Question

Regarding nephrogenic systemic fibrosis (NSF):

a. It usually involves the trunk first and spreads distally to the extremities

b. It can occur in patients with normal kidney function

c. The highest risk is posed by gadolinium compounds with a cyclical structure

d. Most of the described cases are attributed to gadodiamide and gadopentetic acid

e. In patients with severe renal impairment (estimated glomerular filtration rate (eGFR) <30 ml min-1 per 1.73 m2 ), all gadolinium-based contrast agents are contraindicated

Answer 1

a. False. NSF starts as fibrosis of the skin and connective tissue of the extremities.

b. False. There are no known cases of NSF in patients with normal kidney function.

c. False. NSF is thought to be associated with the release of free Gd3þ from the chelate. This is most likely to happen with linear non-ionic compounds, and is least likely with cyclic compounds.

d. True. Most cases have been associated with gadiodiamide (Omniscan). A small number of cases have been associated with gadopentetic acid (Magnevist).

e. False. According to the guidance from the ** Medicine and Healthcare products Regulatory Agency (MHRA), such patients should not be given gadodiamide and gadopentetic acid. In the case of other gadolinium-containing compounds, ‘careful consideration should be given’.