| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
|
|
|
|||||||
|
|||||||||
Genitourinary Imaging |
1 From the Renal Unit (T.A.C., P.C.T., S.T.W.M., K.S.) and Radiology Department (G.H.R.), Glasgow Royal Infirmary, Castle Street, 3rd Floor Walton Bldg, Glasgow G4 0SF, Scotland; and Renal Unit, Level 7, Western Infirmary, Glasgow, Scotland (P.B.M., J.P.T., A.G.J.). Received February 20, 2007; revision requested March 20; revision received April 2; accepted April 16; final version accepted May 2. Address correspondence to P.C.T. (e-mail: peter.thomson{at}northglasgow.scot.nhs.uk).
 |
ABSTRACT |
|---|
 TOP ABSTRACT INTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
Materials and Methods: The ethics committees granted exempt status for this study and also waived the need for informed consent. A retrospective analysis was performed of all adult patients undergoing dialysis in the west of Scotland between January 1, 2000, and July 1, 2006. Diagnoses of nephrogenic systemic fibrosis, episodes of gadolinium-enhanced magnetic resonance (MR) imaging, and cumulative doses of gadolinium-based contrast agent were recorded. Outcomes were analyzed by means of parametric and nonparametric testing.
Results: Fourteen of 1826 patients had a diagnosis of nephrogenic systemic fibrosis. Mortality was similar for affected and nonaffected patients. Thirteen (93%) of 14 patients with nephrogenic systemic fibrosis had undergone gadolinium-enhanced MR imaging compared with 408 (22.5%) of 1812 nonaffected patients (P < .001). Patients with nephrogenic systemic fibrosis received a higher median cumulative dose of gadodiamide (0.39 vs 0.23 mmol per kilogram of body weight, P = .008) and underwent more gadolinium-enhanced MR imaging than their nonaffected gadolinium-exposed counterparts.
Conclusion: The data support a positive association between gadolinium-based contrast agent administration and development of nephrogenic systemic fibrosis in the established renal failure population; in addition, there is a positive association between cumulative dose of gadodiamide used and dosing events.
© RSNA, 2007
|
INTRODUCTION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
Published reports describe cutaneous presentation with thickened, edematous, indurated, or discolored skin affecting the limbs and trunk. The face is typically spared. Progression may occur over weeks, resulting in joint contractures and severe restriction of movement (3–6). Multiorgan involvement has been observed in some patients, which emphasizes the systemic nature of this condition (7–9). Mortality is high, with death occurring often from sepsis as a complication of immobility or from hypoventilation if lung and diaphragm involvement occurs. Improvement has been reported following recovery of renal function, either spontaneously, after renal transplantation, or with immunomodulatory treatments including extracorporeal photophoresis and phototherapy (10–13).
Histologically, skin lesions demonstrate dermal thickening with deep penetration of collagen bundles into the superficial fascia. Staining for dermal mucin is positive (1). Fibrous bundles contain CD34/procollagen-expressing fibroblast-like and CD68/factor VIIIa–expressing dendritic-like cells. Dermal cells expressing CD34 support the concept of a bone marrow–derived "circulating fibrocyte" playing a pathogenic role (14). A combination of pathologic and laboratory features distinguishes NSF from similar conditions, including systemic sclerosis, scleromyxoedema, and eosinophilic vasculitis. These features include the absence of anti-scl70 and anticentromere antibodies, as well as normal serum electrophoresis (3,15).
Demographically, patients with NSF are similar to the general established renal failure (ERF) population, although mean age is lower among patients with NSF (3,16). Vascular disease, thrombotic events, chronic liver disease, and the presence of antiphospholipid antibodies have been associated with NSF although not implicated in its pathogenesis (4,5,15,17–19). Since 1998, the increasing use of gadolinium-enhanced magnetic resonance (MR) imaging in ERF to avoid exposure to iodinated contrast material parallels the description of patients with NSF. Furthermore, MR imaging is increasingly being used for pretransplantation investigation (20). Authors of recent studies have explored the association between NSF and exposure to gadolinium-containing contrast material and have reported a relatively high frequency of gadolinium-enhanced MR imaging in patients prior to their developing NSF (21–23). To our knowledge, there is currently no formal case-control series in which to assess this association or determine if there is a cumulative dose–related relationship between gadolinium-based contrast agents and the subsequent development of NSF. Thus, the purpose of our study was to retrospectively compare the frequency of administration and cumulative dose of gadolinium-based contrast agent in dialysis-dependent patients who did and those who did not develop NSF.
|
MATERIALS AND METHODS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
Patients were identified through a search of our unitary electronic patient record (K.S., J.P.T.), a computerized database containing details of all patients who have ever been referred to either of the two units. The patient record was searched to derive the details of all patients within the two hospitals who had undergone RRT for stage 5 chronic kidney disease between January 1, 2000, and July 1, 2006. Patients who had functioning renal grafts throughout the study period and thus did not undergo dialysis and all patients who underwent RRT for acute renal failure for less than 90 days were excluded since they did not meet the criteria for the category of stage 5 chronic kidney disease. Demographics such as age, sex, underlying renal diagnosis, time undergoing RRT, mode of RRT, and mortality were recorded from the electronic patient record for the full cohort.
Database Interrogation
The diagnosis entries on the electronic patient record for all patients undergoing RRT with stage 5 chronic kidney disease were then searched (K.S., J.P.T., T.A.C.) for the terms "nephrogenic," "systemic," "fibrosis," "fibrosing," "dermopathy," "scleroderma," "scleromyxoedema," and "sclerosis." All patients with a positive match for any of these search terms were reviewed thoroughly with respect to clinical history and histopathologic records to determine those patients with a diagnosis of NSF (T.A.C., P.B.M., P.C.T.). If the original biopsy specimens were available, these specimens underwent further review by a pathologist to ensure the validity of the original diagnosis. Age at start of RRT, age at diagnosis of NSF, sex, cause of renal failure, dialysis modality, time undergoing RRT, presence of a confirmatory skin biopsy finding, serum bicarbonate level (in millimoles per liter) at time of MR imaging, subsequent treatment, recovery of renal function, clinical outcome, duration of follow-up, and time between imaging and a subsequent diagnosis of NSF were recorded (T.A.C., P.B.M., P.C.T.) for each patient with NSF.
The electronic patient record was then interrogated (K.S., J.P.T., T.A.C., P.B.M., P.C.T.) with regard to the cohort's previous exposure to MR imaging. The type of MR system used, number and type of gadolinium-enhanced MR studies, cumulative dose of gadolinium-based contrast agent (in milliliters), cumulative dose adjusted for weight (millimoles per kilogram of body weight), average dose per MR study (millimoles per kilogram per study), and type of gadolinium chelate were recorded (T.A.C., P.B.M., P.C.T.) for each patient. Where complete data were not provided in the radiology reports contained in the electronic patient record, hand searching of the radiology departmental records was conducted (P.B.M., P.C.T., G.H.R.). Gadolinium exposure was calculated (T.A.C., P.B.M., P.C.T., G.H.R.) over the 6-year period for all non-NSF patients and for the period from January 1, 2000, until the first presentation of disease for all patients in the NSF group. Weight-adjusted dose was calculated (T.A.C., P.B.M., P.C.T., G.H.R.) by using the dry weight at the time of imaging in the case of hemodialysis patients or recorded weight within 6 weeks of imaging. The number of MR examinations performed prior to and following the diagnosis of NSF was recorded (T.A.C., P.C.T.) for each patient with NSF. The cumulative frequency of gadolinium-enhanced MR and NSF cases was recorded (T.A.C., P.C.T.) for the study period.
Statistical Analysis
Statistical analysis was performed by using SPSS software (version 12.0.1; SPSS, Chicago, Ill) (P.C.T., P.B.M.). Shapiro-Wilk testing for normality was performed on continuous variables with rejection of the null hypothesis of normality at a significance level of 
.05. Testing for equality or homogeneity of variance was conducted by using Levene tests. For continuous normally distributed variables with homogeneous variances, Student t test was used to assess differences between NSF and non-NSF groups. For continuous variables that did not meet normality assumptions, the Wilcoxon rank sum test was used to assess differences between NSF and non-NSF groups. The 
2 test was conducted on categorical variables.
Specifically, difference in mean age between patients with and those without NSF was assessed with the Student t test. Prevalence of gadolinium-enhanced MR exposure between NSF and non-NSF groups was assessed by using the 2 test. The number of gadolinium-enhanced MR examinations per patient in each group was regarded as a Poisson random variable, with analysis of the difference between groups conducted by using the method of Rothman and Boice. The difference in distribution of gadolinium-based contrast agent dose (in milliliters and in millimoles per kilogram of body weight) and distribution of gadolinium-based contrast material dose (milliliters per kilogram per examinations) in the NSF and non-NSF groups were assessed by means of the Wilcoxon rank sum test. Differences in sex and mortality were assessed with the 2 test. All reported P values were based on two-sided testing, with a significance level set at .05.
|
RESULTS |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
MR Characteristics in the ERF Population
Over the 6-year period, 421 (23.1%) of 1826 patients underwent a total of 542 gadolinium-enhanced MR examinations. Examinations performed with contrast-enhanced MR included angiography (430 of 542, 79.3%), cardiac studies (90 of 542, 16.6%), and central nervous system imaging (22 of 542, 4.1%). A total of 379 (69.9%) of 542 contrast-enhanced MR examinations were performed with 1.5-T superconducting systems, while 163 (30.1%) were performed with 1.0-T superconducting systems. Most examinations were assigned 30-minute appointments, except for cardiac studies, which were usually scheduled 1.5 hours. However, the exact duration for static radiofrequency field and pulse sequence varying fields would have been variable and was not recorded. Four hundred eighty (88.6%) MR imaging examinations were performed with gadodiamide (Omniscan; GE Healthcare, Chalfont St Giles, England), with a median dose volume of 30 mL, reflecting the predominant use of this agent in the west of Scotland since 1998. Sixty-two (11.4%) MR examinations were performed by using other gadolinium-containing contrast agents as follows: 41 were performed with gadobenate dimeglumine (Multihance; Bracco, Milan, Italy) as the contrast agent, with a median dose volume of 15 mL; 13 were performed with gadopentetate dimeglumine (Magnevist; Berlex, Quebec, Canada), with a median dose of 15 mL; six were performed with gadobutrol (Gadovist; Schering, West Sussex, England), with a median dose of 15 mL; and two were performed with gadofosveset trisodium (Vasovist; Schering), with a median dose of 10 mL. The annual incidence of gadolinium-enhanced MR imaging among the cohort increased steadily until 2004, with fewer examinations performed in 2005 and a subsequent reduction in contrast-enhanced MR imaging in patients undergoing RRT in response to the U.S. Food and Drug Administration warning issued in June 2006. The incidence of NSF parallels the rise in MR imaging utilization in the RRT cohort (Figure).
|
|
|
|
|
The time between gadolinium-based contrast material exposure and presentation with NSF ranged between 2 and 2395 days (median time, 76 days). Five patients developed NSF more than 90 days after receiving gadodiamide. Of these, three had a time to onset of more than 1 year. Six patients in the NSF group had undergone previous gadolinium-enhanced MR imaging without apparent complication, and eight went on to undergo further exposure after presentation with NSF.
Outcome
Within the full cohort, no significant difference between NSF and non-NSF groups was found with regard to mortality (P = .77). At the end of the study period, six (42.9%) of 14 patients with NSF had died; however, the follow-up period for four of the remaining eight patients was less than 3 months. The median time to death following diagnosis of NSF was 215 days. The cause of death in three patients was recorded as sepsis related and occurred in the hospital, two patients had an in-hospital cardiac arrest (one in the context of hyperkalemia), and one patient died suddenly at home. Postmortem examinations were not performed and as such the contribution of NSF is unclear. Two patients demonstrated mild functional improvement determined by means of regular review at dialysis outpatient clinics and patient self-reporting of symptoms: Patient 2 started extracorporeal photophoresis in January 2005, and patient 6 had spontaneous improvement of renal function to an estimated glomerular filtration rate of 49 mL/min. Patient 5 started extracorporeal photophoresis in June 2006, and patient 12 received a functioning renal transplant in June 2006, but there was no detectable clinical improvement in the NSF in these two patients at the end of the study period.
|
DISCUSSION |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
Over 95% of patients with NSF reported in the NSF registry were exposed to gadolinium-based contrast material (24). One patient in our study developed biopsy-proved NSF without exposure to gadolinium-based contrast material. The reasons for this are unclear, but this case suggests that gadolinium-based contrast material in isolation does not cause NSF. This patient died prior to the initiation of data collection but exhibited many features associated with NSF (25), including previous thrombotic vascular disease (diagnosed by means of conventional angiography), chronic hepatitis C infection, and dependency on RRT. As an isolated patient, further analysis is unlikely to be informative. Similarly, in patients exposed to gadolinium-based contrast material, although the median time from contrast agent administration to the onset of NSF symptoms was 76 days, in four patients there was a period of months to years before clinical features developed. This lag time is longer than that reported by other groups (21–23,26). The findings in these individual patients suggest that use of gadolinium, although causally implicated, is not the only factor involved in NSF.
Some patients report a gradual improvement over time; however, complete recovery with ongoing stage 5 kidney disease has not been reported. Approximately 5% of patients have a fulminant and aggressive course that may rapidly result in death (25). Despite relatively short follow-up times, our cohort outcome is in keeping with that of other published reports. In addition, mortality was not increased for patients with NSF when compared with the ERF population in general.
Findings of two recent studies using spectroscopy have demonstrated the presence of gadolinium in the skin of some, but not all, patients with NSF (27,28). The authors speculate that gadolinium is phagocytosed by macrophages, triggering a profibrotic cytokine cascade. Therefore these studies, along with our work, strengthen the association between gadolinium-based contrast agents and development of NSF but do not prove causation.
No consistently successful treatment for NSF has emerged, but extracorporeal photophoresis, or ECP, has been more widely advocated (10,11). One patient in our cohort has undergone ECP with some improvement, and a second patient commenced treatment just prior to the end of the study period. ECP involves extracorporeal exposure of blood cells to photoactivated 8-methoxypsoralen, after which the blood cells are subsequently reinfused. Whether ECP targets circulating fibrocytes implicated in the pathogenesis of NSF remains speculative (10). Restoration of renal function, whether by means of treatment of the underlying renal disease or by means of renal transplantation is likely to be of benefit, if only because impaired renal function is a consistent finding in all patients with NSF.
Gadodiamide is distributed in the extracellular fluid and is excreted unchanged by the kidneys with an elimination half-life of 80–100 minutes in patients with normal renal function. Ninety-five percent of administered gadodiamide is excreted at 72 hours in those with normal renal function (29). Studies to assess the pharmacokinetics of gadolinium-based contrast agents in end stage renal disease are limited: In patients with a glomerular filtration rate of 2–10 mL/min, not undergoing dialysis, the elimination half-life of intravenously injected gadodiamide is approximately 34 hours, and 65% of the gadodiamide injected was eliminated during a hemodialysis session (30). Peritoneal clearance appears to be less effective at gadodiamide removal: Approximately 69% is excreted over a 22-day period in patients undergoing peritoneal dialysis (30). Recently three patients have been described who developed NSF developed despite daily hemodialysis for 3 days immediately following gadodiamide exposure (21). Perhaps more pertinent to our current study is the theoretically higher risk of transmetallation (release of toxic free gadolinium from the gadodiamide chelate) with gadodiamide in circumstances of reduced elimination occurring in renal impairment. Gadodiamide has a lower conditional stability constant compared with other gadolinium chelates, despite the addition of excess chelate (31–33). Transmetallation has not been observed in pharmacokinetic studies in patients with ERF and remains to be implicated in the development of NSF.
It has been suggested that acidosis at the time of MR imaging exposure might be important, possibly by means of transmetallation (22,31).This has not been observed in subsequent studies, including our own. The mean bicarbonate level (24.1 mmol/L) in our patients who developed NSF was normal. However, spot serum bicarbonate levels may be misleading, since they will vary depending on sampling time with respect to dialysis. Other authors have commented on hematologic abnormalities, including anemia and hypoalbuminemia, in patients with NSF (26). These data are difficult to interpret because patients may undergo imaging to investigate comorbid conditions, including vascular disease or sepsis, which may be responsible for such abnormalities.
A link between gadolinium-based contrast agents, in particular gadodiamide, and NSF was first postulated in January 2006 (22), with subsequent reports emerging (21,23,31). To date, only a handful of patients with NSF have been linked to non-gadodiamide preparations (24), which implies that the properties of the chelating molecule itself or an interaction between gadodiamide and the uremic milieu leads to development of NSF. It is not clear if alternative gadolinium-based agents are safer or if the preponderance of patients with NSF related to gadodiamide simply reflect its pattern of use. The findings of our current study are in keeping with other published observations and extend this association by demonstrating a dose-dependent relationship.
As a retrospective study, our report has limitations, but by thorough patient review we have attempted to control for these limitations. The duration of each MR examination was not recorded, and the examinations were performed with different MR systems; hence, we cannot comment on any relationship between imaging duration, magnetic field strength, or MR system type and the development of NSF. Our study population was restricted to those with chronic kidney disease stage 5, and thus we cannot comment on the risk of NSF in patients with acute renal failure or other stages of chronic kidney disease. Two patients with NSF did not undergo skin biopsy and thus histologic confirmation of the diagnosis could not be made. Similarly, we cannot exclude the possibility that other patients with NSF were not diagnosed, as awareness of the disease was limited 6 years ago. The number of patients with NSF is small, which limits detailed statistical analyses, such as multivariate analyses, that could be used to examine independence of association alongside other variables such as medications and other medical diseases. Use of the NSF registry will allow these analyses to be performed (2). In the future, it is likely that fewer contrast-enhanced MR examinations will be performed in patients with advanced renal failure, which will both limit diagnostic testing and will expose patients to the well-defined risks of radiation, iodinated contrast material, and intervention associated with conventional angiography. The latter is of particular concern given that the majority of MR examinations performed in our ERF population were for vascular imaging.
The findings of this study confirm the association between gadodiamide-enhanced MR imaging and the development of NSF in patients with stage 5 chronic kidney disease and undergoing RRT. Many centers worldwide have accepted the link between gadolinium-based contrast agents and NSF, changing practice prior to fulfillment of the Koch postulates of causation. As patient care is paramount, this is a reasonable course of action. If there is no alternative to the use of gadodiamide, the lowest diagnostic dose should be used and prompt dialysis after imaging may facilitate removal of gadodiamide. However, on the basis of our findings, together with those of other studies, gadodiamide should no longer be considered as without risk for use in patients with advanced renal failure (glomerular filtration rate of < 15 mL/min) who are undergoing RRT.
|
ADVANCES IN KNOWLEDGE |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
|
IMPLICATIONS FOR PATIENT CARE |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
|
ACKNOWLEDGMENTS |
|---|
|
FOOTNOTES |
|---|
Abbreviations: ERF = established renal failure • NSF = nephrogenic systemic fibrosis • RRT = renal replacement therapy
Author contributions: Guarantors of integrity of entire study, T.A.C., P.C.T.; study concepts/study design or data acquisition or data analysis/interpretation, all authors; manuscript drafting or manuscript revision for important intellectual content, all authors; manuscript final version approval, all authors; literature research, T.A.C., P.C.T., P.B.M., A.G.J., G.H.R.; clinical studies, all authors; statistical analysis, T.A.C., P.C.T., P.B.M., A.G.J.; and manuscript editing, all authors
Authors stated no financial relationship to disclose.
|
References |
|---|
|
TOPABSTRACTINTRODUCTIONMATERIALS AND METHODSRESULTSDISCUSSIONADVANCES IN KNOWLEDGEIMPLICATIONS FOR PATIENT CAREReferences |
|---|
This article has been cited by other articles:
|
|
 |
|
  I. Boehm Which laboratory parameters are characteristic for nephrogenic systemic fibrosis? Nephrol. Dial. Transplant., July 1, 2009; 24(7): 2293 - 2293. [Full Text] [PDF]
|
|
|
|
 |
|
 M. F. Morris, Y. Zhang, H. Zhang, J. C. Prowda, D. N. Silvers, R. A. Fawwaz, and M. R. Prince Features of Nephrogenic Systemic Fibrosis on Radiology Examinations Am. J. Roentgenol., July 1, 2009; 193(1): 61 - 69. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Agarwal, S. M. Brunelli, and C. A. Umscheid Reply Nephrol. Dial. Transplant., July 1, 2009; 24(7): 2293 - 2294. [Full Text] [PDF]
|
|
|
|
|
|
M. D. Bridges, B. S. St. Amant, R. B. McNeil, J. G. Cernigliaro, J. P. Dwyer, and P. M. Fitzpatrick High-Dose Gadodiamide for Catheter Angiography and CT in Patients With Varying Degrees of Renal Insufficiency: Prevalence of Subsequent Nephrogenic Systemic Fibrosis and Decline in Renal Function Am. J. Roentgenol., June 1, 2009; 192(6): 1538 - 1543. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. W. Roemer, A. Guermazi, Y. Zhang, M. Yang, D. J. Hunter, M. D. Crema, and K. Bohndorf Hoffa's Fat Pad: Evaluation on Unenhanced MR Images as a Measure of Patellofemoral Synovitis in Osteoarthritis Am. J. Roentgenol., June 1, 2009; 192(6): 1696 - 1700. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Anzidei, A. Napoli, B. C. Marincola, I. Nofroni, D. Geiger, F. Zaccagna, C. Catalano, and R. Passariello Gadofosveset-enhanced MR Angiography of Carotid Arteries: Does Steady-State Imaging Improve Accuracy of First-Pass Imaging? Comparison with Selective Digital Subtraction Angiography Radiology, May 1, 2009; 251(2): 457 - 466. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 G. Roditi MRI contrast agent safety in renal impairment Clin Risk, March 1, 2009; 15(2): 47 - 53. [Full Text] [PDF]
|
|
|
|
|
|
R. Agarwal, S. M. Brunelli, K. Williams, M. D. Mitchell, H. I. Feldman, and C. A. Umscheid Gadolinium-based contrast agents and nephrogenic systemic fibrosis: a systematic review and meta-analysis Nephrol. Dial. Transplant., March 1, 2009; 24(3): 856 - 863. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Perazella Current Status of Gadolinium Toxicity in Patients with Kidney Disease Clin. J. Am. Soc. Nephrol., February 1, 2009; 4(2): 461 - 469. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Poschenrieder, O. W. Hamer, T. Herold, T. Schleicher, I. Borisch, S. Feuerbach, and N. Zorger Diagnostic Accuracy of Intraarterial and IV MR Angiography for the Detection of Stenoses of the Infrainguinal Arteries Am. J. Roentgenol., January 1, 2009; 192(1): 117 - 121. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Tomasian, N. Salamon, D. G. Lohan, M. Jalili, J. P. Villablanca, and J. P. Finn Supraaortic Arteries: Contrast Material Dose Reduction at 3.0-T High-Spatial-Resolution MR Angiography--Feasibility Study Radiology, December 1, 2008; 249(3): 980 - 990. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. H. Kuo NSF-Active and NSF-Inert Species of Gadolinium: Mechanistic and Clinical Implications Am. J. Roentgenol., December 1, 2008; 191(6): 1861 - 1863. [Full Text] [PDF]
|
|
|
|
|
|
J. C. Weinreb Which Study When? Is Gadolinium-enhanced MR Imaging Safer than Iodine-enhanced CT? Radiology, October 1, 2008; 249(1): 3 - 8. [Full Text] [PDF]
|
|
|
|
|
|
F. G. Shellock and A. Spinazzi MRI Safety Update 2008: Part 1, MRI Contrast Agents and Nephrogenic Systemic Fibrosis Am. J. Roentgenol., October 1, 2008; 191(4): 1129 - 1139. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. R. Prince, H. Zhang, M. Morris, J. L. MacGregor, M. E. Grossman, J. Silberzweig, R. L. DeLapaz, H. J. Lee, C. M. Magro, and A. M. Valeri Incidence of Nephrogenic Systemic Fibrosis at Two Large Medical Centers Radiology, September 1, 2008; 248(3): 807 - 816. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. Wertman, , BA, E. Altun, D. R. Martin, D. G. Mitchell, J. R. Leyendecker, R. B. O'Malley, D. J. Parsons, E. R. Fuller III, and R. C. Semelka Risk of Nephrogenic Systemic Fibrosis: Evaluation of Gadolinium Chelate Contrast Agents at Four American Universities Radiology, September 1, 2008; 248(3): 799 - 806. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. G. Lansberg, V. N. Thijs, R. Bammer, J.-M. Olivot, M. P. Marks, L. R. Wechsler, S. Kemp, and G. W. Albers The MRA-DWI Mismatch Identifies Patients With Stroke Who Are Likely to Benefit From Reperfusion Stroke, September 1, 2008; 39(9): 2491 - 2496. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. M. Rofsky, A. D. Sherry, and R. E. Lenkinski Nephrogenic Systemic Fibrosis: A Chemical Perspective Radiology, June 1, 2008; 247(3): 608 - 612. [Full Text] [PDF]
|
|
|
|
|
|
Y. Tsushima, A. Takahashi-Taketomi, and K. Endo Nephrogenic Systemic Fibrosis in Japan: Advisability of Keeping the Administered Dose as Low as Possible Radiology, June 1, 2008; 247(3): 915 - 916. [Full Text] [PDF]
|
|
|
|
|
|
M. A. Perazella How Should Nephrologists Approach Gadolinium-based Contrast Imaging in Patients with Kidney Disease? Clin. J. Am. Soc. Nephrol., May 1, 2008; 3(3): 649 - 651. [Full Text] [PDF]
|
|
|
|
 |
|
 L R Williams, M J Oldale, and A J Bradley Imaging renal masses and staging renal tumours Imaging, March 1, 2008; 20(1): 73 - 86. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. M. Shabana, R. H. Cohan, J. H. Ellis, H. K. Hussain, I. R. Francis, L. D. Su, S. K. Mukherji, and R. D. Swartz Nephrogenic Systemic Fibrosis: A Report of 29 Cases Am. J. Roentgenol., March 1, 2008; 190(3): 736 - 741. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. Kahana, M. J. Lucarelli, A. M. Grayev, J. J. Van Buren, C. N. Burkat, and L. R. Gentry Noninvasive Dynamic Magnetic Resonance Angiography With Time-Resolved Imaging of Contrast KineticS (TRICKS) in the Evaluation of Orbital Vascular Lesions Arch Ophthalmol, December 1, 2007; 125(12): 1635 - 1642. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Nephrogenic Systemic Fibrosis: A Presumed Complication of Gadolinium-Enhanced MRI Journal Watch (General), October 16, 2007; 2007(1016): 2 - 2. [Full Text]
|
|
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| HOME | HELP | FEEDBACK | SUBSCRIPTIONS | ARCHIVE | SEARCH | TABLE OF CONTENTS |
| RADIOLOGY | RADIOGRAPHICS | RSNA JOURNALS ONLINE |
= incidence of NSF. The increasing use of MR parallels the identification of patients with NSF.