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The World Health Organization issued a restriction on use of several gadolinium contrast agents in November 2009 stating that "High-risk gadolinium-containing contrast agents (Optimark, Omniscan, Magnevist, Magnegita, and Gado-MRT ratiopharm) are contraindicated in patients with severe kidney problems, in patients who are scheduled for or have ...
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
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] Other studies using post-mortem mass spectrometry found most of the deposit remained at least 2 years after an injection and deposit also in individuals with no kidney issues.
In patients with kidney failure, there is a risk of a rare but serious illness called nephrogenic systemic fibrosis (NSF) [61] that is caused by the use of gadolinium-based contrast agents. The disease resembles scleromyxedema and to some extent scleroderma .
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).
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.
Polymeric Gd 3+ chelates are large in size, which prevents leakage into the interstitial space, and provides long imaging windows. Several polymeric gadolinium-based BPAs are currently in development but have not yet been approved for clinical use: Gadomelitol (Guerbet, France), also known as Vistarem and P792 [19] Gadomer-17 (Schering AG, Berlin, Germany) also known as Gd-DTPA-17, SH L 643 A ...