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Fukushima Y, Ozaki D, Taketomi-Takahashi A, Hirasawa H, Ujita K, Suto T, Tsushima Y. Assessment of first-time and repeated acute adverse reactions to gadolinium-based contrast agents in MRI: A retrospective study. Eur J Radiol 2024; 176:111504. [PMID: 38761445 DOI: 10.1016/j.ejrad.2024.111504] [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: 02/09/2024] [Revised: 05/01/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
PURPOSE To identify gadolinium-based contrast agents (GBCAs)-related and patient-related risk factors for acute adverse reactions (AARs), and to examine the incidence and severity of repeated AARs. METHODS This study retrospectively evaluated all intravenous GBCA injections in MRI studies at a single institution from January 2012 to September 2019. First-time AARs in patients without a past history of AARs and risk factors were assessed using multivariable regression models with generalized estimating equations. For patients with a past history of AAR(s), we evaluated the incidence of repeated AARs using the Fisher's exact test, as well as the severity of these repeated AARs. RESULTS First-time AARs occurred in 129 of 41,827 GBCA injections (0.31 %; 0.70 % of 18,431 patients). With gadoterate meglumine as the reference, the odds ratio (OR) for allergic-like reactions to three GBCAs ranged from 3.27 to 8.03 (p = 0.012 to <0.001). For chemotoxic reactions, the OR was 3.75 (p = 0.001) for gadoteridol. Outpatients had a lower OR for chemotoxic reactions, while higher ORs were observed in head/neck and breast MRI (p < 0.05). The OR for age was 0.99 (p < 0.05). Patients with a past history of AAR(s) had a 3.6 % incidence of mild repeated AARs for all GBCA, significantly higher than the 0.31 % in first-time AARs (p < 0.001). No effectiveness was found for steroid premedication. CONCLUSION The occurrence of first-time AARs was related to the GBCA used and other factors. The incidence of repeated AARs was higher than first-time AARs, though all were mild in severity.
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Affiliation(s)
- Yasuhiro Fukushima
- Department of Applied Medical Imaging, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan.
| | - Daisuke Ozaki
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
| | - Hiromi Hirasawa
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Koichi Ujita
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Takayuki Suto
- Department of Radiology, Gunma University Hospital, 3-39-15 Showa, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma 371-8511, Japan
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Gulhane A, Ordovas K. Cardiac magnetic resonance assessment of cardiac involvement in autoimmune diseases. Front Cardiovasc Med 2023; 10:1215907. [PMID: 37808881 PMCID: PMC10556673 DOI: 10.3389/fcvm.2023.1215907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 09/11/2023] [Indexed: 10/10/2023] Open
Abstract
Cardiac magnetic resonance (CMR) is emerging as the modality of choice to assess early cardiovascular involvement in patients with autoimmune rheumatic diseases (ARDs) that often has a silent presentation and may lead to changes in management. Besides being reproducible and accurate for functional and volumetric assessment, the strength of CMR is its unique ability to perform myocardial tissue characterization that allows the identification of inflammation, edema, and fibrosis. Several CMR biomarkers may provide prognostic information on the severity and progression of cardiovascular involvement in patients with ARDs. In addition, CMR may add value in assessing treatment response and identification of cardiotoxicity related to therapy with immunomodulators that are commonly used to treat these conditions. In this review, we aim to discuss the following objectives: •Illustrate imaging findings of multi-parametric CMR approach in the diagnosis of cardiovascular involvement in various ARDs;•Review the CMR signatures for risk stratification, prognostication, and guiding treatment strategies in ARDs;•Describe the utility of routine and advanced CMR sequences in identifying cardiotoxicity related to immunomodulators and disease-modifying agents in ARDs;•Discuss the limitations of CMR, recent advances, current research gaps, and potential future developments in the field.
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Affiliation(s)
- Avanti Gulhane
- Department of Radiology, University of Washington, School of Medicine, Seattle, WA, United States
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3
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Rugani P, Brcic I, Magyar M, Schwarze UY, Jakse N, Ebeleseder K. Pulp Revascularization in an Autotransplanted Mature Tooth: Visualization with Magnetic Resonance Imaging and Histopathologic Correlation. J Clin Med 2023; 12:6008. [PMID: 37762947 PMCID: PMC10531622 DOI: 10.3390/jcm12186008] [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: 08/03/2023] [Revised: 08/31/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023] Open
Abstract
Autotransplantation of a mature tooth usually leads to pulpal necrosis. Root canal treatment is recommended to prevent related inflammatory complications a few weeks after surgery. Extraoral root-end resection may facilitate reperfusion and obviate root canal treatment, but cannot be pictured with conventional dental radiography at this point in time. In the case of a lower mature transplanted molar, contrast-enhanced magnetic resonance imaging proved to be a feasible method for visualizing pulp revascularization just 4 weeks after autotransplantation. Consequently, root canal treatment was obviated. Nevertheless, the tooth had to be extracted 18 months postoperatively due to external cervical root resorption, probably caused by the extraction trauma. This allowed the histological processing and examination of the newly generated intracanal tissue. Uninflamed fibrovascular connective tissue was found, while odontoblasts or cementoblast-like cells were absent. These findings indicated that it was most likely stem cells from the bone marrow and the periodontal ligament that drove the regeneration.
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Affiliation(s)
- Petra Rugani
- Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria
| | - Iva Brcic
- Diagnostic and Research Institute of Pathology, Comprehensive Cancer Centre Graz, Medical University of Graz, 8010 Graz, Austria;
| | - Marton Magyar
- Department of Radiology, Division of Neuroradiology, Vascular and Interventional Radiology, Medical University of Graz, 8010 Graz, Austria;
| | - Uwe Yacine Schwarze
- Department of Dentistry and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, 8010 Graz, Austria;
- Department of Orthopedics and Traumatology, Musculo-Skeletal Research Unit for Biomaterials, Medical University of Graz, 8036 Graz, Austria
| | - Norbert Jakse
- Department of Dental Medicine and Oral Health, Division of Oral Surgery and Orthodontics, Medical University of Graz, Billrothgasse 4, 8010 Graz, Austria
| | - Kurt Ebeleseder
- Department of Dental Medicine and Oral Health, Division of Prosthodontics, Restorative Dentistry and Periodontology, Medical University of Graz, 8010 Graz, Austria;
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4
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Bergmann LL, Ackman JB, Starekova J, Moeller A, Reeder S, Nagle SK, Schiebler ML. MR Angiography of Pulmonary Vasculature. Magn Reson Imaging Clin N Am 2023; 31:475-491. [PMID: 37414473 DOI: 10.1016/j.mric.2023.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/08/2023]
Abstract
Pulmonary MR angiography (MRA) is a useful alternative to computed tomographic angiography (CTA) for the study of the pulmonary vasculature. For pulmonary hypertension and partial anomalous pulmonary venous return, a cardiac MR imaging and the pulmonary MRA are useful for flow quantification and planning treatment. For the diagnosis of pulmonary embolism (PE), MRA-PE has been shown to have non-inferior outcomes at 6 months when compared with CTA-PE. Over the last 15 years, pulmonary MRA has become a routine and reliable examination for the workup of pulmonary hypertension and the primary diagnosis of PE at the University of Wisconsin.
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Affiliation(s)
- Liisa L Bergmann
- Department of Radiology, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA; Department of Medicine, University of Kentucky College of Medicine, 800 Rose Street, HX332E, Lexington, KY 40536-0293, USA.
| | - Jeanne B Ackman
- Massachusetts General Hospital, Department of Radiology, Division of Thoracic Imaging and Intervention Austin Building 202, 55 Fruit Street, Boston, MA 02114, USA
| | - Jitka Starekova
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Alexander Moeller
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott Reeder
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Scott K Nagle
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA
| | - Mark L Schiebler
- Department of Radiology, University of Wisconsin School of Medicine and Public Health, 600 Highland Avenue, Madison, WI 53705, USA.
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5
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Gallo-Bernal S, Patino-Jaramillo N, Calixto CA, Higuera SA, Forero JF, Lara Fernandes J, Góngora C, Gee MS, Ghoshhajra B, Medina HM. Nephrogenic Systemic Fibrosis in Patients with Chronic Kidney Disease after the Use of Gadolinium-Based Contrast Agents: A Review for the Cardiovascular Imager. Diagnostics (Basel) 2022; 12:diagnostics12081816. [PMID: 36010167 PMCID: PMC9406537 DOI: 10.3390/diagnostics12081816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Revised: 07/11/2022] [Accepted: 07/22/2022] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-enhanced cardiac magnetic resonance has revolutionized cardiac imaging in the last two decades and has emerged as an essential and powerful tool for the characterization and treatment guidance of a wide range of cardiovascular diseases. However, due to the high prevalence of chronic renal dysfunction in patients with cardiovascular conditions, the risk of nephrogenic systemic fibrosis (NSF) after gadolinium exposure has been a permanent concern. Even though the newer macrocyclic agents have proven to be much safer in patients with chronic kidney disease and end-stage renal failure, clinicians must fully understand the clinical characteristics and risk factors of this devastating pathology and maintain a high degree of suspicion to prevent and recognize it. This review aimed to summarize the existing evidence regarding the physiopathology, clinical manifestations, diagnosis, and prevention of NSF related to the use of gadolinium-based contrast agents.
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Affiliation(s)
- Sebastian Gallo-Bernal
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Correspondence:
| | - Nasly Patino-Jaramillo
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
| | - Camilo A. Calixto
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Department of Radiology Boston Children’s Hospital, Boston, MA 02115, USA
| | - Sergio A. Higuera
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
| | - Julian F. Forero
- Division of Radiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia;
| | - Juliano Lara Fernandes
- Jose Michel Kalaf Research Institute, Radiologia Clinica de Campinas, São Paulo 13092-123, Brazil;
| | - Carlos Góngora
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; (C.G.); (B.G.)
| | - Michael S. Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA 02114, USA;
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
| | - Brian Ghoshhajra
- Department of Radiology, Harvard Medical School, Boston, MA 02115, USA;
- Cardiovascular Imaging Research Center (CIRC), Division of Cardiology, Massachusetts General Hospital, Boston, MA 02114, USA; (C.G.); (B.G.)
| | - Hector M. Medina
- Division of Cardiology, Fundacion Cardioinfantil-LaCardio, Bogota 110131, Colombia; (N.P.-J.); (S.A.H.); (H.M.M.)
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Zhou Z, Ren L, Rajendran K, Diehn FE, Fletcher JG, McCollough CH, Yu L. Simultaneous dual-contrast imaging using energy-integrating-detector multi-energy CT: An in vivo feasibility study. Med Phys 2022; 49:1458-1467. [PMID: 35018658 DOI: 10.1002/mp.15448] [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: 10/11/2021] [Revised: 12/12/2021] [Accepted: 12/17/2021] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To demonstrate the feasibility of simultaneous dual-contrast imaging in a large animal using a newly developed dual-source energy-integrating-detector (EID) based multi-energy computed tomography (MECT) system. METHODS Two imaging tasks that may have potential clinical applications were investigated: head/neck (HN) CT angiography (CTA)/CT venography (CTV) with iodine and gadolinium, and small bowel imaging with iodine and bismuth in domestic swine. Dual-source x-ray beam configurations of 70 kV+Au120/Sn120 kV and 70 kV+Au140/Sn140 kV were used for the HN-CTA/CTV and small bowel imaging studies, respectively. A test bolus scan was performed for each study. The ROIs in the carotid artery and jugular vein for HN-CTA/CTV imaging and abdominal aorta for small bowel imaging were used to determine the time-attenuation curves, based on which the timing for contrast injection and the CT scan was determined. In the HN-CTA/CTV study, a MECT scan was performed at the time point corresponding to the optimal arterial enhancement by iodine and the optimal venous enhancement by gadolinium. In the small bowel imaging study, A MECT scan was performed at the optimal time point to simultaneously capture the mesenteric arterial enhancement of iodine and the enteric enhancement of bismuth. Image-based material decomposition was performed to decompose different materials for each study. To quantitatively characterize contrast material separation and misclassification, two ROIs on left common carotid artery and left internal jugular vein in HN-CTA/CTV imaging and three ROIs on superior mesenteric artery, ileal lumen, and collapsed ileum (ileal wall) in small bowel imaging were placed to measure the mean concentration values and the standard deviations. RESULTS In the HN-CTA/CTV study, common carotid arteries containing iodine and internal/external jugular veins containing gadolinium were clearly delineated from each other. Fine vessels such as cephalic veins and branches of external jugular veins were noticeable but clear visualization was hindered by image noise in gadolinium-specific (CTV) images, as reviewed by a neuro radiologist. In the small bowel imaging study, the mesenteric arteries and collapsed bowel wall containing iodine and the small bowel loops containing bismuth were clearly distinctive from each other in the iodine- and bismuth-specific images after material decomposition, as reviewed by an abdominal radiologist. Quantitative analyses showed that the misclassifications between the two contrast materials were less than 1.7 mg/mL and 0.1 mg/mL for CTA/CTV and small bowel imaging studies, respectively. CONCLUSIONS Feasibility of simultaneous CTA/CTV imaging in head and neck with iodine and gadolinium and simultaneous imaging of arterial and enteric phases of small bowel with iodine and bismuth, using a dual-source EID-MECT system, was demonstrated in a swine study. Compared to iodine and gadolinium in CTA/CTV, better delineation and classification of iodine and bismuth in small bowel imaging were achieved mainly due to wider separation between the corresponding two K-edge energies. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Zhongxing Zhou
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, US
| | - Liqiang Ren
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, US
| | | | - Felix E Diehn
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, US
| | - Joel G Fletcher
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, US
| | | | - Lifeng Yu
- Department of Radiology, Mayo Clinic, Rochester, MN, 55905, US
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7
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Cerne JW, Pathrose A, Singer AM, Moore JE, Serhal A, Aouad P, Umair M, Ragin A, Allen BD, Avery R, Markl M, Carr JC. MRA of the Supraaortic Vasculature: Comparison of Gadobutrol and Gadoterate Meglumine at 1.5 T. J Magn Reson Imaging 2021; 56:440-449. [PMID: 34953154 DOI: 10.1002/jmri.28044] [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: 10/13/2021] [Revised: 12/14/2021] [Accepted: 12/14/2021] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND Gadobutrol (GB) and gadoterate meglumine (GM) are contrast agents used for contrast-enhanced magnetic resonance angiography (CEMRA). Supraaortic vasculature (SAV) CEMRAs are used to evaluate stroke risk and neurologic symptoms. There is a need to compare the SAV CEMRA image quality obtained with GB and GM. PURPOSE To intra-individually compare MRA images obtained with equimolar GB and GM at 1.5 T in the SAV. STUDY TYPE Prospective, crossover. POPULATION Twenty-eight subjects (54 ± 13 years; 17 female). FIELD STRENGTH/SEQUENCE 1.5 T; three-dimensional (3D) gradient recalled echo. ASSESSMENT Quantitative image quality was measured by normalized signal intensity (SIn ) [SIn = SI blood/SD blood] and contrast ratio (CR) [CR = SI blood/SI muscle], determined by an observer (JWC) with 1 year of vascular imaging experience. Three radiologists (AS, PA, and MU) with (5, 5, and 6 years of) vascular imaging experience evaluated image quality by Likert-scale ratings (of image impression, wall conspicuity, and artifact absence). STATISTICAL TESTS SIn and CR were compared with paired t-tests or Wilcoxon signed-rank tests and Bland-Altman plots. Qualitative ratings were compared with Wilcoxon signed-rank test. RESULTS No significant difference in SIn was found between GB and GM. CRs with GB were significantly higher than GM at the right common carotid (6.9 ± 2.5 vs. 4.8 ± 1), left internal carotid (7.3 ± 2 vs. 4.4 ± 1.2), right internal carotid (7.7 ± 2.2 vs. 5 ± 1.1), and left vertebral (6.6 ± 2.2 vs. 4.5 ± 1.1) arteries. Bland-Altman plots showed relatively greater differences between GB and GM at higher CRs and SIn s. GM showed significantly higher artifact than GB (3.56 ± 0.52 vs. 3.36 ± 0.46) and significantly lower overall image quality (10.73 ± 1.45 vs. 11.26 ± 1.58) at the left vertebral artery. DATA CONCLUSION At 1.5 T and equimolar demonstration, GB (0.1 mL/kg, i.e., 0.1 mmol/kg) showed higher CRs in the SAV compared to GM (0.2 mL/kg, i.e., 0.1 mmol/kg) at most vessels. Subjective image quality was not significantly different between the two agents for most vessels. LEVEL OF EVIDENCE 2 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- John W Cerne
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ashitha Pathrose
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Alyssa M Singer
- Tulane University School of Medicine, New Orleans, Louisiana, USA
| | - Jackson E Moore
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - Ali Serhal
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Pascale Aouad
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Muhammad Umair
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ann Ragin
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Bradley D Allen
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Ryan Avery
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Markl
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Biomedical Engineering, Northwestern University McCormick School of Engineering and Applied Science, Evanston, Illinois, USA
| | - James C Carr
- Department of Radiology, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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8
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Ehrle A, Lilge S, Clegg PD, Maddox TW. Equine flexor tendon imaging part 2: Current status and future directions in advanced diagnostic imaging, with focus on the deep digital flexor tendon. Vet J 2021; 278:105763. [PMID: 34678501 DOI: 10.1016/j.tvjl.2021.105763] [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: 01/30/2021] [Revised: 09/17/2021] [Accepted: 10/15/2021] [Indexed: 11/16/2022]
Abstract
Flexor tendon injuries are a common cause of lameness and early retirement in equine athletes. While ultrasonography is most frequently utilised, advanced diagnostic imaging modalities are becoming more widely available for detection and monitoring of flexor tendon lesions. Part two of this literature review details current experience with low- and high-field magnetic resonance imaging (MRI) and computed tomography (CT) for the diagnosis of equine flexor tendinopathy with a focus on the deep digital flexor tendon. Implications of the 'magic angle' artefact as well as injection techniques and the use of contrast media are discussed. Future developments in tendon imaging aim to gain enhanced structural information about the tendon architecture with the prospect to prevent injury. Techniques as described for the assessment of the human Achilles tendon including ultra-high field MRI and positron emission tomography are highlighted.
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Affiliation(s)
- Anna Ehrle
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; Equine Clinic, Freie Universität Berlin, 10965 Berlin, Germany.
| | - Svenja Lilge
- Equine Clinic, Freie Universität Berlin, 10965 Berlin, Germany
| | - Peter D Clegg
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK
| | - Thomas W Maddox
- Department of Musculoskeletal and Ageing Science, Institute of Life Course and Medical Sciences, University of Liverpool, Liverpool L7 8TX, UK; Institute of Infection, Veterinary and Ecological Sciences, University of Liverpool, Neston CH64 7TE, UK
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9
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Kuhn MJ, Patriarche JW, Patriarche D, Kirchin MA, Bona M, Pirovano G. The TRUTH confirmed: validation of an intraindividual comparison of gadobutrol and gadoteridol for imaging of glioblastoma using quantitative enhancement analysis. Eur Radiol Exp 2021; 5:46. [PMID: 34635965 PMCID: PMC8505590 DOI: 10.1186/s41747-021-00240-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 08/06/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous intraindividual comparative studies evaluating gadobutrol and gadoteridol for contrast-enhanced magnetic resonance imaging (MRI) of brain tumours have relied on subjective image assessment, potentially leading to misleading conclusions. We used artificial intelligence algorithms to objectively compare the enhancement achieved with these contrast agents in glioblastoma patients. METHODS Twenty-seven patients from a prior study who received identical doses of 0.1 mmol/kg gadobutrol and gadoteridol (with appropriate washout in between) were evaluated. Quantitative enhancement (QE) maps of the normalised enhancement of voxels, derived from computations based on the comparison of contrast-enhanced T1-weighted images relative to the harmonised intensity on unenhanced T1-weighted images, were compared. Bland-Altman analysis, linear regression analysis and Pearson correlation coefficient (r) determination were performed to compare net QE and per-region of interest (per-ROI) average QE (net QE divided by the number of voxels). RESULTS No significant differences were observed for comparisons performed on net QE (mean difference -24.37 ± 620.8, p = 0.840, r = 0.989) or per-ROI average QE (0.0043 ± 0.0218, p = 0.313, r = 0.958). Bland-Altman analysis revealed better per-ROI average QE for gadoteridol-enhanced MRI in 19/27 (70.4%) patients although the mean difference (0.0043) was close to zero indicating high concordance and the absence of fixed bias. CONCLUSIONS The enhancement of glioblastoma achieved with gadoteridol and gadobutrol at 0.1 mmol/kg bodyweight is similar indicating that these agents have similar contrast efficacy and can be used interchangeably, confirming the results of a prior double-blind, randomised, intraindividual, crossover study.
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Affiliation(s)
- Matthew J Kuhn
- University of Illinois College of Medicine at Peoria, 221 NE Glen Oak Ave, Peoria, IL, 61636, USA. .,A.I. Analysis, Inc., 1425 Broadway #20-2656, Seattle, WA, 98122, USA.
| | | | | | - Miles A Kirchin
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Via Caduti di Marcinelle, 13, 20134, Milan, Italy
| | - Massimo Bona
- Global Medical & Regulatory Affairs, Bracco Imaging SpA, Via Caduti di Marcinelle, 13, 20134, Milan, Italy
| | - Gianpaolo Pirovano
- Global Medical & Regulatory Affairs, Bracco Diagnostics, Inc., 259 Prospect Plains Rd. Building H, Monroe Township, NJ, 08831, USA
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10
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Wang J, Salzillo T, Jiang Y, Mackeyev Y, David Fuller C, Chung C, Choi S, Hughes N, Ding Y, Yang J, Vedam S, Krishnan S. Stability of MRI contrast agents in high-energy radiation of a 1.5T MR-Linac. Radiother Oncol 2021; 161:55-64. [PMID: 34089753 PMCID: PMC8324543 DOI: 10.1016/j.radonc.2021.05.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Revised: 05/24/2021] [Accepted: 05/26/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Gadolinium-based contrast is often used when acquiring MR images for radiation therapy planning for better target delineation. In some situations, patients may still have residual MRI contrast agents in their tissue while being treated with high-energy radiation. This is especially true when MRI contrast agents are administered during adaptive treatment replanning for patients treated on MR-Linac systems. PURPOSE The purpose of this study was to analyze the molecular stability of MRI contrast agents when exposed to high energy photons and the associated secondary electrons in a 1.5T MR-Linac system. This was the first step in assessing the safety of administering MRI contrast agents throughout the course of treatment. MATERIALS AND METHODS Two common MRI contrast agents were irradiated with 7 MV photons to clinical dose levels. The irradiated samples were analyzed using liquid chromatography-high resolution mass spectrometry to detect degradation products or conformational alterations created by irradiation with high energy photons and associated secondary electrons. RESULTS No significant change in chemical composition or displacement of gadolinium ions from their chelates was discovered in samples irradiated with 7 MV photons at relevant clinical doses in a 1.5T MR-Linac. Additionally, no significant correlation between concentrations of irradiated MRI contrast agents and radiation dose was observed. CONCLUSION The chemical composition stability of the irradiated contrast agents is promising for future use throughout the course of patient treatment. However, in vivo studies are needed to confirm that unexpected metabolites are not created in biological milieus.
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Affiliation(s)
- Jihong Wang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States.
| | - Travis Salzillo
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Yongying Jiang
- The Institute for Applied Cancer Science, MD Anderson Cancer Center, Houston, United States
| | - Yuri Mackeyev
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, United States
| | - Clifton David Fuller
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Caroline Chung
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Seungtaek Choi
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Neil Hughes
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, United States
| | - Yao Ding
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States
| | - Jinzhong Yang
- Department of Radiation Physics, MD Anderson Cancer Center, Houston, United States
| | - Sastry Vedam
- Department of Radiation Oncology, University of Maryland, Baltimore, United States
| | - Sunil Krishnan
- Department of Radiation Oncology, Mayo Clinic, Jacksonville, United States
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11
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Lunyera J, Mohottige D, Alexopoulos AS, Campbell H, Cameron CB, Sagalla N, Amrhein TJ, Crowley MJ, Dietch JR, Gordon AM, Kosinski AS, Cantrell S, Williams JW, Gierisch JM, Ear B, Goldstein KM. Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review. Ann Intern Med 2020; 173:110-119. [PMID: 32568573 PMCID: PMC7847719 DOI: 10.7326/m20-0299] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020. STUDY SELECTION Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure. DATA EXTRACTION Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools. DATA SYNTHESIS Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease. LIMITATIONS Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment. CONCLUSION Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).
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Affiliation(s)
- Joseph Lunyera
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Dinushika Mohottige
- Duke University School of Medicine and Duke University Medical Center, Durham, North Carolina (D.M.)
| | - Anastasia-Stefania Alexopoulos
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Hilary Campbell
- Margolis Center for Health Policy at Duke University, Durham, North Carolina (H.C.)
| | - C Blake Cameron
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Nicole Sagalla
- Durham Veterans Affairs Health Care System and Duke University School of Medicine, Durham, North Carolina (N.S.)
| | - Timothy J Amrhein
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Matthew J Crowley
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Jessica R Dietch
- Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.R.D.)
| | - Adelaide M Gordon
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Andrzej S Kosinski
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina (A.S.K.)
| | - Sarah Cantrell
- Duke University School of Medicine and Duke University Medical Center Library and Archives, Durham, North Carolina (S.C.)
| | - John W Williams
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
| | - Jennifer M Gierisch
- Duke University School of Medicine, Durham Veterans Affairs Health Care System, and Duke University, Durham, North Carolina (J.M.G.)
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Karen M Goldstein
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
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12
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Del Poggio A, Anello G, Calloni SF, Vezzulli P, Pereira C, Iadanza A, Falini A, Anzalone N. Diagnostic efficacy and safety of gadoteridol compared to gadobutrol and gadoteric acid in a large sample of CNS MRI studies at 1.5T. J Neuroradiol 2020; 49:73-79. [PMID: 32603767 DOI: 10.1016/j.neurad.2020.06.005] [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: 03/02/2020] [Revised: 06/10/2020] [Accepted: 06/15/2020] [Indexed: 11/15/2022]
Abstract
PURPOSE To evaluate safety and diagnostic accuracy of gadoteridol vs. other macrocyclic gadolinium-based contrast agents (GBCAs) in a large cohort of consecutive and non-selected patients referred for CE-MRI of the CNS. MATERIAL AND METHODS Between November 2017 and March 2018, we prospectively enrolled a consecutive cohort of patients referred for neuroradiological CE-MRI (1.5T MRI). Image quality and adverse events were assessed. Diagnostic performance was determined for a subgroup of patients with truth standard findings available. Comparison was made between patients receiving gadoteridol and patients receiving other macrocyclic GBCAs. Inter-reader agreement (kappa) between two expert neuroradiologists was calculated for the diagnosis of malignancy. RESULTS Overall, 460 patients (220M/240F; mean age 54±16 years) were enrolled of which 230 received gadoteridol (Group 1) and 230 either gadoteric acid or gadobutrol [n=83 (36.1%) and n=147 (63.9%), respectively; Group 2]. Image quality was rated as good or excellent in both groups. The sensitivity, specificity and diagnostic accuracy for determination of malignancy was 88.2%, 96.5% and 95.4%, respectively, for Group 1 and 93.7%, 97.4% and 96.9%, respectively, for Group 2, with no significant differences between groups (P>0.75) for any determination. Inter-reader agreement for the identification of malignancy was excellent [K=0.877 (95%CI: 0.758-0.995) and K=0.818 (95%CI: 0.663-0.972) for groups 1 and 2, respectively; P=0.0913]. Adverse events occurred in 5 of 460 (1.09%) patients overall, with no significant difference (P=0.972) between groups. CONCLUSION Gadoteridol was safe and guaranteed good image quality without significant differences when compared to gadobutrol and gadoteric acid in a wide range of CNS pathologies.
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Affiliation(s)
- Anna Del Poggio
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy
| | | | - Sonia Francesca Calloni
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy
| | - Paolo Vezzulli
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy
| | - Clodoaldo Pereira
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy
| | - Antonella Iadanza
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy
| | - Andrea Falini
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy
| | - Nicoletta Anzalone
- Department of Neuroradiology and CERMAC, San Raffaele Scientific Institute, San Raffaele Vita-Salute University, Milan, Italy.
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Signal Enhancement and Enhancement Kinetics of Gadobutrol, Gadoteridol, and Gadoterate Meglumine in Various Body Regions. Invest Radiol 2020; 55:367-373. [DOI: 10.1097/rli.0000000000000645] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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14
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Liu X, Zhang W, Li Z, Fu Y, Ren J, Shen W, Wang J, Xu Y, Song B. Improved display of abdominal contrast-enhanced MRA using gadobutrol: comparison with Gd-DTPA. Clin Radiol 2019; 74:978.e1-978.e7. [PMID: 31551147 DOI: 10.1016/j.crad.2019.08.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Accepted: 08/20/2019] [Indexed: 02/05/2023]
Abstract
AIM To qualitatively and quantitatively compare gadobutrol with gadopentetate dimeglumine (Gd-DTPA) in abdominal contrast-enhanced magnetic resonance angiography (CE-MRA) and contrast-enhanced magnetic resonance imaging (CE-MRI) during one-stop imaging. MATERIALS AND METHODS This prospective, blinded, multicentre, intra-individual comparison study was approved by the institutional review board. All patients underwent gadobutrol- and Gd-DTPA-enhanced MRA and MRI. Qualitative analysis for vessels was performed using a three-point scale while quantity analysis was performed by signal-to-noise ratio (SNR). Visceral organs enhancements were also analysed. A Wilcoxon matched-pair signed-rank test was used to evaluate the quality and quantity results. RESULTS One hundred and twelve patients were enrolled. Quality analyses results for large vessels and small vessels of gadobutrol and Gd-DTPA were 18.38±1.51 and 6.76±1.58 and 17.87±1.84 and 6.09±1.55, respectively. Wilcoxon signed-rank tests revealed gadobutrol was significantly superior to Gd-DTPA (p=0.036) for small vessels. For large vessel quantity analysis, gadobutrol demonstrated significantly higher signal-to-noise ratios (SNR; p=0.041) than Gd-DTPA, with mean values of 948.156±349.731 and 838.925±248.197. There was no statistically significant in enhancement of liver, spleen, and renal tissue during gadobutrol- and Gd-DTPA-enhanced imaging (p>0.05). One patient reported an adverse event. Dizziness and vomiting occurred after injection of Gd-DTPA. CONCLUSIONS The present study demonstrates gadobutrol-enhanced MRA was superior to that of Gd-DTPA without statistical significance in visceral organ enhancement. It indicates gadobutrol may be more suitable for abdominal one-stop imaging for CE-MRA and CE-MRI by improving depiction of vessels in MRA images.
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Affiliation(s)
- X Liu
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - W Zhang
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Z Li
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Y Fu
- Department of Radiology, The First Hospital of Jilin University, Changchun, Jilin Province, China
| | - J Ren
- Department of Radiology, Sichuan Cancer Hospital, Chengdu, Sichuan Province, China
| | - W Shen
- Department of Radiology, Tianjin First Central Hospital, Tianjin, Tianjin Province, China
| | - J Wang
- Department of Radiology, The Third Affiliated Hospital of Zhongshan University, Guangzhou, Guangdong Province, China
| | - Y Xu
- Department of Radiology, Nanfang Hospital of Southern Medical University, Guangzhou, Guangdong Province, China
| | - B Song
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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15
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Cho SB, Lee AL, Chang HW, Kim KA, Yoo WJ, Yeom JA, Rho MH, Kim SJ, Lim YJ, Han M. Prospective Multicenter Study of the Safety of Gadoteridol in 6163 Patients. J Magn Reson Imaging 2019; 51:861-868. [PMID: 31663202 PMCID: PMC7027821 DOI: 10.1002/jmri.26940] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/09/2019] [Accepted: 09/09/2019] [Indexed: 12/13/2022] Open
Abstract
Background The safety of gadolinium‐based contrast agents is of fundamental importance. Purpose To determine the frequency and severity of immediate‐type adverse reactions to approved doses of gadoteridol in patients referred for routine gadoteridol‐enhanced MRI in actual clinical practice settings. Study Type Prospective, observational. Population In all, 6163 subjects were enrolled (mean age: 56.7 ± 15.4 years; range: 6–93 years). Field Strength/Sequence 1.5T and 3.0T. Assessment Assessment was of immediate adverse reactions by the investigating radiologist using the MedDRA System Organ Class and preferred term. Statistical Tests Summary statistics for continuous variables, descriptive statistics for demographic characteristics. Results Overall, 19 adverse events occurred in 13 (0.21%) patients, of which 15 in 10 (0.16%) patients were considered related to gadoteridol administration. These events were evenly distributed between male and female subjects and all occurred in adults. Twelve of the 15 related events in eight (0.13%) patients were considered mild in intensity (rapidly self‐resolving), while the remaining three events in two patients (0.03%) were considered moderate in intensity. None were of severe intensity and no serious adverse events occurred. Data Conclusion The rate of immediate‐type adverse events following exposure to approved doses of gadoteridol is extremely low, and mostly limited to transient and self‐resolving symptoms. Level of Evidence: 2 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:861–868.
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Affiliation(s)
- Sung Bum Cho
- Department of Radiology, Anam Hospital, College of Medicine, Korea University, Seoul, Korea
| | - A-Leum Lee
- Department of Radiology, Soonchunhyang University Hospital, Gyeonggi-do, Korea
| | - Hyuk Won Chang
- Department of Radiology, Dongsan Medical Center, Keimyung University, Daegu, Korea
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Seoul, Korea
| | - Won Jong Yoo
- Department of Diagnostic Radiology, Bucheon St. Mary's Hospital, Catholic University of Korea, Gyeonggi-do, Korea
| | - Jeong A Yeom
- Department of Radiology, Pusan National University Yangsan Hospital, Gyeongsangnam-do, Korea
| | - Myung Ho Rho
- Department of Radiology, Kangbuk Samsung Hospital, Seoul, Korea
| | - Sung Jin Kim
- Department of Radiology, Chungbuk National University Hospital, Chungcheongbuk-do, Korea
| | - Yun-Jung Lim
- Department of Radiology, Haeundae Paik Hospital, Busan, Korea
| | - Miran Han
- Department of Radiology, Ajou University Medical Center, Suwon-si, Korea
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16
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Lee CH. Quantitative T2-mapping using MRI for detection of prostate malignancy: a systematic review of the literature. Acta Radiol 2019; 60:1181-1189. [PMID: 30621443 DOI: 10.1177/0284185118820058] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Chau Hung Lee
- 1 Department of Radiology, Charite - Universitätzsmedizin Berlin, Berlin, Germany
- 2 Department of Radiology, Tan Tock Seng Hospital, Singapore
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17
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Lee CH, Vellayappan B, Taupitz M, Hamm B, Asbach P. Dynamic contrast-enhanced MR imaging of the prostate: intraindividual comparison of gadoterate meglumine and gadobutrol. Eur Radiol 2019; 29:6982-6990. [PMID: 31264013 DOI: 10.1007/s00330-019-06321-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2018] [Revised: 05/27/2019] [Accepted: 06/11/2019] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To intraindividually compare the signal-enhancing effect of 0.5 M gadoterate meglumine and 1.0 M gadobutrol in dynamic contrast-enhanced magnetic resonance (DCE-MR) imaging of the prostate. METHODS Fifty patients who underwent two 3-T MR examinations of the prostate were included in this IRB-approved retrospective uncontrolled, unrandomized study. All received two scans (mean time interval, 20.5 months) including T1-weighted DCE-MR imaging, one with 0.5 M gadoterate meglumine and one with 1.0 M gadobutrol. Equimolar doses of gadolinium (0.1 mmol/kg body weight) were administered with identical injection speed (2 mL/s), resulting in differing gadolinium delivery rate. An identical region of interest (ROItz) within a BPH-node was identified on both scans. The area under the time-enhancement curve of each ROItz from 0 to 180 s post contrast arrival and pharmacokinetic parameters were calculated. Relative enhancement and signal-to-noise (SNR) and contrast-to-noise (CNR) ratios in the delayed phase at about 180 s were compared between both agents. RESULTS There was a significantly larger area under the time-enhancement curve (5.53 vs 4.97 p = 0.0007) and higher relative enhancement of BPH nodules (2.23 vs 1.96 p < 0.0001) with gadobutrol compared with gadoterate meglumine. There were no significant differences in SNR (44.55 vs 37.63 p = 0.12), CNR (31.22 vs 26.39 p = 0.18), and pharmacokinetic parameters Ktrans (0.31 vs 0.32 p = 0.86), Ve (1.36 vs 0.98 p = 0.13), and Kep (0.34 vs 0.36 p = 0.12). CONCLUSIONS At equimolar doses, increased gadolinium delivery over time using gadobutrol provides higher relative enhancement parameters in BPH nodules compared with gadoterate meglumine, but does not translate into improved SNR or CNR. KEY POINTS • At equal injection rate and equimolar total dose, gadobutrol compared with gadoterate meglumine provides a significantly greater relative enhancement in DCE-MR imaging of BPH over the first 180 s. • There are no significant differences in SNRs, CNRs, and pharmacokinetic parameters between the two GBCAs.
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Affiliation(s)
- Chau Hung Lee
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany. .,Department of Radiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore.
| | - Balamurugan Vellayappan
- Department of Radiation Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore
| | - Matthias Taupitz
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Bernd Hamm
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
| | - Patrick Asbach
- Department of Radiology, Charité- Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Campus Benjamin Franklin, Berlin, Germany
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Glutig K, Hahn G, Kuvvetli P, Endrikat J. Safety of gadobutrol: results of a non-interventional study of 3710 patients, including 404 children. Acta Radiol 2019; 60:873-879. [PMID: 30253660 PMCID: PMC6604256 DOI: 10.1177/0284185118801151] [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] [Indexed: 11/15/2022]
Abstract
Background The safety of gadolinium-based contrast agents is a hot topic in
radiology. Purpose To evaluate the safety profile of gadobutrol during routine use. Material and Methods Prospective, non-interventional study in 80 centers in Germany. The primary
outcome was the number of adverse drug reactions (ADR) following gadobutrol
administration. Results A total of 3710 patients were included in the analysis, including 404
children (10.9%). A total of 6026 magnetic resonance imaging examinations of
organs/organ systems and 872 magnetic resonance angiography examinations
were performed. A total of 22 (0.59%) patients experienced at least one ADR.
Nausea and vomiting were the most frequent ADRs, experienced by nine (0.24%)
and three (0.08%) patients, respectively. One serious ADR was recorded
(anaphylactoid reaction). No deaths were reported. Conclusion This non-interventional study in 3710 patients confirmed gadobutrol as a safe
and reliable contrast agent in adults and children.
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Affiliation(s)
- Katja Glutig
- Department of Radiology, St. Joseph Hospital, Dresden, Germany
| | - Gabriele Hahn
- Pediatric Radiology, University Hospital Carl Gustav Carus, Dresden, Germany
| | - Petra Kuvvetli
- Bayer Vital GmbH, Pharmaceuticals, Medical Affairs Radiology, Leverkusen, Germany
| | - Jan Endrikat
- Bayer AG, Radiology, Berlin, Germany
- University Medical School of Saarland, Dept of Gynecology, Obstetrics and Reproductive Medicine, 66421 Homburg/Saar, Germany
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19
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Single-Center Retrospective Analysis of Breakthrough Allergic-Like Reactions to Gadobutrol. Invest Radiol 2019; 54:448-451. [DOI: 10.1097/rli.0000000000000557] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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20
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10 Years of Nephrogenic Systemic Fibrosis: A Comprehensive Analysis of Nephrogenic Systemic Fibrosis Reports Received by a Pharmaceutical Company from 2006 to 2016. Invest Radiol 2019; 53:541-550. [PMID: 29547493 PMCID: PMC6092103 DOI: 10.1097/rli.0000000000000462] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives The aim of this study was to critically assess the evaluation and categorization process for nephrogenic systemic fibrosis (NSF) based on reports received by Bayer from 2006 to 2016. Materials and Methods A total of 779 NSF reports received by Bayer globally from 2006 to 2016 were included in the analysis. Arlington Medical Resources provided gadolinium-based contrast agent (GBCA) market share. Reports were conservatively categorized based on the Cowper/Girardi criteria. A statistical model simulated the impact of market share and market introduction on the number of unconfounded reports. Results For all reports, reported onset of disease ranged from 1996 and 2012. Of 779 reports, 325 involved a Bayer product only, 208 involved only products from other companies (or unknown GBCA), and 246 involved both Bayer and non-Bayer products. Most of all reports (86%) originated from the United States. Through 2006, Magnevist and Omniscan dominated the US market (>80% combined market share). All other GBCAs with fewer NSF reports comprised the remaining combined market share of less than 20% or were introduced after May 2007, after safety recommendations came into effect. A total of 563 reports (220 single-agent and 343 multiagent reports) involved Magnevist. In at least 150 of the 343 reports, a different GBCA (Omniscan, 118; OptiMARK, 15; MultiHance, 6; and macrocyclic agent, 11) showed the closest temporal relationship to onset of NSF-like symptoms. The simulation model demonstrated that patients receiving a GBCA with lower market share and late market introduction are less likely to be observed in an unconfounded setting. Conclusions Year of market introduction, as well as US market share in 2000 to 2007, greatly influenced the absolute number of NSF reports for each GBCA, their a priori probability to cause NSF, as well as their a priori probability to be associated with unconfounded cases of NSF. Variability in case interpretation and pharmacovigilance approaches also influence the absolute number of unconfounded cases and should therefore not be used for comparative risk assessments. This should be primarily based on objective product parameters such as structure, stability, pharmacokinetics, and dose.
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Abstract
Intravenous gadobutrol [Gadovist™ (EU); Gadavist® (USA)] is a second-generation, extracellular non-ionic macrocyclic gadolinium-based contrast agent (GBCA) that is approved for use in paediatric (including term neonates) and adult patients undergoing diagnostic contrast-enhanced (CE) MRI for visualization of pathological lesions in all body regions or for CE MRA to evaluate perfusion and flow-related abnormalities. Its unique physicochemical profile, including its high thermostability and proton relaxation times, means that gadobutrol is formulated at twice the gadolinium ion concentration of other GBCAs, resulting in a narrower bolus and consequently, improved dynamic image enhancement. Based on > 20 years of experience in the clinical trial and real-world settings (> 50 million doses) and its low risk for developing nephrogenic systemic fibrosis (NSF), gadobutrol represents an effective and safe diagnostic GBCA for use in CE MRI and MRA to visualize pathological lesions and vascular perfusion and flow-related abnormalities in all body regions in a broad spectrum of patients, including term neonates and other paediatric patients, young and elderly adult patients, and those with moderate or severe renal or hepatic impairment or cardiovascular (CV) disease.
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Post-marketing surveillance of gadobutrol for contrast-enhanced magnetic resonance imaging in Japan. Jpn J Radiol 2018; 36:676-685. [PMID: 30232584 DOI: 10.1007/s11604-018-0778-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/11/2018] [Indexed: 12/28/2022]
Abstract
PURPOSE To evaluate the safety of gadobutrol for magnetic resonance imaging in a prospective, non-interventional, post-marketing surveillance in Japan. MATERIALS AND METHODS Gadobutrol was administered in accordance with Japanese prescribing information over a 2-year enrollment period, using a standardized questionnaire to collect information. The primary outcome was the incidence of adverse reactions (ARs) following gadobutrol injection. RESULTS Questionnaire data were analyzed for 3337 patients (age, 58.1 ± 17.4 years [mean±SD]). Gadobutrol was administered at a dose of 0.10 ± 0.02 mL/kg body weight. Thirty-three patients were observed to have 42 ARs suspected to be due to gadobutrol, an incidence proportion of 0.99%; 29 ARs were acute (<1 h post-injection)-including one case of severe acute AR (0.03%). Patient subpopulations (with hepatic, renal, cardiovascular diseases) did not differ markedly in AR proportions categorized by age, sex, presence of comorbidity, or imaging indication. No cases of nephrogenic systemic fibrosis were reported. Investigators rated images as improved or profoundly improved following gadobutrol injection in 91.1% of examinations. CONCLUSION Gadobutrol was well tolerated with a good safety profile in this post-marketing surveillance of a large patient population in Japan.
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol CB, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: A Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can J Kidney Health Dis 2018; 5:2054358118778573. [PMID: 29977584 PMCID: PMC6024496 DOI: 10.1177/2054358118778573] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/31/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE OF REVIEW Use of gadolinium-based contrast agents (GBCA) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCA are absolutely contraindicated in AKI, category G4 and G5 CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), and dialysis-dependent patients is outdated and may limit access to clinically necessary contrast-enhanced magnetic resonance imaging (MRI) examinations. This review and clinical practice guideline addresses the discrepancy between existing Canadian guidelines regarding use of GBCA in renal impairment and NSF. SOURCES OF INFORMATION Published literature (including clinical trials, retrospective cohort series, review articles, and case reports), online registries, and direct manufacturer databases were searched for reported cases of NSF by class and specific GBCA and exposed patient population. METHODS A comprehensive review was conducted identifying cases of NSF and their association to class of GBCA, specific GBCA used, patient, and dose (when this information was available). Based on the available literature, consensus guidelines were developed by an expert panel of radiologists and nephrologists. KEY FINDINGS In patients with category G2 or G3 CKD (eGFR ≥ 30 and < 60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with category G4 or G5 CKD (eGFR < 30 mL/min/1.73 m2) or on dialysis, administration of GBCA should be considered individually and alternative imaging modalities utilized whenever possible. If GBCA are necessary, newer GBCA may be administered with patient consent obtained by a physician (or their delegate) citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, those with category G4 or G5 CKD, or those on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCA. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCA is recommended. LIMITATIONS Limited available literature (number of injections and use in renal impairment) regarding the use of gadoxetate disodium. Limited, but growing and generally high-quality, number of clinical trials evaluating GBCA administration in renal impairment. Limited data regarding the topic of Gadolinium deposition in the brain, particularly as it related to patients with renal impairment. IMPLICATIONS In patients with AKI and category G4 and G5 CKD (eGFR < 30 mL/min/1.73 m2) and in dialysis-dependent patients who require GBCA-enhanced MRI, GBCA can be administered with exceedingly low risk of causing NSF when using macrocyclic agents and newer linear agents at routine doses.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Jason I. Blaichman
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Andreu F. Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
- Neuroradiology Section, MRI Modality Lead, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Québec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Clinical Epidemiology Program and the University of Ottawa, Ontario, Canada
| | | | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol C, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2018; 69:136-150. [PMID: 29706252 DOI: 10.1016/j.carj.2017.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023] Open
Abstract
Use of gadolinium-based contrast agents (GBCAs) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCAs are absolutely contraindicated in AKI, CKD stage 4 or 5 (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) and dialysis-dependent patients is outdated, and may limit access to clinically necessary contrast-enhanced MRI examinations. Following a comprehensive review of the literature and reported NSF cases to date, a committee of radiologists and nephrologists developed clinical practice guidelines to assist physicians in making decisions regarding GBCA administrations. In patients with mild-to-moderate CKD (eGFR ≥30 and <60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with severe CKD (eGFR <30 mL/min/1.73 m2), or on dialysis, administration of GBCAs should be considered individually and alternative imaging modalities utilized whenever possible. If GBCAs are necessary, newer GBCAs may be administered with patient consent obtained by a physician (or their delegate), citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, with stage 4 or 5 CKD, or on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCAs. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCAs is recommended.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jason I Blaichman
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian van der Pol
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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Renard Y, Hossu G, Chen B, Krebs M, Labrousse M, Perez M. A guide for effective anatomical vascularization studies: useful ex vivo methods for both CT and MRI imaging before dissection. J Anat 2017; 232:15-25. [PMID: 29023687 DOI: 10.1111/joa.12718] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2017] [Indexed: 01/10/2023] Open
Abstract
The objective of this study was to develop a simple and useful injection protocol for imaging cadaveric vascularization and dissection. Mixtures of contrast agent and cast product should provide adequate contrast for two types of ex vivo imaging (MRI and CT) and should harden to allow gross dissection of the injected structures. We tested the most popular contrast agents and cast products, and selected the optimal mixture composition based on their availability and ease of use. All mixtures were first tested in vitro to adjust dilution parameters of each contrast agent and to fine-tune MR imaging acquisition sequences. Mixtures were then injected in 24 pig livers and one human pancreas for MR and computed tomography (CT) imaging before anatomical dissection. Colorized latex, gadobutrol and barite mixture met the above objective. Mixtures composed of copper sulfate (CuSO4 ) gadoxetic acid (for MRI) and iodine (for CT) gave an inhomogeneous signal or extravasation of the contrast agent. Agar did not harden sufficiently for gross dissection but appears useful for CT and magnetic resonance imaging (MRI) studies without dissection. Silicone was very hard to inject but achieved the goals of the study. Resin is particularly difficult to use but could replace latex as an alternative for corrosion instead of dissection. This injection protocol allows CT and MRI images to be obtained of cadaveric vascularization and anatomical casts in the same anatomic specimen. Post-imaging processing software allow easy 3D reconstruction of complex anatomical structures using this technique. Applications are numerous, e.g. surgical training, teaching methods, postmortem anatomic studies, pathologic studies, and forensic diagnoses.
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Affiliation(s)
- Yohann Renard
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Lorraine, Nancy, France.,Department of Anatomy, Faculty of Medicine and University Hospital, University of Reims Champagne-Ardenne, Reims, France.,IADI, INSERM U947, University of Lorraine, Nancy, France
| | - Gabriela Hossu
- IADI, INSERM U947, University of Lorraine, Nancy, France.,INSERM CIT1433, CIC-IT, University Hospital of Nancy, Nancy, France
| | - Bailiang Chen
- IADI, INSERM U947, University of Lorraine, Nancy, France.,INSERM CIT1433, CIC-IT, University Hospital of Nancy, Nancy, France
| | - Marine Krebs
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Lorraine, Nancy, France
| | - Marc Labrousse
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Reims Champagne-Ardenne, Reims, France
| | - Manuela Perez
- Department of Anatomy, Faculty of Medicine and University Hospital, University of Lorraine, Nancy, France.,IADI, INSERM U947, University of Lorraine, Nancy, France
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Endrikat J, Anzalone N. Gadobutrol in India-A Comprehensive Review of Safety and Efficacy. MAGNETIC RESONANCE INSIGHTS 2017; 10:1178623X17730048. [PMID: 28932122 PMCID: PMC5598798 DOI: 10.1177/1178623x17730048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
Gadobutrol is a gadolinium (Gd)-based contrast agent for magnetic resonance imaging (MRI). In India, gadobutrol is approved for MRI of the central nervous system (CNS), liver, kidneys, breast and for MR angiography for patients 2 years and older. The standard dose for all age groups is 0.1 mmol/kg body weight. The safety profile has been demonstrated in 42 clinical phase 2 to 4 studies (>6800 patients), 7 observational studies, and by assessing pharmacovigilance data of 29 million applications. Furthermore, studies in children, adults, and elderly and in patients with impaired liver or kidney function did not show any increased adverse event rate. Diagnostic efficacy was demonstrated in numerous studies and various indications, such as diseases of the CNS, peripheral and supra-aortic vessels, kidneys, liver, and breast.
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Affiliation(s)
- Jan Endrikat
- Radiology, Bayer AG, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Nicoletta Anzalone
- Department of Neuroradiology, Scientific Institute HS Raffaele, Milan, Italy
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Arnoldussen CWKP, Lam Y, Ito N, Winkens B, Kooi ME, Wittens CHA, Wildberger JE. Gadobutrol versus gadofosveset-trisodium in MR venography of the lower extremities. Eur Radiol 2017; 27:4986-4994. [PMID: 28674964 PMCID: PMC5674132 DOI: 10.1007/s00330-017-4902-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2017] [Revised: 04/30/2017] [Accepted: 05/16/2017] [Indexed: 11/25/2022]
Abstract
Objectives MR venography (MRV) protocols have used bloodpool contrast agents and long scan sequences to identify patients suitable for treatment and preoperatively. However, variable availability of bloodpool contrast agents, high costs and a need to shorten acquisition times for routine MR protocols hamper everyday practice. Materials 20 patients (11 men; mean age 54 ± 11.8 years; body mass index 23.6 ± 2.5) were enrolled in this prospective study. An intra-individual comparison of image quality, interpretation and findings for two different contrast agents (regular gadolinium contrast agent gadobutrol vs. bloodpool contrast agent gadofosveset-trisodium) and two different scan protocols (long acquisition time protocol using a high-resolution fast field echo (FFE) sequence vs. short acquisition time protocol using an ultra-fast gradient echo (GE) sequence) were performed. Results Image quality (average of 4.94 vs. 4.92 on a five-point scale), interpretation and contrast-to-noise ratio (44 vs. 45) were equal for both contrast agents. Image findings showed no statistical significant differences between the MR protocols or contrast agents (overall p = 0.328). Conclusions For high-resolution MRV, it is possible to replace gadofosveset-trisodium with gadobutrol. Furthermore, an ultra-fast GE sequence for MRV might considerably shorten acquisition time, without loss of image quality or diagnostic yield. Key Points • High-quality MRV can be performed with a regular gadolinium-based contrast agent. • Ultra-fast GRE vs. HR-FFE MRV: equally suitable for evaluation of venous obstruction. • Regular gadolinium-based contrast agent can supersede a bloodpool contrast agent for MRV. • Equal confidence for gadobutrol vs gadofosveset-trisodium in MRV. • MRV accessible for routine daily practice.
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Affiliation(s)
- Carsten W K P Arnoldussen
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands. .,Department of Radiology, VieCuri Medical Center, Venlo, The Netherlands.
| | - Yeelai Lam
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Nobutake Ito
- Department of Diagnostic Radiology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan.,Department of Diagnostic Radiology, Keio University Hospital, Tokyo, Japan
| | - Bjorn Winkens
- Department of Methodology and Statistics, Maastricht University, Maastricht, The Netherlands
| | - M Eline Kooi
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.,Maastricht University Medical Center, CARIM - School for Cardiovascular Diseases, Maastricht, The Netherlands
| | - Cees H A Wittens
- Department of Vascular Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Joachim E Wildberger
- Department of Radiology, Maastricht University Medical Center, P.O. Box 5800, P.Debyelaan 25, 6202 AZ, Maastricht, The Netherlands.,Maastricht University Medical Center, CARIM - School for Cardiovascular Diseases, Maastricht, The Netherlands
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Nelson BB, Goodrich LR, Barrett MF, Grinstaff MW, Kawcak CE. Use of contrast media in computed tomography and magnetic resonance imaging in horses: Techniques, adverse events and opportunities. Equine Vet J 2017; 49:410-424. [DOI: 10.1111/evj.12689] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 04/04/2017] [Indexed: 12/20/2022]
Affiliation(s)
- B. B. Nelson
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - L. R. Goodrich
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
| | - M. F. Barrett
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
- Department of Environmental and Radiological Health Sciences; Colorado State University; Fort Collins Colorado USA
| | - M. W. Grinstaff
- Departments of Biomedical Engineering, Chemistry, Materials Science & Engineering and Medicine; Boston University; Boston Massachusetts USA
| | - C. E. Kawcak
- Gail Holmes Equine Orthopaedic Research Center, Department of Clinical Sciences; College of Veterinary Medicine and Biomedical Sciences, Colorado State University; Fort Collins Colorado USA
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Reeves C, Galang E, Padalia R, Tran N, Padalia D. Intrathecal Injection of Gadobutrol: A Tale of Caution. J Pain Palliat Care Pharmacother 2017; 31:139-143. [DOI: 10.1080/15360288.2017.1313353] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Safety of gadobutrol in more than 1,000 pediatric patients: subanalysis of the GARDIAN study, a global multicenter prospective non-interventional study. Pediatr Radiol 2016; 46:1317-23. [PMID: 27041276 PMCID: PMC4943967 DOI: 10.1007/s00247-016-3599-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 02/01/2016] [Accepted: 02/25/2016] [Indexed: 11/02/2022]
Abstract
BACKGROUND Gadobutrol is a gadolinium-based contrast agent, uniquely formulated at 1.0 mmol/ml. Although there is extensive safety evidence on the use of gadobutrol in adults, few studies have addressed the safety and tolerability of gadobutrol in pediatric patients. OBJECTIVE This subanalysis of data from the GARDIAN study evaluated the safety and use of gadobutrol in pediatric patients (age <18 years). MATERIALS AND METHODS The GARDIAN study was a large phase IV non-interventional prospective multicenter post-authorization safety study performed in Europe, Asia, North America and Africa. A total of 23,708 patients were included who were scheduled to undergo cranial or spinal MRI, liver or kidney MRI, or MR angiography with gadobutrol enhancement. The primary study endpoint was the overall incidence of adverse drug reactions (ADRs) and serious adverse events (SAEs) following gadobutrol administration. RESULTS The GARDIAN study included 1,142 children (age <18 years) who received gadobutrol at a mean dose of 0.13 (range 0.04-0.50) mmol/kg body weight. Gadobutrol was well tolerated in these children, with low rates of ADRs (0.5%) and no SAEs, consistent with results in adults enrolled in the GARDIAN study. Rates of adverse events and ADRs were unrelated to pediatric age or gadobutrol weight-adjusted dose. There were no symptoms suggestive of nephrogenic systemic fibrosis. Investigators rated the contrast quality of gadobutrol-enhanced images as good or excellent in 97.8% of pediatric patients, similar to the main study population. CONCLUSION Gadobutrol is very well tolerated and provides excellent contrast quality at the recommended weight-adjusted dose in children (age <18 years), similar to the profile in adults.
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