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Ionic imprinted CNTs-chitosan hybrid sponge with 3D network structure for selective and effective adsorption of Gd(III). Sep Purif Technol 2021. [DOI: 10.1016/j.seppur.2021.118792] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Bradu A, Penescu M, Pitrou C, Hao J, Bourrinet P. Pharmacokinetics, Dialysability, and Safety of Gadopiclenol, a New Gadolinium-Based Contrast Agent, in Patients With Impaired Renal Function. Invest Radiol 2021; 56:486-493. [PMID: 34197356 DOI: 10.1097/rli.0000000000000764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the pharmacokinetics (PK) of gadopiclenol, a new macrocyclic gadolinium based-contrast agent, in subjects with impaired renal function, and to assess its dialysability in subjects with end-stage renal disease (ESRD). METHODS AND MATERIALS This 2-center, open-label, phase 1 study included 5 successive cohorts of 8 adult subjects: healthy subjects (cohort 1), subjects with mild (cohort 2), moderate (cohort 3), severe (cohort 4) renal impairment, or ESRD (cohort 5), who received a single intravenous injection of gadopiclenol (0.1 mmol/kg). Blood and urine samples were collected at different time points in cohorts 1 to 4, and blood and dialysate samples were collected at each hemodialysis session (4-hour session on day 1, day 3, and day 5) in cohort 5. Gadopiclenol elimination and safety were assessed for up to 6 months. Pharmacokinetics parameters were calculated using noncompartmental analysis. RESULTS A total of 40 subjects were included, with a mean age of 51.5 years (range, 18-71 years). No significant difference in the mean maximum concentration values and the distribution volume was observed among cohorts 1 to 4. Urinary excretion of unchanged gadopiclenol was delayed with the degree of renal impairment and ranged between 96% and 84% in subjects with mild to severe renal impairment. Compared with that of healthy subjects, the mean area under the plasma concentration curve was 54%, 148%, and 769% higher in subjects with mild, moderate, or severe renal impairment, respectively. The mean terminal half-life was prolonged with the degree of renal impairment (1.9, 3.3, 3.8, and 11.7 hours for cohorts 1-4). In ESRD subjects, gadopiclenol was effectively removed from the plasma (95% to 98%) after the first hemodialysis session. Gadopiclenol concentration in plasma was below the limit of quantification for all subjects after the second hemodialysis session. Gadopiclenol concentration was below limit of quantification in all plasma and urine samples collected at 1, 3, and 6 months. Five subjects (12.5%) experienced adverse events related to gadopiclenol, none serious and all resolved. Laboratory measurements, vital signs, and electrocardiography did not raise any safety concern. CONCLUSIONS Gadopiclenol elimination half-life was prolonged in subjects with mild to severe renal impairment, yet its renal clearance remains complete or nearly complete. In ESRD subjects, gadopiclenol was effectively removed from the plasma after 1 hemodialysis session, and up to 3 hemodialysis sessions were sufficient to completely clear it. No safety concern was raised. Therefore, no dose adjustment seems necessary in this patient population.
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Affiliation(s)
- Andrei Bradu
- From the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Mircea Penescu
- Department of Nephrology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Jing Hao
- Guerbet, Roissy CDG Cedex, France
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Ranga A, Agarwal Y, Garg KJ. Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function. Indian J Radiol Imaging 2021; 27:141-147. [PMID: 28744073 PMCID: PMC5510310 DOI: 10.4103/0971-3026.209212] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.
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Affiliation(s)
- Anju Ranga
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Yatish Agarwal
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanika J Garg
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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Davies J, Marino M, Smith APL, Crowder JM, Larsen M, Lowery L, Castle J, Hibberd MG, Evans PM. Repeat and single dose administration of gadodiamide to rats to investigate concentration and location of gadolinium and the cell ultrastructure. Sci Rep 2021; 11:13950. [PMID: 34230532 PMCID: PMC8260729 DOI: 10.1038/s41598-021-93147-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 06/21/2021] [Indexed: 01/20/2023] Open
Abstract
Gadolinium based contrast agents (GBCA) are used to image patients using magnetic resonance (MR) imaging. In recent years, there has been controversy around gadolinium retention after GBCA administration. We sought to evaluate the potential toxicity of gadolinium in the rat brain up to 1-year after repeated gadodiamide dosing and tissue retention kinetics after a single administration. Histopathological and ultrastructural transmission electron microscopy (TEM) analysis revealed no findings in rats administered a cumulative dose of 12 mmol/kg. TEM-energy dispersive X-ray spectroscopy (TEM-EDS) localization of gadolinium in the deep cerebellar nuclei showed ~ 100 nm electron-dense foci in the basal lamina of the vasculature. Laser ablation-ICP-MS (LA-ICP-MS) showed diffuse gadolinium throughout the brain but concentrated in perivascular foci of the DCN and globus pallidus with no observable tissue injury or ultrastructural changes. A single dose of gadodiamide (0.6 mmol/kg) resulted in rapid cerebrospinal fluid (CSF) and blood clearance. Twenty-weeks post administration gadolinium concentrations in brain regions was reduced by 16-72-fold and in the kidney (210-fold), testes (194-fold) skin (44-fold), liver (42-fold), femur (6-fold) and lung (64-fold). Our findings suggest that gadolinium does not lead to histopathological or ultrastructural changes in the brain and demonstrate in detail the kinetics of a human equivalent dose over time in a pre-clinical model.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales lane, Chalfont St. Giles, UK.
| | - Michael Marino
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Adrian P L Smith
- GE Healthcare, Pollards Wood, Nightingales lane, Chalfont St. Giles, UK
| | - Janell M Crowder
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Michael Larsen
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Lisa Lowery
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | - Jason Castle
- GE Global Research Centre, 1 Research Circle, Niskayuna, NY, USA
| | | | - Paul M Evans
- GE Healthcare, Pollards Wood, Nightingales lane, Chalfont St. Giles, UK
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Gray Matter Nucleus Hyperintensity After Monthly Triple-Dose Gadopentetate Dimeglumine With Long-term Magnetic Resonance Imaging. Invest Radiol 2021; 55:629-635. [PMID: 32898355 DOI: 10.1097/rli.0000000000000663] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Gadolinium deposition is widely believed to occur, but questions regarding accumulation pattern and permanence remain. We conducted a retrospective study of intracranial signal changes on monthly triple-dose contrast-enhanced magnetic resonance imaging (MRI) examinations from the previously published Betaseron vs. Copaxone in Multiple Sclerosis With Triple-Dose Gadolinium and 3-Tesla MRI Endpoints Trial (N = 67) to characterize the dynamics of gadolinium deposition in several deep brain nuclei and track persistence versus washout of gadolinium deposition on long-term follow-up (LTFU) examinations (N = 28) obtained approximately 10 years after enrollment in the Betaseron vs. Copaxone in Multiple Sclerosis With Triple-Dose Gadolinium and 3-Tesla MRI Endpoints Trial. MATERIALS AND METHODS Using T2 and proton density images and using image analysis software (ITK-SNAP), manual regions of interest were created ascribing boundaries of the caudate nucleus, dentate nucleus, globus pallidus, pulvinar, putamen, white matter, and air. Intensity analysis was conducted on T1-weighted fat-saturated (fat-sat) images using the FSL package. A linear rigid-body transform was calculated from the fat-sat image at each target time point to the region of interest segmentation reference time point fat-sat image. Serial MRI signal was analyzed using linear mixed regression modeling with random intercept. Annual MRI signal changes including LTFU scans were assessed with t test. RESULTS During monthly scanning, all gray matter structures demonstrated a significant (P < 0.0001) increase in contrast-to-noise ratio. Yearly changes in deposition showed distinctive patterns for the specific nucleus: globus pallidus showed complete retention, pulvinar showed partial washout, while dentate, caudate, and putamen returned to baseline (ie, complete washout). CONCLUSIONS Monthly increased contrast-to-noise ratio in gray matter nuclei is consistent with gadolinium deposition over time. The study also suggests that some deep gray matter nuclei permanently retain gadolinium, whereas others demonstrate washout of soluble gadolinium.
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Non-contrast MRI of synovitis in the knee using quantitative DESS. Eur Radiol 2021; 31:9369-9379. [PMID: 33993332 DOI: 10.1007/s00330-021-08025-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 03/22/2021] [Accepted: 04/28/2021] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To determine whether synovitis graded by radiologists using hybrid quantitative double-echo in steady-state (qDESS) images can be utilized as a non-contrast approach to assess synovitis in the knee, compared against the reference standard of contrast-enhanced MRI (CE-MRI). METHODS Twenty-two knees (11 subjects) with moderate to severe osteoarthritis (OA) were scanned using CE-MRI, qDESS with a high diffusion weighting (qDESSHigh), and qDESS with a low diffusion weighting (qDESSLow). Four radiologists graded the overall impression of synovitis, their diagnostic confidence, and regional grading of synovitis severity at four sites (suprapatellar pouch, intercondylar notch, and medial and lateral peripatellar recesses) in the knee using a 4-point scale. Agreement between CE-MRI and qDESS, inter-rater agreement, and intra-rater agreement were assessed using a linearly weighted Gwet's AC2. RESULTS Good agreement was seen between CE-MRI and both qDESSLow (AC2 = 0.74) and qDESSHigh (AC2 = 0.66) for the overall impression of synovitis, but both qDESS sequences tended to underestimate the severity of synovitis compared to CE-MRI. Good inter-rater agreement was seen for both qDESS sequences (AC2 = 0.74 for qDESSLow, AC2 = 0.64 for qDESSHigh), and good intra-rater agreement was seen for both sequences as well (qDESSLow AC2 = 0.78, qDESSHigh AC2 = 0.80). Diagnostic confidence was moderate to high for qDESSLow (mean = 2.36) and slightly less than moderate for qDESSHigh (mean = 1.86), compared to mostly high confidence for CE-MRI (mean = 2.73). CONCLUSIONS qDESS shows potential as an alternative MRI technique for assessing the severity of synovitis without the use of a gadolinium-based contrast agent. KEY POINTS The use of the quantitative double-echo in steady-state (qDESS) sequence for synovitis assessment does not require the use of a gadolinium-based contrast agent. Preliminary results found that low diffusion-weighted qDESS (qDESSLow) shows good agreement to contrast-enhanced MRI for characterization of the severity of synovitis, with a relative bias towards underestimation of severity. Preliminary results also found that qDESSLow shows good inter- and intra-rater agreement for the depiction of synovitis, particularly for readers experienced with the sequence.
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Martino F, Amici G, Rosner M, Ronco C, Novara G. Gadolinium-Based Contrast Media Nephrotoxicity in Kidney Impairment: The Physio-Pathological Conditions for the Perfect Murder. J Clin Med 2021; 10:jcm10020271. [PMID: 33450989 PMCID: PMC7828445 DOI: 10.3390/jcm10020271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for the possible development of systemic nephrogenic fibrosis and possible renal complications. This review focuses on the pathological mechanisms underlying the potential kidney toxicity of gadolinium. Gadolinium, as a free compound (Gd3+), is highly toxic in humans because it competes with divalent calcium (Ca2+) and magnesium (Mg2+) ions, interfering in some relevant biologic processes. Its toxicity is blunted by the complexing of Gd3+ with a carrier, allowing its use in magnetic resonance imaging. The binding reaction between gadolinium and a carrier is thermodynamically reversible. Consequently, under some conditions, gadolinium can be released in the interstitial space as a free Gd3+ compound with the possibility of toxicity. Other metals such as iron, copper, and calcium can interfere with the binding between gadolinium and its carrier because they compete for the same binding site. This process is known as transmetallation. In patients with kidney impairment, conditions such as low clearance of the Gd-carrier complex, acid-base derangements, and high serum phosphorous can increase the presence of free Gd3+, leading to a higher risk for toxicity.
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Affiliation(s)
- Francesca Martino
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy;
- UO Nephrology, Dialysis and Kidney Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- Correspondence: (F.M.); (G.N.); Tel.: +39-0444-753650 (F.M.); +39-049-8211250 (G.N.)
| | - Gianpaolo Amici
- UO Nephrology and Dialysis, San Daniele del Friuli and Tolmezzo Hospital, ASUFC, 33038 San Daniele del Friuli, Italy;
| | - Mitchell Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22903, USA;
| | - Claudio Ronco
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy;
- UO Nephrology, Dialysis and Kidney Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic University of Padua, 35124 Padova, Italy
- Correspondence: (F.M.); (G.N.); Tel.: +39-0444-753650 (F.M.); +39-049-8211250 (G.N.)
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Lattanzio SM. Toxicity associated with gadolinium-based contrast-enhanced examinations. AIMS BIOPHYSICS 2021. [DOI: 10.3934/biophy.2021015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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Unruh C, Van Bavel N, Anikovskiy M, Prenner EJ. Benefits and Detriments of Gadolinium from Medical Advances to Health and Ecological Risks. Molecules 2020; 25:molecules25235762. [PMID: 33297578 PMCID: PMC7730697 DOI: 10.3390/molecules25235762] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 11/30/2020] [Accepted: 12/04/2020] [Indexed: 12/17/2022] Open
Abstract
Gadolinium (Gd)-containing chelates have been established as diagnostics tools. However, extensive use in magnetic resonance imaging has led to increased Gd levels in industrialized parts of the world, adding to natural occurrence and causing environmental and health concerns. A vast amount of data shows that metal may accumulate in the human body and its deposition has been detected in organs such as brain and liver. Moreover, the disease nephrogenic systemic fibrosis has been linked to increased Gd3+ levels. Investigation of Gd3+ effects at the cellular and molecular levels mostly revolves around calcium-dependent proteins, since Gd3+ competes with calcium due to their similar size; other reports focus on interaction of Gd3+ with nucleic acids and carbohydrates. However, little is known about Gd3+ effects on membranes; yet some results suggest that Gd3+ interacts strongly with biologically-relevant lipids (e.g., brain membrane constituents) and causes serious structural changes including enhanced membrane rigidity and propensity for lipid fusion and aggregation at much lower concentrations than other ions, both toxic and essential. This review surveys the impact of the anthropogenic use of Gd emphasizing health risks and discussing debilitating effects of Gd3+ on cell membrane organization that may lead to deleterious health consequences.
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Affiliation(s)
- Colin Unruh
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.U.); (N.V.B.)
| | - Nicolas Van Bavel
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.U.); (N.V.B.)
| | - Max Anikovskiy
- Department of Chemistry, University of Calgary, Calgary, AB T2N 1N4, Canada
- Correspondence: (M.A.); (E.J.P.)
| | - Elmar J. Prenner
- Department of Biological Sciences, University of Calgary, Calgary, AB T2N 1N4, Canada; (C.U.); (N.V.B.)
- Correspondence: (M.A.); (E.J.P.)
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Effect of at Least 10 Serial Gadobutrol Administrations on Brain Signal Intensity Ratios on T1-Weighted MRI in Children: A Matched Case-Control Study. AJR Am J Roentgenol 2020; 217:753-760. [PMID: 33112200 DOI: 10.2214/ajr.20.24536] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND. An association is recognized between linear gadolinium-based contrast agents (GBCAs) and intracranial gadolinium retention in children. The relation between macrocyclic GBCAs and gadolinium retention remains incompletely understood. OBJECTIVE. The purpose of this study was to assess whether 10 or more administrations of the macrocyclic GBCA gadobutrol are associated with increased signal intensity (SI) in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MRI of children and to explore clinical variables potentially associated with T1 hyperintensity. METHODS. The case group consisted of 25 children (13 boys, 12 girls; mean age, 7 ± 4 years; range, 2-18 years) who underwent at least 10 (mean, 15 ± 6; range, 10-34) contrast-enhanced MRI examinations exclusively with gadobutrol. The control group consisted of 25 age- and sex-matched patients undergoing MRI who had never been exposed to gadolinium. Two observers in consensus using a 3-point scale assessed visual T1 hyperintensity in the DN and GP. One observer placed ROIs on T1-weighted images to mark the DN, GP, middle cerebellar peduncle (MCP), and pulvinar of the thalamus bilaterally to compute mean DN-to-MCP and GP-to-thalamus SI ratios. SI ratios were compared between the macrocyclic GBCA and control groups. In the macrocyclic GBCA group, Pearson correlation analysis was conducted between SI ratios and clinical variables. ROI measurements were repeated by the original reader and an independent reader, and interobserver and intraobserver agreement were computed by means of Lin concordance correlation coefficient (ρc). RESULTS. No patient had visual T1 hyperintensity in the DN or GP. No significant difference between the macrocyclic GBCA and control groups was observed for DN-to-MCP SI ratio (0.95 ± 0.05 vs 0.95 ± 0.03; p = .67) or GP-to-thalamus SI ratio (1.05 ± 0.06 vs 1.04 ± 0.06; p = .65). In the macrocyclic GBCA group, no significant correlation was observed between DN-to-MCP SI ratio or GP-to-thalamus SI ratio and age (r = 0.355, p = .08; r = 0.167, p = .42), number of contrast-enhanced MRI examinations (r = 0.247, p = .23; r = 0.203, p = .33), mean time between examinations (r = 0.193, p = .36; r = 0.047, p = .82), or cumulative macrocyclic GBCA dose (r = 0.434, p = .07; r = 0.270, p = .19). Interobserver and intraobserver agreement was substantial for DN-to-MCP SI and GP-to-TH SI ratios (ρc = 0.931-0.974). CONCLUSION. Ten or more serial gadobutrol administrations were not associated with T1 hyperintensity in the DN or GP of children. CLINICAL IMPACT. Selection of gadobutrol as an MRI contrast agent may reduce risk of gadolinium retention in children. The findings may help guide practices for GBCA administration to children.
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Wallnöfer EA, Thurner GC, Kremser C, Talasz H, Stollenwerk MM, Helbok A, Klammsteiner N, Albrecht-Schgoer K, Dietrich H, Jaschke W, Debbage P. Albumin-based nanoparticles as contrast medium for MRI: vascular imaging, tissue and cell interactions, and pharmacokinetics of second-generation nanoparticles. Histochem Cell Biol 2020; 155:19-73. [PMID: 33040183 DOI: 10.1007/s00418-020-01919-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
This multidisciplinary study examined the pharmacokinetics of nanoparticles based on albumin-DTPA-gadolinium chelates, testing the hypothesis that these nanoparticles create a stronger vessel signal than conventional gadolinium-based contrast agents and exploring if they are safe for clinical use. Nanoparticles based on human serum albumin, bearing gadolinium and designed for use in magnetic resonance imaging, were used to generate magnet resonance images (MRI) of the vascular system in rats ("blood pool imaging"). At the low nanoparticle doses used for radionuclide imaging, nanoparticle-associated metals were cleared from the blood into the liver during the first 4 h after nanoparticle application. At the higher doses required for MRI, the liver became saturated and kidney and spleen acted as additional sinks for the metals, and accounted for most processing of the nanoparticles. The multiple components of the nanoparticles were cleared independently of one another. Albumin was detected in liver, spleen, and kidneys for up to 2 days after intravenous injection. Gadolinium was retained in the liver, kidneys, and spleen in significant concentrations for much longer. Gadolinium was present as significant fractions of initial dose for longer than 2 weeks after application, and gadolinium clearance was only complete after 6 weeks. Our analysis could not account quantitatively for the full dose of gadolinium that was applied, but numerous organs were found to contain gadolinium in the collagen of their connective tissues. Multiple lines of evidence indicated intracellular processing opening the DTPA chelates and leading to gadolinium long-term storage, in particular inside lysosomes. Turnover of the stored gadolinium was found to occur in soluble form in the kidneys, the liver, and the colon for up to 3 weeks after application. Gadolinium overload poses a significant hazard due to the high toxicity of free gadolinium ions. We discuss the relevance of our findings to gadolinium-deposition diseases.
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Affiliation(s)
- E A Wallnöfer
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - G C Thurner
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Talasz
- Division of Clinical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria
| | - M M Stollenwerk
- Faculty of Health and Society, Biomedical Laboratory Science, University Hospital MAS, Malmö University, 205 06, Malmö, Sweden
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - A Helbok
- Department of Nuclear Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - N Klammsteiner
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - K Albrecht-Schgoer
- Department of Pharmaceutical Technology, Institute of Pharmacy, Leopold-Franzens-University Innsbruck, Innrain 80-82/IV, 6020, Innsbruck, Austria
- Institute of Cell Genetics, Department for Pharmacology and Genetics, Medical University of Innsbruck, Peter-Mayr-Strasse 1a, 6020, Innsbruck, Austria
| | - H Dietrich
- Central Laboratory Animal Facilities, Innsbruck Medical University, Peter-Mayr-Strasse 4a, 6020, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - P Debbage
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria.
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Maecker HT, Wang W, Rosenberg-Hasson Y, Semelka RC, Hickey J, Koran LM. An initial investigation of serum cytokine levels in patients with gadolinium retention. Radiol Bras 2020; 53:306-313. [PMID: 33071374 PMCID: PMC7545733 DOI: 10.1590/0100-3984.2019.0075] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Objective To determine whether individuals with proposed gadolinium deposition disease (GDD) have elevated serum levels of pro-inflammatory and pro-fibrotic cytokines, and whether specific cytokines are correlated with certain symptoms. Materials and Methods Twenty-four participants recruited between May 2016 and June 2017 met GDD diagnostic criteria. The 64 control subjects provided serum samples before prophylactic flu vaccination. Serum cytokine levels were obtained with Luminex serum cytokine assay using eBiosciences/Affymetrix human 62-plex kits. Wilcoxon rank-sum tests were performed to assess the difference between the median fluorescence intensity values for the participants and the control group. Generalized linear models were built to evaluate the association between each cytokine of interest and selected participant symptoms. Results Serum levels of 14 cytokines, including nine pro-inflammatory cytokines, were statistically significantly elevated compared to controls (p ≤ 0.05). Hypotheses regarding pro-fibrotic cytokines and cytokine links to specific symptoms' intensity were not confirmed. Conclusion The statistically significantly elevated cytokines may be markers of susceptibility to GDD or agents of symptom induction. These findings suggest that individuals developing symptoms characteristic of GDD after a contrast-assisted magnetic resonance imaging should be studied to investigate whether gadolinium retention and elevated cytokines may be related to their symptoms.
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Affiliation(s)
| | - Weiqi Wang
- Stanford University Medical Center, Stanford, CA, USA
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Zhao K, Li S, Yi P, Guo Y, Yu Q, Zhu C, Feng Q, Du J, Zhang X, Feng Y. Detection of gadolinium deposition in cortical bone with ultrashort echo time T 1 mapping: an ex vivo study in a rabbit model. Eur Radiol 2020; 31:1569-1577. [PMID: 32929642 DOI: 10.1007/s00330-020-07258-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2020] [Revised: 07/27/2020] [Accepted: 09/03/2020] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To investigate the capacity of ultrashort echo time (UTE) T1 mapping to non-invasively assess gadolinium deposition in cortical bone after gadolinium-based contrast agent (GBCA) administration. METHODS Twenty-eight New Zealand rabbits (male, 3.0-3.5 kg) were randomly allocated into control, macrocyclic, high-dose macrocyclic, and linear GBCA groups (n = 7 for each group), and respectively given daily doses of 0.9 ml/kg bodyweight saline, 0.3 mmol/kg bodyweight gadobutrol, 0.9 mmol/kg bodyweight gadobutrol, and 0.3 mmol/kg bodyweight gadopentetate dimeglumine for five consecutive days per week over a period of 4 weeks. After a subsequent 4 weeks of recovery, the rabbits were sacrificed and their tibiae harvested. T1 value of cortical bone was measured using a combination of UTE actual flip angle imaging and variable repetition time on a 7T animal scanner. Gadolinium concentration in cortical bone was measured using inductively coupled plasma mass spectrometry (ICP-MS). Pearson's correlation between R1 value (R1 = 1/T1) and gadolinium concentration in cortical bone was assessed. RESULTS Bone T1 values were significantly lower in the lower-dose macrocyclic (329.2 ± 21.0 ms, p < 0.05), higher-dose macrocyclic (316.8 ± 21.7 ms, p < 0.01), and linear (296.8 ± 24.1 ms, p < 0.001) GBCA groups compared with the control group (356.3 ± 19.4 ms). Gadolinium concentrations measured by ICP-MS in the control, lower-dose macrocyclic, higher-dose macrocyclic, and linear GBCA groups were 0.04 ± 0.02 μg/g, 2.60 ± 0.48 μg/g, 4.95 ± 1.17 μg/g, and 13.62 ± 1.55 μg/g, respectively. There was a strong positive correlation between R1 values and gadolinium concentrations in cortical bone (r = 0.73, p < 0.001). CONCLUSIONS These results suggest that UTE T1 mapping has the potential to provide a non-invasive assessment of gadolinium deposition in cortical bone following GBCA administration. KEY POINTS • Changes in T1 value related to gadolinium deposition were found in bone after both linear and macrocyclic GBCA administrations. • R1 relaxometry correlates strongly with gadolinium concentration in cortical bone. • UTE T1 mapping provides a potential tool for non-invasively monitoring gadolinium deposition in cortical bone.
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Affiliation(s)
- Kaixuan Zhao
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Shisi Li
- Department of Medical Imaging, Third Affiliated Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Peiwei Yi
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Yihao Guo
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Qinqin Yu
- Department of Medical Imaging, Third Affiliated Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Cuiling Zhu
- Department of Medical Imaging, Third Affiliated Hospital, Southern Medical University, Guangzhou, 510515, China
| | - Qianjin Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China.,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Jiang Du
- Department of Radiology, University of California, San Diego, CA, USA
| | - Xiaodong Zhang
- Department of Medical Imaging, Third Affiliated Hospital, Southern Medical University, Guangzhou, 510515, China.
| | - Yanqiu Feng
- School of Biomedical Engineering, Southern Medical University, Guangzhou, 510515, China. .,Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China.
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Cardiac magnetic resonance imaging and computed tomography for the pediatric cardiologist. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Rudnick MR, Wahba IM, Leonberg-Yoo AK, Miskulin D, Litt HI. Risks and Options With Gadolinium-Based Contrast Agents in Patients With CKD: A Review. Am J Kidney Dis 2020; 77:517-528. [PMID: 32861792 DOI: 10.1053/j.ajkd.2020.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs that bind free gadolinium more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for free gadolinium in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating gadolinium deposition in brain and a possible systemic syndrome attributed to GBCAs. Radiologic advances have resulted in several new imaging modalities that can be used in the severe CKD population and that do not require GBCA administration. In this article, we critically review GBCA use in patients with severe CKD and provide recommendations regarding GBCA use in this population.
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Affiliation(s)
- Michael R Rudnick
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA.
| | - Ihab M Wahba
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA; Corporal Michael J Crescenz Philadelphia Veterans Affairs Hospital Philadelphia, PA
| | - Amanda K Leonberg-Yoo
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA
| | - Dana Miskulin
- Division of Nephrology, Tufts University School of Medicine, Boston, MA
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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Bageac D, DeBevits JJ, Munbodh R, Kaplan J, Wu R, DiCamillo PA, Hu C, Wang Y, Karimeddini D, Naismith RT, Dhib-Jalbut S, Wolansky L. MRI demonstration of gadolinium deposition in bone after monthly triple-dose gadopentetate dimeglumine and correlation with frequency of hypophosphatemia. Clin Imaging 2020; 70:136-141. [PMID: 33161342 DOI: 10.1016/j.clinimag.2020.07.022] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/03/2020] [Accepted: 07/27/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVES We retrospectively analyzed data of the BECOME trial to investigate whether serial administration of triple-dose (3-dose) gadopentetate dimeglumine would result in the development of T1 signal-to-noise (S/N) changes in the cranial diploic space and whether S/N changes correlated with on-study hypophosphatemia. METHODS Signal intensity analysis was performed on the first year's data of the BECOME trial using 3-dose Gd (14 months, maximum number of doses, 39, mean: 36). Routine blood and urine tests were obtained each month for safety monitoring. Linear mixed regression modeling with random intercept was used to analyze monthly signal-to-noise ratio (S/N = Bone/Air) using an ROI of the diploic space created from T2W images and overlaid on T1FS (T1 fat-saturated) images. Incidence of phosphate abnormalities was analyzed using the general estimation equation; correlation of phosphate and S/N change was achieved with type 3 test of fixed effects. RESULTS Cranial diploic space T1FS S/N increased over 14 months: S/N = 0.039 mean monthly increase (S.E. 0.008; p < 0.0001). Subjects with consistently normal phosphate levels (n = 32) experienced more of a S/N increase than patients with at least one episode of hypophosphatemia (n = 35) (0.057 vs. 0.023, respectively, p = 0.037). Those with moderate hypophosphatemia demonstrated no significant S/N increase. CONCLUSION Monthly administration of 3-dose gadopentetate dimeglumine is associated with development of increased S/N on T1FS imaging in the cranial diploic space, suggesting Gd retention in bone. Our data suggests MRI could be used as a noninvasive method of tracking Gd retention in bone, which was more pronounced in patients with normal phosphate levels.
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Affiliation(s)
- Devin Bageac
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America
| | - John J DeBevits
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America
| | - Reshma Munbodh
- Brown University, Alpert Medical School, 222 Richmond St, Providence, RI 02903, United States of America
| | - Joshua Kaplan
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, United States of America
| | - Rong Wu
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America
| | - Paul A DiCamillo
- University of Iowa School of Medicine, 375 Newton Rd, Iowa City, IA 52242, United States of America
| | - Chaoran Hu
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America
| | - Yanlin Wang
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America
| | - David Karimeddini
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America
| | - Robert T Naismith
- Washington U. of St. Louis, Medical School, 660 S Euclid Ave, St. Louis, MO 63110, United States of America
| | - Suhayl Dhib-Jalbut
- Rutgers New Jersey Medical School, 185 S Orange Ave, Newark, NJ 07103, United States of America
| | - Leo Wolansky
- University of Connecticut School of Medicine, 263 Farmington Ave, Farmington, CT 06030, United States of America.
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Dynamic contrast-enhanced magnetic resonance imaging for risk-stratified screening in women with BRCA mutations or high familial risk for breast cancer: are we there yet? Breast Cancer Res Treat 2020; 183:243-250. [PMID: 32621252 DOI: 10.1007/s10549-020-05759-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Accepted: 06/17/2020] [Indexed: 12/20/2022]
Abstract
PURPOSE Women at an elevated lifetime risk for breast cancer (BC), including carriers of pathogenic mutations in BC predisposition genes, are recommended intensified BC screening that includes annual mammography (MG) and annual breast MRI. Controversy exists regarding the clinical utility of MRI as a screening tool in high-risk women. This paper is intended to review recent advances and remaining areas of uncertainty in order to further facilitate the incorporation of breast MRI into an intensified BC screening protocol for women at high familial risk and BRCA carriers. METHODS A multidisciplinary team of medical oncologists and a radiologist specializing in the treatment of BC and high-risk patients searched PubMed to identify studies deemed to have the highest scientific value. Since none of the initial MRI studies were randomized, meta-analyses examining breast MRI screening in high-risk women were prioritized for inclusion. RESULTS Breast MRI performs well in high-risk women, including mutation carriers. Breast MRI screening allows for the detection of early stage, likely curable invasive BC. It is mandatory that radiologists receive appropriate MRI training to reduce false positives and unnecessary biopsies. MRI screening is cost-effective in the highest risk patients and new clinical trials are open examining abbreviated and ultra-fast MRI techniques as a tool to drive down costs and improve specificity. CONCLUSIONS As breast MRI is recommended as part of an intensified screening program in addition to mammography for high-risk women, it important that health care providers understand the benefits and limitations of this screening modality for high-risk women, as well as areas for further investigation.
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Mallio CA, Quattrocchi CC, Rovira À, Parizel PM. Gadolinium Deposition Safety: Seeking the Patient's Perspective. AJNR Am J Neuroradiol 2020; 41:944-946. [PMID: 32381539 DOI: 10.3174/ajnr.a6586] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
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70
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Kálmán FK, Nagy V, Váradi B, Garda Z, Molnár E, Trencsényi G, Kiss J, Même S, Même W, Tóth É, Tircsó G. Mn(II)-Based MRI Contrast Agent Candidate for Vascular Imaging. J Med Chem 2020; 63:6057-6065. [DOI: 10.1021/acs.jmedchem.0c00197] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Ferenc K. Kálmán
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
- Le Studium, Loire Valley Institute for Advanced Studies, 1 Rue Dupanloup, 45000 Orléans, France
| | - Viktória Nagy
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Balázs Váradi
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Zoltán Garda
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - Enikő Molnár
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
| | - György Trencsényi
- Division of Nuclear Medicine, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - János Kiss
- Division of Nuclear Medicine, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - Sandra Même
- Centre de Biophysique Moléculaire, CNRS-UPR 4301, Université d’Orléans, Rue Charles Sadron, CS 80054, 45071 Orléans, France
| | - William Même
- Centre de Biophysique Moléculaire, CNRS-UPR 4301, Université d’Orléans, Rue Charles Sadron, CS 80054, 45071 Orléans, France
| | - Éva Tóth
- Centre de Biophysique Moléculaire, CNRS-UPR 4301, Université d’Orléans, Rue Charles Sadron, CS 80054, 45071 Orléans, France
| | - Gyula Tircsó
- Department of Physical Chemistry, Faculty of Science and Technology, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary
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He J, Yang L, Hou X, Mester Z, Meija J. Determination of the Isotopic Composition of Gadolinium Using Multicollector Inductively Coupled Plasma Mass Spectrometry. Anal Chem 2020; 92:6103-6110. [PMID: 32267665 DOI: 10.1021/acs.analchem.0c00531] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
In this study, we report independent measurements of all stable isotope ratios of gadolinium. Our study employs multicollector inductively coupled plasma mass spectrometry (MC-ICPMS) with National Research Council Canada (NRC) HALF-1 isotopic hafnium standard as a primary calibrator and surveys four commercial gadolinium materials, including a NRC candidate isotopic reference material, GADS-1. The isotopic composition of gadolinium is determined using the regression model without reliance on conventional normalizing isotope ratios or mass-dependent isotope ratio correction models. In this work, all gadolinium isotope ratios were obtained from 160Gd/158Gd which, in turn, was measured from hafnium 178Hf/177Hf either directly or indirectly through 167Er/166Er. The latter approach was used for the final determination of gadolinium isotopic composition, as it provides smaller combined uncertainty. We report high-precision measurements of the isotopic composition of gadolinium, which support a revised standard atomic weight. Isotope amount ratios of R152/158 = 0.008 20(2)k=1, R154/158 = 0.087 98(12)k=1, R155/158 = 0.596 81(63)k=1, R156/158 = 0.825 08(57)k=1, R157/158 = 0.630 60(22)k=1, and R160/158 = 0.879 10(60)k=1, and the atomic weight of Ar(Gd) = 157.2502(6)k=1 were obtained for gadolinium in GADS-1.
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Affiliation(s)
- Juan He
- College of Chemistry, Sichuan University, Chengdu 610064, China.,National Research Council Canada, 1200 Montreal Road, Ottawa, Ontario K1A 0R6, Canada
| | - Lu Yang
- National Research Council Canada, 1200 Montreal Road, Ottawa, Ontario K1A 0R6, Canada
| | - Xiandeng Hou
- Analytical & Testing Center, Sichuan University, 29 Wangjiang Road, Chengdu, Sichuan 610064, China
| | - Zoltan Mester
- National Research Council Canada, 1200 Montreal Road, Ottawa, Ontario K1A 0R6, Canada
| | - Juris Meija
- National Research Council Canada, 1200 Montreal Road, Ottawa, Ontario K1A 0R6, Canada
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Detection and imaging of gadolinium accumulation in human bone tissue by micro- and submicro-XRF. Sci Rep 2020; 10:6301. [PMID: 32286449 PMCID: PMC7156386 DOI: 10.1038/s41598-020-63325-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 03/21/2020] [Indexed: 12/30/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are frequently used in patients undergoing magnetic resonance imaging. In GBCAs gadolinium (Gd) is present in a bound chelated form. Gadolinium is a rare-earth element, which is normally not present in human body. Though the blood elimination half-life of contrast agents is about 90 minutes, recent studies demonstrated that some tissues retain gadolinium, which might further pose a health threat due to toxic effects of free gadolinium. It is known that the bone tissue can serve as a gadolinium depot, but so far only bulk measurements were performed. Here we present a summary of experiments in which for the first time we mapped gadolinium in bone biopsy from a male patient with idiopathic osteoporosis (without indication of renal impairment), who received MRI 8 months prior to biopsy. In our studies performed by means of synchrotron radiation induced micro- and submicro-X-ray fluorescence spectroscopy (SR-XRF), gadolinium was detected in human cortical bone tissue. The distribution of gadolinium displays a specific accumulation pattern. Correlation of elemental maps obtained at ANKA synchrotron with qBEI images (quantitative backscattered electron imaging) allowed assignment of Gd structures to the histological bone structures. Follow-up beamtimes at ESRF and Diamond Light Source using submicro-SR-XRF allowed resolving thin Gd structures in cortical bone, as well as correlating them with calcium and zinc.
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Singer AD, Rosenthal J, Umpierrez M, Guo Y, Gonzalez F, Wagner E. A comparison of saline and gadolinium shoulder MR arthrography to arthroscopy. Skeletal Radiol 2020; 49:625-633. [PMID: 31773187 DOI: 10.1007/s00256-019-03338-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/11/2019] [Accepted: 10/30/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE Compare the diagnostic performance of saline and gadolinium shoulder magnetic resonance arthrograms (MRA) in the detection of labral and rotator cuff injury compared to arthroscopy. MATERIALS AND METHODS Consecutive patients who underwent a gadolinium or saline MRA followed by arthroscopy were retrospectively reviewed. The reports were reviewed for injuries. A chi square or Fisher's exact test was performed to compare the MRA and surgery. Kappa values were calculated to correlate diagnosis of tear between MRA and arthroscopy. RESULTS There were a total of 58 patients included, including 34 gadolinium arthrograms and 24 saline arthrograms. The accuracy of saline MRA was similar compared to gadolinium MRA in the diagnosis of tears of the supraspinatus (accuracy 0.88 vs 0.74, respectively) and infraspinatus (accuracy 0.88 vs 0.65, respectively) tendons and tears of the anterior/anterior inferior, posterior, and superior labrum, (accuracy 0.79 vs 0.76, 0.71 vs 0.62, and 0.58 vs 0.56), and saline vs gadolinium, respectively. Although there was a trend toward overall better saline MRA performance, a statistically significant difference in the accuracy to detect tears was only noted for the infraspinatus tendon. Interobserver agreement for rotator cuff tears was higher for saline than gadolinium MRA. CONCLUSION Saline MRA was accurate, with no significant differences compared gadolinium arthrograms in the diagnosis of labral and rotator cuff pathology. Given expense, and the potential additional information provided by fluid sensitive sequences over T1 fat-suppressed sequences, consideration should be given to using saline for shoulder MRAs. LEVEL OF EVIDENCE Level III, Retrospective Cohort Study.
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Affiliation(s)
- Adam D Singer
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA.
| | - Jeffrey Rosenthal
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Monica Umpierrez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Yi Guo
- Department of Biostatistics and Bioinformatics, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Felix Gonzalez
- Department of Radiology and Imaging Sciences Section of Musculoskeletal Imaging, Emory University Hospital, 59 Executive Park South, 4th Floor Suite 4009, Atlanta, GA, 30329, USA
| | - Eric Wagner
- Department of Orthopaedic Surgery, Emory University Hospital, Atlanta, Georgia
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Costelloe CM, Amini B, Madewell JE. Risks and Benefits of Gadolinium-Based Contrast-Enhanced MRI. Semin Ultrasound CT MR 2020; 41:170-182. [DOI: 10.1053/j.sult.2019.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Costelloe CM, Amini B, Madewell JE. WITHDRAWN: Risks and Benefits of Gadolinium-Based Contrast Enhanced MRI. Semin Ultrasound CT MR 2020; 41:260-274. [PMID: 32446435 DOI: 10.1053/j.sult.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.1053/j.sult.2019.12.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Colleen M Costelloe
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Lattanzio SM, Imbesi F. Fibromyalgia associated with repeated gadolinium contrast-enhanced MRI examinations. Radiol Case Rep 2020; 15:534-541. [PMID: 32180856 PMCID: PMC7063147 DOI: 10.1016/j.radcr.2020.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of a fibromyalgia (FM) patient with an history of brain-cancer presenting signs and symptoms of gadolinium toxicity following repeated administrations of a macrocyclic contrast agent, Gadovist. In the present report, we provide evidence supporting the hypothesis of a causal relationship linking gadolinium deposition to a clinical manifestation of disease, namely fibromyalgia. We unravel a role for gadolinium in the still unknown etiology of fibromyalgia as a metal toxicity disorder. Contrast agents are routinely administered in a clinical context. It is thus possible that the patients are mistakenly believed to show complaint of their primary disease, whereas, in some instances, their symptoms are associated with gadolinium deposition.
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Affiliation(s)
- Silvia Maria Lattanzio
- Department of Biomedical Sciences, University of Padova, Via Marzolo 3, 35131, Padova, Italy
| | - Francesca Imbesi
- Neurological Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Brain tissue gadolinium retention in pediatric patients after contrast-enhanced magnetic resonance exams: pathological confirmation. Pediatr Radiol 2020; 50:388-396. [PMID: 31989188 DOI: 10.1007/s00247-019-04535-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/31/2019] [Accepted: 09/10/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Retained gadolinium from gadolinium-based contrast agents (GBCAs) used in MR exams has been inferred based on signal changes on serial brain MRI and subsequently demonstrated pathologically in adults. Retention has been similarly inferred in children but pathological demonstration in pediatric patients is limited. The long-term effects of retained gadolinium are unknown but are potentially of greater concern in children given their increased vulnerability from continuing development and their expected longer period of exposure. Several factors can influence gadolinium retention. In adults as well as in children, greater accumulation has been demonstrated based on MR signal changes with linear compared with macrocyclic gadolinium chelates, attributed to lower chelate affinity with linear agents. Effects of age at exposure on retention are unknown, while differences in GBCA washout rates are still under investigation and might affect gadolinium retention relative to time of GBCA administration. OBJECTIVE The purpose of this study was to confirm whether gadolinium brain deposits are present in pediatric patients who received GBCAs and to quantify the amounts present. MATERIALS AND METHODS Brain autopsy specimens from 10 pediatric patients between 1 year and 13 years of age who underwent at least one contrast-enhanced MR exam were analyzed for elemental gadolinium using inductively coupled plasma mass spectrometry. Brain samples included white matter, basal ganglia (putamen, globus pallidus), thalamus, dentate nucleus and tumor tissue as available. Type and dose of contrast agent, number and timing of contrast-enhanced MR exams and renal function (estimated glomerular filtration rate [eGFR]) were documented for each child. RESULTS Patient exposures ranged from 1 dose to 20 doses of GBCAs including both macrocyclic and linear ionic agents. Gadolinium was found to be present in brain tissue in all children and was generally highest in the globus pallidus. Those who received only macrocyclic agents showed lower levels of gadolinium retention. CONCLUSION This study demonstrates pathological confirmation of gadolinium retention in brain tissue of a series of pediatric patients exposed to GBCAs including not only linear ionic agents but also macrocyclic agents with both nonionic and ionic compounds. The distribution and deposition levels in this small pediatric population are comparable with the findings in adults. While the clinical significance of these deposits remains unknown, at this point it would be prudent to exert caution and avoid unnecessary use of GBCAs in pediatric patients.
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Halligan S, Kenis SF, Abeyakoon O, Plumb AAO, Mallett S. How to avoid describing your radiological research study incorrectly. Eur Radiol 2020; 30:4648-4655. [PMID: 32086575 PMCID: PMC7338281 DOI: 10.1007/s00330-020-06720-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/05/2020] [Indexed: 12/04/2022]
Abstract
Abstract This review identifies and examines terms used to describe a radiological research “study” or “trial”. A taxonomy of clinical research descriptions is explained with reference to medical imaging examples. Because many descriptive terms have precise methodological implications, it is important that these terms are understood by readers and used correctly by researchers, so that the reader is not misled. Key Points • Multiple different terms are being used to describe radiological research “studies” and “trials”, and many of these terms have precise methodological implications. • Radiological researchers sometimes use titles that describe their research incorrectly. This can mislead the reader as to what was actually done. • It is important that readers and researchers understand the correct taxonomy of clinical research and that researchers adopt the correct description for their work.
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Affiliation(s)
- Steve Halligan
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK.
| | - Shedrack F Kenis
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Oshaani Abeyakoon
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Andrew A O Plumb
- Centre for Medical Imaging, University College London UCL, Charles Bell House, 43-45 Foley Street, London, W1W 7TS, UK
| | - Susan Mallett
- Institute of Applied Health Sciences, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
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Establishing Reference Intervals for Gadolinium Concentrations in Blood, Plasma, and Urine in Individuals Not Previously Exposed to Gadolinium-Based Contrast Agents. Invest Radiol 2020; 55:405-411. [DOI: 10.1097/rli.0000000000000657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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80
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Wang B, Gao J, Zhang Q, Zhang C, Liu G, Wei W, Huang H, Fu Y, Li D, Zhang B, Guo H. Investigating the equivalent performance of biparametric compared to multiparametric MRI in detection of clinically significant prostate cancer. Abdom Radiol (NY) 2020; 45:547-555. [PMID: 31907568 DOI: 10.1007/s00261-019-02281-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE PIRADS v2 stipulates that dynamic contrast-enhanced (DCE) imaging be used to categorize diffusion-weighted-imaging (DWI) score 3 (DWI 3) peripheral zone (PZ) lesions as PIRADS score 3 (PIRADS 3; DCE -) or PIRADS 4 (DCE +). It's controversial for the value of DCE in improving clinically significant prostate cancer (csPCa) detection. We aimed to figure out whether DCE improves csPCa detection and explore new available measures to improve csPCa detection. PATIENTS AND METHODS We retrospectively enrolled 375 patients who underwent mp MRI before MRI/ultrasound (US) fusion-targeted biopsy (TB) with transperineal systematic biopsy (SB). All lesions were classified as DWI 3/DCE -, DWI 3/DCE +, DWI 4/PIRADS 4 lesions. Detection rates of csPCa for each lesion group were analyzed. The diagnostic performance of each approach was analyzed by receiver operating characteristics (ROC) analysis and decision curve analysis. RESULTS Totally, 109 DWI 3 or DWI 4 single lesions in PZ were analyzed (n = 109). The rates of csPCa detection for Group A, Group B, Group C is 10.3%, 13.9%, 55.9%, respectively (A vs. B, p = 0.625; B vs. C, p < 0.001). ROC analysis and decision curve analysis showed the method of combining Age, PSA Density (PSAD) and the mean apparent diffusion coefficient value (ADCmean) outperforms individual approaches for csPCa detection. CONCLUSION For DWI 3 lesions in PZ, DCE sequence has not additional value for improving detection of csPCa. The integration of clinical characteristics and bpMRI parameter improves the detection of csPCa.
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Botár R, Molnár E, Trencsényi G, Kiss J, Kálmán FK, Tircsó G. Stable and Inert Mn(II)-Based and pH-Responsive Contrast Agents. J Am Chem Soc 2020; 142:1662-1666. [DOI: 10.1021/jacs.9b09407] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Richárd Botár
- Department of Physical Chemistry, University of Debrecen, H-4032 Debrecen, Hungary
| | - Enikő Molnár
- Department of Physical Chemistry, University of Debrecen, H-4032 Debrecen, Hungary
| | - György Trencsényi
- Division of Nuclear Medicine, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
| | - János Kiss
- Division of Nuclear Medicine, Department of Medical Imaging, Faculty of Medicine, University of Debrecen, H-4032 Debrecen, Hungary
- Mediso Ltd., H-4032 Debrecen, Hungary
| | - Ferenc K. Kálmán
- Department of Physical Chemistry, University of Debrecen, H-4032 Debrecen, Hungary
| | - Gyula Tircsó
- Department of Physical Chemistry, University of Debrecen, H-4032 Debrecen, Hungary
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Layne KA, Wood DM, Dargan PI. Gadolinium-based contrast agents – what is the evidence for ‘gadolinium deposition disease’ and the use of chelation therapy? Clin Toxicol (Phila) 2019; 58:151-160. [DOI: 10.1080/15563650.2019.1681442] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kerry A. Layne
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - David M. Wood
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Paul I. Dargan
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Does Age Interfere With Gadolinium Toxicity and Presence in Brain and Bone Tissues?: A Comparative Gadoterate Versus Gadodiamide Study in Juvenile and Adult Rats. Invest Radiol 2019; 54:61-71. [PMID: 30394964 PMCID: PMC6310471 DOI: 10.1097/rli.0000000000000517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The main objective of the study was to assess the effect of age on target tissue total gadolinium (Gd) retention after repeated administration of gadodiamide (linear) or gadoterate (macrocyclic) Gd-based contrast agent (GBCA) in rats. The secondary objective was to assess the potential developmental and long-term consequences of GBCA administration during neonatal and juvenile periods. MATERIALS AND METHODS A total of 20 equivalent human clinical doses (cumulated dose, 12 mmol Gd/kg) of either gadoterate or gadodiamide were administered concurrently by the intravenous route to healthy adult and juvenile rats. Saline was administered to juvenile rats forming the control group. In juvenile rats, the doses were administered from postnatal day 12, that is, once the blood-brain barrier is functional as in humans after birth. The tests were conducted on 5 juvenile rats per sex and per group and on 3 adult animals per sex and per group. T1-weighted magnetic resonance imaging of the cerebellum was performed at 4.7 T during both the treatment and treatment-free periods. Behavioral tests were performed in juvenile rats. Rats were euthanatized at 11 to 12 weeks (ie, approximately 3 months) after the last administration. Total Gd concentrations were measured in plasma, skin, bone, and brain by inductively coupled plasma mass spectrometry. Cerebellum samples from the juvenile rats were characterized by histopathological examination (including immunohistochemistry for glial fibrillary acidic protein or GFAP, and CD68). Lipofuscin pigments were also studied by fluorescence microscopy. All tests were performed blindly on randomized animals. RESULTS Transient skin lesions were observed in juvenile rats (5/5 females and 2/4 males) and not in adult rats having received gadodiamide. Persisting (up to completion of the study) T1 hyperintensity in the deep cerebellar nuclei (DCNs) was observed only in gadodiamide-treated rats. Quantitatively, a slightly higher progressive increase in the DCN/brain stem ratio was observed in adult rats compared with juvenile rats, whereas no difference was noted visually. In all tissues, total Gd concentrations were higher (10- to 30-fold higher) in the gadodiamide-treated groups than in the gadoterate groups. No age-related differences were observed except in bone marrow where total Gd concentrations in gadodiamide-treated juvenile rats were higher than those measured in adults and similar to those measured in cortical bone tissue. No significant treatment-related effects were observed in histopathological findings or in development, behavior, and biochemistry parameters. However, in the elevated plus maze test, a trend toward an anxiogenic effect was observed in the gadodiamide group compared with other groups (nonsignificant). Moreover, in the balance beam test, a high number of trials were excluded in the gadodiamide group because rats (mainly males) did not completely cross the beam, which may also reflect an anxiogenic effect. CONCLUSIONS No T1 hyperintensity was observed in the DCN after administration of the macrocyclic GBCA gadoterate regardless of age as opposed to administration of the linear GBCA gadodiamide. Repeated administration of gadodiamide in neonatal and juvenile rats resulted in similar total Gd retention in the skin, brain, and bone to that in adult rats with sex having no effect, whereas Gd distribution in bone marrow was influenced by age. Further studies are required to assess the form of the retained Gd and to investigate the potential risks associated with Gd retention in bone marrow in juvenile animals treated with gadodiamide. Regardless of age, total Gd concentration in the brain and bone was 10- to 30-fold higher after administration of gadodiamide compared with gadoterate.
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Abstract
Gadolinium (Gd)-based contrast agents have been routinely used worldwide in diagnostic MRI since 1988. All routinely applied contrast agents for clinical use were considered extremely safe with regard to tolerance, adverse effects and diagnostic efficacy and when used at Food and Drug Administration-approved doses. With the identification of Gd-associated disorders, namely nephrogenic systemic fibrosis and adverse reactions, and in the longer term Gd-retention in the brain, this view changed and led to the withdrawal or restriction of approval of linear Gd chelates in Europe. Even though Gd deposition in different human body areas was described very early, recently published literature of intracerebral accumulation of contrast agents as well as deposition in bone have created surprising attention. Not only was the fact of Gd deposition in the body well known for many years, but there is currently no clinical evidence of patient symptoms and no resulting health issues of patients have been observed yet. The expression "gadolinium deposition disease" has been termed by active patient advocacy groups with an online presence with reports of individual members stating a broad spectrum of disorders yielding a large symptom complex after administration of Gd-based contrast agents without evidence of any pre-existing or otherwise underlying disease process which could explain the mentioned disorder.
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86
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The gadolinium hypothesis for fibromyalgia and unexplained widespread chronic pain. Med Hypotheses 2019; 129:109240. [PMID: 31371082 DOI: 10.1016/j.mehy.2019.109240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/26/2019] [Accepted: 05/19/2019] [Indexed: 02/01/2023]
Abstract
Fibromyalgia (FM) is a chronic, painful, heterogeneous, and common disorder carrying a substantial socio-economical burden. It lacks effective cures and its aetiology is still unknown. There exists evidence for central and peripheral neurological contribution to the symptoms but grasping the real source of abnormal nervous system sensitization remains an ongoing challenge. There exists an association between an injury/trauma and the onset of the symptoms, but a causal relationship has not been yet sufficiently supported by scientific evidence. I postulate a role for gadolinium-based contrast agents and retention of gadolinium in the body. This conjecture breaks the hypothesis of a direct role for a physical injury/trauma per se in favour of an indirect one by the subsequent diagnostic procedures. It creates a new link between retention of gadolinium in the body and painful conditions as FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness. Experimental evidence demonstrates possible retention of gadolinium species in human body, still lacking conclusive answers on their pathological consequences. Notwithstanding, there exist some initial data that report unexplained chronic widespread pain and symptoms of FM in those patients: they are suggestive for pathological consequences associated with gadolinium retention. Besides clear compelling symptoms overlapping, biochemical findings are provided to sustain the hypothesis of a role for gadolinium in the disease process focusing on neurotransmitters, endogenous metal cations, cytokines, and muscle tissue. Experimental findings strongly support the hypothesis of impairment at the cellular, intracellular, and systemic levels in FM. And these data are highly compatible with collateral effects associated with the interference of the gadolinium ion and its pharmaceutical chelates into biochemical pathways in vivo. The hypothesis presented in this article, along with the support of scientific evidence, links FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness to retention of gadolinium in the body. If the hypothesis is confirmed, it could improve diagnosis and prevention, while providing a ground for development of new treatments.
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House JS, Hall J, Park SS, Planchart A, Money E, Maguire RL, Huang Z, Mattingly CJ, Skaar D, Tzeng JY, Darrah TH, Vengosh A, Murphy SK, Jirtle RL, Hoyo C. Cadmium exposure and MEG3 methylation differences between Whites and African Americans in the NEST Cohort. ENVIRONMENTAL EPIGENETICS 2019; 5:dvz014. [PMID: 31528362 PMCID: PMC6736358 DOI: 10.1093/eep/dvz014] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 06/21/2019] [Accepted: 07/19/2019] [Indexed: 05/06/2023]
Abstract
Cadmium (Cd) is a ubiquitous environmental pollutant associated with a wide range of health outcomes including cancer. However, obscure exposure sources often hinder prevention efforts. Further, although epigenetic mechanisms are suspected to link these associations, gene sequence regions targeted by Cd are unclear. Aberrant methylation of a differentially methylated region (DMR) on the MEG3 gene that regulates the expression of a cluster of genes including MEG3, DLK1, MEG8, MEG9 and DIO3 has been associated with multiple cancers. In 287 infant-mother pairs, we used a combination of linear regression and the Getis-Ord Gi* statistic to determine if maternal blood Cd concentrations were associated with offspring CpG methylation of the sequence region regulating a cluster of imprinted genes including MEG3. Correlations were used to examine potential sources and routes. We observed a significant geographic co-clustering of elevated prenatal Cd levels and MEG3 DMR hypermethylation in cord blood (P = 0.01), and these findings were substantiated in our statistical models (β = 1.70, se = 0.80, P = 0.03). These associations were strongest in those born to African American women (β = 3.52, se = 1.32, P = 0.01) compared with those born to White women (β = 1.24, se = 2.11, P = 0.56) or Hispanic women (β = 1.18, se = 1.24, P = 0.34). Consistent with Cd bioaccumulation during the life course, blood Cd levels increased with age (β = 0.015 µg/dl/year, P = 0.003), and Cd concentrations were significantly correlated between blood and urine (ρ > 0.47, P < 0.01), but not hand wipe, soil or house dust concentrations (P > 0.05). Together, these data support that prenatal Cd exposure is associated with aberrant methylation of the imprint regulatory element for the MEG3 gene cluster at birth. However, neither house-dust nor water are likely exposure sources, and ingestion via contaminated hands is also unlikely to be a significant exposure route in this population. Larger studies are required to identify routes and sources of exposure.
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Affiliation(s)
- John S House
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Bioinformatics Research Center, North Carolina State University, Raleigh, NC, USA
| | - Jonathan Hall
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Sarah S Park
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Antonio Planchart
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Eric Money
- Center for Geospatial Analytics, North Carolina State University, Raleigh, NC, USA
- Department of Natural Resources, North Carolina State University, Raleigh, NC, USA
| | - Rachel L Maguire
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Zhiqing Huang
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Carolyn J Mattingly
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - David Skaar
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Jung Ying Tzeng
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Statistics, North Carolina State University, Raleigh, NC, USA
| | - Thomas H Darrah
- Division of Climate, Water, and Environment, School of Earth Sciences, The Ohio State University, Columbus, OH, USA
| | - Avner Vengosh
- Nicholas School of the Environment, Duke University, Durham, NC, USA
| | - Susan K Murphy
- Department of Obstetrics and Gynecology, Duke University School of Medicine, Durham, NC, USA
| | - Randy L Jirtle
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
| | - Cathrine Hoyo
- Center for Human Health and the Environment, North Carolina State University, Raleigh, NC, USA
- Department of Biological Sciences, North Carolina State University, Raleigh, NC, USA
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Beydemir Ş, Türkeş C, Yalçın A. Gadolinium-based contrast agents: in vitro paraoxonase 1 inhibition, in silico studies. Drug Chem Toxicol 2019; 44:508-517. [PMID: 31179770 DOI: 10.1080/01480545.2019.1620266] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Medications show their biological effects by interaction with enzymes, which have been known to play an essential role in the pathogenesis of many diseases. Inhibition or induction of drug metabolizing enzymes has an essential place in the drug design for many kinds of diseases including cardiovascular, neurological, metabolic, and cancer. The main goal of the current study is to contribute to this growing drug design field by observing PON1-drug interactions. In recent years, the safety of gadolinium-based contrast agents (GBCAs) used in magnetic resonance imaging (MRI) has discussed. In the present study, paraoxonase 1 (PON1) enzyme was purified from human serum by simple chromatographic methods with 4095.24 EU mg-1 protein specific activity. The inhibitory activities of gadoteric acid, gadopentetic acid, gadoxetate disodium, and gadodiamide were investigated on PON1 activity of the enzyme. IC50 values were found in the range of 51.28 ± 0.14 to 285.80 ± 0.96 mM. Ki constants were found as 67.95 ± 0.60 mM, 104.97 ± 0.96 mM, 202.33 ± 1.75 mM, and 299.43 ± 2.64 mM for gadoteric acid, gadopentetic acid, gadoxetate disodium, and gadodiamide, respectively. While the inhibition types are determined as competitive of gadoxetate disodium and gadodiamide by the Lineweaver-Burk curves, it was noncompetitive for other compounds. In addition, the molecular docking analyses of gadoxetate disodium and gadodiamide were carried out to understand the binding interactions on the active site of the PON1 enzyme. The structure-activity relationship (SAR) of the drugs was established on the basis of different substituents and their positions in the compounds.
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Affiliation(s)
- Şükrü Beydemir
- Department of Biochemistry, Faculty of Pharmacy, Anadolu University, Eskişehir, Turkey
| | - Cüneyt Türkeş
- Department of Biochemistry, Faculty of Pharmacy, Erzincan Binali Yıldırım University, Erzincan, Turkey
| | - Ahmet Yalçın
- Department of Radiology, Faculty of Medicine, Erzincan Binali Yıldırım University, Erzincan, Turkey
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Dechelation (Transmetalation): Consequences and Safety Concerns With the Linear Gadolinium-Based Contrast Agents, In View of Recent Health Care Rulings by the EMA (Europe), FDA (United States), and PMDA (Japan). Invest Radiol 2019; 53:571-578. [PMID: 30130320 DOI: 10.1097/rli.0000000000000507] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The issue of dechelation (transmetallation) in vivo after administration of the linear gadolinium-based contrast agents, and potential safety concerns, is considered on the basis of an extensive, focused literature review. Early indications of potential problems included the high level of excess ligand used in the formulation of 2 agents (indeed the 2 least stable thermodynamically) and interference with laboratory tests when blood was drawn from patients relatively soon after administration of these same agents. The advent of nephrogenic systemic fibrosis in the late 2000s raised additional major concerns.The correlation in 2014 of dentate nucleus hyperintensity on precontrast T1-weighted scans with multiple prior injections of linear gadolinium chelates, in patients with normal renal function, has driven subsequent research concerning dechelation of these agents in vivo. Unexpectedly high levels of gadolinium in the bone, skin, and liver have been found long term after administration, in animal models and in humans, although the latter data are limited. Bone may serve as a long-term reservoir, with a residual excretion phase for gadolinium after intravenous injection of the linear agents due to a subsequent slow release from bone. Many different patient populations could be vulnerable and potentially later develop clinical symptoms, although at this stage there are only limited data and small retrospective uncontrolled studies. Possible vulnerable populations include children, menopausal women, patients with osteoporosis (who are predisposed to fractures and often slow to heal or heal poorly), those receiving multiple doses, those with proinflammatory conditions, moderate renal dysfunction, or an undefined genetic predisposition. Of particular concern would be nephrogenic systemic fibrosis-like symptoms-including particularly pain and skin/joint symptoms, or disease related to the incorporation of gadolinium in hydroxyapatite in bone, in small subgroups of patients with a not yet defined propensity and/or cofactor. These concerns have led to withdrawal of the linear agents from the largest clinical market, Europe, with the exception of the hepatobiliary agents for delayed liver imaging, an indication that cannot be fulfilled by the current macrocyclic gadolinium chelates (for which these concerns do not apply).
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Hangaard S, Gade JS, Hansen P, Damm Nybing J, Gudbergsen H, Bliddal H, Boesen M. Single- vs. double-dose gadolinium contrast in delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) in knee osteoarthritis: is dose reduction possible on 3-T MRI? Acta Radiol 2019; 60:749-754. [PMID: 30142997 DOI: 10.1177/0284185118796694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Reduction in gadolinium (Gd) contrast agents is wanted due to the uncertainty of the potential side effects. PURPOSE To investigate whether it is possible to reduce the contrast dose from conventional double dose to single dose when increasing the field strength from 1.5-T to 3-T for separating early cartilage degeneration from healthy cartilage, assessed by delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC). MATERIAL AND METHODS Nine patients with knee osteoarthritis (OA), Kellgren-Lawrence grade (KLG) 1-4, were recruited from an ongoing weight loss cohort study. dGEMRIC was performed at 3-T using single (0.1 mmoI/kg) and double (0.2 mmoI/kg) doses of intravenous (i.v.) Gd-DTPA2-. Regions of interest (ROls) were drawn around the posterior weight-bearing femoral knee cartilage in lateral and medial compartments. In five medial compartments ROIs could not be drawn due to severe degeneration of cartilage. T1-relaxation times were compared to previously published values from 1.5-T and to non-contrast values from 3-T. RESULTS Mean dGEMRIC T1-relaxation time in the lateral compartment was 769 ms for single dose vs. 561 ms for double dose ( P < 0.0001); and 685 ms for single dose vs. 454 ms for double dose ( P = 0.004) in the medial compartment. CONCLUSION We found a dose-response relationship between single and double doses of Gd-DTPA2- using 3-T in knee OA patients, similar to the findings at 1.5-T. Compared to the T1-relaxation time at 3-T without contrast (1240 ms), this further separation between OA and normal cartilage indicates that "single dose" dGEMRIC could be sufficient for cartilage health assessment at 3-T.
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Affiliation(s)
- Stine Hangaard
- 1 The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark.,2 Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Jesper Sörensson Gade
- 2 Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Philip Hansen
- 2 Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Janus Damm Nybing
- 2 Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
| | - Henrik Gudbergsen
- 1 The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bliddal
- 1 The Parker Institute, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Mikael Boesen
- 2 Department of Radiology, Bispebjerg and Frederiksberg Hospital, University of Copenhagen, Denmark
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Le Goff S, Barrat JA, Chauvaud L, Paulet YM, Gueguen B, Ben Salem D. Compound-specific recording of gadolinium pollution in coastal waters by great scallops. Sci Rep 2019; 9:8015. [PMID: 31142781 PMCID: PMC6541655 DOI: 10.1038/s41598-019-44539-y] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 05/16/2019] [Indexed: 02/06/2023] Open
Abstract
Gadolinium-based contrast agents (GBCAs), routinely used in magnetic resonance imaging (MRI), end up directly in coastal seawaters where gadolinium concentrations are now increasing. Because many aquatic species could be sensitive to this new pollution, we have evaluated the possibility of using shellfish to assess its importance. Gadolinium excesses recorded by scallop shells collected in Bay of Brest (Brittany, France) for more than 30 years do not reflect the overall consumption in GBCAs, but are largely controlled by one of them, the gadopentetate dimeglumine. Although its use has been greatly reduced in Europe over the last ten years, gadolinium excesses are still measured in shells. Thus, some gadolinium derived from other GBCAs is bioavailable and could have an impact on marine wildlife.
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Affiliation(s)
- Samuel Le Goff
- Laboratoire Géosciences Océan (UMR CNRS 6538), Université de Bretagne Occidentale et Institut Universitaire Européen de la Mer (IUEM), Place Nicolas Copernic, 29280, Plouzané, France
| | - Jean-Alix Barrat
- Laboratoire Géosciences Océan (UMR CNRS 6538), Université de Bretagne Occidentale et Institut Universitaire Européen de la Mer (IUEM), Place Nicolas Copernic, 29280, Plouzané, France.
| | - Laurent Chauvaud
- Laboratoire des Sciences de l'Environnement Marin (UMR CNRS 6539), LIA BeBEST, Université de Bretagne Occidentale et Institut Universitaire Européen de la Mer, Place Nicolas Copernic, 29280, Plouzané, France
| | - Yves-Marie Paulet
- Laboratoire des Sciences de l'Environnement Marin (UMR CNRS 6539), LIA BeBEST, Université de Bretagne Occidentale et Institut Universitaire Européen de la Mer, Place Nicolas Copernic, 29280, Plouzané, France
| | - Bleuenn Gueguen
- UMS CNRS 3113, Université de Bretagne Occidentale et Institut Universitaire Européen de la Mer, Place Nicolas Copernic, 29280, Plouzané, France
| | - Douraied Ben Salem
- LaTIM (INSERM UMR 1101) Université de Bretagne Occidentale. 22, avenue C. Desmoulins, 29238, Brest Cedex 3, France
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Functionalizing NaGdF4:Yb,Er Upconverting Nanoparticles with Bone-Targeting Phosphonate Ligands: Imaging and In Vivo Biodistribution. INORGANICS 2019. [DOI: 10.3390/inorganics7050060] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Lanthanide-doped upconverting nanoparticles (UCNPs) transform near infrared light (NIR) into higher-energy UV and visible light by multiphotonic processes. Owing to such unique feature, UCNPs have found application in optical imaging and have been investigated for the NIR light activation of prodrugs, including transition metal complexes of interest in photochemotherapy. Besides, UCNPs also function as magnetic resonance imaging (MRI) contrast agents and positron emission tomography (PET) probes when labelled with radionuclides such as 18F. In this contribution, we report on a new series of phosphonate-functionalized NaGdF4:Yb,Er UCNPs that show affinity for hydroxyapatite (inorganic constituent of bones), and we discuss their potential as bone targeting multimodal (MRI/PET) imaging agents. In vivo biodistribution studies of 18F-labelled NaGdF4:Yb,Er UCNPs in rats indicate that surface functionalization with phosphonates favours the accumulation of nanoparticles in bones over time. PET results reveal leakage of 18F− for phosphonate-functionalized NaGdF4:Yb,Er and control nanomaterials. However, Gd was detected in the femur for phosphonate-capped UCNPs by ex vivo analysis using ICP-MS, corresponding to 6–7% of the injected dose.
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93
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Chehabeddine L, Al Saleh T, Baalbaki M, Saleh E, Khoury SJ, Hannoun S. Cumulative administrations of gadolinium-based contrast agents: risks of accumulation and toxicity of linear vs macrocyclic agents. Crit Rev Toxicol 2019; 49:262-279. [DOI: 10.1080/10408444.2019.1592109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lara Chehabeddine
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Tala Al Saleh
- Department of Physics, American University of Beirut, Beirut, Lebanon
| | - Marwa Baalbaki
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Saleh
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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94
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Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium-based contrast agents - review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients. Pediatr Radiol 2019; 49:448-457. [PMID: 30923876 DOI: 10.1007/s00247-018-4304-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Gadolinium has been used as a base for contrast agents in MRI for the last three decades. Numerous studies over the last 4 years have reported increased signal intensity in deep brain nuclei in non-contrast MRI images following gadolinium-based contrast agent (GBCA) administration. Pathology studies performed on adults and children, and rodent necropsy studies have also shown gadolinium deposition in brain and other tissues after GBCA administration. The purpose of this review was to summarize and discuss the knowledge gained from these reports and the relevance for imaging pediatric patients.
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Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 111E 210th St, Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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95
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Investigating the role of DCE-MRI, over T2 and DWI, in accurate PI-RADS v2 assessment of clinically significant peripheral zone prostate lesions as defined at radical prostatectomy. Abdom Radiol (NY) 2019; 44:1520-1527. [PMID: 30361870 DOI: 10.1007/s00261-018-1807-6] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE PI-RADS v2 dictates that dynamic contrast-enhanced (DCE) imaging be used to further classify peripheral zone (PZ) cases that receive a diffusion-weighted imaging equivocal score of three (DWI3), a positive DCE resulting in an increase in overall assessment score to a four, indicative of clinically significant prostate cancer (csPCa). However, the accuracy of DCE in predicting csPCa in DWI3 PZ cases is unknown. This study sought to determine the frequency with which DCE changes the PI-RADS v2 DWI3 assessment category, and to determine the overall accuracy of DCE-MRI in equivocal PZ DWI3 lesions. MATERIALS AND METHODS This is a retrospective study of patients with pathologically proven PCa who underwent prostate mpMRI at 3T and subsequent radical prostatectomy. PI-RADS v2 assessment categories were determined by a radiologist, aware of a diagnosis of PCa, but blinded to final pathology. csPCa was defined as a Gleason score ≥ 7 or extra prostatic extension at pathology review. Performance characteristics and diagnostic accuracy of DCE in assigning a csPCa assessment in PZ lesions were calculated. RESULTS A total of 271 men with mean age of 59 ± 6 years mean PSA 6.7 ng/mL were included. csPCa was found in 212/271 (78.2%) cases at pathology, 209 of which were localized in the PZ. DCE was necessary to further classify (45/209) of patients who received a score of DWI3. DCE was positive in 29/45 cases, increasing the final PI-RADS v2 assessment category to a category 4, with 16/45 having a negative DCE. When compared with final pathology, DCE was correct in increasing the assessment category in 68.9% ± 7% (31/45) of DWI3 cases. CONCLUSION DCE increases the accuracy of detection of csPCa in the majority of PZ lesions that receive an equivocal PI-RADS v2 assessment category using DWI.
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96
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Koiso T, Yamamoto M, Watanabe S, Barfod BE. Signal intensity increases in dentate nucleus/globus pallidus/pulvinar on unenhanced T1WI MR images after multiple examinations with gadodiamide. Neuroradiol J 2019; 32:215-224. [PMID: 30924388 DOI: 10.1177/1971400919839646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND AND PURPOSE Elevated signal intensity (SI) in the dentate nucleus (DN), globus pallidus (GP) and pulvinar (PUL) was reportedly observed on unenhanced T1-weighted (T1WI) magnetic resonance (MR) images in patients receiving multiple enhanced MR examinations. We aimed to clarify whether this phenomenon influences the long-term neurological status of patients. MATERIALS AND METHODS We studied 196 radiosurgically treated patients undergoing ≥10 MR examinations using a single dose of gadodiamide and the same 1.5 Tesla MR unit. SI ratios were calculated by referencing the brainstem (BS) for the DN and the thalamus (TH) for the GP and PUL. We compared the SI ratios at the first, fifth, and 10th, and at the most recent examinations. The neurological symptoms of all 196 patients were assessed at each MR examination by one of the authors (MY). RESULTS The DN/BS and GP/TH SI ratios were significantly increased at the fifth examination ( p < .0001, p = 0.0094) and, thereafter, gradually increased. Although the PUL/TH SI ratio was not significantly increased at the fifth examination ( p = 0.2515), a significant increase was noted at the 10th examination ( p < .0001). There were no significant predictive factors for DN/BS SI increases. Younger age, no brain metastasis, and normal estimated glomerular filtration rate were related to GP/TH SI ratio increases ( p = 0.0308, p = 0.0001, p = 0.0306). Higher age and total bilirubin level were related to an increased PUL/TH SI ratio ( p = 0.0276, p = 0.0097). No patients experienced gadodiamide-related health problems. CONCLUSIONS Although the SI ratios rose as numbers of gadodiamide administrations increased, no adverse health effects have developed to date.
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Affiliation(s)
- Takao Koiso
- 1 Katsuta Hospital Mito GammaHouse, Hitachinaka, Japan.,2 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
| | - Masaaki Yamamoto
- 1 Katsuta Hospital Mito GammaHouse, Hitachinaka, Japan.,3 Department of Neurosurgery, Tokyo Women's Medical University Medical Center East, Japan
| | - Shinya Watanabe
- 2 Department of Neurosurgery, Faculty of Medicine, University of Tsukuba, Japan
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97
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Schöckel L, Balzer T, Pietsch H. [Increased signal intensities and gadolinium levels in the brain after administration of gadolinium-based MR contrast agents : Clinical observations and results from preclinical research]. Radiologe 2019; 59:359-368. [PMID: 30887087 DOI: 10.1007/s00117-019-0511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Numerous clinical MRI studies have been published that describe an association between the repeated administration of (linear) gadolinium-based contrast agents and increased signal intensity in certain brain areas. In November 2017, the European Commission suspended the use of some of these contrast agents. OBJECTIVES The background for this decision, both regulatory and scientific, are presented and discussed. MATERIALS AND METHODS The regulatory decisions are evaluated and the clinical and preclinical literature is discussed. RESULTS Differences in the structure and stability of gadolinium-based contrast agent molecules explain the observed increased signal intensities in individual brain regions (e. g. dentate nucleus) after administration of multiple doses of linear contrast agents. This phenomenon was not observed after administration of multiple doses of macrocyclic contrast agents. Preclinical studies have confirmed these results. CONCLUSION To date, no clinical symptoms have been confirmed to be associated with the increased signal intensity or gadolinium presence in the brain.
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Affiliation(s)
- L Schöckel
- Pharmaceuticals Division, Medical & Clinical Affairs Radiology, Bayer AG, Berlin, Deutschland
| | - T Balzer
- Pharmaceuticals, Medical & Clinical Affairs Radiology, Bayer U.S. LLC, 100 Bayer Boulevard, 07981, Whippany, NJ, USA.
| | - H Pietsch
- Research & Development, Pharmaceuticals, MR and CT Contrast Media Research, Bayer AG, Berlin, Deutschland
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98
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Pujales-Paradela R, Carniato F, Esteban-Gómez D, Botta M, Platas-Iglesias C. Controlling water exchange rates in potential Mn 2+-based MRI agents derived from NO2A 2. Dalton Trans 2019; 48:3962-3972. [PMID: 30834411 DOI: 10.1039/c9dt00211a] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
We report a series of pentadentate ligands based on a 1,4,7-triazacyclononane-1,4-diacetic acid (H2NO2A) containing different substituents attached to the third nitrogen atom of the macrocyclic unit. Detailed 1H Nuclear Magnetic Relaxation Dispersion (NMRD) characterisation of the corresponding Mn2+ complexes suggests the formation of six-coordinate species in solution containing an inner-sphere water molecule. This was confirmed by recording the transverse 17O relaxation time and chemical shift measurements. The water exchange rate of the coordinated water molecule was found to be strongly influenced by the nature of the substituent R at position 7 of the triazacyclononane unit (R = Me, k298ex = 62.6 × 107 s-1; R = Bz, k298ex = 4.4 × 107 s-1; R = 1-phenylethyl, k298ex = 2.6 × 107 s-1). The decreasing exchange rates are explained by the increasing bulkiness of the substituent, which hinders the approach of the entering water molecule in an associatively activated water exchange mechanism. This is supported by DFT calculations (M062X/TZVP), which confirm the associative nature of the water exchange reaction. A potentially decadentate ligand containing two NO2A units linked by a xylenyl spacer in the meta position was also synthesised. The corresponding binuclear Mn2+ complex contains two metal ions with different hydration numbers, as evidenced by 1H NMRD and 17O NMR measurements. DFT calculations show that this is related to the presence of a bridging bidentate μ-η1-carboxylate group connecting the two metal centers. The results reported in this work provide a straightforward strategy to control the exchange rate of the coordinated water molecule in this family of MRI contrast agent candidates.
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Affiliation(s)
- Rosa Pujales-Paradela
- Universidade da Coruña, Centro de Investigacións Científicas Avanzadas (CICA) and Departamento de Química, Facultade de Ciencias, 15071, A Coruña, Galicia, Spain.
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99
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Gadolinium as an Emerging Microcontaminant in Water Resources: Threats and Opportunities. GEOSCIENCES 2019. [DOI: 10.3390/geosciences9020093] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As a result of high doses of paramagnetic gadolinium (Gd) chelates administered in magnetic resonance imaging (MRI) exams, their unmetabolized excretion, and insufficient removal in wastewater treatment plants (WWTPs), large amounts of anthropogenic Gd (Gdanth) are released into surface water. The upward trend of gadolinium-based contrast agent (Gd-CA) administrations is expected to continue growing and consequently higher and higher anthropogenic Gd concentrations are annually recorded in water resources, which can pose a great threat to aquatic organisms and human beings. In addition, the feasibility of Gd retention in patients administered with Gd-CAs repeatedly, and even potentially fatal diseases, including nephrogenic systemic fibrosis (NSF), due to trace amounts of Gd have recently arisen severe health concerns. Thus, there is a need to investigate probable adverse health effects of currently marketed Gd-CAs meticulously and to modify the actual approach in using Gd contrast media in daily practice in order to minimize unknown possible health risks. Furthermore, the employment of enhanced wastewater treatment processes that are capable of removing the stable contrast agents, and the evaluation of the ecotoxicity of Gd chelates and human exposure to these emerging contaminants through dermal and ingestion pathways deserve more attention. On the other hand, point source releases of anthropogenic Gd into the aquatic environment presents the opportunity to assess surface water—groundwater interactions and trace the fate of wastewater plume as a proxy for the potential presence of other microcontaminants associated with treated wastewater in freshwater and marine systems.
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100
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Zhu DY, Lu B, Yin JH, Ke QF, Xu H, Zhang CQ, Guo YP, Gao YS. Gadolinium-doped bioglass scaffolds promote osteogenic differentiation of hBMSC via the Akt/GSK3β pathway and facilitate bone repair in vivo. Int J Nanomedicine 2019; 14:1085-1100. [PMID: 30804672 PMCID: PMC6375113 DOI: 10.2147/ijn.s193576] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Biomaterial-induced osteogenesis is mainly related to hierarchically porous structures and bioactive components. Rare earth elements are well known to promote osteogenesis and stimulate bone repair; however, the underlying biological effects of gadolinium (Gd) element on bone regeneration are not yet known. METHODS In this study, we successfully fabricated gadolinium-doped bioglass (Gd-BG) scaffolds by combining hollow mesoporous Gd-BG microspheres with chitosan and evaluated in vitro effects and underlying mechanisms with Cell Counting Kit-8, scanning electron microscopy, alkaline phosphatase, Alizarin red staining, and polymerase chain reaction. Cranial defect model of rats was constructed to evaluate their in vivo effects. RESULTS The results indicated that Gd-BG scaffolds could promote the proliferation and osteogenic differentiation of human bone marrow-derived mesenchymal stem cells (hBMSCs). Mechanistically, the Akt/GSK3β signaling pathway was activated by the Gd-BG scaffolds. The enhancing effect of Gd-BG scaffolds on the osteogenic differentiation of hBMSCs was inhibited by the addition of LY294002, an inhibitor of Akt. Moreover, the in vivo cranial defect model of rats indicated that the Gd-BG scaffolds could effectively promote bone regeneration. CONCLUSION Both in vitro and in vivo results suggested that Gd-BG scaffolds have promising applications in bone tissue engineering.
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Affiliation(s)
- Dao-Yu Zhu
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China,
| | - Bin Lu
- The Education Ministry Key Lab of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China,
| | - Jun-Hui Yin
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China,
| | - Qin-Fei Ke
- The Education Ministry Key Lab of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China,
| | - He Xu
- The Education Ministry Key Lab of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China,
| | - Chang-Qing Zhang
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China,
| | - Ya-Ping Guo
- The Education Ministry Key Lab of Resource Chemistry, Shanghai Key Laboratory of Rare Earth Functional Materials, Shanghai Normal University, Shanghai 200234, China,
| | - You-Shui Gao
- Department of Orthopedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai 200233, China,
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, The University of Western Australia, Perth, WA 6009, Australia
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