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Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines

Abstract

Purpose

To update the guidelines of the Contrast Media Safety Committee (CMSC) of the European Society of Urogenital Radiology (ESUR) on nephrogenic systemic fibrosis and gadolinium-based contrast media.

Areas covered

Topics reviewed include the history, clinical features and prevalence of nephrogenic systemic fibrosis and the current understanding of its pathophysiology. The risk factors for NSF are discussed and prophylactic measures are recommended. The stability of the different gadolinium-based contrast media and the potential long-term effects of gadolinium in the body have also been reviewed.

Key Points

Clinical features, risk factors and prevention of nephrogenic systemic fibrosis are reviewed

Patients with GFR below 30 ml/min/1.73 m 2 have increased risk of developing NSF

Low stability gadolinium contrast media show the strongest association with NSF

Following guidelines regarding gadolinium contrast agents minimises the risk of NSF

Potential long-term harm from gadolinium accumulation in the body is discussed

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Fig. 1

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Acknowledgements

Members of the Committee: H.S. Thomsen (Chairman, University of Copenhagen, Denmark), F. Stacul (Secretary, University of Trieste, Italy), T. Almén (University of Lund, Sweden), M.-F. Bellin (University of Paris, France), Michele Bertolotto (University of Trieste, Italy), G. Bongartz (University of Basle, Switzerland), O. Clement (University of Paris, France), G. Heinz-Peer (University of Vienna, Austria), Peter Leander (University of Lund, Sweden), S.K. Morcos (University of Sheffield, United Kingdom), P. Reimer (University of Freiburg, Germany), A. van der Molen (University of Leiden, the Netherlands), J.A.W. Webb (St. Bartholomew’s Hospital, United Kingdom). Consultants to the Committee: Eric Lancelot (Guerbet, France), P. Lengsfeld (Bayer Pharma, Germany), A. Spinazzi (Bracco, Italy). ESUR: www.esur.org

Author information

Correspondence to Henrik S. Thomsen.

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Thomsen, H.S., Morcos, S.K., Almén, T. et al. Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Medium Safety Committee guidelines. Eur Radiol 23, 307–318 (2013). https://doi.org/10.1007/s00330-012-2597-9

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Keywords

  • Nephrogenic systemic fibrosis
  • Contrast media
  • Gadolinium
  • Renal insufficiency