Risk factors for NSF: a literature review

Prince, M. R., Zhang, H. L., Roditi, G. H., Leiner, T. and Kucharczyk, W. (2009) Risk factors for NSF: a literature review. Journal of Magnetic Resonance Imaging, 30(6), pp. 1298-1308. (doi: 10.1002/jmri.21973)

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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. 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.

Item Type:Articles
Glasgow Author(s) Enlighten ID:Roditi, Dr Giles
Authors: Prince, M. R., Zhang, H. L., Roditi, G. H., Leiner, T., and Kucharczyk, W.
College/School:College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing
Journal Name:Journal of Magnetic Resonance Imaging
Publisher:Wiley Periodicals, Inc.
ISSN (Online):1522-2586
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