Safety of сontrast-enhanced magnetic resonance imaging in patients with renal function impairment

Gadolinium-chelated compounds have been widely used in clinical practice as contrast agents to improve magnetic resonance imaging quality. Gadolinium-based contrast agents (GBCA) had long been associated with the favorable safety profile being used as an alternative to an iodinated contrast agent in patients with renal dysfunction. Follow-up observations showed that the use of these agents in patients with severe renal excretory dysfunction, especially those receiving dialysis treatment, could result in the development of nephrogenic systemic fibrosis (NSF), which is known to be a fatal fibrosing disease affecting the skin and internal organs. Injunction on the use of GBCA for the risk group patients introduced by supervisory authorities allowed for decreasing the number of new NSF cases; at the same time, they had to refuse to carry out diagnostic magnetic resonance tomography in some patients, which could adversely affect diagnostic accuracy. The findings of the studies performed in the past decade show that the probability of NSF development depends not only on the kidney excretory function state but also on the chemical structure and characteristics of GBCA, which allows divide them into high and low-risk groups. At present, it is a well-known fact that most NSF cases reported previously were associated with the use of old linear GBCA (gadopentetate dimeglumine, gadodiamide and gadoversetamide). At the same time, more stable macrocyclic GBCA (gadobutrol, gadoteric acid, gadoteridol) could be safely used in individuals with acute renal injury, advanced chronic kidney disease and on dialysis. The strategy of NSF prophylaxis also changed. It is assumed that in the cases when only low-risk GBCA are used, kidney function screening using questionnaires or glomerular filtration rate test may be optional. Despite the changes in the safety concept concerning GBCA, there are still cases of unwarranted refusals to undergo contrast-enhanced magnetic resonance imaging in patients with severe kidney excretory function impairment. The goal of the present review is to raise awareness among nephrologists, radiologists and other medical specialists concerning the main aspects of using GBCA in patients at risk of developing NSF. The paper summarizes the main recommendations of the leading relevant international societies, as well as the results of the most representative studies and systematic reviews.

гадолиний-содержащие контрастные средства, магнитно-резонансные контрастные исследования, нефрогенный системный фиброз, почечная недостаточность, gadolinium-based contrast agents, сontrast-enhanced magnetic resonance imaging, nephrogenic systemic fibrosis, kidney failure

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