Drummond KJ. MRI safety: nephrogenic systemic fibrosis and other risks. J Clin Neurosci 2010; 17:1097-104. [PMID: 20542435 DOI: 10.1016/j.jocn.2010.01.016] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2009] [Revised: 01/10/2010] [Accepted: 01/17/2010] [Indexed: 01/29/2023]
Abstract
Magnetic resonance imaging (MRI) is now a commonly used imaging modality in many neurosurgical and neurological conditions. Although generally regarded as safe, there are a number of important safety considerations. These include a recently recognised, rare condition termed nephrogenic systemic fibrosis (NSF) that occurs in patients with significant renal impairment who receive gadolinium based contrast. Currently, NSF remains poorly understood and there is no universally effective treatment beyond the avoidance of contrast in patients with significant renal impairment. Other safety considerations include MRI contraindicated devices and the role of MRI in pregnancy.
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Affiliation(s)
- Andrew J Gauden
- Department of Neurosurgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia.
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Prince MR, Zhang HL, Roditi GH, Leiner T, Kucharczyk W. Risk factors for NSF: a literature review. J Magn Reson Imaging 2010; 30:1298-308. [PMID: 19937930 DOI: 10.1002/jmri.21973] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
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. Nearly half of NSF cases are a milder form that does not cause contractures or reduce mobility. It appears that eliminating even a single risk factor can reduce NSF incidence/risk at least 10-fold. Elimination of multiple risk factors by using single-dose GBCA, dialyzing dialysis patients quickly following GBCA administration, avoiding GBCA in acute renal failure while serum creatinine is rising, and avoiding nonionic linear GBCA in renal failure patients may reduce NSF risk more than a thousand-fold, thereby allowing safe GBCA-enhanced MRI in virtually all patients. J. Magn. Reson. Imaging 2009;30:1298-1308. (c) 2009 Wiley-Liss, Inc.
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Affiliation(s)
- Martin R Prince
- Department of Radiology, Weill Medical College of Cornell University, Ithaca, New York, USA.
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Abstract
Nephrogenic systemic fibrosis (NSF) has now been linked to gadolinium-based contrast (GBC) exposure in those with compromised kidney function, particularly those with end-stage renal disease (ESRD). When ESRD is present, symptoms can be quite devastating for the patient including severe pain and immobility and even death. For those at risk, avoidance of GBC exposure, whenever possible, is absolutely essential to prevent this potentially devastating complication. Identifying those at risk depends in some circumstances on appropriate recognition of renal dysfunction and understanding appropriate use of glomerular filtration rate (GFR) estimation formulas. Although hemodialysis (but not peritoneal dialysis) removes gadolinium, the availability of dialysis should never be used as a justification for GBC use in this high-risk population. Unfortunately there is a lack of a universally effective therapy. Resolution of acute kidney injury (AKI) appears to attenuate disease in most cases, while kidney transplantation has been associated with variable success.
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Affiliation(s)
- Derek M Fine
- Department of Medicine, Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
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11
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Zou Z, Ma L, Li H. Incidence of nephrogenic systemic fibrosis at Chinese PLA General Hospital. J Magn Reson Imaging 2009; 30:1309-12. [DOI: 10.1002/jmri.21769] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Thomsen HS. How to Avoid Nephrogenic Systemic Fibrosis: Current Guidelines in Europe and the United States. Radiol Clin North Am 2009; 47:871-5, vii. [DOI: 10.1016/j.rcl.2009.05.002] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Kribben A, Witzke O, Hillen U, Barkhausen J, Daul AE, Erbel R. Nephrogenic Systemic Fibrosis. J Am Coll Cardiol 2009; 53:1621-8. [DOI: 10.1016/j.jacc.2008.12.061] [Citation(s) in RCA: 137] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 12/03/2008] [Accepted: 12/08/2008] [Indexed: 12/12/2022]
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Cordova KB, Oberg TJ, Malik M, Robinson-Bostom L. Dermatologic Conditions Seen in End-Stage Renal Disease. Semin Dial 2009; 22:45-55. [PMID: 19250446 DOI: 10.1111/j.1525-139x.2008.00534.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Katharine B Cordova
- Department of Dermatology, Warren Alpert Medical School of Brown University, Providence, Rhode Island 02903, USA
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Perazella MA. How should nephrologists approach gadolinium-based contrast imaging in patients with kidney disease? Clin J Am Soc Nephrol 2008; 3:649-51. [PMID: 18385396 DOI: 10.2215/cjn.00670208] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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