Am Fam Physician. 2009 Aug 1;80(3):214.
Original Article: Primary Brain Tumors in Adults
Issue Date: May 15, 2008
Available at: http://www.aafp.org/afp/20080515/1423.html
to the editor: We found the article on brain tumors in adults to be informative and comprehensive. The authors stated that gadolinium-enhanced magnetic resonance imaging (MRI) is the preferred method for evaluating brain tumors. They provide several reasons why MRI is superior to computed tomography (CT) for this evaluation, including the negligible risk of allergic reaction to gadolinium. We agree that MRI is preferred to CT in this situation, but would like to point out that MRI with gadolinium does have some risks, specifically the risk of nephrogenic systemic fibrosis (NSF).
The diagnosis of NSF is relatively new, with the first cases being reported in 1997.1 NSF is a fibrosing disorder in patients with chronic kidney disease that has been linked to the use of gadolinium for enhanced MRI. More than 95 percent of the cases reported to the International NSF Registry involved patients who had been exposed to gadolinium within two to three months of disease onset.2 Manifestations of NSF are thickening of the skin, and fibrosis of the dermis and deeper structures including the muscle, fascia, lungs, and heart.3 NSF is a rare diagnosis with only 200 reported cases as of January 2008.2 The exact pathogenesis is not completely understood, but it is related to fibrocyte overproduction of collagen in response to gadolinium deposition in tissues.
The U.S. Food and Drug Administration recommends using gadolinium only when clearly necessary in patients with stage 4 and 5 renal disease, which it defines as a glomerular filtration rate lower than 30 mL per minute per 1.73 m2. If patients with renal insufficiency receive gadolinium, then hemodialysis should be promptly started after the imaging study is completed.4 Treatments for NSF are limited but include renal transplantation, extracorporeal photopheresis, ultraviolet A phototherapy, and plasmapheresis.
Author disclosure: Nothing to disclose.
The opinions and assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the U.S. Navy Medical Department or the U.S. Navy at large.
1. Hubbard V, Davenport A, Jarmulowicz M, Rustin M. Scleromyxoedema-like changes in four renal dialysis patients. Br J Dermatol. 2003;148(3):563–568.
2. The International Center for Nephrogenic Fibrosing Dermopathy Research (ICNFDR). http://www.icnfdr.org. Accessed May 1, 2008.
3. Galan A, Cowper SE, Bucala R. Nephrogenic systemic fibrosis (nephrogenic fibrosing dermopathy). Curr Opin Rheumatol. 2006;18(6):614–617.
4. U.S. Food and Drug Administration. Center for Drug Evaluation and Research. Public Health Advisory. Gadolinium-containing contrast agents for magnetic resonance imaging (MRI): Omniscan, OptiMARK, Magnevist, ProHance, and MultiHance. http://www.fda.gov/cder/drug/InfoSheets/HCP/gcca_200705.htm. Accessed May 15, 2009.
Send letters to Kenneth W. Lin, MD, MPH, Associate Deputy Editor for AFP Online, e-mail: firstname.lastname@example.org, or 11400 Tomahawk Creek Pkwy., Leawood, KS 66211-2680.
Please include your complete address, e-mail address, and telephone number. Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors.
Letters submitted for publication in AFP must not be submitted to any other publication. Possible conflicts of interest must be disclosed at time of submission. Submission of a letter will be construed as granting the American Academy of Family Physicians permission to publish the letter in any of its publications in any form. The editors may edit letters to meet style and space requirements.
Copyright © 2009 by the American Academy of Family Physicians.
This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Contact email@example.com for copyright questions and/or permission requests.
Want to use this article elsewhere? Get Permissions