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Gordon DS, Langston CE. Effective removal of gadolinium with hemodialysis in a dog with severe acute on chronic kidney injury. J Vet Emerg Crit Care (San Antonio) 2024; 34:406-411. [PMID: 38971980 DOI: 10.1111/vec.13404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Revised: 06/03/2023] [Accepted: 06/12/2023] [Indexed: 07/08/2024]
Abstract
OBJECTIVE To describe the use of intermittent hemodialysis (IHD) to remove gadolinium (28.1 mg/kg dose) in a dog with severe kidney disease. CASE SUMMARY A 12-year-old neutered female Yorkshire Terrier presented with severe acute-on-chronic kidney injury and concurrent neurological signs. The dog received extracorporeal therapy as part of management. Uremia improved after hemodialysis, but central nervous system signs persisted; therefore, a contrast-enhanced magnetic resonance imaging was performed, immediately followed by IHD. Two IHD treatments with a low-flux dialyzer were performed 1.5 and 25.75 hours after administration of gadolinium, with almost complete removal of gadolinium. More than 96% of gadolinium was removed with a single treatment. NEW OR UNIQUE INFORMATION PROVIDED Extracorporeal therapy is effective at removing gadolinium-based chelated contrast agents and could be considered if magnetic resonance imaging is indicated in a patient with substantial kidney impairment. Alternatively, newer contrast agents that have been deemed safer in this patient population could be used.
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Affiliation(s)
- Daniel S Gordon
- Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Cathy E Langston
- Veterinary Medical Center, College of Veterinary Medicine, The Ohio State University, Columbus, Ohio, USA
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van der Molen AJ, Dekkers IA, Geenen RWF, Bellin MF, Bertolotto M, Brismar TB, Correas JM, Heinz-Peer G, Mahnken AH, Quattrocchi CC, Radbruch A, Reimer P, Roditi G, Romanini L, Sebastià C, Stacul F, Clement O. Waiting times between examinations with intravascularly administered contrast media: a review of contrast media pharmacokinetics and updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 2024; 34:2512-2523. [PMID: 37823923 PMCID: PMC10957598 DOI: 10.1007/s00330-023-10085-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Revised: 06/04/2023] [Accepted: 07/07/2023] [Indexed: 10/13/2023]
Abstract
The pharmacokinetics of contrast media (CM) will determine how long safe waiting intervals between successive CT or MRI examinations should be. The Contrast Media Safety Committee has reviewed the data on pharmacokinetics of contrast media to suggest safe waiting intervals between successive contrast-enhanced imaging studies in relation to the renal function of the patient. CLINICAL RELEVANCE STATEMENT: Consider a waiting time between elective contrast-enhanced CT and (coronary) angiography with successive iodine-based contrast media administrations in patients with normal renal function (eGFR > 60 mL/min/1.73 m2) of optimally 12 h (near complete clearance of the previously administered iodine-based contrast media) and minimally 4 h (if clinical indication requires rapid follow-up). KEY POINTS: • Pharmacokinetics of contrast media will guide safe waiting times between successive administrations. • Safe waiting times increase with increasing renal insufficiency. • Iodine-based contrast media influence MRI signal intensities and gadolinium-based contrast agents influence CT attenuation.
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Affiliation(s)
- Aart J van der Molen
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Ilona A Dekkers
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Remy W F Geenen
- Department of Radiology, Northwest Clinics, Alkmaar, The Netherlands
| | - Marie-France Bellin
- Department of Radiology, University Paris Saclay, AP-HP, University Hospital Bicêtre, BioMaps, Le Kremlin-Bicêtre, France
| | | | - Torkel B Brismar
- Department of Clinical Science, Intervention and Technology, Unit of Radiology, Karolinska Institutet and Department of Radiology, Karolinska University Hospital in Huddinge, Stockholm, Sweden
| | - Jean-Michel Correas
- AP-HP, Groupe Hospitalier Necker, DMU Imagina, Service de Radiologie, Université de Paris, Paris, France
| | | | - Andreas H Mahnken
- Department of Diagnostic and Interventional Radiology, Marburg University Hospital, Marburg, Germany
| | | | - Alexander Radbruch
- Clinic for Diagnostic and Interventional Neuroradiology, University Clinic Bonn, and German Center for Neurodegenerative Diseases, DZNE, Bonn, Germany
| | - Peter Reimer
- Department of Radiology, Institute for Diagnostic and Interventional Radiology, Klinikum Karlsruhe, Karlsruhe, Germany
| | - Giles Roditi
- Department of Radiology, Glasgow Royal Infirmary, Glasgow, UK
| | | | - Carmen Sebastià
- Department of Radiology, Hospital Clinic de Barcelona, Barcelona, Spain
| | - Fulvio Stacul
- Department of Radiology, Ospedale Maggiore, Trieste, Italy
| | - Olivier Clement
- AP-HP, Hôpital Européen Georges Pompidou, DMU Imagina, Service de Radiologie, Université de Paris, 20 Rue LeBlanc, 75015, Paris, France.
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Li D, Kirberger M, Qiao J, Gui Z, Xue S, Pu F, Jiang J, Xu Y, Tan S, Salarian M, Ibhagui O, Hekmatyar K, Yang JJ. Protein MRI Contrast Agents as an Effective Approach for Precision Molecular Imaging. Invest Radiol 2024; 59:170-186. [PMID: 38180819 DOI: 10.1097/rli.0000000000001057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024]
Abstract
ABSTRACT Cancer and other acute and chronic diseases are results of perturbations of common molecular determinants in key biological and signaling processes. Imaging is critical for characterizing dynamic changes in tumors and metastases, the tumor microenvironment, tumor-stroma interactions, and drug targets, at multiscale levels. Magnetic resonance imaging (MRI) has emerged to be a primary imaging modality for both clinical and preclinical applications due to its advantages over other modalities, including sensitivity to soft tissues, nondepth limitations, and the use of nonionizing radiation. However, extending the application of MRI to achieve both qualitative and quantitative precise molecular imaging with the capability to quantify molecular biomarkers for early detection, staging, and monitoring therapeutic treatment requires the capacity to overcome several major challenges including the trade-off between metal-binding affinity and relaxivity, which is an issue frequently associated with small chelator contrast agents. In this review, we will introduce the criteria of ideal contrast agents for precision molecular imaging and discuss the relaxivity of current contrast agents with defined first shell coordination water molecules. We will then report our advances in creating a new class of protein-targeted MRI contrast agents (ProCAs) with contributions to relaxivity largely derived from the secondary sphere and correlation time. We will summarize our rationale, design strategy, and approaches to the development and optimization of our pioneering ProCAs with desired high relaxivity, metal stability, and molecular biomarker-targeting capability, for precision MRI. From first generation (ProCA1) to third generation (ProCA32), we have achieved dual high r1 and r2 values that are 6- to 10-fold higher than clinically approved contrast agents at magnetic fields of 1.5 T, and their relaxivity values at high field are also significantly higher, which enables high resolution during small animal imaging. Further engineering of multiple targeting moieties enables ProCA32 agents that have strong biomarker-binding affinity and specificity for an array of key molecular biomarkers associated with various chronic diseases, while maintaining relaxation and exceptional metal-binding and selectivity, serum stability, and resistance to transmetallation, which are critical in mitigating risks associated with metal toxicity. Our leading product ProCA32.collagen has enabled the first early detection of liver metastasis from multiple cancers at early stages by mapping the tumor environment and early stage of fibrosis from liver and lung in vivo, with strong translational potential to extend to precision MRI for preclinical and clinical applications for precision diagnosis and treatment.
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Affiliation(s)
- Dongjun Li
- From the Center for Diagnostics and Therapeutics, Advanced Translational Imaging Facility, Department of Chemistry, Georgia State University, Atlanta, GA (D.L., M.K., J.Q., Z.G., S.X., P.F., J.J., S.T., M.S., O.I., K.H., J.J.Y.); and InLighta BioSciences, LLC, Marietta, GA (Y.X., J.J.Y)
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4
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Nhàn NTT, Yamada T, Yamada KH. Peptide-Based Agents for Cancer Treatment: Current Applications and Future Directions. Int J Mol Sci 2023; 24:12931. [PMID: 37629112 PMCID: PMC10454368 DOI: 10.3390/ijms241612931] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 08/10/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Peptide-based strategies have received an enormous amount of attention because of their specificity and applicability. Their specificity and tumor-targeting ability are applied to diagnosis and treatment for cancer patients. In this review, we will summarize recent advancements and future perspectives on peptide-based strategies for cancer treatment. The literature search was conducted to identify relevant articles for peptide-based strategies for cancer treatment. It was performed using PubMed for articles in English until June 2023. Information on clinical trials was also obtained from ClinicalTrial.gov. Given that peptide-based strategies have several advantages such as targeted delivery to the diseased area, personalized designs, relatively small sizes, and simple production process, bioactive peptides having anti-cancer activities (anti-cancer peptides or ACPs) have been tested in pre-clinical settings and clinical trials. The capability of peptides for tumor targeting is essentially useful for peptide-drug conjugates (PDCs), diagnosis, and image-guided surgery. Immunomodulation with peptide vaccines has been extensively tested in clinical trials. Despite such advantages, FDA-approved peptide agents for solid cancer are still limited. This review will provide a detailed overview of current approaches, design strategies, routes of administration, and new technological advancements. We will highlight the success and limitations of peptide-based therapies for cancer treatment.
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Affiliation(s)
- Nguyễn Thị Thanh Nhàn
- Department of Pharmacology & Regenerative Medicine, University of Illinois College of Medicine, Chicago, IL 60612, USA;
| | - Tohru Yamada
- Department of Surgery, Division of Surgical Oncology, University of Illinois College of Medicine, Chicago, IL 60612, USA;
- Richard & Loan Hill Department of Biomedical Engineering, University of Illinois College of Engineering, Chicago, IL 60607, USA
| | - Kaori H. Yamada
- Department of Pharmacology & Regenerative Medicine, University of Illinois College of Medicine, Chicago, IL 60612, USA;
- Department of Ophthalmology & Visual Sciences, University of Illinois College of Medicine, Chicago, IL 60612, USA
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Pereto C, Lerat-Hardy A, Baudrimont M, Coynel A. European fluxes of medical gadolinium to the ocean: A model based on healthcare databases. ENVIRONMENT INTERNATIONAL 2023; 173:107868. [PMID: 36913780 DOI: 10.1016/j.envint.2023.107868] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 02/08/2023] [Accepted: 03/04/2023] [Indexed: 06/18/2023]
Abstract
Marine ecosystems are exposed to a multitude of stresses, including emerging metals as Rare Earth Elements. The management of these emerging contaminants represents a significant environmental issue. For the past three decades, the increasing medical use of gadolinium-based contrast agents (GBCAs) has contributed to their widespread dispersion in hydrosystems, raising concerns for ocean conservation. In order to control GBCA contamination pathways, a better understanding of the cycle of these elements is needed, based on the reliable characterization of fluxes from watersheds. Our study proposes an unprecedented annual flux model for anthropogenic gadolinium (Gdanth) based on GBCA consumption, demographics and medical uses. This model enabled the mapping of Gdanth fluxes for 48 European countries. The results show that 43 % of Gdanth is exported to the Atlantic Ocean, 24 % to the Black Sea, 23 % to the Mediterranean Sea and 9 % to the Baltic Sea. Together, Germany, France and Italy contribute 40 % of Europe's annual flux. Our study was therefore able to identify the current and future major contributors to Gdanth flux in Europe and identify abrupt changes related to the COVID-19 pandemic.
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Affiliation(s)
- Clément Pereto
- Univ. Bordeaux, CNRS, Bordeaux INP, EPOC, UMR 5805, F-33600 Pessac, France.
| | | | - Magalie Baudrimont
- Univ. Bordeaux, CNRS, Bordeaux INP, EPOC, UMR 5805, F-33600 Pessac, France.
| | - Alexandra Coynel
- Univ. Bordeaux, CNRS, Bordeaux INP, EPOC, UMR 5805, F-33600 Pessac, France.
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Abstract
AKI is a potential complication of intravascular iodinated contrast exposure. Contrast-associated AKI, which typically manifests as small and transient decrements in kidney function that develop within several days of contrast administration, is associated with serious adverse outcomes, including progressive kidney dysfunction and death. However, a causal link between the small increases in serum creatinine that characteristically occur with contrast-associated AKI and serious adverse outcomes remains unproven. This is important given mounting evidence that clinically indicated, potentially lifesaving radiographic procedures are underutilized in patients with CKD. This has been hypothesized to be related to provider concern about precipitating contrast-associated AKI. Intravascular gadolinium-based contrast, an alternative to iodinated contrast that is administered with magnetic resonance imaging, has also been linked with potential serious adverse events, notably the development of nephrogenic systemic fibrosis in patients with severe impairment in kidney function. Patients hospitalized in the intensive care unit frequently have clinical indications for diagnostic and therapeutic procedures that involve the intravascular administration of contrast media. Accordingly, critical care providers and others treating critically ill patients should possess a sound understanding of the risk factors for and incidence of such outcomes, the ability to perform evidence-based risk-benefit assessments regarding intravascular contrast administration, and knowledge of empirical data on the prevention of these iatrogenic complications.
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Affiliation(s)
- Winn Cashion
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Steven D Weisbord
- Renal-Electrolyte Division, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania .,Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania.,Renal Section, Veterans Affairs Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
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7
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Davies J, Siebenhandl-Wolff P, Tranquart F, Jones P, Evans P. Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration. Arch Toxicol 2022; 96:403-429. [PMID: 34997254 PMCID: PMC8837552 DOI: 10.1007/s00204-021-03189-8] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/02/2021] [Indexed: 12/12/2022]
Abstract
Gadolinium-based contrast agents (GBCAs) have transformed magnetic resonance imaging (MRI) by facilitating the use of contrast-enhanced MRI to allow vital clinical diagnosis in a plethora of disease that would otherwise remain undetected. Although over 500 million doses have been administered worldwide, scientific research has documented the retention of gadolinium in tissues, long after exposure, and the discovery of a GBCA-associated disease termed nephrogenic systemic fibrosis, found in patients with impaired renal function. An understanding of the pharmacokinetics in humans and animals alike are pivotal to the understanding of the distribution and excretion of gadolinium and GBCAs, and ultimately their potential retention. This has been well studied in humans and more so in animals, and recently there has been a particular focus on potential toxicities associated with multiple GBCA administration. The purpose of this review is to highlight what is currently known in the literature regarding the pharmacokinetics of gadolinium in humans and animals, and any toxicity associated with GBCA use.
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Affiliation(s)
- Julie Davies
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK.
| | | | | | - Paul Jones
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
| | - Paul Evans
- GE Healthcare, Pollards Wood, Nightingales Lane, Chalfont St. Giles, UK
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Bennett CL, Witherspoon B, Carson KR, Thomsen HS. Was There Something Rotten in Denmark: Nephrogenic System Fibrosis Cases Occurring in Copenhagen. Cancer Treat Res 2022; 184:87-102. [PMID: 36449190 DOI: 10.1007/978-3-031-04402-1_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
More than half of all serious adverse drug reactions are identified seven years after FDA approval. One recent and unusual example involves a syndrome initially termed nephrogenic dermatopathic fibrosis, and then called nephrogenic systemic fibrosis (NSF).
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Affiliation(s)
- Charles L Bennett
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Bartlett Witherspoon
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Kenneth R Carson
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA
| | - Henrik S Thomsen
- SONAR (Southern Network on Adverse Reactions) Program, University of South Carolina College of Pharmacy, Columbia, SC, 29208, USA.
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9
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Jacobi A, Ariza de Schellenberger A, Uca YO, Herbig M, Guck J, Sack I. Real-Time Deformability Cytometry Detects Leukocyte Stiffening After Gadolinium-Based Contrast Agent Exposure. Invest Radiol 2021; 56:837-844. [PMID: 34038063 DOI: 10.1097/rli.0000000000000794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Reports on gadolinium (Gd) retention in soft tissues after administration of Gd-based contrast agents (GBCAs) raise concerns about Gd-induced changes in the biophysical properties of cells and tissues. Here, we investigate if clinical GBCAs of both classes of linear and macrocyclic structure cause changes in the mechanical properties of leukocytes in human blood samples. MATERIAL AND METHODS Real-time deformability cytometry was applied to human blood samples from 6 donors. The samples were treated with 1 mM gadoteric acid (Dotarem), gadopentetic acid (Magnevist), gadobutrol (Gadovist), or Gd trichloride at 37°C for 1 hour to mimic clinical doses of GBCAs and exposure times. Leukocyte subtypes-lymphocytes, monocytes, and neutrophils-were identified based on their size and brightness and analyzed for deformability, which is inversely correlated with cellular stiffness. RESULTS We observed significant stiffening (3%-13%, P < 0.01) of all investigated leukocyte subtypes, which was most pronounced for lymphocytes, followed by neutrophils and monocytes, and the effects were independent of the charge and steric structure of the GBCA applied. In contrast, no changes in cell size and brightness were observed, suggesting that deformability and cell stiffness measured by real-time deformability cytometry are sensitive to changes in the physical phenotypes of leukocytes after GBCA exposure. CONCLUSIONS Real-time deformability cytometry might provide a quantitative blood marker for critical changes in the physical properties of blood cells in patients undergoing GBCA-enhanced magnetic resonance imaging.
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Affiliation(s)
| | - Angela Ariza de Schellenberger
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin
| | - Yavuz Oguz Uca
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin
| | | | - Jochen Guck
- From the Max Planck Institute for the Science of Light & Max-Planck-Zentrum für Physik und Medizin, Erlangen
| | - Ingolf Sack
- Department of Radiology, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin
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Fretellier N, Rasschaert M, Bocanegra J, Robert P, Factor C, Seron A, Idée JM, Corot C. Safety and Gadolinium Distribution of the New High-Relaxivity Gadolinium Chelate Gadopiclenol in a Rat Model of Severe Renal Failure. Invest Radiol 2021; 56:826-836. [PMID: 34091462 DOI: 10.1097/rli.0000000000000793] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of this study was to investigate the toxicological profile of gadopiclenol, a new high-relaxivity macrocyclic gadolinium-based contrast agent (GBCA), in renally impaired rats, in comparison with 2 other macrocyclic GBCAs, gadoterate meglumine and gadobutrol, and 1 linear and nonionic GBCA, gadodiamide. METHODS Renal failure was induced by adding 0.75% wt/wt adenine to the diet for 3 weeks. During the second week of adenine-enriched diet, the animals (n = 8/group × 5 groups) received 5 consecutive intravenous injections of GBCA at 2.5 mmol/kg per injection, resulting in a cumulative dose of 12.5 mmol/kg or saline followed by a 3-week treatment-free period after the last injection. The total (elemental) gadolinium (Gd) concentration in different tissues (brain, cerebellum, femoral epiphysis, liver, skin, heart, kidney, spleen, plasma, urine, and feces) was measured by inductively coupled plasma mass spectrometry. Transmission electron microscopy (and electron energy loss spectroscopy analysis of metallic deposits) was used to investigate the presence and localization of Gd deposits in the skin. Relaxometry was used to evaluate the presence of dissociated Gd in the skin, liver, and bone. Skin histopathology was performed to investigate the presence of nephrogenic systemic fibrosis-like lesions. RESULTS Gadodiamide administrations were associated with high morbidity-mortality but also with macroscopic and microscopic skin lesions in renally impaired rats. No such effects were observed with gadopiclenol, gadoterate, or gadobutrol. Overall, elemental Gd concentrations were significantly higher in gadodiamide-treated rats than in rats treated with the other GBCAs for all tissues except the liver (where no significant difference was found with gadopiclenol) and the kidney and the heart (where statistically similar Gd concentrations were observed for all GBCAs). No plasma biochemical abnormalities were observed with gadopiclenol or the control GBCAs. Histopathology revealed a normal skin structure in the rats treated with gadopiclenol, gadoterate, and gadobutrol, contrary to those treated with gadodiamide. No evidence of Gd deposits on collagen fibers and inclusions in fibroblasts was found with gadopiclenol and its macrocyclic controls, unlike with gadodiamide. Animals of all test groups had Gd-positive lysosomal inclusions in the dermal macrophages. However, the textures differed for the different products (speckled texture for gadodiamide and rough-textured appearance for the 2 tested macrocyclic GBCAs). CONCLUSIONS No evidence of biochemical toxicity or pathological abnormalities of the skin was observed, and similar to other macrocyclic GBCAs, gadoterate and gadobutrol, tissue retention of Gd was found to be low (except in the liver) in renally impaired rats treated with the new high-relaxivity GBCA gadopiclenol.
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Affiliation(s)
- Nathalie Fretellier
- From the Research and Innovation Department, Guerbet, Aulnay-sous-Bois, France
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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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12
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Bradu A, Penescu M, Pitrou C, Hao J, Bourrinet P. Pharmacokinetics, Dialysability, and Safety of Gadopiclenol, a New Gadolinium-Based Contrast Agent, in Patients With Impaired Renal Function. Invest Radiol 2021; 56:486-493. [PMID: 34197356 DOI: 10.1097/rli.0000000000000764] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The aims of this study were to evaluate the pharmacokinetics (PK) of gadopiclenol, a new macrocyclic gadolinium based-contrast agent, in subjects with impaired renal function, and to assess its dialysability in subjects with end-stage renal disease (ESRD). METHODS AND MATERIALS This 2-center, open-label, phase 1 study included 5 successive cohorts of 8 adult subjects: healthy subjects (cohort 1), subjects with mild (cohort 2), moderate (cohort 3), severe (cohort 4) renal impairment, or ESRD (cohort 5), who received a single intravenous injection of gadopiclenol (0.1 mmol/kg). Blood and urine samples were collected at different time points in cohorts 1 to 4, and blood and dialysate samples were collected at each hemodialysis session (4-hour session on day 1, day 3, and day 5) in cohort 5. Gadopiclenol elimination and safety were assessed for up to 6 months. Pharmacokinetics parameters were calculated using noncompartmental analysis. RESULTS A total of 40 subjects were included, with a mean age of 51.5 years (range, 18-71 years). No significant difference in the mean maximum concentration values and the distribution volume was observed among cohorts 1 to 4. Urinary excretion of unchanged gadopiclenol was delayed with the degree of renal impairment and ranged between 96% and 84% in subjects with mild to severe renal impairment. Compared with that of healthy subjects, the mean area under the plasma concentration curve was 54%, 148%, and 769% higher in subjects with mild, moderate, or severe renal impairment, respectively. The mean terminal half-life was prolonged with the degree of renal impairment (1.9, 3.3, 3.8, and 11.7 hours for cohorts 1-4). In ESRD subjects, gadopiclenol was effectively removed from the plasma (95% to 98%) after the first hemodialysis session. Gadopiclenol concentration in plasma was below the limit of quantification for all subjects after the second hemodialysis session. Gadopiclenol concentration was below limit of quantification in all plasma and urine samples collected at 1, 3, and 6 months. Five subjects (12.5%) experienced adverse events related to gadopiclenol, none serious and all resolved. Laboratory measurements, vital signs, and electrocardiography did not raise any safety concern. CONCLUSIONS Gadopiclenol elimination half-life was prolonged in subjects with mild to severe renal impairment, yet its renal clearance remains complete or nearly complete. In ESRD subjects, gadopiclenol was effectively removed from the plasma after 1 hemodialysis session, and up to 3 hemodialysis sessions were sufficient to completely clear it. No safety concern was raised. Therefore, no dose adjustment seems necessary in this patient population.
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Affiliation(s)
- Andrei Bradu
- From the Department of Urology and Surgical Nephrology, Nicolae Testemitanu State University of Medicine and Pharmacy, Chișinău, Republic of Moldova
| | - Mircea Penescu
- Department of Nephrology, Carol Davila University of Medicine and Pharmacy, Bucharest, Romania
| | | | - Jing Hao
- Guerbet, Roissy CDG Cedex, France
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13
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Alabousi M, Davenport MS. Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease and the Risk of Nephrogenic Systemic Fibrosis: Radiology In Training. Radiology 2021; 300:279-284. [PMID: 34060939 DOI: 10.1148/radiol.2021210044] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 66-year-old male patient with end-stage chronic kidney disease undergoing maintenance dialysis and with a history of group I intravenous gadolinium-based contrast media (GBCM) administration presented with clinical and pathologic findings consistent with nephrogenic systemic fibrosis. A summary of the evidence and recommendations for use of intravenous GBCM in patients with kidney disease is presented. © RSNA, 2021.
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Affiliation(s)
- Mostafa Alabousi
- From the Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8 (M.A.); and Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.)
| | - Matthew S Davenport
- From the Department of Radiology, McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8 (M.A.); and Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, Mich (M.S.D.)
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14
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Okabayashi S, Kawane L, Mrabawani NY, Iwai T, Narukawa T, Tsuboi M, Chiba K. Speciation analysis of Gadolinium-based contrast agents using aqueous eluent-hydrophilic interaction liquid chromatography hyphenated with inductively coupled plasma-mass spectrometry. Talanta 2021; 222:121531. [PMID: 33167239 DOI: 10.1016/j.talanta.2020.121531] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/04/2020] [Accepted: 08/07/2020] [Indexed: 11/17/2022]
Abstract
Gadolinium chelates are widely used as contrast agents for magnetic resonance imaging (MRI). In recent decades, the amount of Gd in river water has been increasing owing to the input of Gd-based contrast agents. To identify and quantify the Gd-based contrast agents in river water, the novel technique of hydrophilic interaction liquid chromatography (HILIC) hyphenated with inductively coupled plasma-mass spectrometry (ICP-MS) was developed. To avoid deposition of carbon on the ICP-MS interface, a mobile phase consisting of an ammonium acetate buffer diluted with pure water was applied to separate Gd-based contrast agents. Despite the absence of an organic solvent in the mobile phase, six Gd-based contrast agents, Gd-DTPA, Gd-EOB-DTPA, Gd-DOTA, Gd-DTPA-BMA, Gd-BT-DO3A, and Gd-HP-DO3A, were successfully separated. This technique was applied for river water samples. As a result, Gd-DOTA, Gd-BT-DO3A, and Gd-HP-DO3A were observed from the sample near the outfall of a wastewater treatment plant (WWTP), indicating that at least some of the Gd-based contrast agents are passed through treatment in a WWTP. In addition to Gd-based contrast agents, unidentified Gd compounds were found to be present in river water. These results infer that transformation and/or dissociation of Gd chelates may be caused during the treatment procedure in a WWTP.
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Affiliation(s)
- Satoki Okabayashi
- Department of Applied Chemistry for Environment, Kwansei Gakuin University, 2-1 Gakuen, Sanda, Hyogo, 669-1337, Japan.
| | - Leona Kawane
- Department of Applied Chemistry for Environment, Kwansei Gakuin University, 2-1 Gakuen, Sanda, Hyogo, 669-1337, Japan
| | - Nanda Yusentri Mrabawani
- Transforming the Mining Value Chain (TMVC), An Australia Research Council (ARC) Industrial Transformation Research Hub, University of Tasmania, Hobart, Tasmania, 7001, Australia
| | - Takahiro Iwai
- Forensic Science Group, Photon Science Research Division, RIKEN Spring-8 Center, Kouto 1-1-1, Sayo-cho, Sayo-gun, Hyogo, 679-5148, Japan
| | - Tomohiro Narukawa
- National Metrology Institute of Japan, National Institute of Advanced Industrial Science and Technology, 1-1-1 Umezono, Tsukuba, Ibaraki, 305-8563, Japan
| | - Motohiro Tsuboi
- Department of Applied Chemistry for Environment, Kwansei Gakuin University, 2-1 Gakuen, Sanda, Hyogo, 669-1337, Japan
| | - Koichi Chiba
- Department of Applied Chemistry for Environment, Kwansei Gakuin University, 2-1 Gakuen, Sanda, Hyogo, 669-1337, Japan
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15
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Martino F, Amici G, Rosner M, Ronco C, Novara G. Gadolinium-Based Contrast Media Nephrotoxicity in Kidney Impairment: The Physio-Pathological Conditions for the Perfect Murder. J Clin Med 2021; 10:jcm10020271. [PMID: 33450989 PMCID: PMC7828445 DOI: 10.3390/jcm10020271] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/05/2021] [Accepted: 01/11/2021] [Indexed: 11/16/2022] Open
Abstract
Gadolinium-based contrast media (GBCM) toxicity in patients with kidney disease is a concern for the possible development of systemic nephrogenic fibrosis and possible renal complications. This review focuses on the pathological mechanisms underlying the potential kidney toxicity of gadolinium. Gadolinium, as a free compound (Gd3+), is highly toxic in humans because it competes with divalent calcium (Ca2+) and magnesium (Mg2+) ions, interfering in some relevant biologic processes. Its toxicity is blunted by the complexing of Gd3+ with a carrier, allowing its use in magnetic resonance imaging. The binding reaction between gadolinium and a carrier is thermodynamically reversible. Consequently, under some conditions, gadolinium can be released in the interstitial space as a free Gd3+ compound with the possibility of toxicity. Other metals such as iron, copper, and calcium can interfere with the binding between gadolinium and its carrier because they compete for the same binding site. This process is known as transmetallation. In patients with kidney impairment, conditions such as low clearance of the Gd-carrier complex, acid-base derangements, and high serum phosphorous can increase the presence of free Gd3+, leading to a higher risk for toxicity.
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Affiliation(s)
- Francesca Martino
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy;
- UO Nephrology, Dialysis and Kidney Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
- Correspondence: (F.M.); (G.N.); Tel.: +39-0444-753650 (F.M.); +39-049-8211250 (G.N.)
| | - Gianpaolo Amici
- UO Nephrology and Dialysis, San Daniele del Friuli and Tolmezzo Hospital, ASUFC, 33038 San Daniele del Friuli, Italy;
| | - Mitchell Rosner
- Division of Nephrology, University of Virginia Health System, Charlottesville, VA 22903, USA;
| | - Claudio Ronco
- International Renal Research Institute Vicenza (IRRIV), San Bortolo Hospital, 36100 Vicenza, Italy;
- UO Nephrology, Dialysis and Kidney Transplant, San Bortolo Hospital, 36100 Vicenza, Italy
| | - Giacomo Novara
- Department of Surgery, Oncology, and Gastroenterology, Urology Clinic University of Padua, 35124 Padova, Italy
- Correspondence: (F.M.); (G.N.); Tel.: +39-0444-753650 (F.M.); +39-049-8211250 (G.N.)
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16
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Comprehensive phenotyping revealed transient startle response reduction and histopathological gadolinium localization to perineuronal nets after gadodiamide administration in rats. Sci Rep 2020; 10:22385. [PMID: 33372182 PMCID: PMC7769977 DOI: 10.1038/s41598-020-79374-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Accepted: 12/01/2020] [Indexed: 01/28/2023] Open
Abstract
Gadolinium based contrast agents (GBCAs) are widely used in clinical MRI since the mid-1980s. Recently, concerns have been raised that trace amounts of Gadolinium (Gd), detected in brains even long time after GBCA application, may cause yet unrecognized clinical consequences. We therefore assessed the behavioral phenotype, neuro-histopathology, and Gd localization after repeated administration of linear (gadodiamide) or macrocyclic (gadobutrol) GBCA in rats. While most behavioral tests revealed no difference between treatment groups, we observed a transient and reversible decrease of the startle reflex after gadodiamide application. Residual Gd in the lateral cerebellar nucleus was neither associated with a general gene expression pathway deregulation nor with neuronal cell loss, but in gadodiamide-treated rats Gd was associated with the perineuronal net protein aggrecan and segregated to high molecular weight fractions. Our behavioral finding together with Gd distribution and speciation support a substance class difference for Gd presence in the brain after GBCA application.
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17
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Weinreb JC, Rodby RA, Yee J, Wang CL, Fine D, McDonald RJ, Perazella MA, Dillman JR, Davenport MS. Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Radiology 2020; 298:28-35. [PMID: 33170103 DOI: 10.1148/radiol.2020202903] [Citation(s) in RCA: 106] [Impact Index Per Article: 26.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Inaugural consensus statements were developed and endorsed by the American College of Radiology (ACR) and the National Kidney Foundation to improve and standardize the care of patients with kidney disease who have indication(s) to receive ACR-designated group II or group III intravenous gadolinium-based contrast media (GBCM). The risk of nephrogenic systemic fibrosis (NSF) from group II GBCM in patients with advanced kidney disease is thought to be very low (zero events following 4931 administrations to patients with estimated glomerular filtration rate [eGFR] <30 mL/min per 1.73 m2; upper bounds of the 95% confidence intervals: 0.07% overall, 0.2% for stage 5D chronic kidney disease [CKD], 0.5% for stage 5 CKD and no dialysis). No unconfounded cases of NSF have been reported for the only available group III GBCM (gadoxetate disodium). Depending on the clinical indication, the potential harms of delaying or withholding group II or group III GBCM for an MRI in a patient with acute kidney injury or eGFR less than 30 mL/min per 1.73 m2 should be balanced against and may outweigh the risk of NSF. Dialysis initiation or alteration is likely unnecessary based on group II or group III GBCM administration. This article is a simultaneous joint publication in Radiology and Kidney Medicine. The articles are identical except for stylistic changes in keeping with each journal's style. Either version may be used in citing this article.
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Affiliation(s)
- Jeffrey C Weinreb
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Roger A Rodby
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Jerry Yee
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Carolyn L Wang
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Derek Fine
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Robert J McDonald
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Mark A Perazella
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Jonathan R Dillman
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Matthew S Davenport
- From the American College of Radiology, Reston, Va (J.C.W., C.L.W., R.J.M., J.R.D., M.S.D.); National Kidney Foundation, New York, NY (R.A.R., J.Y., D.F., M.A.P.); Department of Radiology and Biomedical Imaging (J.C.W.) and Department of Internal Medicine, Section of Nephrology (M.A.P.), Yale University School of Medicine, New Haven, Conn; Department of Nephrology, Rush University Medical Center, Chicago, Ill (R.A.R.); Department of Nephrology, Henry Ford Health System, Detroit, Mich (J.Y.); Department of Radiology, University of Washington, Seattle, Wash (C.L.W.); Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, Md (D.F.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, Ohio (J.R.D.); Departments of Radiology (M.S.D.) and Urology (M.S.D.), Michigan Medicine, 1500 E Medical Center Dr, Room B2 A209P, Ann Arbor, MI 48109-5030; and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
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18
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Weinreb JC, Rodby RA, Yee J, Wang CL, Fine D, McDonald RJ, Perazella MA, Dillman JR, Davenport MS. Use of Intravenous Gadolinium-Based Contrast Media in Patients With Kidney Disease: Consensus Statements from the American College of Radiology and the National Kidney Foundation. Kidney Med 2020; 3:142-150. [PMID: 33604544 PMCID: PMC7873723 DOI: 10.1016/j.xkme.2020.10.001] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Inaugural consensus statements were developed and endorsed by the American College of Radiology (ACR) and National Kidney Foundation to improve and standardize the care of patients with kidney disease who have indication(s) to receive ACR-designated group II or group III intravenous gadolinium-based contrast media (GBCM). The risk of nephrogenic systemic fibrosis (NSF) from group II GBCM in patients with advanced kidney disease is thought to be very low (zero events following 4931 administrations to patients with estimated glomerular filtration rate [eGFR] <30 mL/min per 1.73 m2; upper bounds of the 95% confidence intervals: 0.07% overall, 0.2% for stage 5D chronic kidney disease [CKD], 0.5% for stage 5 CKD and no dialysis). No unconfounded cases of NSF have been reported for the only available group III GBCM (gadoxetate disodium). Depending on the clinical indication, the potential harms of delaying or withholding group II or group III GBCM for an MRI in a patient with acute kidney injury or eGFR less than 30 mL/min per 1.73 m2 should be balanced against and may outweigh the risk of NSF. Dialysis initiation or alteration is likely unnecessary based on group II or group III GBCM administration.
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Affiliation(s)
- Jeffrey C Weinreb
- American College of Radiology, Reston, VA.,Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, CT
| | - Roger A Rodby
- National Kidney Foundation, New York, NY.,Department of Nephrology, Rush University Medical Center, Chicago, IL
| | - Jerry Yee
- National Kidney Foundation, New York, NY.,Department of Nephrology, Henry Ford Health System, Detroit, MI
| | - Carolyn L Wang
- American College of Radiology, Reston, VA.,Department of Radiology, University of Washington, Seattle, WA
| | - Derek Fine
- National Kidney Foundation, New York, NY.,Department of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Robert J McDonald
- American College of Radiology, Reston, VA.,Department of Radiology, Mayo Clinic, Rochester, MN
| | - Mark A Perazella
- National Kidney Foundation, New York, NY.,Department of Internal Medicine, Section of Nephrology, Yale University School of Medicine, New Haven, CT
| | - Jonathan R Dillman
- American College of Radiology, Reston, VA.,Department of Radiology, Cincinnati Children's Hospital Medical Center at University of Cincinnati College of Medicine, Cincinnati, OH
| | - Matthew S Davenport
- American College of Radiology, Reston, VA.,Department of Radiology, Michigan Medicine, Ann Arbor, MI.,Department of Urology, Michigan Medicine, Ann Arbor, MI.,Michigan Radiology Quality Collaborative, Ann Arbor, Mich
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19
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Brünjes R, Hofmann T. Anthropogenic gadolinium in freshwater and drinking water systems. WATER RESEARCH 2020; 182:115966. [PMID: 32599421 PMCID: PMC7256513 DOI: 10.1016/j.watres.2020.115966] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Revised: 05/18/2020] [Accepted: 05/19/2020] [Indexed: 05/17/2023]
Abstract
The increasing use of gadolinium-based contrast agents (GBCAs) for magnetic resonance imaging is leading to widespread contamination of freshwater and drinking water systems. Contrary to previous assumptions that GBCAs are stable throughout the water cycle, they can degrade. The stability of GBCAs depends largely on their organic ligands, but also on the physicochemical conditions. There is specific concern regarding UV end-of-pipe water treatments, which may degrade GBCAs. Degradation products in drinking water supplies can increase the risk of adverse health effects. This is of particular relevance where the raw water for drinking water production has a higher proportion of recycled wastewater. GBCAs concentrations in aquatic systems, often referred to as anthropogenic gadolinium, are determined using a variety of calculation methods. Where anthropogenic gadolinium concentrations are low, the inconsistent use of these methods results in high discrepancies and high levels of uncertainty. The current COVID-19 crisis will, in the short-term, drastically decrease the input of GBCAs to freshwater systems. Temporal variations in anthropogenic gadolinium concentrations in river water can be used to better understand river-aquifer interactions and groundwater flow velocities. Collecting urine from all patients following MRI examinations could be a way forward to halt the generally increasing concentrations of Gd in drinking water systems and recover this technologically critical element.
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Affiliation(s)
- Robert Brünjes
- University of Vienna, Centre for Microbiology and Environmental Systems Science, Environmental Geosciences, Althanstraße 14, UZA2, 1090, Vienna, Austria
| | - Thilo Hofmann
- University of Vienna, Centre for Microbiology and Environmental Systems Science, Environmental Geosciences, Althanstraße 14, UZA2, 1090, Vienna, Austria.
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20
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Incidence of nephrogenic systemic fibrosis after administration of gadoteric acid in patients on renal replacement treatment. Magn Reson Imaging 2020; 70:1-4. [PMID: 32112811 DOI: 10.1016/j.mri.2020.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Nephrogenic system fibrosis (NSF) is a rare complication detected in patients with renal insufficiency exposed to gadolinium-based contrast agents (GBCAs). The aim of our study is to evaluate the prevalence of NSF in a cohort of patients on renal replacement treatment who underwent GBCA-enhanced magnetic resonance imaging (MRI). METHOD We retrospectively reviewed all the charts of kidney transplant (KT) recipients, patients on hemodialysis (HD) and peritoneal dialysis (PD) who received a uniform protocol for contrast material enhanced-MRI with gadoteric acid at our center from January 2004 to December 2017. RESULTS Three-hundred forty-four patients (44.1% on HD, 11.3% on PD and 44.4% KT recipients) underwent 551 gadoteric acid-enhanced MRI. The median age of the patients was 58 years (IQR, 45-70 years) and 65.1% were men. Sixty-three patients (18.3%) had skin punch biopsy after integumentary assessment performed by a dermatologist. No cases of NSF were detected after a median follow-up of 4.5 years (IQR, 1.9-8.2 years). During this period of observation, 116 (33.7%) patients died and 11 (3.1%) were lost at follow-up. CONCLUSIONS None of the patients exposed to gadoteric acid developed NSF. Our results, in line with more recent studies, suggest that the use of gadoteric acid, a macrocyclic GBCA, appears safe even in chronic kidney disease (CKD) patients receiving dialysis.
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Al-Chalabi S, Chrysochou C, Kalra PA. Is it time to relax nephrogenic systemic fibrosis guidelines and safely offer magnetic resonance imaging to more patients? Quant Imaging Med Surg 2019; 9:1918-1921. [PMID: 31867244 DOI: 10.21037/qims.2019.10.11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Saif Al-Chalabi
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
| | | | - Philip A Kalra
- Department of Renal Medicine, Salford Royal NHS Foundation Trust, Salford, UK
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Abstract
Inductively coupled plasma mass spectrometry (ICP-MS) is an analytical technique that can be used to measure elements at trace levels in biological fluids. Although older techniques such as atomic absorption and atomic emission are still in use by some laboratories, there has been a slow shift toward ICP-MS, particularly in the last decade. As this shift is likely to continue, clinical scientists should be aware of the analytical aspects of ICP-MS, as well as the potential for both spectroscopic and non-spectroscopic interference, and strategies that can be employed to eliminate or mitigate these issues.
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Abstract
Gadolinium (Gd)-based contrast agents have been routinely used worldwide in diagnostic MRI since 1988. All routinely applied contrast agents for clinical use were considered extremely safe with regard to tolerance, adverse effects and diagnostic efficacy and when used at Food and Drug Administration-approved doses. With the identification of Gd-associated disorders, namely nephrogenic systemic fibrosis and adverse reactions, and in the longer term Gd-retention in the brain, this view changed and led to the withdrawal or restriction of approval of linear Gd chelates in Europe. Even though Gd deposition in different human body areas was described very early, recently published literature of intracerebral accumulation of contrast agents as well as deposition in bone have created surprising attention. Not only was the fact of Gd deposition in the body well known for many years, but there is currently no clinical evidence of patient symptoms and no resulting health issues of patients have been observed yet. The expression "gadolinium deposition disease" has been termed by active patient advocacy groups with an online presence with reports of individual members stating a broad spectrum of disorders yielding a large symptom complex after administration of Gd-based contrast agents without evidence of any pre-existing or otherwise underlying disease process which could explain the mentioned disorder.
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Updated Clinical Practice Guideline on Use of Gadolinium-Based Contrast Agents in Kidney Disease Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2019; 70:226-232. [DOI: 10.1016/j.carj.2019.04.001] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Accepted: 04/17/2019] [Indexed: 12/12/2022] Open
Abstract
In 2017, the Canadian Association of Radiologists issued a clinical practice guideline (CPG) regarding the use of gadolinium-based contrast agents (GBCAs) in patients with acute kidney injury (AKI), chronic kidney disease (CKD), or on dialysis due to mounting evidence indicating that nephrogenic systemic fibrosis (NSF) occurs with extreme rarity or not at all when using Group II GBCAs or the Group III GBCA gadoxetic acid (compared to first generation Group I linear GBCAs). One of the goals of the work group was to re-evaluate the CPG after 24 months to determine the effect of more liberal use of GBCA on reported cases of NSF in patients with AKI, CKD Stage 4 or 5 (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), or those that are dialysis-dependent. A comprehensive review of the literature was conducted by a subcommittee of the initial CPG panel between the dates of January 1, 2017-December 31, 2018 to identify new unconfounded cases of NSF linked to Group II or Group III GBCAs and an updated CPG developed. To our knowledge, when using a Group II or Group III GBCA between 2017-2018, only a single unconfounded case report of a fibrosing dermopathy has been reported in a patient who received gadobenate dimeglumine with Stage 2 CKD. No other unconfounded cases of NSF have been reported with Group II or III agents in during this timeframe. The subcommittee concluded that the main recommendations from the 2017 CPG should remain unaltered, but agreed that screening for renal disease in the outpatient setting is no longer justifiable, cost-effective or recommended. Patients on hemodialysis (HD) should, however, be identified prior to GBCA administration to arrange timely HD to optimize gadolinium clearance, although there remains no evidence that HD reduces the risk of NSF. When administering Group II or III GBCAs to patients with AKI, on dialysis or with severe CKD, informed consent relating to NSF is also no longer explicitly recommended.
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Dechelation (Transmetalation): Consequences and Safety Concerns With the Linear Gadolinium-Based Contrast Agents, In View of Recent Health Care Rulings by the EMA (Europe), FDA (United States), and PMDA (Japan). Invest Radiol 2019; 53:571-578. [PMID: 30130320 DOI: 10.1097/rli.0000000000000507] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The issue of dechelation (transmetallation) in vivo after administration of the linear gadolinium-based contrast agents, and potential safety concerns, is considered on the basis of an extensive, focused literature review. Early indications of potential problems included the high level of excess ligand used in the formulation of 2 agents (indeed the 2 least stable thermodynamically) and interference with laboratory tests when blood was drawn from patients relatively soon after administration of these same agents. The advent of nephrogenic systemic fibrosis in the late 2000s raised additional major concerns.The correlation in 2014 of dentate nucleus hyperintensity on precontrast T1-weighted scans with multiple prior injections of linear gadolinium chelates, in patients with normal renal function, has driven subsequent research concerning dechelation of these agents in vivo. Unexpectedly high levels of gadolinium in the bone, skin, and liver have been found long term after administration, in animal models and in humans, although the latter data are limited. Bone may serve as a long-term reservoir, with a residual excretion phase for gadolinium after intravenous injection of the linear agents due to a subsequent slow release from bone. Many different patient populations could be vulnerable and potentially later develop clinical symptoms, although at this stage there are only limited data and small retrospective uncontrolled studies. Possible vulnerable populations include children, menopausal women, patients with osteoporosis (who are predisposed to fractures and often slow to heal or heal poorly), those receiving multiple doses, those with proinflammatory conditions, moderate renal dysfunction, or an undefined genetic predisposition. Of particular concern would be nephrogenic systemic fibrosis-like symptoms-including particularly pain and skin/joint symptoms, or disease related to the incorporation of gadolinium in hydroxyapatite in bone, in small subgroups of patients with a not yet defined propensity and/or cofactor. These concerns have led to withdrawal of the linear agents from the largest clinical market, Europe, with the exception of the hepatobiliary agents for delayed liver imaging, an indication that cannot be fulfilled by the current macrocyclic gadolinium chelates (for which these concerns do not apply).
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Removal of a gadolinium based contrast agent by a novel sorbent hemoperfusion in a chronic kidney disease (CKD) rodent model. Sci Rep 2019; 9:709. [PMID: 30679698 PMCID: PMC6345740 DOI: 10.1038/s41598-018-37348-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2018] [Accepted: 12/03/2018] [Indexed: 11/24/2022] Open
Abstract
Gadolinium based contrast agents (GBCAs) have been linked to toxicity in patients, regardless of having impaired or normal renal function. Currently, no therapy is considered highly effective for removing gadolinium (Gd) from the body. We propose a new strategy to reduce blood Gd content that facilitates whole body removal of Gd using a hemoperfusion system consisting of a cartridge of porous silica beads (Davisil®) functionalized with 1,2-hydroxypyridinone (1,2-HOPO). Herein, we report optimization of the hemoperfusion system using an ex vivo blood and an in vivo rat model of chronic kidney disease (CKD). In our ex vivo system, 1,2-HOPO-Davisil outperformed Gambro activated charcoal (AC), which is commonly used in clinical hemoperfusion of aqueous toxins, in terms of Gd capture capacity and rate. In the CKD rat model, the 1,2-HOPO-Davisil hemoperfusion system removed Gd by 3.4 times over the Gambro AC system. 1,2-HOPO-Davisil did not change complete blood counts and common blood biochemistry. Thus, this strategy has great potential for clinical translation to manage GBCAs after magnetic resonance imaging (MRI), before Gd can deposit in the body and cause long-term toxicity. Although gadodiamide was used as a proof of concept model for GBCAs in this study, 1,2-HOPO functionalized mesoporous silica could also capture dissociated Gd and other GBCAs.
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Wahsner J, Gale EM, Rodríguez-Rodríguez A, Caravan P. Chemistry of MRI Contrast Agents: Current Challenges and New Frontiers. Chem Rev 2019; 119:957-1057. [PMID: 30350585 PMCID: PMC6516866 DOI: 10.1021/acs.chemrev.8b00363] [Citation(s) in RCA: 843] [Impact Index Per Article: 168.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Tens of millions of contrast-enhanced magnetic resonance imaging (MRI) exams are performed annually around the world. The contrast agents, which improve diagnostic accuracy, are almost exclusively small, hydrophilic gadolinium(III) based chelates. In recent years concerns have arisen surrounding the long-term safety of these compounds, and this has spurred research into alternatives. There has also been a push to develop new molecularly targeted contrast agents or agents that can sense pathological changes in the local environment. This comprehensive review describes the state of the art of clinically approved contrast agents, their mechanism of action, and factors influencing their safety. From there we describe different mechanisms of generating MR image contrast such as relaxation, chemical exchange saturation transfer, and direct detection and the types of molecules that are effective for these purposes. Next we describe efforts to make safer contrast agents either by increasing relaxivity, increasing resistance to metal ion release, or by moving to gadolinium(III)-free alternatives. Finally we survey approaches to make contrast agents more specific for pathology either by direct biochemical targeting or by the design of responsive or activatable contrast agents.
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Affiliation(s)
- Jessica Wahsner
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Eric M. Gale
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Aurora Rodríguez-Rodríguez
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
| | - Peter Caravan
- Athinoula A. Martinos Center for Biomedical Imaging and the Institute for Innovation in Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown, MA 02129, USA
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Foran P, Hwang S, Mazaheri Y, Panicek D. High-Signal Bladder Urine at T1-Weighted MR Imaging Performed 1-7 Days After a Prior Gadolinium-Enhanced MRI: Prevalence and Correlation with Renal Function. BJR Open 2019; 1. [PMID: 32864561 PMCID: PMC7454119 DOI: 10.1259/bjro.20180030] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective: To determine the prevalence of high-signal bladder urine at T1 weighted MRI performed 1–7 days after injection of gadolinium-based contrast material and to assess for correlation with altered renal function. Methods: The study group consisted of 267 patients who underwent MRI that included the bladder 1–7 days after a prior gadolinium-enhanced MRI. A control group consisted of 200 patients who underwent pelvic MRI and had not received gadolinium-based contrast material within the prior month. One reader recorded the relative T1 weighted signal intensity of bladder urine and calculated the estimated glomerular filtration rate (eGFR) for each patient. A positive scan was defined as one with bladder urine T1 weighted signal higher than that of muscle. Results: 25 (9%) of 267 study group scans were positive; this included 68% ( n = 19) of scans obtained 12–24 h after gadolinium-based contrast material administration, 21% ( n = 3) after 25–36 h, 7% ( n = 2) after 37–48 h, and 3% ( n = 1) after 49–72 h. No positive scan occurred after 72 h or in the control group. Mean eGFR in positive scans obtained more than 36 h after gadolinium-based contrast material administration was significantly lower than in negative scans in the same timeframe (37 vs 76 ml/min, respectively; p = 0.01). Conclusion: High T1 weighted signal in bladder urine occasionally is present on MRI performed up to 3 days after gadolinium-based contrast material administration, presumably reflecting residual excreted gadolinium-based contrast material. When visible more than 36 hours after gadolinium-based contrast material administration, such increased signal is associated with low eGFR. Advances in knowledge: Increased signal is occasionally present in bladder urine at MRI performed up to 3 days after gadolinium-based contrast material administration. When higher signal is visible more than 36 hours after contrast administration, it is associated with decreased eGFR.
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Affiliation(s)
- Paul Foran
- Departments of Radiology Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Sinchun Hwang
- Departments of Radiology Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Yousef Mazaheri
- Departments of Radiology Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Medical Physics Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David Panicek
- Departments of Radiology Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Gianolio E, Gregorio ED, Aime S. Chemical Insights into the Issues of Gd Retention in the Brain and Other Tissues Upon the Administration of Gd-Containing MRI Contrast Agents. Eur J Inorg Chem 2018. [DOI: 10.1002/ejic.201801220] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Affiliation(s)
- Eliana Gianolio
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute; Centro di Imaging molecolare; Università degli Studi di Torino; Via Nizza 52 10126 Torino Italy
| | - Enza Di Gregorio
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute; Centro di Imaging molecolare; Università degli Studi di Torino; Via Nizza 52 10126 Torino Italy
| | - Silvio Aime
- Dipartimento di Biotecnologie Molecolari e Scienze per la Salute; Centro di Imaging molecolare; Università degli Studi di Torino; Via Nizza 52 10126 Torino Italy
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Evaluating the Patient with Reported Gadolinium-Associated Illness. J Med Toxicol 2018; 15:36-44. [PMID: 30499040 DOI: 10.1007/s13181-018-0689-x] [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: 07/17/2018] [Revised: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 02/02/2023] Open
Abstract
INTRODUCTION Gadolinium-based contrast agents (GBCAs) have been increasingly used in clinical practice since their introduction in the 1980s. Recently, increased public attention has been given to patients who report new symptoms following GBCA exposure. This review details the current knowledge surrounding GBCAs, with a focus on the known and proposed disease states that may be associated with GBCAs. Recommendations for the appropriate clinical workup of a patient suspected of having symptoms attributable to gadolinium exposure are included. DISCUSSION GBCAs are known to precipitate the disease state nephrogenic systemic fibrosis (NSF), a syndrome characterized by skin thickening in patients with preexisting renal disease. An additional syndrome, termed gadolinium deposition disease, has been proposed to describe patients with normal renal function who develop an array of symptoms following GBCA exposure. While there is a potential physiologic basis for the development of this condition, there is no conclusive evidence to support a causal relationship between GBCA administration and the reported symptoms yet. Clinical evaluation revolves around focused history-taking and physical examination, given the absence of a reliable link between patient symptoms and measured gadolinium levels. There are no recommended treatments for suspected gadolinium deposition disease. Chelation therapy, which is not approved for this indication, carries undue risk without documented efficacy. CONCLUSIONS The extent to which GBCAs contribute to clinically relevant adverse effects remains an important and evolving field of study. NSF remains the only proven disease state associated with GBCA exposure. Additional data are required to evaluate whether other symptoms should be attributed to GBCAs.
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Cruz J, Figueiredo F, Matos AP, Duarte S, Guerra A, Ramalho M. Infectious and Inflammatory Diseases of the Urinary Tract: Role of MR Imaging. Magn Reson Imaging Clin N Am 2018; 27:59-75. [PMID: 30466913 DOI: 10.1016/j.mric.2018.09.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Urinary tract infection (UTI) is among the most common of bacterial infections. Imaging studies are only required in cases of complicated UTIs. Ultrasound remains the first-line imaging method; however, CT is the gold standard for evaluation of UTIs. MR imaging's improved contrast resolution and absence of ionizing radiation may recommend its use for assessment of lower UTIs. Furthermore, MR imaging performs with diagnostic accuracy at least similar to CT in complicated UTIs, except for the identification of calculi and emphysematous pyelonephritis. In this article, the role of MR imaging for the evaluation of infectious and inflammatory disease processes of the urinary tract is reviewed.
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Affiliation(s)
- João Cruz
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal
| | - Filipa Figueiredo
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - António P Matos
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal
| | - Sérgio Duarte
- Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal
| | - Adalgisa Guerra
- Department of Radiology, Hospital da Luz, Avenida Lusíada, 100, Lisbon 1500-650, Portugal
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Av. Torrado da Silva, 2805-267 Almada, Portugal; Department of Radiology, Hospital da Luz, Estrada Nacional 10, km 37, Setúbal 2900-722, Portugal.
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Abstract
Contrast media are essential to the practice of MR imaging. An increasing variety of agents have been approved for clinical use, specific contrast agents can often be tailored to a specific clinical question. Compared with CT contrast media, MR imaging contrast is well tolerated with an excellent safety record and a low incidence of adverse events. In this article, we review the pharmacology, indications, and the common adverse events of the intravenous and oral MR contrast agents most commonly used in contemporary imaging practice, including gadolinium-based contrast, manganese and iron-based agents and the most common oral contrast agents.
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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: 67] [Impact Index Per Article: 11.2] [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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Lord ML, Chettle DR, Gräfe JL, Noseworthy MD, McNeill FE. Observed Deposition of Gadolinium in Bone Using a New Noninvasive in Vivo Biomedical Device: Results of a Small Pilot Feasibility Study. Radiology 2018; 287:96-103. [DOI: 10.1148/radiol.2017171161] [Citation(s) in RCA: 50] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Michelle L. Lord
- From the Interdisciplinary Graduate Program in Radiation Sciences (M.L.L.), Department of Physics and Astronomy (D.R.C., F.E.M.), McMaster School of Biomedical Engineering (M.D.N.), and Department of Electrical and Computer Engineering (M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Department of Physics, Ryerson University, Toronto, Ontario, Canada (J.L.G.)
| | - David R. Chettle
- From the Interdisciplinary Graduate Program in Radiation Sciences (M.L.L.), Department of Physics and Astronomy (D.R.C., F.E.M.), McMaster School of Biomedical Engineering (M.D.N.), and Department of Electrical and Computer Engineering (M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Department of Physics, Ryerson University, Toronto, Ontario, Canada (J.L.G.)
| | - James L. Gräfe
- From the Interdisciplinary Graduate Program in Radiation Sciences (M.L.L.), Department of Physics and Astronomy (D.R.C., F.E.M.), McMaster School of Biomedical Engineering (M.D.N.), and Department of Electrical and Computer Engineering (M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Department of Physics, Ryerson University, Toronto, Ontario, Canada (J.L.G.)
| | - Michael D. Noseworthy
- From the Interdisciplinary Graduate Program in Radiation Sciences (M.L.L.), Department of Physics and Astronomy (D.R.C., F.E.M.), McMaster School of Biomedical Engineering (M.D.N.), and Department of Electrical and Computer Engineering (M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Department of Physics, Ryerson University, Toronto, Ontario, Canada (J.L.G.)
| | - Fiona E. McNeill
- From the Interdisciplinary Graduate Program in Radiation Sciences (M.L.L.), Department of Physics and Astronomy (D.R.C., F.E.M.), McMaster School of Biomedical Engineering (M.D.N.), and Department of Electrical and Computer Engineering (M.D.N.), McMaster University, 1280 Main St W, Hamilton, ON, Canada L8S 4L8; and Department of Physics, Ryerson University, Toronto, Ontario, Canada (J.L.G.)
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Peritoneal and pleural fluids may appear hyperintense on hepatobiliary phase using hepatobiliary MR contrast agents. Eur Radiol 2018; 28:3020-3031. [PMID: 29374320 DOI: 10.1007/s00330-017-5261-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2017] [Revised: 12/06/2017] [Accepted: 12/20/2017] [Indexed: 12/18/2022]
Abstract
AIM To describe the effect of hepatobiliary-specific MR imaging contrast agent (HBCA) administration on the signal intensity of peritoneal and pleural fluid effusions on T1-weighted MR images. MATERIALS AND METHODS From October 2015 to May 2016 139 patients (mean 60±10 years old, 69 % males) with peritoneal or pleural effusions without biliary leakage who underwent HBCA-MRI (Gd-BOPTA or Gd-EOB-DTPA) at 1.5T and 3T were included from two centres. The fluid signal intensity was classified as hypo/iso/hyperintense before/after HBCA administration. The relative signal enhancement (RE) was calculated. RESULTS On hepatobiliary phase (HBP), peritoneal fluids appeared hyper/isointense in 88-100 % and pleural effusions in 100 % of the patients following Gd-BOPTA administration. All fluids remained hypointense following Gd-EOB-DTPA. The signal intensity of fluids increased with both HBCA but RE was significantly higher following Gd-BOPTA (p=0.002 to <0.001). RE was correlated with HBP acquisition time-point (r=0.42, p<0.001 and r=0.50, p=0.033 for peritoneal and pleural fluids). CONCLUSION The signal intensity of pleural and peritoneal fluids progressively increases following HBCA administration in the absence of biliary leakage. Due to its later hepatobiliary phase, this is more pronounced after Gd-BOPTA injection, leading to fluid hyperintensity that is not observed after Gd-EOB-DTPA injection. KEY POINTS • Fluids appear hyper/isointense on HBP in most patients after Gd-BOPTA injection. • Fluids remain hypointense on HBP after Gd-EOB-DTPA injection. • RE of fluids increases with time after liver-specific Gd injection. • RE of fluids is higher in patients with chronic liver disease.
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Martino C, Costa C, Roccheri MC, Koop D, Scudiero R, Byrne M. Gadolinium perturbs expression of skeletogenic genes, calcium uptake and larval development in phylogenetically distant sea urchin species. AQUATIC TOXICOLOGY (AMSTERDAM, NETHERLANDS) 2018; 194:57-66. [PMID: 29156215 DOI: 10.1016/j.aquatox.2017.11.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2017] [Revised: 11/06/2017] [Accepted: 11/09/2017] [Indexed: 06/07/2023]
Abstract
Chelates of Gadolinium (Gd), a lanthanide metal, are employed as contrast agents for magnetic resonance imaging and are released into the aquatic environment where they are an emerging contaminant. We studied the effects of environmentally relevant Gd concentrations on the development of two phylogenetically and geographically distant sea urchin species: the Mediterranean Paracentrotus lividus and the Australian Heliocidaris tuberculata. We found a general delay of embryo development at 24h post-fertilization, and a strong inhibition of skeleton growth at 48h. Total Gd and Ca content in the larvae showed a time- and concentration-dependent increase in Gd, in parallel with a reduction in Ca. To investigate the impact of Gd on the expression of genes involved in the regulation of skeletogenesis, we performed comparative RT-PCR analysis and found a misregulation of several genes involved in the skeletogenic and left-right axis specification gene regulatory networks. Species-specific differences in the biomineralization response were evident, likely due to differences in the skeletal framework of the larvae and the amount of biomineral produced. Our results highlight the hazard of Gd for marine organisms.
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Affiliation(s)
- Chiara Martino
- Dipartimento Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Università di Palermo, Viale delle Scienze, Ed. 16, 90128, Palermo, Italy; Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare "Alberto Monroy", Via Ugo La Malfa 153, 90146, Palermo, Italy.
| | - Caterina Costa
- Consiglio Nazionale delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare "Alberto Monroy", Via Ugo La Malfa 153, 90146, Palermo, Italy
| | - Maria Carmela Roccheri
- Dipartimento Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Università di Palermo, Viale delle Scienze, Ed. 16, 90128, Palermo, Italy
| | - Demian Koop
- Department of Anatomy and Histology, F13, University of Sydney, NSW, Australia
| | - Rosaria Scudiero
- Dipartimento di Biologia, Università di Napoli Federico II, via Mezzocannone 8, 80134, Napoli, Italy
| | - Maria Byrne
- Department of Anatomy and Histology, F13, University of Sydney, NSW, Australia
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Garcia J, Liu SZ, Louie AY. Biological effects of MRI contrast agents: gadolinium retention, potential mechanisms and a role for phosphorus. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2017; 375:rsta.2017.0180. [PMID: 29038383 PMCID: PMC5647271 DOI: 10.1098/rsta.2017.0180] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/06/2023]
Abstract
No discussion of challenges for chemistry in molecular imaging would be complete without addressing the elephant in the room-which is that the purest of chemical compounds needs to interact with a biological system in a manner that does not perturb normal biology while still providing efficacious feedback to assist in diagnosis of disease. In the past decade, magnetic resonance imaging (MRI) agents long considered inert have produced adverse effects in certain patient populations under certain treatment regimens. More recently, inert blood pool agents have been found to deposit in the brain. Release of free metal is often suspected as the culprit but that hypothesis has yet to be validated. In addition, even innocuous agents can cause painful side effects during injection in some patients. In this brief review, we summarize known biological effects for gadolinium- and iron-based MRI contrast agents, and discuss some of the potential mechanisms for the observed biological effects, including the potential role of phosphorus imbalance, related to kidney disease or cancer, in destabilizing gadolinium-based chelates and precipitating free gadolinium.This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.
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Affiliation(s)
- Joel Garcia
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Stephen Z Liu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Angelique Y Louie
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
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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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Martino C, Chiarelli R, Bosco L, Roccheri MC. Induction of skeletal abnormalities and autophagy in Paracentrotus lividus sea urchin embryos exposed to gadolinium. MARINE ENVIRONMENTAL RESEARCH 2017; 130:12-20. [PMID: 28712826 DOI: 10.1016/j.marenvres.2017.07.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2017] [Revised: 06/21/2017] [Accepted: 07/05/2017] [Indexed: 06/07/2023]
Abstract
Gadolinium (Gd) concentration is constantly increasing in the aquatic environment, becoming an emergent environmental pollutant. We investigated the effects of Gd on Paracentrotus lividus sea urchin embryos, focusing on skeletogenesis and autophagy. We observed a delay of biomineral deposition at 24 hours post fertilization (hpf), and a strong impairment of skeleton growth at 48 hpf, frequently displayed by an asymmetrical pattern. Skeleton growth was found partially resumed in recovery experiments. The mesodermal cells designated to biomineralization were found correctly migrated at 24 hpf, but not at 48 hpf. Western blot analysis showed an increase of the LC3-II autophagic marker at 24 and 48 hpf. Confocal microscopy studies confirmed the increased number of autophagolysosomes and autophagosomes. Results show the hazard of Gd in the marine environment, indicating that Gd is able to affect different aspects of sea urchin development: morphogenesis, biomineralization, and stress response through autophagy.
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Affiliation(s)
- Chiara Martino
- Dipartimento Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Università di Palermo, Viale Delle Scienze, Ed. 16, 90128 Palermo, Italy; Consiglio Nazionale Delle Ricerche, Istituto di Biomedicina e Immunologia Molecolare "Alberto Monroy", Via Ugo La Malfa 153, 90146 Palermo, Italy.
| | - Roberto Chiarelli
- Dipartimento Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Università di Palermo, Viale Delle Scienze, Ed. 16, 90128 Palermo, Italy
| | - Liana Bosco
- Dipartimento Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Università di Palermo, Viale Delle Scienze, Ed. 16, 90128 Palermo, Italy
| | - Maria Carmela Roccheri
- Dipartimento Scienze e Tecnologie Biologiche Chimiche e Farmaceutiche, Università di Palermo, Viale Delle Scienze, Ed. 16, 90128 Palermo, Italy
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Fuah KW, Lim CTS. Erythema nodosum masking nephrogenic systemic fibrosis as initial skin manifestation. BMC Nephrol 2017; 18:249. [PMID: 28738858 PMCID: PMC5525362 DOI: 10.1186/s12882-017-0666-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 07/14/2017] [Indexed: 11/22/2022] Open
Abstract
Background Nephrogenic systemic fibrosis (NSF) is a complication of the gadolinium-based contrast agent used in imaging studies. It is typically characterised by hard, erythematous and indurated skin plaques with surrounding subcutaneous oedema. Distinct papules and subcutaneous nodules can also be seen. Fibrocytes in NSF are immunohistochemically positive for CD34. Case presentation We present a case of NSF occurred after gadolinium exposure in which the initial presentation mimics an erythema nodosum (EN)-like picture. An initial skin biopsy showed EN. Subsequently the patient developed progressive skin and joints contracture. A repeated skin biopsy done three months later confirmed the diagnosis of NSF. As far as we are aware, this is the second reported case of NSF that mimicked the presentation of EN in the early phase of the disease. Conclusions The appearance of EN-like disease can be one of the early manifestations of NSF. We hope that early recognition of this unusual presentation can alert the physician or nephrologist to the potential diagnosis of NSF.
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Affiliation(s)
- Kar Wah Fuah
- Department of Medicine, Serdang Hospital, Serdang, Malaysia
| | - Christopher Thiam Seong Lim
- Unit of Nephrology, Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, Serdang, Selangor, Malaysia.
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Savarino E, Chianca V, Bodini G, Albano D, Messina C, Tontini GE, Sconfienza LM. Gadolinium accumulation after contrast-enhanced magnetic resonance imaging: Which implications in patients with Crohn's disease? Dig Liver Dis 2017; 49:728-730. [PMID: 28506472 DOI: 10.1016/j.dld.2017.04.010] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2017] [Accepted: 04/18/2017] [Indexed: 12/11/2022]
Abstract
Crohn's disease (CD) is a chronic inflammatory condition of the bowel, characterized by an alternation of remission and relapse phases, leading to a progressive intestinal damage with loss of function. Magnetic resonance enterography has been widely used in the past for the evaluation of fistulizing disease, but its use increased over time, being considered helpful in different moments of disease course. Intravenous injection of Gadolinium-based contrast agents has been demonstrated to be crucial to assess mucosal inflammation, transmural involvement, and extraintestinal disease. Recently, Gadolinium accumulation in human tissues has been increasingly reported, although clinical implications of this event are still unclear. In the present paper, we review the main evidence on the topic, focusing on the potential implications for gastroenterological practice.
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Affiliation(s)
- Edoardo Savarino
- Department of Surgery, Oncology and Gastroenterology, University of Padua, Padova, Italy
| | - Vito Chianca
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | - Giorgia Bodini
- Department of Internal Medicine, University of Genoa, Genova, Italy
| | - Domenico Albano
- Department of Radiology, DIBIMED, University of Palermo, Palermo, Italy
| | - Carmelo Messina
- Scuola di Specializzazione in Radiodiagnostica, University of Milano, Milano, Italy
| | - Gian Eugenio Tontini
- Unit of Gastroenterology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Luca Maria Sconfienza
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy; Unit of Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Galeazzi, Milano, Italy.
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Prybylski JP, Jay M. The Impact of Excess Ligand on the Retention of Nonionic, Linear Gadolinium-Based Contrast Agents in Patients With Various Levels of Renal Dysfunction: A Review and Simulation Analysis. Adv Chronic Kidney Dis 2017; 24:176-182. [PMID: 28501081 DOI: 10.1053/j.ackd.2017.03.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The role of gadolinium (Gd)-based contrast agents (GBCAs) in the pathophysiology of nephrogenic systemic fibrosis (NSF) is now uncontested. Although the definitive mechanism has not been established, the association with weaker GBCA ligands and with reduced renal clearance supports a hypothesis that Gd release from the GBCAs is a key process in precipitating the disease. Prevention strategies often include the use of more stable GBCA ligands in patients with reduced kidney function, but animal models and some clinical data suggest that better patient outcomes can be achieved when excess ligand is administered with weaker GBCAs; this is particularly significant for OptiMARK, which contains a nonionic, linear ligand similar to gadodiamide, the active ingredient in Omniscan, but contains twice the amount of excess ligand. Here we review evidence regarding the use of OptiMARK over Omniscan for prevention of NSF and perform a pharmacokinetic-based simulation to determine if the presented evidence is consistent with the established kinetics of GBCAs and Gd.
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Bahrainwala JZ, Leonberg-Yoo AK, Rudnick MR. Use of Radiocontrast Agents in CKD and ESRD. Semin Dial 2017; 30:290-304. [DOI: 10.1111/sdi.12593] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Affiliation(s)
- Jehan Z Bahrainwala
- Renal-Electrolyte and Hypertension Division; Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Amanda K Leonberg-Yoo
- Renal-Electrolyte and Hypertension Division; Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
| | - Michael R Rudnick
- Renal-Electrolyte and Hypertension Division; Department of Medicine; University of Pennsylvania; Philadelphia Pennsylvania
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The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review. PLoS One 2017; 12:e0171704. [PMID: 28187173 PMCID: PMC5302442 DOI: 10.1371/journal.pone.0171704] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/23/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Gadolinium based contrast agents (GBCAs) are widely used in magnetic resonance imaging, but recently, high signal intensity in the cerebellum structures was reported after repeated administrations of contrast- enhanced magnetic resonance images. The aim of this systematic review was to investigate the association between increased signal intensity in the dentate nucleus and globus pallidus in the brain and repeated administrations of GBCAs. Additionally, we focused on possible short- and long-term consequences of gadolinium use in those patients. METHODS Systematic review of retrospective investigations in PubMed and Medline was performed in July 2016. Primary outcomes included the presence of increased signal intensity within the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in patients following administrations of GBCAs. Two independent reviewers were responsible for search and data extraction. RESULTS 25 publications satisfied inclusion criteria (19 magnetic resonance images analyses, 3 case reports; 3 autopsy studies). Magnetic resonance images of 1247 patients with increased signal intensity on unenhanced T1-weighted MR images were analyzed as well as tissue specimens from 27 patients. Signal intensity correlated positively with the exposure to GBCAs and was greater after serial administrations of linear nonionic than cyclic contrast agents. Gadolinium was detected in all tissue examinations. CONCLUSIONS High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance images were associated with previous administration of GBCAs. Signal intensity correlated negatively with stability of contrast agents. Clinical significance of gadolinium deposition in the brain remains unclear. There is a strong need for further research to identify type of gadolinium deposited in the brain as well as to gather knowledge about long-term consequences.
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Abstract
Recently, there have been numerous major peer-reviewed publications reporting deposition of gadolinium in the dentate nucleus and globus pallidus in subjects with normal renal function. This review takes a retrospective look back through the development of gadolinium-based contrast agents to describe the historical evidence of gadolinium deposition in vivo and shows that deposition in the basal ganglia should come as no surprise. Evidence for gadolinium deposition in both animal models and human patients is described. Stability differences among gadolinium contrast agents have long been recognized in vitro, and deposition of gadolinium in tissues has been described in animal models since at least 1984. The first major study that showed deposition in humans appeared in 1998 regarding patients with renal failure and in 2004 in patients with normal renal function. The historical literature indicates that gadolinium retention in healthy patients is occurring, although the clinical consequences of deposition remain unknown.
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Effect of Renal Function on Gadolinium-Related Signal Increases on Unenhanced T1-Weighted Brain Magnetic Resonance Imaging. Invest Radiol 2016; 51:677-682. [PMID: 27272543 DOI: 10.1097/rli.0000000000000294] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Gadolinium-based contrast agents (GBCAs), once believed to be safe for patients with renal disease, have been strongly associated with nephrogenic systemic fibrosis (NSF), a severe systemic fibrosing disorder that predominantly afflicts individuals with advanced renal dysfunction. We provide a historical perspective on the appearance and disappearance of NSF, including its initial recognition as a discrete clinical entity, its association with GBCA exposure, and the data supporting a causative relationship between GBCA exposure and NSF. On the basis of this body of evidence, we propose that the name gadolinium-induced fibrosis (GIF) more accurately reflects the totality of knowledge regarding this disease. Use of high-risk GBCAs, such as formulated gadodiamide, should be avoided in patients with renal disease. Restriction of GBCA use in this population has almost completely eradicated new cases of this debilitating condition. Emerging antifibrotic therapies may be useful for patients who suffer from GIF.
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Affiliation(s)
- Derrick J Todd
- Department of Medicine, Harvard Medical School, Boston, Massachusetts 02115.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, Massachusetts 02115
| | - Jonathan Kay
- Division of Rheumatology, Department of Medicine, UMass Memorial Medical Center and University of Massachusetts Medical School, Worcester, Massachusetts 01605;
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Prybylski JP, Maxwell E, Coste Sanchez C, Jay M. Gadolinium deposition in the brain: Lessons learned from other metals known to cross the blood-brain barrier. Magn Reson Imaging 2016; 34:1366-1372. [PMID: 27580521 DOI: 10.1016/j.mri.2016.08.018] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/20/2016] [Indexed: 01/18/2023]
Abstract
The recent discovery of gadolinium (Gd) deposition in the brains of patients receiving Gd-based contrast agents (GBCAs) raises several important questions including by what mechanism Gd or GBCAs pass through the blood-brain barrier. Decades of research focused on the safety and stability of GBCAs have not identified any mechanism of uptake. Here we review findings of Gd deposition from human and animal data, and how distribution mechanisms elucidated for endogenous and toxic metals may explain entrance of Gd into the central nervous system. Three general uptake mechanisms are considered along with examples of metals known to enter the central nervous system by these routes: (1) carrier-mediated, (2) transporter-mediated and (3) passive. The potential for chelation therapy to reduce deposition is also discussed. The work reported for other metals provides guidance for how the mechanism of Gd deposition in the brain can be determined which is essential information for rational prevention or treatment.
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Affiliation(s)
- John P Prybylski
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
| | - Erin Maxwell
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
| | - Carla Coste Sanchez
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
| | - Michael Jay
- Division of Molecular Pharmaceutics, UNC Eshelman School of Pharmacy, University of North Carolina, 4012 Marsico Hall, Chapel Hill, NC, 27599-7362.
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