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Kim PH, Hwang JY, Choi YH, Yoon HM, Lee CW. Safety of Gadoxetate Disodium for Hepatobiliary MRI in Children and Adolescents. Radiology 2024; 311:e232462. [PMID: 38860893 DOI: 10.1148/radiol.232462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2024]
Abstract
Background Despite a proven role in the characterization of liver lesions, use of the gadolinium-based contrast agent (GBCA) gadoxetate disodium at MRI is limited in children due to a lack of comparative safety data. Purpose To evaluate the safety of the GBCA gadoxetate disodium (a linear ionic hepatobiliary contrast agent [HBA]) in children and adolescents, compared with extracellular contrast agents (ECA). Materials and Methods A retrospective analysis was conducted in children and adolescents aged 18 years or younger who underwent HBA-enhanced MRI at one of three tertiary hospitals from January 2010 to December 2022. The incidence of GBCA-associated acute adverse events was compared between MRI examinations with a HBA and those with ECA. Severity was categorized according to American College of Radiology guidelines (mild, moderate, or severe). (a) Propensity score matching using multivariable logistic regression models and (b) inverse probability of treatment weighting analysis based on nine covariates (age, sex, asthma, allergic rhinitis, chronic urticaria or atopy, food allergy, drug allergy, premedication, and history of GBCA-associated adverse events) were used for confounder adjustment. Results A total of 1629 MRI examinations (ECA, n = 1256; HBA, n = 373) in 1079 patients were included (mean age, 8.6 years ± 6.5; 566 girls). The per-examination incidence of GBCA-associated acute adverse events showed no evidence of a difference, with rates of 0.9% (11 of 1256 examinations) for ECA and 1.3% (five of 373 examinations) for HBA (odds ratio [OR], 1.55 [95% CI: 0.54, 4.46]; P = .42). Acute adverse events were all mild with ECA, whereas with HBA, they were mild for four patients and moderate for one patient. There was no evidence of a difference in the incidence of acute adverse events, even in propensity score matching (OR, 1.33 [95% CI: 0.30, 5.96]; P = .71) and inverse probability of treatment weighting analysis (OR, 0.84 [95% CI: 0.25, 2.86]; P = .78). Conclusion Gadoxetate disodium showed no difference in acute adverse events compared with ECA in children and adolescents, with further large-scale pediatric studies required to confirm its safety. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Otero in this issue.
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Affiliation(s)
- Pyeong Hwa Kim
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Jae-Yeon Hwang
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Young Hun Choi
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Hee Mang Yoon
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
| | - Choong Wook Lee
- From the Department of Radiology and Research Institute of Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea (P.H.K., H.M.Y., C.W.L.); Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul 03080, Republic of Korea (J.Y.H., Y.H.C.); and Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Republic of Korea (J.Y.H.)
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Ramirez-Suarez KI, Tierradentro-García LO, Otero HJ, Rapp JB, White AM, Partington SL, Harris MA, Vatsky SA, Whitehead KK, Fogel MA, Biko DM. Optimizing neonatal cardiac imaging (magnetic resonance/computed tomography). Pediatr Radiol 2022; 52:661-675. [PMID: 34657169 DOI: 10.1007/s00247-021-05201-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 07/28/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
Magnetic resonance imaging (MRI) and CT perform an important role in the evaluation of neonates with congenital heart disease (CHD) when echocardiography is not sufficient for surgical planning or postoperative follow-up. Cardiac MRI and cardiac CT have complementary applications in the evaluation of cardiovascular disease in neonates. This review focuses on the indications and technical aspects of these modalities and special considerations for imaging neonates with CHD.
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Affiliation(s)
- Karen I Ramirez-Suarez
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA, 19146, USA. .,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Luis Octavio Tierradentro-García
- Roberts Center for Pediatric Research, Children's Hospital of Philadelphia, 734 Schuylkill Ave, Philadelphia, PA, 19146, USA.,Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Hansel J Otero
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Jordan B Rapp
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Ammie M White
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Sara L Partington
- Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Matthew A Harris
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Seth A Vatsky
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
| | - Kevin K Whitehead
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Mark A Fogel
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA.,Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - David M Biko
- Department of Radiology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.,Perelman School of Medicine at The University of Pennsylvania, Philadelphia, PA, USA
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3
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Snoderly HT, Freshwater KA, Martinez de la Torre C, Panchal DM, Vito JN, Bennewitz MF. PEGylation of Metal Oxide Nanoparticles Modulates Neutrophil Extracellular Trap Formation. BIOSENSORS 2022; 12:123. [PMID: 35200382 PMCID: PMC8869785 DOI: 10.3390/bios12020123] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 02/04/2022] [Accepted: 02/13/2022] [Indexed: 06/01/2023]
Abstract
Novel metal oxide nanoparticle (NP) contrast agents may offer safety and functionality advantages over conventional gadolinium-based contrast agents (GBCAs) for cancer diagnosis by magnetic resonance imaging. However, little is known about the behavior of metal oxide NPs, or of their effect, upon coming into contact with the innate immune system. As neutrophils are the body's first line of defense, we sought to understand how manganese oxide and iron oxide NPs impact leukocyte functionality. Specifically, we evaluated whether contrast agents caused neutrophils to release web-like fibers of DNA known as neutrophil extracellular traps (NETs), which are known to enhance metastasis and thrombosis in cancer patients. Murine neutrophils were treated with GBCA, bare manganese oxide or iron oxide NPs, or poly(lactic-co-glycolic acid) (PLGA)-coated metal oxide NPs with different incorporated levels of poly(ethylene glycol) (PEG). Manganese oxide NPs elicited the highest NETosis rates and had enhanced neutrophil uptake properties compared to iron oxide NPs. Interestingly, NPs with low levels of PEGylation produced more NETs than those with higher PEGylation. Despite generating a low rate of NETosis, GBCA altered neutrophil cytokine expression more than NP treatments. This study is the first to investigate whether manganese oxide NPs and GBCAs modulate NETosis and reveals that contrast agents may have unintended off-target effects which warrant further investigation.
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Affiliation(s)
| | | | | | | | | | - Margaret F. Bennewitz
- Department of Chemical and Biomedical Engineering, West Virginia University, Morgantown, WV 26506, USA; (H.T.S.); (K.A.F.); (C.M.d.l.T.); (D.M.P.); (J.N.V.)
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4
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Chavhan GB, Farras Roca L, Coblentz AC. Liver magnetic resonance imaging: how we do it. Pediatr Radiol 2022; 52:167-176. [PMID: 33797616 DOI: 10.1007/s00247-021-05053-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Revised: 02/04/2021] [Accepted: 03/16/2021] [Indexed: 11/26/2022]
Abstract
Magnetic resonance imaging is used for evaluating focal liver lesions, hepatic vascular diseases, biliary diseases and diffuse liver diseases in children. MRI examinations take a long time, often requiring sedation or anesthesia in smaller children. This makes it essential to understand the concepts and technique necessary to obtain an optimal examination for answering the clinical question while minimizing the need for sedation/anesthesia. We discuss key concepts including appropriate sequence selection, choice of contrast media, dynamic imaging, phases of contrast enhancement and protocol organization.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Lara Farras Roca
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Ailish C Coblentz
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., Toronto, ON, M5G 1X8, Canada.
- Department of Medical Imaging, University of Toronto, Toronto, ON, Canada.
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5
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DeLano MC, Spampinato MV, Chang EY, Barr RG, Lichtenstein RJ, Colosimo C, Vymazal J, Wen Z, Lin DDM, Kirchin MA, Pirovano G. Dose-Lowering in Contrast-Enhanced MRI of the Central Nervous System: A Retrospective, Parallel-Group Comparison Using Gadobenate Dimeglumine. J Magn Reson Imaging 2021; 54:1660-1675. [PMID: 34018290 PMCID: PMC9290706 DOI: 10.1002/jmri.27731] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/05/2021] [Accepted: 05/07/2021] [Indexed: 11/16/2022] Open
Abstract
Background Concerns over gadolinium (Gd) retention encourage the use of lower Gd doses. However, lower Gd doses may compromise imaging performance. Higher relaxivity gadobenate may be suited to reduced dose protocols. Purpose To compare 0.05 mmol/kg and 0.1 mmol/kg gadobenate in patients undergoing enhanced MRI of the central nervous system (CNS). Study Type Retrospective, multicenter. Population Three hundred and fifty‐two patients receiving 0.05 (n = 181) or 0.1 (n = 171) mmol/kg gadobenate. Field Strength/Sequences 1.5 T and 3.0 T/precontrast and postcontrast T1‐weighted spin echo/fast spin echo (SE/FSE) and/or gradient echo/fast field echo (GRE/FFE); precontrast T2‐weighted FSE and T2‐FLAIR. Assessment Images of patients with extra‐axial lesions at 1.5 T or any CNS lesion at 3.0 T were reviewed by three blinded, independent neuroradiologists for qualitative (lesion border delineation, internal morphology visualization, contrast enhancement; scores from 1 = poor to 4 = excellent) and quantitative (lesion‐to‐brain ratio [LBR], contrast‐to‐noise ratio [CNR]; SI measurements at regions‐of‐interest on lesion and normal parenchyma) enhancement measures. Noninferiority of 0.05 mmol/kg gadobenate was determined for each qualitative endpoint if the lower limit of the 95% confidence interval (CI) for the difference in precontrast + postcontrast means was above a noninferiority margin of −0.4. Statistical Tests Student's t‐test for comparison of mean qualitative endpoint scores, Wilcoxon signed rank test for comparison of LBR and CNR values; Wilcoxon rank sum test for comparison of SI changes. Tests were significant for P < 0.05. Results The mean change from precontrast to precontrast + postcontrast was significant for all endpoints. Readers 1, 2, and 3 evaluated 304, 225, and 249 lesions for 0.05 mmol/kg gadobenate, and 382, 309, and 298 lesions for 0.1 mmol/kg gadobenate. The lower limit of the 95% CI was above −0.4 for all comparisons. Significantly, higher LBR and CNR was observed with the higher dose. Data Conclusion 0.05 mmol/kg gadobenate was noninferior to 0.1 mmol/kg gadobenate for lesion visualization. Evidence Level 2 Technical Efficacy Stage 3
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Affiliation(s)
- Mark C DeLano
- Spectrum Health System, Advanced Radiology Services PC, Division of Radiology and Biomedical Imaging, College of Human Medicine, Michigan State University, Michigan, USA
| | - Maria Vittoria Spampinato
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Eric Y Chang
- Radiology Service, VA San Diego Healthcare System, San Diego, California, USA
| | - Richard G Barr
- Department of Radiology, Rootstown, Northeastern Ohio Medical University, Rootstown, Ohio, USA
| | | | - Cesare Colosimo
- Institute of Radiology, Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy
| | - Josef Vymazal
- Department of Radiology, Na Homolce Hospital, Prague, Czech Republic
| | - Zhibo Wen
- Department of Radiology, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Doris D M Lin
- Division of Neuroradiology, Russell H. Morgan Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Miles A Kirchin
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Milan, Italy
| | - Gianpaolo Pirovano
- Global Medical & Regulatory Affairs, Bracco Diagnostics Inc., Monroe, New Jersey, USA
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6
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Enterline DS, Martin KW, Parmar HA, Triulzi FM, Colosimo C. Safety and Diagnostic Efficacy of Gadobenate Dimeglumine in MRI of the Brain and Spine of Neonates and Infants. AJNR Am J Neuroradiol 2019; 40:2001-2009. [PMID: 31727753 DOI: 10.3174/ajnr.a6319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced MR imaging provides essential information for pediatric imaging applications. We evaluated gadobenate dimeglumine for contrast-enhanced MR imaging of infants younger than 2 years of age. MATERIALS AND METHODS Ninety children younger than 2 years of age (including 55 children younger than 1 year) who underwent enhanced MR imaging of the CNS with gadobenate dimeglumine at 0.1 mmol/kg body weight ± 25% by volume were retrospectively enrolled at 2 imaging centers. Safety data were assessed for adverse events and, when available, vital signs and electrocardiogram and clinical laboratory values obtained from 48 hours before until 48 hours after the MR imaging examination. The efficacy of gadobenate dimeglumine-enhanced MR imaging was evaluated prospectively by 3 blinded, unaffiliated readers in terms of the accuracy of combined pre- and postcontrast images relative to precontrast images alone for differentiation of tumor from non-neoplastic disease and the correct diagnosis of specific disease. Differences were tested using the McNemar test. A possible effect of dose on diagnostic accuracy was assessed using the Fisher exact test. RESULTS Nine nonserious adverse events were reported for 8 (8.8%) patients. Five adverse events occurred in patients 12 months of age or older. All events occurred at least 24 hours after gadobenate dimeglumine administration, and in each case, the investigating radiologist considered that there was no reasonable possibility of a relationship to gadobenate dimeglumine. No clinically meaningful changes in vital signs, electrocardiogram results, or laboratory parameters were reported. Accurate differentiation of tumor from non-neoplastic disease and exact matching of each specific MR imaging-determined diagnosis with the on-site final diagnosis were achieved in significantly more patients by each reader following evaluation of combined pre- and postcontrast images relative to precontrast images alone (91.0%-94.4% versus 75.3%-87.6%, P < .04, and 66.3%-73.0% versus 52.8%-58.4%, P < .02, respectively). No significant differences (P > .133) in diagnostic accuracy were noted between patients receiving ≤0.08 mmol/kg of gadobenate dimeglumine and patients receiving >0.08 mmol/kg of gadobenate dimeglumine. CONCLUSIONS Gadobenate dimeglumine is safe and effective for pediatric MR imaging.
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Affiliation(s)
- D S Enterline
- From the Department of Radiology (D.S.E.), Duke University, Durham, North Carolina
| | - K W Martin
- Department of Diagnostic Imaging (K.W.M.), University of California, San Francisco, Benioff Children's Hospital, Oakland, California
| | - H A Parmar
- Department of Radiology (H.A.P.), University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - F M Triulzi
- Department of Neuroradiology (F.M.T.), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinic, Milan, Italy
| | - C Colosimo
- Radiodiagnostica e Neuroradiologia (C.C.), Institute of Radiology, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
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Use and Safety of Gadolinium Based Contrast Agents in Pediatric MR Imaging. Indian J Pediatr 2019; 86:961-966. [PMID: 30796704 DOI: 10.1007/s12098-019-02891-x] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Accepted: 01/28/2019] [Indexed: 01/23/2023]
Abstract
Gadolinium-based contrast agents (GBCA) used for MR imaging are a valuable imaging resource that has benefited patient management over last three decades and largely have a high safety profile. However, recently, adverse effects related to GBCA like nephrogenic systemic fibrosis (NSF) and asymptomatic gadolinium deposition in tissues including brain are concerning. While NSF has largely stopped occurring due to precautions and guidelines to not use GBCA in patients with poor renal function, the long term effects of gadolinium deposition, especially in brain, are not known at this stage. Cautious approach needs to be taken with risk-benefit analysis in each patient to avoid its administration when not necessary. In this review, authors discuss basics of gadolinium, mechanism of enhancement, agents in clinical use and safety issues, and in the end, offer some solutions for safety concerns.
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8
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Metal-Based Complexes as Pharmaceuticals for Molecular Imaging of the Liver. Pharmaceuticals (Basel) 2019; 12:ph12030137. [PMID: 31527492 PMCID: PMC6789861 DOI: 10.3390/ph12030137] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Revised: 09/09/2019] [Accepted: 09/11/2019] [Indexed: 12/13/2022] Open
Abstract
This article reviews the use of metal complexes as contrast agents (CA) and radiopharmaceuticals for the anatomical and functional imaging of the liver. The main focus was on two established imaging modalities: magnetic resonance imaging (MRI) and nuclear medicine, the latter including scintigraphy and positron emission tomography (PET). The review provides an overview on approved pharmaceuticals like Gd-based CA and 99mTc-based radiometal complexes, and also on novel agents such as 68Ga-based PET tracers. Metal complexes are presented by their imaging modality, with subsections focusing on their structure and mode of action. Uptake mechanisms, metabolism, and specificity are presented, in context with advantages and limitations of the diagnostic application and taking into account the respective imaging technique.
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Ayyala RS, Anupindi SA, Gee MS, Trout AT, Callahan MJ. Intravenous gadolinium-based hepatocyte-specific contrast agents (HSCAs) for contrast-enhanced liver magnetic resonance imaging in pediatric patients: what the radiologist should know. Pediatr Radiol 2019; 49:1256-1268. [PMID: 31350632 DOI: 10.1007/s00247-019-04476-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/13/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
Hepatocyte-specific contrast agents (HSCAs) are a group of intravenous gadolinium-based MRI contrast agents that can be used to characterize hepatobiliary pathology. The mechanism by which these agents are taken up by hepatocytes and partially excreted into the biliary tree improves characterization of hepatic lesions and biliary abnormalities relative to conventional extracellular gadolinium-based contrast agents (GBCAs). This manuscript presents an overview of HSCA use in pediatric patients with the intent to provide radiologists a guide for clinical use. We review available HSCAs and discuss dosing and age specifications for use in children. We also review various hepatic and biliary indications for HSCA use in children, with emphasis on the imaging characteristics distinct to HSCAs, as well as discussion of pitfalls one can encounter when imaging with HSCAs. Given the growing concern regarding gadolinium deposition in soft tissues and brain, we also discuss safety of HSCA use in children.
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Affiliation(s)
- Rama S Ayyala
- Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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10
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Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium-based contrast agents - review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients. Pediatr Radiol 2019; 49:448-457. [PMID: 30923876 DOI: 10.1007/s00247-018-4304-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Gadolinium has been used as a base for contrast agents in MRI for the last three decades. Numerous studies over the last 4 years have reported increased signal intensity in deep brain nuclei in non-contrast MRI images following gadolinium-based contrast agent (GBCA) administration. Pathology studies performed on adults and children, and rodent necropsy studies have also shown gadolinium deposition in brain and other tissues after GBCA administration. The purpose of this review was to summarize and discuss the knowledge gained from these reports and the relevance for imaging pediatric patients.
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Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 111E 210th St, Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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11
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Maloney E, Iyer RS, Phillips GS, Menon S, Lee JJ, Callahan MJ. Practical administration of intravenous contrast media in children: screening, prophylaxis, administration and treatment of adverse reactions. Pediatr Radiol 2019; 49:433-447. [PMID: 30923875 DOI: 10.1007/s00247-018-4306-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/14/2018] [Accepted: 11/02/2018] [Indexed: 12/28/2022]
Abstract
Administration of intravenous contrast media to children is a routine practice at many clinical imaging centers, that can involve special considerations. In this paper, we provide practical information to facilitate optimal performance and oversight of this task. We provide targeted screening questions that can help to identify high-risk pediatric patients for both iodine-based and gadolinium-based intravenous contrast media administration. These include children at risk for allergic-like reactions, thyroid dysfunction, contrast-induced nephropathy, and nephrogenic systemic fibrosis. We make recommendations for addressing "yes" responses to screening questions using risk stratification schema that are specific to children. We also present criteria for selecting children for premedication prior to intravenous contrast administration, and suggest pediatric regimens. Additionally, we discuss practical nuances of intravenous contrast media administration to children and provide a quick-reference table of appropriate treatments with pediatric dosages for adverse contrast reactions.
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Affiliation(s)
- Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Grace S Phillips
- Department of Radiology, Seattle Children's Hospital, 4800 Sand Point Way NE, Seattle, WA, 98105, USA
| | - Shina Menon
- Division of Nephrology, Seattle Children's Hospital, Seattle, WA, USA
| | - John J Lee
- Division of Allergy and Immunology, Boston Children's Hospital, Boston, MA, USA
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12
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Xiao MJ, Xiao EH. Staging of liver fibrosis using Gd-EOB-DTPA and Gd-BOPTA enhanced magnetic resonance imaging. Shijie Huaren Xiaohua Zazhi 2018; 26:1907-1913. [DOI: 10.11569/wcjd.v26.i33.1907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The severity of cirrhosis is closely related to its clinical treatment. Therefore, it is important to stage liver fibrosis accurately. Although liver biopsy can accurately stage the degree of cirrhosis, it has certain limitations in clinical application because of its invasive nature. Magnetic resonance imaging (MRI) has been used in the diagnosis of liver diseases. In recent years, two new contrast agents, gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB-DTPA) and gadobenate dimeglumine (Gd-BOPTA), have been successfully used for noninvasive liver imaging. They can be used for liver fibrosis staging and assessment of liver function. Cirrhotic patients with different liver function levels have a statistical difference in the liver parenchyma enhancement after giving contrast agents. This article briefly summarizes the progress of Gd-EOB-DTPA and Gd-BOPTA enhanced MRI in staging liver fibrosis stage.
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Affiliation(s)
- Man-Jun Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
| | - En-Hua Xiao
- Department of Radiology, Second Xiangya Hospital, Central South University, Changsha 410011, Hunan Province, China
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Nouh MR, El-Shazly MA. Radiographic and magnetic resonances contrast agents: Essentials and tips for safe practices. World J Radiol 2017; 9:339-349. [PMID: 29098067 PMCID: PMC5658629 DOI: 10.4329/wjr.v9.i9.339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 06/14/2017] [Accepted: 06/20/2017] [Indexed: 02/06/2023] Open
Abstract
With extended and continued expansion of medical imaging utilization in modern medical practice over last decade, radiologists as well as other faculty staff dealing with radiographic and magnetic resonances contrast media (CM) have to be well oriented with their potential hypersensitivity reactions and recognize high-risk groups liable to develop it and enable early recognition. Radiologists and other medical staff involved in administration and dealing with CM have to be ready to implement prompt, practical and effective management plan to deal with these scenarios should they emerge. Strategies to prevent potential contrast-induced acute and delayed renal injuries have to be routinely exercised. Paying attention to the pregnant and nursing women, pediatrics, diabetics, as well as other fragile populations is of utmost importance for patient safety during contrast administrations. Radiologists should play a pivotal role in orienting patients about necessity to use CM for their imaging studies, in case it is needed, and assure them about its safety. Moreover, they have to be oriented with the medico-legal issues related to use of CM. These will pay as improved patient safety as well as safe daily working environmentat different levels of radiology practices.
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Affiliation(s)
- Mohamed R Nouh
- Department of Radiology and Clinical Imaging, Faculty of Medicine, Alexandria University, Alexandria 21563, Egypt
| | - Mohamed A El-Shazly
- Department of Radiology and Clinical Imaging, Faculty of Medicine, Al-Azhar University, Cairo 11651, Egypt
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Bedoya MA, White AM, Edgar JC, Pradhan M, Raab EL, Meyer JS. Effect of Intravenous Administration of Contrast Media on Serum Creatinine Levels in Neonates. Radiology 2017; 284:530-540. [DOI: 10.1148/radiol.2017160895] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- Maria A. Bedoya
- From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.)
| | - Ammie M. White
- From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.)
| | - J. Christopher Edgar
- From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.)
| | - Madhura Pradhan
- From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.)
| | - Elisabeth L. Raab
- From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.)
| | - James S. Meyer
- From the Departments of Radiology (M.A.B., A.M.W., J.C.E., J.S.M.) and Pediatrics, Division of Nephrology (M.P.), Perelman School of Medicine at the University of Pennsylvania, Children’s Hospital of Philadelphia, 34th and Civic Center Blvd, Philadelphia, PA 19104; and Hospital Neonatal Intensive Care Unit, Pediatric Medical Group, Huntington Memorial Hospital, Pasadena, Calif (E.L.R.)
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Abstract
PURPOSE OF REVIEW Spurred by numerous recent technological advances, cardiac MRI (CMR) is now the gold standard for anatomic evaluation, quantitative assessment of chamber size and function, flow quantification, and tissue characterization. This review focuses on recent advances in pediatric and congenital CMR, highlighting recent safety data, and discussing future directions. RECENT FINDINGS CMR has become an important component of risk stratification and procedural planning in numerous congenital and pediatric heart diseases. Innovative approaches to image acquisition and reconstruction are leading the way toward fast, high-resolution, three- and four-dimensional datasets for delineation of cardiac anatomy, function, and flow. In addition, techniques for assessing the composition of the myocardium may help elucidate the pathophysiology of late complications, identify patients at risk for heart failure, and assist in the evaluation of therapeutic strategies. SUMMARY CMR provides invaluable morphologic, hemodynamic, and functional data that help guide diagnosis, assessment, and management of pediatric and adult congenital heart disease. As imaging techniques advance and data accumulate on the relative and additive value of CMR in patient care, its role in a multimodality approach to the care of this population of patients is becoming clear and is likely to continue to evolve.
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Pharmacokinetics and Safety of Macrocyclic Gadobutrol in Children Aged Younger Than 2 Years Including Term Newborns in Comparison to Older Populations. Invest Radiol 2016; 51:50-7. [PMID: 26340504 DOI: 10.1097/rli.0000000000000204] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES This clinical study evaluated the pharmacokinetics (PK) and safety data of macrocyclic extracellular contrast agent gadobutrol in pediatric subjects aged younger than 2 years. MATERIALS AND METHODS Pediatric subjects (term newborns to those aged younger than 2 years) with normal renal function undergoing magnetic resonance imaging with gadobutrol (0.1 mmol/kg body weight [BW]) were prospectively enrolled in this open-label, multicenter clinical trial to evaluate PK as a primary end point. Plasma PK was analyzed using a population-based PK approach. Safety and qualitative efficacy (evaluation of images) were secondary end points. Safety and tolerability were assessed throughout study participation (approximately 7 days). Imaging efficacy variables were assessed by investigators. RESULTS Forty-four subjects were evaluated for safety and efficacy; 43 subjects were eligible for PK evaluation including 9 term newborns and infants aged younger than 2 months. Gadobutrol PK in pediatric subjects aged younger than 2 years were adequately described by a linear 2-compartmental model with elimination from the central compartment. Total median systemic exposure (area under the curve) of gadobutrol was estimated at 776 μmol · h/L (range, 544-1470 μmol · h/L). Simulated median concentration at 20 minutes after injection of gadobutrol (C20) was 339 μmol/L (range, 230-456 μmol/L). Safety and tolerability profile were similar to older populations. In 1 subject (2.3%), vomiting was reported as a mild adverse event related to gadobutrol, and there were no reported serious adverse events. The evaluation of gadobutrol-enhanced images provided improved diagnosis, increased confidence in diagnosis, and contributed to subject clinical management. CONCLUSIONS The PK profile of gadobutrol in children aged younger than 2 years including newborns is similar to that in older children and adults. At the dose of 0.1 mmol/kg BW, gadobutrol had a favorable safety profile and was well tolerated with similar profile across the age range 0 to younger than 2 years and compared with older children and adults. Extrapolation of efficacy data from adults to the younger pediatric population, including term newborns, is justified. The recommended standard dose of gadobutrol (0.1 mmol/kg BW), as used in the population aged 2 years and older, is also appropriate in children aged younger than 2 years.
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Endrikat J, Vogtlaender K, Dohanish S, Balzer T, Breuer J. Safety of Gadobutrol: Results From 42 Clinical Phase II to IV Studies and Postmarketing Surveillance After 29 Million Applications. Invest Radiol 2016; 51:537-43. [PMID: 26964075 PMCID: PMC4982758 DOI: 10.1097/rli.0000000000000270] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Accepted: 01/28/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this study was to provide a systematic safety analysis of gadobutrol after more than 29 million applications in clinical routine. MATERIALS AND METHODS Forty-two clinical development phase II to IV studies on gadobutrol or comparator and the postmarketing safety surveillance database for gadobutrol (1998-2015) were analyzed. Adverse events (AEs) and drug-related AEs were evaluated in the clinical development database and spontaneous adverse drug reactions (ADRs) in the postmarketing database. Subgroup analyses were run on patients with special medical history and on patients of different age groups. RESULTS In the clinical development studies, 6809 and 2184 patients received gadobutrol or comparators, respectively. The incidence of drug-related AEs was 3.5% for both groups. With the exception of nausea (0.7% related cases in both groups), all other drug-related AEs were 0.3% or less in both groups. Hypersensitivity reactions were sporadic (<0.1%). Patients with history of allergies to contrast agents experienced slightly more drug-related AEs. No differences were seen between age groups.The overall reporting rate of ADRs from postmarketing surveillance was 0.05%. The most frequent ADRs were anaphylactoid/hypersensitivity reactions, nausea, vomiting, and dyspnea.For 3 single-agent reports of nephrogenic systemic fibrosis, using a conservative approach, association with gadobutrol could not be excluded. CONCLUSIONS Gadobutrol is well tolerated and has a favorable safety profile for patients of all age groups.
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Affiliation(s)
- Jan Endrikat
- From the *Radiology, Bayer Pharma AG, Berlin; †Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saarland; ‡Global Integrated Analysis & Life Cycle Management Statistics, Bayer Pharma AG, Wuppertal, Germany; §Global Pharmacovigilance and Risk Management, and ∥Radiology, Bayer Pharma AG, Whippany, NJ
| | - Kai Vogtlaender
- From the *Radiology, Bayer Pharma AG, Berlin; †Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saarland; ‡Global Integrated Analysis & Life Cycle Management Statistics, Bayer Pharma AG, Wuppertal, Germany; §Global Pharmacovigilance and Risk Management, and ∥Radiology, Bayer Pharma AG, Whippany, NJ
| | - Susan Dohanish
- From the *Radiology, Bayer Pharma AG, Berlin; †Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saarland; ‡Global Integrated Analysis & Life Cycle Management Statistics, Bayer Pharma AG, Wuppertal, Germany; §Global Pharmacovigilance and Risk Management, and ∥Radiology, Bayer Pharma AG, Whippany, NJ
| | - Thomas Balzer
- From the *Radiology, Bayer Pharma AG, Berlin; †Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saarland; ‡Global Integrated Analysis & Life Cycle Management Statistics, Bayer Pharma AG, Wuppertal, Germany; §Global Pharmacovigilance and Risk Management, and ∥Radiology, Bayer Pharma AG, Whippany, NJ
| | - Josy Breuer
- From the *Radiology, Bayer Pharma AG, Berlin; †Department of Gynecology, Obstetrics, and Reproductive Medicine, University Medical School of Saarland, Homburg, Saarland; ‡Global Integrated Analysis & Life Cycle Management Statistics, Bayer Pharma AG, Wuppertal, Germany; §Global Pharmacovigilance and Risk Management, and ∥Radiology, Bayer Pharma AG, Whippany, NJ
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Chavhan GB, Shelmerdine S, Jhaveri K, Babyn PS. Liver MR Imaging in Children: Current Concepts and Technique. Radiographics 2016; 36:1517-32. [DOI: 10.1148/rg.2016160017] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Shelmerdine SC, Roebuck DJ, Towbin AJ, McHugh K. MRI of paediatric liver tumours: How we review and report. Cancer Imaging 2016; 16:21. [PMID: 27526937 PMCID: PMC4986178 DOI: 10.1186/s40644-016-0083-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Accepted: 08/09/2016] [Indexed: 12/12/2022] Open
Abstract
Liver tumours are fortunately rare in children. Benign tumours such as haemangiomas and cystic mesenchymal hamartomas are typically seen in infancy, often before 6 months of age. After that age, malignant hepatic tumours increase in frequency. The differentiation of a malignant from benign lesion on imaging can often negate the need for biopsy. Ultrasound is currently the main screening tool for suspected liver pathology, and is ideally suited for evaluation of hepatic lesions in children due to their generally small size. With increasing research, public awareness and parental anxiety regarding radiation dosage from CT imaging, MRI is now unquestionably the modality of choice for further characterisation of hepatic mass lesions. Nevertheless the cost, length of imaging time and perceived complexity of a paediatric liver MR study can be intimidating to the general radiologist and referring clinician. This article outlines standard MR sequences utilised, reasons for their utilisation, types of mixed hepatocyte specific/extracellular contrast agents employed and imaging features that aid the interpretation of paediatric liver lesions. The two commonest paediatric liver malignancies, namely hepatoblastoma and hepatocellular carcinoma are described. Differentiation of primary hepatic malignancies with metastatic disease and mimickers of malignancy such as focal nodular hyperplasia (FNH) and hepatic adenomas are also featured in this review.. Imaging should aim to clarify the presence of a lesion, the likelihood of malignancy and potential for complete surgical resection. Reviewing and reporting the studies should address these issues in a systematic fashion whilst also commenting upon background liver parenchymal appearances. Clinical information and adequate patient preparation prior to MR imaging studies help enhance the diagnostic yield.
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Affiliation(s)
- Susan C Shelmerdine
- Department of Diagnostic Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.
| | - Derek J Roebuck
- Department of Interventional Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Alexander J Towbin
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Kieran McHugh
- Department of Diagnostic Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
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Vikraman J, Hutson JM, Li R, Thorup J. The undescended testis: Clinical management and scientific advances. Semin Pediatr Surg 2016; 25:241-8. [PMID: 27521715 DOI: 10.1053/j.sempedsurg.2016.05.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Undescended testes (UDT), where one or both testes fail to migrate to the base of the scrotum, can be congenital (2-5% of newborn males) or acquired (1-2% of males). The testis may be found in any position along its usual line of descent. Cryptorchidism affects the developing testicular germ cells and increases the risk of infertility and malignancy. Clinical management aims to preserve spermatogenesis and prevent the increased risk of seminoma. Examination to document the testicular position will guide the need for imaging, medical management and the surgical approach to orchidopexy.
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Affiliation(s)
- Jaya Vikraman
- Douglas Stephens Surgical Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - John M Hutson
- Douglas Stephens Surgical Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia; Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia; Department of Urology, The Royal Children׳s Hospital, 50 Flemington Rd, Parkville, Victoria 3052, Australia.
| | - Ruili Li
- Douglas Stephens Surgical Group, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
| | - Jorgen Thorup
- Department of Paediatric Surgery and Surgical Clinic, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, Copenhagen University, Copenhagen, Denmark
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Roberts DR, Chatterjee AR, Yazdani M, Marebwa B, Brown T, Collins H, Bolles G, Jenrette JM, Nietert PJ, Zhu X. Pediatric Patients Demonstrate Progressive T1-Weighted Hyperintensity in the Dentate Nucleus following Multiple Doses of Gadolinium-Based Contrast Agent. AJNR Am J Neuroradiol 2016; 37:2340-2347. [PMID: 27469211 DOI: 10.3174/ajnr.a4891] [Citation(s) in RCA: 90] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 06/13/2016] [Indexed: 02/02/2023]
Abstract
BACKGROUND AND PURPOSE While there have been recent reports of brain retention of gadolinium following gadolinium-based contrast agent administration in adults, a retrospective series of pediatric patients has not previously been reported, to our knowledge. We investigated the relationship between the number of prior gadolinium-based contrast agent doses and increasing T1 signal in the dentate nucleus on unenhanced T1-weighted MR imaging. We hypothesized that despite differences in pediatric physiology and the smaller gadolinium-based contrast agent doses that pediatric patients are typically administered based on weighted-adjusted dosing, the pediatric brain would also demonstrate dose-dependent increasing T1 signal in the dentate nucleus. MATERIALS AND METHODS We included children with multiple gadolinium-based contrast agent administrations at our institution. A blinded reader placed ROIs within the dentate nucleus and adjacent cerebellar white matter. To eliminate reader bias, we also performed automated ROI delineation of the dentate nucleus, cerebellar white matter, and pons. Dentate-to-cerebellar white matter and dentate-to pons ratios were compared with the number of gadolinium-based contrast agent administrations. RESULTS During 20 years at our institution, 280 patients received at least 5 gadolinium-based contrast agent doses, with 1 patient receiving 38 doses. Sixteen patients met the inclusion/exclusion criteria for ROI analysis. Blinded reader dentate-to-cerebellar white matter ratios were significantly associated with gadolinium-based contrast agent doses (rs = 0.77, P = .001). The dentate-to-pons ratio and dentate-to-cerebellar white matter ratios based on automated ROI placement were also significantly correlated with gadolinium-based contrast agent doses (t = 4.98, P < .0001 and t = 2.73, P < .02, respectively). CONCLUSIONS In pediatric patients, the number of prior gadolinium-based contrast agent doses is significantly correlated with progressive T1-weighted dentate hyperintensity. Definitive confirmation of gadolinium deposition requires tissue analysis. Any potential clinical sequelae of gadolinium retention in the developing brain are unknown. Given this uncertainty, we suggest taking a cautious stance, including the use, in pediatric patients, of higher stability, macrocyclic agents, which in both human and animal studies have been shown to be associated with lower levels of gadolinium deposition, and detailed documentation of dosing. Most important, a patient should not be deprived of a well-indicated contrasted MR examination.
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Affiliation(s)
- D R Roberts
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.) .,Neurosciences and Neuroscience Research (D.R.R.)
| | - A R Chatterjee
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - M Yazdani
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - B Marebwa
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - T Brown
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - H Collins
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | - G Bolles
- From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
| | | | - P J Nietert
- Biostatistics (P.J.N.).,Public Health Sciences (P.J.N.), Medical University of South Carolina, Charleston, South Carolina
| | - X Zhu
- Department of Psychology (X.Z.), Normal College, Shihezi University, Xinjiang, China
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Neeley C, Moritz M, Brown JJ, Zhou Y. Acute side effects of three commonly used gadolinium contrast agents in the paediatric population. Br J Radiol 2016; 89:20160027. [PMID: 27194459 DOI: 10.1259/bjr.20160027] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To determine the incidence of acute side effects of three commonly used gadolinium contrast agents in the paediatric population. METHODS A retrospective review of medical records was performed to determine the incidence of acute adverse side effects of i.v. gadolinium contrast agents [MultiHance(®) (Bracco Diagnostics Inc., Princeton, NJ), Magnevist(®) (Bayer Healthcare Pharmaceuticals, Wayne, NJ) or Gadavist(®) (Bayer HealthCare Pharmaceuticals)] in paediatric patients. RESULTS 40 of the 2393 patients who received gadolinium contrast agents experienced acute side effects, representing an incidence of 1.7%. The majority of the acute side effects (in 30 patients) were nausea and vomiting. The incidence was significantly higher in non-sedated patients (2.37% vs 0.7%; p = 0.0018). Furthermore, without sedation, the incidence of both nausea and vomiting was significantly higher in children receiving MultiHance, with a 4.48% incidence of nausea when compared with Magnevist (0.33%, p < 0.0001) and Gadavist (0.28%, p < 0.0001) and a 2.36% incidence of vomiting compared with those for Magnevist (0.50%, p = 0.0054) and Gadavist (0.28%, p = 0.014), whereas no difference was observed between Magnevist and Gadavist within the power of the study. In addition, there was no apparent difference between any of the three contrast agents for the incidence of allergy or other acute side effects detected, given the sample size. CONCLUSION The gadolinium contrast agents MultiHance, Magnevist and Gadavist have a low incidence of acute side effects in the paediatric population, a rate that is further reduced in moderately sedated patients. MultiHance demonstrated significantly increased incidence of gastrointestinal symptoms compared with Magnevist and Gadavist. ADVANCES IN KNOWLEDGE The incidence of acute side effects of three commonly used gadolinium contrast agents was determined in the paediatric population, which can have clinical implications.
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Affiliation(s)
- Chris Neeley
- Department of Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Michael Moritz
- Department of Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Jeffrey J Brown
- Department of Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
| | - Yihua Zhou
- Department of Radiology, Saint Louis University School of Medicine, Saint Louis, Missouri, USA
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Assessment of rates of acute adverse reactions to gadobenate dimeglumine: review of more than 130,000 administrations in 7.5 years. AJR Am J Roentgenol 2015; 204:703-6. [PMID: 25794059 DOI: 10.2214/ajr.14.13430] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the incidence of adverse events associated with gadobenate dimeglumine over 7.5 years in a major hospital system consisting of both academic and community hospitals. SUBJECTS AND METHODS As part of a regular and continuous prospective quality assurance project, MRI technologists contemporaneously recorded all gadolinium-based contrast administrations and any associated adverse reactions, including type of reaction and treatment rendered, between August 1, 2005, and March 14, 2013. Weekly data review was performed by the director of MRI services, who evaluated data both by individual site and by comparison among the participating hospitals and sites within the hospital system. Comparison between reaction rates at different sites was performed with a chi-square test. RESULTS Over 7.5 years, 132,252 doses of gadobenate dimeglumine were administered, and 236 reactions were recorded (0.18% of contrast-enhanced examinations). Of these, 133 (56.4% of all adverse reactions) required treatment and 12 (5.1%) qualified as serious. Reaction rates were significantly different between academic (0.23%) and community (0.07%) hospitals (p<0.001). Reaction rates were higher in the initial years of the study, tapering to a lower baseline rate, which was maintained over more than 5 years. The findings were consistent with the Weber and Lalli effects reported in the literature on other pharmaceutical agents. CONCLUSION Rates of adverse reactions to gadobenate dimeglumine recorded over 7.5 years were comparable to those reported for other gadolinium-based contrast agents examined over smaller time ranges and populations. The findings reinforce the relatively robust safety profile of this agent.
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Chavhan GB, Mann E, Kamath BM, Babyn PS. Gadobenate-dimeglumine-enhanced magnetic resonance imaging for hepatic lesions in children. Pediatr Radiol 2014; 44:1266-74. [PMID: 24771094 DOI: 10.1007/s00247-014-2975-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2013] [Revised: 02/10/2014] [Accepted: 03/12/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Magnetic resonance imaging enhanced by hepatocyte-specific contrast media has been found useful to characterize liver lesions in adults and children. OBJECTIVE To present our experience with gadobenate dimeglumine (Gd-BOPTA)-enhanced MRI for evaluation of focal liver lesions in children. MATERIALS AND METHODS We retrospectively reviewed gadobenate-dimeglumine-enhanced MR images obtained for evaluation of suspected hepatic lesions in 30 children. Signal characteristics on various sequences including 45- to 60-min hepatobiliary phase images were noted by two radiologists. Chart review identified relevant clinical details including history of cancer treatment, available pathology and stability of lesion size on follow-up imaging. RESULTS Of the 30 children who had gadobenate-enhanced MRI, 26 showed focal lesions. Diagnoses in 26 children were focal nodular hyperplasia (FNH) in 15, hemangiomas in 3, regenerating nodules in 3, focal fatty infiltration in 2, indeterminate lesions in 3, and one patient each with adenomas, hepatoblastoma and metastasis. Two patients had multiple diagnoses. All FNH lesions (39), all regenerative nodules (19) and an indeterminate lesion were iso- or hyperintense on hepatobiliary-phase images while all other lesions (28) were hypointense to hepatic parenchyma. The average follow-up period was 21.7 months. CONCLUSION Our experience with gadobenate-enhanced MRI indicates potential utility of gadobenate in the evaluation of pediatric hepatic lesions in differentiating FNH and regenerating nodules from other lesions.
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Affiliation(s)
- Govind B Chavhan
- Department of Diagnostic Imaging, The Hospital for Sick Children and University of Toronto, 555 University Ave., Toronto, Canada, M5G 1X8,
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Cova MA, Stacul F, Quaranta R, Guastalla P, Salvatori G, Banderali G, Fonda C, David V, Gregori M, Zuppa AA, Davanzo R. Radiological contrast media in the breastfeeding woman: a position paper of the Italian Society of Radiology (SIRM), the Italian Society of Paediatrics (SIP), the Italian Society of Neonatology (SIN) and the Task Force on Breastfeeding, Ministry of Health, Italy. Eur Radiol 2014; 24:2012-22. [PMID: 24838733 DOI: 10.1007/s00330-014-3198-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Revised: 03/24/2014] [Accepted: 04/22/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Breastfeeding is a well-recognised investment in the health of the mother-infant dyad. Nevertheless, many professionals still advise breastfeeding mothers to temporarily discontinue breastfeeding after contrast media imaging. Therefore, we performed this review to provide health professionals with basic knowledge and skills for appropriate use of contrast media. METHODS A joint working group of the Italian Society of Radiology (SIRM), Italian Society of Paediatrics (SIP), Italian Society of Neonatology (SIN) and Task Force on Breastfeeding, Ministry of Health, Italy prepared a review of the relevant medical literature on the safety profile of contrast media for the nursing infant/child. RESULTS Breastfeeding is safe for the nursing infant of any post-conceptional age after administration of the majority of radiological contrast media to the mother; only gadolinium-based agents considered at high risk of nephrogenic systemic fibrosis (gadopentetate dimeglumine, gadodiamide, gadoversetamide) should be avoided in the breastfeeding woman as a precaution; there is no need to temporarily discontinue breastfeeding or to express and discard breast milk following the administration of contrast media assessed as compatible with breastfeeding. CONCLUSIONS Breastfeeding women should receive unambiguous professional advice and clear encouragement to continue breastfeeding after imaging with the compatible contrast media. KEY POINTS • Breastfeeding is a well-known investment in the health of the mother-infant dyad. • Breastfeeding is safe after administration of contrast media to the mother. • There is no need to temporarily discontinue breastfeeding following administration of contrast media.
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Affiliation(s)
- Maria Assunta Cova
- Department of Radiology, Cattinara Hospital, University of Trieste, Azienda Ospedaliero-Universitaria "Ospedali Riuniti" Trieste, Strada di Fiume 447, 34149, Trieste, Italy
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Pirovano G, Kirchin MA, Lorusso V, Patel R, Shen N. Pharmacokinetics of gadobenate dimeglumine in children 2 to 5 years of age undergoing MRI of the central nervous system. J Magn Reson Imaging 2014; 41:1096-103. [PMID: 24807269 DOI: 10.1002/jmri.24653] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 01/13/2023] Open
Abstract
PURPOSE To determine the pharmacokinetic profile of gadobenate dimeglumine in children aged between 2 and 5 years. MATERIALS AND METHODS Fifteen children scheduled to undergo contrast-enhanced MRI for suspected disease of the central nervous system received a single intravenous injection of 0.1 mmol/kg gadobenate dimeglumine. Children were stratified into three age groups: 2 to <3 years, 3 to <4 years, and 4 to 5 (i.e., <6 years). Serial blood and urine samples collected at prespecified time-points before and after contrast administration were analyzed for gadolinium concentrations. Pharmacokinetic parameters were calculated using noncompartmental and compartmental techniques. RESULTS Mean values of 65.7 μg/mL for highest blood gadolinium concentration, 0.2 L/h/kg for blood clearance, 0.32 L/kg for steady-state volume of distribution, and 1.2 h for terminal elimination half-life were determined across all age groups combined. On average, more than 80% of the dose was eliminated in the urine during the first 24 h after administration. All pharmacokinetic parameters were similar between age groups and no effects of gender were noted. No adverse events considered related to gadobenate dimeglumine administration were reported. CONCLUSION In terms of pharmacokinetic profile no dosage adjustment from the approved adult gadobenate dimeglumine dose of 0.1 mmol/kg bodyweight is necessary in children aged between 2 and 5 years.
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Affiliation(s)
- Gianpaolo Pirovano
- Global Medical and Regulatory Affairs, Bracco Diagnostics Inc, Monroe, New Jersey, USA
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