• Extremely rare but serious and potentially life-threatening condition.
  • Characterised by the deposition of collagen in the skin and possible organ involvement of other organs, including the lungs, liver, muscles and heart.
  • Cause not fully understood but appears to be associated with the administration of (linear) gadolinium contrast agents in patients with severe renal impairment.
Contrast media and safety

The risk of NSF differs between contrast agents and appears to be dependent on their molecular structure.
  • Safest (cyclical structure):
    • Dotarem, Gadovist, ProHance
  • Intermediate safety (ionic linear structure):
    • MultiHance, Primosvist, Vasovist (Ablavar)
  • Lowest safety (linear non-ionic structure):
    • Magnevist, Omniscan, OptiMARK
Note that no cases of NSF have been reported in patients with normal renal function.

Tips and Tricks
  • eGFR 30-60ml/min/1.73m2: choose safest contrast agent, use only with caution
  • eGFR <30ml/min/1.73m2: linear structured contrast agents contraindicated
  • In patients with severe renal failure: consider haemodialysis within 2 hours after contrast agent administration – not proven to prevent NSF
  • See also: