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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.
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.
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
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).
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]
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.
A contrast agent (or contrast medium) is a substance used to increase the contrast of structures or fluids within the body in medical imaging. [1] Contrast agents absorb or alter external electromagnetism or ultrasound , which is different from radiopharmaceuticals , which emit radiation themselves.
Gadolinium based contrast medium is frequently used in CMR and has been associated with nephrogenic systemic fibrosis, predominantly using linear compounds in patients with renal disease. More recently evidence of intra-cranial deposition of gadolinium has been shown - although no neurological effects have been reported. [12]