Minimizing Risk of Nephrogenic systemic fibrosis in Cardiovascular Magnetic Resonance
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REVIEW
Open Access
Minimizing Risk of Nephrogenic systemic fibrosis in Cardiovascular Magnetic Resonance Theresa Reiter1*, Oliver Ritter1, Martin R Prince2, Peter Nordbeck1, Christoph Wanner1, Eike Nagel3 and Wolfgang Rudolf Bauer1
Abstract Nephrogenic Systemic Fibrosis is a rare condition appearing only in patients with severe renal impairment or failure and presents with dermal lesions and involvement of internal organs. Although many cases are mild, an estimated 5 % have a progressive debilitating course. To date, there is no known effective treatment thus stressing the necessity of ample prevention measures. An association with the use of Gadolinium based contrast agents (GBCA) makes Nephrogenic Systemic Fibrosis a potential side effect of contrast enhanced magnetic resonance imaging and offers the opportunity for prevention by limiting use of gadolinium based contrast agents in renal failure patients. In itself toxic, Gadolinium is embedded into chelates that allow its safe use as a contrast agent. One NSF theory is that Gadolinium chelates distribute into the extracellular fluid compartment and set Gadolinium ions free, depending on multiple factors among which the duration of chelates exposure is directly related to the renal function. Major medical societies both in Europe and in North America have developed guidelines for the usage of GBCA. Since the establishment of these guidelines and the increased general awareness of this condition, the occurrence of NSF has been nearly eliminated. Giving an overview over the current knowledge of NSF pathobiochemistry, pathogenesis and treatment options this review focuses on the guidelines of the European Medicines Agency, the European Society of Urogenital Radiology, the FDA and the American College of Radiology from 2008 up to 2011 and the transfer of this knowledge into every day practice.
Review Cardiovascular Magnetic Resonance (CMR) has gained an increasingly important role among the diagnostic methods due to its superb soft tissue imaging qualities without ionizing radiation and minimal risks. CMR is one of the uprising areas of MRI offering deep insight in both cardiac structure and function which minimizes the risks of failing to make an accurate diagnosis or resorting to more invasive tests [1]. Use of contrast enhanced imaging techniques allows the assessment of perfusion, tissue viability and detailed angiographic studies. The overwhelming majority of these techniques use Gadolinium based contrast agents (GBCAs). From the early days of GBCA enhanced imaging, these contrast agents were considered safe with only rare allergic reactions or local irritation from extravasations. However, in 1997, a new disease emerged, originally called Nephrogenic Fibrosing
Dermopathy. It was first described by Cowper in 2001 [2] and the relationship to GBCA exposure has been strongly suspected since 2006 [3-7]. Later this entity was renamed Nephrogenic Systemic Fibrosis (NSF) when involvement of internal organs was discovered. An NSF Registry, www. icnfdr.org documented
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