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    Letter on 'European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis'.
    J Eur Acad Dermatol Venereol 2017 Dec 28. Epub 2017 Dec 28.
    Consultant Cardiovascular Radiologist NHS Greater Glasgow & Clyde Honorary Clinical Associate Professor, Glasgow University President British Society of Cardiovascular Imaging / British Society of Cardiovascular CT, Glasgow, Scotland, United Kingdom.
    We read with interest the guidelines recently published on sclerosing diseases of the skin (Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis)[1, 2]. However, we are concerned that the guideline recommendations proposed for prevention of nephrogenic systemic fibrosis (NSF) are potentially dangerous. Although we recognise the challenges in constructing comprehensive guidelines, we are concerned that this may be because the guidelines have not involved a multidisciplinary team. Read More

    MR Imaging and Gadolinium: Reassessing the Risk of Nephrogenic Systemic Fibrosis in Patients with Severe Renal Disease.
    Radiology 2018 Jan;286(1):120-121
    From the Department of Radiology, Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (M.R.P.); Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.); and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (J.C.W.).

    [Nephrogenic fibrosing dermatosis: From clinic to microscopy].
    Nephrol Ther 2017 Nov 24. Epub 2017 Nov 24.
    Département d'anatomie et de cytologie pathologique, hôpital Charles-Nicolles, université El-Manar, 1006 Tunis, Tunisie.
    Nephrogenic systemic fibrosis is a rare entity occurred in patients with renal failure. It is related to toxicity to gadolinium, which is used as a contrast agent in magnetic resonance imaging. Clinic manifestations are variable. Read More

    Retention of gadolinium compounds used in magnetic resonance imaging: a critical review and the recommendations of regulatory agencies.
    Radiologia 2017 Nov - Dec;59(6):469-477. Epub 2017 Oct 27.
    Servicio de Farmacia, Hospital General Universitario de Valencia, Valencia, España.
    The Spanish Agency for Drugs and Healthcare Products (AEMPS), based on the recommendations of the European Committee for Risk Assessment in Pharmacovigilance, established on 13 March 2017 that linear gadolinium-based MR contrast media, such as MultiHance, Omniscan, Magnevist (currently not marketed) and Optimark (no longer marketed in Spain), the clinical benefits do not outweigh the potential risks derived from their use. AEMPS recommends to suspend its marketing for general use based on the retention of these compounds in the brain. On the other hand, the AEMPS justifies the maintenance of Primovist and MultiHance for liver studies, and Magnevist of intra-articular administration (not commercialized in Spain), and justified the almost exclusive use of macrocyclic structure contrasts (Gadovist, ProHance and Dotarem). Read More

    Biological effects of MRI contrast agents: gadolinium retention, potential mechanisms and a role for phosphorus.
    Philos Trans A Math Phys Eng Sci 2017 Nov;375(2107)
    Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
    No discussion of challenges for chemistry in molecular imaging would be complete without addressing the elephant in the room-which is that the purest of chemical compounds needs to interact with a biological system in a manner that does not perturb normal biology while still providing efficacious feedback to assist in diagnosis of disease. In the past decade, magnetic resonance imaging (MRI) agents long considered inert have produced adverse effects in certain patient populations under certain treatment regimens. More recently, inert blood pool agents have been found to deposit in the brain. Read More

    A unique case of nephrogenic systemic fibrosis from gadolinium exposure in a patient with normal eGFR.
    BMJ Case Rep 2017 Oct 11;2017. Epub 2017 Oct 11.
    Department of Internal Medicine, William Beaumont Hospital, Royal Oak, Michigan, USA.
    A 57-year-old woman presented with swelling and thickening of the skin of the lower extremities. Three months prior to presentation, patient had MRI with gadolinium as part of an evaluation for suspected pancreatic malignancy. Creatinine levels at the time of gadolinium exposure were 0. Read More

    Nephrogenic systemic fibrosis: A survey of the use of gadolinium-based contrast agents in Ghana.
    Radiography (Lond) 2017 Nov 11;23(4):e108-e113. Epub 2017 May 11.
    Department of Imaging Technology & Sonography, University of Cape Coast, Cape Coast, Central Region, Ghana. Electronic address:
    Introduction: The aim of this study is to identify current practice of administration of gadolinium-based contrast agents (GBCAs) in Ghana.

    Method: A total of 13 MRI (magnetic resonance imaging) facilities were sent a survey questionnaire to request information on their current practice with the use of GBCAs.

    Results: Gadodiamide, a high risk GBCA accounted for 67% of first line agents. Read More

    Safety of Contrast Material Use in Children.
    Magn Reson Imaging Clin N Am 2017 Nov 8;25(4):779-785. Epub 2017 Sep 8.
    Division of Pediatric Radiology and Pediatric Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 1800 Orleans Street, Zayed Tower, Room 4174, Baltimore, MD 21287, USA.
    Iodinated and gadolinium-based contrast materials have excellent safety profiles for use in pediatric computed tomography and MR imaging. The rate of acute adverse reactions and contrast-induced nephropathy is lower than in adults. The relationship between nephrogenic systemic fibrosis and gadolinium administration is well established and only a small number of children suffer from this debilitating disorder. Read More

    Historical Perspective of Imaging Contrast Agents.
    Magn Reson Imaging Clin N Am 2017 Nov 23;25(4):685-696. Epub 2017 Aug 23.
    Department of Radiology, University of North Carolina School of Medicine, 3326 Old Infirmary, Campus Box 7510, Chapel Hill, NC 27599-7510, USA.
    Contrast agents were introduced early in the history of medical imaging. Iodine-based intravascular agents became the radiographic compounds of choice and refinements of their chemical structures led to the highly tolerated low-osmolarity agents in use today. Gadolinium became the most popular compound for MR imaging; however, recognition of nephrogenic systemic fibrosis and in vivo dechelation intensified research on their safety profile. Read More

    Metabolomic Analysis of N-acetylcysteine Protection of Injury from Gadolinium-DTPA Contrast Agent in Rats with Chronic Renal Failure.
    OMICS 2017 Sep;21(9):540-549
    1 Changchun Institute of Applied Chemistry , Chinese Academy of Sciences, Changchun, People's Republic of China .
    Gadolinium-based contrast agents (GBCAs) are frequently used to enhance the diagnostic efficacy of magnetic resonance imaging. On the other hand, the association between GBCA administration in patients with advanced renal disease and nephrogenic systemic fibrosis (NSF) was also noted. NSF is a systemic disorder characterized by widespread tissue fibrosis that may lead to death. Read More

    GBCAs and Risk for Nephrogenic Systemic Fibrosis: A Literature Review.
    Radiol Technol 2017 Jul;88(6):583-589
    Purpose: To examine the risks of using of gadolinium-based contrast agents (GBCAs) in magnetic resonance (MR) imaging and explore strategies to reduce the likeliness of adverse effects in patients who might be at risk for developing nephrogenic system fibrosis (NSF).

    Methods: A search of 3 scholarly databases was performed to identify articles that discuss adverse reactions to GBCAs, specifically relating to kidney function, in MR examinations. A total of 20 peer-reviewed articles were analyzed. Read More

    Value of quantitative magnetic resonance imaging T1-relaxometry in predicting contrast-enhancement in glioblastoma patients.
    Oncotarget 2017 Aug 27;8(32):53542-53551. Epub 2017 Jun 27.
    Division of Clinical Neurooncology, Department of Neurology, University of Bonn Medical Center, Bonn, Germany.
    Summarizing The Importance Of The Study: The repetitive usage of gadolinium-based contrast agents (GBCA) is critical for magnetic resonance imaging (MRI) evaluation of tumor burden in glioblastoma patients. It is also a crucial tool for determination of radiographical response to treatment. GBCA injection, however, comes with a 2. Read More

    Pathophysiological Mechanisms in Sclerosing Skin Diseases.
    Front Med (Lausanne) 2017 18;4:120. Epub 2017 Aug 18.
    Department of Dermatology, University of Cologne, Cologne, Germany.
    Sclerosing skin diseases represent a large number of distinct disease entities, which include systemic sclerosis, localized scleroderma, and scleredema adultorum. These pathologies have a common clinical appearance and share histological features. However, the specific interplay between cytokines and growth factors, which activate different mesenchymal cell populations and production of different extracellular matrix components, determines the biomechanical properties of the skin and the clinical features of each disease. Read More

    Human Fibrotic Diseases: Current Challenges in Fibrosis Research.
    Methods Mol Biol 2017 ;1627:1-23
    The Joan and Joel Rosenbloom Center for Fibrotic Diseases and The Jefferson Institute of Molecular Medicine, Thomas Jefferson University, Philadelphia, PA, USA.
    Human fibrotic diseases constitute a major health problem worldwide owing to the large number of affected individuals, the incomplete knowledge of the fibrotic process pathogenesis, the marked heterogeneity in their etiology and clinical manifestations, the absence of appropriate and fully validated biomarkers, and, most importantly, the current void of effective disease-modifying therapeutic agents. The fibrotic disorders encompass a wide spectrum of clinical entities including systemic fibrotic diseases such as systemic sclerosis (SSc), sclerodermatous graft vs. host disease, and nephrogenic systemic fibrosis, as well as numerous organ-specific disorders including radiation-induced fibrosis and cardiac, pulmonary, liver, and kidney fibrosis. Read More

    European dermatology forum S1-guideline on the diagnosis and treatment of sclerosing diseases of the skin, Part 2: Scleromyxedema, scleredema and nephrogenic systemic fibrosis.
    J Eur Acad Dermatol Venereol 2017 Oct 8;31(10):1581-1594. Epub 2017 Aug 8.
    Department of Dermatology and Venereology, University Hospital of Cologne, Cologne, Germany.
    The term 'sclerosing diseases of the skin' comprises specific dermatological entities which have fibrotic changes of the skin in common. These diseases mostly manifest in different clinical subtypes according to cutaneous and extracutaneous involvement and can sometimes be difficult to distinguish from each other. The present guideline focuses on characteristic clinical and histopathological features, diagnostic scores and the serum autoantibodies most useful for differential diagnosis. Read More

    Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function.
    Indian J Radiol Imaging 2017 Apr-Jun;27(2):141-147
    Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India.
    Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood-brain barrier. Read More

    Erythema nodosum masking nephrogenic systemic fibrosis as initial skin manifestation.
    BMC Nephrol 2017 Jul 24;18(1):249. Epub 2017 Jul 24.
    Unit of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
    Background: Nephrogenic systemic fibrosis (NSF) is a complication of the gadolinium-based contrast agent used in imaging studies. It is typically characterised by hard, erythematous and indurated skin plaques with surrounding subcutaneous oedema. Distinct papules and subcutaneous nodules can also be seen. Read More

    No Incidence of Nephrogenic Systemic Fibrosis after Gadobenate Dimeglumine Administration in Patients Undergoing Dialysis or Those with Severe Chronic Kidney Disease.
    Radiology 2018 Jan 21;286(1):113-119. Epub 2017 Jul 21.
    From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.).
    Purpose To determine the incidence of nephrogenic systemic fibrosis (NSF) in patients with severe chronic kidney disease (CKD) who underwent a uniform protocol for contrast material-enhanced magnetic resonance (MR) imaging with a gadolinium-based contrast agent (GBCA). Materials and Methods This retrospective, single-center, institutional review board-approved, HIPAA-compliant study included 3819 patients with severe (stage 4 or 5) CKD who underwent gadobenate dimeglumine-enhanced MR imaging as part of a preoperative evaluation for potential renal transplantation from January 2008 to February 2014. After undergoing contrast-enhanced MR imaging, patients were assessed for NSF by means of clinical follow-up, including a full integumentary examination, with a minimum of 6 months between administration of the GBCA and clinical skin examination. Read More

    Cutaneous Manifestations of Scleroderma and Scleroderma-Like Disorders: a Comprehensive Review.
    Clin Rev Allergy Immunol 2017 Dec;53(3):306-336
    Section of Dermatology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy.
    Scleroderma refers to an autoimmune connective tissue fibrosing disease, including three different subsets: localized scleroderma, limited cutaneous systemic sclerosis, and diffuse cutaneous systemic sclerosis with divergent patterns of organ involvement, autoantibody profiles, management, and prognostic implications. Although systemic sclerosis is considered the disease prototype that causes cutaneous sclerosis, there are many other conditions that can mimic and be confused with SSc. They can be classified into immune-mediated/inflammatory, immune-mediated/inflammatory with abnormal deposit (mucinoses), genetic, drug-induced and toxic, metabolic, panniculitis/vascular, and (para)neoplastic disorders according to clinico-pathological and pathogenetic correlations. Read More

    Photopheresis Provides Significant Long-Lasting Benefit in Nephrogenic Systemic Fibrosis.
    Case Rep Dermatol Med 2017 12;2017:3240287. Epub 2017 Jun 12.
    Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI, USA.
    Nephrogenic systemic fibrosis (NSF), previously known as nephrogenic fibrosing dermopathy, is a rare complication of exposure to gadolinium-based contrast agents in patients who have significantly decreased renal function. Manifestations include fibrosis of the skin and other tissues. Effective therapies are lacking. Read More

    Non-enhanced versus low-dose contrast-enhanced renal magnetic resonance angiography at 7 T: a feasibility study.
    Acta Radiol 2017 Jan 1:284185117718399. Epub 2017 Jan 1.
    1 Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany.
    Background Considering the currently reported association between a repetitive application and cumulative dosage of Gadolinium (Gd)-based contrast agents and Gd-deposition in brain tissue as well as the risk for the advent of nephrogenic systemic fibrosis (NSF), techniques allowing for a dose reduction become an important key aspect aside from non-enhanced magnetic resonance angiography (MRA) techniques. Thus, this study was focused on the reduction and/or complete omission of contrast agent for renal MRA at 7T. Purpose To evaluate the performance of time-of-flight MRA versus low-dose contrast-enhanced (CE) renal MRA at 7T. Read More

    Nephrogenic systemic fibrosis.
    Clin Case Rep 2017 Jul 16;5(7):1184-1185. Epub 2017 May 16.
    Division of Nephrology, Hypertension and Renal TransplantationUniversity of FloridaGainesvilleFlorida.
    Nephrogenic systemic fibrosis (NSF) is a fibrosing disorder seen in patients with renal dysfunction, commonly precipitated by administration of gadolinium contrast. There is no consistently successful treatment, but oral steroids, topical dovonex, extracorporeal photopheresis, and plasmapheresis have been tried [http://www.icnfdr. Read More

    Scleroderma-like Disorders.
    Curr Rheumatol Rev 2017 06 11. Epub 2017 Jun 11.
    Fortis Escorts Hospital, Jaipur, India
    Scleroderma is a term used to describe diseases that involve hardening and tightening of the skin and the underlying subcutaneous connective tissue. It could be localized to skin and subcutaneous tissue, or may involve the internal organs too in systemic sclerosis. There are disorders that can cause hardening and tightening of skin and mimic scleroderma but are rarely associated with Raynaud phenomenon, sclerodactyly, and autoantibodies in the serum, features specific to scleroderma/systemic sclerosis. Read More

    Delayed enhancement cardiac computed tomography for the assessment of myocardial infarction: from bench to bedside.
    Cardiovasc Diagn Ther 2017 Apr;7(2):159-170
    Department of Cardiovascular Imaging, Diagnóstico Maipú, Buenos Aires, Argentina.
    A large number of studies support the increasingly relevant prognostic value of the presence and extent of delayed enhancement (DE), a surrogate marker of fibrosis, in diverse etiologies. Gadolinium and iodinated based contrast agents share similar kinetics, thus leading to comparable myocardial characterization with cardiac magnetic resonance (CMR) and cardiac computed tomography (CT) at both first-pass perfusion and DE imaging. We review the available evidence of DE imaging for the assessment of myocardial infarction (MI) using cardiac CT (CTDE), from animal to clinical studies, and from 16-slice CT to dual-energy CT systems (DECT). Read More

    The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis.
    Adv Chronic Kidney Dis 2017 05;24(3):176-182
    Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, Chapel Hill, NC.
    The role of gadolinium (Gd)-based contrast agents (GBCAs) in the pathophysiology of nephrogenic systemic fibrosis (NSF) is now uncontested. Although the definitive mechanism has not been established, the association with weaker GBCA ligands and with reduced renal clearance supports a hypothesis that Gd release from the GBCAs is a key process in precipitating the disease. Prevention strategies often include the use of more stable GBCA ligands in patients with reduced kidney function, but animal models and some clinical data suggest that better patient outcomes can be achieved when excess ligand is administered with weaker GBCAs; this is particularly significant for OptiMARK, which contains a nonionic, linear ligand similar to gadodiamide, the active ingredient in Omniscan, but contains twice the amount of excess ligand. Read More

    Gadolinium Retention and Toxicity-An Update.
    Adv Chronic Kidney Dis 2017 05;24(3):138-146
    Department of Radiology, Hospital Garcia de Orta, Almada, Portugal; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC; and Department of Radiology, Centro Hospitalar de Lisboa Central, Lisbon, Portugal. Electronic address:
    Until 2006, the main considerations regarding safety for all gadolinium-based contrast agents (GBCAs) were related to short-term adverse reactions. However, the administration of certain "high-risk" GBCAs to patients with renal failure resulted in multiple reported cases of nephrogenic systemic fibrosis. Findings have been reported regarding gadolinium deposition within the body and various reports of patients who report suffering from acute and chronic symptoms secondary to GBCA's exposure. Read More

    Scleroderma Mimickers.
    Curr Treatm Opt Rheumatol 2016 Mar 5;2(1):69-84. Epub 2016 Feb 5.
    Division of Rheumatology, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
    Cutaneous fibrosing disorders encompass a diverse array of diseases united by the presence of varying degrees of dermal sclerosis. The quality and distribution of skin involvement, presence or absence of systemic complications and unique associated laboratory abnormalities often help to distinguish between these diseases. It is imperative that an effort is made to accurately differentiate between scleroderma and its mimics, in order to guide long-term management and facilitate implementation of the appropriate treatment modality where indicated. Read More

    Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA.
    AJNR Am J Neuroradiol 2017 Jul 4;38(7):1383-1390. Epub 2017 May 4.
    Department of Radiology (H.S.A.), Armed Forces Yangju Hospital, Yangju, Korea.
    Background And Purpose: The development of nephrogenic systemic fibrosis and neural tissue deposition is gadolinium dose-dependent. The purpose of this study was to determine the appropriate minimal dose of gadobutrol with time-resolved MRA to assess supra-aortic arterial stenosis with contrast-enhanced MRA as a reference standard.

    Materials And Methods: Four hundred sixty-two consecutive patients underwent both standard-dose contrast-enhanced MRA and low-dose time-resolved MRA and were classified into 3 groups; group A (a constant dose of 1 mL for time-resolved MRA), group B (2 mL), or group C (3 mL). Read More

    Improving contrast enhancement in magnetic resonance imaging using 5-aminolevulinic acid-induced protoporphyrin IX for high-grade gliomas.
    Oncol Lett 2017 Mar 27;13(3):1269-1275. Epub 2016 Dec 27.
    Department of Neurosurgery, University of Occupational and Environmental Health, Kitakyushu, Fukuoka 807-8555, Japan.
    Magnetic resonance imaging (MRI) with a gadolinium-based contrast agent is the gold standard for high-grade gliomas (HGGs). The compound 5-aminolevulinic acid (5-ALA) undergoes a high rate of cellular uptake, particularly in cancer cells. In addition, fluorescence-guided resection with 5-ALA is widely used for imaging HGGs. Read More

    Use of blood pool agents with steady-state MRI to assess the vascular system.
    J Magn Reson Imaging 2017 Jun 19;45(6):1559-1572. Epub 2017 Apr 19.
    Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
    Over the past two decades there have been significant advances in the use of magnetic resonance imaging (MRI) to assess the vascular system. New imaging sequences and improvements in magnet design have enabled the creation of higher spatial resolution images. MRI is now a viable alternative imaging modality when compared to both invasive angiography and computed tomographic angiography. Read More

    Effect of Intravenous Administration of Contrast Media on Serum Creatinine Levels in Neonates.
    Radiology 2017 Aug 6;284(2):530-540. Epub 2017 Apr 6.
    From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children's Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.).
    Purpose To assess the effect of intravenous contrast media on renal function in neonates. Materials and Methods Institutional review board approval was obtained with waiver of consent. Electronic health records from January 2011 to April 2013 were reviewed retrospectively. Read More

    Critical Questions Regarding Gadolinium Deposition in the Brain and Body After Injections of the Gadolinium-Based Contrast Agents, Safety, and Clinical Recommendations in Consideration of the EMA's Pharmacovigilance and Risk Assessment Committee Recommendation for Suspension of the Marketing Authorizations for 4 Linear Agents.
    Invest Radiol 2017 Jun;52(6):317-323
    From the University Institute of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University Hospital, University of Bern, Bern, Switzerland.
    For magnetic resonance, the established class of intravenous contrast media is the gadolinium-based contrast agents. In the 3 decades since initial approval, these have proven in general to be very safe for human administration. However, in 2006, a devastating late adverse reaction to administration of the less stable gadolinium-based contrast agents was identified, nephrogenic systemic fibrosis. Read More

    Gadolinium contrast agents - are they really safe?
    J Vasc Access 2017 Mar 21;18(Suppl. 2):1-7. Epub 2017 Mar 21.
    Department of Radiology, Faculty Hospital Kralovske Vinohrady and Third Faculty of Medicine, Charles University in Prague, Prague - Czech Republic.
    Gadolinium-based contrast agents (GBCA) are used worldwide for enhanced MRI examinations, including heart and vessels. Gadolinium is a highly toxic heavy metal. If used in GBCA it must be tightly bound to ligands. Read More

    Histology and Gadolinium Distribution in the Rodent Brain After the Administration of Cumulative High Doses of Linear and Macrocyclic Gadolinium-Based Contrast Agents.
    Invest Radiol 2017 Jun;52(6):324-333
    From the *MR and CT Contrast Media Research, †Research Pathology Berlin, and ‡Medical and Clinical Affairs Radiology, Bayer AG, Berlin; §Special Histopathology, Bayer AG, Elberfeld; ∥Institute of Vegetative Physiology, Charité; ¶Clinical Project Management, Bayer AG, Berlin; and #Central Institute for Engineering, Electronics and Analytics (ZEA-3), Forschungszentrum Juelich GmbH, Juelich, Germany.
    Objectives: Retrospective studies in patients with primary brain tumors or other central nervous system pathologies as well as postmortem studies have suggested that gadolinium (Gd) deposition occurs in the dentate nucleus (DN) and globus pallidus (GP) after multiple administrations of primarily linear Gd-based contrast agents (GBCAs). However, this deposition has not been associated with any adverse effects or histopathological alterations. The aim of this preclinical study was to systematically examine differences between linear and macrocyclic GBCAs in their potential to induce changes in brain and skin histology including Gd distribution in high spatial resolution. Read More

    Nephrogenic systemic fibrosis: A 15-year retrospective study at a single tertiary care center.
    J Am Acad Dermatol 2017 Aug 18;77(2):235-240. Epub 2017 Mar 18.
    Department of Dermatology, University of Texas Medical Branch, University of Texas, Galveston, Texas.
    Background: Despite multiple therapeutic approaches for nephrogenic systemic fibrosis (NSF), no single treatment has convincingly shown consistent benefit. The most successful outcomes have been associated with recovery of renal function, although evidence remains limited and past studies have been inconclusive.

    Objective: We sought to investigate whether improvement of renal function via successful transplantation or via return of renal function after acute kidney injury correlates with improvement of NSF, and to further characterize the clinical features and progression of NSF. Read More

    Safety and Efficacy of A High Performance Graphene-Based Magnetic Resonance Imaging Contrast Agent for Renal Abnormalities.
    Graphene Technol 2016 Dec 3;1(1):17-28. Epub 2016 Aug 3.
    Department of Biomedical Engineering, Northeastern University, Boston, MA, USA.
    The etiology of renal insufficiency includes primary (e.g polycystic kidney disease) or secondary (e.g. Read More

    Exceedingly small iron oxide nanoparticles as positive MRI contrast agents.
    Proc Natl Acad Sci U S A 2017 Feb 13;114(9):2325-2330. Epub 2017 Feb 13.
    Department of Chemistry, Massachusetts Institute of Technology, Cambridge, MA 02139;
    Medical imaging is routine in the diagnosis and staging of a wide range of medical conditions. In particular, magnetic resonance imaging (MRI) is critical for visualizing soft tissue and organs, with over 60 million MRI procedures performed each year worldwide. About one-third of these procedures are contrast-enhanced MRI, and gadolinium-based contrast agents (GBCAs) are the mainstream MRI contrast agents used in the clinic. Read More

    [Plasma exchange in nephrology: Indications and technique].
    Nephrol Ther 2017 Feb 16;13(1):43-55. Epub 2017 Jan 16.
    Service des urgences néphrologiques et transplantation rénale, hôpital Tenon, 4, rue de la Chine, 75020 Paris, France; Université Pierre-et-Marie-Curie, 4, place Jussieu, 75005 Paris, France.
    Plasma exchange is a non-selective apheresis technique that can be performed by filtration or centrifugation allowing rapid purification of high molecular weight pathogens. An immunosuppressive treatment is generally associated to reduce the rebound effect of the purified substance. Substitution solutes such as human albumin and macromolecules are needed to compensate for plasma extraction. Read More

    Gd-DTPA-induced dynamic metabonomic changes in rat biofluids.
    Magn Reson Imaging 2017 Dec 14;44:15-25. Epub 2017 Jan 14.
    Changchun Institute of Applied Chemistry Chinese Academy of Sciences, No. 5625, Renmin Street, Changchun 130022, China.
    Objectives: The purposes of this study were (1) to detect the dynamic metabonomic changes induced by gadopentetate dimeglumine (Gd-DTPA) and (2) to investigate the potential metabolic disturbances associated with the pathogenesis of nephrogenic systemic fibrosis (NSF) at the early stage.

    Methods: A nuclear magnetic resonance (NMR)-based metabolomics approach was used to investigate the urinary and serum metabolic changes induced by a single tail vein injection of Gd-DTPA (dosed at 2 and 5mmol/kg body weight) in rats. Urine and serum samples were collected on days 1, 2 and 7 after dosing. Read More

    Gadolinium-based contrast agents: A comprehensive risk assessment.
    J Magn Reson Imaging 2017 Aug 13;46(2):338-353. Epub 2017 Jan 13.
    Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA.
    Gadolinium-based contrast agents (GBCAs) have been used in magnetic resonance imaging (MRI) since the 1980s and are now administered in up to 35% of all MRI examinations. While GBCAs were initially felt to carry minimal risk, the subsequent identification of GBCAs as the key etiologic factor in the development of nephrogenic systemic fibrosis (NSF) has raised concerns about the broader health impacts of gadolinium exposure. Clinicians, radiologists, and patients should be aware of the most up-to-date data pertaining to the risks of GBCA administration. Read More

    Differential Expression of Hedgehog and Snail in Cutaneous Fibrosing Disorders: Implications for Targeted Inhibition.
    Am J Clin Pathol 2016 Dec;146(6):709-717
    From the Dermatopathology Unit, Pathology Service, Massachusetts General Hospital and Harvard Medical School, Boston
    Objectives: To examine Hedgehog signaling in cutaneous fibrosing disorders for which effective approved therapies are lacking, expand our knowledge of pathophysiology, and explore the rationale for targeted inhibition.

    Methods: Stain intensity and percentage of cells staining for Sonic hedgehog (Shh), Indian hedgehog (Ihh), Patched (Ptch), glycogen synthase kinase 3 β (GSK3-β), β-catenin, and Snail were evaluated in human skin biopsy specimens of keloid, hypertrophic scar (Hscar), scleroderma, nephrogenic systemic fibrosis (NSF), scar, and normal skin using a tissue microarray.

    Results: Ihh, but not Shh, was detected in a significantly larger proportion of cells for all case types. Read More

    Severe thrombocytopenia induced by iodinated contrast after coronary angiography: The use of gadolinium contrast and intravascular ultrasound as an alternative to guide percutaneous coronary intervention.
    Rev Port Cardiol 2017 Jan 14;36(1):61.e1-61.e4. Epub 2016 Dec 14.
    Haemodynamic and Interventional Cardiology, University Hospital Virgen del Rocío, Seville, Spain.
    Acute contrast-induced thrombocytopenia is a rare event with the use of modern low osmolarity iodinated contrast media. The pathophysiological mechanism that causes platelet counts to drop has not been identified, but an immunological mechanism is suspected due to cytotoxicity after previous exposure to contrast. We report the case of a 47-year-old male patient with acute severe thrombocytopenia due to iodinated contrast media exposure. Read More

    [Cutaneous manifestations in renal diseases].
    Hautarzt 2016 Dec;67(12):960-969
    Dermatologische Abteilung, Donauspital, Langobardenstr. 122, 1220, Wien, Österreich.
    In addition to general skin changes like pallor or dryness and the frequent, often excruciating nephrogenic pruritus, specific diseases in patients with renal failure may occur. Acquired perforating dermatoses are usually also highly pruritic. Calciphylaxis is a severe disease with poor prognosis. Read More

    A novel blood-pooling MR contrast agent: Carboxymethyl-diethylaminoethyl dextran magnetite.
    Mol Med Rep 2016 Dec 21;14(6):5195-5198. Epub 2016 Oct 21.
    Department of Radiology, Shiga University of Medical Science, Otsu, Shiga 520‑2192, Japan.
    Gadofosveset trisodium is available as a prolonged pooling vascular contrast agent for magnetic resonance imaging. As gadolinium (Gd)-based agents may increase the risk for nephrogenic systemic fibrosis in patients with severe renal insufficiency, the present study synthesized carboxymethyl-diethylaminoethyl dextran magnetite (CMEADM) particles as a blood-pooling, non-Gd‑based contrast agent. CMEADM particles carry a negative or positive charge due to the binding of amino and carboxyl groups to the hydroxyl group of dextran. Read More

    The diagnostic value of non-contrast enhanced quiescent interval single shot (QISS) magnetic resonance angiography at 3T for lower extremity peripheral arterial disease, in comparison to CT angiography.
    J Cardiovasc Magn Reson 2016 Oct 20;18(1):71. Epub 2016 Oct 20.
    MR Scientific, SIEMENS Healthcare, Shanghai, China.
    Background: The high incidence of renal insufficiency in patients with Peripheral Arterial Disease raises the concern for nephrogenic systemic fibrosis (NSF) with respect to contrast enhanced MRA. The risk of NSF is eliminated with non-contrast enhanced magnetic resonance angiography. The purpose of the current study is to compare image quality and diagnostic performance of non-contrast enhanced Quiescent Interval Single Shot (QISS) magnetic resonance angiography at 3 T versus CT angiography for evaluation of lower extremity Peripheral Arterial Disease (PAD). Read More

    Revisiting the Pharmacokinetic Profiles of Gadolinium-Based Contrast Agents: Differences in Long-Term Biodistribution and Excretion.
    Invest Radiol 2016 11;51(11):691-700
    From Guerbet, Roissy CdG Cedex, France.
    Objectives: Gadolinium-based contrast agents (GBCAs) have been used for years for magnetic resonance imaging examinations. Because of their rapid blood clearance, they were considered as very safe products until some of them were shown to induce nephrogenic systemic fibrosis in patients with renal failure and hypersignals on T1-weighted unenhanced brain scans of patients with normal renal function. To date, these adverse effects have been related almost exclusively to the use of low-stability linear agents, which are more prone to release free gadolinium. Read More

    Incidence of Nephrogenic Systemic Fibrosis Using Gadobenate Dimeglumine in 1423 Patients With Renal Insufficiency Compared With Gadodiamide.
    Invest Radiol 2016 11;51(11):701-705
    From the Departments of *Radiology, and †Medical Physics, University of Wisconsin, Madison, WI; ‡Department of Dermatology, University of California San Francisco, San Francisco, CA; §Department of Radiology, Saint Louis University, Saint Louis, MO; ∥Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, IL; Departments of ¶Medicine, and #Obstetrics and Gynecology, University of Wisconsin, Madison, WI.
    Objective: The purpose of this study was to assess the incidence of nephrogenic systemic fibrosis (NSF) before and after educational interventions, implementation of a clinical screening process, and change to gadobenate dimeglumine in patients who had an estimated glomerular filtration rate (eGFR) of 30 mL/min per 1.72 m or less.

    Methods: This is a Health Insurance Portability and Accountability Act compliant, institutional review board exempt study. Read More

    Incidence and Risk Factors for Gadolinium-Based Contrast Agent Immediate Reactions.
    Top Magn Reson Imaging 2016 Dec;25(6):257-263
    Department of Medical Imaging, University of Arizona, Tucson, AZ.
    Since their clinical introduction in 1988, gadolinium-based contrast agents (GBCAs) have demonstrated an excellent safety profile with a reported acute adverse reaction rate ranging from 0.01% to 2%. By comparison, the acute adverse reaction rate of low osmolar nonionic computed tomography contrast agents (CTCs) ranges from 0. Read More

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