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首页> 外文期刊>AJR: American Journal of Roentgenology : Including Diagnostic Radiology, Radiation Oncology, Nuclear Medicine, Ultrasonography and Related Basic Sciences >Gadolinium-based contrast exposure, nephrogenic systemic fibrosis, and gadolinium detection in tissue.
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Gadolinium-based contrast exposure, nephrogenic systemic fibrosis, and gadolinium detection in tissue.

机译：基于d的对比暴露，肾原性全身纤维化和组织中detection的检测。

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OBJECTIVE: The objective of our study was to retrospectively review one institution's cases of nephrogenic systemic fibrosis (NSF), evaluate possible associated factors, determine the prevalence of NSF, and search for gadolinium in skin samples obtained from patients with NSF. MATERIALS AND METHODS: A retrospective review of our dermatopathology database from 1997 to 2007 was performed to search for patients with NSF. The records of patients with NSF were reviewed for factors suspected to be associated with NSF such as acidosis, low hemoglobin levels, low serum calcium levels, inflammatory conditions, serum antibodies, pharmaceutical erythropoietin, angiotensin-converting enzyme inhibitors, gadolinium-based contrast agents (GBCAs), renal failure, and dialysis. The biopsy samples from NSF patients and from control subjects were examined with energy-dispersive X-ray spectroscopy to detect gadolinium. Retrospective chart reviews of patients evaluated at our local dialysis center and our dermatology clinicwere conducted to identify patients who underwent MRI, who had NSF managed exclusively by our tertiary referral centers, or both from 1997 to 2007. RESULTS: Seven cases of NSF were found in the dermatopathology database. Two of the seven patients were also followed up at our outpatient dialysis clinic. No other cases of NSF were discovered within the dialysis clinic's population exclusively followed within our institution. All seven dermatopathology database NSF patients developed symptoms of NSF after receiving GBCAs during renal failure and showed concomitant proinflammatory conditions. No other proposed risk factors were uniformly present in these NSF cases. All four NSF patients with chronic renal failure developed NSF after hemodialysis, with one patient dialyzed 12 hours after receiving a contrast dose. Gadodiamide was the only GBCA that all seven NSF patients received before symptom onset. Symptom onset was from 3 weeks to 18 months after GBCA exposure, with cumulative GBCA doses ranging from 0.16 to 0.43 mmol/kg. Gadolinium was detected in six of seven NSF patients' skin biopsies. Seven of eight random control specimens obtained from three healthy control subjects, three patients with renal insufficiency who had not been exposed to gadodiamide, and two patients without renal disease who had been exposed to gadodiamide were negative. Seventy-two dialysis clinic patients underwent 127 contrast-enhanced MR examinations from 1997 to 2007. Eighteen patients received gadopentetate, none of whom developed NSF. Sixty-three patients received gadodiamide, two of whom developed NSF (prevalence of NSF in patients exposed to GBCA, 2.8%; odds ratio, 0.82 [95% CI, 0.04-18.10]; likelihood ratio, 1.16 [95% CI, 1.06-1.26]). Nine patients received both contrast agents. CONCLUSION: An association with GBCAs in the development of NSF is suggested in the setting of renal insufficiency, but other factors seem to play a role. Dialysis did not prevent the development of NSF. Gadolinium was detected in skin samples from NSF patients.
机译：目的：本研究的目的是回顾性审查一间机构的肾原性系统性纤维化（NSF）病例，评估可能的相关因素，确定NSF的患病率，并从NSF患者的皮肤样本中搜索g。材料与方法：回顾性分析我们1997年至2007年的皮肤病理学数据库，以寻找NSF患者。对NSF患者的病历进行了审查，以检查怀疑与NSF相关的因素，例如酸中毒，血红蛋白水平低，血清钙水平低，炎症，血清抗体，药物促红细胞生成素，血管紧张素转换酶抑制剂，inhibitor基造影剂（ GBCAs），肾衰竭和透析。用能量分散X射线光谱法检查了来自NSF患者和对照组的活检样品，以检测g。对我们在当地透析中心和皮肤病学诊所评估的患者进行回顾性图表审查，以鉴定1997年至2007年间接受MRI检查的，仅由我们的三级转诊中心进行NSF治疗的患者，或两者均由NSF治疗。皮肤病理学数据库。我们的门诊透析诊所也对7例患者中的2例进行了随访。在我们机构内，仅在透析诊所的人群中未发现其他NSF病例。所有七个皮肤病理学数据库的NSF患者在肾衰竭期间接受GBCA后均出现NSF症状，并伴有促炎性疾病。在这些NSF病例中，没有其他建议的危险因素统一存在。所有四名患有慢性肾功能衰竭的NSF患者在血液透析后均会发展为NSF，其中一名患者在接受对比剂量后12小时进行了透析。 Gadodiamide是所有7名NSF患者在症状发作之前接受的GBCA。症状发作是在GBCA暴露后3周至18个月，累积GBCA剂量为0.16至0.43 mmol / kg。在7例NSF患者的皮肤活检中检测到了detected。从三个健康对照受试者中获得的八个随机对照样本中有七个是阴性的，其中三个未暴露于gadodiamide的肾功能不全患者和两个未暴露于gadodiamide的无肾脏疾病的患者。从1997年至2007年，对72例透析门诊患者进行了127例造影剂增强MR检查。18例患者接受了加多戊酯治疗，但均未出现NSF。 63例患者接受了gadodiamide，其中2例患有NSF（接触GBCA的患者NSF患病率为2.8％;比值比为0.82 [95％CI，0.04-18.10];似然比为1.16 [95％CI，1.06-] 1.26]）。 9名患者接受了两种造影剂。结论：在肾功能不全的情况下，提示GBCAs与NSF的发展有关，但其他因素似乎也起作用。透析并不能阻止NSF的发展。在NSF患者的皮肤样本中检测到了。

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