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Dekker HM, Stroomberg GJ, Van der Molen AJ, Prokop M. Review of strategies to reduce the contamination of the water environment by gadolinium-based contrast agents. Insights Imaging 2024; 15:62. [PMID: 38411847 PMCID: PMC10899148 DOI: 10.1186/s13244-024-01626-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/19/2024] [Indexed: 02/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCA) are essential for diagnostic MRI examinations. GBCA are only used in small quantities on a per-patient basis; however, the acquisition of contrast-enhanced MRI examinations worldwide results in the use of many thousands of litres of GBCA per year. Data shows that these GBCA are present in sewage water, surface water, and drinking water in many regions of the world. Therefore, there is growing concern regarding the environmental impact of GBCA because of their ubiquitous presence in the aquatic environment. To address the problem of GBCA in the water system as a whole, collaboration is necessary between all stakeholders, including the producers of GBCA, medical professionals and importantly, the consumers of drinking water, i.e. the patients. This paper aims to make healthcare professionals aware of the opportunity to take the lead in making informed decisions about the use of GBCA and provides an overview of the different options for action.In this paper, we first provide a summary on the metabolism and clinical use of GBCA, then the environmental fate and observations of GBCA, followed by measures to reduce the use of GBCA. The environmental impact of GBCA can be reduced by (1) measures focusing on the application of GBCA by means of weight-based contrast volume reduction, GBCA with higher relaxivity per mmol of Gd, contrast-enhancing sequences, and post-processing; and (2) measures that reduce the waste of GBCA, including the use of bulk packaging and collecting residues of GBCA at the point of application.Critical relevance statement This review aims to make healthcare professionals aware of the environmental impact of GBCA and the opportunity for them to take the lead in making informed decisions about GBCA use and the different options to reduce its environmental burden.Key points• Gadolinium-based contrast agents are found in sources of drinking water and constitute an environmental risk.• Radiologists have a wide spectrum of options to reduce GBCA use without compromising diagnostic quality.• Radiology can become more sustainable by adopting such measures in clinical practice.
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Affiliation(s)
- Helena M Dekker
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands.
| | - Gerard J Stroomberg
- RIWA-Rijn - Association of River Water Works, Groenendael 6, 3439 LV, Nieuwegein, The Netherlands
| | - Aart J Van der Molen
- Department of Radiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, The Netherlands
| | - Mathias Prokop
- Department of Medical Imaging, Radboud University Medical Center, Geert Grooteplein Zuid 10, 6525 GA, Nijmegen, The Netherlands
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Chaudhry M, McGinty KA, Mervak B, Lerebours R, Li C, Shropshire E, Ronald J, Commander L, Hertel J, Luo S, Bashir MR, Burke LMB. The LI-RADS Version 2018 MRI Treatment Response Algorithm: Evaluation of Ablated Hepatocellular Carcinoma. Radiology 2020; 294:320-326. [PMID: 31845843 DOI: 10.1148/radiol.2019191581] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Background The Liver Imaging Reporting and Data System (LI-RADS) treatment response algorithm (TRA) is used to assess presumed hepatocellular carcinoma (HCC) after local-regional therapy, but its performance has not been extensively assessed. Purpose To assess the performance of LI-RADS version 2018 TRA in the evaluation of HCC after ablation. Materials and Methods In this retrospective study, patients who underwent ablation therapy for presumed HCC followed by liver transplantation between January 2011 and December 2015 at a single tertiary care center were identified. Lesions were categorized as completely (100%) or incompletely (≤99%) necrotic based on transplant histology. Three radiologists assessed pre- and posttreatment MRI findings using LI-RADS version 2018 and the TRA, respectively. Interreader agreement was assessed by using the Fleiss κ test. Performance characteristics for predicting necrosis category based on LI-RADS treatment response (LR-TR) category (viable or nonviable) were calculated by using generalized mixed-effects models to account for clustering by subject. Results A total of 36 patients (mean age, 58 years ± 5 [standard deviation]; 32 men) with 53 lesions was included. Interreader agreement for pretreatment LI-RADS category was 0.40 (95% confidence interval [CI]: 0.15, 0.67; P < .01) and was lower than the interreader agreement for TRA category (κ = 0.71; 95% CI: 0.59, 0.84; P < .01). After accounting for clustering by subject, sensitivity of tumor necrosis across readers ranged from 40% to 77%, and specificity ranged from 85% to 97% when LR-TR equivocal assessments were treated as nonviable. When LR-TR equivocal assessments were treated as viable, sensitivity of tumor necrosis across readers ranged from 81% to 87%, and specificity ranged from 81% to 85% across readers. Six (11%) of 53 treated lesions were LR-TR equivocal by consensus, with most (five of six) incompletely necrotic at histopathology. Conclusion The Liver Imaging Reporting and Data System treatment response algorithm can be used to predict viable or nonviable hepatocellular carcinoma after ablation. Most ablated lesions rated as treatment response equivocal were incompletely necrotic at histopathology. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Do and Mendiratta-Lala in this issue.
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Affiliation(s)
- Mohammad Chaudhry
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Katrina A McGinty
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Benjamin Mervak
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Reginald Lerebours
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Cai Li
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Erin Shropshire
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - James Ronald
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Leah Commander
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Johann Hertel
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Sheng Luo
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Mustafa R Bashir
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
| | - Lauren M B Burke
- From the Department of Radiology (M.C., E.S., J.R., M.R.B.), Division of Gastroenterology, Department of Medicine (M.R.B.), and Center for Advanced Magnetic Development (M.R.B.), Duke University Medical Center, 200 Trent Dr, Durham, NC 27710; Departments of Radiology (M.C., K.A.M., B.M., L.M.B.B.) and Pathology (L.C., J.H.); Department of Biostatistics and Bioinformatics, Duke University School of Medicine, Durham, NC (R.L., C.L., S.L.)
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Kamali M, Clarke SE, Costa AF. Evaluation of liver MRI examinations with two dosages of gadobenate dimeglumine: a blinded intra-individual study. Abdom Radiol (NY) 2020; 45:36-44. [PMID: 31372778 DOI: 10.1007/s00261-019-02158-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE There is discrepancy in the literature regarding the optimal dose of gadobenate for liver MRI. We evaluated the quality of liver MRIs performed in the same individual using two dosages. METHODS With ethics approval, this retrospective study evaluated sixty patients who underwent liver MRIs between July 2015 and May 2017 (low dose, 0.06 mmol/kg) and May 2017 and September 2018 (standard dose, 0.10 mmol/kg). Regions of interest were drawn over the aorta, portal veins, and liver on unenhanced and post-contrast phases; relative enhancement values were compared (paired t-tests). Two blinded radiologists graded the arterial and portal venous sequences of each MRI from 1 to 4 (1 = suboptimal, 2 = adequate, 3 = good, 4 = excellent); grades were compared overall and in cirrhotic and non-cirrhotic subgroups (Wilcoxon signed-rank test). Radiologists graded each MRI pair from 1 to 5 (1 = substantially inferior, 2 = slightly inferior, 3 = equivalent, 4 = slightly improved, 5 = substantially improved). Inter-reader agreement was assessed (kappa statistic). RESULTS Relative enhancement increased significantly with the standard dose for all structures on all phases (p < 0.05). For both radiologists and both post-contrast phases, individual grades of the low- and standard-dose MRIs were similar, including the cirrhotic and non-cirrhotic subgroups (p > 0.05). Compared to the low-dose MRIs, the number of standard-dose MRIs graded 1-5 were 9, 31, 97, 88, and 11 for all patients, and 6, 13, 26, 45, and 6 in cirrhotics. Inter-observer agreement was fair-moderate (Κ range 0.23-0.45). CONCLUSIONS Although the standard dose of gadobenate yields greater relative enhancement, there is overall little improvement in subjective imaging quality. A trend towards better image quality is observed in cirrhotics.
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Affiliation(s)
- Mahsa Kamali
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Sharon E Clarke
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Victoria General Building, 3rd Floor, 1276 South Park Street, Halifax, NS, B3H 2Y9, Canada.
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Jiang W, Fang H, Liu F, Zhou X, Zhao H, He X, Guo D. PEG-coated and Gd-loaded fluorescent silica nanoparticles for targeted prostate cancer magnetic resonance imaging and fluorescence imaging. Int J Nanomedicine 2019; 14:5611-5622. [PMID: 31413566 PMCID: PMC6662520 DOI: 10.2147/ijn.s207098] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 06/17/2019] [Indexed: 01/01/2023] Open
Abstract
Background: Multimodal imaging probes have become a powerful tool for improving detection sensitivity and accuracy, which are important in disease diagnosis and treatment. Methods: In this study, novel bifunctional magnetic resonance imaging (MRI)/fluorescence probes were prepared by loading gadodiamide into fluorescent silica nanoparticles (NPs) (Gd@Cy5.5@SiO2-PEG-Ab NPs) for targeting of prostate cancer (PCa). The physicochemical characteristics, biosafety and PCa cell targeting ability of the Gd@Cy5.5@SiO2-PEG-Ab NPs were studied in vitro and in vivo. Results: The Gd@Cy5.5@SiO2-PEG-Ab NPs had a spherical morphology with a relatively uniform size distribution and demonstrated high efficiency for Gd loading. In vitro and in vivo cell-targeting experiments demonstrated a high potential for the synthesized NPs to target prostate-specific membrane antigen (PSMA) receptor-positive PCa cells, enabling MRI and fluorescence imaging. In vitro cytotoxicity assays and in vivo hematological and pathological assays showed that the prepared NPs exhibited good biological safety. Conclusion: Our study demonstrates that the synthesized Gd@Cy5.5@SiO2-PEG-Ab NPs have great potential as MRI/fluorescence contrast agents for specific identification of PSMA receptor-positive PCa cells.
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Affiliation(s)
- Wei Jiang
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Huiying Fang
- Department of Breast Diseases, Chongqing University Cancer Hospital, Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing 400030, People's Republic of China
| | - Fengqiu Liu
- Institute of Ultrasound Imaging, Department of Ultrasound, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Xue Zhou
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Hongyun Zhao
- Department of Gastroenterology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Xiaojing He
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China
| | - Dajing Guo
- Department of Radiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing 400010, People's Republic of China
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