Article

Nephrogenic systemic fibrosis and its impact on abdominal imaging.

Department of Radiology, Weill Cornell Medical Center, Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022, USA.
Radiographics (Impact Factor: 2.79). 10/2009; 29(6):1565-74. DOI: 10.1148/rg.296095517
Source: PubMed

ABSTRACT The objective of this article is to review the current knowledge about nephrogenic systemic fibrosis (NSF) and how to prevent it. More than 300 cases of NSF in patients with severe chronic renal insufficiency or acute renal failure or in patients undergoing dialysis have been reported in the peer-reviewed literature, with an overwhelming majority occurring within weeks to months after injection of a gadolinium-based contrast agent (GBCA). Because administration of a high dose of a GBCA is a primary risk factor and because most high-dose magnetic resonance (MR) imaging applications involve abdominal imaging (eg, liver and abdominal MR angiography), NSF cases have been associated with abdominal MR imaging. Additional major risk factors for developing NSF include proinflammatory conditions, failure to perform dialysis promptly after GBCA administration, use of nonionic linear contrast agents, hyperphosphatemia, and younger age. Recent recommendations to use GBCAs with caution in patients with acute renal failure, patients receiving dialysis, or patients with an estimated glomerular filtration rate of less than 30 mL/min have resulted in virtually no new NSF cases being reported with onset in 2008 or 2009 in spite of a high level of awareness about this entity. In conclusion, NSF has been virtually eliminated by using caution in administering GBCAs to patients known to have severe or acute renal failure. In these patients, avoid high doses; and for patients undergoing dialysis, schedule MR imaging to occur just before a dialysis session to ensure rapid elimination of gadolinium.

0 Bookmarks
 · 
61 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Photodynamic therapy (PDT) is a site-specific treatment of cancer involving the administration of a photosensitizer (PS) followed by the local light activation. Besides efficient PSs, image guidance is essential for precise and safe light delivery to the targeting site, thus improving the therapeutic effectiveness. Herein, we report the fabrication of theranostic porphyrin dyad nanoparticles (TPD NPs) for magnetic resonance imaging (MRI)-guided PDT cancer therapy, where the inner metal free porphyrin functions as a photosensitizer for PDT while the outer Mn-porphyrin serve as an MRI contrast agent. Covalent attachment of porphyrins to TPD NPs avoids premature release during systemic circulation. In addition, TPD NPs (~60 nm) could passively accumulate in tumors and be avidly taken up by tumor cells. The PDT and MRI capabilities of TPD NPs can be conveniently modulated by varying the molar ratio of metal free porphyrin/Mn-porphyrin. At the optimal molar ratio of 40.1%, the total drug loading content is up to 49.8%, 31.3% for metal free porphyrin and 18.5% for Mn-porphyrin. The laser light ablated the tumor completely within 7 days in the presence of TPD NPs and the tumor growth inhibition was 100%. The relaxivities were determined to be 20.58 s−1 mm−1 for TPD NPs, about four times as much as that of Mn-porphyrin (5.16 s−1 mm−1). After 24 h intravenous injection of TPD NPs, MRI images showed that the whole tumor area remained much brighter than surrounding healthy tissue, allowing to guide the laser light to the desired tumor site for photodynamic ablation.
    Biomaterials 01/2014; 35(24):6379–6388. · 8.31 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To evaluate value of adding non-contrast MR angiographic sequence (In-Flow Inversion Recovery [IFIR]) to standard fat-suppressed T1-weighted postcontrast sequence (3D spoiled gradient echo [3D-GRE]) for evaluating hepatic arterial anatomy. Methods Retrospective evaluation of 30 consecutive patients undergoing multiphase liver MRI. Individual vessels for IFIR/3D-GRE sequences were evaluated by two blinded readers using a four-point scale. Statistical analysis was performed using the Wilcoxon signed-rank test for vessel conspicuity between IFIR/3D-GRE sequences. Results IFIR alone diagnostically imaged 8.1% of vessels, 3D-GRE alone 25.8%, 55.8% by both 3D-GRE/IFIR, and 10.3% of vessels by neither. Two patients with variant vascular anatomy were visualized with both sequences. Addition of IFIR to 3D-GRE resulted in statistically significant increase in arterial visualization (p < 0.001), 10% relative increase in identified vessels, and 3-to-5 minute increase in acquisition time for total scan time of 30-35 minutes. Conclusions IFIR may be a useful adjunct to 3D-GRE in hepatic angiography without adding considerably to scan time. 10% more hepatic arteries were seen when combining information from IFIR/3D-GRE vs. 3D-GRE alone.
    European journal of radiology 01/2014; · 2.65 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Magnetic resonance imaging (MRI) is the leading imaging technique for disease diagnostics, providing high resolution, three-dimensional images noninvasively. MRI contrast agents are designed to improve the contrast and sensitivity of MRI. However, current clinically used MRI contrast agents have relaxivities far below the theoretical upper limit, which largely prevent advancing molecular imaging of biomarkers with desired sensitivity and specificity. This review describes current progress in the development of a new class of protein-based MRI contrast agents (ProCAs) with high relaxivity using protein design to optimize the parameters that govern relaxivity. Further, engineering with targeting moiety allows these contrast agents to be applicable for molecular imaging of prostate cancer biomarkers by MRI. The developed protein-based contrast agents also exhibit additional in vitro and in vivo advantages for molecular imaging of disease biomarkers, such as high metal-binding stability and selectivity, reduced toxicity, proper blood circulation time, and higher permeability in tumor tissue in addition to improved relaxivities.
    Medicinal Research Reviews 03/2014; · 9.58 Impact Factor