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Radiol Clin North Am. 2009 Sep;47(5):827-31, vi. doi: 10.1016/j.rcl.2009.05.003.

Nephrogenic systemic fibrosis: history and epidemiology.

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  • 1Department of Diagnostic Sciences, Faculty of Health Sciences, University of Copenhagen, Blegdamsvej 3B, DK-2200 Copenhagen N, Denmark.


Nephrogenic systemic fibrosis (NSF) is a new disease; the first case was diagnosed in 1997. It took 9 years before an association between NSF and gadolinium-based contrast agents (Gd-CAs) was identified. Gadolinium has several advantages for use in relation to enhanced MRI, but it is also a toxic heavy metal. For nearly 20 years, it was believed that Gd-CAs were safe, and they were used liberally. The prevalence of NSF cases varies between the various Gd-CAs, and adequate documentation of NSF cases after exposure to extracellular Gd-CAs remains a problem. All evidence points toward the fact that the real number of patients who have NSF has not been accurately totaled; the disease seems to be underdiagnosed for various reasons.

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