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Nephrogenic systemic fibrosis is a rare syndrome that involves fibrosis of the skin, joints, eyes, and internal organs. NSF is caused by exposure to gadolinium in gadolinium-based MRI contrast agents (GBCAs) in patients with impaired kidney function.
European guidelines classify a pre-existing decreased kidney function to be a risk factor of contrast-induced nephropathy in the following cases: [5]. Estimated glomerular filtration rate (eGFR) < 45 ml/min/1.73 m 2 of body surface area before intra-arterial administration with first-pass renal exposure (not passing lungs or peripheral circulation before kidneys), or in the intensive care unit
While NSF is a severe form of disease, gadolinium deposition disease (GDD) is a mild variant with pain (e.g. headache), fatigue, and / or gadolinium depositions. [ 26 ] As a free solubilized aqueous ion, gadolinium(III) is highly toxic, but the chelated compounds are generally regarded as safe for individuals without kidney disease.
Gadodiamide is one of the main GBCA associated with nephrogenic systemic fibrosis (NSF), a toxic reaction occurring in some people with kidney problems. [6] No cases have been seen in people with normal kidney function. [7] A 2015 study found gadolinium deposited in the brain tissue of people who had received gadodiamide. [8]
The contrast-enhancing effect is a result of the neutral complex of gadolinium and dihydroxy-hydroxymethylpropyl- tetraazacyclododecane-triacetic acid (butrol), which works to decrease differences in longitudinal relaxation times (T1) and differences in spin-spin or transverse relaxation times (T2).
Gadolinium is a silvery-white metal when oxidation is removed. It is a malleable and ductile rare-earth element. Gadolinium reacts with atmospheric oxygen or moisture slowly to form a black coating. Gadolinium below its Curie point of 20 °C (68 °F) is ferromagnetic, with an attraction to a magnetic field higher than that of nickel.
Gadoteric acid, sold under the brand name Dotarem among others, is a macrocycle-structured gadolinium-based MRI contrast agent (GBCA).It consists of the organic acid DOTA as a chelating agent, and gadolinium (Gd 3+), and is used in form of the meglumine salt (gadoterate meglumine).
Although it is better tolerated than iodinated contrast media used for CT-scan, the use of gadolinium-based contrast agent should always be preceded by kidney function assessment, in order to reduce the risk of nephrogenic systemic fibrosis, and prophylactic protocol in case of previous allergic reactions.