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Brismar TB, Geisel D, Kartalis N, Madrazo BL, Persson Hedman H, Norlin A. Oral Manganese Chloride Tetrahydrate: A Novel Magnetic Resonance Liver Imaging Agent for Patients With Renal Impairment: Efficacy, Safety, and Clinical Implication. Invest Radiol 2024; 59:197-205. [PMID: 37934630 PMCID: PMC11441735 DOI: 10.1097/rli.0000000000001042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
ABSTRACT Manganese-based contrast agents (MBCAs) show promise to complement gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI) of the liver. Management of patients with focal liver lesions and severely impaired renal function uses unenhanced liver MRI or GBCA-enhanced MRI. However, unenhanced MRI risks reducing patient's survival.Gadolinium-based contrast agents, which help to detect and visualize liver lesions, are associated with increased risk of nephrogenic systemic fibrosis in renally impaired patients, a severe adverse event (AE) with potentially fatal outcome. Therefore, use of GBCA in patients with impaired renal function requires careful consideration. Other concerns are related to tissue deposition in the brain and other organs due to lack of gadolinium clearance, which could lead to concerns also for other patient populations, for example, those exposed to multiple procedures with GBCA. Of particular concern are the linear chelates that remain available for liver MRI, where there is no replacement technology. This has highlighted the urgency for safer alternatives.An alternative may be the drug candidate Ascelia-MBCA (ACE-MBCA, Orviglance), oral manganese chloride tetrahydrate. This candidate effectively visualizes and detects focal liver lesions, as demonstrated in 8 clinical studies on 201 adults (healthy or with known or suspected focal liver lesions). ACE-MBCA has a low and transient systemic exposure, which is likely the reason for its beneficial safety profile. The AEs were primarily mild and transient, and related to the gastrointestinal tract. This new, orally administered product may offer a simple imaging approach, allowing appropriate patient management in renally impaired patients when use of GBCA requires careful consideration.In this review, we highlight the clinical development of ACE-MBCA-a novel, liver-specific contrast agent. We begin with a brief overview of manganese properties, addressing the need for MBCAs and describing their optimal properties. We then review key findings on the novel agent and how this allows high-quality MRIs that are comparable to GBCA and superior to unenhanced MRI. Lastly, we provide our view of future perspectives that could advance the field of liver imaging, addressing the medical needs of patients with focal liver lesions and severe renal impairment.Our review suggests that ACE-MBCA is a promising, effective, and well-tolerated new tool in the radiologist's toolbox.
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Non-Contrast-Enhanced and Contrast-Enhanced Magnetic Resonance Angiography in Living Donor Liver Vascular Anatomy. Diagnostics (Basel) 2022; 12:diagnostics12020498. [PMID: 35204588 PMCID: PMC8871101 DOI: 10.3390/diagnostics12020498] [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: 01/19/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 02/04/2023] Open
Abstract
Background: Since the advent of a new generation of inflow-sensitive inversion recovery (IFIR) technology, three-dimensional non-contrast-enhanced magnetic resonance angiography is being used to obtain hepatic vessel images without applying gadolinium contrast agent. The purpose of this study was to explore the diagnostic efficacy of non-contrast-enhanced magnetic resonance angiography (non-CE MRA), contrast-enhanced magnetic resonance angiography (CMRA), and computed tomography angiography (CTA) in the preoperative evaluation of living liver donors. Methods: A total of 43 liver donor candidates who were evaluated for living donor liver transplantation completed examinations. Donors’ age, gender, renal function (eGFR), and previous CTA and imaging were recorded before non-CE MRA and CMRA. CTA images were used as the standard. Results: Five different classifications of hepatic artery patterns (types I, III, V, VI, VIII) and three different classifications of portal vein patterns (types I, II, and III) were identified among 43 candidates. The pretransplant vascular anatomy was well identified using combined non-CE MRA and CMRA of hepatic arteries (100%), PVs (98%), and hepatic veins (100%) compared with CTA images. Non-CE MRA images had significantly stronger contrast signal intensity of portal veins (p < 0.01) and hepatic veins (p < 0.01) than CMRA. No differences were found in signal intensity of the hepatic artery between non-CE MRA and CMRA. Conclusion: Combined non-CE MRA and CMRA demonstrate comparable diagnostic ability to CTA and provide enhanced biliary anatomy information that assures optimum donor safety.
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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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Fakhardo A, Anastasova E, Makarov V, Ikonnikova EV, Kulko E, Nicole A, Yakunina M, Shkodenko L, Tsvetikova SA, Toropko M, Koshel EI, Zakharov M, Alexandrov G, Khuttunen O, Kulikov P, Burmistrov O, Vinogradov VV, Prilepskii AY. Heparin-coated iron oxide nanoparticles: application as liver contrast agent, toxicity and pharmacokinetics. J Mater Chem B 2022; 10:7797-7807. [DOI: 10.1039/d2tb00759b] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The newly prepared heparin-coated iron oxide nanoparticles (Hep-IONPs) contrasted cholangioma tumors in the liver in T2 MRI. NPs were not toxic to rats and rabbits after 14 days of consecutive...
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Åkesson M, Lehti L, Leander P, Sterner G, Wassélius J. Long-term safety of Gadofosveset in clinical practice. Magn Reson Imaging 2021; 86:70-73. [PMID: 34848324 DOI: 10.1016/j.mri.2021.11.011] [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: 08/16/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to systematically search for long-term complications, including Nephrogenic Systemic Fibrosis (NSF), in patients who were previously administered the gadolinium-based contrast agent Gadofosveset at our institute. MATERIALS AND METHODS All patients who were administered Gadofosveset at our institute between 2006 and 2009 were identified in our Radiological Information System (RIS). Clinical data such as cause of death during follow-up, and dermatological or nephrological diseases were systematically searched for in electronic patient records (EPR). RESULTS During 2006-2009, Gadofosveset was administered a total of 67 times to 62 patients. One patient was unavailable for follow-up. The remaining 61 patients were followed up for up to 14 (median 12) years based on RIS and EPR data. There were 13 deaths among the 61 patients, all assessed as unrelated to Gadofosveset administration. No dermatological or renal disease suggestive of NSF, or potentially related to Gadofosveset administration, was found. At the time of examination, six patients were diagnosed with various stages of renal insufficiency, three of whom were on hemodialysis. Another three patients were diagnosed with renal insufficiency during the follow-up period, but none of these diagnoses were suspected to be related to the administration of Gadofosveset. CONCLUSIONS Based on the results of this retrospective safety analysis of up to 14 years following 1-2 exposures, we conclude that Gadofosveset in clinical practice is safe in the long-term.
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Affiliation(s)
- Michael Åkesson
- Department of Clinical Sciences Lund, Lund University, Sweden
| | - Leena Lehti
- Department of Clinical Sciences Lund, Lund University, Sweden; Vascular Center, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Peter Leander
- Department of Clinical Sciences Lund, Lund University, Sweden; Department of Radiology, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Gunnar Sterner
- Department of Clinical Sciences Lund, Lund University, Sweden; Department of Nephrology and Transplantation, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Johan Wassélius
- Department of Clinical Sciences Lund, Lund University, Sweden; Vascular Center, Skåne University Hospital Lund/Malmö, Lund, Sweden.
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Towbin AJ, Zhang B, Dillman JR. Evaluation of the effect of multiple administrations of gadopentetate dimeglumine or gadoterate meglumine on brain T1-weighted hyperintensity in pediatric patients. Pediatr Radiol 2021; 51:2568-2580. [PMID: 34286351 DOI: 10.1007/s00247-021-05134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repeated administrations of linear gadolinium-based contrast media (GBCM) are associated with T1-weighted (T1-W) signal intensity change in brain structures. OBJECTIVE The purpose of this study was to compare different brain structures in children after unconfounded, repeated administrations of either a macrocyclic or linear GBCM. MATERIALS AND METHODS We performed a retrospective cohort study, identifying subjects with ≥5 unconfounded administrations of gadoterate meglumine. We matched subjects with repeated administrations of gadopentetate dimeglumine to the gadoterate meglumine arm based on the number of unconfounded GBCM administrations. Two reviewers drew regions of interest on 27 structures in and around the brain. We recorded demographic, modality and study parameters and evaluated them to determine whether they were associated with T1-W signal intensity (SI) changes. Linear mixed effects models evaluated the relationships between the number of GBCM doses and T1-W SI ratio. Finally, we identified differences in the rate of T1-W SI ratio change among individuals using a linear mixed effects model with random slope. RESULTS We included a total of 52 patients (age range at first MRI: 6.0 months to 17.1 years), 26 in each arm. We detected a significant change in the T1-W SI ratio with repeated administrations of GBCM in one location in the gadoterate meglumine arm and in four locations in the gadopentetate dimeglumine arm. Patient gender and age were not associated with T1-W SI change. Modality vendor, imaging sequence and field strength were variably associated with a systematic difference in the ability to detect a T1-W SI change. Finally, linear mixed effects model with random slope showed that there were individual differences in the slope of SI change at various structures among individuals for both arms. This effect was present in more brain structures in the gadopentetate dimeglumine arm (14 vs. 8). CONCLUSION There is a significant change in the T1-W SI ratio over time in multiple brain structures after repeated gadopentetate dimeglumine administrations. This effect was only seen in one ratio after repeated administrations of gadoterate meglumine. There are individual differences in the rate of change of SI ratios over time after repeated administration of gadopentetate dimeglumine and gadoterate meglumine, suggesting that individual differences are present.
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Affiliation(s)
- Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Bin Zhang
- Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
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Ozturk K, Nascene D. Dentate Nucleus Signal Intensity Changes in Children with Adrenoleukodystrophy in Comparison to Primary Brain Tumor with and without Radiotherapy after Gadobutrol Administration. J Neuroimaging 2021; 31:602-608. [PMID: 33783925 DOI: 10.1111/jon.12844] [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: 01/08/2021] [Revised: 02/07/2021] [Accepted: 02/09/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND AND PURPOSE To determine whether cerebral adrenoleukodystrophy (cALD) or brain irradiation in patients with primary brain tumor affects T1-weighted imaging (T1WI) signal intensity (SI) of the dentate nucleus (DN) in a pediatric cohort who had received consecutive macrocyclic gadolinium-based contrast agent (mcGBCA) gadobutrol. METHODS This study included 97 pediatric patients who underwent mcGBCA-enhanced MRI from 2010 to 2020 (29 children with primary brain tumors without brain radiation therapy [mcGBCA group-1], 33 children with primary brain tumors and radiation treatment [mcGBCA group-2], 35 children with cALD [mcGBCA group-3], and 97 sex-/age-matched control subjects [subgroups matched to each of the three subject groups] without GBCA administration). The DN-to-middle cerebellar peduncle (MCP) SI ratios on T1WI were then determined. A paired t-test was performed to compare SI ratios between children exposed to mcGBCA in each group and control subjects. The relationships between SI ratios and confounding variables were analyzed utilizing the Pearson correlation analysis. RESULTS The DN-to-MCP SI ratio was significantly higher of mcGBCA group-2 (1.046±.071) or mcGBCA group-3 (.972±.038) than in the control group-2 (.983±.041, P<.001) and control group-3 (.937±.051, P = .002), respectively, but no significant difference of the SI ratio was noted between mcGBCA group-1 (.984±.032) and control-group-1 (.982±.035, P = .860). No significant correlation was noted between SI ratio values and the cumulative dose or number of mcGBCA administrations, age, or the elapsed time between the MRI examinations (all P>.05). CONCLUSIONS Hyperintense T1WI signal in the DN may be seen in children with brain tumors undergoing brain irradiation, as well as in children with cALD.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota Health, Minneapolis, MN
| | - David Nascene
- Department of Radiology, University of Minnesota Health, Minneapolis, MN
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A retrospective cohort evaluation of the effect of multiple administrations of gadopentetate dimeglumine on brain magnetic resonance imaging T1-weighted signal. Pediatr Radiol 2021; 51:457-470. [PMID: 33399985 DOI: 10.1007/s00247-020-04860-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Gadolinium deposition occurs following repeated administration of gadolinium-based contrast media. However, few studies have evaluated factors that lead to increased detection of deposition or the individual differences among patients. OBJECTIVE To measure the effect of repeated dosages of gadopentetate dimeglumine on pediatric brains and to determine the factors that influence signal intensity changes. MATERIALS AND METHODS A retrospective study evaluated magnetic resonance imaging (MRI) in patients <18 years of age who received >5 doses of gadopentetate dimeglumine. Regions of interest were placed in 30 locations in the brain on axial precontrast T1 images. Signal intensity ratios were evaluated throughout the brain. The effect of increasing gadopentetate dimeglumine exposure on signal intensity ratios was assessed using linear mixed models adjusted for gender, age, imaging sequence type (fast spin echo or gradient echo), MRI manufacturer (General Electric, Philips or Siemens), and field strength (1.5 tesla [T] or 3 T). Finally, the variance of the random slope in the linear mixed models was tested to determine if there were differences in the rate of signal intensity ratio change among individuals. RESULTS Fifty patients (M:F=25:25; mean age at first imaging: 6.4 years) with a mean of 21.5 gadopentetate dimeglumine administrations (range: 6-86) were included. There were significant increases in T1 signal in the globus pallidus, dentate nucleus and pulvinar with an increasing number of contrast administrations. Patient gender, age, and MRI field strength were not associated with changing signal intensity ratios. However, MRI sequence type and vendor significantly impacted some measured signal intensity ratios. Finally, significant differences in the slopes of the ratios were present among patients for multiple locations. CONCLUSION Repeated administration of gadopentetate dimeglumine is associated with T1 hyperintense signal in the dentate nucleus, globus pallidus and pulvinar. Detection is significantly affected by MRI sequence type and scanner vendor. Even when accounting for these differences, there are individual differences in the slope of signal intensity change suggesting a patient-level effect influences gadolinium deposition.
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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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Perfusion in hand arthritis on dynamic contrast-enhanced computed tomography: a randomized prospective study using MRI as a standard of reference. Skeletal Radiol 2021; 50:59-68. [PMID: 32607803 PMCID: PMC7677157 DOI: 10.1007/s00256-020-03526-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 06/15/2020] [Accepted: 06/18/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the performance of dynamic contrast-enhanced CT (DCE-CT) in detecting and quantitatively assessing perfusion parameters in patients with arthritis of the hand compared with dynamic contrast-enhanced MRI (DCE-MRI) as a standard of reference. MATERIALS AND METHODS In this IRB-approved randomized prospective single-centre study, 36 consecutive patients with suspected rheumatoid arthritis underwent DCE-CT (320-row, tube voltage 80 kVp, tube current 8.25 mAs) and DCE-MRI (1.5 T) of the hand. Perfusion maps were calculated separately for mean transit time (MTT), time to peak (TTP), relative blood volume (rBV), and relative blood flow (rBF) using four different decomposition techniques. Region of interest (ROI) analysis was performed in metacarpophalangeal joints II-V and in the wrist. Pairs of perfusion parameters in DCE-CT and DCE-MRI were compared using a two-tailed t test for paired samples and interpreted for effect size (Cohen's d). According to the Rheumatoid Arthritis Magnetic Resonance Imaging Score (RAMRIS) scoring results, differentiation of synovitis-positive and synovitis-negative joints with both modalities was assessed with the independent t test. RESULTS The two modalities yielded similar perfusion parameters. Identified differences had small effects (d 0.01-0.4). DCE-CT additionally differentiates inflamed and noninflamed joints based on rBF and rBV but tends to underestimate these parameters in severe inflammation. The total dose-length product (DLP) was 48 mGy*cm with an estimated effective dose of 0.038 mSv. CONCLUSION DCE-CT is a promising imaging technique in arthritis. In patients with a contraindication to MRI or when MRI is not available, DCE-CT is a suitable alternative to detect and assess arthritis.
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Effect of Long-Term Retention of Gadolinium on Metabolism of Deep Cerebellar Nuclei After Repeated Injections of Gadodiamide in Rats. Invest Radiol 2020; 55:120-128. [PMID: 31876627 DOI: 10.1097/rli.0000000000000621] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine potential metabolism and histological modifications due to gadolinium retention within deep cerebellar nuclei (DCN) after linear gadolinium-based contrast agent injection (gadodiamide) in rats at 1 year after the last injection. MATERIALS AND METHODS Twenty female rats received 20 doses of gadodiamide (0.6 mmol of gadolinium per kilogram each) over 5 weeks. They were followed at 1 week (M0), 6 weeks (M1), and 54 to 55 weeks (M13) postinjections to evaluate hypersignal on unenhanced T1-weighted magnetic resonance imaging and metabolic alterations by H magnetic resonance spectroscopy (H-MRS). At 1 year postinjections, brains were sampled to determine the localization of gadolinium within cerebellum by laser ablation inductively coupled mass spectroscopy and to evaluate morphological changes by semiquantitative immunofluorescence analysis. RESULTS There is a significant increase of the ratio DCN/brainstem for the gadodiamide group at M0 (+7.2% vs control group = 0.989 ± 0.01), M1 (+7.6% vs control group = 1.002 ± 0.018), and it lasted up to M13 (+4.7% vs control group = 0.9862 ± 0.008). No variation among metabolic markers (cellular homeostasis [creatine, choline, taurine], excitatory neurotransmitter [glutamate], and metabolites specific to a cellular compartment [N-acetyl aspartate for neurons and myo-inositol for glial cells]) were detected by H-MRS between gadodiamide and saline groups at M0, M1, and M13. At M13, laser ablation inductively coupled mass spectroscopy demonstrated that long-term gadolinium retention occurred preferentially in DCN. No histological abnormalities (including analysis of astrocytes, neurons, and microglial cells) were found in the rostral part of DCN. CONCLUSIONS Repeated administration of gadodiamide lead to a retention of gadolinium preferentially within DCN at 1 year postinjections. This retention did not lead to any detectable changes of the measured metabolic biomarkers nor histological alterations.
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Montagne A, Huuskonen MT, Rajagopal G, Sweeney MD, Nation DA, Sepehrband F, D'Orazio LM, Harrington MG, Chui HC, Law M, Toga AW, Zlokovic BV. Undetectable gadolinium brain retention in individuals with an age-dependent blood-brain barrier breakdown in the hippocampus and mild cognitive impairment. Alzheimers Dement 2020; 15:1568-1575. [PMID: 31862169 DOI: 10.1016/j.jalz.2019.07.012] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Revised: 07/02/2019] [Accepted: 07/14/2019] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Blood-brain barrier (BBB) breakdown is an early independent biomarker of human cognitive dysfunction, as found using gadolinium (Gd) as a contrast agent. Whether Gd accumulates in brains of individuals with an age-dependent BBB breakdown and/or mild cognitive impairment remains unclear. METHODS We analyzed T1-weighted magnetic resonance imaging (MRI) scans from 52 older participants with BBB breakdown in the hippocampus 19-28 months after either cyclic or linear Gd agent. RESULTS There was no change in T1-weighted signal intensity between the baseline contrast MRI and unenhanced MRI on re-examination in any of the studied 10 brain regions with either Gd agent suggesting undetectable Gd brain retention. DISCUSSION Gd does not accumulate in brains of older individuals with a BBB breakdown in the hippocampus. Thus, Gd agents can be used without risk of brain retention within a ∼2-year follow-up to study BBB in the aging human brain in relation to cognition and/or other pathologies.
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Affiliation(s)
- Axel Montagne
- Zilkha Neurogenetic Institute, Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mikko T Huuskonen
- Zilkha Neurogenetic Institute, Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Gautham Rajagopal
- Zilkha Neurogenetic Institute, Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Melanie D Sweeney
- Zilkha Neurogenetic Institute, Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Daniel A Nation
- Zilkha Neurogenetic Institute, Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Farshid Sepehrband
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Lina M D'Orazio
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Helena C Chui
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Neurology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Meng Law
- Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Radiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Arthur W Toga
- Laboratory of Neuro Imaging (LONI), USC Stevens Neuroimaging and Informatics Institute, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Berislav V Zlokovic
- Zilkha Neurogenetic Institute, Department of Physiology and Neuroscience, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Alzheimer's Disease Research Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
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Choi Y, Jang J, Kim J, Nam Y, Shin NY, Ahn KJ, Jeon SS, Kim BS. MRI and Quantitative Magnetic Susceptibility Maps of the Brain after Serial Administration of Gadobutrol: A Longitudinal Follow-up Study. Radiology 2020; 297:143-150. [PMID: 32692298 DOI: 10.1148/radiol.2020192579] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Background The relationship between administration of macrocyclic gadolinium-based contrast agents and T1-weighted signal intensity (SI) change of the globus pallidus (GP) and dentate nucleus (DN) is, to the knowledge of the authors, not known. Purpose To determine if quantitative susceptibility mapping (QSM) can detect changes in magnetic susceptibility of the GP and DN after serial administration of macrocyclic gadobutrol in patients with primary brain tumors. Materials and Methods Patients diagnosed with primary brain tumors from August 2014 to February 2019 were eligible for this single-center retrospective study. Among 501 consecutive adult patients who were given at least one administration of gadobutrol, those who were previously administered an unknown or linear gadolinium-based contrast agent were excluded. Brain MRI scans with three-dimensional gradient-recalled-echo image phase data for QSM processing were reviewed. Regions of interest were drawn on the GP and DN on the basis of semiautomatic thresholding. Univariable generalized estimation equations were used to determine the associations between MRI measures (SI on T1-weighted images and magnetic susceptibility on QSM) and number of gadobutrol doses. Potential confounding factors were adjusted for in multivariable generalized estimating equation. Results Ninety patients (mean age, 51 years ± 17 [standard deviation]; 51 men) with 199 MRI scans were analyzed. In models adjusted for repeated observations between injections, the number of injections of gadobutrol was associated with the magnetic susceptibility of the GP (1.4 × 10-3 ppm/number of gadobutrol injections; P = .01) and DN (8.1 × 10-4 ppm/number of gadobutrol injections; P = .03). After adjustment for confounders, the number of gadobutrol injections remained an independent predictor of increased magnetic susceptibility in the GP (1.3 × 10-3 ppm/number of gadobutrol injections; 95% confidence interval: 0.39 × 10-3, -2.4 × 10-3; P = .006). There were no associations between number of gadobutrol injections and SI or magnetic susceptibility in the DN. Conclusion The magnetic susceptibility of the globus pallidus increased after serial administration of gadobutrol. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Wang and Prince in this issue.
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Affiliation(s)
- Yangsean Choi
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Jinhee Jang
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Jiwoong Kim
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Yoonho Nam
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Na-Young Shin
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Kook-Jin Ahn
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Sin-Soo Jeon
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
| | - Bum-Soo Kim
- From the Departments of Radiology (Y.C., J.J., J.K., Y.N., N.Y.S., K.J.A., B.S.K.) and Neurosurgery (S.S.J.), Seoul Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-gu, Seoul 06591, Korea; and Department of Radiology, Eunpyeong Saint Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea (Y.N.)
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Lang SM, Alsaied T, Moore RA, Rattan M, Ryan TD, Taylor MD. Conservative gadolinium administration to patients with Duchenne muscular dystrophy: decreasing exposure, cost, and time, without change in medical management. Int J Cardiovasc Imaging 2019; 35:2213-2219. [DOI: 10.1007/s10554-019-01670-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Accepted: 07/13/2019] [Indexed: 01/16/2023]
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Chehabeddine L, Al Saleh T, Baalbaki M, Saleh E, Khoury SJ, Hannoun S. Cumulative administrations of gadolinium-based contrast agents: risks of accumulation and toxicity of linear vs macrocyclic agents. Crit Rev Toxicol 2019; 49:262-279. [DOI: 10.1080/10408444.2019.1592109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lara Chehabeddine
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Tala Al Saleh
- Department of Physics, American University of Beirut, Beirut, Lebanon
| | - Marwa Baalbaki
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Saleh
- 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
| | - 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
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Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium-based contrast agents - review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients. Pediatr Radiol 2019; 49:448-457. [PMID: 30923876 DOI: 10.1007/s00247-018-4304-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Gadolinium has been used as a base for contrast agents in MRI for the last three decades. Numerous studies over the last 4 years have reported increased signal intensity in deep brain nuclei in non-contrast MRI images following gadolinium-based contrast agent (GBCA) administration. Pathology studies performed on adults and children, and rodent necropsy studies have also shown gadolinium deposition in brain and other tissues after GBCA administration. The purpose of this review was to summarize and discuss the knowledge gained from these reports and the relevance for imaging pediatric patients.
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Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 111E 210th St, Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Arendt CT, Beeres M, Leithner D, Tischendorf P, Langenbach M, Kaltenbach B, Dalgicdir J, Vogl TJ, Gruber-Rouh T. Gadolinium-enhanced imaging of pediatric thoracic lymphoma: is intravenous contrast really necessary? Eur Radiol 2018; 29:2553-2559. [PMID: 30547199 DOI: 10.1007/s00330-018-5859-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 09/27/2018] [Accepted: 10/25/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Increasing awareness of potential side effects from gadolinium-based contrast agents has underlined the need for contrast-free magnetic resonance imaging (MRI). Numerous recent articles evaluated the risk of potential brain deposits, with the result that research is putting the focus more on alternative unenhanced imaging techniques. The aim of this study was to determine the need for contrast media for chest MRI in primary staging and follow-up care of lymphoma. METHODS This monocentric, retrospective study encompassed patients under 25 years of age who had undergone histopathological examination of thoracic lymph nodes and at least one chest MRI examination with unenhanced and contrast-enhanced sequences. Seven different thoracic lymph node stations including mediastinal, hilar, periclavicular, and axillary regions were evaluated by two readers regarding lesion diameter, number, shape, necrosis, and infiltration of surrounding structures. Findings were categorized into suspicious (> 1 cm; round; necrosis; infiltration) or non-suspicious. RESULTS Fifty-one patients (mean age, 16.0 ± 3.7 yrs) with thoracic Hodgkin (70.6%) and non-Hodgkin lymphoma (25.5%) and lymphadenopathy (3.9%) were retrospectively included. Most lymph nodes categorized as suspicious were located in the mediastinal station (86.4%). High agreement (κ = 0.81) between unenhanced and contrast-enhanced sequences was found for both suspicious and non-suspicious lymph nodes. Significant (p < 0.001), but small difference (1 mm) was observed only in sizing mediastinal lymph nodes (all other p > 0.05). No significant difference (smallest p = 0.08) was shown for the use of five different types of contrast media. CONCLUSION MRI in young patients with thoracic lymphoma can safely be done without the use of contrast agent. KEY POINT • Thoracic magnetic resonance imaging in young lymphoma patients can safely be done without gadolinium-based contrast agents.
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Affiliation(s)
- Christophe T Arendt
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany.
| | - Martin Beeres
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Doris Leithner
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Patricia Tischendorf
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Marcel Langenbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Benjamin Kaltenbach
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Jasmin Dalgicdir
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Thomas J Vogl
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
| | - Tatjana Gruber-Rouh
- Department of Diagnostic and Interventional Radiology, University Hospital Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt/Main, Germany
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Quattrocchi CC, Ramalho J, van der Molen AJ, Rovira À, Radbruch A. Standardized assessment of the signal intensity increase on unenhanced T1-weighted images in the brain: the European Gadolinium Retention Evaluation Consortium (GREC) Task Force position statement. Eur Radiol 2018; 29:3959-3967. [PMID: 30413951 DOI: 10.1007/s00330-018-5803-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/29/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
Abstract
After the initial report in 2014 on T1-weighted (T1w) hyperintensity of deep brain nuclei following serial injections of linear gadolinium-based contrast agents (GBCAs), a multitude of studies on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain have been published. The vast majority of these studies found a signal intensity (SI) increase for linear GBCAs in the brain-first and foremost in the dentate nucleus-while no SI increase was found for macrocyclic GBCAs. However, the scientific debate about this finding is kept alive by the fact that SI differences do not unequivocally represent the amount of gadolinium retained. Since the study design of the SI measurement in various brain structures is relatively simple, MRI studies investigating gadolinium-dependent T1w hyperintensity are currently conducted at multiple institutions worldwide. However, methodological mistakes may result in flawed conclusions. In this position statement, we assess the methodological basis of the published retrospective studies and define quality standards for future studies to give guidance to the scientific community and to help identify studies with potentially flawed methodology and misleading results. KEY POINTS: • A multitude of studies has been published on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain. • The gadolinium-dependent T1w hyperintensity in the brain depends on patient's history, types of GBCAs used (i.e., linear vs. macrocyclic GBCAs) and MR imaging setup and protocols. • Quality standards for the design of future studies are needed to standardize methodology and avoid potentially misleading results from retrospective studies.
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Affiliation(s)
- Carlo C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Aart J van der Molen
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Alexander Radbruch
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Colafati GS, Rossi E, Carducci C, Piga S, Voicu IP, Mastronuzzi A, Tomà P. Half-dose versus full-dose macrocyclic gadolinium at 3-T magnetic resonance imaging in paediatric bone and soft-tissue disease. Pediatr Radiol 2018; 48:1724-1735. [PMID: 30046901 DOI: 10.1007/s00247-018-4204-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 05/31/2018] [Accepted: 07/02/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Given the recent concerns about gadolinium-based contrast agent safety, dose reduction strategies are being investigated. OBJECTIVE To compare half-dose and standard full-dose gadoterate meglumine at 3-tesla (T) MRI in paediatric bone and soft-tissue diseases. MATERIALS AND METHODS We prospectively enrolled 45 children (age range 2.7 months to 17.5 years, median age 8.7 years, 49 total anatomical segments) with bone and soft-tissue diseases (neoplastic, inflammatory/infectious, ischaemic and vascular) imaged at 3-T MRI. Two consecutive half-doses of gadoterate meglumine (0.05 mmol/kg body weight) were administered. Two sets of post-contrast T1-weighted images were obtained, one after the first half dose and the other after the second half dose. For qualitative analysis, three radiologists, masked to the gadolinium dose, compared the diagnostic quality of the images. For quantitative analysis, we compared signal-to-noise ratio and contrast-to-noise ratio at half and full doses. RESULTS Signal-to-noise ratio and contrast-to-noise ratio did not vary significantly between the two groups. Qualitative analysis yielded excellent image quality in both post-contrast image datasets (Cohen κ=0.8). CONCLUSION In paediatric bone and soft-tissue 3-T MRI, it is feasible to halve the standard dose of gadoterate meglumine without losing image quality.
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Affiliation(s)
- Giovanna Stefania Colafati
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy.
| | - Enrica Rossi
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Chiara Carducci
- Department of Imaging, Neuroradiology Unit, Bambino Gesù Children's Hospital, Piazza Sant'Onofrio 4, 00165, Rome, Italy
| | - Simone Piga
- Unit of Clinical Epidemiology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Ioan Paul Voicu
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Angela Mastronuzzi
- Department of Hematology/Oncology and Stem Cell Transplantation, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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Magnetic resonance enterography, small bowel ultrasound and colonoscopy to diagnose and stage Crohn's disease: patient acceptability and perceived burden. Eur Radiol 2018; 29:1083-1093. [PMID: 30128615 PMCID: PMC6510862 DOI: 10.1007/s00330-018-5661-2] [Citation(s) in RCA: 42] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 07/02/2018] [Accepted: 07/12/2018] [Indexed: 12/12/2022]
Abstract
Objectives To compare patient acceptability and burden of magnetic resonance enterography (MRE) and ultrasound (US) to each other, and to other enteric investigations, particularly colonoscopy. Methods 159 patients (mean age 38, 94 female) with newly diagnosed or relapsing Crohn’s disease, prospectively recruited to a multicentre diagnostic accuracy study comparing MRE and US completed an experience questionnaire on the burden and acceptability of small bowel investigations between December 2013 and September 2016. Acceptability, recovery time, scan burden and willingness to repeat the test were analysed using the Wilcoxon signed rank and McNemar tests; and group differences in scan burden with Mann–Whitney U and Kruskal–Wallis tests. Results Overall, 128 (88%) patients rated MRE as very or fairly acceptable, lower than US (144, 99%; p < 0.001), but greater than colonoscopy (60, 60%; p < 0.001). MRE recovery time was longer than US (p < 0.001), but shorter than colonoscopy (p < 0.001). Patients were less willing to undergo MRE again than US (127 vs. 133, 91% vs. 99%; p = 0.012), but more willing than for colonoscopy (68, 75%; p = 0.017). MRE generated greater burden than US (p < 0.001), although burden scores were low. Younger age and emotional distress were associated with greater MRE and US burden. Higher MRE discomfort was associated with patient preference for US (p = 0.053). Patients rated test accuracy as more important than scan discomfort. Conclusions MRE and US are well tolerated. Although MRE generates greater burden, longer recovery and is less preferred than US, it is more acceptable than colonoscopy. Patients, however, place greater emphasis on diagnostic accuracy than burden. Key Points • MRE and US are rated as acceptable by most patients and superior to colonoscopy. • MRE generates significantly greater burden and longer recovery times than US, particularly in younger patients and those with high levels of emotional distress. • Most patients prefer the experience of undergoing US than MRE; however, patients rate test accuracy as more importance than scan burden. Electronic supplementary material The online version of this article (10.1007/s00330-018-5661-2) contains supplementary material, which is available to authorized users.
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Miller E, Inarejos Clemente EJ, Tzaribachev N, Guleria S, Tolend M, Meyers AB, von Kalle T, Stimec J, Koos B, Appenzeller S, Arvidsson LZ, Kirkhus E, Doria AS, Kellenberger CJ, Larheim TA. Imaging of temporomandibular joint abnormalities in juvenile idiopathic arthritis with a focus on developing a magnetic resonance imaging protocol. Pediatr Radiol 2018; 48:792-800. [PMID: 29766249 DOI: 10.1007/s00247-017-4005-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Accepted: 09/27/2017] [Indexed: 11/26/2022]
Abstract
Inflammation and damage in the temporomandibular joint (TMJ) often develop without clinical symptoms but can lead to severe facial growth abnormalities and impaired health-related quality of life, making early diagnosis of TMJ changes crucial to identify. Inflammatory and osteochondral changes detectable through magnetic resonance imaging (MRI) occur in TMJs of approximately 40% of children with juvenile idiopathic arthritis (JIA), and no other imaging modality or physical method of examination can reliably detect these changes. Therefore contrast-enhanced MRI is the diagnostic standard for diagnosis and interval monitoring of JIA. However the specific usage of MRI for TMJ arthritis is not standardized at present. There is a recognized need for a consensus effort toward standardization of an imaging protocol with required and optional sequences to improve detection of pathological changes and shorten study time. Such a consensus imaging protocol is important for providing maximum information with minimally necessary sequences in a way that allows inter-site comparison of results of clinical trials and improved clinical management. In this paper we describe the challenges of TMJ imaging and present expert-panel consensus suggestions for a standardized TMJ MRI protocol.
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Affiliation(s)
- Elka Miller
- Department of Medical Imaging, Children's Hospital of Eastern Ontario, Ottawa, ON, Canada
| | | | | | | | - Mirkamal Tolend
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada.
- Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 08.9840-L4, Toronto, ON, M5G 1A4, Canada.
| | - Arthur B Meyers
- Department of Radiology, Nemours Children's Health System, Orlando, FL, USA
| | - Thekla von Kalle
- Department of Pediatric Radiology, Radiologisches Institut, Olgahospital Klinikum Stuttgart, Stuttgart, Germany
| | - Jennifer Stimec
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | - Bernd Koos
- Department of Orthodontics, University Hospital Tübingen, Tübingen, Germany
| | | | - Linda Z Arvidsson
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
| | - Eva Kirkhus
- Department of Radiology and Nuclear Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, ON, Canada
| | | | - Tore A Larheim
- Department of Maxillofacial Radiology, Institute of Clinical Dentistry, University of Oslo, Oslo, Norway
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Manto M, Perrotta G. Toxic-induced cerebellar syndrome: from the fetal period to the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:333-352. [DOI: 10.1016/b978-0-444-64189-2.00022-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Xu Q, Liu Q, Ge H, Ge X, Wu J, Qu J, Xu K. Tumor recurrence versus treatment effects in glioma: A comparative study of three dimensional pseudo-continuous arterial spin labeling and dynamic susceptibility contrast imaging. Medicine (Baltimore) 2017; 96:e9332. [PMID: 29390403 PMCID: PMC5815815 DOI: 10.1097/md.0000000000009332] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Gliomas constitute over 90% of primary brain tumors. Accurate identification of glioma recurrence and treatment effects is important, as it can help determine whether to continue with standard adjuvant chemotherapy or to switch to a second-line therapy for recurrence. Our purpose is to compare three dimensional pseudo-continuous arterial spin labeling (3D-pcASL) technique and dynamic susceptibility contrast perfusion magnetic resonance imaging (DSC-MRI) for differentiation tumor recurrence from treatment-related effects in gliomas. METHODS Twenty-nine patients with gliomas previously who showed enlarged, contrast-enhancing lesions within the radiation field after surgery and concurrent chemoradiotherapy (CCRT) were assessed with 3D-pcASL and DSC-MRI. These patients were classified into 2 groups, tumor recurrence group (n = 17) and treatment effects group (n = 12), based on pathologic analysis or clinical-radiologic follow-up. The perfusion imaging quality was assessed using a 3-point scale (1 = poor imaging, 2 = moderate imaging, and 3 = good imaging). Comparison for perfusion imaging-quality score between the 2 techniques was performed with Wilcoxon one-sample test. Quantitative analyses were performed between the 2 groups with cerebral blood flow values (ASL-CBF), relative cerebral blood flow values (ASL-rCBF, DSC-rCBF), and relative cerebral blood volume values (DSC-rCBV) using Wilcoxon one-sample test. The intra-class correlation coefficient (ICC) statistics were calculated for testing intrareader variability in regions of interest (ROIs) measurement of all perfusion parameters. RESULTS The imaging-quality score of 3D-pcASL was higher than that of DSC-MRI (P = .01). The perfusion parameters between tumor recurrence group and treatment effects group had statistically significant differences. There was a significant correlation between ASL-rCBF and DSC-rCBF values (r = 0.803), between ASL-rCBF and DSC-rCBV values (r = 0.763), and between DSC-rCBF and DSC-rCBV (r = 0.907). A receiver operating characteristic (ROC) curve analysis was performed for significant results of perfusion parameters between the 2 groups. Using a cutoff value of 1.110, ASL-rCBF showed the maximum area under the ROC curve (AUC). However, there were no significant differences among different AUCs. The ICC demonstrated excellent agreement for ROIs measurements of ASL-CBF (ICC = 0.9636), dynamic susceptibility contrast- cerebral blood flow (DSC-CBF) (ICC = 0.8508), and dynamic susceptibility contrast-cerebral blood volume (DSC-CBV) (ICC = 0.8543). CONCLUSION 3D-pcASL is an alternative perfusion method to DSC-MRI for the differentiation between tumor recurrence and treatment effects in gliomas. 3D-pcASL is noninvasive and shows fewer susceptibility artifacts than DSC-MRI.
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Affiliation(s)
- Qian Xu
- The First School of Clinical Medicine, Nanjing Medical University
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Qi Liu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
| | - Haitao Ge
- Department of Medical Imaging, Xuzhou Medical University
| | - Xinting Ge
- Department of Medical Imaging, Xuzhou Medical University
| | | | | | - Kai Xu
- The First School of Clinical Medicine, Nanjing Medical University
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University
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Liu JM, Liu A, Leal J, McMillan F, Francis J, Greiser A, Rider OJ, Myerson S, Neubauer S, Ferreira VM, Piechnik SK. Measurement of myocardial native T1 in cardiovascular diseases and norm in 1291 subjects. J Cardiovasc Magn Reson 2017; 19:74. [PMID: 28954631 PMCID: PMC5618724 DOI: 10.1186/s12968-017-0386-y] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2017] [Accepted: 09/05/2017] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Native T1-mapping provides quantitative myocardial tissue characterization for cardiovascular diseases (CVD), without the need for gadolinium. However, its translation into clinical practice is hindered by differences between techniques and the lack of established reference values. We provide typical myocardial T1-ranges for 18 commonly encountered CVDs using a single T1-mapping technique - Shortened Look-Locker Inversion Recovery (ShMOLLI), also used in the large UK Biobank and Hypertrophic Cardiomyopathy Registry study. METHODS We analyzed 1291 subjects who underwent CMR (1.5-Tesla, MAGNETOM-Avanto, Siemens Healthcare, Erlangen, Germany) between 2009 and 2016, who had a single CVD diagnosis, with mid-ventricular T1-map assessment. A region of interest (ROI) was placed on native T1-maps in the "most-affected myocardium", characterized by the presence of late gadolinium enhancement (LGE), or regional wall motion abnormalities (RWMA) on cines. Another ROI was placed in the "reference myocardium" as far as possible from LGE/RWMA, and in the septum if no focal abnormality was present. To further define normality, we included native T1 of healthy subjects from an existing dataset after sub-endocardial pixel-erosions. RESULTS Native T1 of patients with normal CMR (938 ± 21 ms) was similar compared to healthy subjects (941 ± 23 ms). Across all patient groups (57 ± 19 yrs., 65% males), focally affected myocardium had significantly different T1 value compared to reference myocardium (all p < 0.001). In the affected myocardium, cardiac amyloidosis (1119 ± 61 ms) had the highest native T1 compared to normal and all other CVDs, while iron-overload (795 ± 58 ms) and Anderson-Fabry disease (863 ± 23 ms) had the lowest native reference T1 (all p < 0.001). Future studies designed to detect the large T1 differences between affected and reference myocardium are estimated to require small sample-sizes (n < 50). However, studies designed to detect the small T1 differences between reference myocardium in CVDs and healthy controls can require several thousand of subjects. CONCLUSIONS We provide typical T1-ranges for common clinical cardiac conditions in the largest cohort to-date, using ShMOLLI T1-mapping at 1.5 T. Sample-size calculations from this study may be useful for the design of future studies and trials that use T1-mapping as an endpoint.
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Affiliation(s)
- Joanna M. Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Alexander Liu
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Joana Leal
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Fiona McMillan
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Jane Francis
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | | | - Oliver J. Rider
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Saul Myerson
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Stefan Neubauer
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Vanessa M. Ferreira
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
| | - Stefan K. Piechnik
- Oxford Centre for Clinical Magnetic Resonance Research (OCMR), Division of Cardiovascular Medicine, Radcliffe Department of Medicine, University of Oxford, Oxford, OX3 9DU UK
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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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Abstract
Clinicians, radiologists, and patients should be aware of the most up-to-date data on the risks of gadolinium-based contrast agent (GBCA) administration. In this review, we discuss in vivo gadolinium retention, particularly brain tissue retention, and potential toxic effects. GBCA pharmacokinetics and biodistribution are reviewed briefly. Based on the more recent published literature and society guidelines, general safety recommendations for clinical practice are provided.
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Affiliation(s)
- Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal.
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
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Gadolinium retention in the body: what we know and what we can do. Radiol Med 2017; 122:589-600. [PMID: 28361260 DOI: 10.1007/s11547-017-0757-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 01/08/2023]
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Radbruch A, Haase R, Kickingereder P, Bäumer P, Bickelhaupt S, Paech D, Wick W, Schlemmer HP, Seitz A, Bendszus M. Pediatric Brain: No Increased Signal Intensity in the Dentate Nucleus on Unenhanced T1-weighted MR Images after Consecutive Exposure to a Macrocyclic Gadolinium-based Contrast Agent. Radiology 2017; 283:828-836. [PMID: 28273007 DOI: 10.1148/radiol.2017162980] [Citation(s) in RCA: 69] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Purpose To determine the effect of at least five serial injections of the macrocyclic gadolinium-based contrast agent (GBCA) gadoterate meglumine on the signal intensity (SI) of the dentate nucleus (DN) of the pediatric brain on nonenhanced T1-weighted magnetic resonance (MR) images. Materials and Methods In this retrospective, institutional review board-approved study, 41 pediatric patients (age range, 3-17 years) who were imaged in at least five consecutive 1.5-T MR examinations with the exclusive use of gadoterate meglumine (plus a final additional nonenhanced MR imaging examination) were evaluated. SI ratio differences between the first and last MR examination were calculated for DN-to-pons and DN-to-middle cerebellar peduncle (MCP) ratios in a region-of-interest-based analysis, and one-sample t tests were used to examine if the SI ratio differences differed from 0. Bayes factors were calculated to quantify the strength of evidence for each test. Results Patients underwent a mean of 8.6 ± 3.9 GBCA administrations (mean accumulated dose, 32.07 mmol ± 17.62, with an average of 16.7 weeks ± 7.9 between every administration). Both ratio differences did not differ significantly from 0 (DN-to-pons ratio: -0.0012 ± 0.0101, P = .436; DN-to-MCP ratio: 0.0007 ± 0.0088, P = .604), and one-sided Bayes factors provided substantial evidence against an SI ratio increase (0.10 for DN-to-pons ratio; 0.27 for DN-to-MCP ratio). Conclusion No increase of the SI in the DN was found after a mean of 8.6 serial injections of the macrocyclic GBCA gadoterate meglumine in pediatric patients, confirming previous studies that did not find this effect after serial injections of macrocyclic GBCAs in adults. © RSNA, 2017.
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Affiliation(s)
- Alexander Radbruch
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Robert Haase
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Philipp Kickingereder
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Philipp Bäumer
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Sebastian Bickelhaupt
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Daniel Paech
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Wolfgang Wick
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Heinz-Peter Schlemmer
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Angelika Seitz
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
| | - Martin Bendszus
- From the Department of Neuroradiology (A.R., R.H., P.K., P.B., A.S., M.B.) and Neurology Clinic (W.W.), University of Heidelberg Medical Center, Im Neuenheimer Feld 280, 69120 Heidelberg, Germany; Department of Radiology, German Cancer Research Center (DKFZ), Heidelberg, Germany (A.R., R.H., P.B., S.B., D.P., H.P.S.); Department of Radiology, German Cancer Consortium (DKTK), Heidelberg, Germany (A.R., R.H.); and Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, University Duisburg-Essen, Essen, Germany (A.R.)
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