On Tuesday, Dr. Kanal provided a succinct overview of the contemporary state of Nephrogenic Systemic Fibrosis (NSF), and information about the number of the unconfounded cases of NSF by gadolinium based MR contrast agent.
Beyond the historic numbers, Dr. Kanal explained the technical differences between ionic vs. non-ionic bonds, as well as linear vs. macrocyclic molecular structures, and what each of those means when it comes to evaluating the relative strength of the gadolinium – chelate bond.
In addition to describing the state of NSF (and what the industry has done to virtually eliminate new cases), he described new and growing concerns about non-NSF bio-retention.
A small number of cases, including one presented by Dr. Kanal from his own site, show abnormal, increasing T1 shortening within specific areas of the brain in patients with normal renal function who have received multiple doses of one or more of a few gadolinium-based contrast agents (without apparent toxic effects). If the enhancement is due to gad accumulation, this conflicts with what has been believed about retention / elimination of GBCA.
In a similar recent development, a self-organizing patient community is releasing test results that show significant gadolinium elimination, months or years following contrast enhanced MRI exam. This small group says that not only have they retained the gadolinium from their MR exams far beyond its projected clearance, but that the gadolinium they received caused a variety of persistent symptoms very shortly following contrast administration.