Gadodiamide-associated nephrogenic systemic fibrosis: Why radiologists should be concerned
Gadodiamide-associated nephrogenic systemic fibrosis: Why radiologists should be concerned
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DOI：
10.2214/ajr.06.1094
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发表时间：
2007-02-01
影响因子：
5
通讯作者：
Kirk, Gerald A.
中科院分区：
文献类型：
--
作者：
Broome, Dale R.;Girguis, Mark S.;Kirk, Gerald A.
OBJECTIVE.肾源性系统性纤维化（NSF）是一种罕见的多系统纤维化疾病，主要影响皮肤，但也可能影响肾功能不全患者的其他器官。我们研究的目的是确定任何常见的危险因素，并确定静脉注射钆双胺是否与NSF的发展有关。对2000年至2006年期间在我们机构诊断为NSF的所有12例患者进行了回顾性病历审查，以确定钆双胺给药的临床表现、时间和剂量;透析记录;合并用药;合并症和手术;实验室检查结果;影像学检查结果和临床结局。回顾2000年至2006年期间的透析和MR记录，显示168名透析患者进行了559次MRI检查（包括301次对比增强检查）。根据临床表现和组织学诊断NSF。所有12名患者均患有肾功能不全-8名患有透析依赖性慢性肾功能不全，4名患有急性肝肾综合征。所有12例患者均在钆双胺给药后2 - 11周内发生皮肤纤维化。钆双胺暴露后发生NSF的比值比为22.3。没有发现其他常见的事件或暴露。4例患者的骨扫描异常，伴有皮肤和肌肉摄取，下肢MRI发现肌肉、肌间筋膜和皮肤水肿。尽管10例患者在钆双胺给药后2天内进行了透析，但这并不能阻止NSF的发生。在急性肝肾综合征或透析依赖性慢性肾功能不全的情况下，NSF的发生与钆双胺给药密切相关。
OBJECTIVE. Nephrogenic systemic fibrosis (NSF) is a rare multisystemic fibrosing disorder that principally affects the skin but may affect other organs of patients with renal insufficiency. The purpose of our study was to identify any common risk factors and determine whether IV gadodiamide is associated with the development of NSF.MATERIALS AND METHODS. A retrospective chart review was performed for all 12 patients diagnosed with NSF at our institution between 2000 and 2006 to identify the clinical manifestations, timing, and dose of gadodiamide administration; dialysis records; concurrent medications; comorbid conditions and surgeries; laboratory findings; imaging findings; and clinical outcome. A review of the dialysis and MR records between 2000 and 2006 showed 559 MRI examinations on 168 dialysis patients (including 301 contrast-enhanced examinations).RESULTS. NSF was diagnosed by clinical findings and tissue diagnosis. All 12 patients had renal insufficiency - eight with dialysis-dependent chronic renal insufficiency and four with acute hepatorenal syndrome. All 12 patients developed skin fibrosis within 2 - 11 weeks after gadodiamide administration. The odds ratio for development of NSF after gadodiamide exposure was 22.3. No other common event or exposure could be found. Four patients had abnormal scintigraphic bone scans with skin and muscle uptake and lower-extremity MRI finding of edema in the muscles, intermuscular fascia, and skin. Despite the fact that 10 patients were dialyzed within 2 days of gadodiamide administration, this did not prevent the development of NSF.CONCLUSION. Development of NSF was strongly associated with gadodiamide administration in the setting of either acute hepatorenal syndrome or dialysis-dependent chronic renal insufficiency.