Concern about the association between GBCA and NSF has led to widespread screening of MRI patients for renal dysfunction and withholding GBCA when GFR is < 30 mL/min. Analysis of 78 retrospective case series reporting 292 NSF cases explores the risk factors for NSF. Elimination of multiple risk factors by using single dose GBCA, dialyzing dialysis patients quickly following GBCA administration, avoiding GBCA in acute renal failure while serum creatinine is rising, and avoiding non-ionic linear GBCA in renal failure patients, may reduce NSF risk more than a thousand fold, thereby allowing safe GBCA enhanced MRI in virtually all patients.
