Focus on contrast‐associated nephrogenic systemic fibrosis

Abstract

The first published reports of presumed gadolinium-associated nephrogenic systemic fibrosis “NSF” (1-3) drew the attention of the international community to the development of apparent new risks for clinical applications of gadolinium contrast-enhanced MRI studies in patients with renal disease. Subsequently, priority attention has been directed to this problem in an effort to understand the basic mechanisms, chemistry, and risks in various stages of renal failure, and to develop protocols and guidelines for the safe use of gadolinium-enhanced MRI. In addition, since patients in renal failure are at increased risk of developing NSF, exclusion criteria have been developed for gadolinium-enhanced MRI studies. The focus of scientific societies and institutions on this critically important problem included an NSF workshop, “Nephrogenic Systemic Fibrosis (NSF)/Nephrogenic Fibrosing Dermopathy (NFD),” sponsored by the 2007 International Society for Magnetic Resonance in Medicine at its annual meeting in Berlin and moderated by Georg Bongartz, MD, and Walter Kucharczyk, MD (4). Participants in this workshop included scientists, clinicians, and nephrologists of the international community. Guest editorials from this workshop were published in the Journal of Magnetic Resonance Imaging (5, 6). Numerous investigations and analyses of NSF and reporting systems have been published in multiple journals, including the Journal of Magnetic Resonance Imaging (7-14). Furthermore, a summary report on MR safety by the American College of Radiology included a separate section entitled “Renal Disease, Gadolinium-based MR Contrast Agents, and Nephrogenic Systemic Fibrosis (NSF)” (15). A more recent interdisciplinary team will publish their study of decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols (16). The Journal of Magnetic Resonance Imaging seeks to develop special issues entirely devoted to timely and important clinical topics as they become apparent. Recently these special issues have included “Interventional MRI” (17-20), “Molecular Imaging” (21), “Cardiac MR and CT” (22), “Clinical Potential of Brain Mapping Using MRI” (23), “Frontiers in Musculoskeletal Imaging” (24), and “MR Safety” (25). Continuing in the tradition of publishing special issues on timely clinical topics, it is a pleasure to present in this issue gadolinium-associated nephrogenic systemic fibrosis, with guest editors Tim Leiner, MD, PhD, and Walter Kucharczyk, MD. In this special issue, 18 invited articles have been developed and reviewed by a wide range of investigators and institutions. The entire JMRI issue is, as usual, totally devoted to this topic as a vehicle to enhance the production, distribution, and understanding of information related to NSF. This process highlights the commitment of the Board of Trustees, the Safety Committee, and the journals of the ISMRM to address and help resolve issues related to ensuring the safe clinical use of MRI and MRS studies, including, but not limited to, gadolinium-based enhanced MRI studies. As Editor, I want to take this opportunity to express my sincere appreciation to each contributor and reviewer for a timely and significant contribution. As usual, your comments, critical review, and analyses of the content of this special issue, as well as others in the literature, will be welcome as submissions to JMRI as we continue to evaluate this exceedingly important clinical challenge. It is my hope that our ongoing efforts to share information and encourage dialogue will result in a deeper level of understanding of the mechanisms of and indications for contrast-enhanced MRI studies and the development of exclusion criteria for patients in renal failure.