![]() American College of Radiology recommendations Group II GBCAs may be administered to high-risk patients without kidney function screening and without contact with the referring provider, depending on individual practice patterns 9. The 2021 ACR Committee on Drugs and Contrast Media considers the risk of NSF among patients administered standard doses of group II GBCAs "sufficiently low or possibly nonexistent such that assessment of renal function with a questionnaire or laboratory testing is optional prior to intravenous administration" 12. ![]() Recommendations pertaining to the administration of gadolinium-based contrast agents (GBCAs) in patients with kidney disease have recently been updated, specifically with regard to the three different groups of GBCAs. Skin thickening and subcutaneous stranding on multiple modalitiesĭiffuse soft tissue tracer uptake on bone scan Microscopic appearanceĪ deep dermal biopsy is required, however, findings are non-specific, showing thickened collagen bundle, mucin deposition, spindle cell proliferation, and CD3+ fibroblasts. Low-stability gadolinium contrast media show the strongest association with nephrogenic systemic fibrosis 3. A literature review has shown that ~78% of all unconfounded, single-agent cases of nephrogenic systemic fibrosis have been associated with Omniscan (gadodiamide), while ~20% have been associated with Magnevist (gadopentetate dimeglumine), and less than 2% with OptiMARK (gadoversetamide) 4, all of which are group I GBCAs. Prolonged clearance times of gadolinium-based contrast agents in significant renal insufficiency contribute to this transmetallation process 7. This could be due to transmetallation, which is the replacement of the gadolinium from the chelate and forming a free gadolinium ion, free gadolinium ions may then deposit in different tissues and result in inflammation and fibrosis. The development of nephrogenic systemic fibrosis with exposure to group I gadolinium-containing MRI contrast agents has been strongly reported in patients with moderate to end-stage renal impairment. lungs, heart, diaphragm, liver, kidneys, esophagus, and skeletal muscles) can also be involved, eventually leading to death 7 Skin lesions: hyperpigmented, thickened brawny induration, associated with subcutaneous edema, pain, pruritus, skin tightness or burning sensation 1įlexure joint contractures eventually developĪlthough the skin is primarily involved, many other organs (e.g. Presentation resembles scleromyxedema or eosinophilic fasciitis Typically involves the dermis in the extremities symmetrically, less commonly the trunk with the face spared, typically sparing the antecubital and popliteal fossae Typically presents weeks to months after the administration of GBCAs New consensus suggests that kidney function screening is optional for the use of group II GBCAs 9. Outpatient screening (not on dialysis): eGFR use is controversial as they rarely develop nephrogenic systemic fibrosis Liver failure patients: should have eGFR checked History of renal disease: renal transplant (20% develop NSF), dialysis, single kidney, renal malignancy, renal surgery should have eGFR checked ![]() Patients should be screened for the possible risk of developing nephrogenic systemic fibrosis (NSF) by using institutional screening questionnaires and calculating the eGFR 2,7,9: Additional positive risk factors include:Ĭoncurrent infectious/inflammatory conditionĬoncurrent infarcted/ischemic tissue (e.g. ![]()
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