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Cho SB, Lee AL, Chang HW, Kim KA, Yoo WJ, Yeom JA, Rho MH, Kim SJ, Lim YJ, Han M. Prospective Multicenter Study of the Safety of Gadoteridol in 6163 Patients. J Magn Reson Imaging 2019; 51:861-868. [PMID: 31663202 PMCID: PMC7027821 DOI: 10.1002/jmri.26940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The safety of gadolinium‐based contrast agents is of fundamental importance. Purpose To determine the frequency and severity of immediate‐type adverse reactions to approved doses of gadoteridol in patients referred for routine gadoteridol‐enhanced MRI in actual clinical practice settings. Study Type Prospective, observational. Population In all, 6163 subjects were enrolled (mean age: 56.7 ± 15.4 years; range: 6–93 years). Field Strength/Sequence 1.5T and 3.0T. Assessment Assessment was of immediate adverse reactions by the investigating radiologist using the MedDRA System Organ Class and preferred term. Statistical Tests Summary statistics for continuous variables, descriptive statistics for demographic characteristics. Results Overall, 19 adverse events occurred in 13 (0.21%) patients, of which 15 in 10 (0.16%) patients were considered related to gadoteridol administration. These events were evenly distributed between male and female subjects and all occurred in adults. Twelve of the 15 related events in eight (0.13%) patients were considered mild in intensity (rapidly self‐resolving), while the remaining three events in two patients (0.03%) were considered moderate in intensity. None were of severe intensity and no serious adverse events occurred. Data Conclusion The rate of immediate‐type adverse events following exposure to approved doses of gadoteridol is extremely low, and mostly limited to transient and self‐resolving symptoms. Level of Evidence: 2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:861–868.
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Affiliation(s)
- Sung Bum Cho
- Department of Radiology, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - A-Leum Lee
- Department of Radiology, Soonchunhyang University Hospital, Gyeonggi-do, Korea
| | - Hyuk Won Chang
- Department of Radiology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Won Jong Yoo
- Department of Diagnostic Radiology, Bucheon St. Mary's Hospital, Catholic University of Korea, Gyeonggi-do, Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Korea
| | - Myung Ho Rho
- Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Sung Jin Kim
- Department of Radiology, Chungbuk National University Hospital, Chungcheongbuk-do, Korea
| | - Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Busan, Korea
| | - Miran Han
- Department of Radiology, Ajou University Medical Center, Suwon-si, Korea
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Increased Retention of Gadolinium in the Inflamed Brain After Repeated Administration of Gadopentetate Dimeglumine. Invest Radiol 2019; 54:617-626. [DOI: 10.1097/rli.0000000000000571] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Kuo AH, Nagpal P, Ghoshhajra BB, Hedgire SS. Vascular magnetic resonance angiography techniques. Cardiovasc Diagn Ther 2019; 9:S28-S36. [PMID: 31559152 DOI: 10.21037/cdt.2019.06.07] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance angiography (MRA) denotes a unique option for the evaluation of peripheral vasculature due to its noninvasive nature, lack of ionizing radiation exposure, potential for non-contrast examination, and ability for generating volumetric representations that showcase vascular pathology. The constant evolution of the available MRA techniques, however, makes understanding and determining an optimal imaging protocol difficult. Here we present a brief overview of the major MRA sequence options, their major weaknesses and strengths, and related imaging considerations. Understanding the technical underpinnings of the various MRA methods helps with recognition of common imaging issues and artifacts and rendering clinically relevant interpretations.
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Affiliation(s)
- Anderson H Kuo
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Prashant Nagpal
- Department of Radiology, University of Iowa/Carver College of Medicine, Iowa City, USA
| | - Brian B Ghoshhajra
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
| | - Sandeep S Hedgire
- Department of Radiology, Massachusetts General Hospital/Harvard Medical School, Boston, MA, USA
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Splendiani A, Corridore A, Torlone S, Martino M, Barile A, Di Cesare E, Masciocchi C. Visible T1-hyperintensity of the dentate nucleus after multiple administrations of macrocyclic gadolinium-based contrast agents: yes or no? Insights Imaging 2019; 10:82. [PMID: 31482392 PMCID: PMC6722174 DOI: 10.1186/s13244-019-0767-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the appearance of visible dentate nucleus (DN) T1-hyperintensity and quantify changes in DN/pons (DN/P) signal intensity (SI) ratio in MS patients after the exclusive administration of macrocyclic GBCAs. MATERIALS AND METHODS One hundred forty-nine patients with confirmed MS were evaluated. Patients received at least two administrations of gadobutrol (n = 63), gadoterate (n = 57), or both (n = 29). Two experienced neuroradiologists in consensus evaluated unenhanced T1-weighted MR images from all examinations in each patient for evidence of visible DN hyperintensity. Thereafter, SI measurements were made in the left and right DN and pons on unenhanced T1-weighted images from the first and last scans. A two-sample t test compared the DN/P SI ratios for patients with and without visible T1-hyperintensity. RESULTS Visible T1-hyperintensity was observed in 42/149 (28.2%) patients (19 after gadobutrol only, 15 after gadoterate only, 8 after both), typically at the 4th or 5th follow-up exam at 3-4 years after the initial examination. Significant increases in DN/P SI ratio from first to last examination were determined for patients with visible T1-hyperintensity (0.998 ± 0.002 to 1.153 ± 0.016, p < 0.0001 for gadobutrol; 1.003 ± 0.004 to 1.110 ± 0.014, p < 0.0001 for gadoterate; 1.004 ± 0.011 to 1.163 ± 0.032, p = 0.0004 for both) but not for patients without visible T1-hyperintensity (p > 0.05; all groups). CONCLUSION Multiple injections of gadobutrol and/or gadoterate can lead to visible and quantifiable increases in DN/P SI ratio in some patients with MS.
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Affiliation(s)
- Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Antonella Corridore
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvia Torlone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Milvia Martino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
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Does Age Interfere With Gadolinium Toxicity and Presence in Brain and Bone Tissues?: A Comparative Gadoterate Versus Gadodiamide Study in Juvenile and Adult Rats. Invest Radiol 2019; 54:61-71. [PMID: 30394964 PMCID: PMC6310471 DOI: 10.1097/rli.0000000000000517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The main objective of the study was to assess the effect of age on target tissue total gadolinium (Gd) retention after repeated administration of gadodiamide (linear) or gadoterate (macrocyclic) Gd-based contrast agent (GBCA) in rats. The secondary objective was to assess the potential developmental and long-term consequences of GBCA administration during neonatal and juvenile periods. MATERIALS AND METHODS A total of 20 equivalent human clinical doses (cumulated dose, 12 mmol Gd/kg) of either gadoterate or gadodiamide were administered concurrently by the intravenous route to healthy adult and juvenile rats. Saline was administered to juvenile rats forming the control group. In juvenile rats, the doses were administered from postnatal day 12, that is, once the blood-brain barrier is functional as in humans after birth. The tests were conducted on 5 juvenile rats per sex and per group and on 3 adult animals per sex and per group. T1-weighted magnetic resonance imaging of the cerebellum was performed at 4.7 T during both the treatment and treatment-free periods. Behavioral tests were performed in juvenile rats. Rats were euthanatized at 11 to 12 weeks (ie, approximately 3 months) after the last administration. Total Gd concentrations were measured in plasma, skin, bone, and brain by inductively coupled plasma mass spectrometry. Cerebellum samples from the juvenile rats were characterized by histopathological examination (including immunohistochemistry for glial fibrillary acidic protein or GFAP, and CD68). Lipofuscin pigments were also studied by fluorescence microscopy. All tests were performed blindly on randomized animals. RESULTS Transient skin lesions were observed in juvenile rats (5/5 females and 2/4 males) and not in adult rats having received gadodiamide. Persisting (up to completion of the study) T1 hyperintensity in the deep cerebellar nuclei (DCNs) was observed only in gadodiamide-treated rats. Quantitatively, a slightly higher progressive increase in the DCN/brain stem ratio was observed in adult rats compared with juvenile rats, whereas no difference was noted visually. In all tissues, total Gd concentrations were higher (10- to 30-fold higher) in the gadodiamide-treated groups than in the gadoterate groups. No age-related differences were observed except in bone marrow where total Gd concentrations in gadodiamide-treated juvenile rats were higher than those measured in adults and similar to those measured in cortical bone tissue. No significant treatment-related effects were observed in histopathological findings or in development, behavior, and biochemistry parameters. However, in the elevated plus maze test, a trend toward an anxiogenic effect was observed in the gadodiamide group compared with other groups (nonsignificant). Moreover, in the balance beam test, a high number of trials were excluded in the gadodiamide group because rats (mainly males) did not completely cross the beam, which may also reflect an anxiogenic effect. CONCLUSIONS No T1 hyperintensity was observed in the DCN after administration of the macrocyclic GBCA gadoterate regardless of age as opposed to administration of the linear GBCA gadodiamide. Repeated administration of gadodiamide in neonatal and juvenile rats resulted in similar total Gd retention in the skin, brain, and bone to that in adult rats with sex having no effect, whereas Gd distribution in bone marrow was influenced by age. Further studies are required to assess the form of the retained Gd and to investigate the potential risks associated with Gd retention in bone marrow in juvenile animals treated with gadodiamide. Regardless of age, total Gd concentration in the brain and bone was 10- to 30-fold higher after administration of gadodiamide compared with gadoterate.
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Abstract
Gadolinium (Gd)-based contrast agents have been routinely used worldwide in diagnostic MRI since 1988. All routinely applied contrast agents for clinical use were considered extremely safe with regard to tolerance, adverse effects and diagnostic efficacy and when used at Food and Drug Administration-approved doses. With the identification of Gd-associated disorders, namely nephrogenic systemic fibrosis and adverse reactions, and in the longer term Gd-retention in the brain, this view changed and led to the withdrawal or restriction of approval of linear Gd chelates in Europe. Even though Gd deposition in different human body areas was described very early, recently published literature of intracerebral accumulation of contrast agents as well as deposition in bone have created surprising attention. Not only was the fact of Gd deposition in the body well known for many years, but there is currently no clinical evidence of patient symptoms and no resulting health issues of patients have been observed yet. The expression "gadolinium deposition disease" has been termed by active patient advocacy groups with an online presence with reports of individual members stating a broad spectrum of disorders yielding a large symptom complex after administration of Gd-based contrast agents without evidence of any pre-existing or otherwise underlying disease process which could explain the mentioned disorder.
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The Effects of Gadolinium-Based Contrast Agents on the Cerebellum: from Basic Research to Neurological Practice and from Pregnancy to Adulthood. THE CEREBELLUM 2019; 17:247-251. [PMID: 29196974 DOI: 10.1007/s12311-017-0903-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) are used in magnetic resonance imaging (MRI) to increase the diagnostic yield. Current reports using animal models or human subjects have shown that GBCAs may be deposited in brain including the cerebellum. Although further studies may be required to clarify the toxicity of GBCAs, we should be more cautious to use these agents particularly in patients who more likely to have repeated enhanced MRI along their lifespan. In this editorial, current studies to clarify the toxicity of GBCAs in the cerebellum are introduced.
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Multimodal Imaging Study of Gadolinium Presence in Rat Cerebellum: Differences Between Gd Chelates, Presence in the Virchow-Robin Space, Association With Lipofuscin, and Hypotheses About Distribution Pathway. Invest Radiol 2019; 53:518-528. [PMID: 29985204 PMCID: PMC6092107 DOI: 10.1097/rli.0000000000000490] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Purpose The aim of this study was to investigate, based on in-depth multimodal imaging, the presence of Gd deposits, their ultrastructure, location, and co-location with endogenous elements, in the cerebellum, after repeated administrations of gadolinium-based contrast agents (GBCAs). Methods Rats sensitized by subtotal nephrectomy received 20 daily intravenous injections of 0.6 mmol Gd/kg for 5 weeks of commercial forms of either gadoterate, gadobenate or gadodiamide, or saline (n = 2/group). The study was randomized and blinded. Magnetic resonance imaging examination was performed weekly. One month after the last injection, electron microscopy analysis of the deep cerebellar nuclei, the granular layer of cerebellar cortex, and the choroid plexus was performed. Elemental analysis of deposits was carried out by electron energy loss spectroscopy. Secondary ion mass spectroscopy was used for complementary chemical mapping. Results A T1 hypersignal was evidenced in the deep cerebellar nuclei of rats treated with linear GBCAs, and Gd deposits were identified in all the studied cerebellar structures with gadobenate and gadodiamide (except in the granular layer in gadobenate-treated rats). No such effect was found with the macrocyclic GBCA gadoterate. Most of the Gd deposits revealed a characteristic spheroid “sea urchin-like” morphology, rich in phosphorus, and were localized in the basal lamina of microvessels, in the perivascular Virchow-Robin space, and in the interstitium. Gd was also identified in the glial cells, associated with lipofuscin pigments, for these same groups. Conclusions Transmission electron microscopy analysis of cerebellums of renally impaired rats repeatedly injected with gadobenate and gadodiamide revealed the presence of Gd. Spheroid Gd depositions consisting of a filamentous meshwork were observed in the wall of microvessels, in perivascular Virchow-Robin space, and in the interstitium. Gd was also found in choroid plexus and was associated with pigments (likely lipofuscin) in glial cells. This is consistent with the involvement of the glymphatic distribution pathway for GBCAs. No insoluble Gd deposits were detected in rats injected with the macrocyclic GBCA gadoterate and controls.
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Methodological Aspects for Preclinical Evaluation of Gadolinium Presence in Brain Tissue: Critical Appraisal and Suggestions for Harmonization-A Joint Initiative. Invest Radiol 2019; 53:499-517. [PMID: 29659381 PMCID: PMC6092104 DOI: 10.1097/rli.0000000000000467] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) are pharmaceuticals that have been approved for 30 years and used daily in millions of patients worldwide. Their clinical benefits are indisputable. Recently, unexpected long-term presence of Gd in the brain has been reported by numerous retrospective clinical studies and confirmed in preclinical models particularly after linear GBCA (L-GBCA) compared with macrocyclic GBCA (M-GBCA). Even if no clinical consequences of Gd presence in brain tissue has been demonstrated so far, in-depth investigations on potential toxicological consequences and the fate of Gd in the body remain crucial to potentially adapt the clinical use of GBCAs, as done during the nephrogenic systemic fibrosis crisis. Preclinical models are instrumental in the understanding of the mechanism of action as well as the potential safety consequences. However, such models may be associated with risks of biases, often related to the protocol design. Selection of adequate terminology is also crucial. This review of the literature intends to summarize and critically discuss the main methodological aspects for accurate design and translational character of preclinical studies.
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Gadolinium Retention and Clearance in the Diabetic Brain after Administrations of Gadodiamide, Gadopentetate Dimeglumine, and Gadoterate Meglumine in a Rat Model. BIOMED RESEARCH INTERNATIONAL 2019; 2019:3901907. [PMID: 31192255 PMCID: PMC6525955 DOI: 10.1155/2019/3901907] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/13/2019] [Accepted: 04/16/2019] [Indexed: 01/02/2023]
Abstract
Purpose To evaluate gadolinium (Gd) retention and clearance in the brain of diabetic rats after administrations of gadodiamide, gadopentetate dimeglumine, and gadoterate meglumine. Materials and Methods Both diabetic rats (n = 52) and normal rats (n = 52) intravenously received 20 injections of 0.6 mmol Gd/kg gadodiamide, gadopentetate dimeglumine, gadoterate meglumine, or saline. Both diabetic rats and normal rats were divided into 2 subgroups of 24 and 28 rats for the 7-day and 42-day evaluations (i.e., they were sacrificed at 7 days (n = 6 per group) and 42 days (n = 7 per group)), respectively, after the last injection. For the 7-day subgroup, 6 rats were euthanized for inductively coupled plasma mass spectrometry (ICP-MS) analysis. For the 42-day subgroup, 6 rats underwent T1-weighted magnetic resonance imaging (MRI) and ICP-MS, and 1 rat was analyzed by transmission electron microscopy (TEM). Results The T1 enhancements in the deep cerebellar nuclei (DCNs) of diabetic rats were lower than those of normal rats in both linear Gd-based contrast agent (GBCA) groups (p < 0.05). The average Gd concentrations in the brains of diabetic rats were significantly lower than those of healthy rats in both the short-term groups and long-term groups (p < 0.05). The highest Gd retentions were in the olfactory bulb, DCN, and striatum with gadodiamide. Compared with the results obtained 7 days after the last injection, the residual Gd concentrations of the 42-day subgroups in the brains of diabetic rats showed no significant difference in both linear GBCA groups (p>0.05). Conclusions Compared with normal rats, the diabetic status decreased the residual Gd concentrations in the brain after multiple administrations of gadodiamide, gadopentetate dimeglumine, and gadoterate meglumine. The clearable fraction of Gd in the brain was eliminated faster in diabetic rats than in normal rats.
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112
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Fluorinated MRI contrast agents and their versatile applications in the biomedical field. Future Med Chem 2019; 11:1157-1175. [DOI: 10.4155/fmc-2018-0463] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
MRI has been recognized as one of the most applied medical imaging techniques in clinical practice. However, the presence of background signal coming from water protons in surrounding tissues makes sometimes the visualization of local contrast agents difficult. To remedy this, fluorine has been introduced as a reliable perspective, thanks to its magnetic properties being relatively close to those of protons. In this review, we aim to give an overall description of fluorine incorporation in contrast agents for MRI. The different kinds of fluorinated probes such as perfluorocarbons, fluorinated dendrimers, polymers and paramagnetic probes will be described, as will their imaging applications such as chemical exchange saturation transfer (CEST) imaging, physico-chemical changes detection, drug delivery, cell tracking and inflammation or tumors detection.
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Do C, Drel V, Tan C, Lee D, Wagner B. Nephrogenic Systemic Fibrosis Is Mediated by Myeloid C-C Chemokine Receptor 2. J Invest Dermatol 2019; 139:2134-2143.e2. [PMID: 30978353 DOI: 10.1016/j.jid.2019.03.1145] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 03/12/2019] [Accepted: 03/25/2019] [Indexed: 12/19/2022]
Abstract
Gadolinium-based contrast agents are implicated in several pathologic abnormalities (long-term retention in vital organs such as the skin and the brain) and are the cause of a sometimes fatal condition in patients, nephrogenic systemic fibrosis. Bone marrow-derived fibrocytes and the monocyte chemoattractant protein-1 inflammatory pathway have been implicated as mediators of the adverse effects induced by gadolinium-based contrast agents. Mechanistic studies are scant; therefore, a mouse model of nephrogenic systemic fibrosis was established. Dermal cellularity was increased in contrast-treated green fluorescent protein (GFP) chimeric mice. GFP in the skin and fibrosis were increased in the contrast-treated chimeric animals. Monocyte chemoattractant protein-1 and C-C chemokine receptor 2 were increased in the tissues from contrast-treated mice. C-C chemokine receptor 2-deficient recipients of GFP-expressing marrow had an abrogation of gadolinium-induced pathology and displayed less GFP-positive cells in the skin. Wild-type animals that received C-C chemokine receptor 2-deficient bone marrow had a complete abrogation of dermal pathology. That GFP levels and expression increase in the skin, in tandem with a fibrocyte marker, supports the blood-borne circulating fibrocyte hypothesis of the disease. As of now, fibrocyte trafficking has yet to be demonstrated. Importantly, our data demonstrate that the monocyte chemoattractant protein-1/C-C chemokine receptor 2 axis plays a critical role in the pathogenesis of nephrogenic systemic fibrosis.
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Affiliation(s)
- Catherine Do
- South Texas Veterans Health Care System, San Antonio, Texas, USA; University of Texas Health Science Center, San Antonio, Texas, USA
| | - Viktor Drel
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Chunyan Tan
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Doug Lee
- University of Texas Health Science Center, San Antonio, Texas, USA
| | - Brent Wagner
- Kidney Institute of New Mexico, Albuquerque, New Mexico, USA; University of New Mexico Health Science Center, Albuquerque, New Mexico, USA; New Mexico Veterans Administration Health Care System, Albuquerque, New Mexico, USA.
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Sarma A, Poussaint TY. Indications and Imaging Modality of Choice in Pediatric Headache. Neuroimaging Clin N Am 2019; 29:271-289. [PMID: 30926117 DOI: 10.1016/j.nic.2019.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pediatric headache is a common problem, with various underlying causes. Appropriate patient selection for neuroimaging is necessary to optimize the clinical evaluation. This review aims to provide a focused discussion of the clinical evaluation of children with headache, including published guidelines pertaining to neuroimaging, technical considerations for neuroimaging, and tailoring of examinations for specific clinical entities known to cause pediatric headache.
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Affiliation(s)
- Asha Sarma
- Department of Radiology, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, 2200 Children's Way, Suite 1421, Nashville, TN 37232-9700, USA.
| | - Tina Young Poussaint
- Department of Radiology, Harvard Medical School, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA 02130, USA
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Changes in tissue gadolinium biodistribution measured in an animal model exposed to four chelating agents. Jpn J Radiol 2019; 37:458-465. [PMID: 30929137 DOI: 10.1007/s11604-019-00835-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 03/22/2019] [Indexed: 12/19/2022]
Abstract
PURPOSE This study investigated the potential to reduce gadolinium levels in rodents after repetitive IV Gadodiamide administration using several chelating agents. MATERIALS AND METHODS The following six groups of rats were studied. Group 1: Control; Group 2: Gadodiamide only; Group 3: Meso-2,3-Dimercaptosuccinic acid (DMSA) + Gadodiamide; Group 4: N-Acetyl-L-cysteine (NAC) + Gadodiamide; Group 5: Coriandrum sativum extract + Gadodiamide; and Group 6: Deferoxamine + Gadodiamide. Brain, kidney, and blood samples were evaluated via inductively coupled plasma mass spectrometry. The brain was also evaluated histologically. RESULTS Kidney gadolinium levels in Groups 4 and 5 were approximately double that of Group 2 (p = 0.033 for each). There was almost no calcification in rat hippocampus for Group 4 rodents when compared with Groups 2, 3, 5 and 6. CONCLUSION Our preliminary study shows that excretion to the kidney has a higher propensity in NAC and Coriandrum sativum groups. It may be possible to change the distribution of gadolinium by administrating several agents. NAC may lower Gadodiamide-induced mineralization in rat hippocampus.
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Schöckel L, Balzer T, Pietsch H. [Increased signal intensities and gadolinium levels in the brain after administration of gadolinium-based MR contrast agents : Clinical observations and results from preclinical research]. Radiologe 2019; 59:359-368. [PMID: 30887087 DOI: 10.1007/s00117-019-0511-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Numerous clinical MRI studies have been published that describe an association between the repeated administration of (linear) gadolinium-based contrast agents and increased signal intensity in certain brain areas. In November 2017, the European Commission suspended the use of some of these contrast agents. OBJECTIVES The background for this decision, both regulatory and scientific, are presented and discussed. MATERIALS AND METHODS The regulatory decisions are evaluated and the clinical and preclinical literature is discussed. RESULTS Differences in the structure and stability of gadolinium-based contrast agent molecules explain the observed increased signal intensities in individual brain regions (e. g. dentate nucleus) after administration of multiple doses of linear contrast agents. This phenomenon was not observed after administration of multiple doses of macrocyclic contrast agents. Preclinical studies have confirmed these results. CONCLUSION To date, no clinical symptoms have been confirmed to be associated with the increased signal intensity or gadolinium presence in the brain.
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Affiliation(s)
- L Schöckel
- Pharmaceuticals Division, Medical & Clinical Affairs Radiology, Bayer AG, Berlin, Deutschland
| | - T Balzer
- Pharmaceuticals, Medical & Clinical Affairs Radiology, Bayer U.S. LLC, 100 Bayer Boulevard, 07981, Whippany, NJ, USA.
| | - H Pietsch
- Research & Development, Pharmaceuticals, MR and CT Contrast Media Research, Bayer AG, Berlin, Deutschland
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Gadolinium Accumulation in the Deep Cerebellar Nuclei and Globus Pallidus After Exposure to Linear but Not Macrocyclic Gadolinium-Based Contrast Agents in a Retrospective Pig Study With High Similarity to Clinical Conditions. Invest Radiol 2019; 53:278-285. [PMID: 29319556 PMCID: PMC5902136 DOI: 10.1097/rli.0000000000000440] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The aim of this retrospective study was to determine the gadolinium (Gd) concentration in different brain areas in a pig cohort that received repeated administration of Gd-based contrast agents (GBCAs) at standard doses over several years, comparable with a clinical setting. Material and Methods Brain tissue was collected from 13 Göttingen mini pigs that had received repeated intravenous injections of gadopentetate dimeglumine (Gd-DTPA; Magnevist) and/or gadobutrol (Gadovist). The animals have been included in several preclinical imaging studies since 2008 and received cumulative Gd doses ranging from 7 to 129 mmol per animal over an extended period. Two animals with no history of administration of GBCA were included as controls. Brain autopsies were performed not earlier than 8 and not later than 38 months after the last GBCA application. Tissues from multiple brain areas including cerebellar and cerebral deep nuclei, cerebellar and cerebral cortex, and pons were analyzed for Gd using inductively coupled plasma mass spectrometry. Results Of the 13 animals, 8 received up to 48 injections of gadobutrol and Gd-DTPA and 5 received up to 29 injections of gadobutrol only. In animals that had received both Gd-DTPA and gadobutrol, a median (interquartile range) Gd concentration of 1.0 nmol/g tissue (0.44-1.42) was measured in the cerebellar nuclei and 0.53 nmol/g (0.29-0.62) in the globus pallidus. The Gd concentration in these areas in gadobutrol-only animals was 50-fold lower with median concentrations of 0.02 nmol/g (0.01-0.02) for cerebellar nuclei and 0.01 nmol/g (0.01-0.01) for globus pallidus and was comparable with control animals with no GBCA history. Accordingly, in animals that received both GBCAs, the amount of residual Gd correlated with the administered dose of Gd-DTPA (P ≤ 0.002) but not with the total Gd dose, consisting of Gd-DTPA and gadobutrol. The Gd concentration in cortical tissue and in the pons was very low (≤0.07 nmol/g tissue) in all animals analyzed. Conclusion Multiple exposure to macrocyclic gadobutrol is not associated with Gd deposition in brain tissue of healthy pigs. A single additional administration of linear Gd-DTPA is sufficient for Gd accumulation in the nucleus dentatus and globus pallidus, underlining the importance of obtaining a complete GBCA history in clinical studies.
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Aime S. Differences in Molecular Structure Markedly Affect GBCA Elimination Behavior. Radiology 2019; 291:267-268. [PMID: 30806598 DOI: 10.1148/radiol.2019182748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Silvio Aime
- Molecular Imaging Center and Department of Molecular Biotechnology and Health Science, University of Torino, Via Nizza 52, 10126 Torino, Italy
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Le Fur M, Caravan P. The biological fate of gadolinium-based MRI contrast agents: a call to action for bioinorganic chemists. Metallomics 2019; 11:240-254. [PMID: 30516229 PMCID: PMC6486840 DOI: 10.1039/c8mt00302e] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) are widely used with clinical magnetic resonance imaging (MRI), and 10 s of millions of doses of GBCAs are administered annually worldwide. GBCAs are hydrophilic, thermodynamically stable and kinetically inert gadolinium chelates. In clinical MRI, 5-10 millimoles of Gd ion is administered intravenously and the GBCA is rapidly eliminated intact primarily through the kidneys into the urine. It is now well-established that the Gd3+ ion, in some form(s), is partially retained in vivo. In patients with advanced kidney disease, there is an association of Gd retention with nephrogenic systemic fibrosis (NSF) disease. However Gd is also retained in the brain, bone, skin, and other tissues in patients with normal renal function, and the presence of Gd can persist months to years after the last administration of a GBCA. Regulatory agencies are restricting the use of specific GBCAs and inviting health care professionals to evaluate the risk/benefit ratio prior to using GBCAs. Despite the growing number of studies investigating this issue both in animals and humans, the biological distribution and the chemical speciation of the residual gadolinium are not fully understood. Is the GBCA retained in its intact form? Is the Gd3+ ion dissociated from its chelator, and if so, what is its chemical form? Here we discuss the current state of knowledge regarding the issue of Gd retention and describe the analytical and spectroscopic methods that can be used to investigate the Gd speciation. Many of the physical methods that could be brought to bear on this problem are in the domain of bioinorganic chemistry and we hope that this review will serve to inspire this community to take up this important problem.
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Affiliation(s)
- Mariane Le Fur
- The Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth Street, Charlestown, Massachusetts 02129, USA.
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Gadolinium as an Emerging Microcontaminant in Water Resources: Threats and Opportunities. GEOSCIENCES 2019. [DOI: 10.3390/geosciences9020093] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As a result of high doses of paramagnetic gadolinium (Gd) chelates administered in magnetic resonance imaging (MRI) exams, their unmetabolized excretion, and insufficient removal in wastewater treatment plants (WWTPs), large amounts of anthropogenic Gd (Gdanth) are released into surface water. The upward trend of gadolinium-based contrast agent (Gd-CA) administrations is expected to continue growing and consequently higher and higher anthropogenic Gd concentrations are annually recorded in water resources, which can pose a great threat to aquatic organisms and human beings. In addition, the feasibility of Gd retention in patients administered with Gd-CAs repeatedly, and even potentially fatal diseases, including nephrogenic systemic fibrosis (NSF), due to trace amounts of Gd have recently arisen severe health concerns. Thus, there is a need to investigate probable adverse health effects of currently marketed Gd-CAs meticulously and to modify the actual approach in using Gd contrast media in daily practice in order to minimize unknown possible health risks. Furthermore, the employment of enhanced wastewater treatment processes that are capable of removing the stable contrast agents, and the evaluation of the ecotoxicity of Gd chelates and human exposure to these emerging contaminants through dermal and ingestion pathways deserve more attention. On the other hand, point source releases of anthropogenic Gd into the aquatic environment presents the opportunity to assess surface water—groundwater interactions and trace the fate of wastewater plume as a proxy for the potential presence of other microcontaminants associated with treated wastewater in freshwater and marine systems.
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Jost G, Frenzel T, Boyken J, Lohrke J, Nischwitz V, Pietsch H. Long-term Excretion of Gadolinium-based Contrast Agents: Linear versus Macrocyclic Agents in an Experimental Rat Model. Radiology 2019; 290:340-348. [DOI: 10.1148/radiol.2018180135] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregor Jost
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Thomas Frenzel
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Janina Boyken
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Jessica Lohrke
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Volker Nischwitz
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Hubertus Pietsch
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
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Gibby W, Parish W, Merrill RM, Fernandez D, Anderson CR, Merchel E, Parr R. The use of a binary chelate formulation: Could gadolinium based linear contrast agents be rescued by the addition of zinc selective chelates? Magn Reson Imaging 2019; 58:76-81. [PMID: 30639754 DOI: 10.1016/j.mri.2019.01.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/31/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022]
Abstract
Tissue and bone retention of gadolinium based contrast agents (GBCAs) has become a clinical concern because of the potential short and long term toxic effects of free gadolinium. This is a critical problem for most open-chain agents that more readily transmetallate in vivo, in comparison to macrocyclic compounds. Gadolinium diethylene tri-aminepentaacetic acid bis-glucosamide (Gd-DTPA-BIGA) is an experimental, open-chain contrast agent which has a significantly increased relaxivity coefficient in comparison to other GBCAs. This results in greater signal intensity and improved contrast enhancement. These superior imaging qualities initiated a search for a solution to the transmetallation of this agent. Plasma zinc is a well-known GBCA transmettalation agent. Since the base chelate of Gadodiamide (Gd-DPTA-Bis-Methylamide or Omniscan), DTPA-Bis-Methylamide (DTPA-BMA), readily transmettalates with and binds serum zinc, we hypothesized that a plasma "zinc sink," may significantly reduce transmetallation of linear agents. 5% DTPA-BMA was added to a formulation of Gd-DTPA-BIGA, which was tested against the original formulation of Gd-DTPA-BIGA with 0.2% of the base chelate DTPA-BIGA. These formulations, including gadodiamide, were labeled with 153GdCl3 followed by infusion into cohorts of Sprague Dawley rats which were sacrificed at 1, 30 and 60 days. Internal organs were harvested, along with blood, skin and femur, and analyzed for residual gadolinium. A subset of tissues were also interrogated with ICP-MS. Labeled Gadodiamide and saline where used as controls. Conclusion: The addition of 5% DTPA-BMA, as a zinc binding agent, reduced the transmetallation of the linear agent Gd-DTPA-BIGA, in comparison to its original formulation supplemented with 0.2% BIGA. This result indicates that supplementing linear GBCAs with ancillary chelates may hold promise for reducing, or eliminating the biological archiving of gadolinium in tissues. In addition, this paper provides valuable animal data on the long term retention of gadolinium from linear based contrast agents.
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Affiliation(s)
- Wendell Gibby
- Magnetic Research Inc., 3152 N University Ave #50, Provo, UT 84604, United States of America; University of California San Diego, 9500 Gilman Drive, La Jolla, CA 92093, United States of America.
| | - Wes Parish
- Magnetic Research Inc., 3152 N University Ave #50, Provo, UT 84604, United States of America
| | - Ray M Merrill
- Department of Health Science, Brigham Young University, College of Life Sciences, Life Sciences Building (LSB), Provo, UT 84602, United States of America.
| | - Diego Fernandez
- Department of Geology and Geophysics, University of Utah, Frederick Albert Sutton Building, 115 S, 1460 E #383, Salt Lake City, UT 84112, United States of America.
| | - Christopher R Anderson
- Department of Geology and Geophysics, University of Utah, Frederick Albert Sutton Building, 115 S, 1460 E #383, Salt Lake City, UT 84112, United States of America.
| | - Eric Merchel
- Department of Geology and Geophysics, University of Utah, Frederick Albert Sutton Building, 115 S, 1460 E #383, Salt Lake City, UT 84112, United States of America
| | - Ryan Parr
- Magnetic Research Inc., 3152 N University Ave #50, Provo, UT 84604, United States of America.
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Prybylski JP, Coste Sanchez C, Jay M. Impact of chelation timing on gadolinium deposition in rats after contrast administration. Magn Reson Imaging 2019; 55:140-144. [PMID: 30321663 PMCID: PMC6263939 DOI: 10.1016/j.mri.2018.10.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Revised: 10/02/2018] [Accepted: 10/06/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To determine if gadolinium (Gd) can be rechelated once released from Gd-based contrast agents (GBCAs) and deposited in vivo. Despite extensive research comparing GBCAs and GBCA formulations as well as the ongoing debate about their risks of deposition and the role of Gd release, it remains unknown if retained Gd can be eliminated by administering chelating agents. MATERIALS AND METHODS Rats were injected intravenously with 10 doses of 1 mmol/kg gadodiamide and treated with intravenous Zn-DTPA (30 μmol/kg) concomitantly or 1, 4 or 8 h after GBCA administration (N = 3 rats per group). After euthanization, tissues were harvested three days after the last dose of gadodiamide and tissue Gd concentrations were assessed by ICP-MS. Additionally, a simulation of a single 0.1 mmol/kg gadopentetate dose with 30 μmol/kg DTPA given either concomitantly or within the first 24 h after GBCA was run; simulated tissue Gd concentrations were compared with those observed in rats to determine if simulated trends were accurate. RESULTS Concomitant DTPA did not produce a significant reduction in Gd concentration in any organ for rats. There was a time-dependent trend in liver Gd reduction. The 1 h timepoint was associated with a non-significant increase in kidney, brain and femur Gd relative to untreated controls. There were no significant deviations from the model-predicted Gd changes. DISCUSSION Both the simulation and rat study did not identify major benefits for chelation at the doses given, despite the simulation assuming all Gd deposited in tissues is unchelated. The potential redistribution in the rat study provide a compelling result that may impact the clinical relevance of further work investigating rechelation of Gd. Future work should further describe the three-dimensional dose-time-response relationship for preventing Gd deposition, and how that relates to long-term Gd toxicities.
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Affiliation(s)
- John P Prybylski
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Carla Coste Sanchez
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America
| | - Michael Jay
- Division of Pharmacoengineering and Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, United States of America.
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Gadolinium retention and clearance after administration of macrocyclic magnetic resonance contrast agents to rats. Pediatr Radiol 2019; 49:1110-1111. [PMID: 31254022 PMCID: PMC6598947 DOI: 10.1007/s00247-019-04439-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 04/09/2019] [Accepted: 05/21/2019] [Indexed: 02/02/2023]
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125
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Rahatli FK, Donmez FY, Kesim C, Haberal KM, Turnaoglu H, Agildere AM. Can unenhanced brain magnetic resonance imaging be used in routine follow up of meningiomas to avoid gadolinium deposition in brain? Clin Imaging 2019; 53:155-161. [DOI: 10.1016/j.clinimag.2018.10.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 10/01/2018] [Accepted: 10/12/2018] [Indexed: 11/17/2022]
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Gianolio E, Gregorio ED, Aime S. Chemical Insights into the Issues of Gd Retention in the Brain and Other Tissues Upon the Administration of Gd-Containing MRI Contrast Agents. Eur J Inorg Chem 2018. [DOI: 10.1002/ejic.201801220] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Eliana Gianolio
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute; Centro di Imaging molecolare; Università degli Studi di Torino; Via Nizza 52 10126 Torino Italy
| | - Enza Di Gregorio
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute; Centro di Imaging molecolare; Università degli Studi di Torino; Via Nizza 52 10126 Torino Italy
| | - Silvio Aime
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute; Centro di Imaging molecolare; Università degli Studi di Torino; Via Nizza 52 10126 Torino Italy
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Choi JW, Moon WJ. Gadolinium Deposition in the Brain: Current Updates. Korean J Radiol 2018; 20:134-147. [PMID: 30627029 PMCID: PMC6315073 DOI: 10.3348/kjr.2018.0356] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used for enhancement in MR imaging and have long been considered safe when administered at recommended doses. However, since the report that nephrogenic systemic fibrosis is linked to the use of GBCAs in subjects with severe renal diseases, accumulating evidence has suggested that GBCAs are not cleared entirely from our bodies; some GBCAs are deposited in our tissues, including the brain. GBCA deposition in the brain is mostly linked to the specific chelate structure of the GBCA: linear GBCAs were responsible for brain deposition in almost all reported studies. This review aimed to summarize the current knowledge about GBCA brain deposition and discuss its clinical implications.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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T1-weighted Grey Matter Signal Intensity Alterations After Multiple Administrations of Gadobutrol in Patients with Multiple Sclerosis, Referenced to White Matter. Sci Rep 2018; 8:16844. [PMID: 30442977 PMCID: PMC6237839 DOI: 10.1038/s41598-018-35186-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2018] [Accepted: 10/26/2018] [Indexed: 01/28/2023] Open
Abstract
The aim of the study was to investigate the signal-intensity-(SI)-ratio changes in the basal ganglia, the pulvinar thalami (PN), and the dentate nucleus (DN) using frontal white matter (FWM) as reference area, in patients with multiple sclerosis after frequent administrations of gadobutrol. A control group (group I) was compared to three stratified patient groups (group II: mean applications of gadobutrol 3.7; group III: 7.5 applications; group IV: 13.8 applications). SI-ratios of the pallidum, putamen, caudate nucleus, and pulvinar thalami were calculated with: 1. FWM, and 2. PN. DN-to-pons and DN-to-FWM ratios were also calculated. The most significant SI-ratio-changes were found by comparing group I and IV for both reference values. However, by using FWM as reference an SI-ratio increase was observed, while an SI-ratio decrease was seen if referenced to the PN. DN-to-FWM showed an SI-ratio increase, too. The PN revealed a significant SI-ratio increase itself, correlating with the number of gadolinium applications, when referenced to FWM. Therefore, SI-ratio calculations using the thalamus as reference might be flawed. In addition, a minor gadolinium accumulation is possible, if FWM was used as reference area. Further studies are necessary to verify our results.
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Gadolinium Deposition in the Brain: A Systematic Review of Existing Guidelines and Policy Statement Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2018; 69:373-382. [DOI: 10.1016/j.carj.2018.04.002] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 04/08/2018] [Indexed: 12/20/2022] Open
Abstract
Emerging evidence has confirmed that, following administration of a gadolinium-based contrast agent (GBCA), very small amounts of gadolinium will deposit in the brain of humans with intact blood-brain barriers. The literature is evolving rapidly and the degree to which gadolinium will deposit for a particular GBCA or class of GBCAs remains undetermined. Several studies suggest that linear GBCAs deposit more gadolinium in the brain compared with macrocyclic GBCAs; however, our understanding of the molecular composition of deposited gadolinium is preliminary, and the clinical significance of gadolinium deposition remains unknown. To date, there is no conclusive evidence linking gadolinium deposition in the brain with any adverse patient outcome. A panel of radiologists representing the Canadian Association of Radiologists was assembled to assist the Canadian medical imaging community in making informed decisions regarding the issue of gadolinium deposition in the brain. The objectives of the working group were: 1) to review the evidence from animal and human studies; 2) to systematically review existing guidelines and position statements issued by other organizations and health agencies; and 3) to formulate an evidence-based position statement on behalf of the Canadian Association of Radiologists. Based on our appraisal of the evidence and systematic review of 9 guidelines issued by other organizations, the working group established the following consensus statement. GBCA administration should be considered carefully with respect to potential risks and benefits, and only used when required. Standard dosing should be used and repeat administrations should be avoided unless necessary. Gadolinium deposition is one of several issues to consider when prescribing a particular GBCA. Currently there is insufficient evidence to recommend one class of GBCA over another. The panel considered it inappropriate to withhold a linear GBCA if a macrocyclic agent is unavailable, if hepatobiliary phase imaging is required, or if there is a history of severe allergic reaction to a macrocyclic GBCA. Further study in this area is required, and the evidence should be monitored regularly with policy statements updated accordingly.
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The Critical Need for Pediatric and Juvenile Animal Research Addressing Gadolinium Retention in the Developing Body. Invest Radiol 2018; 54:72-75. [PMID: 30273280 DOI: 10.1097/rli.0000000000000516] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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Guo BJ, Yang ZL, Zhang LJ. Gadolinium Deposition in Brain: Current Scientific Evidence and Future Perspectives. Front Mol Neurosci 2018; 11:335. [PMID: 30294259 PMCID: PMC6158336 DOI: 10.3389/fnmol.2018.00335] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023] Open
Abstract
In the past 4 years, many publications described a concentration-dependent deposition of gadolinium in the brain both in adults and children, seen as high signal intensities in the globus pallidus and dentate nucleus on unenhanced T1-weighted images. Postmortem human or animal studies have validated gadolinium deposition in these T1-hyperintensity areas, raising new concerns on the safety of gadolinium-based contrast agents (GBCAs). Residual gadolinium is deposited not only in brain, but also in extracranial tissues such as liver, skin, and bone. This review summarizes the current evidence on gadolinium deposition in the human and animal bodies, evaluates the effects of different types of GBCAs on the gadolinium deposition, introduces the possible entrance or clearance mechanism of the gadolinium and potential side effects that may be related to the gadolinium deposition on human or animals, and puts forward some suggestions for further research.
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Affiliation(s)
- Bang J. Guo
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, China
| | - Zhen L. Yang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Long J. Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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McDonald RJ, Levine D, Weinreb J, Kanal E, Davenport MS, Ellis JH, Jacobs PM, Lenkinski RE, Maravilla KR, Prince MR, Rowley HA, Tweedle MF, Kressel HY. Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates. Radiology 2018; 289:517-534. [PMID: 30204075 DOI: 10.1148/radiol.2018181151] [Citation(s) in RCA: 189] [Impact Index Per Article: 31.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) have revolutionized MRI, enabling physicians to obtain crucial life-saving medical information that often cannot be obtained with other imaging modalities. Since initial approval in 1988, over 450 million intravenous GBCA doses have been administered worldwide, with an extremely favorable pharmacologic safety profile; however, recent information has raised new concerns over the safety of GBCAs. Mounting evidence has shown there is long-term retention of gadolinium in human tissues. Further, a small subset of patients have attributed a constellation of symptoms to GBCA exposure, although the association of these symptoms with GBCA administration or gadolinium retention has not been proven by scientific investigation. Despite evidence that macrocyclic GBCAs show less gadolinium retention than linear GBCAs, the safety implications of gadolinium retention are unknown. The mechanism and chemical forms of gadolinium retention, as well as the biologic activity and clinical importance of these retained gadolinium species, remain poorly understood and underscore the need for additional research. In February 2018, an international meeting was held in Bethesda, Md, at the National Institutes of Health to discuss the current literature and knowledge gaps about gadolinium retention, to prioritize future research initiatives to better understand this phenomenon, and to foster collaborative standardized studies. The greatest priorities are to determine (a) if gadolinium retention adversely affects the function of human tissues, (b) if retention is causally associated with short- or long-term clinical manifestations of disease, and (c) if vulnerable populations, such as children, are at greater risk for experiencing clinical disease. The purpose of the research roadmap is to highlight important information that is not known and to identify and prioritize needed research. ©RSNA, 2018 Online supplemental material is available for this article .
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Affiliation(s)
- Robert J McDonald
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Deborah Levine
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Jeffrey Weinreb
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Emanuel Kanal
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Matthew S Davenport
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - James H Ellis
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Paula M Jacobs
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Robert E Lenkinski
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Kenneth R Maravilla
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Martin R Prince
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Howard A Rowley
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Michael F Tweedle
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
| | - Herbert Y Kressel
- From the Division of Neuroradiology, Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02215 (D.L., H.Y.K.); Department of Radiology & Biomedical Imaging, Yale School of Medicine, New Haven, Conn (J.W.); Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa (E.K.); Department of Radiology, University of Michigan Health System, Ann Arbor, Mich (M.S.D., J.H.E.); Cancer Imaging Program, National Institutes of Health, National Cancer Institute, Bethesda, Md (P.M.J.); Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (R.E.L.); Department of Radiology, University of Washington, Seattle, Wash (K.R.M.); Department of Radiology, Cornell and Columbia Universities, New York, NY (M.R.P.); Department of Radiology, University of Wisconsin, Madison, Wis (H.A.R.); and Department of Radiology, The Ohio State University, Columbus, Ohio (M.F.T.)
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Robert P, Fingerhut S, Factor C, Vives V, Letien J, Sperling M, Rasschaert M, Santus R, Ballet S, Idée JM, Corot C, Karst U. One-year Retention of Gadolinium in the Brain: Comparison of Gadodiamide and Gadoterate Meglumine in a Rodent Model. Radiology 2018; 288:424-433. [PMID: 29786486 DOI: 10.1148/radiol.2018172746] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Philippe Robert
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Stefanie Fingerhut
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Cécile Factor
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Véronique Vives
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Justine Letien
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Michael Sperling
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Marlène Rasschaert
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Robin Santus
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Sébastien Ballet
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Jean-Marc Idée
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Claire Corot
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
| | - Uwe Karst
- From the Department of Research and Innovation, Imaging and Biological Research Division, Guerbet Group, BP57400, 95943 Roissy CDG, France (P.R., C.F., V.V., J.L., M.R., R.S., S.B., J.M.I., C.C.); and Institute of Inorganic and Analytical Chemistry, University of Münster, Münster, Germany (S.F., M.S., U.K.)
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Karimian-Jazi K, Wildemann B, Diem R, Schwarz D, Hielscher T, Wick W, Bendszus M, Breckwoldt MO. Gd contrast administration is dispensable in patients with MS without new T2 lesions on follow-up MRI. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 5:e480. [PMID: 30038948 PMCID: PMC6053940 DOI: 10.1212/nxi.0000000000000480] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 06/05/2018] [Indexed: 12/11/2022]
Abstract
Objective To assess the diagnostic value of gadolinium (Gd) contrast administration in MRI follow-up examinations of patients with MS if the T2 lesion load is stable. Methods We included 100 patients with MS with at least 2 cranial MRI follow-up examinations (mean follow-up time 4.0 ± 2.6 years). MRI was performed at 3 Tesla with a standardized protocol including T2-weighted, fluid-attenuated inversion recovery (FLAIR) and T1-weighted contrast-enhanced sequences. Images were analyzed for T2/FLAIR and contrast-enhancing (CE) lesions by 3 independent neuroradiologists. Isolated Gd-enhancing lesions without correlate in T2 and FLAIR images, and reactivated Gd+ lesions were further assessed for size and signal intensity. Results We identified a total of 343 new T2 lesions and 152 CE lesions in a total of 559 MRI follow-up examinations. New T2/FLAIR lesions were present in 30% of the scans. Of the Gd-enhancing lesions, 145/152 (95.4%) showed a correlate as a new T2/FLAIR lesion. There were 3 enhancing lesions (1.9% of all enhancing lesions) without T2/FLAIR correlate and 4 lesions (2.6%) that exhibited lesion reactivation or persistent enhancement over time. As a predictive factor of enhancement, we found that enhancing lesions had a higher T2 signal ratio (T2 SRlesion/normal-appearing white matter: 3.0 ± 0.1 vs 2.2 ± 0.1, p < 0.001). Conclusion The likelihood of missing “active lesions” is overall small (1.7%) if T2 lesions are stable compared with the previous MRI examination. Lesion reactivation is rare. Our study indicates that Gd contrast administration might be dispensable in follow-up MRI of patients with MS if no new T2/FLAIR lesions and no new neurologic symptoms are present.
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Affiliation(s)
- Kianush Karimian-Jazi
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Brigitte Wildemann
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Ricarda Diem
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Daniel Schwarz
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Thomas Hielscher
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Wolfgang Wick
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Martin Bendszus
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
| | - Michael O Breckwoldt
- Department of Neuroradiology (K.K.-J., D.S., M.B., M.O.B.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Neurology Clinic (B.W., R.D., W.W.), University Hospital Heidelberg, Im Neuenheimer Feld 400; Division of Biostatistics (T.H.), German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280; and Clinical Cooperation Unit Neurooncology (W.W.), German Cancer Consortium, German Cancer Research Center, DKFZ, Im Neuenheimer Feld 280, Heidelberg, Germany
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Gadolinium-based contrast agents induce gadolinium deposits in cerebral vessel walls, while the neuropil is not affected: an autopsy study. Acta Neuropathol 2018; 136:127-138. [PMID: 29748901 DOI: 10.1007/s00401-018-1857-4] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/23/2018] [Accepted: 04/29/2018] [Indexed: 02/02/2023]
Abstract
Recent studies showed gadolinium depositions following serial administrations of gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging examinations in various parts of the brain with the dentate nucleus (DN) being most affected. Even though no clinical correlates of the deposits are known yet, an intensive debate developed if this might be harmful. The aim of the current study was to specify the gadolinium distribution in brain tissue of patients who received serial injections of GBCAs in the low-µm range and to explore any potential pathological tissue changes caused by gadolinium deposits. Thirteen autopsy cases-eight receiving GBCA administrations, five serving as controls-were identified and analyzed. For all patients, total gadolinium quantification after acidic digestion by means of inductively coupled plasma-mass spectrometry (ICP-MS) was performed. Six cases were utilized for the spatially resolved quantification of gadolinium within the cerebellum and the basal ganglia by means of high-resolution laser ablation (LA)-ICP-MS. Histopathological and immunohistochemical examinations were performed to determine tissue reactions. LA-ICP-MS revealed gadolinium depositions in the walls of small blood vessels of the DN in all GBCA exposed patients, while no gadolinium was found in the control group. Additionally, the detection of phosphorus and metals like copper, zinc and iron provides evidence that transmetalation reactions might have occurred. No significant pathological changes of the brain tissue in the vicinity of the DN with respect to micro-/astrogliosis and neuronal loss were found in any of the patients. This notably holds true even for a patient who died from nephrogenic systemic fibrosis exhibiting extremely high gadolinium concentrations within the DN. The findings show that gadolinium depositions in the brain are restricted to blood vessel walls, while the neuropil is spared and apparent cellular reactions are absent.
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Clases D, Sperling M, Karst U. Analysis of metal-based contrast agents in medicine and the environment. Trends Analyt Chem 2018. [DOI: 10.1016/j.trac.2017.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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Boyken J, Niendorf T, Flemming B, Seeliger E. Gadolinium Deposition in the Brain after Contrast-enhanced MRI: Are the Data Valid? Radiology 2018; 288:630-632. [PMID: 29916783 DOI: 10.1148/radiol.2018171762] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Janina Boyken
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Hessische Str 3-4, D-10115 Berlin, Germany
| | - Thoralf Niendorf
- Berlin Ultrahigh Field Facility, Max Delbrück Center for Molecular Medicine in the Helmholtz Association, Berlin, Germany †
| | - Bert Flemming
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Hessische Str 3-4, D-10115 Berlin, Germany
| | - Erdmann Seeliger
- Institute of Physiology, Charité-Universitätsmedizin Berlin, Hessische Str 3-4, D-10115 Berlin, Germany
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Ackman JB. Invited Commentary on "Mediastinal and Pleural MR Imaging: Practical Approach for Daily Practice". Radiographics 2018; 38:55-57. [PMID: 29320318 DOI: 10.1148/rg.2018170198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jeanne B Ackman
- Division of Thoracic Imaging and Intervention, Department of Radiology, Massachusetts General Hospital Boston, Massachusetts
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Rahatli FK, Donmez FY, Kibaroglu S, Kesim C, Haberal KM, Turnaoglu H, Agildere AM. Does renal function affect gadolinium deposition in the brain? Eur J Radiol 2018; 104:33-37. [PMID: 29857863 DOI: 10.1016/j.ejrad.2018.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/16/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Was to compare T1 signal intensity ratios of dentate nucleus to cerebellar white matter (DN/cerebellum), dentate nucleus to pons (DN/pons) and globus pallidus to thalamus (GP/thalamus) in patients with normal renal function and in patients on chronic hemodialysis. To find out if renal function affects the deposition of gadolinium in brain after administration of linear gadolinium based contrast agents (GBCA). METHODS Seventy eight contrast enhanced brain MRIs (Magnetic Resonance Imaging) with linear GBCA of 13 patients on chronic hemodialysis and 13 patients with normal renal function retrospectively evaluated. The DN/pons, DN/cerebellum and GP/thalamus signal intensity ratios were measured from each brain MRI on unenhanced axial T1 weighted images. RESULTS In hemodialysis group statistically significant increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus were found between the first and the last brain MRIs (p = .001). The increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus between the first and the last brain MRIs in control group were not significant (p > 0.05). The signal intensity increase in DN and globus pallidus were significantly higher in hemodialysis group than control group (p < 0.05). CONCLUSIONS Patients on hemodialysis had significantly higher DN and GP signal intensity increase compared to the patients with normal renal function. Renal function affects the rate of gadolinium deposition in the brain after administration of linear GBCA.
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Affiliation(s)
- Feride Kural Rahatli
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | | | - Seda Kibaroglu
- Baskent University, Faculty of Medicine, Department of Neurology, Ankara, Turkey.
| | - Cagri Kesim
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Kemal Murat Haberal
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Hale Turnaoglu
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
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Idée JM, Robert P, Raynaud JS, Rasschaert M, Fretellier N, Factor C, Corot C. Region of Interest Selection in Nonclinical Studies of Accumulated Gadolinium-based Contrast Agent–induced T1 Hyperintensity in Deep Cerebellar Nuclei. Radiology 2018; 287:360-362. [DOI: 10.1148/radiol.2017171740] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Jean-Marc Idée
- Research & Innovation Division, Guerbet, BP 57400, 95943 Roissy CdG cedex, France
| | - Philippe Robert
- Research & Innovation Division, Guerbet, BP 57400, 95943 Roissy CdG cedex, France
| | | | - Marlène Rasschaert
- Research & Innovation Division, Guerbet, BP 57400, 95943 Roissy CdG cedex, France
| | - Nathalie Fretellier
- Research & Innovation Division, Guerbet, BP 57400, 95943 Roissy CdG cedex, France
| | - Cécile Factor
- Research & Innovation Division, Guerbet, BP 57400, 95943 Roissy CdG cedex, France
| | - Claire Corot
- Research & Innovation Division, Guerbet, BP 57400, 95943 Roissy CdG cedex, France
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Dekkers IA, Roos R, van der Molen AJ. Gadolinium retention after administration of contrast agents based on linear chelators and the recommendations of the European Medicines Agency. Eur Radiol 2018; 28:1579-1584. [PMID: 29063255 DOI: 10.1007/s00330-017-5065-8] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/19/2017] [Accepted: 09/07/2017] [Indexed: 10/18/2022]
Abstract
The Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) earlier this year recommended to suspend some marketing authorisations for Gadolinium Containing Contrast Agents (GCCAs) based on linear chelators due to the potential risk of gadolinium retention in the human body. These recommendations have recently been re-evaluated by EMA's Committee for Medicinal Products for Human Use (CHMP), and confirmed the final opinion of the European Medicines Agency. This editorial provides an overview of the available GCCAs and summarises the recent evidence of gadolinium retention. Moreover, a critical appraisal of the strengths and limitations of the scientific evidence currently available on gadolinium retention is given. KEY POINTS • EMA recommended suspension of some EU marketing authorisations of four linear GCCAs. • Brain MRI findings indicating gadolinium retention have been confirmed by mass spectrometry. • Current scientific evidence for gadolinium retention has several methodological limitations. • No clear clinical evidence exists indicating that gadolinium retention causes neurotoxicity. • Long-term safety of GCCAs, however, remains unclear.
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Affiliation(s)
- Ilona A Dekkers
- Department of Radiology, Leiden University Medical Centre, C-2S, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands.
| | - Rick Roos
- Department of Radiology, Leiden University Medical Centre, C-2S, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands
| | - Aart J van der Molen
- Department of Radiology, Leiden University Medical Centre, C-2S, Albinusdreef 2, NL-2333, ZA, Leiden, The Netherlands
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Mercantepe T, Tümkaya L, Çeliker FB, Topal Suzan Z, Çinar S, Akyildiz K, Mercantepe F, Yilmaz A. Effects of gadolinium-based MRI contrast agents on liver tissue. J Magn Reson Imaging 2018; 48:1367-1374. [PMID: 29607566 DOI: 10.1002/jmri.26031] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 03/13/2018] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND MRI with contrast is often used clinically. However, recent studies have reported a high accumulation of gadolinium-based contrast agents (GBCAs) in kidney, liver, and spleen tissues in several mouse models. PURPOSE To compare the effects on liver tissue of gadolinium-based MRI contrast agents in the light of biochemical and histopathological evaluation. STUDY TYPE Institutional Review Board (IRB)-approved controlled longitudinal study. ANIMAL MODEL In all, 32 male Sprague-Dawley rats were divided into a healthy control group subjected to no procedure (Group 1), a sham group (Group 2), a gadodiamide group (Group 3), and a gadoteric acid group (Group 4). FIELD STRENGTH/SEQUENCE Not applicable. ASSESSMENT Liver tissues removed at the end of the fifth week and evaluated pathologically (scored Knodell's histological activity index [HAI] method by two histopathologists) immunohistochemical (caspase-3 and biochemical tests (AST, ALT, TAS, TOS, and OSI method by Erel et al) were obtained. STATISTICAL TESTS Differences between groups were analyzed using the nonparametric Kruskal-Wallis test followed by the Tamhane test, and one-way analysis of variance (ANOVA) followed by Turkey's HSD test. RESULTS An increase was observed in histological activity scores in sections from rats administered gadodiamide and gadoteric acid, and in caspase-3, AST and ALT values (P < 0.05). In contrast, we determined no change in TOS (P = 0.568 and P = 0.094, respectively), TAS (P = 0.151 and P = 0.055, respectively), or OSI (P = 0.949 and P = 0.494, respectively) values. DATA CONCLUSION These data suggest that gadodiamide and gadoteric acid trigger hepatocellular necrosis and apoptosis by causing damage in hepatocytes, although no change occurs in total antioxidant and antioxidant capacity. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 4 J. Magn. Reson. Imaging 2018;47:1367-1374.
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Affiliation(s)
- Tolga Mercantepe
- Department of Histology and Embryology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Levent Tümkaya
- Department of Histology and Embryology, Recep Tayyip Erdogan University, Rize, Turkey
| | | | - Zehra Topal Suzan
- Department of Histology and Embryology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Seda Çinar
- Department of Histology and Embryology, Recep Tayyip Erdogan University, Rize, Turkey
| | - Kerimali Akyildiz
- Department of Biochemistry, Recep Tayyip Erdogan University, Rize, Turkey
| | - Filiz Mercantepe
- Department of Internal Medicine, Faculty of Medicine, Recep Tayyip Erdogan University, Rize, Turkey
| | - Adnan Yilmaz
- Department of Biochemistry, Recep Tayyip Erdogan University, Rize, Turkey
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Quan GM, Zheng YL, Yuan T, Lei JM. Increasing FLAIR signal intensity in the postoperative cavity predicts progression in gross-total resected high-grade gliomas. J Neurooncol 2018; 137:631-638. [DOI: 10.1007/s11060-018-2758-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2017] [Accepted: 01/03/2018] [Indexed: 01/01/2023]
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Kanda T. The New Restrictions on the Use of Linear Gadolinium-based Contrast Agents in Japan. Magn Reson Med Sci 2018; 18:1-3. [PMID: 29553066 PMCID: PMC6326772 DOI: 10.2463/mrms.e.2017-0176] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Tomonori Kanda
- Department of Radiology, Kobe University School of Medicine
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145
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Behzadi AH, Farooq Z, Zhao Y, Shih G, Prince MR. Dentate Nucleus Signal Intensity Decrease on T1-weighted MR Images after Switching from Gadopentetate Dimeglumine to Gadobutrol. Radiology 2018. [PMID: 29533723 DOI: 10.1148/radiol.2018171398] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To determine if the increased dentate nucleus signal intensity following six or more doses of a linear gadolinium-based contrast agent (GBCA) (gadopentetate dimeglumine) changes at follow-up examinations performed with a macrocyclic GBCA (gadobutrol). Materials and Methods This retrospective study included 13 patients with increased dentate nucleus signal intensity following at least six (range, 6-18) gadopentetate dimeglumine administrations who then underwent at least 12 months of follow-up imaging with multiple (range, 3-29) gadobutrol-enhanced magnetic resonance (MR) examinations. Dentate nucleus-to-pons and dentate nucleus-to-cerebellar peduncle signal intensity ratios were measured by two radiologists blinded to all patient information, and changes were analyzed by using the paired t test and linear regression. Results The mean dentate nucleus-to-pons and dentate nucleus-to-cerebellar peduncle signal intensity ratios increased after gadopentetate dimeglumine administration, from 0.98 ± 0.03 to 1.10 ± 0.03 (P < .0001) and from 0.98 ± 0.030 to 1.09 ± 0.02 (P < .0001), respectively. With gadobutrol, the mean dentate nucleus-to-pons and dentate nucleus-to-cerebellar peduncle signal intensity ratios decreased to 1.03 ± 0.03 and 1.02 ± 0.04, respectively (P < .0001). With use of a mixed effects model linear regression allowing for each patient to have a different y intercept, mean dentate nucleus-to-pons and dentate nucleus-to-cerebellar peduncle signal intensity ratios decreased with follow-up time (dentate nucleus-to-pons: slope = -0.2% per month [95% confidence interval: -0.0024, -0.0015], R2 = 0.58, P < .0001 for nonzero slope; dentate nucleus-to-cerebellar peduncle: slope = -0.2% per month [95% confidence interval: -0.0024, -0.0015], R2 = 0.61, P < .0001 for nonzero slope). Conclusion Dentate signal intensity increased with at least six gadopentetate dimeglumine-enhanced MR examinations and decreased after switching from a linear (gadopentetate dimeglumine) to a macrocyclic (gadobutrol) GBCA. © RSNA, 2018 Online supplemental material is available for this article.
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Affiliation(s)
- Ashkan Heshmatzadeh Behzadi
- From the Department of Radiology (A.H.B., Z.F., G.S., M.R.P.) and Department of Healthcare Policy and Research (Y.Z.), Weill Cornell Medical Center, 416 E 55th St, New York, NY 10022; and Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Zerwa Farooq
- From the Department of Radiology (A.H.B., Z.F., G.S., M.R.P.) and Department of Healthcare Policy and Research (Y.Z.), Weill Cornell Medical Center, 416 E 55th St, New York, NY 10022; and Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Yize Zhao
- From the Department of Radiology (A.H.B., Z.F., G.S., M.R.P.) and Department of Healthcare Policy and Research (Y.Z.), Weill Cornell Medical Center, 416 E 55th St, New York, NY 10022; and Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - George Shih
- From the Department of Radiology (A.H.B., Z.F., G.S., M.R.P.) and Department of Healthcare Policy and Research (Y.Z.), Weill Cornell Medical Center, 416 E 55th St, New York, NY 10022; and Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY (M.R.P.)
| | - Martin R Prince
- From the Department of Radiology (A.H.B., Z.F., G.S., M.R.P.) and Department of Healthcare Policy and Research (Y.Z.), Weill Cornell Medical Center, 416 E 55th St, New York, NY 10022; and Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY (M.R.P.)
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146
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Davenport MS. Choosing the Safest Gadolinium-based Contrast Medium for MR Imaging: Not So Simple after All. Radiology 2018; 286:483-485. [DOI: 10.1148/radiol.2017172224] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Matthew S. Davenport
- From the Department of Radiology, University of Michigan, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030
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147
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Moser FG, Watterson CT, Weiss S, Austin M, Mirocha J, Prasad R, Wang J. High Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted MR Images: Comparison between Gadobutrol and Linear Gadolinium-Based Contrast Agents. AJNR Am J Neuroradiol 2018; 39:421-426. [PMID: 29419400 DOI: 10.3174/ajnr.a5538] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 11/15/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE In view of the recent observations that gadolinium deposits in brain tissue after intravenous injection, our aim of this study was to compare signal changes in the globus pallidus and dentate nucleus on unenhanced T1-weighted MR images in patients receiving serial doses of gadobutrol, a macrocyclic gadolinium-based contrast agent, with those seen in patients receiving linear gadolinium-based contrast agents. MATERIALS AND METHODS This was a retrospective analysis of on-site patients with brain tumors. Fifty-nine patients received only gadobutrol, and 60 patients received only linear gadolinium-based contrast agents. Linear gadolinium-based contrast agents included gadoversetamide, gadobenate dimeglumine, and gadodiamide. T1 signal intensity in the globus pallidus, dentate nucleus, and pons was measured on the precontrast portions of patients' first and seventh brain MRIs. Ratios of signal intensity comparing the globus pallidus with the pons (globus pallidus/pons) and dentate nucleus with the pons (dentate nucleus/pons) were calculated. Changes in the above signal intensity ratios were compared within the gadobutrol and linear agent groups, as well as between groups. RESULTS The dentate nucleus/pons signal ratio increased in the linear gadolinium-based contrast agent group (t = 4.215, P < .001), while no significant increase was seen in the gadobutrol group (t = -1.422, P = .08). The globus pallidus/pons ratios followed similarly, with an increase in the linear gadolinium-based contrast agent group (t = 2.931, P < .0001) and no significant change in those receiving gadobutrol (t = 0.684, P = .25). CONCLUSIONS Successive doses of gadobutrol do not result in T1 shortening compared with changes seen in linear gadolinium-based contrast agents.
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Affiliation(s)
- F G Moser
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - C T Watterson
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - S Weiss
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - M Austin
- Department of Radiology (M.A.), Lahey Clinic, Burlington, Massachusetts
| | - J Mirocha
- Samuel Oschin Comprehensive Cancer Institute (J.M.), Cedars Sinai Medical Center, Los Angeles, California
| | - R Prasad
- From the Department of Imaging (F.G.M., C.T.W., S.W., R.P.), S. Mark Taper Foundation Imaging Center
| | - J Wang
- Bayer Healthcare (J.W.), Whippany, New Jersey
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148
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Bolles GM, Yazdani M, Stalcup ST, Creeden SG, Collins HR, Nietert PJ, Roberts DR. Development of High Signal Intensity within the Globus Pallidus and Dentate Nucleus following Multiple Administrations of Gadobenate Dimeglumine. AJNR Am J Neuroradiol 2018; 39:415-420. [PMID: 29348135 DOI: 10.3174/ajnr.a5510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/30/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have evaluated various gadolinium based contrast agents and their association with gadolinium retention, however, there is a discrepancy in the literature concerning the linear agent gadobenate dimeglumine. Our aim was to determine whether an association exists between the administration of gadobenate dimeglumine and the development of intrinsic T1-weighted signal in the dentate nucleus and globus pallidus. MATERIALS AND METHODS In this single-center, retrospective study, the signal intensity of the globus pallidus, dentate nucleus, thalamus, and middle cerebellar peduncle was measured on unenhanced T1-weighted images in 29 adult patients who had undergone multiple contrast MRIs using exclusively gadobenate dimeglumine (mean, 10.1 ± 3.23 doses; range, 6-18 doses). Two neuroradiologists, blinded to the number of prior gadolinium-based contrast agent administrations, separately placed ROIs within the globi pallidi, thalami, dentate nuclei, and middle cerebellar peduncles on the last MR imaging examinations. The correlations between the globus pallidus:thalamus and the dentate nucleus:middle cerebellar peduncle signal intensity ratios with the number of gadolinium-based contrast agent administrations and cumulative dose were tested with either 1-tailed Pearson or Spearman correlations. A priori, P < .05 was considered statistically significant. RESULTS Both the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the number of gadolinium-based contrast agent administrations (r = 0.39, P = .017, and r = 0.58, P = .001, respectively). Additionally, the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the cumulative dose of gadobenate dimeglumine (r = 0.48, P = .004, and r = 0.43, P = .009, respectively). Dentate nucleus hyperintensity was qualitatively present on the last MR imaging in 79.3%-86.2% of patients and in all patients who had received >10 doses. CONCLUSIONS At high cumulative doses (commonly experienced by patients, for example, with neoplastic disease), gadobenate dimeglumine is associated with an increase in the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncles signal intensity ratios.
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Affiliation(s)
- G M Bolles
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - M Yazdani
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - S T Stalcup
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - S G Creeden
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - H R Collins
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - P J Nietert
- Department of Public Health Sciences (P.J.N.), Medical University of South Carolina, Charleston, South Carolina
| | - D R Roberts
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
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149
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Bussi S, Penard L, Bonafè R, Botteron C, Celeste R, Coppo A, Queliti R, Kirchin MA, Tedoldi F, Maisano F. Non-clinical assessment of safety and gadolinium deposition after cumulative administration of gadobenate dimeglumine (MultiHance ®) to neonatal and juvenile rats. Regul Toxicol Pharmacol 2017; 92:268-277. [PMID: 29278694 DOI: 10.1016/j.yrtph.2017.12.016] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 12/21/2017] [Indexed: 01/01/2023]
Abstract
To determine the impact of single and cumulative doses of MultiHance on toxicity, pharmacokinetics, tissue gadolinium presence, behavior and neurological function in juvenile rats. Juvenile male and female rats received either physiological saline or MultiHance at 0.6, 1.25 or 2.5 mmol/kg bodyweight. Animals received either single or six consecutive MultiHance administrations and were sacrificed the day after the last administration or after a 60-day treatment-free period. Animals were assessed for behavior, cognitive function, grip strength, gait, pupillary reflex, and auditory reflex, as well as for physical development, sexual maturation and histopathology. Gadolinium presence in brain, femur, kidneys, liver and skin was determined using inductively coupled plasma-mass spectrometry (ICP-MS). No effects of MultiHance on behavior, cognitive function or any other parameter were noted, even for the highest administered cumulative dose (15 mmol/kg). Gadolinium presence was variable across tissues and decreased during the 60-day treatment-free period. The highest levels were noted in the femur and the lowest levels in the brain. Gadolinium presence in juvenile rat brain following single or repeated MultiHance administrations was minimal and non-impactful.
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Affiliation(s)
- Simona Bussi
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
| | - Laure Penard
- Charles River, 329 Impasse du Domaine Rozier, 69210 Saint Germain-Nuelles, Lyon, France.
| | - Roberta Bonafè
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
| | - Catherine Botteron
- Bracco Suisse SA, Route de la Galaise 31, 1228 Plan-les-Ouates, Genève, Switzerland.
| | - Roberto Celeste
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
| | - Alessandra Coppo
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
| | - Roberta Queliti
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
| | - Miles A Kirchin
- Bracco Imaging Spa, Via Caduti di Marcinelle 13, 20134 Milano, Italy.
| | - Fabio Tedoldi
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
| | - Federico Maisano
- Bracco Imaging Spa, Bracco Research Centre, Via Ribes 5, 10010 Colleretto Giacosa, TO, Italy.
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150
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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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