Contemporary Applications and Limitations of Magnetic Resonance Imaging Contrast Materials

Purpose

Improvements in imaging technologies have dramatically increased the ability to accurately diagnose and treat many urological disease processes. As urological patients often have chronic kidney disease, the well characterized nephrotoxicity of contrast induced nephropathy when using iodine based contrast materials has long been a concern. With the development of gadolinium based contrast agents it seemed that the concern regarding nephrotoxicity had been resolved. In 1997 a new disorder, nephrogenic systemic fibrosis, appeared in patients with severe renal failure. Nephrogenic systemic fibrosis is a serious and potentially devastating disorder characterized by progressive thickening and hardening of the skin and other body tissues, and complicated by flexion contractures of the joints.

Materials and Methods

We performed a survey of the available literature on nephrogenic systemic fibrosis and magnetic resonance contrast media. We focused on mechanisms in the development of nephrogenic systemic fibrosis as well as its association with magnetic resonance contrast media, disease treatment and prevention, and its relevance to clinical urology.

Results

An association between nephrogenic systemic fibrosis and gadolinium based contrast agents has been reported. Gadolinium is a toxic metal and it must be chelated to be a safe injectable contrast agent. It is now hypothesized that the majority of nephrogenic systemic fibrosis cases present with gadolinium based contrast agent exposure as the triggering factor, although this mechanism has not been elucidated. As gadolinium enhanced magnetic resonance imaging is an important tool in the diagnosis and surveillance of urological diseases, the severe consequences of nephrogenic systemic fibrosis demand that practicing urologists understand and know its history and treatment strategies.

Conclusions

This review provides clarification of the gadolinium based contrast agent characteristics, tissue interactions that lead to the development of nephrogenic systemic fibrosis, prevention possibilities and available treatment options.

Key Words: magnetic resonance imaging, gadolinium, nephrogenic fibrosing dermopathy, kidney failure, chronic

Abbreviations and Acronyms: CF, circulating fibrocytes, CKD, chronic kidney disease, ECP, extracorporeal photopheresis, FDA, Food and Drug Administration, GBCA, gadolinium based contrast agent, Gd, gadolinium, GFR, glomerular filtration rate, MRA, magnetic resonance angiography, MRI, magnetic resonance imaging, NSF, nephrogenic systemic fibrosis