Nephrogenic systemic fibrosis (NSF) following MRI with gadolinium contrast is MOST strongly associated with which patient group?
- A Patients with mild chronic kidney disease (eGFR 45–60 mL/min)
- B Patients with severe renal failure (eGFR <30 mL/min) or on haemodialysis, especially with high-risk gadolinium agents ✓
- C Patients with iodine allergy given gadolinium as an alternative
- D Patients receiving gadolinium for cardiac MRI at standard doses
Correct answer: B. Patients with severe renal failure (eGFR <30 mL/min) or on haemodialysis, especially with high-risk gadolinium agents
Explanation
NSF is a fibrosing condition of skin and internal organs caused by gadolinium deposition in patients with severely impaired renal function (eGFR <30 mL/min, AKI, or dialysis). It is most strongly linked to high-risk (less stable, linear) gadolinium agents (gadodiamide, gadopentetate, gadoversetamide). In severe renal failure, prolonged gadolinium circulation leads to transmetallation and free Gd3+ release, triggering fibrosis. Macrocyclic agents (gadobutrol, gadoteridol) have a much lower NSF risk. Iodine allergy is not a risk factor.
Reference: Grainger & Allison's Diagnostic Radiology, 7th ed.
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