No abstract available.
Nephrogenic Fibrosing Dermopathy

Gadolinium-based contrast agents (GBCAs) are commonly used for enhancement in MR imaging and have long been considered safe when administered at recommended doses. However, since the report that nephrogenic systemic fibrosis is linked to the use of GBCAs in subjects with severe renal diseases, accumulating evidence has suggested that GBCAs are not cleared entirely from our bodies; some GBCAs are deposited in our tissues, including the brain. GBCA deposition in the brain is mostly linked to the specific chelate structure of the GBCA: linear GBCAs were responsible for brain deposition in almost all reported studies. This review aimed to summarize the current knowledge about GBCA brain deposition and discuss its clinical implications.
Brain* ; Contrast Media ; Gadolinium* ; Magnetic Resonance Imaging ; Nephrogenic Fibrosing Dermopathy

Nephrogenic systemic fibrosis is a rare multisystemic disorder mainly affecting the skin and joints in patients with underlying renal insufficiency exposed to gadolinium-based contrast. We report a patient who had renal insufficiency caused by multiple myeloma and developed nephrogenic systemic fibrosis after exposure to gadolinium-based contrast for the first time in Korea.
Fibrosis ; Gadolinium ; Humans ; Joints ; Korea ; Multiple Myeloma ; Nephrogenic Fibrosing Dermopathy ; Renal Insufficiency ; Skin

Gadolinium contrast agents (CAs) are integral components of clinical magnetic resonance imaging (MRI). However, safety concerns have arisen regarding the use of gadolinium CAs, due to their association with nephrogenic systemic fibrosis (NSF). Furthermore, recently the long-term retention of Gd²⁺-based CAs in brains patients with normal renal function raised another possible safety issue. The safety concerns of Gd²⁺-based CAs have been based on the ligand structure of Gd²⁺-based CAs, and findings that Gd²⁺-based CAs with linear ligand structures showed much higher incidences of NSF and brain retention of CAs than Gd²⁺-based CAs with macrocyclic ligand structure. In the current study, we report the in vivo biodistribution profile of a new highly stable multifunctional Gd²⁺-based CA, with macrocyclic ligand structure (HNP-2006). MR imaging using HNP-2006 demonstrated a significant contrast enhancement in many different organs. Furthermore, the contrast enhanced tumor imaging using HNP-2006 confirmed that this new macrocyclic CA can be used for detecting tumor in the central nervous system. Therefore, this new multifunctional HNP-2006 with macrocyclic ligand structure shows great promise for whole-body clinical application.
Brain ; Central Nervous System ; Contrast Media ; Gadolinium ; Humans ; Incidence ; Magnetic Resonance Imaging ; Nephrogenic Fibrosing Dermopathy

Contrast enhanced ultrasound, which was introduced in 1996, has been widely used in Europe and Eastern Asia. Ultrasound contrast agent can be classified as first generation and second generation, depending on the gas within the microbubble. With the first generation contrast agent, the high MI technique was used, and only intermittent scanning was possible due to destruction of the microbubble during scanning. Use of the second generation contrast agent with the low MI technique makes continuous scanning possible. Contrast enhanced US can be used in detection and differentiation of focal liver lesions. It is also helpful for monitoring of radiofrequency ablation and for targeting of US guided biopsy. Currently, because morphologic criteria alone may not reflect the response of the tumor to treatment, new criteria are needed for treatment evaluation after administration of anti-angiogenic agents. Contrast enhanced US could provide quantitative markers for evaluation of the response to treatment via use of dynamic contrast enhanced US. Due to cost-effectiveness, contrast enhanced US is not yet widely used in Korea; however, considering recent issues regarding contrast agent related adverse reaction, such as contrast induced nephropathy and nephrogenic systemic fibrosis, and radiation exposure, contrast enhanced US might be more widely used in Korea, as an alternative imaging modality in the future.
Abdomen ; Biopsy ; Europe ; Far East ; Korea ; Liver ; Microbubbles ; Nephrogenic Fibrosing Dermopathy

Nephrogenic systemic fibrosis (NSF) is a rare fibrosing disorder of the skin and joints that occurs in patients with advanced renal insufficiency. This condition is progressive and can be seriously disabling. Gadolinium based contrast agent (GBCA) has been identified as a potential cause of this condition. A 56-years-old man in hemodialysis developed stiffness and contracture of the whole limbs eight years after frequent GBCA exposure for cervical magnetic resonance imaging. For the first time in Korea, we report late-onset nephrogenic systemic fibrosis after GBCA exposure and performed an electrophysiologic study of this condition.
Contracture ; Extremities ; Gadolinium ; Humans ; Joints ; Korea ; Magnetic Resonance Imaging ; Nephrogenic Fibrosing Dermopathy ; Renal Dialysis ; Renal Insufficiency ; Skin

Gadolinium is widely used as a contrast agent for magnetic resonance imaging (MRI). In patients with radiocontrast media-induced nephrotoxicity, MRI has generally been considered to be a safe substitute for computed tomography (CT). However, recent studies have described the potential emergence of gadolinium-related nephrogenic systemic fibrosis (NSF) in patients with advanced kidney disease. NSF is a fibrosing disorder seen only in patients with moderate to severe kidney failure; it is particularly common in patients on dialysis. Skin involvement occurs in all patients and is characterized by plaques, papules, nodules, thickening, and hardening of the skin overlying the extremities and trunk. Histopathologic examination of an incisional or punch biopsy of affected skin reveals marked expansion and fibrosis of the dermis with proliferation of CD34+ fibrocytes and long dendritic processes. There is no proven medical treatment for NSF other than recovery of renal function. Therefore, the currently recommended preventive measure for NSF in patients with advanced kidney failure is avoidance of gadolinium. Gadolinium-containing contrast agents, especially at high doses, should be used only if clearly necessary. Prompt commencement of hemodialysis may be necessary after gadolinium administration.
Biopsy ; Contrast Media ; Dermis ; Dialysis ; Extremities ; Fibrosis ; Gadolinium ; Humans ; Kidney Diseases ; Magnetic Resonance Imaging ; Nephrogenic Fibrosing Dermopathy* ; Renal Dialysis ; Renal Insufficiency ; Skin

Nephrogenic fibrosing dermopathy (NFD) is a rare cutaneous fibrosing disorder that primarily affects patients with a history of renal disease. NFD manifests with induration, thickening and hardening of the skin with brawny hyperpigmentation. Lesions are typically symmetrical and usually develop on the limbs and trunk. Flexion contractures of the joints may be a feature of the disease. Histopathological features of NFD include proliferation of dermal fibroblasts and dendritic cells, thickened collagen bundles, increased elastic fibers and focal mucin deposition. Although the pathogenesis remains largely unknown, some of the factors implicated in the pathogenesis include renal dysfunction, circulating fibrocytes, vascular injury, and gadolinium which is a contrast material used in magnetic resonance imaging. Currently, no definitive or uniformly effective therapies are available for the treatment of NFD. We herein describe the case of a 44-year-old female NFD patient who undergoes significant improvement of skin lesions and associated joint contracture after renal transplantation.
Adult ; Carubicin ; Collagen ; Contracture ; Dendritic Cells ; Elastic Tissue ; Extremities ; Female ; Fibroblasts ; Gadolinium ; Humans ; Hyperpigmentation ; Joints ; Kidney Transplantation ; Magnetic Resonance Imaging ; Mucins ; Nephrogenic Fibrosing Dermopathy ; Skin ; Vascular System Injuries

Nephrogenic systemic fibrosis is a systemic illness that only affects patients with kidney failure. Exposure to gadolinium-based contrast agents has been associated with the subsequent development of nephrogenic systemic fibrosis in patients with decreased renal function. Nephrogenic systemic fibrosis is characterized by skin induration after swelling and limited joint movement through a loss in flexibility that preferentially affects the extremities. A 58-year-old man in peritoneal dialysis developed swelling and stiffness of the lower limbs following gadolinium exposure for brain magnetic resonance imaging. This patient was diagnosed with nephrogenic systemic fibrosis by CD34 immunoreactivity of subcutaneous fibroblasts in a skin biopsy. We report, for the first time in Korea, that nephrogenic systemic fibrosis developed after gadolinium exposure in a peritoneal dialysis patient.
Biopsy ; Brain ; Contrast Media ; Extremities ; Fibroblasts ; Gadolinium ; Humans ; Joints ; Korea ; Lower Extremity ; Magnetic Resonance Imaging ; Middle Aged ; Nephrogenic Fibrosing Dermopathy ; Peritoneal Dialysis ; Pliability ; Renal Insufficiency ; Skin

CO2 was firstly used as an intravenous contrast medium in the early 1950s for diagnosing pericardial effusion. In the 1970s Cho and Hawkins pioneered the intraarterial use of CO2. In 1980, with the appearance of digital subtraction angiography (DSA), excellent imaging of "low density" contrast material was available. CO2 can be used very safely not only in patients with contrast allergies and renal failure, but also in patients undergoing routine angiographic evaluations and many interventional procedures. Nowadays, conventional invasive vascular imaging is being replaced by high-technology imaging modalities, including ultrasound, computed tomography, and magnetic resonance angiography (MRA): however, angiography continues to be the gold common procedure. Gadodiamide has been proposed to replace iodinated contrast material in high-risk patients with contrast allergy and renal insuffieciency. Neither nonionic iodinated contrast medium nor gadolinium-based contrast medium is safe, because these contrast medium may cause allergic reactions or nephrotoxicity. In recent years, its gadolinium-containing contrast agents have been shown to cause nephrogenic systemic fibrosis in patients with end-stage renal disease. Therefore, the use of carbon dioxide as a contrast agent has increased significantly with its wide clinical applications, including the use of carbon dioxide during peripheral vascular stenting and abdominal aortic stent graft placement. Familiarity with the physical properties of carbon dioxide, avoidance of air contamination, catheterization techniques, vascular anatomy, physiologic monitoring, and radiation safety is essential for the safe and effective performance of carbon dioxide angiography. Recently, CO2 has been reported as a "black blood" contrast agent for MRA. Today, carbon dioxide is used worldwide as a contrast agent for numerous vascular and nonvascular procedures in various organs and arterial circulation below the diagram, as well as in the venous circulation. There are over 200 publications proving that CO2 is not nephrotoxic and is without any kind of allergy. For safe and reliable utilization, one must understand the principles of CO2 delivery in the vascular system. A very safe and inexpensive plastic bag delivery system (CO2 Plastic Bag Delivery System(TM), AngioDynamics, Inc., USA) has been used during the over past 20 years. High-resolution DSA 1024x1024 systems with high frame rates have produce images nearly comparable to those with iodinated contrast material.
Angiography ; Angiography, Digital Subtraction ; Carbon Dioxide ; Catheterization ; Catheters ; Contrast Media ; Gadolinium DTPA ; Humans ; Hypersensitivity ; Kidney Failure, Chronic ; Magnetic Resonance Angiography ; Monitoring, Physiologic ; Nephrogenic Fibrosing Dermopathy ; Pericardial Effusion ; Plastics ; Recognition (Psychology) ; Renal Insufficiency ; Stents ; Transplants