1
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Gordon DS, Langston CE. Effective removal of gadolinium with hemodialysis in a dog with severe acute on chronic kidney injury. J Vet Emerg Crit Care (San Antonio) 2024. [PMID: 38971980 DOI: 10.1111/vec.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To describe the use of intermittent hemodialysis (IHD) to remove gadolinium (28.1 mg/kg dose) in a dog with severe kidney disease. CASE SUMMARY A 12-year-old neutered female Yorkshire Terrier presented with severe acute-on-chronic kidney injury and concurrent neurological signs. The dog received extracorporeal therapy as part of management. Uremia improved after hemodialysis, but central nervous system signs persisted; therefore, a contrast-enhanced magnetic resonance imaging was performed, immediately followed by IHD. Two IHD treatments with a low-flux dialyzer were performed 1.5 and 25.75 hours after administration of gadolinium, with almost complete removal of gadolinium. More than 96% of gadolinium was removed with a single treatment. NEW OR UNIQUE INFORMATION PROVIDED Extracorporeal therapy is effective at removing gadolinium-based chelated contrast agents and could be considered if magnetic resonance imaging is indicated in a patient with substantial kidney impairment. Alternatively, newer contrast agents that have been deemed safer in this patient population could be used.
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Affiliation(s)
- Daniel S Gordon
- Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cathy E Langston
- Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
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2
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Wehrend J, Gimarc D, Ashwell ZR, Jensen A, Major N, Ho CK. The effect of gadolinium-based intravenous contrast in the initial characterization of musculoskeletal soft tissue tumors. Curr Probl Diagn Radiol 2024; 53:470-476. [PMID: 38480060 DOI: 10.1067/j.cpradiol.2024.03.002] [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] [Received: 05/18/2023] [Revised: 02/01/2024] [Accepted: 03/06/2024] [Indexed: 06/17/2024]
Abstract
OBJECTIVE To determine if gadolinium-based contrast agents increase the sensitivity, specificity or reader confidence of malignant potential in musculoskeletal soft tissue tumors. METHODS Pre- and post-contrast MRI studies from 87 patients were read by three independent radiologists of different experience. Readers noted malignant potential and confidence in their diagnosis based on pre-contrast and post-contrast MRI studies. Statistical models assessed for agreement between MRI reader diagnosis and pathologic results as well as analyzing effects of contrast on reader confidence. Inter- and intra-observer variabilities of malignant potential were also calculated. RESULTS 87 patients (48 benign and 39 malignant; mean [± SD] age 51 ± 17.9 and 57.1 ± 17.1, respectively) were evaluated. For all readers, pre-contrast and post-contrast sensitivities were 68.1 % and 70.6 % while pre-contrast and post-contrast specificities were 84.6 % and 83.8 %, respectively without significant change (p=0.88). There was not a significant association with the use of contrast and prediction of malignant potential with or without the resident reader (p=0.65 and p=0.82). Use of contrast was significantly associated with higher levels of reader confidence (p=0.02) for all readers. Inter- and intra-observer variabilities were in good agreement (W = 0.77 and 0.70). CONCLUSION The addition of a post-contrast sequence increased reader confidence in their diagnosis without a corresponding significant increase in accurate prediction of malignant potential.
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Affiliation(s)
- Jonathan Wehrend
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - David Gimarc
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Zachary R Ashwell
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Alexandria Jensen
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Nancy Major
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA
| | - Corey K Ho
- University of Colorado-Anschutz Medical Campus, Department of Radiology, 12605 E 16th Avenue, Aurora, CO 80045, USA.
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3
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Coimbra S, Rocha S, Sousa NR, Catarino C, Belo L, Bronze-da-Rocha E, Valente MJ, Santos-Silva A. Toxicity Mechanisms of Gadolinium and Gadolinium-Based Contrast Agents-A Review. Int J Mol Sci 2024; 25:4071. [PMID: 38612881 PMCID: PMC11012457 DOI: 10.3390/ijms25074071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/28/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have been used for more than 30 years to improve magnetic resonance imaging, a crucial tool for medical diagnosis and treatment monitoring across multiple clinical settings. Studies have shown that exposure to GBCAs is associated with gadolinium release and tissue deposition that may cause short- and long-term toxicity in several organs, including the kidney, the main excretion organ of most GBCAs. Considering the increasing prevalence of chronic kidney disease worldwide and that most of the complications following GBCA exposure are associated with renal dysfunction, the mechanisms underlying GBCA toxicity, especially renal toxicity, are particularly important. A better understanding of the gadolinium mechanisms of toxicity may contribute to clarify the safety and/or potential risks associated with the use of GBCAs. In this work, a review of the recent literature concerning gadolinium and GBCA mechanisms of toxicity was performed.
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Affiliation(s)
- Susana Coimbra
- 1H-TOXRUN—1H-Toxicology Research Unit, University Institute of Health Sciences, Cooperativa de Ensino Superior Politécnico e Universitário (CESPU), Advanced Polytechnic and University Cooperative, CRL, 4585-116 Gandra, Portugal
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Susana Rocha
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Nícia Reis Sousa
- Departamento de Ciências e Tecnologia da Saúde, Instituto Superior Politécnico de Benguela, Benguela, Angola
| | - Cristina Catarino
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Luís Belo
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Elsa Bronze-da-Rocha
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
| | - Maria João Valente
- National Food Institute, Technical University of Denmark, Kongens Lyngby, 2800 Copenhagen, Denmark
| | - Alice Santos-Silva
- Associate Laboratory i4HB—Institute for Health and Bioeconomy, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
- UCIBIO—Applied Molecular Biosciences Unit, Department of Biological Sciences, Faculdade de Farmácia da Universidade do Porto, 4050-313 Porto, Portugal
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4
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Li D, Kirberger M, Qiao J, Gui Z, Xue S, Pu F, Jiang J, Xu Y, Tan S, Salarian M, Ibhagui O, Hekmatyar K, Yang JJ. Protein MRI Contrast Agents as an Effective Approach for Precision Molecular Imaging. Invest Radiol 2024; 59:170-186. [PMID: 38180819 DOI: 10.1097/rli.0000000000001057] [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: 01/07/2024]
Abstract
ABSTRACT Cancer and other acute and chronic diseases are results of perturbations of common molecular determinants in key biological and signaling processes. Imaging is critical for characterizing dynamic changes in tumors and metastases, the tumor microenvironment, tumor-stroma interactions, and drug targets, at multiscale levels. Magnetic resonance imaging (MRI) has emerged to be a primary imaging modality for both clinical and preclinical applications due to its advantages over other modalities, including sensitivity to soft tissues, nondepth limitations, and the use of nonionizing radiation. However, extending the application of MRI to achieve both qualitative and quantitative precise molecular imaging with the capability to quantify molecular biomarkers for early detection, staging, and monitoring therapeutic treatment requires the capacity to overcome several major challenges including the trade-off between metal-binding affinity and relaxivity, which is an issue frequently associated with small chelator contrast agents. In this review, we will introduce the criteria of ideal contrast agents for precision molecular imaging and discuss the relaxivity of current contrast agents with defined first shell coordination water molecules. We will then report our advances in creating a new class of protein-targeted MRI contrast agents (ProCAs) with contributions to relaxivity largely derived from the secondary sphere and correlation time. We will summarize our rationale, design strategy, and approaches to the development and optimization of our pioneering ProCAs with desired high relaxivity, metal stability, and molecular biomarker-targeting capability, for precision MRI. From first generation (ProCA1) to third generation (ProCA32), we have achieved dual high r1 and r2 values that are 6- to 10-fold higher than clinically approved contrast agents at magnetic fields of 1.5 T, and their relaxivity values at high field are also significantly higher, which enables high resolution during small animal imaging. Further engineering of multiple targeting moieties enables ProCA32 agents that have strong biomarker-binding affinity and specificity for an array of key molecular biomarkers associated with various chronic diseases, while maintaining relaxation and exceptional metal-binding and selectivity, serum stability, and resistance to transmetallation, which are critical in mitigating risks associated with metal toxicity. Our leading product ProCA32.collagen has enabled the first early detection of liver metastasis from multiple cancers at early stages by mapping the tumor environment and early stage of fibrosis from liver and lung in vivo, with strong translational potential to extend to precision MRI for preclinical and clinical applications for precision diagnosis and treatment.
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Affiliation(s)
- Dongjun Li
- From the Center for Diagnostics and Therapeutics, Advanced Translational Imaging Facility, Department of Chemistry, Georgia State University, Atlanta, GA (D.L., M.K., J.Q., Z.G., S.X., P.F., J.J., S.T., M.S., O.I., K.H., J.J.Y.); and InLighta BioSciences, LLC, Marietta, GA (Y.X., J.J.Y)
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5
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Cruz A, Pereira D, Batista S. [Use of Gadolinium in Follow-Up MRI of Multiple Sclerosis Patients: Current Recommendations]. ACTA MEDICA PORT 2024; 37:53-63. [PMID: 38183232 DOI: 10.20344/amp.20467] [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] [Received: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
Multiple sclerosis is the most frequent demyelinating disease of the central nervous system and is characterized by early onset and progressive disability. Magnetic resonance imaging, due to its high sensitivity and specificity in the detection of demyelinating lesions, is the most useful diagnostic test for this disease, with the administration of gadolinium-based contrast agents being an important contribution to imaging interpretation. Although contrast is essential for diagnostic purposes, its routine use in monitoring disease activity, response to treatment, and related complications is controversial. This article aims to collate current recommendations regarding the use of gadolinium in the imaging follow-up of multiple sclerosis and establish effective and safe guidelines for clinical practice. The literature review was conducted in PubMed, using the terms 'multiple sclerosis', 'magnetic resonance imaging' and 'gadolinium', or 'contrast media'. Articles published between January 2013 and January 2023 concerning the safety of gadolinium and the use of these contrast agents in follow-up scans of adult patients diagnosed with multiple sclerosis were selected. Although no biological or clinical consequences have been unequivocally attributed to the retention of gadolinium in the brain, which were mostly reported with linear agents, health authorities have been recommending the restriction of contrast to essential clinical circumstances. In multiple sclerosis, the detection of subclinical contrast-enhancing lesions with no corresponding new/ enlarging T2-WI lesions is rare and has a questionable impact on therapeutic decisions. On the other hand, gadolinium has a higher sensitivity in the differential diagnosis of relapses, in the detection of recent disease activity, before and after treatment initiation, and in patients with a large lesion burden or diffuse/confluent T2-WI lesions. Contrary to progressive multifocal leukoencephalopathy screening, monitoring of immune restitution inflammatory syndrome also benefits from the administration of gadolinium. It is feasible and safe to exclude gadolinium-based contrast agents from routine follow-up scans of multiple sclerosis, despite their additional contribution in specific clinical circumstances that should be acknowledged by the neurologist and neuroradiologist.
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Affiliation(s)
- Andreia Cruz
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Daniela Pereira
- Área Funcional de Neurorradiologia. Serviço de Imagem Médica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Sónia Batista
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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6
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Le Fur M, Moon BF, Zhou IY, Zygmont S, Boice A, Rotile NJ, Ay I, Pantazopoulos P, Feldman AS, Rosales IA, How IDAL, Izquierdo-Garcia D, Hariri LP, Astashkin AV, Jackson BP, Caravan P. Gadolinium-based Contrast Agent Biodistribution and Speciation in Rats. Radiology 2023; 309:e230984. [PMID: 37874235 PMCID: PMC10623187 DOI: 10.1148/radiol.230984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 08/07/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023]
Abstract
Background Gadolinium retention has been observed in organs of patients with normal renal function; however, the biodistribution and speciation of residual gadolinium is not well understood. Purpose To compare the pharmacokinetics, distribution, and speciation of four gadolinium-based contrast agents (GBCAs) in healthy rats using MRI, mass spectrometry, elemental imaging, and electron paramagnetic resonance (EPR) spectroscopy. Materials and Methods In this prospective animal study performed between November 2021 and September 2022, 32 rats received a dose of gadoterate, gadoteridol, gadobutrol, or gadobenate (2.0 mmol/kg) for 10 consecutive days. GBCA-naive rats were used as controls. Three-dimensional T1-weighted ultrashort echo time images and R2* maps of the kidneys were acquired at 3, 17, 34, and 52 days after injection. At 17 and 52 days after injection, gadolinium concentrations in 23 organ, tissue, and fluid specimens were measured with mass spectrometry; gadolinium distribution in the kidneys was evaluated using elemental imaging; and gadolinium speciation in the kidney cortex was assessed using EPR spectroscopy. Data were assessed with analysis of variance, Kruskal-Wallis test, analysis of response profiles, and Pearson correlation analysis. Results For all GBCAs, the kidney cortex exhibited higher gadolinium retention at 17 days after injection than all other specimens tested (mean range, 350-1720 nmol/g vs 0.40-401 nmol/g; P value range, .001-.70), with gadoteridol showing the lowest level of retention. Renal cortex R2* values correlated with gadolinium concentrations measured ex vivo (r = 0.95; P < .001), whereas no associations were found between T1-weighted signal intensity and ex vivo gadolinium concentration (r = 0.38; P = .10). EPR spectroscopy analysis of rat kidney cortex samples showed that all GBCAs were primarily intact at 52 days after injection. Conclusion Compared with other macrocyclic GBCAs, gadoteridol administration led to the lowest level of retention. The highest concentration of gadolinium was retained in the kidney cortex, but T1-weighted MRI was not sensitive for detecting residual gadolinium in this tissue. © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Tweedle in this issue.
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Affiliation(s)
- Mariane Le Fur
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Brianna F. Moon
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Iris Y. Zhou
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Samantha Zygmont
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Avery Boice
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Nicholas J. Rotile
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Ilknur Ay
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Pamela Pantazopoulos
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Adam S. Feldman
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Ivy A. Rosales
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Ira Doressa Anne L. How
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - David Izquierdo-Garcia
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Lida P. Hariri
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Andrei V. Astashkin
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Brian P. Jackson
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
| | - Peter Caravan
- From the Athinoula A. Martinos Center for Biomedical Imaging,
Department of Radiology (M.L.F., B.F.M., I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P.,
D.I.G., P.C.), Department of Urology (A.S.F.), and Department of Pathology
(I.A.R., I.D.A.L.H., L.P.H.), Massachusetts General Hospital and Harvard Medical
School, 149 13th St, Charlestown, MA 02129; Institute for Innovation in
Imaging, Massachusetts General Hospital, Charlestown, Mass (M.L.F., B.F.M.,
I.Y.Z., S.Z., A.B., N.J.R., I.A., P.P., P.C.); Harvard-MIT Health Sciences and
Technology, Cambridge, Mass (D.I.G.); Bioengineering Department, Universidad
Carlos III de Madrid, Madrid, Spain (D.I.G.); Department of Chemistry and
Biochemistry, University of Arizona, Tucson, Ariz (A.V.A.); and Trace Element
Analysis Laboratory, Dartmouth College, Hanover, NH (B.P.J.)
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7
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Mohammadzadeh M, Kolahi S, Mehrabi Nejad MM, Firouznia K, Naghibi H, Mohammadzadeh A, Shakiba M, Mohebi F, Komaki H, Sharifian H, Hashemi H, Harirchian MH, Azimi A, Adin ME, Yousem DM. Does Gadolinium Deposition Lead to Metabolite Alteration in the Dentate Nucleus? An MRS Study in Patients with MS. AJNR Am J Neuroradiol 2022; 43:1403-1410. [PMID: 36574329 PMCID: PMC9575534 DOI: 10.3174/ajnr.a7623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Repeat contrast-enhanced MR imaging exposes patients with relapsing-remitting MS to frequent administration of gadolinium-based contrast agents. We aimed to investigate the potential metabolite and neurochemical alterations of visible gadolinium deposition on unenhanced T1WI in the dentate nucleus using MRS. MATERIALS AND METHODS This prospective study was conducted in a referral university hospital from January 2020 to July 2021. The inclusion criteria for case and control groups were as follows: 1) case: patients with relapsing-remitting MS, visible gadolinium deposition in the dentate nucleus (ribbon sign), >5 contrast-enhanced MR images obtained; 2) control 1: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, >5 contrast-enhanced MR images obtained; 3) control 2: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, <5 contrast-enhanced-MR images obtained; and 4) control 3: adult healthy individuals, with no contrast-enhanced MR imaging. Dentate nucleus and pontine single-voxel 12 × 12 × 12 MRS were analyzed using short TEs. RESULTS Forty participants (10 per group; 27 [67.5%] female; mean age, 35.6 [SD, 9.6] years) were enrolled. We did not detect any significant alteration in the levels of NAA and choline between the studied groups. The mean concentrations of mIns were 2.7 (SD, 0.73) (case), 1.5 (SD, 0.8) (control 1), 2.4 (SD, 1.2) (control 2), and 1.7 (SD, 1.2) (control 3) (P = .04). The mean concentration of Cr and mIns (P = .04) and the relative metabolic concentration (dentate nucleus/pons) of lipid 1.3/Cr (P = .04) were significantly higher in the case-group than in healthy individuals (controls 1-3). Further analyses compared the case group with cumulative control 1 and 2 groups and showed a significant increase in lactate (P = .02), lactate/Cr (P = .04), and Cr (dentate nucleus/pons) (P = .03) in the case group. CONCLUSIONS Although elevated concentrations of Cr, lactate, mIns, and lipid in the dentate nucleus of the case group indicate a metabolic disturbance, NAA and choline levels were normal, implying no definite neuronal damage.
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Affiliation(s)
- M Mohammadzadeh
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - S Kolahi
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - M-M Mehrabi Nejad
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - K Firouznia
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - H Naghibi
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - A Mohammadzadeh
- Department of Radiology (A.M.), Iran University of Medical Sciences, Tehran, Iran
| | - M Shakiba
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - F Mohebi
- Hass School of Business (F.M.), University of California, Berkeley, Berkeley, California
| | - H Komaki
- Khoury College of Computer Sciences (H.K.), Northeastern University, Boston, Massachusetts
| | - H Sharifian
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - H Hashemi
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - M H Harirchian
- Neurology (M.H.H., A.A.), Tehran University of Medical Sciences, Tehran, Iran
| | - A Azimi
- Neurology (M.H.H., A.A.), Tehran University of Medical Sciences, Tehran, Iran
| | - M E Adin
- Department of Radiology and Biomedical Imaging (M.E.A.), Yale School of Medicine, New Haven, Connecticut
| | - D M Yousem
- Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland
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8
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Myers KS, Yousem DM, Mills KA, Gad K, Niri SG, Bienko N, Munro CA. Brain MRI and clinical exam findings in women with multiple gadolinium-based contrast agent (GBCA) exposures due to screening breast MRIs. Clin Imaging 2022; 92:57-62. [DOI: 10.1016/j.clinimag.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 11/26/2022]
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9
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Asadollahzade E, Ghadiri F, Ebadi Z, Moghadasi AN. The benefits and side effects of gadolinium-based contrast agents in multiple sclerosis patients. Rev Assoc Med Bras (1992) 2022; 68:979-981. [PMID: 36134822 PMCID: PMC9574993 DOI: 10.1590/1806-9282.20220643] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Accepted: 06/18/2022] [Indexed: 11/25/2022] Open
Affiliation(s)
- Elnaz Asadollahzade
- Tehran University of Medical Sciences, Neuroscience Institute, Multiple Sclerosis Research Center - Tehran, Iran
| | - Fereshteh Ghadiri
- Tehran University of Medical Sciences, Neuroscience Institute, Multiple Sclerosis Research Center - Tehran, Iran
| | - Zahra Ebadi
- Tehran University of Medical Sciences, Neuroscience Institute, Multiple Sclerosis Research Center - Tehran, Iran
| | - Abdorreza Naser Moghadasi
- Tehran University of Medical Sciences, Neuroscience Institute, Multiple Sclerosis Research Center - Tehran, Iran
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10
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Ramalho J, Semelka R, Cruz J, Morais T, Ramalho M. T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: An observational study. RADIOLOGIA 2022; 64:397-406. [DOI: 10.1016/j.rxeng.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/13/2020] [Indexed: 10/18/2022]
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11
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The Effect of Gadolinium-Based Contrast Agents on Longitudinal Changes of Magnetic Resonance Imaging Signal Intensities and Relaxation Times in the Aging Rat Brain. Invest Radiol 2022; 57:453-462. [PMID: 35125411 PMCID: PMC9172901 DOI: 10.1097/rli.0000000000000857] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to investigate the possible influence of changes in the brain caused by age on relaxometric and relaxation time–weighted magnetic resonance imaging (MRI) parameters in the deep cerebellar nuclei (DCN) and the globus pallidus (GP) of Gd-exposed and control rats over the course of 1 year.
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12
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Violas X, Rasschaert M, Santus R, Factor C, Corot C, Catoen S, Idée JM, Robert P. Small Brain Lesion Enhancement and Gadolinium Deposition in the Rat Brain: Comparison Between Gadopiclenol and Gadobenate Dimeglumine. Invest Radiol 2022; 57:130-139. [PMID: 34411032 PMCID: PMC8746880 DOI: 10.1097/rli.0000000000000819] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/07/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aim of the set of studies was to compare gadopiclenol, a new high relaxivity gadolinium (Gd)-based contrast agent (GBCA) to gadobenate dimeglumine in terms of small brain lesion enhancement and Gd retention, including T1 enhancement in the cerebellum. MATERIALS AND METHODS In a first study, T1 enhancement at 0.1 mmol/kg body weight (bw) of gadopiclenol or gadobenate dimeglumine was evaluated in a small brain lesions rat model at 2.35 T. The 2 GBCAs were injected in an alternated and cross-over manner separated by an interval of 4.4 ± 1.0 hours (minimum, 3.5 hours; maximum, 6.1 hours; n = 6). In a second study, the passage of the GBCAs into cerebrospinal fluid (CSF) was evaluated by measuring the fourth ventricle T1 enhancement in healthy rats at 4.7 T over 23 minutes after a single intravenous (IV) injection of 1.2 mmol/kg bw of gadopiclenol or gadobenate dimeglumine (n = 6/group). In a third study, Gd retention at 1 month was evaluated in healthy rats who had received 20 IV injections of 1 of the 2 GBCAs (0.6 mmol/kg bw) or a similar volume of saline (n = 10/group) over 5 weeks. T1 enhancement of the deep cerebellar nuclei (DCN) was assessed by T1-weighted magnetic resonance imaging at 2.35 T, performed before the injection and thereafter once a week up to 1 month after the last injection. Elemental Gd levels in central nervous system structures, in muscle and in plasma were determined by inductively coupled plasma mass spectrometry (ICP-MS) 1 month after the last injection. RESULTS The first study in a small brain lesion rat model showed a ≈2-fold higher number of enhanced voxels in lesions with gadopiclenol compared with gadobenate dimeglumine. T1 enhancement of the fourth ventricle was observed in the first minutes after a single IV injection of gadopiclenol or gadobenate dimeglumine (study 2), resulting, in the case of gadopiclenol, in transient enhancement during the injection period of the repeated administrations study (study 3). In terms of Gd retention, T1 enhancement of the DCN was noted in the gadobenate dimeglumine group during the month after the injection period. No such enhancement of the DCN was observed in the gadopiclenol group. Gadolinium concentrations 1 month after the injection period in the gadopiclenol group were slightly increased in plasma and lower by a factor of 2 to 3 in the CNS structures and muscles, compared with gadobenate dimeglumine. CONCLUSIONS In the small brain lesion rat model, gadopiclenol provides significantly higher enhancement of brain lesions compared with gadobentate dimeglumine at the same dose. After repeated IV injections, as expected for a macrocyclic GBCA, Gd retention is minimalized in the case of gadopiclenol compared with gadobenate dimeglumine, resulting in no T1 hypersignal in the DCN.
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Davies J, Siebenhandl-Wolff P, Tranquart F, Jones P, Evans P. Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration. Arch Toxicol 2022; 96:403-429. [PMID: 34997254 PMCID: PMC8837552 DOI: 10.1007/s00204-021-03189-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have transformed magnetic resonance imaging (MRI) by facilitating the use of contrast-enhanced MRI to allow vital clinical diagnosis in a plethora of disease that would otherwise remain undetected. Although over 500 million doses have been administered worldwide, scientific research has documented the retention of gadolinium in tissues, long after exposure, and the discovery of a GBCA-associated disease termed nephrogenic systemic fibrosis, found in patients with impaired renal function. An understanding of the pharmacokinetics in humans and animals alike are pivotal to the understanding of the distribution and excretion of gadolinium and GBCAs, and ultimately their potential retention. This has been well studied in humans and more so in animals, and recently there has been a particular focus on potential toxicities associated with multiple GBCA administration. The purpose of this review is to highlight what is currently known in the literature regarding the pharmacokinetics of gadolinium in humans and animals, and any toxicity associated with GBCA use.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK.
| | | | | | - Paul Jones
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
| | - Paul Evans
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
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14
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Bi Q, Li H, Du J, Li H, Li Q, Wang J, Huang Y, Gong X. Gadolinium deposition in the brain is related to various contrast agents: a matched case-control study. Clin Radiol 2022; 77:299-306. [PMID: 35094817 DOI: 10.1016/j.crad.2021.12.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 12/29/2021] [Indexed: 11/15/2022]
Abstract
AIM To assess the relationship between gadolinium deposition in the brain and various gadolinium-based contrast agents (GBCAs) and to explore confounding variables. METHODS The study group included 87 patients with multiple enhanced brain magnetic resonance imaging (MRI) examinations of which 48 patients were in the linear GBCA group (33 patients in gadopentetate dimeglumine group and 15 patients in gadobenate dimeglumine group) and 39 patients in the macrocyclic GBCA group (22 patients in gadobutrol group and 17 patients in gadoterate meglumine group). The control group included 87 normal participants who were matched regarding age, sex, MRI machine and imaging sequences to the study cohort. T1 signal intensity (SI) ratios of the dentate nucleus to the pons (DN/pons) and of the globus pallidus to the frontal white matter (GP/FWM) in both groups were calculated and compared. The relationships between SI ratios and confounding variables were analysed. RESULTS Significant differences were detected between two linear GBCA groups and control groups in T1 SI ratios of the DN/pons and GP/FWM (all p<0.001). There were no differences for two the macrocyclic GBCA groups compared with matching control groups (all p>0.05). T1 SI ratios of the linear GBCA group were significantly higher than those of the macrocyclic GBCA group (p<0.001). In the linear GBCA group, the T1 SI ratios of the DN/pons correlated moderately positively with the number of GBCA administrations (r=0.643, p<0.001), and MRI machine and sequence used. CONCLUSIONS Increased T1 SI could be observed after repeated administrations of linear GBCA. T1 SI of the DN correlated with the number of linear GBCA administrations, and detection might be affected by MRI machine and sequence.
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Affiliation(s)
- Q Bi
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - H Li
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - J Du
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - H Li
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - Q Li
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - J Wang
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - Y Huang
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China
| | - X Gong
- Department of MRI, The First People's Hospital of Yunnan Province, The Affiliated Hospital of Kunming University of Science and Technology, Kunming, 650032, Yunnan, China.
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15
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Do QN, Lenkinski RE, Tircso G, Kovacs Z. How the Chemical Properties of GBCAs Influence Their Safety Profiles In Vivo. Molecules 2021; 27:58. [PMID: 35011290 PMCID: PMC8746842 DOI: 10.3390/molecules27010058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 01/21/2023] Open
Abstract
The extracellular class of gadolinium-based contrast agents (GBCAs) is an essential tool for clinical diagnosis and disease management. In order to better understand the issues associated with GBCA administration and gadolinium retention and deposition in the human brain, the chemical properties of GBCAs such as relative thermodynamic and kinetic stabilities and their likelihood of forming gadolinium deposits in vivo will be reviewed. The chemical form of gadolinium causing the hyperintensity is an open question. On the basis of estimates of total gadolinium concentration present, it is highly unlikely that the intact chelate is causing the T1 hyperintensities observed in the human brain. Although it is possible that there is a water-soluble form of gadolinium that has high relaxitvity present, our experience indicates that the insoluble gadolinium-based agents/salts could have high relaxivities on the surface of the solid due to higher water access. This review assesses the safety of GBCAs from a chemical point of view based on their thermodynamic and kinetic properties, discusses how these properties influence in vivo behavior, and highlights some clinical implications regarding the development of future imaging agents.
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Affiliation(s)
- Quyen N. Do
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; (Q.N.D.); (R.E.L.)
| | - Robert E. Lenkinski
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; (Q.N.D.); (R.E.L.)
| | - Gyula Tircso
- Department of Physical Chemistry Debrecen, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary;
| | - Zoltan Kovacs
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
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16
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Furlan C, Montarolo F, Di Gregorio E, Parolisi R, Atlante S, Buffo A, Bertolotto A, Aime S, Gianolio E. Analysis of the Gadolinium retention in the Experimental Autoimmune Encephalomyelitis (EAE) murine model of Multiple Sclerosis. J Trace Elem Med Biol 2021; 68:126831. [PMID: 34364067 DOI: 10.1016/j.jtemb.2021.126831] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 07/28/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of this study is to quantitatively investigate, at the preclinical level, the extent of Gd retention in the CNS, and peripheral organs, of immune-mediated murine models (Experimental Autoimmune Encephalomyelitis -EAE) of Multiple Sclerosis, compared to control animals, upon the injection of gadodiamide. The influence of the Gadolinium Based Contrast Agent administration timing during the course of EAE development is also monitored. METHODS EAE mice were injected with three doses (1.2 mmol/kg each) of gadodiamide at three different time points during the EAE development and sacrificed after 21 or 39 days. Organs were collected and the amount of Gd was quantified through Inductively Coupled Plasma-Mass Spectrometry. Transmission electron microscopy (TEM) and MRI techniques were applied to add spatial and qualitative information to the obtained results. RESULTS In the spinal cord of EAE group, 21 days after gadodiamide administration, a significantly higher accumulation of Gd occurred. Conversely, in the encephalon, a lower amount of Gd retention was reached, even if differences emerged between EAE and controls mice. After 39 days, the amounts of retained Gd markedly decreased. TEM validated the presence of Gd in CNS. MRI of the encephalon at 7.1T did not highlight any hyper intense region. CONCLUSION In the spinal cord of EAE mice, which is the mostly damaged region in this specific animal model, a preferential but transient accumulation of Gd is observed. In the encephalon, the Gd retention could be mostly related to inflammation occurring upon immunization rather than to demyelination.
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Affiliation(s)
- Chiara Furlan
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Nizza 52, 10126, Torino, Italy
| | - Francesca Montarolo
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Nizza 52, 10126, Torino, Italy; Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Enza Di Gregorio
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Nizza 52, 10126, Torino, Italy
| | - Roberta Parolisi
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy; Department of Neuroscience Rita Levi-Montalcini, University of Torino, Via Cherasco 15, 10126, Torino, Italy
| | - Sandra Atlante
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Nizza 52, 10126, Torino, Italy
| | - Annalisa Buffo
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy; Department of Neuroscience Rita Levi-Montalcini, University of Torino, Via Cherasco 15, 10126, Torino, Italy
| | - Antonio Bertolotto
- Neuroscience Institute Cavalieri Ottolenghi (NICO), University of Torino, Regione Gonzole 10, 10043, Orbassano, Torino, Italy; Neurology Unit, -CReSM (Regional Referring Center of Multiple Sclerosis), AOU San Luigi Gonzaga, Regione Gonzole 10, 10043, Orbassano, Torino, Italy
| | - Silvio Aime
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Nizza 52, 10126, Torino, Italy
| | - Eliana Gianolio
- Department of Molecular Biotechnologies and Health Sciences, University of Torino, Via Nizza 52, 10126, Torino, Italy.
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17
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Ranga A, Agarwal Y, Garg KJ. Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function. Indian J Radiol Imaging 2021; 27:141-147. [PMID: 28744073 PMCID: PMC5510310 DOI: 10.4103/0971-3026.209212] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.
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Affiliation(s)
- Anju Ranga
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Yatish Agarwal
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanika J Garg
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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18
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Layne KA, Raja K, Dargan PI, Wood DM. Gadolinium Concentrations in Biological Matrices From Patients Exposed to Gadolinium-Based Contrast Agents. Invest Radiol 2021; 56:458-464. [PMID: 34086014 DOI: 10.1097/rli.0000000000000762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES There is increasing evidence that Gd may be retained within the skin, bones, and solid organs in patients with normal renal function after exposure to Gd-based contrast agents (GBCAs). Here we present clinical data from 19 patients who requested referral to our clinical toxicology service for assessment of potential "Gd toxicity." MATERIALS AND METHODS Patients had undergone a median of 2 (interquartile range [IQR], 1-5) exposures to GBCAs and were reviewed at a median of 5 months (IQR, 2-8 months) after the last GBCA exposure. Patients had a clinical assessment by a clinical toxicologist, and biological samples were taken in 17 patients (89.5%). Gd concentrations were measured in these samples using inductively coupled plasma mass spectrometry. RESULTS All patients had significant comorbidities, and after an extensive clinical review, none of the reported symptoms were considered likely to be related to "Gd toxicity." Whole blood, plasma, and urine samples had detectable Gd concentrations in 69.2%, 78.6%, and 95.2% of samples, respectively. Median (IQR) concentrations of Gd were as follows: whole blood, 0.013 ng/mL (IQR, limit of detection [LOD]-0.884 ng/mL); plasma, 0.012 ng/mL (IQR, LOD-0.046 ng/mL); and spot urine, 0.304 μg/g creatinine (IQR, 0.070-3.702 μg/g creatinine). There were positive correlations between whole blood and plasma (P = 0.0024, r = 0.84), whole blood and urine (P = 0.0018, r = 0.82), and plasma and urine (P = 0.0001, r = 0.89) Gd concentrations. There was a negative correlation between Gd concentrations and the period after exposure for whole blood (P = 0.0028, r = -0.80), plasma (P = 0.0004, r = -0.86), and urine (P < 0.0001, r = -0.91). CONCLUSIONS We identified detectable Gd concentrations in biological matrices from all patients reporting exposure to GBCAs who were reviewed in our clinical toxicology outpatient clinic with concerns regarding potential "Gd toxicity"; however, there were no clinical features of toxicity present in this cohort. Further research is required to explore the pharmacokinetics and pharmacodynamics of GBCAs in patients with normal renal function and to determine the clinical significance of these detectable Gd concentrations.
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Affiliation(s)
- Kerry A Layne
- From the Clinical Toxicology, Guy's and St Thomas' NHS Foundation Trust
| | - Kishor Raja
- Viapath Analytics, King's College Hospital NHS Foundation Trust
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19
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Rezk T, Fontana M, Gillmore JD. A review of the criteria for non-invasive diagnosis of cardiac transthyretin amyloidosis. Expert Opin Orphan Drugs 2021. [DOI: 10.1080/21678707.2021.1898371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Tamer Rezk
- National Amyloidosis Centre, University College London, London, UK
- Departement of Nephrology, UCL Department of Nephrology, Division of Medicine, London, UK
| | - Marianna Fontana
- National Amyloidosis Centre, University College London, London, UK
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20
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Abstract
OBJECTIVES Quantitative T1 relaxometry is the benchmark in imaging potential gadolinium deposition and known to be superior to semiquantitative signal intensity ratio analyses. However, T1 relaxometry studies are rare, commonly limited to a few target structures, and reported results are inconsistent.We systematically investigated quantitative T1 relaxation times (qT1) of a variety of brain nuclei after serial application of gadobutrol. MATERIALS AND METHODS Retrospectively, qT1 measurements were performed in a patient cohort with a mean number of 11 gadobutrol applications (n = 46) and compared with a control group with no prior gadolinium-based contrast agent administration (n = 48). The following target structures were evaluated: dentate nucleus, globus pallidus, thalamus, hippocampus, putamen, caudate, amygdala, and different white matter areas. Subsequently, multivariate regression analysis with adjustment for age, presence of brain metastases and previous cerebral radiotherapy was performed. RESULTS No assessed site revealed a significant correlation between qT1 and number of gadobutrol administrations in multivariate regression analysis. However, a significant negative correlation between qT1 and age was found for the globus pallidus as well as anterior and lateral thalamus (P < 0.05 each). CONCLUSIONS No T1 relaxation time shortening due to gadobutrol injection was found in any of the assessed brain structures after serial administration of 11 doses of gadobutrol.
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21
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Dogra S, Borja MJ, Lui YW. Impact of Kidney Function on CNS Gadolinium Deposition in Patients Receiving Repeated Doses of Gadobutrol. AJNR Am J Neuroradiol 2021; 42:824-830. [PMID: 33632738 DOI: 10.3174/ajnr.a7031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Studies associate repeat gadolinium-based contrast agent administration with T1 shortening in the dentate nucleus and globus pallidus, indicating CNS gadolinium deposition, most strongly with linear agents but also reportedly with macrocyclics. Renal impairment effects on long-term CNS gadolinium deposition remain underexplored. We investigated the relationship between signal intensity changes and renal function in patients who received ≥10 administrations of the macrocyclic agent gadobutrol. MATERIALS AND METHODS Patients who underwent ≥10 brain MR imaging examinations with administration of intravenous gadobutrol between February 1, 2014, and January 1, 2018, were included in this retrospective study. Dentate nucleus-to-pons and globus pallidus-to-thalamus signal intensity ratios were calculated, and correlations were calculated between the estimated glomerular filtration rate (minimum and mean) and the percentage change in signal intensity ratios from the first to last scan. Partial correlations were calculated to control for potential confounders. RESULTS One hundred thirty-one patients (73 women; mean age at last scan, 55.9 years) showed a mean percentage change of the dentate nucleus-to-pons of 0.31%, a mean percentage change of the globus pallidus-to-thalamus of 0.15%, a mean minimum estimated glomerular filtration rate of 69.65 (range, 10.16-132.26), and a mean average estimated glomerular filtration rate at 89.48 (range, 38.24-145.93). No significant association was found between the estimated glomerular filtration rate and percentage change of the dentate nucleus-to-pons (minimum estimated glomerular filtration rate, r = -0.09, P = .28; average estimated glomerular filtration rate, r = -0.09, P = .30,) or percentage change of the globus pallidus-to-thalamus (r = 0.07, P = .43; r = 0.07, P = .40). When we controlled for age, sex, number of scans, and total dose, there were no significant associations between the estimated glomerular filtration rate and the percentage change of the dentate nucleus-to-pons (r = 0.16, P = .07; r = 0.15, P = .08) or percentage change of the globus pallidus-to-thalamus (r = -0.14, P = .12; r = -0.15, P = .09). CONCLUSIONS In patients receiving an average of 12 intravenous gadobutrol administrations, no correlation was found between renal function and signal intensity ratio changes, even in those with mild or moderate renal impairment.
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Affiliation(s)
- S Dogra
- From the Department of Radiology, New York University Langone Health, New York, New York
| | - M J Borja
- From the Department of Radiology, New York University Langone Health, New York, New York
| | - Y W Lui
- From the Department of Radiology, New York University Langone Health, New York, New York
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22
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Hannoun S, Kocevar G, Codjia P, Maucort-Boulch D, Cotton F, Vukusic S, Durand-Dubief F, Sappey-Marinier D. Signal Intensity Evaluation in the Dentate Nucleus and Subcortical Gray Matter : Effect of Several Administrations of Gadoterate Meglumine in Multiple Sclerosis. Clin Neuroradiol 2021; 32:677-685. [PMID: 33630120 DOI: 10.1007/s00062-021-00995-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Several studies reported gadolinium deposition in the dentate nuclei (DN) and the globus pallidus (GP) that was associated to linear GBCA administrations rather than macrocyclic. It is therefore imperative to evaluate and assess the safety of cumulative administration of gadoterate meglumine (macrocyclic). Thus, T1-weighted images (T1WI) of multiple sclerosis (MS) patients longitudinally followed for 4 years were retrospectively analyzed. METHODS In this study 44 patients, 10 with clinically isolated syndrome (CIS), 24 relapsing-remitting MS (RRMS) and 10 primary-progressive MS (PPMS) were examined every 6 months (first four scans) and then with a 1-year interval (last two scans). Image processing consisted in reorienting unenhanced T1WI to standard space, followed by B1 inhomogeneity correction. A patient-specific template was then generated to normalize T1WI signal intensity (SI) and segment the DN and subcortical GM structures. All structures were then transformed to each patient space in order to measure the SI in each region. The cerebellar peduncles (CP) and semi-oval (SO) white matter were then manually delineated and used as reference to calculate SI ratios in the DN and subcortical GM structures. A linear mixed-effect model was finally applied to longitudinally analyze SI variations. RESULTS The SI measurements performed in all structures showed no significant increases with the cumulative GBCA administration. CONCLUSION This study showed no significant SI increases within the DN and subcortical GM structures of longitudinally followed MS patients even with the cumulative administration of the macrocyclic GBCA gadoterate meglumine.
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Affiliation(s)
- Salem Hannoun
- Medical Imaging Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gabriel Kocevar
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Datascience pole, Seenovate, Lyon, France
| | - Pekes Codjia
- Service de Neurologie A, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | | | - François Cotton
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Françoise Durand-Dubief
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Service de Neurologie A, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Dominique Sappey-Marinier
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France. .,CERMEP-Imagerie du Vivant, Université de Lyon, Bron, France.
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23
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Lattanzio SM. Toxicity associated with gadolinium-based contrast-enhanced examinations. AIMS BIOPHYSICS 2021. [DOI: 10.3934/biophy.2021015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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24
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Messadeg L, Hordonneau C, Bouguen G, Goutorbe F, Reimund JM, Goutte M, Boucher AL, Scanzi J, Reymond M, Allimant C, Dapoigny M, Pereira B, Bommelaer G, Buisson A. Early Transmural Response Assessed Using Magnetic Resonance Imaging Could Predict Sustained Clinical Remission and Prevent Bowel Damage in Patients with Crohn's Disease Treated with Anti-Tumour Necrosis Factor Therapy. J Crohns Colitis 2020; 14:1524-1534. [PMID: 32533769 DOI: 10.1093/ecco-jcc/jjaa098] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Magnetic resonance imaging [MRI] is a promising tool to evaluate therapeutic efficacy in ileocolonic Crohn's disease [CD]. AIMS We aimed to assess the feasibility of early MRI evaluation (week 12 [W12]) to predict corticosteroid-free remission [CFREM] at W52 and prevent long-term bowel damage. METHODS All patients with active CD needing anti-tumour necrosis factor [anti-TNF] therapy were consecutively enrolled in this multicentre prospective study. MRI was performed before starting therapy, at W12 and W52. CFREM was defined as Crohn's Disease Activity Index < 150, C-reactive protein < 5 mg/L and faecal calprotectin < 250 µg/g, with no switch of anti-TNF agents, no bowel resection and no therapeutic intensification between W12 and W52. RESULTS Among 46 patients, 22 [47.8%] achieved CFREM at W52. Anti-TNF agents were able to heal almost all CD lesions as soon as W12 [p < 0.05]. Early transmural response defined as a 25% decrease of either Clermont score (odds ratio [OR] = 7.7 [1.7-34.0], p < 0.001) or Magnetic Resonance Index of Activity (OR = 4.2 [1.3-13.3], p = 0.015) was predictive of CFREM at W52. Achieving at least two items on W12-MRI among ulceration healing, disappearance of enlarged lymph nodes or sclerolipomatosis, ΔADC [apparent diffusion coefficient] > +10% or ΔRCE [relative contrast enhancement] > -30% was associated with a likelihood of CFREM at W52 of 84.6% vs 37.5% in patients without transmural response [p < 0.001]. Early transmural response could prevent bowel damage progression over time using Clermont score (hazard ratio = 0.21 [0.0-0.9]; p = 0.037). CONCLUSION Evaluation of early transmural response by MRI is feasible and is a promising end point to monitor therapeutic efficacy in patients with CD.
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Affiliation(s)
- L Messadeg
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - C Hordonneau
- Université Clermont Auvergne, CHU Clermont-Ferrand, Service de Radiologie, Clermont-Ferrand, France
| | - G Bouguen
- CHU Rennes, Univ Rennes, INSERM, CIC1414, Institut NUMECAN (Nutrition Metabolisms and Cancer), F-35000 Rennes, France
| | - F Goutorbe
- Centre Hospitalier de la côte basque, Service d'Hépato-Gastro Entérologie, Bayonne, France
| | - J M Reimund
- Université de Strasbourg, INSERM UMR_1113 IRFAC, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, Service d'Hépato-Gastro Entérologie et d'Assistance Nutritive, Strasbourg, France
| | - M Goutte
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A L Boucher
- CH Issoire, Service d'Hépato-Gastro Entérologie, Issoire, France
| | - J Scanzi
- CH Thiers, Service d'Hépato-Gastro Entérologie, Thiers, France
| | - M Reymond
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - C Allimant
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - M Dapoigny
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France
| | - B Pereira
- Université Clermont Auvergne, CHU Clermont-Ferrand, DRCI, Unité de Biostatistiques, Clermont-Ferrand, France
| | - G Bommelaer
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
| | - A Buisson
- Clermont Auvergne, INSERM, 3iHP, CHU Clermont-Ferrand, Service d'Hépato-Gastro Entérologie, Clermont-Ferrand, France.,Université Clermont Auvergne, INSERM U1071, M2iSH, USC-INRA 2018, F-63000 Clermont-Ferrand, France
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25
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Wallnöfer EA, Thurner GC, Kremser C, Talasz H, Stollenwerk MM, Helbok A, Klammsteiner N, Albrecht-Schgoer K, Dietrich H, Jaschke W, Debbage P. Albumin-based nanoparticles as contrast medium for MRI: vascular imaging, tissue and cell interactions, and pharmacokinetics of second-generation nanoparticles. Histochem Cell Biol 2020; 155:19-73. [PMID: 33040183 DOI: 10.1007/s00418-020-01919-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
This multidisciplinary study examined the pharmacokinetics of nanoparticles based on albumin-DTPA-gadolinium chelates, testing the hypothesis that these nanoparticles create a stronger vessel signal than conventional gadolinium-based contrast agents and exploring if they are safe for clinical use. Nanoparticles based on human serum albumin, bearing gadolinium and designed for use in magnetic resonance imaging, were used to generate magnet resonance images (MRI) of the vascular system in rats ("blood pool imaging"). At the low nanoparticle doses used for radionuclide imaging, nanoparticle-associated metals were cleared from the blood into the liver during the first 4 h after nanoparticle application. At the higher doses required for MRI, the liver became saturated and kidney and spleen acted as additional sinks for the metals, and accounted for most processing of the nanoparticles. The multiple components of the nanoparticles were cleared independently of one another. Albumin was detected in liver, spleen, and kidneys for up to 2 days after intravenous injection. Gadolinium was retained in the liver, kidneys, and spleen in significant concentrations for much longer. Gadolinium was present as significant fractions of initial dose for longer than 2 weeks after application, and gadolinium clearance was only complete after 6 weeks. Our analysis could not account quantitatively for the full dose of gadolinium that was applied, but numerous organs were found to contain gadolinium in the collagen of their connective tissues. Multiple lines of evidence indicated intracellular processing opening the DTPA chelates and leading to gadolinium long-term storage, in particular inside lysosomes. Turnover of the stored gadolinium was found to occur in soluble form in the kidneys, the liver, and the colon for up to 3 weeks after application. Gadolinium overload poses a significant hazard due to the high toxicity of free gadolinium ions. We discuss the relevance of our findings to gadolinium-deposition diseases.
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Affiliation(s)
- E A Wallnöfer
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - G C Thurner
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Talasz
- Division of Clinical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria
| | - M M Stollenwerk
- Faculty of Health and Society, Biomedical Laboratory Science, University Hospital MAS, Malmö University, 205 06, Malmö, Sweden
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - A Helbok
- Department of Nuclear Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - N Klammsteiner
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - K Albrecht-Schgoer
- Department of Pharmaceutical Technology, Institute of Pharmacy, Leopold-Franzens-University Innsbruck, Innrain 80-82/IV, 6020, Innsbruck, Austria
- Institute of Cell Genetics, Department for Pharmacology and Genetics, Medical University of Innsbruck, Peter-Mayr-Strasse 1a, 6020, Innsbruck, Austria
| | - H Dietrich
- Central Laboratory Animal Facilities, Innsbruck Medical University, Peter-Mayr-Strasse 4a, 6020, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - P Debbage
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria.
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26
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Ramalho J, Semelka RC, Cruz J, Morais T, Ramalho M. T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: an observational study. RADIOLOGIA 2020; 64:S0033-8338(20)30112-0. [PMID: 33032813 DOI: 10.1016/j.rx.2020.07.003] [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: 05/07/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND AIMS Contradictory results have been reported about hyperintensity of the globus pallidus and/or dentate nucleus on unenhanced T1-weighted magnetic resonance (MR) images after exposure to various gadolinium-based contrast agents. This change in signal intensity varies with different gadolinium-based contrast agents. We aimed to determine whether signal intensity in the dentate nucleus is increased in unenhanced T1-weighted images in patients who have undergone multiple studies with the macrocyclic gadolinium-based contrast agent gadoterate meglumine. We thoroughly reviewed the literature to corroborate our results. MATERIALS AND METHODS We included patients who had undergone more than 10 MR studies with gadoterate meglumine. We quantitatively analyzed the signal intensity in unenhanced T1-weighted MR images measured in regions of interest placed in the dentate nucleus and the pons, and we calculated the dentate nucleus-to-pons signal intensity ratios and the differences between the ratio in the first MR study and the last MR study. We used t-tests to evaluate whether the differences between the signal intensity ratios were different from 0. We also analyzed the subgroups of patients who had been administered<15 and ≥15 doses of gadoterate meglumine. We used Pearson correlation to determine the relationships between the differences in the signal intensity ratios and the number of doses of gadoterate meglumine administered. RESULTS The 54 patients (26 men) had received a mean of 13.8±3.47 doses (range, 10-23 doses). The difference in the dentate nucleus-pons signal intensity ratio between the first and last MR study was -0.0275±0.1917 (not significantly different from 0; p=0.2968) in the entire group, -0.0357±0.2204 (not significantly different from 0; p=0.351 in the patients who had received <15 doses (n=34), and -0.0135±0.1332 (not significantly different from 0; p=0.655) in those who had received ≥15 doses (n=20). Differences in signal intensity ratios did not correlate significantly with the accumulated dose of gadoterate meglumine (P=0.9064; ρ=-0.0164 [95%]). CONCLUSIONS Receiving more than 10 doses of gadoterate meglumine was not associated with increased signal intensity in the dentate nucleus.
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Affiliation(s)
- J Ramalho
- Departamento de Neurorradiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - R C Semelka
- Dr. Richard Semelka. Empresa privada de consultoría
| | - J Cruz
- Departamento de Radiología, Hospital Garcia de Orta, EPE, Almada, Portugal; Departamento de Radiología, Hospital da Luz, Lisboa y Setúbal, Portugal
| | - T Morais
- Departamento de Neurorradiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - M Ramalho
- Departamento de Radiología, Hospital Garcia de Orta, EPE, Almada, Portugal; Departamento de Radiología, Hospital da Luz, Lisboa y Setúbal, Portugal.
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27
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Shrestha R, Teesdale-Spittle PH, Lewis AR, Rendle PM. Gadolinium Complexes Attached to Poly Ethoxy Ethyl Glycinamide (PEE-G) Dendrons: Magnetic Resonance Imaging Contrast Agents with Increased Relaxivity. Chempluschem 2020; 85:1881-1892. [PMID: 32845091 DOI: 10.1002/cplu.202000409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/01/2020] [Indexed: 12/16/2022]
Abstract
A range of poly ethoxy ethyl glycinamide (PEE-G) dendron scaffolds with gadolinium (III) complexes attached were synthesized with a focus on product purity and high Gd(III) loading. The nuclear magnetic resonance relaxivity of these products was measured and compared with commercially available low-molecular-weight magnetic resonance imaging contrast agents. Over twice the relaxivity based on Gd(III) concentration, and up to 20-fold increase in relaxivity were observed based on molecular concentration. Relaxivity properties were observed to increase with both increasing molecular weight and number of Gd(III) complexes attached, however a plateau was reached for molecular weight increase. T1 and T2 relaxivity properties were also investigated at two different magnetic fields. Transverse relaxivity is unaffected by magnetic field strength whereas increase in longitudinal relaxivity was not as pronounced at the higher field.
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Affiliation(s)
- Rinu Shrestha
- Victoria University of Wellington, PO Box 33 436, Petone, 5046, New Zealand
| | | | - Andrew R Lewis
- Victoria University of Wellington, PO Box 33 436, Petone, 5046, New Zealand.,Callaghan Innovation, PO Box 31 310, Lower Hutt, 5010, New Zealand
| | - Phillip M Rendle
- Victoria University of Wellington, PO Box 33 436, Petone, 5046, New Zealand
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28
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Kunchok A, Lechner-Scott J, Granella F, Trojano M, Alroughani R, Sola P, Ferraro D, Lugaresi A, Onofrj M, Ozakbas S, Izquierdo G, Grammond P, Luis Sanchez-Menoyo J, Van Wijmeersch B, Boz C, Pucci E, McCombe P, Grand’Maison F, Spitaleri D, Vucic S, Hupperts R, Jokubaitis V, Sormani MP, Butzkueven H, Kalincik T. Prediction of on-treatment disability worsening in RRMS with the MAGNIMS score. Mult Scler 2020; 27:695-705. [DOI: 10.1177/1352458520936823] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: The magnetic resonance imaging in multiple sclerosis (MAGNIMS) score combines relapses and magnetic resonance imaging (MRI) lesions to predict disability outcomes in relapsing–remitting multiple sclerosis (RRMS) treated with interferon-β. Objective: To validate the MAGNIMS score and extend to other disease-modifying therapies (DMTs). To examine the prognostic value of gadolinium contrast-enhancing (Gd+) lesions. Methods: This RRMS MSBase cohort study ( n = 2293) used a Cox model to examine the prognostic value of relapses, MRI activity and the MAGNIMS score for disability worsening during treatment with interferon-β and three other DMTs. Results: Three new T2 lesions (hazard ratio (HR) = 1.60, p = 0.028) or two relapses (HR = 2.24, p = 0.002) on interferon-β (for 12 months) were predictive of disability worsening over 4 years. MAGNIMS score = 2 (1 relapse and ⩾3 T2 lesions or ⩾2 relapses) was associated with a greater risk of disability worsening on interferon-β (HR = 2.0, p = 0.001). In pooled cohort of four DMTs, similar associations were seen (MAGNIMS score = 2: HR = 1.72, p = 0.001). Secondary analyses demonstrated that the addition of Gd+ to the MAGNIMS did not materially improve its prediction of disability worsening. Conclusion: We have validated the MAGNIMS score in RRMS and extended its application to three other DMTs: 1 relapse and ⩾3 T2 lesions or ⩾2 relapses predicted worsening of disability. Contrast-enhancing lesions did not substantially improve the prognostic score.
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Affiliation(s)
- Amy Kunchok
- CORe, Department of Medicine, The University of Melbourne, Melbourne, VIC, Australia/Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia/The University of Sydney, Sydney, NSW, Australia/Department of Neurology, Mayo Clinic, Rochester, Minnesota, USA
| | - Jeannette Lechner-Scott
- School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia/Department of Neurology, John Hunter Hospital, Hunter New England Health, Newcastle, NSW, Australia
| | - Franco Granella
- Department of Medicine and Surgery, University of Parma, Parma, Italy/Department of Emergency and General Medicine, Parma University Hospital, Parma, Italy
| | - Maria Trojano
- Department of Basic Medical Sciences, Neuroscience and Sense Organs, University of Bari, Bari, Italy
| | - Raed Alroughani
- Division of Neurology, Department of Medicine, Amiri Hospital, Kuwait City, Kuwait
| | - Patrizia Sola
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Diana Ferraro
- Department of Neuroscience, Azienda Ospedaliera Universitaria, Modena, Italy
| | - Alessandra Lugaresi
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Bologna, Italy/Dipartimento di Scienze Biomediche e Neuromotorie, Università di Bologna, Bologna, Italy
| | - Marco Onofrj
- Clinica Neurologica, Department of Neuroscience, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | | | | | | | - Bart Van Wijmeersch
- Rehabilitation and MS Centre Overpelt, Overpelt, Belgium/Hasselt University, Hasselt, Belgium
| | - Cavit Boz
- KTU Medical Faculty, Farabi Hospital, Trabzon, Turkey
| | - Eugenio Pucci
- UOC Neurologia, Azienda Sanitaria Unica Regionale Marche – AV3, Macerata, Italy
| | - Pamela McCombe
- The University of Queensland, Brisbane, QLD, Australia/Royal Brisbane and Women’s Hospital, Herston, QLD, Australia
| | | | - Daniele Spitaleri
- Azienda Ospedaliera di Rilievo Nazionale San Giuseppe Moscati Avellino, Avellino, Italy
| | - Steve Vucic
- Westmead Hospital, The University of Sydney, Sydney, NSW, Australia
| | | | - Vilija Jokubaitis
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Maria Pia Sormani
- Department of Health Sciences (DISSAL), University of Genoa, Genoa, Italy
| | - Helmut Butzkueven
- Central Clinical School, Monash University, Melbourne, VIC, Australia/Department of Medicine, The Alfred Hospital, Melbourne, VIC, Australia
| | - Tomas Kalincik
- CORe, Department of Medicine, The Royal Melbourne Hospital, The University of Melbourne, Melbourne, VIC, Australia/ Melbourne MS Centre, Department of Neurology, The Royal Melbourne Hospital, Melbourne, VIC, Australia
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29
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Dobrocky T, Winklehner A, Breiding PS, Grunder L, Peschi G, Häni L, Mosimann PJ, Branca M, Kaesmacher J, Mordasini P, Raabe A, Ulrich CT, Beck J, Gralla J, Piechowiak EI. Spine MRI in Spontaneous Intracranial Hypotension for CSF Leak Detection: Nonsuperiority of Intrathecal Gadolinium to Heavily T2-Weighted Fat-Saturated Sequences. AJNR Am J Neuroradiol 2020; 41:1309-1315. [PMID: 32554417 DOI: 10.3174/ajnr.a6592] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 04/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Spine MR imaging plays a pivotal role in the diagnostic work-up of spontaneous intracranial hypotension. The aim of this study was to compare the diagnostic accuracy of unenhanced spine MR imaging and intrathecal gadolinium-enhanced spine MR imaging for identification and localization of CSF leaks in patients with spontaneous intracranial hypotension. MATERIALS AND METHODS A retrospective study of patients with spontaneous intracranial hypotension examined from February 2013 to October 2017 was conducted. Their spine MR imaging was reviewed by 3 blinded readers for the presence of epidural CSF using 3 different sequences (T2WI, 3D T2WI fat-saturated, T1WI gadolinium). In patients with leaks, the presumed level of the leak was reported. RESULTS In total, 103 patients with spontaneous intracranial hypotension (63/103 [61%] women; mean age, 50 years) were evaluated. Seventy had a confirmed CSF leak (57/70 [81%] proved intraoperatively), and 33 showed no epidural CSF on multimodal imaging. Intrathecal gadolinium-enhanced spine MR imaging was nonsuperior to unenhanced spine MR imaging for the detection of epidural CSF (P = .24 and .97). All MR imaging sequences had a low accuracy for leak localization. In all patients, only 1 leakage point was present, albeit multiple suspicious lesions were reported in all sequences (mean, 5.0). CONCLUSIONS Intrathecal gadolinium-enhanced spine MR imaging does not improve the diagnostic accuracy for the detection of epidural CSF. Thus, it lacks a rationale to be included in the routine spontaneous intracranial hypotension work-up. Heavily T2-weighted images with fat saturation provide high accuracy for the detection of an epidural CSF collection. Low accuracy for leak localization is due to an extensive CSF collection spanning several vertebrae (false localizing sign), lack of temporal resolution, and a multiplicity of suspicious lesions, albeit only a single leakage site is present. Thus, dynamic examination is mandatory before targeted treatment is initiated.
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Affiliation(s)
- T Dobrocky
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - A Winklehner
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - P S Breiding
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - L Grunder
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - G Peschi
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
- Department of Interventional, Pediatric, and Diagnostic Radiology (G.P., J.K.)
| | - L Häni
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
| | - P J Mosimann
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - M Branca
- Clinical Trials Unit (M.B.), University of Bern, Bern, Switzerland
| | - J Kaesmacher
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
- Department of Interventional, Pediatric, and Diagnostic Radiology (G.P., J.K.)
| | - P Mordasini
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - A Raabe
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
| | - C T Ulrich
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
| | - J Beck
- Neurosurgery (L.H., A.R., C.T.U., J.B.), University of Bern, Inselspital, Bern, Switzerland
- Department of Neurosurgery (J.B.), Medical Center, University of Freiburg, Freiburg, Germany
| | - J Gralla
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
| | - E I Piechowiak
- From the University Institute of Diagnostic and Interventional Neuroradiology (T.D., A.W., P.S.B., L.G., G.P., P.J.M., J.K., P.M., J.G., E.I.P.)
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Nörenberg D, Schmidt F, Schinke K, Frenzel T, Pietsch H, Giese A, Ertl-Wagner B, Levin J. Investigation of potential adverse central nervous system effects after long term oral administration of gadolinium in mice. PLoS One 2020; 15:e0231495. [PMID: 32324769 PMCID: PMC7179865 DOI: 10.1371/journal.pone.0231495] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 03/24/2020] [Indexed: 11/22/2022] Open
Abstract
Objectives To examine potential gadolinium (Gd) accumulation in the brain of healthy mice after long-term oral administration of Gd-containing food pellets and to investigate whether Gd leads to adverse central nervous system (CNS) effects, specifically focussing on locomotor impairment in Gd exposed compared to control animals. Materials and methods The local Animal Experimental Ethics Committee approved all procedures and applications. Fifteen female C57Bl/6 mice were orally exposed to a daily intake of 0.57 mmol Gd chloride/ kg body weight over a period of 90 weeks from the age of 4 weeks on. Gd-free, but otherwise equivalent experimental diets were given to the control group (N = 13). The animals were monitored daily by animal caretakers regarding any visible signs of distress and evaluated clinically every four weeks for the first 60 weeks and afterwards every two weeks for a better temporal resolution of potential long-term effects regarding impairment of motor performance and loss of body weight. The individual Gd content was measured using mass spectrometry in a sub-cohort of N = 6 mice. Results The absolute brain Gd levels of the Gd-exposed mice were significantly increased compared to control mice (0.033± 0.009 vs. 0.006± 0.002 nmol Gd/ g brain tissue). Long-term oral Gd exposure over almost the entire life-span did not lead to adverse CNS effects including locomotor changes (rotarod performance, p = 0.1467) in healthy mice throughout the study period. Gd-exposed mice showed less increased body weight compared to control mice during the study period (p = 0.0423). Histopathological alterations, such as hepatocellular vacuolization due to fatty change in the liver and a loss of nucleated cells in the red pulp of the spleen, were found in peripheral organs of both groups. Conclusions Low levels of intracerebral Gd caused by chronic oral exposure over almost the entire life span of mice did not lead to alterations in locomotor abilities in healthy mice throughout the normal aging process.
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Affiliation(s)
- Dominik Nörenberg
- Department of Clinical Radiology and Nuclear Medicine, University Medical Center Mannheim, Mannheim, Germany
- Department of Radiology, Munich University Hospitals, LMU, Munich, Germany
- * E-mail:
| | - Felix Schmidt
- Munich Center for Neuropathology, Ludwig-Maximilians-University Munich, Munich, Germany
- Department of Neurology, Munich University Hospitals, LMU, Munich, Germany
| | - Karin Schinke
- Munich Center for Neuropathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Thomas Frenzel
- MR and CT Contrast Media Research, Bayer AG, Berlin, Germany
| | | | - Armin Giese
- Munich Center for Neuropathology, Ludwig-Maximilians-University Munich, Munich, Germany
| | - Birgit Ertl-Wagner
- Department of Radiology, Munich University Hospitals, LMU, Munich, Germany
- Department of Medical Imaging, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Johannes Levin
- Department of Neurology, Munich University Hospitals, LMU, Munich, Germany
- German Center of Neurodegenerative Diseases (DZNE), Munich, Germany
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31
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Costelloe CM, Amini B, Madewell JE. Risks and Benefits of Gadolinium-Based Contrast-Enhanced MRI. Semin Ultrasound CT MR 2020; 41:170-182. [DOI: 10.1053/j.sult.2019.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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32
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Costelloe CM, Amini B, Madewell JE. WITHDRAWN: Risks and Benefits of Gadolinium-Based Contrast Enhanced MRI. Semin Ultrasound CT MR 2020; 41:260-274. [PMID: 32446435 DOI: 10.1053/j.sult.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.1053/j.sult.2019.12.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Colleen M Costelloe
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Absence of T1 Hyperintensity in the Brain of High-risk Patients After Multiple Administrations of High-dose Gadobutrol for Cardiac Magnetic Resonance. Clin Neuroradiol 2020; 31:347-355. [PMID: 32185401 DOI: 10.1007/s00062-020-00897-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 02/28/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE A prospective study was conducted to evaluate signal changes in the dentate nucleus, globus pallidus, pons, and thalamus (normalized to the deep cerebellum white matter) in T1-weighted magnetic resonance (MR) images after serial injections of gadobutrol in patients with thalassemia without neurological lesions. METHODS In this study three groups were scanned at both 1.5 T and 3 T: 15 thalassemia patients transfused and chelated with ≥4 gadobutrol administrations at a high dose (0.2 mmol/kg per scan) for late gadolinium enhancement (LGE) cardiovascular MR, 8 thalassemia patients and 13 healthy subjects who had never received gadolinium-based contrast agents (GBCA). RESULTS Signal intensity (SI) ratios at 1.5 T in all regions were comparable among the three groups and were not correlated with the number of gadobutrol administrations. In healthy subjects SI ratios were significantly different among the 4 regions, being higher in the pallidus. The SI ratios at 1.5 T were significantly higher and not correlated with SI ratios at 3 T or with iron overload in the same regions assessed by the T2* technique. CONCLUSION This article describes the lack of increased SI in T1-weighted MR images after repeated administration of gadobutrol for cardiovascular MR studies in a high-risk population (high dose per scan, iron overload that can facilitate the transmetalation of gadolinium) scanned at 3 T and 1.5 T.
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Oh H, Chung YE, You JS, Joo CG, Kim PK, Lim JS, Kim MJ. Gadolinium retention in rat abdominal organs after administration of gadoxetic acid disodium compared to gadodiamide and gadobutrol. Magn Reson Med 2020; 84:2124-2132. [PMID: 32162406 DOI: 10.1002/mrm.28249] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Revised: 01/14/2020] [Accepted: 02/15/2020] [Indexed: 01/09/2023]
Abstract
PURPOSE To compare gadolinium retention in the abdominal organs after administration of gadoxetic acid disodium, a liver-specific contrast agent, compared to gadodiamide and gadobutrol. METHODS Three types of gadolinium-based contrast agents (GBCAs) were administered to rats. A single (gadodiamide and gadobutrol, 0.1 mmol/kg; gadoxetic acid disodium, 0.025 mmol/kg) or double label-recommended dose was intravenously administered once (Group 1), a single dose was administered 4 times (Group 2) and a single dose with or without a chelating agent (intraperitoneal injection immediately after each GBCA administration) was administered (Group 3). Rats were sacrificed after 1, 4, and 12 weeks and gadolinium concentrations in the liver, spleen, kidney, muscle, and bone were measured by inductively coupled plasma mass spectrometry. P values less than 0.05 were considered statistically significant. RESULTS More gadolinium was retained with a double dose compared to a single dose, but there was no observed significant difference in gadolinium retention after a double dose compared to a single dose (P > .05). Gadodiamide was retained the most in all tissues followed by gadobutrol and gadoxetic acid disodium. Residual gadolinium was significantly less at 4 weeks compared to 1 week (P < .05), but no further decrease was observed after 4 weeks (P > .05). The presence of the chelating agent did not significantly decrease the concentration of residual gadolinium (P > .05). CONCLUSION Gadolinium was retained the least in abdominal organs after gadoxetic acid disodium was administered and most of the residual gadolinium was excreted 4 weeks after GBCA administration when a label-recommended dose was administered. A commercially available chelation therapy agent could not reduce gadolinium retention.
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Affiliation(s)
- Hyewon Oh
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.,BK21PLUS project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Yong Eun Chung
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.,BK21PLUS project for Medical Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Chan Gyu Joo
- Severance Biomedical Science Institute, Yonsei University of College of Medicine, Seoul, Republic of Korea
| | - Pan Ki Kim
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea.,Research Institute of Radiological Science, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Joon Seok Lim
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
| | - Myeong-Jin Kim
- Department of Radiology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, Republic of Korea
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Grahl S, Bussas M, Pongratz V, Kirschke JS, Zimmer C, Berthele A, Hemmer B, Mühlau M. T1-Weighted Intensity Increase After a Single Administration of a Linear Gadolinium-Based Contrast Agent in Multiple Sclerosis. Clin Neuroradiol 2020; 31:235-243. [PMID: 32055874 PMCID: PMC7943513 DOI: 10.1007/s00062-020-00882-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Accepted: 01/24/2020] [Indexed: 11/28/2022]
Abstract
Purpose Through analysis of T1-weighted (T1w) images this study investigated gadolinium (Gd) deposition in the brain after administration of a linear (gadopentetic acid) and a cyclic (gadoteric acid) gadolinium-based contrast agent (GBCA) in patients with multiple sclerosis (MS), a disorder frequently requiring magnetic resonance imaging (MRI) scans over years. Methods A total of 3233 T1w images (unenhanced with respect to the same scanning session) of 881 MS patients were retrospectively analyzed. After spatial normalization and intensity scaling using a sphere within the pons, differences of all pairs of subsequent scans were calculated and attributed to either linear (n = 2718) or cyclic (n = 385) or no GBCA (n = 130) according to the first scan. Regional analyses were performed, focusing on the dentate nucleus, and whole brain analyses. By 1‑sample t‑tests, signal intensity increases within conditions were searched for; conditions were compared by 2‑sample t‑tests. Furthermore, recent hypotheses on the reversibility of GBCA deposition were tested. Results In the dentate nucleus, a significant increase was observed only after administration of linear GBCA even after a single GBCA administration. This increase differed significantly (p < 0.001) from the other conditions (cyclic and no GBCA). Whole brain analyses revealed T1w signal increases only after administration of linear GBCA within two regions, the dentate nucleus and globus pallidus. Additional analyses did not indicate any decline of Gd deposition in the brain. Conclusion The data point towards Gd deposition in the brain after administration of linear GBCA even after a single administration.
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Affiliation(s)
- S Grahl
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - M Bussas
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - V Pongratz
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - J S Kirschke
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - C Zimmer
- Department of Neuroradiology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - A Berthele
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany
| | - B Hemmer
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Feodor-Lynen-Str. 17, 81377, Munich, Germany
| | - M Mühlau
- Department of Neurology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany. .,TUM Neuroimaging Center, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Str. 22, 81541, Munich, Germany.
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Gadolinium deposition in the brain of dogs after multiple intravenous administrations of linear gadolinium based contrast agents. PLoS One 2020; 15:e0227649. [PMID: 32012163 PMCID: PMC6996830 DOI: 10.1371/journal.pone.0227649] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/22/2019] [Indexed: 01/24/2023] Open
Abstract
Objective To determine the effect of a linear gadolinium-based contrast agent (GBCA) on the signal intensity (SI) of the deep cerebellar nuclei (DCN) in a retrospective clinical study on dogs after multiple magnetic resonance (MR) examinations with intravenous injections of gadodiamide and LA-ICP-MS analysis of a canine cerebellum after gadodiamide administration. Animals 15 client-owned dogs of different breeds and additionally 1 research beagle dog cadaver. Procedures In the retrospective study part, 15 dogs who underwent multiple consecutive MR imaging examinations with intravenous injection of linear GBCA gadodiamide were analyzed. SI ratio differences on unenhanced T1-weighted MR images before and after gadodiamide injections was calculated by subtracting SI ratios between DCN and pons of the first examination from the ratio of the last examination. Additionally, 1 research beagle dog cadaver was used for LA-ICP-MS (Laser ablation inductively coupled plasma mass spectrometry) analysis of gadolinium in the cerebellum as an add-on to another animal study. Descriptive and non-parametrical statistical analysis was performed and a p-value of < 0.05 was considered significant. Results No statistically significant differences of SI ratios, between DCN and pons, were detectable based on unenhanced T1-weighted MR images. LA-ICP-MS analyses showed between 1.5 to 2.5 μg gadolinium/g tissue in the cerebellum of the examined dog, 35 months after the last of 3 MRI examination with gadodiamide (two examinations at a dose of 1 x 0.1mmol/kg, last examination at a dose of 3 x 0.05mmol/kg). Conclusion and clinical relevance Although the retrospective MRI study did not indicate any visible effect of SI increase after multiple gadodiamide exposures, further studies based on LA-ICP-MS showed that the optical threshold was not reached for a potential visible effect. Gadolinium was detectable at a level of 1.5 to 2.5 μg gadolinium/g tissue by using LA-ICP-MS in the cerebellum 35 months after last MRI examination. The general importance of gadolinium retention of subvisible contents requires further investigation.
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Unal S, Peker E, Erdogan S, Erden MI. Is It Possible to Discriminate Active MS Lesions with Diffusion Weighted Imaging? Eurasian J Med 2019; 51:219-223. [PMID: 31692763 DOI: 10.5152/eurasianjmed.2019.18473] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective Patients with multiple sclerosis (MS) are at a risk of gadolinium deposition because of multiple control imaging. Therefore, it is important to determine biomarkers that can differentiate active and chronic lesions without using contrast agent. This study aimed to assess mean apparent diffusion coefficient (ADC) values and signal intensities (SI) on diffusion weighted imaging (DWI) values of active and nonactive lesions. Materials and Methods We included 25 patients in this study. We measured mean ADC values and SI on DWI of the randomly selected active and nonactive lesions and normal appearing white matter (NAWM) for all patients with MS. SI on DWI and ADC values were normalized to the SI of the CSF. We compared all of the measurements between active and nonactive lesions, active lesions and NAWM, and nonactive lesions and NAWM. SI on DWI and mean ADC values of normal healthy white matter (NHWM) of control group were measured. A comparison was made between NHWM and NAWM. Results For patients with active lesions, the mean nADC value was 0.35±0.06 for active lesions and 0.30±0.07 for nonactive lesions (p>0.050). The mean nDWI-SI value was 3.69±0.68 for active lesions was 3.39±0.68 for nonactive lesions (p<0.050). When patients with and without active lesions were compared, both nDWI values and nADC values for active and nonactive lesions were statistically insignificant (p>0.050). Discussion In MS lesions, diffusion alternations can be quantitatively evaluated with ADC mapping. Lesions seen in patients with MS have higher mean ADC values than NAWM and NHWM.
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Affiliation(s)
- Sena Unal
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Elif Peker
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
| | - Seyda Erdogan
- Department of Neurology, Ankara University School of Medicine, Ankara, Turkey
| | - Memet Ilhan Erden
- Department of Radiology, Ankara University School of Medicine, Ankara, Turkey
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Damme NM, Fernandez DP, Wang LM, Wu Q, Kirk RA, Towner RA, McNally JS, Hoffman JM, Morton KA. Analysis of retention of gadolinium by brain, bone, and blood following linear gadolinium-based contrast agent administration in rats with experimental sepsis. Magn Reson Med 2019; 83:1930-1939. [PMID: 31677194 DOI: 10.1002/mrm.28060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE It is important to identify populations that may be vulnerable to the brain deposition of gadolinium (Gd) from MRI contrast agents. At intervals from 24 hours to 6 weeks following injection of a linear Gd contrast agent, the brain, blood and bone content of Gd were compared between control rats and those with experimental endotoxin-induced sepsis that results in neuroinflammation and blood-brain barrier disruption. METHODS Male rats were injected intraperitoneally with 10 mg/kg lipopolysaccharide. Control animals received no injection. Twenty-four hours later, 0.2 mmol/kg of gadobenate dimeglumine was injected intravenously. Brain, blood, and bone Gd levels were measured at 24 hours, 1 week, 3 weeks, and 6 weeks by inductively coupled plasma mass spectroscopy. RESULTS Blood Gd decreased rapidly between 24 hours and 1 week, and thereafter was undetectable, with no significant difference between lipopolysaccharide and control rats. Brain levels of Gd were significantly higher (4.29-2.36-fold) and bone levels slightly higher (1.35-1.11-fold) in lipopolysaccharide than control rats at all time points with significant retention at 6 weeks. CONCLUSION Experimental sepsis results in significantly higher deposition of Gd in the brain and bone in rats. While blood Gd clears rapidly, brain and bone retained substantial Gd even at 6 weeks following contrast injection.
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Affiliation(s)
- Nikolas M Damme
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Diego P Fernandez
- Department of Geology and Geophysics, University of Utah, Salt Lake City, Utah
| | - Li-Ming Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Qi Wu
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Ryan A Kirk
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Rheal A Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - John M Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Kathryn A Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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Expert opinion: Criteria for second-line treatment failure in patients with multiple sclerosis. Mult Scler Relat Disord 2019; 36:101406. [DOI: 10.1016/j.msard.2019.101406] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/17/2019] [Indexed: 11/21/2022]
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Layne KA, Wood DM, Dargan PI. Gadolinium-based contrast agents – what is the evidence for ‘gadolinium deposition disease’ and the use of chelation therapy? Clin Toxicol (Phila) 2019; 58:151-160. [DOI: 10.1080/15563650.2019.1681442] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kerry A. Layne
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - David M. Wood
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Paul I. Dargan
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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Topcuoglu ED, Topcuoglu OM, Semiz Oysu A, Bukte Y. Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case-Control Study. J Magn Reson Imaging 2019; 51:1471-1477. [PMID: 31665554 DOI: 10.1002/jmri.26954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Accumulation of macrocyclic gadolinium agents in children's brains remain to be determined. PURPOSE To demonstrate whether there is an intracranial macrocyclic gadolinium deposition after multiple contrast-enhanced MRI with gadoterate meglumine in a pediatric population. STUDY TYPE Retrospective case-control. POPULATION In all, 45 children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the study group and 45 healthy children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the control group. FIELD STRENGTH/SEQUENCE T1 - and T2 -weighted axial images on a 1.5T scanner. ASSESSMENT Children with at least three enhanced brain MRIs and an age- and sex-matched control group with an unenhanced brain MRIs were compared in terms of T1 signal intensity (SI). All patients in the study group received gadoterate meglumine intravenously (0.1 mmol/kg). SI measurements were made by drawing six regions of interest (ROIs): dentate nuclei (DN), pons, globus pallidi (GP), frontal white matter (FWM), thalamus (T), clivus, and cerebrospinal fluid (CSF) for both groups on unenhanced T1 -weighted images. STATISTICAL TESTS Student's t-test was used for comparison of SI. The Pearson correlation was calculated for the correlation between the SI and the number of gadolinium administrations. RESULTS A significant difference was detected between two groups for DN/CSF, pons/CSF, GP/CSF, thalamus/CSF, and FWM/CSF (P < 0.001, P < 0.001, P = 0.002, P = 0.002, P = 0.024, respectively). There was no significant difference between the two groups for clivus/CSF (P = 0.15). A good correlation between the number of gadoterate meglumine administrations and the SI for DN/CSF, pons/CSF, GP/CSF, and T/CSF (r = 0.80, r = 0.73, r = 0.91, and r = 0.90, respectively) was found. DATA CONCLUSION A significant T1 SI increase reflecting gadolinium retention in the brain was detected for children with at least three gadoterate meglumine administrations in this series. The number of administrations correlated well with the increased SI. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:1471-1477.
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Affiliation(s)
- Elif Dilara Topcuoglu
- University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | | | - Aslihan Semiz Oysu
- University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Yasar Bukte
- University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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Bennani-Baiti B, Krug B, Giese D, Hellmich M, Bartsch S, Helbich TH, Baltzer PAT. Evaluation of 3.0-T MRI Brain Signal after Exposure to Gadoterate Meglumine in Women with High Breast Cancer Risk and Screening Breast MRI. Radiology 2019; 293:523-530. [PMID: 31638488 DOI: 10.1148/radiol.2019190847] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Otherwise healthy women at high risk for breast cancer undergo annual contrast agent-enhanced breast MRI screening examinations, resulting in high cumulative doses of gadolinium-based contrast agents (GBCAs). Whereas the majority of studies showed no T1 signal ratio increase in deep brain nuclei after more than six doses of macrocyclic GBCA, this has not been explored in a healthy study population. Purpose To assess whether women who are administered large cumulative doses of macrocyclic GBCA with breast MRI at high-risk breast cancer screening exhibit T1 alterations in deep brain nuclei. Materials and Methods In this prospective study from November 2017 to March 2018, healthy women who were either exposed (because of high-risk breast cancer screening) or unexposed to only gadoterate meglumine underwent 3.0-T brain MRI with a dedicated head coil, including T1 mapping and magnetization-prepared rapid gradient-echo sequences. T1 times and T1 signal intensities were measured in the dentate nucleus (DN), globus pallidus (GP), crus anterior of capsula interna (CA), and pons. Ratios of DN to pons and GP to CA were calculated, and univariable Pearson correlation coefficients were calculated. Multivariable analysis included partial regression analysis. Results This study evaluated 25 women (mean age, 51 years ± 11 [standard deviation]) who were exposed to a mean GBCA dose of 129 mL (median 112 mL; range, 70-302 mL) and 16 women (mean age, 37 years ± 10) who were never exposed to any GBCA. Infratentorially, no correlation between cumulative GBCA dose and T1 times or signal intensity ratios was detected (P = .66 and .55, respectively). In partial correlation analysis by considering age as a confounder, there was a moderate negative correlation between GP-to-CA ratio and GBCA dose (r = -0.40; P = .01) but not for GP T1 times (r = 0.19; P = .24). Conclusion After administration of relatively large cumulative doses of gadoterate dimeglumine, healthy women at high risk for breast cancer who underwent annual contrast-enhanced breast MRI screening did not exhibit T1 signal increase in deep brain nuclei at 3.0-T MRI. © RSNA, 2019.
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Affiliation(s)
- Barbara Bennani-Baiti
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
| | - Barbara Krug
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
| | - Daniel Giese
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
| | - Martin Hellmich
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
| | - Sophie Bartsch
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
| | - Thomas H Helbich
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
| | - Pascal A T Baltzer
- From the Department of Biomedical Imaging and Image-guided Therapy, Divisions of General and Pediatric Radiology (B.B.B., T.H.H., P.A.T.B.) and Neurology and Musculoskeletal Radiology (S.B.), Allgemeines Krankenhaus, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria; and Department of Radiology (B.K., D.G.) and Department of Medical Statistics and Bioinformatics (M.H.), University Hospital Cologne, Cologne, Germany
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Hannoun S, Issa R, El Ayoubi NK, Haddad R, Baalbaki M, Yamout BI, Khoury SJ, Hourani R. Gadoterate Meglumine Administration in Multiple Sclerosis has no Effect on the Dentate Nucleus and the Globus Pallidus Signal Intensities. Acad Radiol 2019; 26:e284-e291. [PMID: 30527456 DOI: 10.1016/j.acra.2018.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Previous studies on possible accumulation of gadolinium-based contrast agents (GBCA) in the brain suggest that macrocyclic GBCA are less likely to accumulate than linear GBCA. However, conflicting results have been reported, especially in MS. The aim of this study is to investigate retrospectively the correlation between gadoterate-meglumine (macrocyclic GBCA) use and T1 signal intensity changes (SI) in the dentate nucleus and the GP on unenhanced T1-weighted images in a large cohort of MS patients. MATERIALS AND METHODS Unenhanced T1-weighted images of 232 MS patients who previously received multiple intravenous administrations of 0.1 mmol/kg of gadoterate-meglumine were reviewed. The change in T1 SI ratios of dentate nucleus/central pons (DN/CP) and globus pallidus/centrum semiovale (GP/CSO) was calculated between the first and last MRIs and correlated with age, number of injections, time interval between MRIs, disease duration, activity, and therapy. RESULTS DN/CP ratio showed no significant changes whereas the GP/CSO ratio showed a significant decrease (p < 0.0001) between the first and last MRIs. Multivariable analyses of both ratios, controlling for age, disease duration, and time interval between MRIs, showed no significant correlation between the number of gadolinium injections and the differences in DN/CP (standardized beta = -0.018, p = 0.811) or GP/CSO SI ratios (standardized beta = -0.049, p = 0.499). CONCLUSION Repeated administration of gadoterate-meglumine in MS patients did not result in increased T1 SI in the DN or the GP. The significant decrease of GP/CSO ratio between the first and last MRIs is not due to gadolinium accumulation but rather to varying MR parameters.
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Affiliation(s)
- Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayane Issa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ribal Haddad
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwa Baalbaki
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem I Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
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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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Walczak P. Imaging Myeloperoxidase in Demyelinating Lesions: Biomarker with Clinical Value for Multiple Sclerosis or Merely a Tool for Animal Research? Radiology 2019; 293:166-167. [PMID: 31483203 DOI: 10.1148/radiol.2019191777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Piotr Walczak
- From the Division of MR Research, Associate Professor, The Russell H. Morgan Department of Radiology and Radiological Science, Institute for Cell Engineering, Johns Hopkins University School of Medicine, 733 N Broadway, Broadway Research Building Room 647, Baltimore, Md 21205
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Splendiani A, Corridore A, Torlone S, Martino M, Barile A, Di Cesare E, Masciocchi C. Visible T1-hyperintensity of the dentate nucleus after multiple administrations of macrocyclic gadolinium-based contrast agents: yes or no? Insights Imaging 2019; 10:82. [PMID: 31482392 PMCID: PMC6722174 DOI: 10.1186/s13244-019-0767-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the appearance of visible dentate nucleus (DN) T1-hyperintensity and quantify changes in DN/pons (DN/P) signal intensity (SI) ratio in MS patients after the exclusive administration of macrocyclic GBCAs. MATERIALS AND METHODS One hundred forty-nine patients with confirmed MS were evaluated. Patients received at least two administrations of gadobutrol (n = 63), gadoterate (n = 57), or both (n = 29). Two experienced neuroradiologists in consensus evaluated unenhanced T1-weighted MR images from all examinations in each patient for evidence of visible DN hyperintensity. Thereafter, SI measurements were made in the left and right DN and pons on unenhanced T1-weighted images from the first and last scans. A two-sample t test compared the DN/P SI ratios for patients with and without visible T1-hyperintensity. RESULTS Visible T1-hyperintensity was observed in 42/149 (28.2%) patients (19 after gadobutrol only, 15 after gadoterate only, 8 after both), typically at the 4th or 5th follow-up exam at 3-4 years after the initial examination. Significant increases in DN/P SI ratio from first to last examination were determined for patients with visible T1-hyperintensity (0.998 ± 0.002 to 1.153 ± 0.016, p < 0.0001 for gadobutrol; 1.003 ± 0.004 to 1.110 ± 0.014, p < 0.0001 for gadoterate; 1.004 ± 0.011 to 1.163 ± 0.032, p = 0.0004 for both) but not for patients without visible T1-hyperintensity (p > 0.05; all groups). CONCLUSION Multiple injections of gadobutrol and/or gadoterate can lead to visible and quantifiable increases in DN/P SI ratio in some patients with MS.
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Affiliation(s)
- Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Antonella Corridore
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvia Torlone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Milvia Martino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
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Age, But Not Repeated Exposure to Gadoterate Meglumine, Is Associated With T1- and T2-Weighted Signal Intensity Changes in the Deep Brain Nuclei of Pediatric Patients. Invest Radiol 2019; 54:537-548. [DOI: 10.1097/rli.0000000000000564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Abstract
Gadolinium (Gd)-based contrast agents have been routinely used worldwide in diagnostic MRI since 1988. All routinely applied contrast agents for clinical use were considered extremely safe with regard to tolerance, adverse effects and diagnostic efficacy and when used at Food and Drug Administration-approved doses. With the identification of Gd-associated disorders, namely nephrogenic systemic fibrosis and adverse reactions, and in the longer term Gd-retention in the brain, this view changed and led to the withdrawal or restriction of approval of linear Gd chelates in Europe. Even though Gd deposition in different human body areas was described very early, recently published literature of intracerebral accumulation of contrast agents as well as deposition in bone have created surprising attention. Not only was the fact of Gd deposition in the body well known for many years, but there is currently no clinical evidence of patient symptoms and no resulting health issues of patients have been observed yet. The expression "gadolinium deposition disease" has been termed by active patient advocacy groups with an online presence with reports of individual members stating a broad spectrum of disorders yielding a large symptom complex after administration of Gd-based contrast agents without evidence of any pre-existing or otherwise underlying disease process which could explain the mentioned disorder.
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Re: “Increased signal intensity in the unenhanced T1-weighted magnetic resonance in the brain after repeated administrations of a macrocyclic-ionic gadolinium-based contrast agent”. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.602855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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