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Nephrogenic systemic fibrosis following the administration of extracellular gadolinium based contrast agents: is the stability of the contrast agent molecule an important factor in the pathogenesis of this condition?

Department of Diagnostic Imaging, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield S5 7AU, UK

View larger version (24K): [in this window] [in a new window]   Figure 1. The chemical structure of gadopentetate(Gd-DTPA, an ionic linear molecule). Gadolinium ion (Gd+++ ) in the chelate has nine coordination sites (dotted lines), five with carboxyl groups and three with amino nitrogen atoms. The remaining vacant site is coordinated with a water molecule (H2O).

View larger version (32K): [in this window] [in a new window]   Figure 2. The chemical structure of gadodiamide(Gd-DTPA-BMA, a non-ionic linear molecule). In this molecule, the carboxyl groups are reduced to three as the other two carboxyl groups have been replaced by non-ionic methyl amide (CONHC3). Both amide carbonyl atoms are directly coordinated to Gd+++, but the binding is weaker in comparison with that of the carboxyl groups. A coordination site with a water molecule (H2O) is present.

View larger version (24K): [in this window] [in a new window]   Figure 3. The chemical structure of gadoterate(Gd-DOTA, an ionic cyclic molecule). In this molecule, Gd+++ in the centre of the chelate has coordination sites with four carboxyl groups and four amino nitrogen atoms. The remaining vacant site is coordinated with a water molecule (H2O).