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Letters

Letters
DOI:10.2214/AJR.06.1651
dodiamide and gadoversetamide. Although to our
www.ajronline.org. Accessed December 15, 2006
WEB—This is a Web exclusive article.
knowledge no data that associate gadoversetamide
3. Evenepoel P, Zeegers M, Segaert S, et al. Nephro-
with nephrogenic systemic fibrosis have been pub-
genic fibrosing dermopathy: a novel, disabling dis-
Nephrogenic Systemic Fibrosis and
lished to date, there is a genuine theoretic concern
order in patients with renal failure. Nephrol Dial
Nonionic Linear Chelates
that nonionic linear chelates probably can release
Transplant 2004; 49:469–473
We read with great interest the article by
gadolinium like gadodiamide under similar condi-
4. Grobner T. Gadolinium: a specific trigger for the de-
Broome et al. [1] and Editor in Chief Dr. Robert
tions. The absence of reported cases of nephro-
velopment of nephrogenic fibrosing dermopathy
Stanley’s editorial [2] highlighting a possible
genic systemic fibrosis associated with gadover-
and nephrogenic systemic fibrosis? Nephrol Dial
causal relationship between gadodiamide and
setamide could be partly because it is not marketed
Transplant 2006; 21:1104–1108
nephrogenic systemic fibrosis. These cases are
in Europe and its use in the United States is un-
5. Maloo M, Abt P, Kashyap R, et al. Nephrogenic sys-
in agreement with the findings of previous re-
known. On the other hand, more than 30 million
temic fibrosis among liver transplant recipients: a
ports [3–6] and bring the total number of pub-
patients have received gadodiamide worldwide
single institution experience and topic update. Am
lished cases of nephrogenic systemic fibrosis
since it introduction in 1993 [7].
J Transplant 2006; 6:2212–2217
associated with gadodiamide to 47. These cases
At this stage of our understanding, we believe
6. Marckmann P, Skov L, Rossen K, et al. Nephro-
are probably the so-called “tip of an iceberg” be-
that it would be safer to avoid the use of all non-
genic systemic fibrosis: suspected etiological role
cause a significant number of unreported cases
ionic linear chelates, including gadodiamide and
of gadodiamide used for contrast-enhanced mag-
have been brought to our attention [7].
gadoversetamide, in patients on dialysis and in
netic resonance imaging. J Am Soc Nephrol 2006;
We have explored the possible mechanisms
those with chronic kidney disease (grade 3 or
17:2359–2362
that may explain the association between ga-
more or a glomerular filtration rate < 60 mL/min
7. Thomsen HS. Nephrogenic systemic fibrosis: a se-
dodiamide and nephrogenic systemic fibrosis,
[Sadowski et al., presented at the 2006 annual
rious late adverse reaction to gadodiamide. Eur
and it becomes apparent that the stability of the
meeting of the Radiological Society of North
Radiol 2006; 16:2619–2621
chelate and the release of free gadolinium could
America]) or acute hepatorenal syndrome. In ad-
8. Idée J-M, Port M, Raynal I, Schaefer M, Le Gre-
be involved in triggering the fibrotic process [8,
dition, we agree with the observation of Broome
neur S, Corot C. Clinical and biological conse-
9]. In recent reports, investigators have docu-
et al. [1] that prophylactic hemodialysis immedi-
quences of transmetallation induced by contrast
mented the presence of gadolinium atoms in skin
ately after contrast-enhanced MRI examination
agents for magnetic resonance imaging: a review.
biopsies of patients with nephrogenic systemic
does not offer any protection against the develop-
Fundam Clin Pharmacol 2006; 20:563–576
fibrosis [10, 11]. Of the extracellular chelates in
ment of nephrogenic systemic fibrosis.
9. Morcos SK. Nephrogenic systemic fibrosis fol-
clinical use, the least stable molecules in terms of
Thomsen HS, Morcos SK
Henrik S. Thomsen
lowing the administration of extracellular gadolin-
the physiochemical properties are the nonionic
Sameh K. Morcos
ium based contrast agents: is the stability of the
linear chelates (i.e., gadodiamide and gadover-
Copenhagen University Hospital at Herlev
contrast agent molecule an important factor in the
setamide) and the most stable molecules are the
DK-2730 Herlev, Denmark
pathogenesis of this condition? Br J Radiol 2007;
cyclic chelates.
[Epub ahead of print]
We agree with Dr. Stanley’s recommendation
References
10. High W, Ayers RA, Chandler J, Zito G, Cowper
that gadodiamide use should be strictly avoided in
1. Broome DR, Girguis MS, Baron PW, Cottrell AC,
SE. Gadolinium is detectable within the tissue of
patients on dialysis and in patients with end-stage
Kjellin I, Kirk GA. Gadodiamide-associated neph-
patients with nephrogenic systemic fibrosis. J Am
renal disease or acute hepatorenal syndrome.
rogenic systemic fibrosis: why radiologists should
Acad Dermatol 2007; 56:21–26
However, we believe that the warning should ex-
be concerned. AJR 2007; 188:586–592
11. Boyd AS, Zic JA, Abraham JL. Gadolinium dep-
tend to include all the nonionic linear chelates that
2. AJR Website. Stanley RJ. Alert: MRI contrast agent
osition in nephrogenic fibrosing dermopathy. J Am
share the same physicochemical properties as ga-
use in patients with renal failure. Available at:
Acad Dermatol 2007; 56:27–30
AJR 2007; 188:W580 0361–803X/07/1886–W580 © American Roentgen Ray Society
W580
AJR:188, June 2007