Commentary

Abstract

The emergence of nephrogenic systemic fibrosis (NSF) forced the radiologists to  look at the issue of contrast safety in MR imaging.  Prior to this the gadolinium based agents were considered so safe that they were used as a contrast agents in catheter angiography in high risk patients.  For the record gadolinium based contrast agents are at least as nephrotoxic as iodinated agents.  Their myth of relative safety  in patients with renal failure was based on the fact that a very small dose is required in routine  examinations.  After an initial period of denial it is now accepted that NSF exists and is probably due to the chelation of Gadolinium breaking down due to impaired clearance.