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MR Imaging in Patients at Risk for Developing Nephrogenic Systemic Fibrosis: Protocols, Practices, and Imaging Techniques to Maximize Patient Safety¹

¹ From the Department of Radiology, Weill Cornell Medical Center, 525 E 68th St, F-056, New York, NY 10065 (K.J., A.S.); and Department of Radiology and Radiological Sciences, Johns Hopkins University School of Medicine, Baltimore, Md (J.V.C., K.J.M., I.R.K., D.A.B.). Presented as an education exhibit at the 2007 RSNA Annual Meeting. Received March 27, 2008; revision requested June 3 and received July 18; accepted July 23. J.V.C. received a research grant from Siemens; D.A.B. is a consultant with GE Healthcare; I.R.K. received a research grant from Bracco; all remaining authors have no financial relationships to disclose. Address correspondence to K.J. (e-mail: kjuluru{at}med.cornell.edu).

Abstract

Nephrogenic systemic fibrosis (NSF) is a rare but potentially debilitating or even fatal fibrosing condition that most often affects the skin but is now also recognized to involve multiple organs. The first report on NSF was published in 1997, and there is mounting evidence that this condition is associated with renal failure and the administration of large amounts of gadolinium. Although gadolinium-enhanced magnetic resonance (MR) imaging was once considered one of the safer imaging procedures, concerns over NSF have led the radiology community to rethink its imaging practices. Several noncontrast angiographic techniques based on fast spin-echo, gradient-echo, phase-contrast, and inversion-recovery principles are currently available. These techniques allow MR angiography to be performed safely, even in patients at risk for developing NSF. When use of gadolinium-based contrast material is necessary for diagnosis, it is possible to reduce total gadolinium administration through the use of agents with higher relaxivity, time-resolved imaging, high-field-strength magnets, and body compression devices. Management of NSF also requires an understanding of the risk factors of this disease and developing an institutional policy for identifying and testing at-risk patients.

© RSNA, 2009