Nephrogenic systemic fibrosis: the end of the story?

Gadolinium-based contrast agents (GBCA) have been standardly intravenously applied to improve visibility of MRI examinations since 1988, when gadopentetate dimeglumine (Magnevist ® ) was approved for clinical practice.Gadolinium itself is a heavy metal, highly toxic in biological systems.Therefore, gadolinium must be bound to ligands for the purpose of contrast agents.GBCA consist of gadolinium ion and a chelating molecule, which could be cyclic or linear.The macrocyclic molecule pre-organizes the rigid ring to cage the gadolinium ion, which offers better protection and binding of gadolinium ion.Linear chelates with a flexible open chain are less stable and provide weaker link of the gadolinium ion.The rate of gadolinium dissociation from the macrocyclic ligands is remarkably slower than their dissociation from the linear chelates (1).Nephrogenic systemic fibrosis (NSF) is a disease associated with GBCA applications and connected to impaired kidney function.NSF was firstly described by Cowper et al. in 2000 (2).It is necessary to mention that Cowper et al. did not link that disease to gadolinium applications (2).This was done several years later (in 2006) by a group of nephrologists led by Grobner and Marckmann (3,4).NSF represents a systemic multiorgan disorder characterized by fibrosis.It is a serious and possibly life-threatening disease, affecting not only skin, but all fibrous tissues in the body including those in internal organs such as heart, liver, lungs and muscles.The failure of these organs may be responsible for patients' death.However, NSF is a highly clinically variable disease, some patients may suffer only from mild cosmetics skin affection, others