Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines
TL;DR: The history, clinical features and prevalence of nephrogenic systemic fibrosis and the current understanding of its pathophysiology are reviewed and the risk factors for NSF are discussed and prophylactic measures are recommended.
Abstract: Purpose
To update the guidelines of the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) on nephrogenic systemic fibrosis and gadolinium-based contrast media.
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TL;DR: IV LOCM is a nephrotoxic risk factor in patients with a stable eGFR less than 30 mL/min/1.73 m(2) or greater, with a trend toward significance at 30-44 mL/Min/1m(2), while IV LOCM does not appear to be a nePHrotoxic Risk Factor in patientsWith stable renal function.
Abstract: Intravenous low-osmolality contrast material is a nephrotoxic risk factor in patients with stable estimated glomerular filtration (eGFR) rate of less than 30 mL/min/1.73 m2, with a trend toward significance in patients with stable eGFR of 30–44 mL/min/1.73 m2.
312 citations
Radboud University Nijmegen Medical Centre1, Institut Gustave Roussy2, Medical University of Vienna3, Charité4, University of Nottingham5, Ninewells Hospital6, Medical University of Graz7, University of Cambridge8, RWTH Aachen University9, Sapienza University of Rome10, University of Navarra11, University Medical Center Utrecht12, Oslo University Hospital13, University of Milan14
TL;DR: Information on breast MRI concerns advantages/disadvantages and preparation to the examination, and Claustrophobia, implantable devices, allergic predisposition, and renal function should be checked.
Abstract: This paper summarizes information about breast MRI to be provided to women and referring physicians. After listing contraindications, procedure details are described, stressing the need for correct scheduling and not moving during the examination. The structured report including BI-RADS® categories and further actions after a breast MRI examination are discussed. Breast MRI is a very sensitive modality, significantly improving screening in high-risk women. It also has a role in clinical diagnosis, problem solving, and staging, impacting on patient management. However, it is not a perfect test, and occasionally breast cancers can be missed. Therefore, clinical and other imaging findings (from mammography/ultrasound) should also be considered. Conversely, MRI may detect lesions not visible on other imaging modalities turning out to be benign (false positives). These risks should be discussed with women before a breast MRI is requested/performed. Because breast MRI drawbacks depend upon the indication for the examination, basic information for the most important breast MRI indications is presented. Seventeen notes and five frequently asked questions formulated for use as direct communication to women are provided. The text was reviewed by Europa Donna–The European Breast Cancer Coalition to ensure that it can be easily understood by women undergoing MRI. • Information on breast MRI concerns advantages/disadvantages and preparation to the examination
• Claustrophobia, implantable devices, allergic predisposition, and renal function should be checked
• Before menopause, scheduling on day 7–14 of the cycle is preferred
• During the examination, it is highly important that the patient keeps still
• Availability of prior examinations improves accuracy of breast MRI interpretation
308 citations
Cites background from "Nephrogenic systemic fibrosis and g..."
...73 m(2)), contrast injection implies a real, but very low risk of a rare disease called nephrogenic systemic fibrosis [13]; CE MRI is also generally contraindicated in pregnant women, but this condition should be evaluated on a case-by-case basis [14]....
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Bayer Corporation1, University of Wisconsin-Madison2, University of Southern California3, Seoul National University Hospital4, Utrecht University5, Capital Medical University6, Ludwig Maximilian University of Munich7, Cornell University8, University of Bonn9, Yale University10, Komazawa University11
TL;DR: An overview on the history of MRI and contrast media development is provided, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives.
Abstract: In 1988, the first contrast agent specifically designed for magnetic resonance imaging (MRI), gadopentetate dimeglumine (Magnevist®), became available for clinical use. Since then, a plethora of studies have investigated the potential of MRI contrast agents for diagnostic imaging across the body, including the central nervous system, heart and circulation, breast, lungs, the gastrointestinal, genitourinary, musculoskeletal and lymphatic systems, and even the skin. Today, after 25 years of contrast-enhanced (CE-) MRI in clinical practice, the utility of this diagnostic imaging modality has expanded beyond initial expectations to become an essential tool for disease diagnosis and management worldwide. CE-MRI continues to evolve, with new techniques, advanced technologies, and novel contrast agents bringing exciting opportunities for more sensitive, targeted imaging and improved patient management, along with associated clinical challenges. This review aims to provide an overview on the history of MRI and contrast media development, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives. Bayer HealthCare.
278 citations
University of British Columbia1, Oregon Health & Science University2, Cleveland Clinic3, University of Virginia4, Yale University5, Johns Hopkins University6, University of Toronto7, National Institutes of Health8, Biogen Idec9, University of Miami10, Wayne State University11, University of Basel12, University of New Mexico13
TL;DR: Suggestions for MR imaging protocols are given for the brain, for surveillance imaging for progressive multifocal leukoencephalopathy, for spinal cord imaging, and for the orbit, from an international group of neurologists and radiologists.
Abstract: An international group of neurologists and radiologists developed revised guidelines for standardized brain and spinal cord MR imaging for the diagnosis and follow-up of MS. A brain MR imaging with gadolinium is recommended for the diagnosis of MS. A spinal cord MR imaging is recommended if the brain MR imaging is nondiagnostic or if the presenting symptoms are at the level of the spinal cord. A follow-up brain MR imaging with gadolinium is recommended to demonstrate dissemination in time and ongoing clinically silent disease activity while on treatment, to evaluate unexpected clinical worsening, to re-assess the original diagnosis, and as a new baseline before starting or modifying therapy. A routine brain MR imaging should be considered every 6 months to 2 years for all patients with relapsing MS. The brain MR imaging protocol includes 3D T1-weighted, 3D T2-FLAIR, 3D T2-weighted, post-single-dose gadolinium-enhanced T1-weighted sequences, and a DWI sequence. The progressive multifocal leukoencephalopathy surveillance protocol includes FLAIR and DWI sequences only. The spinal cord MR imaging protocol includes sagittal T1-weighted and proton attenuation, STIR or phase-sensitive inversion recovery, axial T2- or T2*-weighted imaging through suspicious lesions, and, in some cases, postcontrast gadolinium-enhanced T1-weighted imaging. The clinical question being addressed should be provided in the requisition for the MR imaging. The radiology report should be descriptive, with results referenced to previous studies. MR imaging studies should be permanently retained and available. The current revision incorporates new clinical information and imaging techniques that have become more available.
266 citations
TL;DR: Laser ablation in liquid (LAL) has received considerable attention over the last decade, and is gradually becoming an irreplaceable technique to synthesize nanocrystals and fabricate functional nanostructures because it can offer effective solutions to some challenges in the field of nanotechnology as discussed by the authors.
261 citations
References
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Journal Article•
TL;DR: In the early 1990s, the National Kidney Foundation (K/DOQI) developed a set of clinical practice guidelines to define chronic kidney disease and to classify stages in the progression of kidney disease.
10,265 citations
TL;DR: Nine end stage renal disease patients undergoing magnetic resonance (MR) angiography are presented, in five of whom skin changes of nephrogenic fibrosing dermatopathy became apparent about 2–4 weeks after the administration of gadolinium-containing contrast agent for MR, demonstrating that Gd–DTPA possibly plays a triggering role in the development of NFD under certain circumstances.
Abstract: Nephrogenic fibrosing dermopathy (NFD) is an acquired, idiopathic disorder that is observed in patients with renal disease. Most patients with NFD have undergone dialysis for renal failure [1,2]. It tends to affect mostly the middle-aged. An association of NFD with coagulation abnormalities, recent vascular surgery or intervention (e.g. shunt/fistula and angioplasty), and presence of antiphospholipid antibodies has been discussed by several authors thus far [1,3], but the origin of the disease is still unknown. A more widespread variant of this fibrosing skin disease with involvement of other organs (e.g. lungs, liver, muscles and the heart) is described as nephrogenic systemic fibrosis (NSF) by Leboit [4], Ting et al. [5] and Daram et al. [6]. NFD is characterized clinically by thickening, induration and hardening of the skin. Distinct nodules also can be seen. The (distal) extremities are the most common area of involvement, followed by the trunk, and the face is almost never involved [1]. The diagnosis of NFD is confirmed in a skin biopsy by specific histopathologic features, namely thickened collagen bundles with surrounding clefts, mucin deposition and a proliferation of fibroblasts and elastic fibers. Signs of inflammation are absent, which makes this disorder a distinct entity [1,7]. In this report, nine end stage renal disease patients undergoing magnetic resonance (MR) angiography are presented, in five of whom skin changes of nephrogenic fibrosing dermatopathy became apparent about 2–4 weeks after the administration of gadolinium (Gd)-containing contrast agent for MR. Patients with and without NFD were compared for possible risk factors to develop this skin disease. Gd is thought to be safe as a contrast agent in renal failure. This case series however, demonstrates that Gd–DTPA possibly plays a triggering role in the development of NFD under certain circumstances.
1,730 citations
TL;DR: It is shown that gadodiamide plays a causative role in nephrogenic systemic fibrosis, and seven patients became severely disabled, and one died 21 mo after exposure.
Abstract: Nephrogenic systemic fibrosis is a new, rare disease of unknown cause that affects patients with renal failure. Single cases led to the suspicion of a causative role of gadodiamide that is used for magnetic resonance imaging. This study therefore reviewed all of the authors' confirmed cases of nephrogenic systemic fibrosis (n = 13) with respect to clinical characteristics, gadodiamide exposure, and subsequent clinical course. It was found that all had been exposed to gadodiamide before the development of nephrogenic systemic fibrosis. The delay from exposure to first sign of the disease was 2 to 75 d (median 25 d). Odds ratio for acquiring the disease when gadodiamide exposed was 32.5 (95% confidence interval 1.9 to 549.2; P < 0.0001). Seven (54%) patients became severely disabled, and one died 21 mo after exposure. No other exposure/event than gadodiamide that was common to more than a minority of the patients could be identified. These findings indicate that gadodiamide plays a causative role in nephrogenic systemic fibrosis.
1,284 citations
"Nephrogenic systemic fibrosis and g..." refers background in this paper
...[8] reported a further 13 cases, again after exposure to gadodiamide in patients with end-stage renal disease....
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TL;DR: 15 renal dialysis patients have been identified with a skin condition characterised by thickening and hardening of the skin of the extremities and an increase in dermal fibroblast-like cells associated with collagen remodelling and mucin deposition.
850 citations
"Nephrogenic systemic fibrosis and g..." refers background in this paper
...In 2000, Cowper published the first report about this new scleromyxoedemalike disease with fibrotic changes in the skin which occurred in renal dialysis patients [6]....
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TL;DR: The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN) with updated topics covered.
Abstract: The Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) has updated its 1999 guidelines on contrast medium-induced nephropathy (CIN). Topics reviewed include the definition of CIN, the choice of contrast medium, the prophylactic measures used to reduce the incidence of CIN, and the management of patients receiving metformin. Key Points
• Definition, risk factors and prevention of contrast medium induced nephropathy are reviewed.
• CIN risk is lower with intravenous than intra-arterial iodinated contrast medium.
• eGFR of 45 ml/min/1.73 m
2
is CIN risk threshold for intravenous contrast medium.
• Hydration with either saline or sodium bicarbonate reduces CIN incidence.
• Patients with eGFR ≥60 ml/min/1.73 m
2
receiving contrast medium can continue metformin normally.
757 citations
"Nephrogenic systemic fibrosis and g..." refers methods in this paper
...Therefore, the Committee decided to critically review the literature for new evidence and to update its guidelines for reducing the risk of NSF....
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...The Contrast Media Safety Committee of the European Society of Urogenital Radiology produced guidelines on nephrogenic systemic fibrosis (NSF) in 2007 [1]....
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...Acknowledgements Members of the Committee: H.S. Thomsen (Chairman, University of Copenhagen, Denmark), F. Stacul (Secretary, University of Trieste, Italy), T. Almén (University of Lund, Sweden), M.-F. Bellin (University of Paris, France), Michele Bertolotto (University of Trieste, Italy), G. Bongartz (University of Basle, Switzerland), O. Clement (University of Paris, France), G. Heinz-Peer (University of Vienna, Austria), Peter Leander (University of Lund, Sweden), S.K. Morcos (University of Sheffield, United Kingdom), P. Reimer (University of Freiburg, Germany), A. van der Molen (University of Leiden, the Netherlands), J.A.W. Webb (St. Bartholomew’s Hospital, United Kingdom)....
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...Consultants to the Committee: Eric Lancelot (Guerbet, France), P. Lengsfeld (Bayer Pharma, Germany), A. Spinazzi (Bracco, Italy)....
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...The same scales have previously been used by the Committee [2]....
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