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Türker E, Demirçak N, Arslan-Yildiz A. Scaffold-free three-dimensional cell culturing using magnetic levitation. Biomater Sci 2018; 6:1745-1753. [DOI: 10.1039/c8bm00122g] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Magnetic levitation platform ensures a scaffold-free 3D cell culture formation by utilizing Gadolinium(iii) chelates, which provide paramagnetic environment for levitation; therefore, the cells are assembled into complex 3D structures.
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Affiliation(s)
- Esra Türker
- Department of Bioengineering
- Izmir Institute of Technology (IZTECH)
- Izmir
- Turkey
| | - Nida Demirçak
- Department of Bioengineering
- Izmir Institute of Technology (IZTECH)
- Izmir
- Turkey
| | - Ahu Arslan-Yildiz
- Department of Bioengineering
- Izmir Institute of Technology (IZTECH)
- Izmir
- Turkey
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102
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Young JR, Orosz I, Franke MA, Kim HJ, Woodworth D, Ellingson BM, Salamon N, Pope WB. Gadolinium deposition in the paediatric brain: T1-weighted hyperintensity within the dentate nucleus following repeated gadolinium-based contrast agent administration. Clin Radiol 2017; 73:290-295. [PMID: 29208312 DOI: 10.1016/j.crad.2017.11.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Accepted: 11/02/2017] [Indexed: 01/19/2023]
Abstract
AIM To determine whether repeated gadolinium-based contrast agent administration (GBCA) in children is associated with the development of increased T1-weighted signal intensity within the cerebellar dentate nucleus. MATERIALS AND METHODS With institutional review board approval for this The Health Insurance Portability and Accountability Act-compliant retrospective study, a cohort of 41 patients under the age of 18 years who underwent at least four contrast-enhanced magnetic resonance imaging (MR) examinations of the brain from 2005 to 2015 were identified. For each examination, both dentate nuclei were manually contoured, and the mean dentate nucleus-to-pons signal intensity (DN-P SI) ratio was calculated. The DN-P SI ratios from the last to first MRI examination were compared, and the correlation between DN-P SI ratio and cumulative gadolinium dose was calculated using a linear mixed effect model to control for potentially confounding variables. RESULTS For the 41 patients in the cohort, there was a significant increase in the mean DN-P SI ratio from the first MRI to the last MRI examination (1.05 versus 1.11, p=0.004). After controlling for patient diagnosis, history of chemotherapy or radiation, sex, and age, there was a significant positive association between DN-P SI ratio and cumulative gadolinium dose (coefficient=0.401, p=0.032). CONCLUSION Repeated GBCA administration in children is associated with increased T1-weighted signal intensity within the dentate nucleus.
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Affiliation(s)
- J R Young
- Department of Radiology, UC Davis School of Medicine, 4860 Y. Street, Suite #3100, Sacramento, CA 95817, USA; Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - I Orosz
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - M A Franke
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - H J Kim
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - D Woodworth
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - B M Ellingson
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - N Salamon
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA
| | - W B Pope
- Department of Radiological Sciences, David Geffen School of Medicine at UCLA, 757 Westwood Plaza, 1621E, Los Angeles, CA 90095, USA.
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103
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Garcia J, Liu SZ, Louie AY. Biological effects of MRI contrast agents: gadolinium retention, potential mechanisms and a role for phosphorus. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2017; 375:rsta.2017.0180. [PMID: 29038383 PMCID: PMC5647271 DOI: 10.1098/rsta.2017.0180] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/06/2023]
Abstract
No discussion of challenges for chemistry in molecular imaging would be complete without addressing the elephant in the room-which is that the purest of chemical compounds needs to interact with a biological system in a manner that does not perturb normal biology while still providing efficacious feedback to assist in diagnosis of disease. In the past decade, magnetic resonance imaging (MRI) agents long considered inert have produced adverse effects in certain patient populations under certain treatment regimens. More recently, inert blood pool agents have been found to deposit in the brain. Release of free metal is often suspected as the culprit but that hypothesis has yet to be validated. In addition, even innocuous agents can cause painful side effects during injection in some patients. In this brief review, we summarize known biological effects for gadolinium- and iron-based MRI contrast agents, and discuss some of the potential mechanisms for the observed biological effects, including the potential role of phosphorus imbalance, related to kidney disease or cancer, in destabilizing gadolinium-based chelates and precipitating free gadolinium.This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.
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Affiliation(s)
- Joel Garcia
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Stephen Z Liu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Angelique Y Louie
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
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104
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Kinner S, Schubert TB, Bruce RJ, Rebsamen SL, Diamond CA, Reeder SB, Rowley HA. Deep Brain Nuclei T1 Shortening after Gadobenate Dimeglumine in Children: Influence of Radiation and Chemotherapy. AJNR Am J Neuroradiol 2017; 39:24-30. [PMID: 29146718 DOI: 10.3174/ajnr.a5453] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2017] [Accepted: 08/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Intrinsic T1-hyperintense signal has recently been reported in the deep gray nuclei on brain MR imaging after multiple doses of gadolinium-based contrast agents. Most reports have included adult patients and excluded those undergoing radiation or chemotherapy. We investigated whether T1 shortening is also observed in children and tried to determine whether radiochemotherapy is a risk factor for this phenomenon. MATERIALS AND METHODS In this single-center retrospective study, we reviewed clinical charts and images of all patients 18 years of age or younger with ≥4 gadobenate dimeglumine-enhanced MRIs for 6 years. Seventy-six children (mean age, 9.3 years; 60 unconfounded by treatment, 16 with radiochemotherapy) met the selection criteria (>4 MR imaging examinations; mean, 8). T1 signal intensity ratios for the dentate to pons and globus pallidus to thalamus were calculated and correlated with number of injections, time interval, and therapy. RESULTS Among the 60 children without radiochemotherapy, only 2 had elevated T1 signal intensity ratios (n = 20 and 16 injections). Twelve of the 16 children with radiochemotherapy showed elevated signal intensity ratios. Statistical analysis demonstrated a significant signal intensity ratio change for the number of injections (P < .001) and amount of gadolinium (P = .008), but not for the interscan time interval (P = .35). There was a significant difference in the average signal intensity ratio change between those with and without radiochemotherapy (P < .001). Chart review revealed no new neurologic deficits in any patients, related to their underlying conditions and prior surgeries. CONCLUSIONS Compared with published adult series, children show a similar pattern of T1 hyperintense signal changes of the dentate and globus pallidus after multiple gadobenate dimeglumine injections. The T1 signal changes in children may have a later onset but are accelerated by radiochemotherapy.
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Affiliation(s)
- S Kinner
- From the Departments of Radiology (S.K., T.B.S., R.J.B., S.L.R., S.B.R., H.A.R.) .,Department of Diagnostic and Interventional Radiology and Neuroradiology (S.K.), University Hospital Essen, Essen, Germany
| | - T B Schubert
- From the Departments of Radiology (S.K., T.B.S., R.J.B., S.L.R., S.B.R., H.A.R.).,Clinic of Radiology and Nuclear Medicine (T.B.S.), Basel University Hospital, Basel, Switzerland
| | - R J Bruce
- From the Departments of Radiology (S.K., T.B.S., R.J.B., S.L.R., S.B.R., H.A.R.)
| | - S L Rebsamen
- From the Departments of Radiology (S.K., T.B.S., R.J.B., S.L.R., S.B.R., H.A.R.)
| | | | - S B Reeder
- From the Departments of Radiology (S.K., T.B.S., R.J.B., S.L.R., S.B.R., H.A.R.).,Medical Physics (S.B.R.).,Emergency Medicine (S.B.R.).,Biomedical Engineering (S.B.R.).,Medicine (S.B.R.), University of Wisconsin-Madison, Madison, Wisconsin
| | - H A Rowley
- From the Departments of Radiology (S.K., T.B.S., R.J.B., S.L.R., S.B.R., H.A.R.)
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105
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Intraindividual Analysis of Signal Intensity Changes in the Dentate Nucleus After Consecutive Serial Applications of Linear and Macrocyclic Gadolinium-Based Contrast Agents. Invest Radiol 2017; 51:683-690. [PMID: 27495187 DOI: 10.1097/rli.0000000000000308] [Citation(s) in RCA: 80] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Recent studies reported an increase in the dentate nucleus (DN)-to-pons signal intensity (SI) ratio (DN-pons SI ratio) on unenhanced T1-weighted images in patients who received consecutive serial injections of linear gadolinium-based contrast agents (GBCAs). In contrast, most studies found no increase in the DN-pons SI ratio when patients were treated with consecutive serial injections of macrocyclic GBCAs. However, the potential difference between macrocyclic and linear GBCAs has never been assessed in individuals who received subsequent applications of both contrast agents. In this retrospective study, we assessed the evolution of the DN-pons SI ratio change in patients that were treated with a comparable number of serial consecutive injections of the linear GBCA gadopentetate dimeglumine and subsequent serial injections of the macrocyclic GBCAs gadobutrol and gadoterate meglumine. MATERIALS AND METHODS Data of 36 patients was analyzed. All patients underwent at least 5 consecutive administrations of the linear GBCA gadopentetate dimeglumine followed by an equal number of consecutive administrations of the macrocyclic GBCA gadobutrol. In 12 of the 36 patients, 5 or more final consecutive injections of the macrocyclic GBCA gadoterate meglumine were analyzed additionally. The difference of DN-pons SI ratios on unenhanced T1-weighted images was calculated by subtracting the ratio at the first examination from the ratio at the last examination in each of the 3 periods. RESULTS The mean DN-pons SI ratio difference in the gadopentetate dimeglumine period was significantly greater than 0 (mean ± SD, 0.0448 ± 0.0345; P < 0.001), whereas the mean DN-pons SI ratio difference in the subsequent gadobutrol and gadoterate meglumine period was significantly smaller than 0 (gadobutrol: -0.0178 ± 0.0459, P = 0.026; gadoterate meglumine: -0.0250 ± 0.0284, P = 0.011). CONCLUSIONS In this observational study, the application of the linear GBCA gadopentetate dimeglumine was associated with a DN-pons SI ratio increase, whereas subsequent applications of the macrocyclic GBCAs gadobutrol or gadoterate meglumine in the same patients were not. Rather, the current data tentatively suggest a decrease in preexisting hyperintensities over time when linear GBCAs are changed to macrocyclic GBCAs, potentially indicating a washout effect or precipitation of gadolinium. Future patient studies need to include control groups to replicate the present results, and additional animal studies should be conducted to clarify the underlying mechanism of the proposed SI decrease.
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106
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Affiliation(s)
- Emanuel Kanal
- From the Department of Radiology, University of Pittsburgh Medical Center, 200 Lothrop St, Room D132, Pittsburgh, PA 15213
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107
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Magnetic resonance index of activity (MaRIA) and Clermont score are highly and equally effective MRI indices in detecting mucosal healing in Crohn's disease. Dig Liver Dis 2017; 49:1211-1217. [PMID: 28919192 DOI: 10.1016/j.dld.2017.08.033] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 08/15/2017] [Accepted: 08/16/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND Magnetic resonance index of activity (MaRIA) and Clermont score are currently the two main MRI indices that have been validated compared to endoscopy in Crohn's disease (CD). AIMS To compare the accuracy of MaRIA and Clermont score in assessing CD mucosal healing. METHODS Fourty-four CD patients underwent prospectively and consecutively MRI and colonoscopy. RESULTS Considering 207 segments, MaRIA>7 and Clermont score>8.4 demonstrated substantial accuracy to detect endoscopic ulcerations (73.9% and 74.0%, respectively) and presented with high specificity (82.1% and 81.3%) and high negative predictive value (NPV) (82.1% and 82.4%) for MaRIA and Clermont score, respectively. The sensitivity for detecting deep ulcerations was 90.9% for both MaRIA>11 and Clermont score>12.5, with a specificity of 82.0% and 80.0%, respectively. Among 44 patients, deep MRI remission predicted mucosal healing with specificity=85.3% and NPV=85.3% according to Barcelona criteria (no segmental MaRIA>7), and specificity=88.2% and NPV=85.7% according to Clermont criteria (no segmental Clermont score>8.4). In addition, MRI remission predicted mucosal healing with specificity=76.5% and NPV=86.7% according to Barcelona criteria (no segmental MaRIA>11), and specificity=79.4% and NPV=84.4% according to Clermont criteria (no segmental Clermont score>12.5). CONCLUSION MaRIA and Clermont score are equally effective in detecting CD endoscopic ulcerations supporting their use as therapeutic endpoints.
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108
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Kanda T, Nakai Y, Hagiwara A, Oba H, Toyoda K, Furui S. Distribution and chemical forms of gadolinium in the brain: a review. Br J Radiol 2017; 90:20170115. [PMID: 28749164 DOI: 10.1259/bjr.20170115] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the 3 years since residual gadolinium-based contrast agent (GBCA) in the brain was first reported, much has been learned about its accumulation, including the pathway of GBCA entry into the brain, the brain distribution of GBCA and its excretion. Here we review recent progress in understanding the routes of gadolinium deposition in brain structures.
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Affiliation(s)
- Tomonori Kanda
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan
| | - Yudai Nakai
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan.,2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akifumi Hagiwara
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan.,2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Oba
- 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiko Toyoda
- 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeru Furui
- 3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
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109
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Effects of serial macrocyclic-based contrast materials gadoterate meglumine and gadobutrol administrations on gadolinium-related dentate nuclei signal increases in unenhanced T1-weighted brain: a retrospective study in 158 multiple sclerosis (MS) patients. Radiol Med 2017; 123:125-134. [PMID: 28952018 DOI: 10.1007/s11547-017-0816-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To perform T1 signal intensity (SI) measurements in the dentate nuclei of adult patients with confirmed multiple sclerosis (MS) after serial administrations of the macrocyclic gadolinium-based contrast agents (GBCAs), gadoterate meglumine and gadobutrol. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and informed consent was waived. A review of our PACS database for the period from March 1, 2007 to July 31, 2016 revealed 158 confirmed MS patients who received exclusively either gadoterate meglumine (n = 81) or gadobutrol (n = 77) for diagnosis and follow-up. SI measurements on unenhanced T1-weighted images were performed on all scans of all patients and at regions of interest (ROIs) positioned on the dentate nucleus (DN) and pons. The dentate nucleus-to-pons (DNP) T1-SI ratio was subsequently calculated. Unpaired T test and regression analysis were used to evaluate statistical differences. RESULTS An increase in DNP was noted between the first and last MR examinations for both gadoterate meglumine (0.0032 ± 0.0216) and gadobutrol (0.0019 ± 0.0346). Although the differences were not statistically significant based across the entire patient population, visible T1 hyperintensity in the DN was noted in approximately one-third of all patients in each group that received at least five administrations of either GBCA. CONCLUSIONS SI increases on unenhanced T1-weighted images possibly indicative of gadolinium retention occur after serial administrations of the macrocyclic GBCAs, gadoterate meglumine and gadobutrol.
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110
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Perrotta G, Metens T, Absil J, Lemort M, Manto M. Absence of clinical cerebellar syndrome after serial injections of more than 20 doses of gadoterate, a macrocyclic GBCA: a monocenter retrospective study. J Neurol 2017; 264:2277-2283. [PMID: 28956156 DOI: 10.1007/s00415-017-8631-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
Sound evidence of gadolinium accumulation in brain has been recently provided after repeated administrations of linear gadolinium-based contrast agents (GBCAs), especially at the cerebellum level. Although data regarding brain accumulation of macrocyclic GBCAs are more reassuring, there is now a genuine concern ("gadolinium-phobia") about possible long-term consequences of gadolinium deposits, especially in terms of cerebellar sequelae. We, therefore, questioned about the clinical impact of serial administration of gadoterate meglumine, a macrocyclic GBCA. In this retrospective study (2000-2016) of medical files of patients who received more than 20 administrations of gadoterate, we searched for cerebellar symptoms and signs developing during the regular follow-up. We reviewed medical files of ten patients (mean age 34.4 ± 20.8 years; 4 males, 6 females) who received 28.2 ± 5.3 doses of gadoterate (average total dose of GBCA 518 ± 226 ml; range 185-785 ml). Patients were examined by at least two medical specialists depending on initial diagnosis, and at least once by a neurosurgeon. Mean follow-up time was 91 months (range 49-168) and six out of ten patients experienced new symptoms or signs. No clinician reported the appearance of a rising cerebellar syndrome, nor newly appeared symptoms or signs suggested cerebellar toxicity. This retrospective clinical study shows no de novo clinical cerebellar syndrome following repeated administrations of gadoterate. Our results argue against a cerebellar toxicity of this macrocyclic agent. Still, confirmation in a larger number of subjects is required, as well as clinical studies concerning linear GBCAs whose structure and in vivo stability are distinct.
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Affiliation(s)
- Gaetano Perrotta
- Service de Neurologie, ULB-Hôpital Erasme, Route de Lennik, Brussels, Belgium
| | - Thierry Metens
- Service de Neuroimagerie, ULB-Hôpital Erasme, Route de Lennik, Brussels, Belgium
| | - Julie Absil
- Service de Neuroimagerie, ULB-Hôpital Erasme, Route de Lennik, Brussels, Belgium
| | - Marc Lemort
- Service de Radiologie, Institut Bordet, Brussels, Belgium
| | - Mario Manto
- FNRS, ULB-Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium.
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111
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Endrikat J, Anzalone N. Gadobutrol in India-A Comprehensive Review of Safety and Efficacy. MAGNETIC RESONANCE INSIGHTS 2017; 10:1178623X17730048. [PMID: 28932122 PMCID: PMC5598798 DOI: 10.1177/1178623x17730048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
Gadobutrol is a gadolinium (Gd)-based contrast agent for magnetic resonance imaging (MRI). In India, gadobutrol is approved for MRI of the central nervous system (CNS), liver, kidneys, breast and for MR angiography for patients 2 years and older. The standard dose for all age groups is 0.1 mmol/kg body weight. The safety profile has been demonstrated in 42 clinical phase 2 to 4 studies (>6800 patients), 7 observational studies, and by assessing pharmacovigilance data of 29 million applications. Furthermore, studies in children, adults, and elderly and in patients with impaired liver or kidney function did not show any increased adverse event rate. Diagnostic efficacy was demonstrated in numerous studies and various indications, such as diseases of the CNS, peripheral and supra-aortic vessels, kidneys, liver, and breast.
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Affiliation(s)
- Jan Endrikat
- Radiology, Bayer AG, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Nicoletta Anzalone
- Department of Neuroradiology, Scientific Institute HS Raffaele, Milan, Italy
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112
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Bjørnerud A, Vatnehol SAS, Larsson C, Due-Tønnessen P, Hol PK, Groote IR. Signal Enhancement of the Dentate Nucleus at Unenhanced MR Imaging after Very High Cumulative Doses of the Macrocyclic Gadolinium-based Contrast Agent Gadobutrol: An Observational Study. Radiology 2017; 285:434-444. [PMID: 28885891 DOI: 10.1148/radiol.2017170391] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To test for measurable visual enhancement of the dentate nucleus (DN) on unenhanced T1-weighted magnetic resonance (MR) images in a cohort of patients with a primary brain tumor who had not received linear gadolinium-based contrast agents (GBCAs) but had received many injections of macrocyclic GBCAs. Materials and Methods Seventeen patients with high-grade gliomas who had received 10-44 administrations of the macrocyclic GBCA gadobutrol (0.1 mmol/kg of body weight) were retrospectively included in this regional ethics committee-approved study. Two neuroradiologists inspected T1-weighted MR images with optimized window settings to visualize small differences in contrast at the baseline and at the last examination for the presence of visual DN signal enhancement. Signal intensity (SI) in the DN was normalized to the SI of the pons, and a one-sample t test was used to test for differences between baseline normalized SI (nSI) in the DN (nSIDN) and the average change in nSIDN of all postbaseline MR imaging sessions (ΔnSIDNavg) or the change in nSIDN from baseline to the last MR imaging session (ΔnSIDN). Linear and quadratic correlation analyses were used to examine the association between the number of macrocyclic GBCA administrations and ΔnSIDN or ΔnSIDNavg. Results The mean ± standard deviation number of macrocyclic GBCA administrations was 22.2 ± 10.6 administered throughout 706 days ± 454. Visually appreciable signal enhancement was observed in two patients who had received 37 and 44 macrocyclic GBCA injections. Mean ΔnSIDN was greater than zero (0.03 ± 0.05; P = .016), and there was a significant linear association between the number of macrocyclic GBCA injections and ΔnSIDN (r = 0.69, P = .002) and ΔnSIDNavg (r = 0.77, P < .001). Conclusion A small but statistically significant dose-dependent T1-weighted signal enhancement was observed in the DN after multiple macrocyclic GBCA injections. Visually appreciable enhancement in the DN was observed on contrast-optimized images in two patients who had received 37 and 44 standard doses of macrocyclic GBCAs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Atle Bjørnerud
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Svein Are Sirirud Vatnehol
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Christopher Larsson
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Paulina Due-Tønnessen
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Per Kristian Hol
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Inge Rasmus Groote
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
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Gianolio E, Bardini P, Arena F, Stefania R, Di Gregorio E, Iani R, Aime S. Gadolinium Retention in the Rat Brain: Assessment of the Amounts of Insoluble Gadolinium-containing Species and Intact Gadolinium Complexes after Repeated Administration of Gadolinium-based Contrast Agents. Radiology 2017; 285:839-849. [PMID: 28873047 DOI: 10.1148/radiol.2017162857] [Citation(s) in RCA: 88] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To evaluate the speciation of gadolinium-containing species after multiple administrations of the gadolinium-based contrast agents (GBCAs) gadodiamide and gadoteridol and to quantify the amount of intact gadolinium complexes and insoluble gadolinium-containing species. Materials and Methods A total dose of 13.2 mmol per kilogram of body weight of each GBCA was administered in healthy Wistar rats over a period of 8 weeks. Three days after the final administration, rats were sacrificed, and the brains were excised and divided into three portions. Each portion of brain homogenate was divided into two parts, one for determination of the total gadolinium concentration with inductively coupled plasma mass spectrometry and one for determination of the amount of intact GBCA and gadolinium-containing insoluble species. Relaxometric measurements of gadodiamide and gadolinium trichloride in the presence of polysialic acid were also performed. Results The mean total gadolinium concentrations for gadodiamide and gadoteridol, respectively, were 0.317 μg/g ± 0.060 (standard deviation) and 0.048 μg/g ± 0.004 in the cortex, 0.418 μg/g ± 0.078 and 0.051 μg/g ± 0.009 in the subcortical brain, and 0.781 μg/g ± 0.079 and 0.061 μg/g ± 0.012 in the cerebellum. Gadoteridol comprised 100% of the gadolinium species found in rats treated with gadoteridol. In rats treated with gadodiamide, the largest part of gadolinium retained in brain tissue was insoluble species. In the cerebellum, the amount of intact gadodiamide accounts for 18.2% ± 10.6 of the total gadolinium found therein. The mass balance found for gadolinium implies the occurrence of other soluble gadolinium-containing species (approximately 30%). The relaxivity of the gadolinium polysialic acid species formed in vitro was 97.8 mM/sec at 1.5 T and 298 K. Conclusion Gadoteridol was far less retained, and the entire detected gadolinium was intact soluble GBCA, while gadodiamide yielded both soluble and insoluble gadolinium-containing species, with insoluble species dominating. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Eliana Gianolio
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
| | - Paola Bardini
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
| | - Francesca Arena
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
| | - Rachele Stefania
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
| | - Enza Di Gregorio
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
| | - Rebecca Iani
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
| | - Silvio Aime
- From the Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Turin, Italy (E.G., P.B., F.A., R.S., E.D.G., R.I., S.A.); and Centro di Eccellenza di Imaging Preclinico (CEIP), Colleretto Giacosa, Italy (P.B., F.A., S.A.)
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Rossi Espagnet MC, Bernardi B, Pasquini L, Figà-Talamanca L, Tomà P, Napolitano A. Signal intensity at unenhanced T1-weighted magnetic resonance in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in children. Pediatr Radiol 2017; 47:1345-1352. [PMID: 28526896 DOI: 10.1007/s00247-017-3874-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/26/2017] [Accepted: 04/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few studies have been conducted on the relations between T1-weighted signal intensity changes in the pediatric brain following gadolinium-based contrast agent (GBCA) exposure. OBJECTIVE The purpose of this study is to investigate the effect of multiple administrations of a macrocyclic GBCA on signal intensity in the globus pallidus and dentate nucleus of the pediatric brain on unenhanced T1-weighted MR images. MATERIALS AND METHODS This retrospective study included 50 patients, mean age: 8 years (standard deviation: 4.8 years), with normal renal function exposed to ≥6 administrations of the same macrocyclic GBCA (gadoterate meglumine) and a control group of 59 age-matched GBCA-naïve patients. The globus pallidus-to-thalamus signal intensity ratio and dentate nucleus-to-pons signal intensity ratio were calculated from unenhanced T1-weighted images for both patients and controls. A mixed linear model was used to evaluate the effects on signal intensity ratios of the number of GBCA administrations, the time interval between administrations, age, radiotherapy and chemotherapy. T-test analyses were performed to compare signal intensity ratio differences between successive administrations and baseline MR signal intensity ratios in patients compared to controls. P-values were considered significant if <0.05. RESULTS A significant effect of the number of GBCA administrations on relative signal intensities globus pallidus-to-thalamus (F[8]=3.09; P=0.002) and dentate nucleus-to-pons (F[8]=2.36; P=0.021) was found. The relative signal intensities were higher at last MR examination than at baseline (P<0.001). CONCLUSION Quantitative analysis evaluation of globus pallidus:thalamus and dentate nucleus:pons of the pediatric brain demonstrated an increase after serial administrations of macrocyclic GBCA. Further research is necessary to fully understand GBCA pharmacokinetic in children.
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Affiliation(s)
- Maria Camilla Rossi Espagnet
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Bruno Bernardi
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Luca Pasquini
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,Neuroradiology Unit, Azienda Ospedaliera Sant'Andrea, University Sapienza, Via di Grottarossa 1035, Rome, Italy
| | - Lorenzo Figà-Talamanca
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, Rome, Italy
| | - Antonio Napolitano
- Enterprise Risk Management, Medical Physics Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, Rome, Italy
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Lee JY, Park JE, Kim HS, Kim SO, Oh JY, Shim WH, Jung SC, Choi CG, Kim SJ. Up to 52 administrations of macrocyclic ionic MR contrast agent are not associated with intracranial gadolinium deposition: Multifactorial analysis in 385 patients. PLoS One 2017; 12:e0183916. [PMID: 28859167 PMCID: PMC5578663 DOI: 10.1371/journal.pone.0183916] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine whether multiple repeated administrations of gadolinium-based macrocyclic ionic MR contrast agent (MICA) are associated with intracranial gadolinium deposition and identify the predisposing factors for deposition in various clinical situations. MATERIALS AND METHODS In this institutional review board-approved retrospective study, 385 consecutive patients who underwent MICA-enhanced MR imaging were enrolled. The dentate nucleus-to-pons (DN/P) and globus pallidus-to-thalamus (GP/Th) signal intensity (SI) ratios on unenhanced T1-weighted images were recorded by 2 independent readers and averaged. The mean DN/P and GP/Th SI ratio difference between the last and the first examinations were tested using the one-sample t-test. Student's t-test and stepwise regression analysis were used to identify the predisposing factors for deposition based on the number of administrations, time interval, hepatic and renal function, magnetic field strength, and chemo- or radiation therapy. RESULTS The mean DN/P SI ratio difference was not different from zero (P = .697), even in patients with ≥20 administrations (n = 33). Only patients with abnormal renal function showed an increase in the mean DN/P SI ratio difference (P = .019). The mean DN/P SI ratio difference was not associated with any predisposing factors. However, the mean GP/Th SI ratio difference showed decrease (P < .001), which was associated with age (P = .007), number of administrations (P = .01) and number of radiation therapy sessions (P = .022) on multivariate analysis. CONCLUSION Multiple repeated administrations of MICA were not associated with increased T1 signal intensity in deep brain nuclei suggestive of Gd deposition in patients with normal renal function.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Wonmi-gu, Bucheon, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Abstract
Advanced imaging techniques including computed tomography (CT) angiography, CT perfusion, magnetic resonance (MR) angiography, MR with diffusion- and perfusion-weighted imaging, and, more recently, resting-state BOLD (Blood Oxygen Level Dependent) functional MRI (rs-fMRI) are increasingly used to evaluate patients with acute ischemic stroke. Advanced imaging allows for identification of patients with ischemic stroke and determination of the size of infarcted and potentially salvageable tissue, all of which yield crucial information for proper stroke management. The addition of rs-fMRI for ischemia adds information at the microvascular level, thereby improving the understanding of pathophysiologic mechanisms of impaired cerebral perfusion and tissue oxygenation beyond the known concepts at the macrovascular level. As such, it may further delineate functional and dysfunctional neuronal networks, guide stroke interventions, and improve prognosis and monitoring of patient outcomes.
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Abstract
Cerebral blood flow measurement by magnetic resonance imaging perfusion (MRP) techniques is broadly applied to patients with acute ischemic stroke, vasospasm following aneurysmal subarachnoid hemorrhage, chronic arterial steno-occlusive disease, cervical atherosclerotic disease, and primary brain neoplasms. MRP may be performed using an exogenous tracer, most commonly gadolinium-based intravenous contrast, or an endogenous tracer, such as arterial spin labeling (ASL) or intravoxel incoherent motion (IVIM). Here, we review the technical basis of commonly performed MRP techniques, the interpretation of MRP imaging maps, and how MRP provides valuable clinical information in the triage of patients with cerebral disease.
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Rovira A, Auger C, Huerga E, Corral JF, Mitjana R, Sastre-Garriga J, Tintoré M, Montalban X. Cumulative Dose of Macrocyclic Gadolinium-Based Contrast Agent Improves Detection of Enhancing Lesions in Patients with Multiple Sclerosis. AJNR Am J Neuroradiol 2017; 38:1486-1493. [PMID: 28619842 DOI: 10.3174/ajnr.a5253] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2016] [Accepted: 04/02/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Gadolinium-enhanced MR imaging is currently the reference standard for detecting active inflammatory lesions in patients with multiple sclerosis. The sensitivity of MR imaging for this purpose may vary according to the physicochemical characteristics of the contrast agent used and the acquisition strategy. The purpose of this study was to compare detection of gadolinium-enhancing lesions or active disease following a single or cumulative dose of a macrocyclic gadolinium-based contrast agent with different image acquisition delays in patients with clinically isolated syndrome or relapsing multiple sclerosis. MATERIALS AND METHODS All patients received a first dose (0.1 mmol/kg) of gadobutrol and, 20 minutes later, a second dose (0.1 mmol/kg), with a cumulative dose of 0.2 mmol/kg. Two contrast-enhanced T1-weighted sequences were performed at 5 and 15 minutes after the first contrast administration, and 2 additional T1-weighted sequences at 5 and 15 minutes after the second contrast administration with a 3T magnet. RESULTS One hundred fifteen patients were considered evaluable. A significantly larger number of lesions were detected in scans obtained at 5 and 15 minutes after the second contrast injection compared with scans obtained at 5 and 15 minutes after the first injection (P < .001). The number of patients with active lesions on MR imaging was significantly higher after the second dose administration (52.0%, first dose versus 59.2%, second dose; P < .001). CONCLUSIONS Cumulative dosing of a macrocyclic gadolinium-based contrast agent increases detection of enhancing lesions and patients with active lesions. These data could be considered in the design of MR imaging protocols aimed at detecting active multiple sclerosis lesions.
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Affiliation(s)
- A Rovira
- From the Neuroradiology and Magnetic Resonance Units (A.R., C.A., E.H., J.F.C., R.M.), Department of Radiology
| | - C Auger
- From the Neuroradiology and Magnetic Resonance Units (A.R., C.A., E.H., J.F.C., R.M.), Department of Radiology
| | - E Huerga
- From the Neuroradiology and Magnetic Resonance Units (A.R., C.A., E.H., J.F.C., R.M.), Department of Radiology
| | - J F Corral
- From the Neuroradiology and Magnetic Resonance Units (A.R., C.A., E.H., J.F.C., R.M.), Department of Radiology
| | - R Mitjana
- From the Neuroradiology and Magnetic Resonance Units (A.R., C.A., E.H., J.F.C., R.M.), Department of Radiology
| | - J Sastre-Garriga
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - M Tintoré
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - X Montalban
- Centre d'Esclerosi Múltiple de Catalunya (J.S.-G., M.T., X.M.), Department of Neurology/Neuroimmunology, Hospital Universitari Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, Spain
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119
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Neuroimaging Techniques to Assess Inflammation in Multiple Sclerosis. Neuroscience 2017; 403:4-16. [PMID: 28764938 DOI: 10.1016/j.neuroscience.2017.07.055] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Revised: 07/21/2017] [Accepted: 07/21/2017] [Indexed: 01/07/2023]
Abstract
Multiple Sclerosis (MS) is a chronic neurological disease that represents a leading cause of disability in young adults and is characterized by inflammation and degeneration of both white matter (WM) and gray matter (GM). Defining the presence or absence of inflammation on individual basis is a key point in choosing the therapy and monitoring the treatment response. Magnetic resonance imaging (MRI) represents the most sensitive non-invasive tool to monitor inflammation in the clinical practice. Indeed, in the early phase of inflammation MRI detects new lesions as extrusion of gadolinium contrast agents across the altered blood-brain-barrier (BBB). The occurrence of MRI lesions is used to confirm diagnosis and has been validated as surrogate marker of relapse to monitor response to treatments. However, focal gadolinium-enhancing lesions represent only an aspect of neuroinflammation. Recent studies have suggested the presence of a widespread inflammation of the central nervous system (CNS), which is mainly related to microglial cells activation occurring both at the edge of chronic focal lesions and throughout the normal-appearing brain tissue. New imaging techniques have been developed to study diffuse inflammation taking place outside the focal plaques. The scope of this review is to examine the various neuroimaging techniques and those biophysical quantities that can be non-invasively detected to enlighten the different aspects of neuroinflammation. Some techniques are commonly used in the clinical practice, while others are used in the research field to better understand the pathophysiological mechanisms of the disease and the role of inflammation.
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Brain relaxometry after macrocyclic Gd-based contrast agent. Clin Neuroradiol 2017; 27:459-468. [PMID: 28741075 DOI: 10.1007/s00062-017-0608-6] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Accepted: 06/29/2017] [Indexed: 02/03/2023]
Abstract
PURPOSE To assess if ratios of T1-weighted (T1w) signal intensity (SI) and quantitative T1 relaxometry (qT1) change on serial administration of macrocyclic gadobutrol. METHODS A total of 17 glioblastoma patients were scanned at 3.0 T magnetic resonance imaging (MRI) every 6 weeks after tumor resection with standard MRI and T1 and T2 relaxometry before and after gadobutrol administration. On co-registered images T1w SI was measured and relaxation times T1 (qT1) and quantitative T2 (qT2) were quantified in several deep grey matter nuclei as ratios relative to frontal white matter and to the pons. Ratio changes were evaluated over time with a paired t‑test and multiple regression. RESULTS An average of 8 (range 5-14) scans per patient were completed. Ratios of T1w SI, qT1 and qT2 remained unchanged for all target regions from the first to the last time point (p > 0.05) and did not correlate with the number of gadobutrol administrations. Multivariate regression showed no significant impact of gadobutrol on qT1 or qT2 ratios, but a significant negative effect on T1w SI ratios. Gender also had no impact on the ratios but age had a significant negative influence on the qT1 ratio. CONCLUSION Multiple administrations of a macrocyclic contrast agent did not change relaxation time T1 ratios in any deep grey matter structure.
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Bussi S, Coppo A, Botteron C, Fraimbault V, Fanizzi A, De Laurentiis E, Colombo Serra S, Kirchin MA, Tedoldi F, Maisano F. Differences in gadolinium retention after repeated injections of macrocyclic MR contrast agents to rats. J Magn Reson Imaging 2017; 47:746-752. [PMID: 28730643 PMCID: PMC5836870 DOI: 10.1002/jmri.25822] [Citation(s) in RCA: 83] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2017] [Accepted: 07/06/2017] [Indexed: 11/16/2022] Open
Abstract
Purpose To compare the levels of gadolinium in the blood, cerebrum, cerebellum, liver, femur, kidneys, and skin after multiple exposure of rats to the macrocyclic gadolinium‐based contrast agents (GBCAs) gadoterate, gadobutrol, and gadoteridol. Materials and Methods Fifty male Wistar Han rats were randomized to three exposure groups (n = 15 per group) and one control group (n = 5). Animals in the exposure groups received a total of 20 GBCA administrations (four administrations per week for 5 consecutive weeks) at a dose of 0.6 mmol/kg bodyweight. After a 28‐day recovery period animals were sacrificed and the blood and tissues harvested for determination of gadolinium (Gd) levels. Gd determination was performed by inductively coupled plasma mass spectrometry (ICP‐MS). Results After 28 days' recovery no Gd was found in the blood, liver, or skin of any animal in any group. Significantly lower levels of Gd were noted with gadoteridol compared to gadoterate and gadobutrol in the cerebellum (0.150 ± 0.022 vs. 0.292 ± 0.057 and 0.287 ± 0.056 nmol/g, respectively; P < 0.001), cerebrum (0.116 ± 0.036 vs. 0.250 ± 0.032 and 0.263 ± 0.045 nmol/g, respectively; P < 0.001), and kidneys (25 ± 13 vs. 139 ± 88 [P < 0.01] and 204 ± 109 [P < 0.001], respectively). Higher levels of Gd were noted in the femur (7.48 ± 1.37 vs. 5.69 ± 1.75 and 8.60 ± 2.04 nmol/g, respectively) with significantly less Gd determined for gadoterate than for gadobutrol (P < 0.001) and gadoteridol (P < 0.05). Conclusion Differences exist between macrocyclic agents in terms of their propensity to accumulate in tissues. The observed differences in Gd concentration point to differences in GBCA washout rates in this setting and in this experimental model, with gadoteridol being the GBCA that is most efficiently removed from both cerebral and renal tissues. Level of Evidence: 2 Technical Efficacy: Stage 5 J. Magn. Reson. Imaging 2018;47:746–752.
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Affiliation(s)
- Simona Bussi
- Bracco Imaging SpA, Bracco Research Centre, Colleretto Giacosa, TO, Italy
| | - Alessandra Coppo
- Bracco Imaging SpA, Bracco Research Centre, Colleretto Giacosa, TO, Italy
| | | | | | - Antonello Fanizzi
- Bracco Imaging SpA, Bracco Research Centre, Colleretto Giacosa, TO, Italy
| | | | | | - Miles A Kirchin
- Bracco Imaging SpA, Worldwide Medical Affairs, Milano, Italy
| | - Fabio Tedoldi
- Bracco Imaging SpA, Bracco Research Centre, Colleretto Giacosa, TO, Italy
| | - Federico Maisano
- Bracco Imaging SpA, Bracco Research Centre, Colleretto Giacosa, TO, Italy
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Jost G, Frenzel T, Lohrke J, Lenhard DC, Naganawa S, Pietsch H. Penetration and distribution of gadolinium-based contrast agents into the cerebrospinal fluid in healthy rats: a potential pathway of entry into the brain tissue. Eur Radiol 2017; 27:2877-2885. [PMID: 27832312 PMCID: PMC5486780 DOI: 10.1007/s00330-016-4654-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Signal hyperintensity on unenhanced MRI in certain brain regions has been reported after multiple administrations of some, but not all, gadolinium-based contrast agents (GBCAs). One potential initial pathway of GBCA entry into the brain, infiltration from blood into the cerebrospinal fluid (CSF), was systematically evaluated in this preclinical study. METHODS GBCA infiltration and distribution in the CSF were investigated in healthy rats using repeated fluid-attenuated MRI up to 4 h after high-dose (1.8 mmol/kg) administration of six marketed and one experimental GBCA. Additionally, gadolinium measurements in CSF, blood and brain tissue samples (after 24 h) were performed using inductively coupled plasma mass spectrometry. RESULTS Enhanced MRI signals in the CSF spaces with similar distribution kinetics were observed for all GBCAs. No substantial differences in the gadolinium concentrations among the marketed GBCAs were found in the CSF, blood or brain tissue. After 4.5 h, the concentration in the CSF was clearly higher than in blood but was almost completely cleared and lower than the brain tissue concentration after 24 h. CONCLUSIONS In contrast to the brain signal hyperintensities, no differences in penetration and distribution into the CSF of healthy rats exist among the marketed GBCAs. KEY POINTS • Gadolinium-based contrast agents can cross the blood-CSF barrier. • Fluid-attenuated MRI shows GBCA distribution with CSF flow. • GBCA structure and physicochemical properties do not impact CSF penetration and distribution. • GBCA clearance from CSF was almost complete within 24 h in rats. • CSF is a potential pathway of GBCA entry into the brain.
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Affiliation(s)
- Gregor Jost
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany.
| | - Thomas Frenzel
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Jessica Lohrke
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | | | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
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Schneider GK, Stroeder J, Roditi G, Colosimo C, Armstrong P, Martucci M, Buecker A, Raczeck P. T1 Signal Measurements in Pediatric Brain: Findings after Multiple Exposures to Gadobenate Dimeglumine for Imaging of Nonneurologic Disease. AJNR Am J Neuroradiol 2017. [PMID: 28642266 DOI: 10.3174/ajnr.a5270] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Signal intensity increases possibly suggestive of gadolinium retention have recently been reported on unenhanced T1-weighted images of the pediatric brain following multiple exposures to gadolinium-based MR contrast agents. Our aim was to determine whether T1 signal changes suggestive of gadolinium deposition occur in the brains of pediatric nonneurologic patients after multiple exposures to gadobenate dimeglumine. MATERIALS AND METHODS Thirty-four nonneurologic patients (group 1; 17 males/17 females; mean age, 7.18 years) who received between 5 and 15 injections (mean, 7.8 injections) of 0.05 mmol/kg of gadobenate during a mean of 2.24 years were compared with 24 control patients (group 2; 16 males/8 females; mean age, 8.78 years) who had never received gadolinium-based contrast agents. Exposure to gadobenate was for diagnosis and therapy monitoring. Five blinded readers independently determined the signal intensity at ROIs in the dentate nucleus, globus pallidus, pons, and thalamus on unenhanced T1-weighted spin-echo images from both groups. Unpaired t tests were used to compare signal-intensity values and dentate nucleus-pons and globus pallidus-thalamus signal-intensity ratios between groups 1 and 2. RESULTS Mean signal-intensity values in the dentate nucleus, globus pallidus, pons, and thalamus of gadobenate-exposed patients ranged from 366.4 to 389.2, 360.5 to 392.9, 370.5 to 374.9, and 356.9 to 371.0, respectively. Corresponding values in gadolinium-based contrast agent-naïve subjects were not significantly different (P > .05). Similarly, no significant differences were noted by any reader for comparisons of the dentate nucleus-pons signal-intensity ratios. One reader noted a difference in the mean globus pallidus-thalamus signal-intensity ratios (1.06 ± 0.006 versus 1.02 ± 0.009, P = .002), but this reflected nonsignificantly higher T1 signal in the thalamus of control subjects. The number of exposures and the interval between the first and last exposures did not influence signal-intensity values. CONCLUSIONS Signal-intensity increases potentially indicative of gadolinium deposition are not seen in pediatric nonneurologic patients after multiple exposures to low-dose gadobenate.
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Affiliation(s)
- G K Schneider
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
| | - J Stroeder
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
| | - G Roditi
- Department of Radiology (G.R., P.A.), National Health Service Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - C Colosimo
- Institute of Radiology (C.C., M.M.), Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Armstrong
- Department of Radiology (G.R., P.A.), National Health Service Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - M Martucci
- Institute of Radiology (C.C., M.M.), Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Buecker
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
| | - P Raczeck
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
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124
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Tibussek D, Rademacher C, Caspers J, Turowski B, Schaper J, Antoch G, Klee D. Gadolinium Brain Deposition after Macrocyclic Gadolinium Administration: A Pediatric Case-Control Study. Radiology 2017. [PMID: 28640695 DOI: 10.1148/radiol.2017161151] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine whether signal intensity (SI) in T1 sequences as a potential indicator of gadolinium deposition increases after repeated administration of the macrocyclic gadolinium-based contrast agents (GBCAs) gadoteridol and gadoterate meglumine in a pediatric cohort. Materials and Methods This retrospective case-control study of children with brain tumors who underwent nine or more contrast material-enhanced brain magnetic resonance (MR) imaging studies from 2008 to 2015 was approved by the local ethics board. Informed consent was obtained for MR imaging. Twenty-four case patients aged 5-18 years and appropriate control patients with nonpathologic MR neuroimaging findings (and no GBCA administration), matched for age and sex, were inculded. SI was measured on unenhanced T1-weighted MR images for the following five regions of interest (ROIs): the dentate nucleus (DN), pons, substantia nigra (SN), pulvinar thalami, and globus pallidus (GP). Paired t tests were used to compare SI and SI ratios (DN to pons, GP to thalamus) between case patients and control patients. Pearson correlations between relative signal changes and the number of GBCA administrations and total GBCA dose were calculated. Results The mean number of GBCA administrations was 14.2. No significant differences in mean SI for any ROI and no group differences were found when DN-to-pons and GP-to-pulvinar ratios were compared (DN-to-pons ratio in case patients: mean, 1.0083 ± 0.0373 [standard deviation]; DN-to-pons ratio in control patients: mean, 1.0183 ± 0.01917; P = .37; GP-to-pulvinar ratio in case patients: mean, 1.1335 ± 0.04528; and GP-to-pulvinar ratio in control patients: mean, 1.1141 ± 0.07058; P = .29). No correlation was found between the number of GBCA administrations or the total amount of GBCA administered and signal change for any ROI. (Number of GBCA applications: DN: r = -0.254, P = .31; pons: r = -0.097, P = .65; SN: r = -0.194, P = .38; GP: r = -0.175, P = .41; pulvinar: r = -0.067, P = .75; total amount of administered GBCA: DN: r = 0.091, P = .72; pons: r = 0.106, P = .62; SN: r = -0.165, P = .45; GP: r = 0.111, P = .61; pulvinar: r = 0.173, P = .42.) Conclusion Multiple intravenous administrations of these macrocyclic GBCAs in children were not associated with a measurable increase in SI in T1 sequences as an indicator of brain gadolinium deposition detectable by using MR imaging. Additional imaging and pathologic studies are needed to confirm these findings. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Daniel Tibussek
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
| | - Christin Rademacher
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
| | - Julian Caspers
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
| | - Bernd Turowski
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
| | - Jörg Schaper
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
| | - Gerald Antoch
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
| | - Dirk Klee
- From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.)
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125
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Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol 2017; 16:564-570. [PMID: 28653648 DOI: 10.1016/s1474-4422(17)30158-8] [Citation(s) in RCA: 511] [Impact Index Per Article: 73.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 12/13/2022]
Abstract
Emerging evidence has linked MRI signal changes in deep nuclei of the brain with repeated administration of gadolinium-based contrast agents. Gadolinium deposits have been confirmed in brain tissue, most notably in the dentate nuclei and globus pallidus. Although some linear contrast agents appear to cause greater MRI signal changes than some macrocyclic agents, deposition of gadolinium has also been observed with macrocyclic agents. However, the extent of gadolinium deposition varies between agents. Furthermore, the clinical significance of the retained gadolinium in the brain, if any, remains unknown. No data are available in human beings or animals to show adverse clinical effects due to the gadolinium deposition in the brain. On behalf of the International Society for Magnetic Resonance in Medicine, we present recommendations for the clinical and research use of gadolinium-based contrast agents. These recommendations might evolve as new evidence becomes available.
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Affiliation(s)
- Vikas Gulani
- Department of Radiology, Department of Urology, and Department of Biomedical Engineering, Case Comprehensive Cancer Center, Case Western Reserve University, and University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Fernando Calamante
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Frank G Shellock
- Department of Radiology, Department of Medicine, and National Science Foundation Engineering Research Center, University of Southern California, Los Angeles, CA, USA
| | - Emanuel Kanal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Scott B Reeder
- Department of Radiology, Department of Medical Physics, Department of Biomedical Engineering, Department of Medicine, and Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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126
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Gupta A, Al-Dasuqi K, Xia F, Askin G, Zhao Y, Delgado D, Wang Y. The Use of Noncontrast Quantitative MRI to Detect Gadolinium-Enhancing Multiple Sclerosis Brain Lesions: A Systematic Review and Meta-Analysis. AJNR Am J Neuroradiol 2017; 38:1317-1322. [PMID: 28522663 DOI: 10.3174/ajnr.a5209] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2017] [Accepted: 02/22/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND Concerns have arisen about the long-term health effects of repeat gadolinium injections in patients with multiple sclerosis and the incomplete characterization of MS lesion pathophysiology that results from relying on enhancement characteristics alone. PURPOSE Our aim was to perform a systematic review and meta-analysis analyzing whether noncontrast MR imaging biomarkers can distinguish enhancing and nonenhancing brain MS lesions. DATA SOURCES Our sources were Ovid MEDLINE, Ovid Embase, and the Cochrane data base from inception to August 2016. STUDY SELECTION We included 37 journal articles on 985 patients with MS who had MR imaging in which T1-weighted postcontrast sequences were compared with noncontrast sequences obtained during the same MR imaging examination by using ROI analysis of individual MS lesions. DATA ANALYSIS We performed random-effects meta-analyses comparing the standard mean difference of each MR imaging metric taken from enhancing-versus-nonenhancing lesions. DATA SYNTHESIS DTI-based fractional anisotropy values are significantly different between enhancing and nonenhancing lesions (P = .02), with enhancing lesions showing decreased fractional anisotropy compared with nonenhancing lesions. Of the other most frequently studied MR imaging biomarkers (mean diffusivity, magnetization transfer ratio, or ADC), none were significantly different (P values of 0.30, 0.47, and 0.19. respectively) between enhancing and nonenhancing lesions. Of the limited studies providing diagnostic accuracy measures, gradient-echo-based quantitative susceptibility mapping had the best performance in discriminating enhancing and nonenhancing MS lesions. LIMITATIONS MR imaging techniques and patient characteristics were variable across studies. Most studies did not provide diagnostic accuracy measures. All imaging metrics were not studied in all 37 studies. CONCLUSIONS Noncontrast MR imaging techniques, such as DTI-based FA, can assess MS lesion acuity without gadolinium.
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Affiliation(s)
- A Gupta
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.) .,Clinical and Translational Neuroscience Unit (A.G.), Feil Family Brain and Mind Research Institute
| | - K Al-Dasuqi
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.)
| | - F Xia
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.).,Department of Biomedical Engineering (F.X., Y.W.), Cornell University, Ithaca, New York
| | - G Askin
- Department of Healthcare Policy and Research (G.A., Y.Z.)
| | - Y Zhao
- Department of Healthcare Policy and Research (G.A., Y.Z.)
| | - D Delgado
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center (D.D.), Weill Cornell Medicine, New York, New York
| | - Y Wang
- From the Department of Radiology (A.G., K.A.-D., F.X., Y.W.).,Department of Biomedical Engineering (F.X., Y.W.), Cornell University, Ithaca, New York
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127
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Forslin Y, Shams S, Hashim F, Aspelin P, Bergendal G, Martola J, Fredrikson S, Kristoffersen-Wiberg M, Granberg T. Retention of Gadolinium-Based Contrast Agents in Multiple Sclerosis: Retrospective Analysis of an 18-Year Longitudinal Study. AJNR Am J Neuroradiol 2017; 38:1311-1316. [PMID: 28495943 DOI: 10.3174/ajnr.a5211] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 03/03/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND AND PURPOSE Gadolinium-based contrast agents have been associated with lasting high T1-weighted signal intensity in the dentate nucleus and globus pallidus, with histopathologically confirmed gadolinium retention. We aimed to longitudinally investigate the relationship of multiple gadolinium-based contrast agent administrations to the Signal Intensity Index in the dentate nucleus and globus pallidus and any associations with cognitive function in multiple sclerosis. MATERIALS AND METHODS The Signal Intensity Index in the dentate nucleus and globus pallidus was retrospectively evaluated on T1-weighted MR imaging in an 18-year longitudinal cohort study of 23 patients with MS receiving multiple gadolinium-based contrast agent administrations and 23 healthy age- and sex-matched controls. Participants also underwent comprehensive neuropsychological testing. RESULTS Patients with MS had a higher Signal Intensity Index in the dentate nucleus (P < .001), but not in the globus pallidus (P = .19), compared with non-gadolinium-based contrast agent-exposed healthy controls by an unpaired t test. Increasing numbers of gadolinium-based contrast agent administrations were associated with an increased Signal Intensity Index in the dentate nucleus (β = 0.45, P < .001) and globus pallidus (β = 0.60, P < .001). This association remained stable with corrections for the age, disease duration, and physical disability for both the dentate nucleus (β = 0.43, P = .001) and globus pallidus (β = 0.58, P < .001). An increased Signal Intensity Index in the dentate nucleus among patients with MS was associated with lower verbal fluency scores, which remained significant after correction for several aspects of disease severity (β = -0.40 P = .013). CONCLUSIONS Our data corroborate previous reports of lasting gadolinium retention in brain tissues. An increased Signal Intensity Index in the dentate nucleus and globus pallidus was associated with lower verbal fluency, which does not prove causality but encourages further studies on cognition and gadolinium-based contrast agent administration.
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Affiliation(s)
- Y Forslin
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.) .,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - S Shams
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - F Hashim
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - P Aspelin
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - G Bergendal
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Neurology (G.B., S.F.)
| | - J Martola
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - S Fredrikson
- Neurology (G.B., S.F.).,Clinical Neuroscience (S.F.), Karolinska Institutet, Stockholm, Sweden
| | - M Kristoffersen-Wiberg
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
| | - T Granberg
- From the Departments of Clinical Science Intervention and Technology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.).,Radiology (Y.F., S.S., F.H., P.A., G.B., J.M., M.K.-W., T.G.)
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128
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Bak SH, Roh HG, Moon WJ, Choi JW, An HS. Appropriate Minimal Dose of Gadobutrol for 3D Time-Resolved MRA of the Supra-Aortic Arteries: Comparison with Conventional Single-Phase High-Resolution 3D Contrast-Enhanced MRA. AJNR Am J Neuroradiol 2017; 38:1383-1390. [PMID: 28473338 DOI: 10.3174/ajnr.a5176] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/13/2017] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND PURPOSE The development of nephrogenic systemic fibrosis and neural tissue deposition is gadolinium dose-dependent. The purpose of this study was to determine the appropriate minimal dose of gadobutrol with time-resolved MRA to assess supra-aortic arterial stenosis with contrast-enhanced MRA as a reference standard. MATERIALS AND METHODS Four hundred sixty-two consecutive patients underwent both standard-dose contrast-enhanced MRA and low-dose time-resolved MRA and were classified into 3 groups; group A (a constant dose of 1 mL for time-resolved MRA), group B (2 mL), or group C (3 mL). All studies were independently evaluated by 2 radiologists for image quality by using a 5-point scale (from 0 = failure to 4 = excellent), grading of arterial stenosis (0 = normal, 1 = mild [<30%], 2 = moderate [30%-69%], 3 = severe to occlusion [≥70%]), and signal-to-noise ratio. RESULTS The image quality of time-resolved MRA was similar to that of contrast-enhanced MRA in groups B and C, but it was inferior to contrast-enhanced MRA in group A. For the grading of arterial stenosis, there was an excellent correlation between contrast-enhanced MRA and time-resolved MRA (R = 0.957 for group A, R = 0.988 for group B, R = 0.991 for group C). The SNR of time-resolved MRA tended to be lower than that of contrast-enhanced MRA in groups A and B. However, SNR was higher for time-resolved MRA compared with contrast-enhanced MRA in group C. CONCLUSIONS Low-dose time-resolved MRA is feasible in the evaluation of supra-aortic stenosis and could be used as an alternative to contrast-enhanced MRA for a diagnostic technique in high-risk populations.
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Affiliation(s)
- S H Bak
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea.,Department of Radiology (S.H.B.), Kangwon National University Hospital, Chuncheon, Korea
| | - H G Roh
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - W-J Moon
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - J W Choi
- From the Department of Radiology (S.H.B., H.G.R., W.-J.M., J.W.C.), Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - H S An
- Department of Radiology (H.S.A.), Armed Forces Yangju Hospital, Yangju, Korea
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Ramalho M, Ramalho J, Burke LM, Semelka RC. Gadolinium Retention and Toxicity-An Update. Adv Chronic Kidney Dis 2017; 24:138-146. [PMID: 28501075 DOI: 10.1053/j.ackd.2017.03.004] [Citation(s) in RCA: 67] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Until 2006, the main considerations regarding safety for all gadolinium-based contrast agents (GBCAs) were related to short-term adverse reactions. However, the administration of certain "high-risk" GBCAs to patients with renal failure resulted in multiple reported cases of nephrogenic systemic fibrosis. Findings have been reported regarding gadolinium deposition within the body and various reports of patients who report suffering from acute and chronic symptoms secondary to GBCA's exposure. At the present state of knowledge, it has been proved that gadolinium deposits also occur in the brain, irrespective of renal function and GBCAs stability class. To date, no definitive clinical findings are associated with gadolinium deposition in brain tissue. Gadolinium deposition disease is a newly described and probably infrequent entity. Patients presenting with gadolinium deposition disease may show signs and symptoms that somewhat follows a pattern similar but not identical, and also less severe, to those observed in nephrogenic systemic fibrosis. In this review, we will address gadolinium toxicity focusing on these 2 recently described concerns.
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130
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Suthiphosuwan S, Kim D, Bharatha A, Oh J. Imaging Markers for Monitoring Disease Activity in Multiple Sclerosis. Curr Treat Options Neurol 2017; 19:18. [DOI: 10.1007/s11940-017-0453-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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131
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Gadolinium retention in the body: what we know and what we can do. Radiol Med 2017; 122:589-600. [PMID: 28361260 DOI: 10.1007/s11547-017-0757-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 01/08/2023]
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132
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Signal intensity change on unenhanced T1-weighted images in dentate nucleus and globus pallidus after multiple administrations of gadoxetate disodium: an intraindividual comparative study. Eur Radiol 2017; 27:4372-4378. [PMID: 28357495 DOI: 10.1007/s00330-017-4810-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/13/2017] [Indexed: 10/25/2022]
Abstract
PURPOSE To investigate whether there is an increased signal intensity (SI) of dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted magnetic resonance imaging (MRI), in patients who had undergone multiple administrations of gadoxetate disodium. MATERIALS AND METHODS We retrospectevely included stage III melanoma patients, who had been previously enrolled in a trial of adjuvant therapy and who had undergone whole-body contrast-enhanced MRIs with gadoxetate disodium every three months for their follow-up. The SI ratios of DN-to-pons and GP-to-thalamus on unenhanced T1-weighted images were calculated. The difference in SI ratios between the first and the last MRI examinations was assessed and a linear mixed model was performed to detect how SI ratios varied with the number of administrations. RESULTS Eighteen patients were included in our study. The number of gadoxetate disodium administrations ranged from 2 to 18. Paired t-test did not show any significant difference in DN-to-pons (p=0.21) and GP-to-thalamus (p=0.09) SI ratios by the end of the study. DN-to-pons SI ratio and GP-to-thalamus SI ratio did not significantly increase with increasing the number of administrations (p=0.14 and p=0.06, respectively). CONCLUSION Multiple administrations of gadoxetate disodium are not associated with increased SI in DN and GP in the brain. KEY POINTS • Gadolinium may deposit in the human brain after multiple GBCA administrations. • Gadolinium deposition is associated with increased T1W signal intensity • Increase in signal intensity is most apparent within the DN and GP • Multiple administrations of gadoxetate disodium do not increase T1W signal.
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133
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Tedeschi E, Cocozza S, Borrelli P, Ugga L, Morra VB, Palma G. Longitudinal Assessment of Dentate Nuclei Relaxometry during Massive Gadobutrol Exposure. Magn Reson Med Sci 2017; 17:100-104. [PMID: 28367903 PMCID: PMC5760240 DOI: 10.2463/mrms.cr.2016-0137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report the assessment of Dentate Nuclei (DN) R1 (1/T1) and R2* (1/T2*) values in a patient with relapsing-remitting Multiple Sclerosis, exposed to 22 standard (0.1 mmol/kg) doses of gadobutrol, who underwent eight relaxometric MR measurements within 2 years. DN R1 did not significantly increase nor correlated with cumulative gadobutrol administration, even after a total dose of 130 ml. Likewise, DN R2* relaxometry remained unchanged. In conclusion, massive gadobutrol exposure did not induce significant DN relaxometry changes.
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Affiliation(s)
- Enrico Tedeschi
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II"
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II"
| | | | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II"
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odonto-stomatological Sciences, University "Federico II"
| | - Giuseppe Palma
- Institute of Biostructure and Bioimaging, National Research Council
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Abstract
Gadolinium-based contrast agents (GBCA) are used worldwide for enhanced MRI examinations, including heart and vessels. Gadolinium is a highly toxic heavy metal. If used in GBCA it must be tightly bound to ligands. The configuration of ligands influences the stability of the GBCA and two types of chelates have been used. Macrocyclic chelates offer better protection and binding of gadolinium ion than linear chelates with a flexible open chain - gadolinium could be more easily released from the latter ones. GBCAs are excreted from the body mostly by the kidneys, which is of importance in chronic kidney disease. Two states are related to gadolinium: nephrogenic systemic fibrosis (NSF) and gadolinium body storage. NSF is a severe and debilitating disease, directly connected to gadolinium toxicity, proven after the use of linear chelates. Due to strict recommendations of radiology societies, NSF was practically eradicated. Gadolinium deposition was observed especially in bones and in some brain areas: in dentate nucleus and in globus pallidus, even years after the GBCA administration. The form of the storage (chelated or free), as well as their clinical impact, are not clear, but first observations of “gadolinium deposition disease” have been reported.
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Repeated intravenous administration of gadobutrol does not lead to increased signal intensity on unenhanced T1-weighted images-a voxel-based whole brain analysis. Eur Radiol 2017; 27:3687-3693. [PMID: 28289935 DOI: 10.1007/s00330-017-4777-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 02/06/2017] [Accepted: 02/13/2017] [Indexed: 10/20/2022]
Abstract
OBJECTIVES To identify a possible association between repeated intravenous administration of gadobutrol and increased signal intensity in the grey and white matter using voxel-based whole-brain analysis. METHODS In this retrospective single-centre study, 217 patients with a clinically isolated syndrome underwent baseline brain magnetic resonance imaging and at least one annual follow-up examination with intravenous administration of 0.1 mmol/kg body weight of gadobutrol. Using the "Diffeomorphic Anatomical Registration using Exponentiated Lie algebra" (DARTEL) normalisation process, tissue templates for grey matter (GM), white matter (WM), and cerebrospinal fluid (CSF) were calculated, as were GM-CSF and WM-CSF ratios. Voxel-based whole-brain analysis was used to calculate the signal intensity for each voxel in each data set. Paired t-test was applied to test differences to baseline MRI for significance. RESULTS Voxel-based whole-brain analysis demonstrated no significant changes in signal intensity of grey and white matter after up to five gadobutrol administrations. There was no significant change in GM-CSF and grey WM-CSF ratios. CONCLUSION Voxel-based whole-brain analysis did not demonstrate increased signal intensity of GM and WM on unenhanced T1-weighted images after repeated gadobutrol administration. The molecular structure of gadolinium-based contrast agent preparations may be an essential factor causing SI increase on unenhanced T1-weighted images. KEY POINTS • Repeated administration of gadobutrol does not lead to increased signal intensity. • Voxel-based whole-brain analysis allows assessment of subtle changes in signal intensity. • Macrocyclic contrast agents in a proven dosage are safe.
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Radbruch A, Haase R, Kickingereder P, Bäumer P, Bickelhaupt S, Paech D, Wick W, Schlemmer HP, Seitz A, Bendszus M. Pediatric Brain: No Increased Signal Intensity in the Dentate Nucleus on Unenhanced T1-weighted MR Images after Consecutive Exposure to a Macrocyclic Gadolinium-based Contrast Agent. Radiology 2017; 283:828-836. [PMID: 28273007 DOI: 10.1148/radiol.2017162980] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose To determine the effect of at least five serial injections of the macrocyclic gadolinium-based contrast agent (GBCA) gadoterate meglumine on the signal intensity (SI) of the dentate nucleus (DN) of the pediatric brain on nonenhanced T1-weighted magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 41 pediatric patients (age range, 3-17 years) who were imaged in at least five consecutive 1.5-T MR examinations with the exclusive use of gadoterate meglumine (plus a final additional nonenhanced MR imaging examination) were evaluated. SI ratio differences between the first and last MR examination were calculated for DN-to-pons and DN-to-middle cerebellar peduncle (MCP) ratios in a region-of-interest-based analysis, and one-sample t tests were used to examine if the SI ratio differences differed from 0. Bayes factors were calculated to quantify the strength of evidence for each test. Results Patients underwent a mean of 8.6 ± 3.9 GBCA administrations (mean accumulated dose, 32.07 mmol ± 17.62, with an average of 16.7 weeks ± 7.9 between every administration). Both ratio differences did not differ significantly from 0 (DN-to-pons ratio: -0.0012 ± 0.0101, P = .436; DN-to-MCP ratio: 0.0007 ± 0.0088, P = .604), and one-sided Bayes factors provided substantial evidence against an SI ratio increase (0.10 for DN-to-pons ratio; 0.27 for DN-to-MCP ratio). Conclusion No increase of the SI in the DN was found after a mean of 8.6 serial injections of the macrocyclic GBCA gadoterate meglumine in pediatric patients, confirming previous studies that did not find this effect after serial injections of macrocyclic GBCAs in adults. © RSNA, 2017.
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Affiliation(s)
- Alexander Radbruch
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Robert Haase
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Philipp Kickingereder
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Philipp Bäumer
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Sebastian Bickelhaupt
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Daniel Paech
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Wolfgang Wick
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Heinz-Peter Schlemmer
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Angelika Seitz
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Martin Bendszus
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
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Smith APL, Marino M, Roberts J, Crowder JM, Castle J, Lowery L, Morton C, Hibberd MG, Evans PM. Clearance of Gadolinium from the Brain with No Pathologic Effect after Repeated Administration of Gadodiamide in Healthy Rats: An Analytical and Histologic Study. Radiology 2017; 282:743-751. [PMID: 27673510 DOI: 10.1148/radiol.2016160905] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Adrian P. L. Smith
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Michael Marino
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Jeanette Roberts
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Janell M. Crowder
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Jason Castle
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Lisa Lowery
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Christine Morton
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Mark G. Hibberd
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
| | - Paul M. Evans
- From GE Healthcare, The Grove Centre (GC18), White Lion Rd, Amersham HP7 9LL, England (A.P.L.S., P.M.E.); GE Global Research Centre, Niskayuna, NY (M.M., J.R., J.M.C., J.C., L.L., C.M.); and GE Healthcare, Life Sciences, Marlborough, Mass (M.G.H.)
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The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review. PLoS One 2017; 12:e0171704. [PMID: 28187173 PMCID: PMC5302442 DOI: 10.1371/journal.pone.0171704] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/23/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Gadolinium based contrast agents (GBCAs) are widely used in magnetic resonance imaging, but recently, high signal intensity in the cerebellum structures was reported after repeated administrations of contrast- enhanced magnetic resonance images. The aim of this systematic review was to investigate the association between increased signal intensity in the dentate nucleus and globus pallidus in the brain and repeated administrations of GBCAs. Additionally, we focused on possible short- and long-term consequences of gadolinium use in those patients. METHODS Systematic review of retrospective investigations in PubMed and Medline was performed in July 2016. Primary outcomes included the presence of increased signal intensity within the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in patients following administrations of GBCAs. Two independent reviewers were responsible for search and data extraction. RESULTS 25 publications satisfied inclusion criteria (19 magnetic resonance images analyses, 3 case reports; 3 autopsy studies). Magnetic resonance images of 1247 patients with increased signal intensity on unenhanced T1-weighted MR images were analyzed as well as tissue specimens from 27 patients. Signal intensity correlated positively with the exposure to GBCAs and was greater after serial administrations of linear nonionic than cyclic contrast agents. Gadolinium was detected in all tissue examinations. CONCLUSIONS High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance images were associated with previous administration of GBCAs. Signal intensity correlated negatively with stability of contrast agents. Clinical significance of gadolinium deposition in the brain remains unclear. There is a strong need for further research to identify type of gadolinium deposited in the brain as well as to gather knowledge about long-term consequences.
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139
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Zhang Y, Cao Y, Shih GL, Hecht EM, Prince MR. Extent of Signal Hyperintensity on Unenhanced T1-weighted Brain MR Images after More than 35 Administrations of Linear Gadolinium-based Contrast Agents. Radiology 2017; 282:516-525. [PMID: 27513848 DOI: 10.1148/radiol.2016152864] [Citation(s) in RCA: 86] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Yang Zhang
- From the Department of Radiology, Weill Cornell Medical College and Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022 (Y.Z., Y.C., G.L.S., M.R.P.); and Department of Radiology, Columbia University Medical Center, New York, NY (E.M.H., M.R.P.)
| | - Yan Cao
- From the Department of Radiology, Weill Cornell Medical College and Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022 (Y.Z., Y.C., G.L.S., M.R.P.); and Department of Radiology, Columbia University Medical Center, New York, NY (E.M.H., M.R.P.)
| | - George L Shih
- From the Department of Radiology, Weill Cornell Medical College and Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022 (Y.Z., Y.C., G.L.S., M.R.P.); and Department of Radiology, Columbia University Medical Center, New York, NY (E.M.H., M.R.P.)
| | - Elizabeth M Hecht
- From the Department of Radiology, Weill Cornell Medical College and Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022 (Y.Z., Y.C., G.L.S., M.R.P.); and Department of Radiology, Columbia University Medical Center, New York, NY (E.M.H., M.R.P.)
| | - Martin R Prince
- From the Department of Radiology, Weill Cornell Medical College and Columbia College of Physicians and Surgeons, 416 E 55th St, New York, NY 10022 (Y.Z., Y.C., G.L.S., M.R.P.); and Department of Radiology, Columbia University Medical Center, New York, NY (E.M.H., M.R.P.)
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Gadolinium deposition in the brain: association with various GBCAs using a generalized additive model. Eur Radiol 2017; 27:3353-3361. [DOI: 10.1007/s00330-016-4724-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Revised: 12/11/2016] [Accepted: 12/20/2016] [Indexed: 10/20/2022]
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Hoggard N, Roditi GH. T 1 hyperintensity on brain imaging subsequent to gadolinium-based contrast agent administration: what do we know about intracranial gadolinium deposition? Br J Radiol 2017; 90:20160590. [PMID: 27653560 PMCID: PMC5605029 DOI: 10.1259/bjr.20160590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 11/05/2022] Open
Abstract
There is growing evidence for the accumulation of gadolinium (Gd) in patients administered with intravenous Gd-based contrast agents, even in the absence of renal impairment. This review of the literature will discuss what has been found to date in cadaveric human studies, clinical studies of patients and from animal models. Evidence for the potential route of entry into the brain will be examined. The current state of knowledge of effects of Gd accumulation in the brain is discussed. We will then discuss what the possible implications may be for the choice of Gd-based contrast agents in clinical practice.
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Affiliation(s)
- Nigel Hoggard
- Academic Unit of Radiology, INSIGNEO, University of Sheffield, Sheffield, UK
| | - Giles H Roditi
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
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Vågberg M, Axelsson M, Birgander R, Burman J, Cananau C, Forslin Y, Granberg T, Gunnarsson M, von Heijne A, Jönsson L, Karrenbauer VD, Larsson EM, Lindqvist T, Lycke J, Lönn L, Mentesidou E, Müller S, Nilsson P, Piehl F, Svenningsson A, Vrethem M, Wikström J. Guidelines for the use of magnetic resonance imaging in diagnosing and monitoring the treatment of multiple sclerosis: recommendations of the Swedish Multiple Sclerosis Association and the Swedish Neuroradiological Society. Acta Neurol Scand 2017; 135:17-24. [PMID: 27558404 PMCID: PMC5157754 DOI: 10.1111/ane.12667] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2016] [Indexed: 01/28/2023]
Abstract
Multiple sclerosis (MS) is associated with inflammatory lesions in the brain and spinal cord. The detection of such inflammatory lesions using magnetic resonance imaging (MRI) is important in the consideration of the diagnosis and differential diagnoses of MS, as well as in the monitoring of disease activity and predicting treatment efficacy. Although there is strong evidence supporting the use of MRI for both the diagnosis and monitoring of disease activity, there is a lack of evidence regarding which MRI protocols to use, the frequency of examinations, and in what clinical situations to consider MRI examination. A national workshop to discuss these issues was held in Stockholm, Sweden, in August 2015, which resulted in a Swedish consensus statement regarding the use of MRI in the care of individuals with MS. The aim of this consensus statement is to provide practical advice for the use of MRI in this setting. The recommendations are based on a review of relevant literature and the clinical experience of workshop attendees. It is our hope that these recommendations will benefit individuals with MS and guide healthcare professionals responsible for their care.
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Affiliation(s)
- M. Vågberg
- Department of Pharmacology and Clinical Neuroscience, Section of Neuroscience; Umeå University; Umeå Sweden
| | - M. Axelsson
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - R. Birgander
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Burman
- Department of Neuroscience; Uppsala University; Uppsala Sweden
| | - C. Cananau
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - Y. Forslin
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - T. Granberg
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - M. Gunnarsson
- Department of Neurology; School of Medical Sciences; Örebro University; Örebro Sweden
| | - A. von Heijne
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - L. Jönsson
- Department of Neuroradiology; Sahlgrenska University Hospital; Gothenburg Sweden
| | - V. D. Karrenbauer
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E.-M. Larsson
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
| | - T. Lindqvist
- Department of Radiation Sciences; Umeå University; Umeå Sweden
| | - J. Lycke
- Department of Clinical Neuroscience; Institute of Neuroscience and Physiology at Sahlgrenska Academy; University of Gothenburg; Gothenburg Sweden
| | - L. Lönn
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - E. Mentesidou
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - S. Müller
- Department of Clinical Science, Intervention and Technology; Department of Radiology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - P. Nilsson
- Department of Clinical Sciences Lund, Neurology; Faculty of Medicine; Lund University; Lund Sweden
| | - F. Piehl
- Department of Clinical Neuroscience; Department of Neurology; Karolinska Institutet; Karolinska University Hospital; Stockholm Sweden
| | - A. Svenningsson
- Department of Clinical Sciences; Karolinska Institutet; Danderyd Hospital; Stockholm Sweden
| | - M. Vrethem
- Department of Neurology and Department of Clinical and Experimental Medicine; Linköping University; Linköping Sweden
| | - J. Wikström
- Department of Surgical Sciences, Radiology; Uppsala University; Uppsala Sweden
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Radbruch A, Haase R, Kieslich PJ, Weberling LD, Kickingereder P, Wick W, Schlemmer HP, Bendszus M. No Signal Intensity Increase in the Dentate Nucleus on Unenhanced T1-weighted MR Images after More than 20 Serial Injections of Macrocyclic Gadolinium-based Contrast Agents. Radiology 2016; 282:699-707. [PMID: 27925871 DOI: 10.1148/radiol.2016162241] [Citation(s) in RCA: 93] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine the effect of more than 20 serial injections of macrocyclic gadolinium-based contrast agents (GBCAs) on the signal intensity (SI) of the dentate nucleus (DN) on unenhanced T1-weighted magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 33 patients who underwent at least 20 consecutive MR imaging examinations (plus an additional MR imaging for reference) with the exclusive use of macrocyclic GBCAs gadoterate meglumine and gadobutrol were analyzed. SI ratio differences were calculated for DN-to-pons and DN-to-middle cerebellar peduncle (MCP) ratios by subtracting the SI ratio at the first MR imaging examination from the SI ratio at the last MR imaging examination. One-sample t tests were used to examine if the SI ratio differences differed from 0, and Bayes factors were calculated to quantify the strength of evidence for each test. Results Patients underwent a mean of 23.03 ± (standard deviation) 4.20 GBCA administrations (mean accumulated dose, 491.21 mL ± 87.04 of a 0.5 M GBCA solution) with an average of 12.09 weeks ± 2.16 between every administration. Both ratio differences did not differ significantly from 0 (DN-to-pons ratio: -0.0032 ± 0.0154, P = .248; DN-to-MCP ratio: -0.0011 ± 0.0093, P = .521), and one-sided Bayes factors provided substantial to strong evidence against an SI ratio increase (Bayes factor for DN-to-pons ratio = 0.09 and that for DN-to-MCP ratio = 0.12). Conclusion The study indicates that 20 or more serial injections of macrocyclic GBCAs administered with on average 3 months between each injection are not associated with an SI increase in the DN. © RSNA, 2016.
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Affiliation(s)
- Alexander Radbruch
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Robert Haase
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Pascal J Kieslich
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Lukas D Weberling
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Philipp Kickingereder
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Wolfgang Wick
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Heinz-Peter Schlemmer
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
| | - Martin Bendszus
- From the Department of Neuroradiology (A.R., R.H., L.D.W., P.K., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 400, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., L.D.W., H.P.S.); German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H., L.D.W.); Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.); and Department of Psychology, University of Mannheim, Mannheim, Germany (P.J.K.)
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Gadolinium based contrast agents (GBCA): Safety overview after 3 decades of clinical experience. Magn Reson Imaging 2016; 34:1341-1345. [DOI: 10.1016/j.mri.2016.08.017] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2016] [Accepted: 08/20/2016] [Indexed: 11/24/2022]
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145
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Gadolinium tissue deposition in brain and bone. Magn Reson Imaging 2016; 34:1359-1365. [DOI: 10.1016/j.mri.2016.08.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/19/2022]
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146
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Kanda T, Nakai Y, Oba H, Toyoda K, Kitajima K, Furui S. Gadolinium deposition in the brain. Magn Reson Imaging 2016; 34:1346-1350. [DOI: 10.1016/j.mri.2016.08.024] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/30/2022]
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147
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Pinter NK, Klein JP, Mechtler LL. Potential Safety Issues Related to the Use of Gadolinium-based Contrast Agents. Continuum (Minneap Minn) 2016; 22:1678-1684. [PMID: 27740994 DOI: 10.1212/con.0000000000000378] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
PURPOSE OF REVIEW This article reviews recent research on gadolinium deposit formation in the brain linked to contrast-enhanced MRI studies. RECENT FINDINGS Human and animal studies have confirmed the presence of gadolinium in the brain following the serial administration of gadolinium-based contrast agents. This is a relatively new and growing field of research primarily driven by concerns regarding unknown and potentially harmful side effects of gadolinium-based contrast agents. Retrospective observational in vivo studies in humans demonstrated T1 shortening effects in the brain parenchyma resulting from gadolinium exposure. These studies were followed by postmortem human and animal studies. Evidence exists that gadolinium may cause deposits in the brain and that this may occur independently of impaired renal function and in the presence of an intact blood-brain barrier. Gadolinium deposition has been linked primarily with the use of linear, rather than macrocyclic, gadolinium-based contrast agents. SUMMARY The formation of gadolinium deposits and its implications have been the focus of only a small number of research groups. The currently available data must be verified, and the potential factors that may be linked to this phenomenon and the clinical significance must be explored. Depending on future findings, changes in the clinical application of gadolinium-based contrast agents may be expected.
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148
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Goischke HK. “Gadolinium-Phobia:” Not a Helpful “Criterion” for Indication for Gadolinium-based Contrast Agent Administration in Multiple Sclerosis. Radiology 2016; 281:323-4. [DOI: 10.1148/radiol.2016160720] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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149
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Hu HH, Pokorney A, Towbin RB, Miller JH. Increased signal intensities in the dentate nucleus and globus pallidus on unenhanced T1-weighted images: evidence in children undergoing multiple gadolinium MRI exams. Pediatr Radiol 2016; 46:1590-8. [PMID: 27282825 DOI: 10.1007/s00247-016-3646-3] [Citation(s) in RCA: 110] [Impact Index Per Article: 13.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2015] [Revised: 04/07/2016] [Accepted: 05/17/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Recent reports have suggested residual gadolinium deposition in the brain in subjects undergoing multiple contrast-enhanced MRI exams. These findings have raised some concerns regarding gadolinium-based contrast agent (GBCA) usage and retention in brain tissues. OBJECTIVE To summarize findings of hyperintense brain structures on precontrast T1-weighted images in 21 children undergoing multiple GBCA MRI exams. MATERIALS AND METHODS This retrospective study involved 21 patients, each of whom received multiple MRI examinations (range: 5-37 exams) with GBCA over the course of their medical treatment (duration from first to most recent exam: 1.2-12.9 years). The patients were between 0.9 and 14.4 years of age at the time of their first GBCA exam. Regions of interest were drawn in the dentate nucleus and the globus pallidus on 2-D fast spin echo images acquired at 1.5 T. The signal intensities of these two structures were normalized by that of the corpus callosum genu. Signal intensity ratios from these patients were compared to control patients of similar ages who have never received GBCA. RESULTS Signal intensity ratios increased between the first and the most recent MRI exam in all 21 patients receiving GBCA, with an increase of 18.6%±12.7% (range: 0.5% to 47.5%) for the dentate nucleus and 12.4%±7.4% (range: -1.2% to 33.7%) for the globus pallidus (P<0.0001). Signal intensity ratios were also higher in GBCA patients than in controls (P<0.01). The degree of signal intensity enhancement did not correlate with statistical significance to the cumulative number or volume of GBCA administrations each patient received, the patient's age or the elapsed time between the first and most recent GBCA MRI exams. CONCLUSION These results in children are consistent with recent findings in adults, suggesting possible gadolinium deposition in the brain.
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Affiliation(s)
- Houchun H Hu
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA.
| | - Amber Pokorney
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
| | - Richard B Towbin
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
| | - Jeffrey H Miller
- Department of Medical Imaging and Radiology, Phoenix Children's Hospital, 1919 E. Thomas Road, Phoenix, AZ, 85016, USA
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Schlemm L, Chien C, Bellmann-Strobl J, Dörr J, Wuerfel J, Brandt AU, Paul F, Scheel M. Gadopentetate but not gadobutrol accumulates in the dentate nucleus of multiple sclerosis patients. Mult Scler 2016; 23:963-972. [PMID: 27679460 DOI: 10.1177/1352458516670738] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Previous studies have postulated an association between dentate nucleus T1 hyperintensity and multiple sclerosis (MS)-related progressive neurodegeneration. Therefore, MS patients have been excluded from most studies investigating brain deposition of gadolinium-based contrast agents (GBCAs). Objective: To study the hypothesis that dentate nucleus T1 hyperintensity in MS patients is associated with GBCA administration. Methods: In a cohort of 97 MS patients, the dentate-to-pons signal intensity ratio (DPSIR) was calculated for 265 consecutive T1-weighted magnetic resonance (MR) scans (including sessions with and without the administration of GBCA). Patients exclusively received either gadopentetate dimeglumine (Gd-DTPA, linear) or gadobutrol (Gd-BT-DO3A, macrocyclic). Results: In patients receiving Gd-DTPA, DPSIR increased significantly between the first and the last scan (+0.009, p < 0.001), and following magnetic resonance imaging (MRI) with Gd-DTPA administration as compared to following an MRI without Gd-DTPA administration (+0.005 vs −0.001; p = 0.022). Additionally, there was a positive linear relationship between the number of Gd-DTPA administrations and the increase in DPSIR ( p = 0.017). No DPSIR increase was observed after Gd-BT-DO3A administration. Conclusion: Dentate nucleus T1 hyperintensity in MS patients is associated with Gd-DTPA (but not Gd-BT-DO3A) administration, suggesting an alternative explanation for the association of T1 hyperintensity with disease duration and severity.
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Affiliation(s)
- Ludwig Schlemm
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Medical Image Analysis Center (MIAC AG), Basel, Switzerland
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany/NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
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