Zou Zhitong, Ma Lin
Department of Radiology, Weill Medical College of Cornell University, Ithaca, New York, USA; and Chinese Peoples' Liberation Army General Hospital, Beijing, China.
Indian J Dermatol. 2011 Jan;56(1):65-73. doi: 10.4103/0019-5154.77556.
Nephrogenic systemic fibrosis (NSF) has now been virtually eliminated by the discovery of its association with gadolinium-based contrast agents (GBCAs) and the consequent reduced use of GBCA-enhanced magnetic resonance imaging (MRI) in severe renal failure patients. This review of 408 biopsy-confirmed cases shows how to minimize NSF risk when performing GBCA-enhanced MRI or magnetic resonance angiography. The absence of any NSF cases in patients less than 8 years old or greater than 87 years old suggests that infants and elderly patients are already protected. Limiting GBCA dose to a maximum of 0.1 mMol/kg, dialyzing dialysis patients quickly following GBCA administration, delaying administration of GBCA in acute renal failure until after renal function returns or dialysis is initiated, and avoiding nonionic linear GBCA in renal failure patients, especially when there are pro-inflammatory conditions, appear to have reduced NSF risk to the point where safe GBCA-enhanced MRI is possible in most patients.
由于发现肾源性系统性纤维化（NSF）与钆基造影剂（GBCA）有关联，且严重肾衰竭患者中GBCA增强磁共振成像（MRI）的使用量因此减少，如今NSF几乎已被消除。这篇对408例经活检确诊病例的综述展示了在进行GBCA增强MRI或磁共振血管造影时如何将NSF风险降至最低。8岁以下或87岁以上患者未出现任何NSF病例，这表明婴儿和老年患者已受到保护。将GBCA剂量限制在最大0.1毫摩尔/千克，在GBCA给药后迅速对透析患者进行透析，在急性肾衰竭时推迟GBCA给药直至肾功能恢复或开始透析，并避免在肾衰竭患者中使用非离子线性GBCA，尤其是在存在促炎情况时，这些措施似乎已将NSF风险降低到大多数患者能够安全进行GBCA增强MRI的程度。
