MRI and Genetic Damage: An Update

Perceptions of Risk, Benefit and Trust - A Comparative Assessment Between Healthcare Workers and the General Public Towards 3 Medical Technologies

Background and Objective

While there is a substantial amount of research on risk perception, there has been less focus on the way medical technologies are perceived by experts as opposed to lay individuals. We investigated the factors that may influence the risk perception of healthcare workers (HCWs) and the general public regarding 3 distinct medical technologies: magnetic resonance imaging (MRI), laser-assisted in situ keratomileusis (LASIK) and the Covid-19 vaccine.

Methods

A cross-sectional study conducted in 2021 among 2 populations: HCWs employed at a general public hospital and a sample of outpatients and individuals who are not medical professionals. The participants completed an electronic questionnaire.

Results

In total, 739 respondents were included: 197 HCWs (26.7%) and 542 members of the public (73.3%). Most of the respondents (89.4%) reported being vaccinated against Covid-19, 43.8% had previously undergone an MRI but 90% had not undergone LASIK. Overall, all 3 technologies assessed in the study were rated by the respondents as having a high benefit and low risk. HCWs and the public showed statistically significant differences in perceived risk towards MRI and LASIK, as well as in some of the risk perception characteristics of each technology. In contrast, no differences in risk perception towards the Covid-19 vaccine were found between HCWs and the public. Both study populations showed a significant negative correlation between trust in the MoH and the perceived risk towards MRI and the Covid-19 vaccine. Both study populations regarded information provided by medical sources as the most reliable for decision-making.

Conclusion

The perceptions and concerns towards medical technologies influence individuals' behavior and acceptance of technologies. They are also essential for risk communication. The study contributes to the understanding of attitudes towards various medical technologies, including risk perception, risk characteristics, trust and sources of information pertaining to each of the technologies, by examining the differences between HCWs and the general public.

Genotoxic effects of gadobutrol and gadoversetamide active substances used in magnetic resonance imaging in human peripheral lymphocytes in vitro

Gadobutrol and gadoversetamide are gadolinium-based contrast agents (GBCAs) widely used during magnetic resonance imaging examination. In this study, the genotoxicity of two GBCAs, gadobutrol and gadoversetamide, was investigated by using different endpoints: chromosome aberration (CAs), sister chromatid exchange (SCEs), and micronucleus (MNi). Human peripheral lymphocytes (PBLs) were treated with five concentrations (7 000, 14 000, 28 000, 56 000, and 112 000 μg/mL) of both agents. While a few concentrations of gadobutrol significantly increased abnormal cell frequency and CA/Cell, nearly all the concentrations of gadoversetamide significantly elevated the same aberrations. Similarly, the effect of gadoversetamide on the formation of SCEs was higher than those of gadobutrol. Only one concentration of gadoversetamide significantly increased MN% but no gadobutrol. The comet assay was applied for the only gadobutrol which induced a significant increase in tail intensity at the highest concentration only. On the other hand, significantly decreased mitotic index (MI) was observed following both substances, again gadoversetamide was slightly higher than those of the gadobutrol. The results revealed that both the contrast agents are likely to induce genotoxic risk in PBLs. However, different concentrations and treatment periods should be examined in vitro and specifically in vivo with different test systems for the safer usage of these contrast agents.

Valid Exposure Protocols Needed in Magnetic Resonance Imaging Genotoxic Research

Several in vitro and in vivo studies have investigated if a magnetic resonance imaging (MRI) examination can cause DNA damage in human blood cells. However, the electromagnetic field (EMF) exposure that the cells received in the MR scanner was not sufficiently described. The first studies looking into this could be regarded as hypothesis-generating studies. However, for further exploration into the role of MRI exposure on DNA integrity, the exposure itself cannot be ignored. The lack of sufficient method descriptions makes the early experiments difficult, if not impossible, to repeat. The golden rule in all experimental work is that a study should be repeatable by someone with the right knowledge and equipment, and this is simply not the case with many of the recent studies on MRI and genotoxicity. Here we discuss what is lacking in previous studies, and how we think the next generation of in vitro and in vivo studies on MRI and genotoxicity should be performed. Bioelectromagnetics. © 2020 Bioelectromagnetics Society.

EMF exposure variation among MRI sequences from pediatric examination protocols

The magnetic resonance imaging (MRI) exposure environment is unique due to the mixture and intensity of magnetic fields involved. Current safety regulations are based on well-known acute effects of heating and neuroexcitation while the scientific grounds for possible long-term effects from MRI exposure are lacking. Epidemiological research requires careful exposure characterization, and as a first step toward improved exposure assessment we set out to characterize the MRI-patient exposure environment. Seven MRI sequences were run on a 3-Tesla scanner while the radiofrequency and gradient magnetic fields were measured inside the scanner bore. The sequences were compared in terms of 14 different exposure parameters. To study within-sequence variability, we varied sequence settings such as flip angle and slice thickness one at a time, to determine if they had any impact on exposure endpoints. There were significant differences between two or more sequences for all fourteen exposure parameters. Within-sequence differences were up to 60% of the corresponding between-sequence differences, and a 5-8 fold exposure increase was caused by variations in flip angle, slice spacing, and field of view. MRI exposure is therefore not only sequence-specific but also patient- and examination occurrence-specific, a complexity that requires careful consideration for an MRI exposure assessment in epidemiological studies to be meaningful. Bioelectromagnetics. 40:3-15, 2019. © 2018 The Authors. Bioelectromagnetics Published by Wiley Periodicals, Inc.

Pros and cons of ultra-high-field MRI/MRS for human application

Magnetic resonance imaging and spectroscopic techniques are widely used in humans both for clinical diagnostic applications and in basic research areas such as cognitive neuroimaging. In recent years, new human MR systems have become available operating at static magnetic fields of 7 T or higher (≥300 MHz proton frequency). Imaging human-sized objects at such high frequencies presents several challenges including non-uniform radiofrequency fields, enhanced susceptibility artifacts, and higher radiofrequency energy deposition in the tissue. On the other side of the scale are gains in signal-to-noise or contrast-to-noise ratio that allow finer structures to be visualized and smaller physiological effects to be detected. This review presents an overview of some of the latest methodological developments in human ultra-high field MRI/MRS as well as associated clinical and scientific applications. Emphasis is given to techniques that particularly benefit from the changing physical characteristics at high magnetic fields, including susceptibility-weighted imaging and phase-contrast techniques, imaging with X-nuclei, MR spectroscopy, CEST imaging, as well as functional MRI. In addition, more general methodological developments such as parallel transmission and motion correction will be discussed that are required to leverage the full potential of higher magnetic fields, and an overview of relevant physiological considerations of human high magnetic field exposure is provided.

The potential toxic impact of different gadolinium-based contrast agents combined with 7-T MRI on isolated human lymphocytes

Background

To investigate a potentially amplifying genotoxic or cytotoxic effect of different gadolinium-based contrast agents (GBCAs) in combination with ultra-high-field 7-T magnetic resonance imaging (MRI) exposure in separated human peripheral blood lymphocytes.

Methods

This in vitro study was approved by the local ethics committee and written informed consent was obtained from all participants. Isolated lymphocytes from twelve healthy donors were incubated with gadobutrol, gadoterate meglumine, gadodiamide, gadopentetate dimeglumine, or gadoxetate either alone or combined with 7-T MRI (1 h). Deoxyribonucleic acid (DNA) double-strand breaks were assessed 15 min after MRI exposure by automated γH2AX foci quantification. Cytotoxicity was determined at later endpoints by Annexin V/propidium iodide apoptosis assay (24 h) and [³H]-thymidine proliferation test (72 h). As a reference, lymphocytes from four different donors were exposed analogously to iodinated contrast agents (iomeprol, iopromide) in combination with computed tomography.

Results

Baseline γH2AX levels (0.08 ± 0.02 foci/cell) were not significantly (p between 0.135 and 1.000) enhanced after administration of GBCAs regardless of MRI exposure. In contrast to the two investigated macrocyclic GBCAs, lymphocytes exposed to the three linear GBCAs showed a dose-dependent increase in apoptosis (maximum 186% of unexposed control, p < 0.001) and reduced proliferation rate (minimum 0.7% of unexposed control, p < 0.001). However, additional 7-T MRI co-exposure did not alter GBCA-induced cytotoxicity.

Conclusions

Exposure of lymphocytes to different GBCAs did not reveal significant induction of γH2AX foci, and enhanced cytotoxicity was only observed in lymphocytes treated with the linear GBCAs used in this study, independent of additional 7-T MRI co-exposure.

Electronic supplementary material

The online version of this article (10.1186/s41747-018-0069-y) contains supplementary material, which is available to authorized users.