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MRI Safety Update 2008: Part 1, MRI Contrast Agents and Nephrogenic Systemic Fibrosis

¹ Keck School of Medicine, University of Southern California and Institute for Magnetic Resonance Safety, Education, and Research, 7511 McConnell Ave., Los Angeles, CA 90045.
² Group Medical and Regulatory Affairs, Bracco Diagnostics, Inc., Princeton, NJ.

View larger version (52K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A —Cutaneous changes of nephrogenic systemic fibrosis (NSF). Photographs show cutaneous changes of NSF with brawny hyperpigmentation and tethering of skin on arms and legs resulting in flexion contractures of the fingers, elbows, and knees. (Reprinted with permission of John Wiley & Sons, Inc. [129]; Kay J. What causes nephrogenic systemic fibrosis? The Rheumatologist 2007; 9:18–20; courtesy of Jonathan Kay, Massachusetts General Hospital and Harvard Medical School, Boston, MA)

View larger version (76K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B —Cutaneous changes of nephrogenic systemic fibrosis (NSF). Photographs show cutaneous changes of NSF with brawny hyperpigmentation and tethering of skin on arms and legs resulting in flexion contractures of the fingers, elbows, and knees. (Reprinted with permission of John Wiley & Sons, Inc. [129]; Kay J. What causes nephrogenic systemic fibrosis? The Rheumatologist 2007; 9:18–20; courtesy of Jonathan Kay, Massachusetts General Hospital and Harvard Medical School, Boston, MA)

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2 —Photograph shows hyperpigmented, brawny plaques with skin induration and flexion contractures of fingers, ankles, and knees accompanied by edema of fingers in 35-year-old woman with nephrogenic systemic fibrosis. (Reprinted with permission of [130]; Thomsen HS. Nephrogenic systemic fibrosis. Imaging Decisions 2008; 11:13–18; courtesy of Henrik S. Thomsen, Copenhagen University Hospital, Herlev, Denmark)

View larger version (77K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3 —Photograph shows late stage of nephrogenic systemic fibrosis in patient with plaques and skin induration of both legs up to thighs and flexion contractures. Skin involvement is symmetric and bilateral. Affected skin is hairless, sclerotic, and brown. (Reprinted with permission of [67]; Khurram M, Skov L, Rossen K, Thomsen HS, Marckmann P. Nephrogenic systemic fibrosis: a serious iatrogenic disease of renal failure patients. Scand J Urol Nephrol 2007; 41:565–566; courtesy of Henrik S. Thomsen, Copenhagen University Hospital, Herlev, Denmark [www.informaworld.com/suro])

View larger version (75K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 4 —Photograph shows plaques of nephrogenic systemic fibrosis in patient with follicular dimpling changes and severe contractures of elbow, wrist, and fingers. (Reprinted with permission of [130]; Thomsen HS. Nephrogenic systemic fibrosis. Imaging Decisions 2008; 11:13–18; courtesy of Henrik S. Thomsen, Copenhagen University Hospital, Herlev, Denmark)

View larger version (107K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 5 —Hyperpigmented, brawny plaques and flexion contractures of wrist and fingers accompanied by edema of fingers in patient with nephrogenic systemic fibrosis. Courtesy of Henrik S. Thomsen, Copenhagen University Hospital, Herlev, Denmark)

View larger version (150K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 6 —Skin biopsy from skin of patient with nephrogenic systemic fibrosis. Photomicrograph shows CD34+ spindle or epithelioid cells in a reticular or parallel arrangement. (Reprinted with permission of [129]; Kay J. What causes nephrogenic systemic fibrosis? The Rheumatologist 2007; 9:18–20; courtesy of Jonathan Kay, Massachusetts General Hospital and Harvard Medical School, Boston, MA)

View larger version (169K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 7 —Skin biopsy (H and E) from leg of patient with nephrogenic systemic fibrosis. Photomicrograph shows thick dermal collagen bundles surrounded by clefts with spindle cells intercalated between collagen bundles throughout reticular dermis. (Reprinted with permission of [129]; Kay J. What causes nephrogenic systemic fibrosis? The Rheumatologist 2007; 9:18–20; courtesy of Jonathan Kay, Massachusetts General Hospital and Harvard Medical School, Boston, MA)

View larger version (13K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 8 —Graph shows number of unconfounded cases of nephrogenic systemic fibrosis reported in peer-reviewed literature. Data are from [22, 36–81]. NA = name of contrast agent was not reported. Manufacturers of contrast agents: Omniscan, GE Healthcare; Magnevist, Bayer HealthCare; ProHance and MultiHance, Bracco Diagnastics; Gadovist, Vasovist, and Primovist, Bayer Schering Pharma; OptiMARK, Covidien; and Dotarem, Guerbet.

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