BMJ  2007;334:1335-1336 (30 June), doi:10.1136/bmj.39254.924641.1F

Letters

Imaging peripheral disease

Gadolinium contrast may be risky in kidney disease

The first 150 words of the full text of this article appear below.

Collins et al and the accompanying editorial conclude that contrast enhanced magnetic resonance angiography (MRA) is a viable alternative to conventional contrast angiography for assessing patients with peripheral arterial disease before treatment.^{1 2} The authors found an adverse event rate of up to 10% associated with contrast enhanced MRA, lower than other techniques and generally mild compared with conventional contrast angiography.

We draw attention to the association between the use of gadolinium based contrast agents for MRA and the development of nephrogenic systemic fibrosis,³ a newly described chronic, debilitating disease characterised by progressive fibrosis of the skin, heart, lungs and pleura with considerable morbidity and mortality. Development is predominately restricted to patients with stage V chronic kidney disease (estimated glomerular filtration rate less than 15 ml/min) and in those with acute renal failure, especially with liver failure. Most cases have been associated with the use of gadodiamide (Omniscan), some with gadopentate . . . [Full text of this article]

¹ Renal Unit, Glasgow Royal Infirmary, Glasgow G4 0SF, ² Renal Unit, Western Infirmary, Glasgow G11 6PE

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Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic, lower limb peripheral arterial disease: systematic review

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• Rofsky, N. M., Sherry, A. D., Lenkinski, R. E. (2008). Nephrogenic Systemic Fibrosis: A Chemical Perspective. Radiology 247: 608-612 [Full text]