Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist's Primer
Gadolinium Deposition and Nephrogenic Systemic Fibrosis: A Radiologist's Primer
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DOI：
10.1148/rg.2020190110
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发表时间：
2020-01-01
期刊：
影响因子：
5.5
通讯作者：
Weinreb, Jeffrey C.
中科院分区：
文献类型：
--
作者：
Mathur, Mahan;Jones, Jason R.;Weinreb, Jeffrey C.
钆基造影剂（GBCA）具有极佳的安全性。然而，在过去的20年里，出现了两个具体的问题。GBCA与肾源性系统性纤维化（NSF）和钆的组织滞留有关。NSF是一种罕见的纤维化疾病，预后不良，其特征是皮肤和皮下增厚以及全身表现。该疾病仅在晚期肾病患者中报告，并且与较高剂量和特定类型的GBCA相关。在过去的十年中，NSF的新病例数量有所下降，这可能是因为医疗保健提供者遵守了不断发展的监管指南。虽然已知钆保留发生在肝脏和骨骼中，但相对较新的脑中沉积和保留的发现重新引发了关于GBCA安全性的争论。尽管存在这些问题，但除了NSF之外，还没有证明与钆沉积和保留相关的健康影响。作者回顾了可用于商业用途的不同类别的GBCA，讨论了NSF和钆在大脑中的保留，并提供了有关这些药物使用的最新美国和欧洲监管指南的更新。鉴于GBCA在临床实践中的使用频率，所有放射科医生都必须学习当前的指南，以提供最安全和最高质量的患者护理。(C)RSNA，2019 center dot radiographics.rsna.org
Gadolinium-based contrast agents (GBCAs) have an excellent safety profile. However, over the last 2 decades, two specific concerns have surfaced. GBCAs are associated with nephrogenic systemic fibrosis (NSF) and tissue retention of gadolinium. NSF is a rare fibrosing disorder with a poor prognosis, which is characterized by skin and subcutaneous thickening as well as systemic manifestations. The disease has been reported exclusively in patients with advanced renal disease, and it is associated with higher doses and specific types of GBCAs. The number of new cases of NSF has fallen over the past decade, presumably because of adherence by health care providers to regulatory guidelines, which continue to evolve. While gadolinium retention has been known to occur in the liver and bones, the relatively recent findings of deposition and retention in the brain have reignited the debate concerning the safety profile of GBCAs. Despite these concerns, there have been no proven health effects related to gadolinium deposition and retention other than NSF. The authors review the different categories of GBCAs available for commercial use, discuss NSF and gadolinium retention in the brain, and provide updates on the latest U.S. and European regulatory guidelines regarding use of these agents. Given the frequency with which GBCAs are used in clinical practice, it is imperative for all radiologists to learn the current guidelines to provide the safest and highest quality of patient care. (C) RSNA, 2019 center dot radiographics.rsna.org