Forghani Reza
*Department of Radiology †Segal Cancer Centre ‡Lady Davis Institute for Medical Research, Jewish General Hospital & McGill University, Montreal, Quebec, Canada.
Top Magn Reson Imaging. 2016 Aug;25(4):163-9. doi: 10.1097/RMR.0000000000000095.
Gadolinium-based contrast agents have been used for magnetic resonance imaging (MRI) examinations since the late 1980s with an excellent overall cumulative safety record. Initially favored for use in patients with renal impairment because of lack of significant nephrotoxic effect at clinical doses, in 2006, multiple reports convincingly linked the rare but serious disease nephrogenic systemic fibrosis to the administration of gadolinium-based contrast agents in patients with severe renal failure. This in turn led to new policies on administration of these agents, resulting in changes in practice patterns that have virtually resulted in the elimination of the disease after the year 2009. The purpose of this review is to summarize the factors that led to the emergence of nephrogenic systemic fibrosis, including the risk associated with different types of contrast agents based on their stability, and the changes in practice patterns and usage of gadolinium-based contrast agents in recent years that have been mainly driven by the discovery and association with nephrogenic systemic fibrosis. The article will conclude with a brief overview of new emerging safety concerns that could further impact the use of this class of contrast agents and impact practice patterns in the future.
自20世纪80年代末以来，钆类造影剂一直用于磁共振成像（MRI）检查，总体累积安全性记录良好。由于在临床剂量下缺乏显著的肾毒性作用，最初它受到肾功能损害患者的青睐。但在2006年，多份报告令人信服地将罕见但严重的疾病——肾源性系统性纤维化与严重肾衰竭患者使用钆类造影剂联系起来。这反过来导致了这些药物给药的新政策，导致了实践模式的改变，实际上在2009年后这种疾病已基本消除。本综述的目的是总结导致肾源性系统性纤维化出现的因素，包括基于不同类型造影剂稳定性的相关风险，以及近年来主要由肾源性系统性纤维化的发现和关联所驱动的钆类造影剂实践模式和使用情况的变化。本文将简要概述可能进一步影响这类造影剂使用并在未来影响实践模式的新出现的安全问题作为结语。
