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Stojanov D, Aracki-Trenkic A, Benedeto-Stojanov D. Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status. Neuroradiology 2016; 58:433-41. [PMID: 26873830 DOI: 10.1007/s00234-016-1658-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Gadolinium-based contrast agents (GBCAs) have been used clinically since 1988 for contrast-enhanced magnetic resonance imaging (CE-MRI). Generally, GBCAs are considered to have an excellent safety profile. However, GBCA administration has been associated with increased occurrence of nephrogenic systemic fibrosis (NSF) in patients with severely compromised renal function, and several studies have shown evidence of gadolinium deposition in specific brain structures, the globus pallidus and dentate nucleus, in patients with normal renal function. METHODS Gadolinium deposition in the brain following repeated CE-MRI scans has been demonstrated in patients using T1-weighted unenhanced MRI and inductively coupled plasma mass spectroscopy. Additionally, rodent studies with controlled GBCA administration also resulted in neural gadolinium deposits. RESULTS Repeated GBCA use is associated with gadolinium deposition in the brain. This is especially true with the use of less-stable, linear GBCAs. In spite of increasing evidence of gadolinium deposits in the brains of patients after multiple GBCA administrations, the clinical significance of these deposits continues to be unclear. CONCLUSION Here, we discuss the current state of scientific evidence surrounding gadolinium deposition in the brain following GBCA use, and the potential clinical significance of gadolinium deposition. There is considerable need for further research, both to understand the mechanism by which gadolinium deposition in the brain occurs and how it affects the patients in which it occurs.
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Affiliation(s)
- Dragan Stojanov
- Faculty of Medicine, University of Nis, Bul. Dr. Zorana Djindjica 81, Nis, 18000, Serbia.
- Center for Radiology, Clinical Center Nis, Nis, Serbia.
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Robert P, Violas X, Grand S, Lehericy S, Idée JM, Ballet S, Corot C. Linear Gadolinium-Based Contrast Agents Are Associated With Brain Gadolinium Retention in Healthy Rats. Invest Radiol 2016; 51:73-82. [PMID: 26606549 PMCID: PMC4747982 DOI: 10.1097/rli.0000000000000241] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2015] [Accepted: 11/11/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate Gd retention in the deep cerebellar nuclei (DCN) of linear gadolinium-based contrast agents (GBCAs) compared with a macrocyclic contrast agent. MATERIALS AND METHODS The brain tissue retention of Gd of 3 linear GBCAs (gadobenate dimeglumine, gadopentetate dimeglumine, and gadodiamide) and a macrocyclic GBCA (gadoterate meglumine) was compared in healthy rats (n = 8 per group) that received 20 intravenous injections of 0.6 mmol Gd/kg (4 injections per week for 5 weeks). An additional control group with saline was included. T1-weighted magnetic resonance imaging was performed before injection and once a week during the 5 weeks of injections and for another 4 additional weeks after contrast period. Total gadolinium concentration was measured with inductively coupled plasma mass spectrometry. Blinded qualitative and quantitative evaluations of the T1 signal intensity in DCN were performed, as well as a statistical analysis on quantitative data. RESULTS At completion of the injection period, all the linear contrast agents (gadobenate dimeglumine, gadopentetate dimeglumine, and gadodiamide) induced a significant increase in signal intensity in DCN, unlike the macrocyclic GBCA (gadoterate meglumine) or saline. The T1 hypersignal enhancement kinetic was fast for gadodiamide. Total Gd concentrations for the 3 linear GBCAs groups at week 10 were significantly higher in the cerebellum (1.21 ± 0.48, 1.67 ± 0.17, and 3.75 ± 0.18 nmol/g for gadobenate dimeglumine, gadopentetate dimeglumine, and gadodiamide, respectively) than with the gadoterate meglumine (0.27 ± 0.16 nmol/g, P < 0.05) and saline (0.09 ± 0.12 nmol/g, P < 0.05). No significant difference was observed between the macrocyclic agent and saline. CONCLUSIONS Repeated administrations of the linear GBCAs gadodiamide, gadobenate dimeglumine, and gadopentetate dimeglumine to healthy rats were associated with progressive and significant T1 signal hyperintensity in the DCN, along with Gd deposition in the cerebellum. This is in contrast with the macrocyclic GBCA gadoterate meglumine for which no effect was observed.
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Affiliation(s)
- Philippe Robert
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Xavier Violas
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Sylvie Grand
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Stéphane Lehericy
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Jean-Marc Idée
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Sébastien Ballet
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
| | - Claire Corot
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †INSERM, U836; ‡Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble; §Institut du Cerveau et de la Moelle Epinière, Centre de Neuroimagerie de Recherche; ∥Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225; and ¶Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France
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153
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Jost G, Lenhard DC, Sieber MA, Lohrke J, Frenzel T, Pietsch H. Signal Increase on Unenhanced T1-Weighted Images in the Rat Brain After Repeated, Extended Doses of Gadolinium-Based Contrast Agents: Comparison of Linear and Macrocyclic Agents. Invest Radiol 2016; 51:83-9. [PMID: 26606548 PMCID: PMC4747981 DOI: 10.1097/rli.0000000000000242] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Accepted: 11/11/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In this prospective preclinical study, we evaluated T1-weighted signal intensity in the deep cerebellar nuclei (CN) and globus pallidus (GP) up to 24 days after repeated administration of linear and macrocyclic gadolinium-based contrast agents (GBCAs) using homologous imaging and evaluation methods as in the recently published retrospective clinical studies. In a second part of the study, cerebrospinal fluid (CSF) spaces were evaluated for contrast enhancement by fluid-attenuated magnetic resonance imaging (MRI). MATERIALS AND METHODS Sixty adult male Wistar-Han rats were randomly divided into a control and 5 GBCA groups (n = 10 per group). The administered GBCAs were gadodiamide, gadopentetate dimeglumine, and gadobenate dimeglumine (linear GBCAs) as well as gadobutrol and gadoterate meglumine (macrocyclic GBCAs) and saline (control). Over a period of 2 weeks, the animals received 10 intravenous injections at a dose of 2.5 mmol Gd/kg body weight, each on 5 consecutive days per week. Before GBCA administration, as well as 3 and 24 days after the last injection, a whole-brain MRI was performed using a standard T1-weighted 3-dimensional turbo spin echo sequence on a clinical 1.5 T scanner. The ratios of signal intensities in deep CN to pons (CN/Po) and GP to thalamus (GP/Th) were determined. For the evaluation of the CSF spaces, 18 additional rats were randomly divided into 6 groups (n = 3 per group) that received the same GBCAs as in the first part of the study. After MR cisternography for anatomical reference, a fluid-attenuated inversion recovery sequence was performed before and 1 minute after intravenous injection of a dose of 1 mmol Gd/kg body weight GBCA or saline. RESULTS A significantly increased signal intensity ratio of CN/Po was observed 3 and 24 days after the last injection of gadodiamide and gadobenate dimeglumine. No significant changes were observed between the 2 time points. Gadopentetate dimeglumine injection led to a moderately elevated but statistically not significant CN/Po signal intensity ratio. No increased CN/Po signal intensity ratios were determined in the MRI scans of rats that received macrocyclic GBCAs gadobutrol and gadoterate meglumine or saline. The ratio of signal intensity in GP/Th was not elevated in any group injected with GBCAs or saline. Enhanced signal intensities of CSF spaces were observed in the postcontrast fluid-attenuated inversion recovery images of all animals receiving GBCAs but not for saline. CONCLUSIONS In this animal study in rats, increased signal intensity in the CN was found up to 24 days after multiple, extended doses of linear GBCAs. However, in contrast to clinical reports, the signal enhancement in the GP was not reproduced, demonstrating the limitations of this animal experiment. The elevated signal intensities remained persistent over the entire observation period. In contrast, no changes of signal intensities in either the CN or the GP were observed for macrocyclic GBCAs. However, all GBCAs investigated were able to pass the blood-CSF barrier in rats to a certain, not yet quantified extent.
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Affiliation(s)
- Gregor Jost
- From the *MR and CT Contrast Media Research, Bayer Healthcare; †Institute of Vegetative Physiology, Charité; and ‡Clinical Project Management, Bayer Healthcare, Berlin, Germany
| | - Diana Constanze Lenhard
- From the *MR and CT Contrast Media Research, Bayer Healthcare; †Institute of Vegetative Physiology, Charité; and ‡Clinical Project Management, Bayer Healthcare, Berlin, Germany
| | - Martin Andrew Sieber
- From the *MR and CT Contrast Media Research, Bayer Healthcare; †Institute of Vegetative Physiology, Charité; and ‡Clinical Project Management, Bayer Healthcare, Berlin, Germany
| | - Jessica Lohrke
- From the *MR and CT Contrast Media Research, Bayer Healthcare; †Institute of Vegetative Physiology, Charité; and ‡Clinical Project Management, Bayer Healthcare, Berlin, Germany
| | - Thomas Frenzel
- From the *MR and CT Contrast Media Research, Bayer Healthcare; †Institute of Vegetative Physiology, Charité; and ‡Clinical Project Management, Bayer Healthcare, Berlin, Germany
| | - Hubertus Pietsch
- From the *MR and CT Contrast Media Research, Bayer Healthcare; †Institute of Vegetative Physiology, Charité; and ‡Clinical Project Management, Bayer Healthcare, Berlin, Germany
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154
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National Institutes of Health Perspective on Reports of Gadolinium Deposition in the Brain. J Am Coll Radiol 2016; 13:237-41. [PMID: 26810815 DOI: 10.1016/j.jacr.2015.11.009] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2015] [Accepted: 11/09/2015] [Indexed: 01/22/2023]
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155
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Barbieri S, Schroeder C, Froehlich JM, Pasch A, Thoeny HC. High signal intensity in dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in three patients with impaired renal function and vascular calcification. CONTRAST MEDIA & MOLECULAR IMAGING 2016; 11:245-50. [PMID: 26929131 PMCID: PMC5066707 DOI: 10.1002/cmmi.1683] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/16/2015] [Accepted: 12/03/2015] [Indexed: 11/16/2022]
Abstract
Gadolinium‐based contrast agents (primarily those with linear chelates) are associated with a dose‐dependent signal hyperintensity in the dentate nucleus and the globus pallidus on unenhanced T1‐weighted MRI following administration to selected patients with normal renal function. The accumulation of gadolinium has also been reported in the skin, heart, liver, lung, and kidney of patients with impaired renal function suffering from nephrogenic systemic fibrosis (NSF). Here we report on three patients with impaired renal function and vascular calcification (two with confirmed NSF) whose unenhanced T1‐weighted MRIs showed conspicuous high signal intensity in the dentate nucleus and the globus pallidus after they had been exposed to relatively low doses of linear gadolinium‐based contrast agents (0.27, 0.45, and 0.68 mmol/kg). Signal ratios between dentate nucleus and pons and between globus pallidus and thalamus were comparable with previously reported measurements in subjects without renal impairment. Of note, all three analysed patients suffered from transient signs of neurological disorders of undetermined cause. In conclusion, the exposure to 0.27‐0.68 mmol/kg of linear gadolinium‐based contrast agent was associated with probable gadolinium accumulation in the brain of three patients suffering from impaired renal function and vascular calcification. © 2016 The Authors. Contrast Media & Molecular Imaging published by John Wiley & Sons Ltd.
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Affiliation(s)
- Sebastiano Barbieri
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Christophe Schroeder
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Johannes M Froehlich
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Andreas Pasch
- Department of Clinical Chemistry, University Hospital Bern (Inselspital), Bern, Switzerland
| | - Harriet C Thoeny
- Institute of Diagnostic, Pediatric, and Interventional Radiology, University Hospital Bern (Inselspital), Bern, Switzerland
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156
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Lohrke J, Frenzel T, Endrikat J, Alves FC, Grist TM, Law M, Lee JM, Leiner T, Li KC, Nikolaou K, Prince MR, Schild HH, Weinreb JC, Yoshikawa K, Pietsch H. 25 Years of Contrast-Enhanced MRI: Developments, Current Challenges and Future Perspectives. Adv Ther 2016; 33:1-28. [PMID: 26809251 PMCID: PMC4735235 DOI: 10.1007/s12325-015-0275-4] [Citation(s) in RCA: 225] [Impact Index Per Article: 28.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Indexed: 12/17/2022]
Abstract
UNLABELLED In 1988, the first contrast agent specifically designed for magnetic resonance imaging (MRI), gadopentetate dimeglumine (Magnevist(®)), became available for clinical use. Since then, a plethora of studies have investigated the potential of MRI contrast agents for diagnostic imaging across the body, including the central nervous system, heart and circulation, breast, lungs, the gastrointestinal, genitourinary, musculoskeletal and lymphatic systems, and even the skin. Today, after 25 years of contrast-enhanced (CE-) MRI in clinical practice, the utility of this diagnostic imaging modality has expanded beyond initial expectations to become an essential tool for disease diagnosis and management worldwide. CE-MRI continues to evolve, with new techniques, advanced technologies, and novel contrast agents bringing exciting opportunities for more sensitive, targeted imaging and improved patient management, along with associated clinical challenges. This review aims to provide an overview on the history of MRI and contrast media development, to highlight certain key advances in the clinical development of CE-MRI, to outline current technical trends and clinical challenges, and to suggest some important future perspectives. FUNDING Bayer HealthCare.
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Affiliation(s)
- Jessica Lohrke
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany
| | - Thomas Frenzel
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany
| | - Jan Endrikat
- Global Medical Affairs Radiology, Bayer HealthCare, Berlin, Germany
- Saarland University Hospital, Homburg, Germany
| | | | - Thomas M Grist
- Radiology, Medical Physics and Biomedical Engineering, University of Wisconsin, Madison, WI, USA
| | - Meng Law
- Radiology and Neurological Surgery, University of South California, Keck School of Medicine, USC University Hospital, Los Angeles, CA, USA
| | - Jeong Min Lee
- College of Medicine, Seoul National University Hospital, Seoul, South Korea
| | - Tim Leiner
- Radiology, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Kun-Cheng Li
- Radiology, Xuan Wu Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Konstantin Nikolaou
- Radiology, Ludwig-Maximilians University, University Hospitals, Munich, Germany
| | - Martin R Prince
- Radiology, Weill Cornell Medical College, New York, NY, USA
- Columbia College of Physicians and Surgeons, New York, NY, USA
| | | | | | - Kohki Yoshikawa
- Graduate Division of Medical Health Sciences, Graduate School of Komazawa University, Tokyo, Japan
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer HealthCare, Berlin, Germany.
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157
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Adin ME, Kleinberg L, Vaidya D, Zan E, Mirbagheri S, Yousem DM. REPLY. AJNR Am J Neuroradiol 2016; 37:E3-4. [PMID: 26494696 DOI: 10.3174/ajnr.a4608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M E Adin
- Division of Neuroradiology The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, Maryland
| | - L Kleinberg
- Department of Radiation Oncology and Radiation Molecular Sciences The Johns Hopkins Medical Institutions Baltimore, Maryland
| | - D Vaidya
- Johns Hopkins Bloomberg School of Public Health The Johns Hopkins Medical Institutions Baltimore, Maryland
| | - E Zan
- Division of Neuroradiology The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, Maryland
| | - S Mirbagheri
- Division of Neuroradiology The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, Maryland
| | - D M Yousem
- Division of Neuroradiology The Russell H. Morgan Department of Radiology and Radiological Science The Johns Hopkins Medical Institutions Baltimore, Maryland
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158
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Beomonte Zobel B, Quattrocchi CC, Errante Y, Grasso RF. Gadolinium-based contrast agents: did we miss something in the last 25 years? Radiol Med 2015; 121:478-81. [PMID: 26706453 DOI: 10.1007/s11547-015-0614-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 12/01/2015] [Indexed: 01/22/2023]
Abstract
In the last 24 months, several clinical and experimental studies, suggested first and demonstrated later, a progressive concentration of Gadolinium in the brain of normal renal function patients, following repeated injections of some of the commercially approved Gadolinium-Based Contrast Agents. Although, till now, Gadolinium brain deposits have not been associated to any kind of neurological signs or symptoms, they oblige the radiology community to modify the actual approach in using Gadolinium contrast media in daily practice, to reduce unknown possible risks for patients.
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Affiliation(s)
- Bruno Beomonte Zobel
- Department of Medicine, Unit of Diagnostic Imaging, Università Campus Bio-Medico di Roma, via Alvàro del Portillo 21, 00128, Rome, Italy.
| | - Carlo Cosimo Quattrocchi
- Department of Medicine, Unit of Diagnostic Imaging, Università Campus Bio-Medico di Roma, via Alvàro del Portillo 21, 00128, Rome, Italy
| | - Yuri Errante
- Department of Medicine, Unit of Diagnostic Imaging, Università Campus Bio-Medico di Roma, via Alvàro del Portillo 21, 00128, Rome, Italy
| | - Rosario Francesco Grasso
- Department of Medicine, Unit of Diagnostic Imaging, Università Campus Bio-Medico di Roma, via Alvàro del Portillo 21, 00128, Rome, Italy
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159
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Signal Change in the Dentate Nucleus on T1-Weighted MR Images After Multiple Administrations of Gadopentetate Dimeglumine Versus Gadobutrol. AJR Am J Roentgenol 2015; 206:414-9. [PMID: 26700156 DOI: 10.2214/ajr.15.15327] [Citation(s) in RCA: 138] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The objective of this study was to evaluate signal changes in the dentate nucleus on unenhanced T1-weighted MR images after multiple administrations of gadopentetate dimeglumine versus gadobutrol. MATERIALS AND METHODS Two study groups were identified, each of which included 25 consecutive patients. Each group received six or more administrations of either gadobutrol only or gadopentetate dimeglumine only, without having had exposure to any other gadolinium-based contrast agent (GBCA). The mean signal intensity (SI) in the dentate nucleus on unenhanced T1-weighted MR images was measured, with the use of the pons and the cerebellar peduncle as references to calculate the DNP SI ratio (i.e., the ratio of the SI in the dentate nucleus to the SI in the pons) and the DCP SI ratio (i.e., the ratio of the SI in the dentate nucleus to the SI in the cerebellar peduncle). RESULTS After six administrations of gadopentetate dimeglumine, the SI in the dentate nucleus on unenhanced T1-weighted MR images increased from a DCP SI ratio of 0.997 before administration to 1.034 after the last of six administrations (p = 0.0007) and then to 1.063 after all administrations (p = 0.0004). No statistically significant increase was noted in association with administration of gadobutrol, for which the DCP SI ratio was 0.995 before administration, 1.009 after the last of six administrations (p = 0.1172), and 0.992 after all administrations (p = 0.7592). The change in the DCP SI ratio after administration of gadopentetate dimeglumine correlated with the number of administrations the patient received (p < 0.0001). CONCLUSION Unenhanced T1 signal hyperintensity was observed in the dentate nucleus after multiple administrations of gadopentetate dimeglumine, a linear ionic agent, but not after multiple administrations of gadobutrol, a macrocyclic GBCA.
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160
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Ramalho J, Semelka RC, Ramalho M, Nunes RH, AlObaidy M, Castillo M. Gadolinium-Based Contrast Agent Accumulation and Toxicity: An Update. AJNR Am J Neuroradiol 2015; 37:1192-8. [PMID: 26659341 DOI: 10.3174/ajnr.a4615] [Citation(s) in RCA: 270] [Impact Index Per Article: 30.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
In current practice, gadolinium-based contrast agents have been considered safe when used at clinically recommended doses in patients without severe renal insufficiency. The causal relationship between gadolinium-based contrast agents and nephrogenic systemic fibrosis in patients with renal insufficiency resulted in new policies regarding the administration of these agents. After an effective screening of patients with renal disease by performing either unenhanced or reduced-dose-enhanced studies in these patients and by using the most stable contrast agents, nephrogenic systemic fibrosis has been largely eliminated since 2009. Evidence of in vivo gadolinium deposition in bone tissue in patients with normal renal function is well-established, but recent literature showing that gadolinium might also deposit in the brain in patients with intact blood-brain barriers caught many individuals in the imaging community by surprise. The purpose of this review was to summarize the literature on gadolinium-based contrast agents, tying together information on agent stability and animal and human studies, and to emphasize that low-stability agents are the ones most often associated with brain deposition.
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Affiliation(s)
- J Ramalho
- From the Departments of Neuroradiology (J.R., R.H.N., M.C.) Centro Hospitalar de Lisboa Central (J.R.), Lisbon, Portugal
| | - R C Semelka
- Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina
| | - M Ramalho
- Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina Hospital Garcia de Orta (M.R.), Almada, Portugal
| | - R H Nunes
- From the Departments of Neuroradiology (J.R., R.H.N., M.C.) Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina Santa Casa de Misericórdia de São Paulo (R.H.N.), São Paulo, Brazil
| | - M AlObaidy
- Radiology (R.C.S., M.R., R.H.N., M.A.), University of North Carolina Hospital, Chapel Hill, North Carolina King Faisal Specialist Hospital and Research Center (M.A.), Riyadh, Saudi Arabia
| | - M Castillo
- From the Departments of Neuroradiology (J.R., R.H.N., M.C.)
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161
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High-Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Images. Invest Radiol 2015; 50:805-10. [PMID: 26523910 DOI: 10.1097/rli.0000000000000227] [Citation(s) in RCA: 174] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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162
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Miller JH, Hu HH, Pokorney A, Cornejo P, Towbin R. MRI Brain Signal Intensity Changes of a Child During the Course of 35 Gadolinium Contrast Examinations. Pediatrics 2015; 136:e1637-40. [PMID: 26574593 DOI: 10.1542/peds.2015-2222] [Citation(s) in RCA: 89] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/24/2015] [Indexed: 11/24/2022] Open
Abstract
We describe the observed and quantitative signal intensity changes in the brain on baseline precontrast T1-weighted MRI data of a pediatric patient who received 35 MRI examinations with gadolinium-based contrast agent (GBCA) between the ages of 8 and 20 years. The contrast agent this patient received belongs to a class of agents with linear molecular structures, which has been recently investigated in studies of gadolinium deposition in the brains of adult patients. Visual changes in signal intensity were assessed by 3 pediatric neuroradiologists, and progressive increases were the most evident in the dentate nuclei, the globus pallidus, and the thalamus. Quantitative measurements as determined from signal intensity ratios confirmed visual findings. The pattern of regional brain hyperintensity observed in this pediatric patient is consistent with findings from adult studies.
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Affiliation(s)
- Jeffrey H Miller
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona; and Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona
| | - Houchun H Hu
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Amber Pokorney
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona; and
| | - Richard Towbin
- Department of Radiology, Phoenix Children's Hospital, Phoenix, Arizona; and Department of Child Health, University of Arizona College of Medicine, Phoenix, Arizona
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Giorgi H, Ammerman J, Briffaux JP, Fretellier N, Corot C, Bourrinet P. Non-clinical safety assessment of gadoterate meglumine (Dotarem®) in neonatal and juvenile rats. Regul Toxicol Pharmacol 2015; 73:960-70. [DOI: 10.1016/j.yrtph.2015.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 09/10/2015] [Accepted: 09/12/2015] [Indexed: 11/27/2022]
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164
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Kanda T, Oba H, Toyoda K, Kitajima K, Furui S. Brain gadolinium deposition after administration of gadolinium-based contrast agents. Jpn J Radiol 2015; 34:3-9. [PMID: 26608061 DOI: 10.1007/s11604-015-0503-5] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/09/2015] [Indexed: 01/05/2023]
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165
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Increased Signal Intensity in the Dentate Nucleus on Unenhanced T1-Weighted Images After Gadobenate Dimeglumine Administration. Invest Radiol 2015; 50:743-8. [PMID: 26352749 DOI: 10.1097/rli.0000000000000206] [Citation(s) in RCA: 144] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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166
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Vaneckova M, Herman M, Smith MP, Mechl M, Maravilla KR, Weichet J, Spampinato MV, Žižka J, Wippold FJ, Baima JJ, Babbel R, Bültmann E, Huang RY, Buhk JH, Bonafé A, Colosimo C, Lui S, Kirchin MA, Shen N, Pirovano G, Spinazzi A. The Benefits of High Relaxivity for Brain Tumor Imaging: Results of a Multicenter Intraindividual Crossover Comparison of Gadobenate Dimeglumine with Gadoterate Meglumine (The BENEFIT Study). AJNR Am J Neuroradiol 2015; 36:1589-98. [PMID: 26185325 DOI: 10.3174/ajnr.a4468] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Gadobenate dimeglumine (MultiHance) has higher r1 relaxivity than gadoterate meglumine (Dotarem) which may permit the use of lower doses for MR imaging applications. Our aim was to compare 0.1- and 0.05-mmol/kg body weight gadobenate with 0.1-mmol/kg body weight gadoterate for MR imaging assessment of brain tumors. MATERIALS AND METHODS We performed crossover, intraindividual comparison of 0.1-mmol/kg gadobenate with 0.1-mmol/kg gadoterate (Arm 1) and 0.05-mmol/kg gadobenate with 0.1-mmol/kg gadoterate (Arm 2). Adult patients with suspected or known brain tumors were randomized to Arm 1 (70 patients) or Arm 2 (107 patients) and underwent 2 identical examinations at 1.5 T. The agents were injected in randomized-sequence order, and the 2 examinations were separated by 2-14 days. MR imaging scanners, imaging sequences (T1-weighted spin-echo and T1-weighted high-resolution gradient-echo), and acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images for diagnostic information (degree of definition of lesion extent, lesion border delineation, visualization of lesion internal morphology, contrast enhancement) and quantitatively for percentage lesion enhancement and lesion-to-background ratio. Safety assessments were performed. RESULTS In Arm 1, a highly significant superiority (P < .002) of 0.1-mmol/kg gadobenate was demonstrated by all readers for all end points. In Arm 2, no significant differences (P > .1) were observed for any reader and any end point, with the exception of percentage enhancement for reader 2 (P < .05) in favor of 0.05-mmol/kg gadobenate. Study agent-related adverse events were reported by 2/169 (1.2%) patients after gadobenate and by 5/175 (2.9%) patients after gadoterate. CONCLUSIONS Significantly superior morphologic information and contrast enhancement are demonstrated on brain MR imaging with 0.1-mmol/kg gadobenate compared with 0.1-mmol/kg gadoterate. No meaningful differences were recorded between 0.05-mmol/kg gadobenate and 0.1-mmol/kg gadoterate.
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Affiliation(s)
- M Vaneckova
- From the Charles University in Prague (M.V.), First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - M Herman
- University Hospital Olomouc (M.H.), Olomouc, Czech Republic
| | - M P Smith
- Beth Israel Deaconess Medical Center (M.P.S.), Boston, Massachusetts
| | - M Mechl
- Faculty of Medicine (M.M.), University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - K R Maravilla
- MR Research Laboratory (K.R.M.), University of Washington, Seattle, Washington
| | - J Weichet
- Na Homolce Hospital (J.W.), Prague, Czech Republic
| | - M V Spampinato
- Department of Radiology and Radiological Science (M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - J Žižka
- University Faculty of Medicine in Hradec Králové (J.Ž.), University Hospital Hradec Králové and Charles University in Prague, Prague, Czech Republic
| | - F J Wippold
- Mallinckrodt Institute of Radiology (F.J.W.), Washington University School of Medicine, St. Louis, Missouri
| | - J J Baima
- Clinical Radiologists, S.C. (J.J.B.), Springfield, Illinois
| | - R Babbel
- Good Samaritan Regional Medical Center (R.B.), Corvallis, Oregon
| | - E Bültmann
- Institute of Diagnostic and Interventional Neuroradiology (E.B.), Hannover, Germany
| | - R Y Huang
- Harvard Medical School (R.Y.H.), Brigham and Women's Hospital, Boston, Massachusetts
| | - J-H Buhk
- University Medical Center Hamburg Eppendorf (J.-H.B.), Hamburg, Germany
| | - A Bonafé
- Hopital Gui de Chauliac (A.B.), Montpellier, France
| | - C Colosimo
- Policlinico "Agostino Gemelli" (C.C.), Rome, Italy
| | - S Lui
- West China Hospital of Sichuan University (S.L.), Chengdu, Sichuan, China
| | - M A Kirchin
- Global Medical & Regulatory Affairs (M.A.K.), Bracco Imaging S.p.A., Milan, Italy
| | - N Shen
- Global Medical & Regulatory Affairs (N.S., G.P., A.S.), Bracco Diagnostics, Monroe, New Jersey
| | - G Pirovano
- Global Medical & Regulatory Affairs (N.S., G.P., A.S.), Bracco Diagnostics, Monroe, New Jersey
| | - A Spinazzi
- Global Medical & Regulatory Affairs (N.S., G.P., A.S.), Bracco Diagnostics, Monroe, New Jersey
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167
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Robert P, Lehericy S, Grand S, Violas X, Fretellier N, Idée JM, Ballet S, Corot C. T1-Weighted Hypersignal in the Deep Cerebellar Nuclei After Repeated Administrations of Gadolinium-Based Contrast Agents in Healthy Rats: Difference Between Linear and Macrocyclic Agents. Invest Radiol 2015; 50:473-80. [PMID: 26107651 PMCID: PMC4494686 DOI: 10.1097/rli.0000000000000181] [Citation(s) in RCA: 210] [Impact Index Per Article: 23.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 05/02/2015] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To prospectively compare in healthy rats the effect of multiple injections of macrocyclic (gadoterate meglumine) and linear (gadodiamide) gadolinium-based contrast agents (GBCAs) on T1-weighted signal intensity in the deep cerebellar nuclei (DCN), including the dentate nucleus. MATERIALS AND METHODS Healthy rats (n = 7/group) received 20 intravenous injections of 0.6 mmol of gadolinium (Gd) per kilogram (4 injections per week during 5 weeks) of gadodiamide, gadoterate meglumine, or hyperosmolar saline (control group). Brain T1-weighted magnetic resonance imaging was performed before and once a week during the 5 weeks of injections and during 5 additional weeks (treatment-free period). Gadolinium concentrations were measured with inductively coupled plasma mass spectrometry in plasma and brain. Blinded qualitative and quantitative evaluations of the T1 signal intensity in DCN were performed, as well as a statistical analysis on quantitative data. RESULTS A significant and persistent T1 signal hyperintensity in DCN was observed only in gadodiamide-treated rats. The DCN-to-cerebellar cortex signal ratio was significantly increased from the 12th injection of gadodiamide (1.070 ± 0.024) compared to the gadoterate meglumine group (1.000 ± 0.033; P < 0.001) and control group (1.019 ± 0.022; P < 0.001) and did not significantly decrease during the treatment-free period. Total Gd concentrations in the gadodiamide group were significantly higher in the cerebellum (3.66 ± 0.91 nmol/g) compared with the gadoterate meglumine (0.26 ± 0.12 nmol/g; P < 0.05) and control (0.06 ± 0.10 nmol/g; P < 0.05) groups. CONCLUSIONS Repeated administrations of the linear GBCA gadodiamide to healthy rats are associated with progressive and persistent T1 signal hyperintensity in the DCN, with Gd deposition in the cerebellum in contrast with the macrocyclic GBCA gadoterate meglumine for which no effect was observed.
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Affiliation(s)
- Philippe Robert
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Stéphane Lehericy
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Sylvie Grand
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Xavier Violas
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Nathalie Fretellier
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Jean-Marc Idée
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Sébastien Ballet
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
| | - Claire Corot
- From the *Guerbet Research and Innovation Department, Aulnay-sous-Bois; †Institut du Cerveau et de la Moelle Epinière (ICM), Centre de Neuroimagerie de Recherche (CENIR), Paris, France; Sorbonne Universités, Université Pierre et Marie Curie-Paris 6, INSERM UMR-S1127, CNRS 7225, Paris; Service de Neuroradiologie, Hôpital de la Pitié-Salpêtrière, Paris, France; and ‡INSERM, U836, Grenoble, France; Université Grenoble Alpes, Grenoble Institute of Neurosciences, Grenoble, France
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