Contrast agents for magnetic resonance imaging: safety update

Relationship Between Patient-Friendly Audiovisual Systems and MRI Contrast Agent to Adverse Reactions

BACKGROUND

Patient-friendly audiovisual (AV) systems in head MRI examinations can potentially reduce patient anxiety and contrast-enhanced MRI (CE-MRI) adverse reactions to gadolinium.

PURPOSE

To evaluate whether a patient-friendly AV system reduces the rate of adverse reactions to gadolinium-based contrast agents.

STUDY TYPE

Retrospective.

POPULATION

Four thousand eight hundred thirty-two outpatients (2462 female) attending for clinical CE-MRI studies. (Gadoteridol: 1971, Meglumine gadoterate: 2733, Gadobutrol: 128.) FIELD STRENGTH/SEQUENCE: Routine CE-MRI of head and neck using a 1.5 T or 3 T scanner with or without a patient-friendly AV system.

ASSESSMENT

One thousand one hundred fifty-nine patients were scanned on MRI machines equipped with patient-friendly AV systems (AV group) and 3673 on MRI machines without AV systems (control group). Adverse reaction rate and symptoms were reviewed by referring to the system database and electronic medical records and compared between the two groups. Adverse reactions were defined as physiological reactions, such as vomiting and allergic-like reactions, such as urticaria, occurring within 1 hour of contrast injection. We compare patient backgrounds, adverse reaction rate, adverse reactions symptoms and the severity between the two groups.

STATISTICAL TESTS

Adverse reaction rate with and without a patient-friendly AV system were compared using Fisher's exact test. The relationship between patient-friendly AV systems and the occurrence of adverse reactions was evaluated with logistic regression. Statistical significance was set at P < 0.05.

RESULTS

Of the 4832 patients enrolled, 65 (1.35%) experienced adverse reactions. The most common adverse reactions in both groups were urticaria and pruritus. Adverse reaction rate was significantly lower in the AV group than in the control group (0.7% vs. 1.6%). No significant difference was observed in the severity (P = 1.000) of adverse reactions and symptoms (allergic-like reaction: P = 0.08, physiologic reaction: P = 1.000) between the two groups.

DATA CONCLUSION

The patient-friendly AV system significantly reduce adverse reaction occurrence to gadolinium-based contrast agents.

EVIDENCE LEVEL

4 TECHNICAL EFFICACY: Stage 1.

The impact of global climate changes on trace and rare earth elements mobilization in emerging periglacial terrains: Insights from western shore of Admiralty Bay (King George Island, Antarctic)

In the rapidly changing climate, the biogeochemical behaviours of trace elements and Rare Earth Elements (REEs) in emerging periglacial environments assumes profound importance. This study provides pivotal insights into this dynamic by investigating the Antarctic's response to global climate change. The bedrock of King George Island is rich in REEs, with the presence of trace metals (TEs), with the highest concentrations of metals found in ornithogenic soil (∑REE 84.01-85.53 mg∙kg-1 dry weight). REEs in the studied soil, found mainly in igneous rocks, as is indicated by the positive correlation of these elements with sodium and calcium. The TEs released as a result of weathering are leached by water flowing down local watercourses to Admiralty Bay, as indicated by the decreasing results of ∑REE = 11.59 μg∙dm-3 in watercourse water, ∑REE = 1.62 μg∙dm-3 in watercourse pools and ∑REE = 0.66 μg∙dm-3 in the water of Admiralty Bay at the outlet of the watercourse. Water originating from the melting of snow on the glacier also carried REEs (∑REE = 0.14 μg∙dm-3), a fact which suggest the further influx of these elements from atmospheric deposition. The Prasiola crispa turned out to be the most susceptible to the accumulation of REEs (∑ 80.73 ± 5.05 μg g-1) and TEs, with the exception of chromium and zinc, whose concentrations were found to be at their highest in Deschampsia antarctica. In Usnea antarctica, Xanthoria candelaria, and Ceratodon purpureus and Politrichastrum alpinum, a dominant role in the accumulation of REEs was played by HREEs. The determined enrichment factor (EF) indicates that the soil cover is a source of REEs (EFAlgae for ∑REE = 5.07; EFLichen for ∑REE = 6.65; EFBryophyta for ∑REE = 5.04; EFVascular for ∑REE = 4.38), while Ni, As and Pb accumulated in plants may originate from other sources than the soil.

Contrast Media Adverse Drug Reactions in Highly Polluted Environment

Iodinated- (ICM) and gadolinium-based (GCM) contrast media are used in radiology imaging techniques, such as computer tomography (CT) and magnetic resonance (MR), respectively. The paper aims to analyze the adverse drug reactions of ICM and GCM on different sites of the body in a highly polluted environment. We analyzed the pharmacovigilance in contrast media on the basis of reports submitted to the Regional Center for Monitoring of Adverse Drug Reactions (ADR) at the Department of Clinical Pharmacology in Wrocław. Safety profiles were compared between different ICM and GCM and at the system organ level using the proportional reporting ratio (PRR). We analyzed 124 reports of adverse reactions related to contrast agents between 2006 and 2021. Our findings revealed that ADR combinations occurred more frequently after the use of iodinated contrast agents (72.08%) than gadolinium contrast agents (27.92%). Iomeprol and Iopromide were identified as the most frequently reported media. Each medium presented a different safety profile. Skin disorders are the most common adverse drug reactions among patients using both iodine- and gadolinium-based contrast media. Gadolinium-based contrast agents are characterized by similar organ toxicity. Conversely, iodine-based contrast agents are more diverse—some of which show tissue specificity, such as Iodixanol for the gastrointestinal system or Iohexol for the respiratory tract. This study shows relatively high occurrence of respiratory tract related ADRs in Wrocław. We also prove that it is possible to choose the most optimal contrast agent for patients with specific organ site problems to omit the possible complications.

Trace elements in the muscle, ova and seminal fluid of key clupeid representatives from the Gdansk Bay (South Baltic Sea) and Iberian Peninsula (North-East Atlantic)

BACKGROUND

Baltic herring and European sardine are pelagic, fish of particular ecological importance, on the one hand control numbers of planktonic organisms, and on the other hand exist as food for predators on higher trophic levels. Moreover, these fish are among the main species caught for human consumption. Rare earth elements (REEs) come mainly from geogenic sources but, due to their use in technology, agriculture and medicine, the importance of anthropogenic sources is growing steadily.

METHODS

Samples used for the study were available on the market. Fresh materials of fish muscle, ova and seminal fluid were mineralized and elements were determined by means of inductively coupled plasma - mass spectrometry (ICP-MS).

RESULTS

The conducted research indicated the presence of REEs in the muscles of the Baltic herring (∑REE = 0.076 ± 0.047 mg/kg) and European sardine (∑REE = 0.191 ± 0.163 mg/kg), with a clear dominance of heavy REEs in both fish species. Trace elements (TE) in the muscles of the tested fish demonstrated a similar system of concentration (Baltic herring: Zn > As > Se > Cu > Cr > Ni > Pb > Cd; European sardine: Zn > As > Se > Cu > Ni > Cr > Pb > Cd). REEs and TEs in these fish were presence in ova and seminal fluid indicates intergenerational transfer.

CONCLUSION

Changes in the concentrations of some trace elements (As, Cu, Cd) in the muscles of herring indicate increases compared to the historical data. The availability of metals in the aquatic environment may be determined by ongoing climate changes, effected water salinity and warming increased availability of labile forms of trace metals. Decline trends in the condition of pelagic fish need to extend the research in the context of contemporary environmental threats.

Understanding the Effect of the Electron Spin Relaxation on the Relaxivities of Mn(II) Complexes with Triazacyclononane Derivatives

Investigating the relaxation of water ¹H nuclei induced by paramagnetic Mn(II) complexes is important to understand the mechanisms that control the efficiency of contrast agents used in diagnostic magnetic resonance imaging (MRI). Herein, a series of potentially hexadentate triazacyclononane (TACN) derivatives containing different pendant arms were designed to explore the relaxation of the electron spin in the corresponding Mn(II) complexes by using a combination of ¹H NMR relaxometry and theoretical calculations. These ligands include 1,4,7-triazacyclononane-1,4,7-triacetic acid (H₃NOTA) and three derivatives in which an acetate group is replaced by sulfonamide (H₃NO2ASAm), amide (H₂NO2AM), or pyridyl (H₂NO2APy) pendants. The analogue of H₃NOTA containing three propionate pendant arms (H₃NOTPrA) was also investigated. The X-ray structure of the derivative containing two acetate groups and a sulfonamide pendant arm [Mn(NO2ASAm)]^- evidenced six-coordination of the ligand to the metal ion, with the coordination polyhedron being close to a trigonal prism. The relaxivities of all complexes at 20 MHz and 25 °C (1.1-1.3 mM^-1 s^-1) are typical of systems that lack water molecules coordinated to the metal ion. The nuclear magnetic relaxation profiles evidence significant differences in the relaxivities of the complexes at low fields (<1 MHz), which are associated with different spin relaxation rates. The zero field splitting (ZFS) parameters calculated by using DFT and CASSCF methods show that electronic relaxation is relatively insensitive to the nature of the donor atoms. However, the twist angle of the two tripodal faces that delineate the coordination polyhedron, defined by the N atoms of the TACN unit (lower face) and the donor atoms of the pendant arms (upper face), has an important effect in the ZFS parameters. A twist angle close to the ideal value for an octahedral coordination (60°), such as that in [Mn(NOTPrA)]^-, leads to a small ZFS energy, whereas this value increases as the coordination polyhedron approaches to a trigonal prism.

Alimentary exposure and elimination routes of rare earth elements (REE) in marine mammals from the Baltic Sea and Antarctic coast

Marine mammals found at the top of the trophic pyramid are excellent bioindicators of pollutants in the marine environment, the concentrations of which increase along with the trophic level of the organism. As these animals are usually protected species, their contamination has to be assessed non-invasively by analysing excrement and epidermal structures such as fur or claws. The present study involved testing the excrement and fur of the grey seal (Halichoerus grypus) from the Southern Baltic coast and the Southern elephant seal (Mirounga leonine) from Admiralty Bay, along with fish muscle (food) and the lithological background of both areas, for the presence of rare earth elements (REE). The soil on the Baltic coast is characterized by the predomination of light rare earth elements (LREE): yttrium, lanthanum and cerium (∑REE = 7.86 mg·kg^-1 dw). In the soil and bedrock of Admiralty Bay all REEs were found except for terbium, thulium and lutetium (∑REE = 96.1 mg·kg^-1 dw). The REE levels found in the muscles of Baltic herring (∑REE = 0.057 mg·kg^-1 ww) were lower than those in the muscles of marbled rockcod (∑REE = 0.540 mg·kg^-1 ww). The situation was analogous in the mammals, with the REE concentrations in grey seal fur (∑REE = 0.489 mg·kg^-1 dw) and excrement (∑REE = 0.676 mg·kg^-1 dw) being lower than those found in the fur (∑REE = 10.1 mg·kg^-1 dw) and excrement (∑REE = 83.6 mg·kg^-1 dw) of the elephant seal. The LREE/HREE partition coefficients in the grey seal excrement (3.37) and its fur (4.00), but also in the faeces of the elephant seal (2.63) and its fur (2.65), indicate that in each species the process of elimination from the body occurs in similar proportions.

Non-Cardiogenic Pulmonary Oedema Following the use of Gadolinium-Based Contrast Medium: A Case Report

Non-cardiogenic pulmonary oedema can be life threatening and requires prompt treatment. While gadolinium-based contrast is generally considered safe with a low risk of severe side effects, non-cardiogenic pulmonary oedema has become increasingly recognised as a rare, but possibly life-threatening complication. We present a case of a usually well, young 23-year-old female who developed non-cardiogenic pulmonary oedema with a moderate oxygenation impairment and no mucosal or cutaneous features of anaphylaxis following the administration of gadolinium-based contrast. She did not respond to treatment of anaphylaxis but made a rapid recovery following the commencement of positive pressure ventilation. Our case highlights the importance of recognising the rare complication of non-cardiogenic pulmonary oedema following gadolinium-based contrast administration in order to promptly implement the appropriate treatment.

Late-onset acute respiratory distress syndrome induced by a gadolinium-based contrast agent

Rapid decline of pulmonary function in acute respiratory distress syndrome (ARDS) can make ARDS a dangerous and potentially life-threatening condition. Gadolinium-based contrast agents are considered safe alternatives to iodine-based contrast agents, with comparatively fewer adverse effects and a lower incidence of serious adverse events, such as dyspnea or hypotension. There are five reported cases of gadolinium-induced ARDS. A 59-year-old woman with respiratory failure 30 min after gadolinium administration was diagnosed with ARDS; she was admitted to the intensive care unit. Her condition improved by artificial respiration management and adrenaline and steroids administration. She was discharged on day 13. Considering ARDS occurred 30 min after gadolinium administration and findings suggesting anaphylaxis, such as wheezing and failure in organs other than the lungs, were absent, the involvement of any immediate-onset reaction was excluded; thus, a diagnosis of gadolinium-induced ARDS was made.

The incidence of skin lesions in contrast media-induced chemical hypersensitivity

Contrast agents are used in radiology to increase the sensibility and specificity of radiological techniques. Some of these compounds have side effects that include organ toxicity (with kidney being the most affected organ) and hypersensitivity reactions. We performed multiple PubMed searches from January, 2008 to January, 2018 for studies regarding adverse reactions to compounds used as contrast agents in imagistic techniques. The initial research identified 929 records written in English. After further excluding 223 non-human studies, 292 articles that had irrelevant designs as reviews, meta-analysis, commentaries, editorials and case reports, 414 studies were selected for retrieval. After reading the abstracts, we excluded 363 studies as they had little relevance to the study. In total, 51 full-articles were assessed for eligible studies to be included. Finally, 20 articles were included in the analysis. In our systematic literature search the incidence of overall skin immediate reactions to iodinated contrast media (ICM) had an incidence between 1.15 and 0.12%, depending on the cohort analyzed in the studies. The percentage of cutaneous manifestations in the cohort that experienced immediate hypersensitivity reactions was between 33.33 and 87.7%. The most frequent skin manifestations were urticaria, rashes, pruritus and limited facial edema. Non-iodinated contrast agents have a safer profile compared with ICM, the incidence of immediate adverse reactions being very low in gadolinium-based contrast agents and other agents used for contrast-enhanced ultrasound. The incidence of delayed reactions was between 10.1 and 0.03%. In the studies analyzed by us the main adverse reactions due to delayed hypersensitivity phenomena were cutaneous manifestations that were present between 70.27 and 100% of the cases. Regarding the risk factors for developing immediate adverse reactions, being female was a predisposing factor accompanied by history of allergy and history of reactions to contrast media. An accurate anamnesis of the patients and a correctly conducted pretreatment can limit the incidence and the severity of the adverse reactions and also can avoid the life occurrence of life-threatening reactions.

The effectiveness of allogeneic mesenchymal stem cells therapy for knee osteoarthritis in pigs

Background

Intraarticular injection of the mesenchymal stem cells (MSCs) has shown to be successful for treating osteoarthritis (OA). Nevertheless, many studies have been focusing on autologous MSCs. The following study investigates the safety and effectiveness of intraarticular injection of allogenic MSCs in a pig OA model.

Methods

Superparamagnetic iron oxide (SPIO) nanoparticles were labelled with bone marrow-derived mesenchymal stem cells (BM-MSCs) to allow cells tracking using magnetic resonance imaging (MRI). A pig OA model was established by bilateral medial meniscectomy. Next, SPIO-BM-MSCs were injected into the right knee, while the left knee was left untreated. MRI and radiography were used to assess the degree of OA and to evaluate the effectiveness of allogenic MSCs. Hematoxylin and eosin (H&E), safranin-o fast green staining, toluidine blue, and immunohistochemical staining were used to evaluate the therapeutic effect of the injections.

Results

At concentration of ≤20 µg/mL, SPIO caused no toxicity to BM-MSCs. Four weeks after surgery, OA changes were observed on MRI scan. The SPIO labeled BM-MSCs were found moving towards the impaired part of the cartilage 8 to 24 h after injections. In addition, no significant differences between the right side (therapeutic side) and the left side (untreated side) were observed following histological and immunohistochemistry analysis.

Conclusions

The suitable concentration of SPIO for labelling BMSCs was 20 µg/mL, while the allogenic MSCs could move towards and accumulate around the impaired cartilage. No significant difference was found between treatment and control group.

Incidence and Risk Factors for Gadolinium-Based Contrast Agent Immediate Reactions

Since their clinical introduction in 1988, gadolinium-based contrast agents (GBCAs) have demonstrated an excellent safety profile with a reported acute adverse reaction rate ranging from 0.01% to 2%. By comparison, the acute adverse reaction rate of low osmolar nonionic computed tomography contrast agents (CTCs) ranges from 0.7% to 3.1%. Many of the risk factors associated with CTC reactions (drug allergies, asthma, atopy, prior contrast reaction) also point toward an increased incidence of acute adverse events to GBCAs. With CTCs, an increased adverse event rate was associated with ionic preparations and high osmolality. In response to concerns for nephrogenic systemic fibrosis, GBCAs are now selected for their augmented chemical stability. These agents possess some combination of macrocyclic chelates or ionic preparations. With their improved chemical stability, these agents also possess higher osmolality and the increased potential to elicit an acute adverse reaction. In light of these concerns, researchers are now focusing greater efforts on reexamining acute adverse reactions to GBCAs and whether there is an increased association with certain agents. In addition to hypersensitivity reactions, this article will also discuss contrast extravasations, safety of GBCAs for pregnant and nursing patients, and the potential nephrotoxic effects of GBCAs.

MR Lymphangiography: A Practical Guide to Perform It and a Brief Review of the Literature from a Technical Point of View

We propose a practical approach for performing high-resolution MR lymphangiography (MRL). We shall discuss and illustrate the technical approach for the visualization of lymphatic vessels in patients suffering from lymphedema, how to distinguish lymphatic vessels from veins, and MRL role in supermicrosurgery treatment planning. A brief review of literature, from a technical point of view, is also reported.

Immediate Adverse Reactions to Gadolinium-Based MR Contrast Media: A Retrospective Analysis on 10,608 Examinations

Background and Purpose. Contrast media (CM) for magnetic resonance imaging (MRI) may determine the development of acute adverse reactions. Objective was to retrospectively assess the frequency and severity of adverse reactions associated with gadolinium-based contrast agents (GBCAs) injection in patients who underwent MRI. Material and Methods. At our center 10608 MRI examinations with CM were performed using five different GBCAs: Gd-BOPTA (MultiHance), Gd-DTPA (Magnevist), Gd-EOBDTPA (Primovist), Gd-DOTA (Dotarem), and Gd-BTDO3A (Gadovist). Results. 32 acute adverse reactions occurred, accounting for 0.3% of all administration. Twelve reactions were associated with Gd-DOTA injection (0.11%), 9 with Gd-BOPTA injection (0.08%), 6 with Gd-BTDO3A (0.056%), 3 with Gd-EOB-DTPA (0.028%), and 2 with Gd-DTPA (0.018%). Twenty-four reactions (75.0%) were mild, four (12.5%) moderate, and four (12.5%) severe. The most severe reactions were seen associated with use of Gd-BOPTA, with 3 severe reactions in 32 total reactions. Conclusion. Acute adverse reactions are generally rare with the overall adverse reaction rate of 0.3%. The most common adverse reactions were not severe, consisting in skin rash and hives.

Alternatives to GBCA: Are We There Yet?

Gadolinium has been widely used as the contrast agent of choice for magnetic resonance imaging (MRI). However, gadolinium administration is not always desired due to its inherent enhancement properties and potential side effects (nephrogenic systemic fibrosis). This article reviews gadolinium alternatives, iron-, and manganese- based agents, and their current clinical usage for contrast-enhanced MRI examinations.

Rare earth elements in human and animal health: State of art and research priorities

BACKGROUND

A number of applications have been developed using rare earth elements (REE), implying several human exposures and raising unsolved questions as to REE-associated health effects.

METHODS

A MedLine survey was retrieved from early reports (1980s) up to June 2015, focused on human and animal exposures to REE. Literature from animal models was selected focusing on REE-associated health effects.

RESULTS

Some REE occupational exposures, in jobs such as glass polishers, photoengravers and movie projectionists showed a few case reports on health effects affecting the respiratory system. No case-control or cohort studies of occupational REE exposures were retrieved. Environmental exposures have been biomonitored in populations residing in REE mining areas, showing REE accumulation. The case for a iatrogenic REE exposure was raised by the use of gadolinium-based contrast agents for nuclear magnetic resonance. Animal toxicity studies have shown REE toxicity, affecting a number of endpoints in liver, lungs and blood. On the other hand, the use of REE as feed additives in livestock is referred as a safe and promising device in zootechnical activities, possibly suggesting a hormetic effect both known for REE and for other xenobiotics. Thus, investigations on long-term exposures and observations are warranted.

CONCLUSION

The state of art provides a limited definition of the health effects in occupationally or environmentally REE-exposed human populations. Research priorities should be addressed to case-control or cohort studies of REE-exposed humans and to life-long animal experiments.

Assessment of rates of acute adverse reactions to gadobenate dimeglumine: review of more than 130,000 administrations in 7.5 years

OBJECTIVE

The purpose of this study was to determine the incidence of adverse events associated with gadobenate dimeglumine over 7.5 years in a major hospital system consisting of both academic and community hospitals.

SUBJECTS AND METHODS

As part of a regular and continuous prospective quality assurance project, MRI technologists contemporaneously recorded all gadolinium-based contrast administrations and any associated adverse reactions, including type of reaction and treatment rendered, between August 1, 2005, and March 14, 2013. Weekly data review was performed by the director of MRI services, who evaluated data both by individual site and by comparison among the participating hospitals and sites within the hospital system. Comparison between reaction rates at different sites was performed with a chi-square test.

RESULTS

Over 7.5 years, 132,252 doses of gadobenate dimeglumine were administered, and 236 reactions were recorded (0.18% of contrast-enhanced examinations). Of these, 133 (56.4% of all adverse reactions) required treatment and 12 (5.1%) qualified as serious. Reaction rates were significantly different between academic (0.23%) and community (0.07%) hospitals (p<0.001). Reaction rates were higher in the initial years of the study, tapering to a lower baseline rate, which was maintained over more than 5 years. The findings were consistent with the Weber and Lalli effects reported in the literature on other pharmaceutical agents.

CONCLUSION

Rates of adverse reactions to gadobenate dimeglumine recorded over 7.5 years were comparable to those reported for other gadolinium-based contrast agents examined over smaller time ranges and populations. The findings reinforce the relatively robust safety profile of this agent.

Health effects and toxicity mechanisms of rare earth elements-Knowledge gaps and research prospects

In the recent decades, rare earth elements (REE) have undergone a steady spread in several industrial and medical applications, and in agriculture. Relatively scarce information has been acquired to date on REE-associated biological effects, from studies of bioaccumulation and of bioassays on animal, plant and models; a few case reports have focused on human health effects following occupational REE exposures, in the present lack of epidemiological studies of occupationally exposed groups. The literature is mostly confined to reports on few REE, namely cerium and lanthanum, whereas substantial information gaps persist on the health effects of other REE. An established action mechanism in REE-associated health effects relates to modulating oxidative stress, analogous to the recognized redox mechanisms observed for other transition elements. Adverse outcomes of REE exposures include a number of endpoints, such as growth inhibition, cytogenetic effects, and organ-specific toxicity. An apparent controversy regarding REE-associated health effects relates to opposed data pointing to either favorable or adverse effects of REE exposures. Several studies have demonstrated that REE, like a number of other xenobiotics, follow hormetic concentration-related trends, implying stimulatory or protective effects at low levels, then adverse effects at higher concentrations. Another major role for REE-associated effects should be focused on pH-dependent REE speciation and hence toxicity. Few reports have demonstrated that environmental acidification enhances REE toxicity; these data may assume particular relevance in REE-polluted acidic soils and in REE mining areas characterized by concomitant REE and acid pollution. The likely environmental threats arising from REE exposures deserve a new line of research efforts.

Gd(III)-labeled peptide nanofibers for reporting on biomaterial localization in vivo

Bioactive supramolecular nanostructures are of great importance in regenerative medicine and the development of novel targeted therapies. In order to use supramolecular chemistry to design such nanostructures, it is extremely important to track their fate in vivo through the use of molecular imaging strategies. Peptide amphiphiles (PAs) are known to generate a wide array of supramolecular nanostructures, and there is extensive literature on their use in areas such as tissue regeneration and therapies for disease. We report here on a series of PA molecules based on the well-established β-sheet amino acid sequence V3A3 conjugated to macrocyclic Gd(III) labels for magnetic resonance imaging (MRI). These conjugates were shown to form cylindrical supramolecular assemblies using cryogenic transmission electron microscopy and small-angle X-ray scattering. Using nuclear magnetic relaxation dispersion analysis, we observed that thermal annealing of the nanostructures led to a decrease in water exchange lifetime (τm) of hundreds of nanoseconds only for molecules that self-assemble into nanofibers of high aspect ratio. We interpret this decrease to indicate more solvent exposure to the paramagnetic moiety on annealing, resulting in faster water exchange within angstroms of the macrocycle. We hypothesize that faster water exchange in the nanofiber-forming PAs arises from the dehydration and increase in packing density on annealing. Two of the self-assembling conjugates were selected for imaging PAs after intramuscular injections of the PA C16V3A3E3-NH2 in the tibialis anterior muscle of a murine model. Needle tracts were clearly discernible with MRI at 4 days postinjection. This work establishes Gd(III) macrocycle-conjugated peptide amphiphiles as effective tracking agents for peptide amphiphile materials in vivo over the timescale of days.

Novel epigenetic target therapy for prostate cancer: a preclinical study

Epigenetic events are critical contributors to the pathogenesis of cancer, and targeting epigenetic mechanisms represents a novel strategy in anticancer therapy. Classic demethylating agents, such as 5-Aza-2′-deoxycytidine (Decitabine), hold the potential for reprograming somatic cancer cells demonstrating high therapeutic efficacy in haematological malignancies. On the other hand, epigenetic treatment of solid tumours often gives rise to undesired cytotoxic side effects. Appropriate delivery systems able to enrich Decitabine at the site of action and improve its bioavailability would reduce the incidence of toxicity on healthy tissues. In this work we provide preclinical evidences of a safe, versatile and efficient targeted epigenetic therapy to treat hormone sensitive (LNCap) and hormone refractory (DU145) prostate cancers. A novel Decitabine formulation, based on the use of engineered erythrocyte (Erythro-Magneto-Hemagglutinin Virosomes, EMHVs) drug delivery system (DDS) carrying this drug, has been refined. Inside the EMHVs, the drug was shielded from the environment and phosphorylated in its active form. The novel magnetic EMHV DDS, endowed with fusogenic protein, improved the stability of the carried drug and exhibited a high efficiency in confining its delivery at the site of action in vivo by applying an external static magnetic field. Here we show that Decitabine loaded into EMHVs induces a significant tumour mass reduction in prostate cancer xenograft models at a concentration, which is seven hundred times lower than the therapeutic dose, suggesting an improved pharmacokinetics/pharmacodynamics of drug. These results are relevant for and discussed in light of developing personalised autologous therapies and innovative clinical approach for the treatment of solid tumours.

Design of ProCAs (protein-based Gd(3+) MRI contrast agents) with high dose efficiency and capability for molecular imaging of cancer biomarkers

Magnetic resonance imaging (MRI) is the leading imaging technique for disease diagnostics, providing high resolution, three-dimensional images noninvasively. MRI contrast agents are designed to improve the contrast and sensitivity of MRI. However, current clinically used MRI contrast agents have relaxivities far below the theoretical upper limit, which largely prevent advancing molecular imaging of biomarkers with desired sensitivity and specificity. This review describes current progress in the development of a new class of protein-based MRI contrast agents (ProCAs) with high relaxivity using protein design to optimize the parameters that govern relaxivity. Further, engineering with targeting moiety allows these contrast agents to be applicable for molecular imaging of prostate cancer biomarkers by MRI. The developed protein-based contrast agents also exhibit additional in vitro and in vivo advantages for molecular imaging of disease biomarkers, such as high metal-binding stability and selectivity, reduced toxicity, proper blood circulation time, and higher permeability in tumor tissue in addition to improved relaxivities.

Understanding the metabolic fate and assessing the biosafety of MnO nanoparticles by metabonomic analysis

Recently, some types of MnO nanoparticle (Mn-NP) with favorable imaging capacity have been developed to improve the biocompatible profile of the existing Mn-based MRI contrast agent Mn-DPDP; however, the overall bio-effects and potential toxicity remain largely unknown. In this study, (1)H NMR-based metabolic profiling, integrated with traditional biochemical analysis and histopathological examinations, was used to investigate the absorption, distribution, metabolism, excretion and toxicity of Mn-NPs as candidates for MRI contrast agent. The metabolic responses in biofluids (plasma and urine) and tissues (liver, spleen, kidney, lung and brain) from rats could be divided into four classes following Mn-NP administration: Mn biodistribution-dependent, time-dependent, dose-dependent and complicated metabolic variations. The variations of these metabolites involved in lipid, energy, amino acid and other nutrient metabolism, which disclosed the metabolic fate and biological effects of Mn-NPs in rats. The changes of metabolic profile implied that the disturbance and impairment of biological functions induced by Mn-NP exposure were correlated with the particle size and the surface chemistry of nanoparticles. Integration of metabonomic technology with traditional methods provides a promising tool to understand the toxicological behavior of biomedical nanomaterials and will result in informed decision-making during drug development.

Optimizing contrast-enhanced magnetic resonance imaging characterization of brain metastases: relevance to stereotactic radiosurgery

Intracranial metastases are the most common form of intra-axial brain tumor. Management approaches to brain metastases include surgical resection, whole-brain radiotherapy, and stereotactic radiosurgery (SRS). The management approach that is selected is based typically on algorithms that incorporate the number, size, and location of lesions. SRS is the treatment of choice when metastases detected on imaging are few (maximum, 3-5) and/or of small size (≤30 mm) and offers the advantages of noninvasiveness and the ability to treat inaccessible lesions compared with surgical resection. Contrast-enhanced magnetic resonance imaging (MRI) is the standard imaging technique for determining the number, size, and location of metastatic lesions. In SRS, the capability of MRI to delineate lesion borders precisely in 3 dimensions helps reduce recurrence rates and minimize radiation necrosis in surrounding tissue. Optimization of the MRI protocol, including selection of the appropriate gadolinium-based contrast agent (GBCA), is paramount for accurate lesion imaging. GBCAs differ in their safety, tolerability, and efficacy because of their diverse physicochemical properties. Gadobutrol and gadobenate dimeglumine are high-relaxivity GBCAs that demonstrate superior efficacy for imaging metastatic lesions compared with other GBCAs, whereas gadobutrol additionally provides macrocyclic stability. This article reviews recent comparative trials of GBCAs and discusses their relevance for optimizing MRI protocols in the management of brain metastases, with particular relevance to SRS.

Safety and adverse effects during 24 hours after contrast-enhanced MRI with gadobenate dimeglumine (MultiHance) in children

BACKGROUND

Gadolinium-based MR contrast agents have long been considered safe for routine diagnostic imaging. However, the advent of nephrogenic systemic fibrosis (NSF) among certain patients with severe renal insufficiency has brought the issue of safety into question. Nowhere is safety of greater concern than among children who frequently require multiple contrast-enhanced MRI examinations over an extended period of time.

OBJECTIVE

To retrospectively evaluate the safety of gadobenate dimeglumine for contrast-enhanced (CE) MRI across a range of indications.

MATERIALS AND METHODS

Two hundred pediatric inpatients (age: 4 days to 15 years) underwent CE MRI as part of clinical routine. The children received a gadobenate dimeglumine dose of either 0.05 mmol/kg body weight (liver, abdominal imaging, musculoskeletal imaging, brain and other rare indications) or 0.1 mmol/kg bodyweight (cardiovascular imaging, MR-urography). Young (< 8 years) children with congenital heart disease were intubated and underwent MRA evaluation with controlled ventilation. Monitoring for adverse events was performed for at least 24 h after each gadobenate dimeglumine injection. Depending on clinical necessity, laboratory measurements and, in some cases, vital sign and ECG determinations were made before and after contrast injection. Safety was evaluated by age group, indication and dose administered.

RESULTS

No clinically adverse events were reported among children who had one MRI scan only or among children who had several examinations. There were no changes in creatinine or bilirubin levels even in very young children.

CONCLUSIONS

No adverse events were recorded during the first 24 h following administration of gadobenate dimeglumine in 200 children.

Gadobenate dimeglumine (MultiHance) in MR angiography: an in-vitro phantom comparison with gadopentetate dimeglumine (Magnevist) at different concentrations

BACKGROUND

Numerous clinical studies suggest that gadobenate dimeglumine is diagnostically superior to other gadolinium chelates for MR imaging applications, including contrast-enhanced MR angiography (CE-MRA). However, confirmatory in-vitro phantom studies have thus far been lacking.

PURPOSE

To evaluate the difference in signal intensity achieved with the high-relaxivity MR contrast agent gadobenate dimeglumine (MultiHance) relative to that achieved with the standard-relaxivity non-specific agent gadopentetate dimeglumine (Magnevist) at different concentrations using an in-vitro phantom study design.

MATERIAL AND METHODS

Test tubes with whole human blood were prepared with concentrations of gadobenate dimeglumine or gadopentetate dimeglumine ranging from 0 to 12 mM. A three-dimensional (3D) T1-weighted gradient echo sequence normally used for CE-MRA of the renal arteries was performed at flip angles of 25° and 35°. The signal-to-noise ratio (SNR) was calculated for all concentrations of both contrast agents. Furthermore a Look-Locker sequence was used and quantitative T1 mapping was performed for all the test tubes. The contrast agent concentration in the aorta was simulated using previously published data on T1 in the aorta during the first pass of a contrast agent. The differences between gadobenate dimeglumine and gadopentetate dimeglumine were compared at the simulated concentrations.

RESULTS

The SNR achieved with gadobenate dimeglumine was consistently greater than that achieved with gadopentetate dimeglumine at all concentrations. An improvement of 15-25% in SNR was obtained when increasing the flip angle from 25° to 35°. The relative improvement in SNR with gadobenate dimeglumine relative to gadopentetate dimeglumine ranged from 25-72% and was markedly greater at lower concentrations with a flip angle of 35°.

CONCLUSION

Our findings suggest that the relative benefit of gadobenate dimeglumine over gadopentetate dimeglumine for CE-MRA applications is greater at lower concentrations.

Which patients with dilated common bile and/or pancreatic ducts have positive findings on EUS?

BACKGROUND

Patients with dilated common bile duct (CBD) (>7mm) and/or pancreatic duct (PD) on abdominal imaging are often referred for endoscopic ultrasound (EUS). In many cases, the EUS shows no obvious etiology for the dilated ducts.

OBJECTIVE

Find clinical factors that may predict which patients are more likely to have positive findings on EUS to explain the etiologies for the dilated ducts.

DESIGN

Retrospective database analysis.

SETTING

Tertiary-care university hospital.

PATIENTS

Patients referred for EUS for dilated CBD and/or PD from January 2004 to February 2010 were included in this study. Only patients without an obvious etiology for the dilated ducts on abdominal imaging were included.

INTERVENTIONS

An EUS was performed by using either a radial echoendoscope or a linear endoscope to evaluate the common bile duct and/or the pancreatic duct. When appropriate fine needle aspiration of the mass or cyst was performed.

MAIN OUTCOME MEASUREMENTS

The characteristics of patients who had positive findings on EUS to explain the etiology of their dilated PD and/or CBD.

RESULTS

A total of 140 patients were included in the study with a mean age of 64 years, 51 (36%) male and 115 (82%) white. The majority of our patients had a presenting symptom of abdominal pain 105 (75%). 49 (36%) had elevated AST or ALT, 25 (8%) had an elevated bilirubin and 13 (23%) had an elevated lipase. EUS findings explained the dilated ducts in 54 (39%) of our patients, most common diagnoses included: CBD stone in 11 (8%), non-calcific chronic pancreatitis in 9 (6%), pancreatic mass in 8 (6%), IPMN in 7 (5%). On bivarate analysis patients who were older (p = 0.006), male (p = 0.001), had elevated LFTs (p = <0.001), had elevated lipase (p = 0.021) or had dilated CBD and PD (p = 0.007) were more likely to have an etiology for their dilated duct(s) discovered on EUS.

LIMITATIONS

A retrospective study with a small number of patients.

CONCLUSION

Older patients, males and those patients presenting with concurrent elevations in the AST/ALT and/or lipase were more likely to have an underlying etiology discovered on EUS. Furthermore, EUS may detect an undiagnosed pancreatic malignancy in patients presenting with unexplained duct dilation.

In vivo magnetic resonance imaging tracking of SPIO-labeled human umbilical cord mesenchymal stem cells

Human umbilical cord mesenchymal stem cells (hUC-MSCs) can be efficiently labeled by superparamagnetic iron oxide (SPIO) nanoparticles, which produces low signal intensity on magnetic resonance imaging (MRI) in vitro. This study was to evaluate the feasibility of in vivo tracking for hUC-MSCs labeled by SPIO with noninvasive MRI. SPIO was added to cultures at concentrations equivalent to 0, 7, 14, 28, and 56 µg Fe/ml (diluted with DMEM/F12) and incubated for 16 h. Prussian Blue staining was used to determinate the labeling efficiency. Rats were randomly divided into three groups, control group, hUC-MSCs group, and SPIO-labeled hUC-MSCs group. All groups were subjected to spinal cord injury (SCI) by weight drop device. Rats were examined for neurological function. In vivo MRI was used to track SPIO-labeled hUC-MSCs transplanted in rats spinal cord. Survival and migration of hUC-MSCs were also explored using immunofluorescence. Significant improvements in locomotion were observed in the hUC-MSCs groups. There was statistical significance compared with control group. In vivo MRI 1 and 3 weeks after injection showed a large reduction in signal intensity in the region transplanted with SPIO-labeled hUC-MSCs. The images from unlabeled hUC-MSCs showed a smaller reduction in signal intensity. Transplanted hUC-MSCs engrafted within the injured rats spinal cord and survived for at least 8 weeks. In conclusion, hUC-MSCs can survive and migrate in the host spinal cord after transplantation, which promote functional recovery after SCI. Noninvasive imaging of transplanted SPIO-labeled hUC-MSCs is feasible.

Does higher gadolinium concentration play a role in the morphologic assessment of brain tumors? Results of a multicenter intraindividual crossover comparison of gadobutrol versus gadobenate dimeglumine (the MERIT Study)

BACKGROUND AND PURPOSE

Gadobenate dimeglumine has proved advantageous compared with other gadolinium-based contrast agents for contrast-enhanced brain MR imaging. Gadobutrol is a more highly concentrated agent (1.0 mol/L). This study intraindividually compared 0.1-mmol/kg doses of these agents for qualitative and quantitative evaluation of brain tumors.

MATERIALS AND METHODS

Adult patients with suspected or known brain tumors underwent 2 identical MR imaging examinations at 1.5T, 1 with gadobenate dimeglumine and the other with gadobutrol, both at a dose of 0.1-mmol/kg body weight. The agents were injected in randomized order separated by 3-14 days. Imaging sequences and acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images qualitatively for diagnostic information (lesion extent, delineation, morphology, enhancement, global preference) and quantitatively for CNR and LBR.

RESULTS

One hundred fourteen of 123 enrolled patients successfully underwent both examinations. Final diagnoses were intra-axial tumors, metastases, extra-axial tumors, "other" tumors, and "nontumor" (49, 46, 8, 7, and 4 subjects, respectively). Readers 1, 2, and 3 demonstrated preference for gadobenate dimeglumine in 46 (40.7%), 54 (47.4%), and 49 (43.0%) patients, respectively, compared with 6, 7, and 7 patients for gadobutrol (P < .0001, all readers). Highly significant (P < .0001, all readers) preference for gadobenate dimeglumine was demonstrated for all other qualitative end points. Inter-reader agreement was good for all evaluations (κ = 0.414-0.629). Significantly superior CNR and LBR were determined for gadobenate dimeglumine (P < .019, all readers).

CONCLUSIONS

Significantly greater morphologic information and lesion enhancement are achieved on brain MR imaging with 0.1-mmol/kg gadobenate dimeglumine compared with gadobutrol at an equivalent dose.

Immediate hypersensitivity reaction to gadolinium-based MR contrast media

PURPOSE

To determine the incidence and risk factors of immediate hypersensitivity reactions to gadolinium-based magnetic resonance (MR) contrast agents.

MATERIALS AND METHODS

Institutional review board approval and a waiver of informed consent were obtained. A retrospective study of patients who had been given gadolinium-based MR contrast media between August 2004 and July 2010 was performed by reviewing their electronic medical records. In addition to data on immediate hypersensitivity reaction, the kinds of MR contrast media and demographic data including age, sex, and comorbidity were collected. To compare the groups, the χ(2) test, Fisher exact test, χ(2) test for trend, Student t test, analysis of variance test, and multiple logistic regression test were performed.

RESULTS

A total of 112 immediate hypersensitivity reactions (0.079% of 141 623 total doses) were identified in 102 patients (0.121% of 84 367 total patients). Among the six evaluated MR contrast media, gadodiamide had the lowest rate (0.013%) of immediate hypersensitivity reactions, while gadobenate dimeglumine had the highest rate (0.22%). The rate for immediate hypersensitivity reactions was significantly higher in female patients (odds ratio = 1.687; 95% confidence interval: 1.143, 2.491) and in patients with allergies and asthma (odds ratio = 2.829; 95% confidence interval: 1.427, 5.610). Patients with a previous history of immediate hypersensitivity reactions had a higher rate of recurrence after reexposure to MR contrast media (30%) compared with the incidence rate in total patients (P < .0001). The incidence of immediate hypersensitivity reactions increased depending on the number of times patients were exposed to MR contrast media (P for trend = .036). The most common symptom was urticaria (91.1%), and anaphylaxis occurred in 11 cases (9.8%). The mortality rate was 0.0007% because of one fatality.

CONCLUSION

The incidence of immediate hypersensitivity reactions to MR contrast media was 0.079%, and the recurrence rate of hypersensitivity reactions was 30% in patients with previous reactions.

MR lymphangiography at 3.0 T: correlation with lymphoscintigraphy

PURPOSE

To prospectively compare findings of magnetic resonance (MR) lymphangiography with those of lymphoscintigraphy, evaluate the pattern and delay of lymphatic drainage, compare typical findings, and investigate discrepancies between the techniques.

MATERIALS AND METHODS

This prospective study was performed according to the Declaration of Helsinki and was approved by the local ethics committee. Thirty consecutive patients with uni- or bilateral lymphedema and lymph vessel transplants of the lower extremities were examined with 3.0-T fat-saturated three-dimensional gradient-echo MR after gadopentetate dimeglumine injection. Results of all examinations were correlated with corresponding results of lymphoscintigraphy examinations. Results of both techniques were separately reviewed in consensus by a radiologist and a nuclear physician, who rated delay and pattern of drainage, number of enhancing levels, and quality of conspicuity of the depiction of lymph nodes and lymph vessels. Sensitivity and specificity were calculated by using combined results of both techniques and clinical presentation findings as reference standard. Correlation was calculated with weighted k coefficients.

RESULTS

Weak lymphatic drainage at lymphoscintigraphy correlated with lymphangiectasia at MR lymphangiography (13 of 33 affected extremities). Lymph vessels were clearly visualized with MR lymphangiography (five of 24 affected extremities), while they were not detectable with lymphoscintigraphy. Depiction of inguinal lymph nodes was clearer with lymphoscintigraphy (five of 60 extremities). Correlation of both techniques was excellent for delay (κ=0.93) and pattern (κ=0.84) of drainage, good for depiction of lymph nodes (κ=0.67) and number of enhancing levels (κ=0.77), and moderate for depiction of lymph vessels (κ=0.50). Sensitivity and specificity for delay and pattern of drainage were concordant, whereas MR lymphangiography showed a higher sensitivity for lymph vessel abnormalities (100% vs 79%) and lower specificity for lymph node abnormalities (78% vs 100%).

CONCLUSION

Imaging findings of MR lymphangiography and lymphoscintigraphy show a clear concordance. With lymphoscintigraphy, better visualization of inguinal lymph nodes was achieved, whereas with MR lymphangiography, better depiction of lymph vessels and morphologic features of lymph vessel abnormalities were achieved.

Role of Structural Imaging in Lymphoma

The lymphomas, Hodgkin lymphoma and non-Hodgkin lymphoma, are among the most common types of cancer in the United States. Imaging plays an important role in the evaluation of patients with lymphoma, because it aids in treatment planning and in the determination of prognosis. Structural imaging entails the assessment of morphologic features of normal tissues and organs of the body and of malignant lesions within these structures, and plays a major role in the noninvasive assessment of lymphoma. This article reviews cross-sectional structural imaging modalities with an emphasis on computed tomography and magnetic resonance imaging, with some mention of ultrasonography.

Safety of gadoterate meglumine (Gd-DOTA) as a contrast agent for magnetic resonance imaging: results of a post-marketing surveillance study in Japan

Background: Safety is a primary concern with contrast agents used for MRI. If precautions could be taken before the repeated administration of gadolinium-based contrast media, then the awareness and management of adverse reactions would be more efficient.

Objectives: To assess the safety and efficacy of gadoterate meglumine (Gd-DOTA) [Magnescope® in Japan, Dotarem® in other countries], a gadolinium-based contrast agent, in patients undergoing imaging of the brain/spinal cord and/or trunk/limbs, and to identify factors associated with the onset of adverse reactions.

Methods: The study ran for 4 years and included 3444 cases. The study was conducted before it became known that gadolinium-based contrast agents could trigger the development of nephrogenic systemic fibrosis. Patients for whom the contrast agent was indicated and who underwent imaging of the brain/spinal cord and/or trunk/limbs by MRI were enrolled. There were 1300 inpatients who were followed up during hospitalization (for several days), and 2144 outpatients who were followed up for at least 2 hours on-site. After Gd-DOTA administration, 13 patient baseline characteristics were used to explore factors that might predict a greater likelihood of acute non-renal adverse reactions. The physician’s appraisal of the efficacy of Gd-DOTA was also assessed.

Results: A total of 40 adverse reactions were recorded in 32 patients, giving an overall incidence of adverse reactions of 0.93%. Gastrointestinal disorders were the most commonly reported adverse reactions (0.49%). Most adverse reactions reported were of mild intensity and no serious adverse reactions were reported. This study found that statistically significant risk factors for adverse reactions were general patient condition, liver disorder, kidney disorder, health complications, concomitant treatments, and Gd-DOTA dose (although the incidence of adverse reactions was not dose dependent). In the majority of cases (99.53%), the efficacy of Gd-DOTA was rated as ‘effective’ or ‘very effective’; only the presence of kidney disorder was associated with a significantly greater likelihood of Gd-DOTA inefficacy.

Conclusion: Overall, this postmarketing surveillance study did not reveal any untoward or unexpected findings concerning the safety or efficacy of Gd-DOTA. The low incidence of adverse reactions (<1%) and the absence of serious adverse reactions reported during the survey period showed that Gd-DOTA was very well tolerated. The use of Gd-DOTA as an MRI-enhancing contrast medium in the clinical practice setting appears to be safe and effective.

Magnetic resonance investigation of blood flow after aortic valve bypass (apicoaortic conduit)

BACKGROUND

Aortic valve bypass (AVB, apicoaortic conduit) is an alternative to aortic valve replacement (AVR) for high-risk patients with aortic stenosis (AS). The redistribution of blood flow after AVB has been poorly characterized. In order to understand cardiovascular physiology after AVB, we performed cardiac magnetic resonance (CMR) imaging of AVB recipients.

METHODS

Fifteen patients with symptomatic AS underwent beating-heart AVB. Electrocardiography-gated two-dimensional phase-contrast velocity mapping CMR imaging was conducted on each patient. Instantaneous flow was acquired at discrete intervals within the cardiac cycle and ventricular function and volumes were evaluated. Five age-matched patients without aortic valve disease served as controls.

RESULTS

Conduit flow (as a percent of total cardiac output) was 65% ± 5%. Ejection fraction was unchanged compared with before AVB (50% ± 17% versus 57% ± 13%; p = 0.91). Ventricular volumes and cardiac indices were within normal limits and similar to those values in controls (cardiac index 2.9 ± 1.0 versus 2.3 L/min/m(2); p = 0.26; end-diastolic volume index 59 ± 17 mL versus 55 ± 20 mL; p = 0.66; end-systolic volume index, 25 ± 12 versus 25 ± 18 mL; p = 0.91; stroke volume index, 33 ± 11 versus 30 ± 6 mL; p = 0.57 for AVB and control patients, respectively). There was a small degree of retrograde blood flow in the descending aorta above the level of the conduit insertion (10% ± 8% of cardiac output).

CONCLUSIONS

Aortic valve bypass results in a predictable blood flow distribution between the native aorta and conduit and is associated with normal ventricular volumes and function.

Tolerability and diagnostic value of gadoteric acid in the general population and in patients with risk factors: results in more than 84,000 patients

PURPOSE

To review the tolerability and diagnostic effectiveness of gadoteric acid under daily practice conditions in the general population and at-risk patients.

MATERIALS AND METHODS

A total of 84,621 patients (45.4% men, 54.6% women, mean age 52.0 ± 16.9 years) were studied in 129 German centers. Patients underwent contrast-enhanced magnetic resonance imaging (MRI) using gadoteric acid (Gd-DOTA, Dotarem(®), Guerbet, Roissy CdG, France) as IV contrast medium (mean volume, 16.4 ml). 22.9% of the patients had at least one risk factor (e.g., allergies, previous allergic reaction to a contrast medium, and renal impairment). 554 patients received pretreatment before contrast medium administration (0.7%). Adverse events were documented and image quality was assessed.

RESULTS

A diagnosis was possible in 99.7% of all cases. Image quality was rated good or excellent in 97.1%. Adverse events (e.g., nausea, vomiting, and urticaria) were observed in 0.34% of the examinations and were mostly rated as minor. There were 8 patients with serious adverse events. The adverse event rate was significantly higher in patients with a history of allergies (0.62%; p<0.001) and in patients with a previous allergic reaction to contrast medium (1.23%; p<0.001). There was no elevated incidence of adverse events in patients with renal impairment.

CONCLUSION

Gadoteric acid is a well-tolerated MRI contrast medium in patients with and without risk factors that is associated with a low rate of adverse events and good or excellent image quality in most patients.

Assessment of adverse reaction rates during gadoteridol-enhanced MR imaging in 28,078 patients

PURPOSE

To determine adverse reaction rates in a tertiary care clinical setting after adoption of gadoteridol as the institutional routine magnetic resonance (MR) imaging contrast agent.

MATERIALS AND METHODS

With institutional review board approval, informed consent waiver, and HIPAA compliance, a prospective observational study of 28 078 patients who underwent intravenous gadoteridol-enhanced MR imaging from July 2007 to December 2009 was performed. Reactions were recorded by technologists who noted types of reactions, method of injection, and treatment. Reactions were classified as mild, moderate, or severe per American College of Radiology definitions. Comparisons of reaction rates with dose and method of injection were analyzed with the Fisher exact and χ(2) tests.

RESULTS

Overall reaction rate was 0.666% (187 patients), including 177 mild, six moderate, and four severe reactions. Treatment was given in 27 patients (14.4%). The most frequent reaction was nausea (and/or vomiting) in 149 patients (79.7% of patients with any adverse reaction, 0.530% of overall population). Method of injection did not affect reaction rate or severity. There was no difference in type or severity of reactions in comparison of patients receiving half the dose versus patients receiving the standard dose (P = .33-.75).

CONCLUSION

The observed adverse reaction rate to gadoteridol was lower than previously reported. Specifically, the rate of nausea (0.530%) was less than half the rate (1.4%) in clinical trials of 1251 patients, leading to FDA approval in 1992. Rates of adverse reactions for this macrocyclic contrast agent are comparable to those published for linear gadolinium-based contrast agents.

Contrast agents used in cardiovascular magnetic resonance imaging: current issues and future directions

Cardiovascular MRI is being increasingly used in the evaluation of ischemic heart disease, cardiac masses, complex congenital heart disease, and morphologic evaluation of the vascular anatomy throughout the body. Many and varied contrast media may be used to increase the sensitivity and specificity of detecting and evaluating various pathologies, and a knowledge of the different mechanisms of action, distributions and safety profiles of these agents is required for safe and effective imaging. This article reviews the currently available magnetic resonance (MR) contrast media, discusses the risks and benefits, and gives illustrated examples of current clinical applications in cardiovascular disease. A literature search covered the period 1990 to the present with the use of multiple databases including MEDLINE, PUBMED, SciSearch and Google Medical. All identified studies containing information relevant to the topic of cardiovascular MRI and cardiovascular MR contrast agents and their uses and properties were evaluated. Evaluation was limited to studies in English. The conclusions were that the use of contrast agents vastly increases the diagnostic yield, sensitivity and specificity of cardiovascular MRI in the non-invasive diagnosis of the full breadth of cardiovascular pathology. The use of contrast MRI for investigating ischemic heart disease, cardiac masses, and congenital heart disease and in angiography is now well established, and the referring physician, cardiologist, or radiologist requires an in-depth knowledge of the safety profiles and correct dosing of commonly prescribed contrast agents. As the number of MR contrast agents on the market continues to increase, knowledge of the basic mechanism of action is vital for keeping abreast of how new and emerging agents will affect clinical practice in the future.