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Kim JW, Lee CH, Kim KA, Lee J, Park YS. Abbreviated MRI with second shot arterial phase for HCC evaluation: modified version of LI-RADS and recall reduction strategy. Eur Radiol 2022; 33:4401-4411. [PMID: 36562784 DOI: 10.1007/s00330-022-09348-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 10/19/2022] [Accepted: 11/29/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To evaluate the feasibility of simulated abbreviated MRI (AMRI) with second shot arterial phase (SSAP) for HCC surveillance and diagnosis. METHODS A total of 129 consecutive patients (age, 58.8 ± 11.4 years; male, 71.3%) underwent gadoxetic acid-enhanced MRI using a modified injection protocol for HCC evaluation from July 2017 to February 2018. The modified injection protocol consisted of routine dynamic imaging (6 mL) and SSAP imaging (4 mL). Two radiologists independently reviewed two AMRI sets: AMRI without SSAP (surveillance set) and AMRI with SSAP (diagnosis set). A modified version of the Liver Imaging Reporting and Data System (LI-RADS) for the diagnosis set was devised by referring to contrast-enhanced ultrasound LI-RADS. RESULTS Sixty-seven patients with HCC and 62 patients without HCC were included. In the surveillance set, sensitivity and specificity for the detection of patients with HCC were 95.5% and 96.8%, and 94.0% and 96.8% in reviewers 1 and 2, respectively. In the diagnosis set, the scores of most HCCs (76/78, 97.4%) were consistent between LI-RADS of full-protocol and modified LI-RADS of AMRI with SSAP protocol. When the HCC surveillance and diagnosis strategy was changed from strategy 1 (AMRI without SSAP) to strategy 2 (AMRI with SSAP), the recall rate significantly decreased from 52.7 to 3.9% (p < 0.001). CONCLUSIONS The modified LI-RADS score of the AMRI with SSAP protocol showed high agreement with the LI-RADS score of the full protocol. The HCC surveillance and diagnosis strategy using the AMRI with SSAP protocol reduced the recall rate. These results may enable to diagnose HCC simultaneously with surveillance. KEY POINTS • A modified version of LI-RADS was devised for the diagnostic algorithm using AMRI with the second shot arterial phase (SSAP) by referring to CEUS LI-RADS. • The modified LI-RADS scores using AMRI with SSAP showed a high concordance rate with the conventional LI-RADS score using full-protocol MRI. • The recall rate significantly decreased when the HCC surveillance and diagnosis strategy was changed from strategy 1 (AMRI without SSAP; surveillance then recall test) to strategy 2 (AMRI with SSAP; simultaneous surveillance and diagnosis).
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Affiliation(s)
- Jeong Woo Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Chang Hee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea.
| | - Kyeong Ah Kim
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Jongmee Lee
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
| | - Yang Shin Park
- Department of Radiology, Korea University Guro Hospital, Korea University College of Medicine, 148 Gurodong-ro, Guro-gu, Seoul, 08380, Korea
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Cheong BYC, Wilson JM, Preventza OA, Muthupillai R. Gadolinium-Based Contrast Agents: Updates and Answers to Typical Questions Regarding Gadolinium Use. Tex Heart Inst J 2022; 49:482255. [PMID: 35612906 DOI: 10.14503/thij-21-7680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents have expanded the diagnostic usefulness and capability of magnetic resonance imaging. Despite their highly favorable safety profile, these agents have been associated with nephrogenic systemic fibrosis in a small number of patients who have advanced kidney disease. Recently, trace amounts of gadolinium deposition in the brain and other organs have been reported after contrast exposure, even in patients with normal renal function. In this review, we provide a brief overview of recent updates and discuss typical clinical situations related to the use of gadolinium-based contrast agents.
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Affiliation(s)
- Benjamin Y C Cheong
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiovascular Radiology, Texas Heart Institute, Houston, Texas
| | - James M Wilson
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Ourania A Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Raja Muthupillai
- Department of Cardiovascular Radiology, Texas Heart Institute, Houston, Texas.,University of Houston College of Medicine, Houston, Texas
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Gadoxetate Disodium-Enhanced Imaging of Gradenigo Syndrome in End-Stage Renal Disease. J Neuroophthalmol 2021; 41:e375-e377. [PMID: 33813531 DOI: 10.1097/wno.0000000000001218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT A 65-year-old man with end-stage renal disease on peritoneal dialysis was admitted for new onset binocular double vision, failure to thrive, and debilitating right-sided headaches. Medical history was significant for tympanomastoidectomy for polymicrobial mastoiditis and treatment with IV antibiotics. MRI brain without contrast was read by radiology initially as showing expected postsurgical changes; however, given patient's history of mastoiditis infection, there was a high clinical suspicion for Gradenigo syndrome. MRI brain was repeated with gadoxetate contrast to minimize the risk of nephrogenic systemic fibrosis (NSF) in a patient with severe renal disease and this revealed an intracranial empyema involving both the trigeminal and abducens nerves confirming the diagnosis of Gradenigo syndrome. This case presented a diagnostic challenge because of suboptimal visualization on initial nonenhanced MRI. Gadoxetate was chosen because of its unique properties including high hepatobiliary excretion making it a safer form of gadolinium-based contrast agent that may not have the potential to precipitate NSF.
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Yang SY, Chiou TTY, Shiao CC, Lin HYH, Chan MJ, Wu CH, Sun CY, Wang WJ, Huang YT, Wu VC, Chen YC, Fang JT, Hwang SJ, Pan HC. Nomenclature and diagnostic criteria for acute kidney injury - 2020 consensus of the Taiwan AKI-task force. J Formos Med Assoc 2021; 121:749-765. [PMID: 34446340 DOI: 10.1016/j.jfma.2021.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 06/23/2021] [Accepted: 08/06/2021] [Indexed: 12/31/2022] Open
Abstract
Acute kidney injury (AKI) is a common syndrome that has a significant impact on prognosis in various clinical settings. To evaluate whether new evidence supports changing the current definition/classification/staging systems for AKI suggested by the Kidney Disease: Improving Global Outcomes (KDIGO) 2012 Clinical Practice Guideline, the Taiwan AKI-TASK Force, composed of 64 experts in various disciplines, systematically reviewed the literature and proposed recommendations about the current nomenclature and diagnostic criteria for AKI. The Taiwan Acute Kidney Injury (TW-AKI) Consensus 2020 was established following the principles of evidence-based medicine to investigate topics covered in AKI guidelines. The Taiwan AKI-TASK Force determined that patients with AKI have a higher risk of developing chronic kidney disease, end-stage renal disease, and death. After a comprehensive review, the TASK Force recommended using novel biomarkers, imaging examinations, renal biopsy, and body fluid assessment in the diagnosis of AKI. Clinical issues with regards to the definitions of baseline serum creatinine (sCr) level and renal recovery, as well as the use of biomarkers to predict renal recovery are also discussed in this consensus. Although the present classification systems using sCr and urine output for the diagnosis of AKI are not perfect, there is not enough evidence to change the current criteria in clinical practice. Future research should investigate and clarify the roles of the aforementioned tools in clinical practice for AKI.
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Affiliation(s)
- Shao-Yu Yang
- Department of Internal Medicine, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Terry Ting-Yu Chiou
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan; Chung Shan Medical University School of Medicine, Taichung, Taiwan
| | - Chih-Chung Shiao
- Division of Nephrology, Department of Internal Medicine, Camillians Saint Mary's Hospital Luodong, Saint Mary's Junior College of Medicine, Nursing and Management, Luodong, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan
| | - Hugo You-Hsien Lin
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Department of Internal Medicine, Kaohsiung Municipal Ta-Tung Hospital, Kaohsiung, Taiwan; Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Ming-Jen Chan
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Che-Hsiung Wu
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Taipei Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Taipei, Taiwan
| | - Chiao-Yin Sun
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Wei-Jie Wang
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Yen-Ta Huang
- Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Vin-Cent Wu
- Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yung-Chang Chen
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Ji-Tsung Fang
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan
| | - Shang-Jyh Hwang
- Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Heng-Chih Pan
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Taiwan Consortium for Acute Kidney Injury and Renal Diseases (CAKs), Taiwan; Division of Nephrology, Department of Internal Medicine, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan; Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan; Community Medicine Research Center, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan.
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Risk of nephrogenic systemic fibrosis in patients with impaired renal function undergoing fixed-dose gadoxetic acid-enhanced magnetic resonance imaging. Abdom Radiol (NY) 2021; 46:3995-4001. [PMID: 33742216 DOI: 10.1007/s00261-021-03045-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Revised: 03/02/2021] [Accepted: 03/05/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE To assess the risk of nephrogenic systemic fibrosis (NSF) in patients with renal impairment undergoing gadoxetic acid-enhanced magnetic resonance imaging. METHODS This retrospective study included patients who had an estimated glomerular filtration rate (eGFR) below 60 mL/min per 1.73 m2 or had undergone dialysis around the time of gadoxetic acid exposure from January 2010 to November 2019. All patients received at least one intravenous injection of gadoxetic acid at a fixed dose of 2.5 mmol. The primary endpoint was the development of NSF after exposure to gadoxetic acid based on Girardi's clinicopathological scoring system. RESULTS A total of 204 patients with renal impairment received 424 injections of gadoxetic acid, of which 131 and 54 had an eGFR of 30-59 and < 30 mL/min per 1.73 m2, respectively, and 19 had undergone hemodialysis. Eighty-two patients received multiple injections, with 23 receiving five or more injections. The dose of each exposure ranged from 0.02 to 0.07 mmol/kg and the cumulative doses ranged from 0.02 to 0.45 mmol/kg. Thirty-three patients had concomitant Child-Pugh class B or C cirrhosis. No NSF was detected during follow-up (median 20 months; range 6 days to 111 months). The upper bound of the 95% confidence interval for NSF risk was 2.2% and 1.1% per patient and examination, respectively. CONCLUSION No NSF was detected in this study. However, it is premature to ascertain the risk of NSF using gadoxetic acid in patients with renal impairment and further studies are warranted.
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Hama Y, Tate E. Superparamagnetic iron oxide-enhanced MRI-guided stereotactic ablative radiation therapy for liver metastasis. Rep Pract Oncol Radiother 2021; 26:470-474. [PMID: 34277103 PMCID: PMC8281898 DOI: 10.5603/rpor.a2021.0052] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Accepted: 02/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background MRI-guided radiation therapy can image a target and irradiate it at the same time. Superparamagnetic iron oxide (SPIO) is a liver-specific contrast agent that can selectively visualize liver tumors, even if plain MRI does not depict them. The purpose of this study was to present a proof of concept of SPIO-enhanced MRI-guided radiation therapy for liver tumor. Case presentation MRI-guided stereotactic ablative radiation therapy (SABR) was planned for a patient with impaired renal function who developed liver metastases after nephroureterectomy for ureteral cancer. Because liver metastasis was not visualized on plain MRI, SPIO-enhanced MRI was performed at 0.35 T using true fast imaging with steady-state free precession (true FISP) pulse sequence and SABR was performed. Liver metastasis was clearly visualized by SPIO-enhanced MRI, and MRI-guided SABR was performed without adverse events. Conclusion Even if liver metastasis is not visualized by plain MRI, liver metastasis can be clearly depicted by administering SPIO, and MRI-guided radiation therapy can be performed.
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Affiliation(s)
- Yukihiro Hama
- Department of Radiation Oncology, Tokyo-Edogawa Cancer Centre, Edogawa Hospital, Tokyo, Japan
| | - Etsuko Tate
- Department of Radiation Oncology, Tokyo-Edogawa Cancer Centre, Edogawa Hospital, Tokyo, Japan
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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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Watson TA, Barber J, Woodley H. Paediatric gastrointestinal and hepatobiliary radiology: why do we need subspecialists, and what is new? Pediatr Radiol 2021; 51:554-569. [PMID: 33743039 DOI: 10.1007/s00247-020-04778-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/06/2020] [Accepted: 07/08/2020] [Indexed: 12/17/2022]
Abstract
We present the case for subspecialisation in paediatric gastrointestinal and hepato-pancreatico-biliary radiology. We frame the discussion around a number of questions: What is different about the paediatric patient and paediatric gastrointestinal system? What does the radiologist need to do differently? And finally, what can be translated from these subspecialty areas into everyday practice? We cover conditions that the sub-specialist might encounter, focusing on entities such as inflammatory bowel disease and hepatic vascular anomalies. We also highlight novel imaging techniques that are a focus of research in the subspecialties, including contrast-enhanced ultrasound, MRI motility, magnetisation transfer factor, and magnetic resonance elastography.
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Affiliation(s)
- Tom A Watson
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, Great Ormond Street, London, WC1N 3JH, UK.
| | - Joy Barber
- Department of Radiology, St. George's Hospital NHS Foundation Trust, London, UK
| | - Helen Woodley
- Department of Radiology, Leeds Teaching Hospital NHS Trust, Leeds, UK
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Xu C, Zhang D, Chong J, Chen B, Li S. Synthesis of gadolinium-enhanced liver tumors on nonenhanced liver MR images using pixel-level graph reinforcement learning. Med Image Anal 2021; 69:101976. [PMID: 33535110 DOI: 10.1016/j.media.2021.101976] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 01/11/2021] [Accepted: 01/18/2021] [Indexed: 01/24/2023]
Abstract
If successful, synthesis of gadolinium (Gd)-enhanced liver tumors on nonenhanced liver MR images will be critical for liver tumor diagnosis and treatment. This synthesis will offer a safe, efficient, and low-cost clinical alternative to eliminate the use of contrast agents in the current clinical workflow and significantly benefit global healthcare systems. In this study, we propose a novel pixel-level graph reinforcement learning method (Pix-GRL). This method directly takes regular nonenhanced liver images as input and outputs AI-enhanced liver tumor images, thereby making them comparable to traditional Gd-enhanced liver tumor images. In Pix-GRL, each pixel has a pixel-level agent, and the agent explores the pixels features and outputs a pixel-level action to iteratively change the pixel value, ultimately generating AI-enhanced liver tumor images. Most importantly, Pix-GRL creatively embeds a graph convolution to represent all the pixel-level agents. A graph convolution is deployed to the agent for feature exploration to improve the effectiveness through the aggregation of long-range contextual features, as well as outputting the action to enhance the efficiency through shared parameter training between agents. Moreover, in our Pix-GRL method, a novel reward is used to measure pixel-level action to significantly improve the performance by considering the improvement in each action in each pixel with its own future state, as well as those of neighboring pixels. Pix-GRL significantly upgrades the existing medical DRL methods from a single agent to multiple pixel-level agents, becoming the first DRL method for medical image synthesis. Comprehensive experiments on three types of liver tumor datasets (benign, cancerous, and healthy controls) with 325 patients (24,375 images) show that our novel Pix-GRL method outperforms existing medical image synthesis learning methods. It achieved an SSIM of 0.85 ± 0.06 and a Pearson correlation coefficient of 0.92 in terms of the tumor size. These results prove that the potential exists to develop a successful clinical alternative to Gd-enhanced liver MR imaging.
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Affiliation(s)
- Chenchu Xu
- School of Computer Science and Technology, Anhui University, Hefei, China; Department of Medical Imaging, Western University, London ON, Canada
| | - Dong Zhang
- Department of Medical Imaging, Western University, London ON, Canada
| | - Jaron Chong
- Department of Medical Imaging, Western University, London ON, Canada
| | - Bo Chen
- School of Health Science, Western University, London ON, Canada
| | - Shuo Li
- Department of Medical Imaging, Western University, London ON, Canada.
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Paro EDL, Puchnick A, Szejnfeld J, Goldman SM. Use of diffusion-weighted imaging in the noninvasive diagnostic of obstructed biliary ducts. Abdom Radiol (NY) 2021; 46:268-279. [PMID: 32666232 DOI: 10.1007/s00261-020-02636-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 06/22/2020] [Accepted: 07/04/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study sought to evaluate the role of diffusion-weighted imaging (DWI) in differentiation between obstructed and unobstructed bile ducts in patients undergoing magnetic resonance imaging (MRI). METHODS Eighty-four patients, 40 males and 44 females (mean age: 56.4 ± 15.1 years), undergoing MRI with DWI (0-50-500-700) were evaluated and divided into two groups: 58 with abnormal laboratory tests (obstructed group) and 26 with normal laboratory values (unobstructed group). Laboratory tests were total bilirubin, alkaline phosphatase, and gamma-glutamyltransferase. Median ADC values were calculated and correlated with laboratory tests and degree of bile-duct dilatation (absent, moderate, or severe). The persistence of signal on DWI (b500 and b700) in the biliary tract was evaluated. Bilirubin values were tested for correlation with bile-duct ADC values and persistence of b700 signal. For statistical analysis, Student t test, chi-square test and Wilcoxon-Mann-Whitney test were used. ADC maps were plotted for three levels of the biliary tree, and a receiver operating characteristic (ROC) curve was calculated. RESULTS In the obstructed group, 15 patients had severe dilatation, 24 had moderate dilatation, and 19 had no appreciable dilatation; 38 patients had persistent signal on b700 images. In the unobstructed group, 23 patients had no dilatation and 3 had moderate dilatation; 4 patients had persistent signal on b700 images. Correlation was found between degree of bile-duct dilatation, bilirubin levels, persistence of b700 signal, and ADC map values. The calculated ADC map cutoff value (353 10-6 mm2/s) was able to differentiate the obstructed and unobstructed groups with 92.3% sensitivity, 81% specificity, and 91.9% accuracy. CONCLUSIONS DWI is able to distinguish patients with obstructed versus unobstructed bile ducts, regardless of the degree of dilatation, correlating with clinical and laboratory findings.
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Affiliation(s)
- Eliane Donato Leite Paro
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil.
| | - Andrea Puchnick
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Jacob Szejnfeld
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
| | - Suzan Menasce Goldman
- Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo (UNIFESP), Rua Napoleão de Barros, 800, Vila Clementino, São Paulo, SP, 04024-002, Brazil
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Rodby RA. Group II GBCM Can Be Used Safely for Imaging in Stage 4/5 CKD Patients: PRO. KIDNEY360 2020; 2:10-12. [PMID: 35368815 PMCID: PMC8785746 DOI: 10.34067/kid.0005792020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Accepted: 12/02/2020] [Indexed: 02/04/2023]
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Schieda N, van der Pol CB, Walker D, Tsampalieros AK, Maralani PJ, Woo S, Davenport MS. Adverse Events to the Gadolinium-based Contrast Agent Gadoxetic Acid: Systematic Review and Meta-Analysis. Radiology 2020; 297:565-572. [DOI: 10.1148/radiol.2020200073] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
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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: 99] [Impact Index Per Article: 24.8] [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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14
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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: 34] [Impact Index Per Article: 8.5] [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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15
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Starekova J, Bruce RJ, Sadowski EA, Reeder SB. No Cases of Nephrogenic Systemic Fibrosis after Administration of Gadoxetic Acid. Radiology 2020; 297:556-562. [PMID: 32990511 DOI: 10.1148/radiol.2020200788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background Gadoxetic acid (GA) has distinctive pharmacokinetic properties with important applications in hepatobiliary imaging. However, there are limited data evaluating the safety of GA administration in patients with impaired kidney function and the incidence of nephrogenic systemic fibrosis (NSF). Purpose To evaluate safety of GA regarding risk of NSF in patients with impaired kidney function. Materials and Methods This retrospective study identified all GA-enhanced MRI (hereafter, GA MRI) examinations performed between July 2008 and December 2019 through a search of the electronic medical record. Serum creatinine values within 180 days or less of each GA MRI examination were retrieved and estimated glomerular filtration rate (eGFR) was calculated. The eGFR value nearest to each MRI examination was used. A separate search in the electronic medical record was also performed to identify patients with NSF. Dermatologists, nephrologists, and nephrologists at our institution were surveyed for any cases of NSF. In patients with NSF, all MRI examinations performed and contrast agents administered to these patients were recorded. Results Overall, 7820 GA MRI examinations were identified, performed in 5351 patients (3022 women and 2329 men). These included 299 examinations (242 patients) with eGFR of 30-44 mL/min/1.73 m2 and 183 examinations (157 patients) with eGFR less than 30 mL/min/1.73 m2. There were 109 examinations (in 94 patients) with eGFR of 15-29 mL/min/1.73 m2, 40 examinations (in 39 patients) with eGFR less than 15 mL/min/1.73 m2, and 34 examinations in 27 patients undergoing hemodialysis. Seventeen patients with eGFR less than 30 mL/min/1.73 m2 or undergoing dialysis underwent GA MRI two or more times. Eighteen patients with biopsy-confirmed NSF were identified, none of whom were exposed to GA. The mean follow-up period for GA MRI examinations performed in patients with severe kidney impairment was 4.2 years (range, 0.2-11.3 years). Conclusion Gadoxetic acid may be safe with respect to nephrogenic systemic fibrosis in this patient population, although further studies are needed to confirm this. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by Davenport and Shankar in this issue.
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Affiliation(s)
- Jitka Starekova
- From the Departments of Radiology (J.S., R.J.B., E.A.S., S.B.R.), Obstetrics and Gynecology (E.A.S.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Richard J Bruce
- From the Departments of Radiology (J.S., R.J.B., E.A.S., S.B.R.), Obstetrics and Gynecology (E.A.S.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Elizabeth A Sadowski
- From the Departments of Radiology (J.S., R.J.B., E.A.S., S.B.R.), Obstetrics and Gynecology (E.A.S.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792
| | - Scott B Reeder
- From the Departments of Radiology (J.S., R.J.B., E.A.S., S.B.R.), Obstetrics and Gynecology (E.A.S.), Medical Physics (S.B.R.), Biomedical Engineering (S.B.R.), Medicine (S.B.R.), and Emergency Medicine (S.B.R.), University of Wisconsin, 600 Highland Ave, Madison, WI 53792
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16
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Rudnick MR, Wahba IM, Leonberg-Yoo AK, Miskulin D, Litt HI. Risks and Options With Gadolinium-Based Contrast Agents in Patients With CKD: A Review. Am J Kidney Dis 2020; 77:517-528. [PMID: 32861792 DOI: 10.1053/j.ajkd.2020.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs that bind free gadolinium more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for free gadolinium in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating gadolinium deposition in brain and a possible systemic syndrome attributed to GBCAs. Radiologic advances have resulted in several new imaging modalities that can be used in the severe CKD population and that do not require GBCA administration. In this article, we critically review GBCA use in patients with severe CKD and provide recommendations regarding GBCA use in this population.
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Affiliation(s)
- Michael R Rudnick
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA.
| | - Ihab M Wahba
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA; Corporal Michael J Crescenz Philadelphia Veterans Affairs Hospital Philadelphia, PA
| | - Amanda K Leonberg-Yoo
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA
| | - Dana Miskulin
- Division of Nephrology, Tufts University School of Medicine, Boston, MA
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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17
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Doimo S, Ricci F, Aung N, Cooper J, Boubertakh R, Sanghvi MM, Sinagra G, Petersen SE. Tissue-tracking in the assessment of late gadolinium enhancement in myocarditis and myocardial infarction. Magn Reson Imaging 2020; 73:62-69. [PMID: 32853757 DOI: 10.1016/j.mri.2020.08.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Revised: 07/21/2020] [Accepted: 08/20/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE To test the diagnostic performance of cardiovascular magnetic resonance (CMR) tissue-tracking (TT) to detect the presence of late gadolinium enhancement (LGE) in patients with a diagnosis of myocardial infarction (MI) or myocarditis (MYO), preserved left ventricular ejection fraction (LVEF) and no visual regional wall motion abnormalities (RWMA). METHODS We selected consecutive CMR studies of 50 MI, 50 MYO and 96 controls. Receiving operating characteristic (ROC) curve and net reclassification index (NRI) analyses were used to assess the predictive ability and the incremental diagnostic yield of 2D and 3D TT-derived strain parameters for the detection of LGE and to measure the best cut-off values of strain parameters. RESULTS Overall, cases showed significantly reduced 2D global longitudinal strain (2D-GLS) values compared with controls (-20.1 ± 3.1% vs -21.6 ± 2.7%; p = 0.0008). 2D-GLS was also significantly reduced in MYO patients compared with healthy controls (-19.7 ± 2.9% vs -21.9 ± 2.4%; p = 0.0001). 3D global radial strain (3D-GRS) was significantly reduced in MI patients compared with controls with risk factors (34.3 ± 11.8% vs 40.3 ± 12.5%, p = 0.024) Overall, 2D-GLS yielded good diagnostic accuracy for the detection of LGE in the MYO subgroup (AUROC 0.79; NRI (95% CI) = 0.6 (0.3, 1.02) p = 0.0004), with incremental predictive value beyond risk factors and LV function parameters (p for AUROC difference = 0.048). In the MI subgroup, 2D-GRS (AUROC 0.81; NRI (95% CI) = 0.56 (0.17, 0.95) p = 0.004), 3D-GRS (AUROC 0.82; NRI (95% CI) = 0.57 (0.17, 0.97) p = 0.006) and 3D global circumferential strain (3D-GCS) (AUROC 0.81; NRI (95% CI) = 0.62 (0.22, 1.01) p = 0.002) emerged as potential markers of disease. The best cut-off for 2D-GLS was -21.1%, for 2D- and 3D-GRS were 39.1% and 37.7%, respectively, and for 3D-GCS was -16.4%. CONCLUSIONS At CMR-tissue tracking analysis, 2D-GLS was a significant predictor of LGE in patients with myocarditis but preserved LVEF and no visual RWMA. Both 2D- and 3D-GRS and 2D-GCS yielded good diagnostic accuracy for LGE detection in patients with previous MI but preserved LVEF and no visual RWMA.
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Affiliation(s)
- Sara Doimo
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy.
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G. D'Annunzio" University, Chieti, Italy; Department of Clinical Sciences, Malmo, Faculty of Medicine, Lund University, Clinical Research Center, 214 28 Malmo, Sweden; Casa di Cura Villa Serena, Città Sant'Angelo, 65013 Pescara, Italy
| | - Nay Aung
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Jackie Cooper
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK
| | - Redha Boubertakh
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Mihir M Sanghvi
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
| | - Gianfranco Sinagra
- Cardiovascular Department, Azienda Sanitaria Universitaria Integrata, University of Trieste, Trieste, Italy
| | - Steffen E Petersen
- William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, London, UK; Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, West Smithfield, London, UK
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18
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Lunyera J, Mohottige D, Alexopoulos AS, Campbell H, Cameron CB, Sagalla N, Amrhein TJ, Crowley MJ, Dietch JR, Gordon AM, Kosinski AS, Cantrell S, Williams JW, Gierisch JM, Ear B, Goldstein KM. Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review. Ann Intern Med 2020; 173:110-119. [PMID: 32568573 PMCID: PMC7847719 DOI: 10.7326/m20-0299] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020. STUDY SELECTION Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure. DATA EXTRACTION Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools. DATA SYNTHESIS Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease. LIMITATIONS Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment. CONCLUSION Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).
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Affiliation(s)
- Joseph Lunyera
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Dinushika Mohottige
- Duke University School of Medicine and Duke University Medical Center, Durham, North Carolina (D.M.)
| | - Anastasia-Stefania Alexopoulos
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Hilary Campbell
- Margolis Center for Health Policy at Duke University, Durham, North Carolina (H.C.)
| | - C Blake Cameron
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Nicole Sagalla
- Durham Veterans Affairs Health Care System and Duke University School of Medicine, Durham, North Carolina (N.S.)
| | - Timothy J Amrhein
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Matthew J Crowley
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Jessica R Dietch
- Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.R.D.)
| | - Adelaide M Gordon
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Andrzej S Kosinski
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina (A.S.K.)
| | - Sarah Cantrell
- Duke University School of Medicine and Duke University Medical Center Library and Archives, Durham, North Carolina (S.C.)
| | - John W Williams
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
| | - Jennifer M Gierisch
- Duke University School of Medicine, Durham Veterans Affairs Health Care System, and Duke University, Durham, North Carolina (J.M.G.)
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Karen M Goldstein
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
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19
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Ludwig DR, Shetty AS, Broncano J, Bhalla S, Raptis CA. Magnetic Resonance Angiography of the Thoracic Vasculature: Technique and Applications. J Magn Reson Imaging 2020; 52:325-347. [PMID: 32061029 DOI: 10.1002/jmri.27067] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 01/05/2020] [Accepted: 01/07/2020] [Indexed: 12/12/2022] Open
Abstract
Magnetic resonance angiography (MRA) is a powerful clinical tool for evaluation of the thoracic vasculature. MRA can be performed on nearly any magnetic resonance imaging (MRI) scanner, and provides images of high diagnostic quality without the use of ionizing radiation. While computed tomographic angiography (CTA) is preferred in the evaluation of hemodynamically unstable patients, MRA represents an important tool for evaluation of the thoracic vasculature in stable patients. Contrast-enhanced MRA is generally performed unless there is a specific contraindication, as it shortens the duration of the exam and provides images of higher diagnostic quality than noncontrast MRA. However, intravenous contrast is often not required to obtain a diagnostic evaluation for most clinical indications. Indeed, a variety of noncontrast MRA techniques are used for thoracic imaging, often in conjunction with contrast-enhanced MRA, each of which has a differing degree of reliance on flowing blood to produce the desired vascular signal. In this article we review contrast-enhanced MRA, with a focus on contrast agents, methods of bolus timing, and considerations in imaging acquisition. Next, we cover the mechanism of contrast, strengths, and weaknesses of various noncontrast MRA techniques. Finally, we present an approach to protocol development and review representative protocols used at our institution for a variety of thoracic applications. Further attention will be devoted to additional techniques employed to address specific clinical questions, such as delayed contrast-enhanced imaging, provocative maneuvers, electrocardiogram and respiratory gating, and phase-contrast imaging. The purpose of this article is to review basic techniques and methodology in thoracic MRA, discuss an approach to protocol development, and illustrate commonly encountered pathology on thoracic MRA examinations. Level of Evidence 5 Technical Efficacy Stage 3.
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Affiliation(s)
- Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Anup S Shetty
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jordi Broncano
- Cardiothoracic Imaging Section, Health Time, Hospital de la Cruz Roja and San Juan de Dios, Cordoba, Spain
| | - Sanjeev Bhalla
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Constantine A Raptis
- Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA
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Abstract
Intravenous and intraarterial contrast media are invaluable tools in the diagnosis of anatomic lesions. However, they have been associated with deleterious renal events, ranging from acute kidney injury (iodinated contrast) to nephrogenic systemic fibrosis (gadolinium-containing agents). Contrast-associated acute kidney injury has a wide incidence, likely due to differences in populations studied, with incidence likely overstated due to comorbid conditions at the time of contrast exposure. Pathophysiology includes hemodynamic and direct toxic effects. Preventative strategies include intravenous saline administration, higher urine pH, and statin administration. Importantly, because of fears of contrast-associated acute kidney injury, practitioners may be selecting only the healthiest patients for contrast exposure. Gadolinium-based contrast agents may cause their toxicity through being unbound from their ligand, and certain preparations may be less harmful than others.
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Ayyala RS, Anupindi SA, Gee MS, Trout AT, Callahan MJ. Intravenous gadolinium-based hepatocyte-specific contrast agents (HSCAs) for contrast-enhanced liver magnetic resonance imaging in pediatric patients: what the radiologist should know. Pediatr Radiol 2019; 49:1256-1268. [PMID: 31350632 DOI: 10.1007/s00247-019-04476-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 06/13/2019] [Accepted: 07/09/2019] [Indexed: 12/15/2022]
Abstract
Hepatocyte-specific contrast agents (HSCAs) are a group of intravenous gadolinium-based MRI contrast agents that can be used to characterize hepatobiliary pathology. The mechanism by which these agents are taken up by hepatocytes and partially excreted into the biliary tree improves characterization of hepatic lesions and biliary abnormalities relative to conventional extracellular gadolinium-based contrast agents (GBCAs). This manuscript presents an overview of HSCA use in pediatric patients with the intent to provide radiologists a guide for clinical use. We review available HSCAs and discuss dosing and age specifications for use in children. We also review various hepatic and biliary indications for HSCA use in children, with emphasis on the imaging characteristics distinct to HSCAs, as well as discussion of pitfalls one can encounter when imaging with HSCAs. Given the growing concern regarding gadolinium deposition in soft tissues and brain, we also discuss safety of HSCA use in children.
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Affiliation(s)
- Rama S Ayyala
- Department of Diagnostic Imaging, Rhode Island Hospital - Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, 593 Eddy St., Providence, RI, 02903, USA.
| | - Sudha A Anupindi
- Department of Radiology, The Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Michael S Gee
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Andrew T Trout
- Department of Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Kim JW, Lee CH, Park YS, Lee J, Kim KA. Abbreviated Gadoxetic Acid-enhanced MRI with Second-Shot Arterial Phase Imaging for Liver Metastasis Evaluation. Radiol Imaging Cancer 2019; 1:e190006. [PMID: 33778670 PMCID: PMC7983790 DOI: 10.1148/rycan.2019190006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 04/16/2019] [Accepted: 04/23/2019] [Indexed: 05/15/2023]
Abstract
PURPOSE To evaluate the feasibility of an abbreviated gadoxetic acid-enhanced MRI protocol including second-shot arterial phase (SSAP) imaging for liver metastasis evaluation. MATERIALS AND METHODS For this retrospective study, a total of 197 patients with cancer (117 men and 80 women; mean age, 62.9 years) were included who underwent gadoxetic acid-enhanced MRI performed by using a modified injection protocol for liver metastasis evaluation from July to August 2017. The modified injection protocol included routine dynamic imaging after a first injection of 6 mL and SSAP imaging after a second injection of 4 mL. Image set 1 was obtained with the full original protocol. Image set 2 consisted of T2-weighted, diffusion-weighted, hepatobiliary phase, and SSAP images (the simulated abbreviated protocol). Acquisition time was measured in each image set. The diagnostic performance of each image set was compared by using a jackknife alternative free-response receiver operating characteristic analysis. Image quality evaluation and visual assessment of vascularity were performed on the original arterial phase images, the SSAP images, and their subtraction images. RESULTS The acquisition time was significantly shorter in image set 2 than in image set 1 (18.6 vs 6.2 minutes, P <.0001). The reader-averaged figure-of-merit was not significantly different between image sets 1 and 2 (P = .197). The mean motion artifact score was significantly lower for the SSAP images than for the original arterial phase images (P <.001). All hypervascular metastases (n = 72) showed hyperintensity on the SSAP and/or the second subtraction images. CONCLUSION An abbreviated MRI protocol including SSAP is feasible for liver metastasis evaluation, providing faster image acquisition while preserving diagnostic performance, image quality, and visual vascularity.Keywords: Abdomen/GI, Comparative Studies, Liver, MR-Imaging, Metastases© RSNA, 2019Supplemental material is available for this article.
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Modeling Gadoxetate Liver Uptake and Efflux Using Dynamic Contrast-Enhanced Magnetic Resonance Imaging Enables Preclinical Quantification of Transporter Drug-Drug Interactions. Invest Radiol 2019; 53:563-570. [PMID: 29771727 DOI: 10.1097/rli.0000000000000480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVES The aim of this study was to model the in vivo transporter-mediated uptake and efflux of the hepatobiliary contrast agent gadoxetate in the liver. The efficacy of the proposed technique was assessed for its ability to provide quantitative insights into drug-drug interactions (DDIs), using rifampicin as inhibitor. MATERIALS AND METHODS Three groups of C57 mice were scanned twice with a dynamic gadoxetate-enhanced magnetic resonance imaging protocol, using a 3-dimensional spoiled gradient-echo sequence for approximately 72 minutes. Before the second magnetic resonance imaging session, 2 of the groups received a rifampicin dose of 20 (n = 7) or 40 (n = 7) mg/kg, respectively. Data from regions of interest in the liver were analyzed using 2 simplifications of a 2-compartment uptake and efflux model to provide estimates for the gadoxetate uptake rate (ki) into the hepatocytes and its efflux rate (kef) into the bile. Both models were assessed for goodness-of-fit in the group without rifampicin (n = 9), and the appropriate model was selected for assessing the ability to monitor DDIs in vivo. RESULTS Seven of 9 mice from the group without rifampicin were assessed for model implementation and reproducibility. A simple 3 parameter model (ki, kef, and extracellular space, vecs) adequately described the observed liver concentration time series with mean ki = 0.47 ± 0.11 min and mean kef = 0.039 ± 0.016 min. Visually, the area under the liver concentration time profile was reduced for the groups receiving rifampicin. Furthermore, tracer kinetic modeling demonstrated a significant dose-dependent decrease in the uptake (5.9- and 17.3-fold decrease for 20 mg/kg and 40 mg/kg, respectively) and efflux rates (2.2- and 7.9-fold decrease) compared with the first scan for each group. CONCLUSIONS This study presents the first in vivo implementation of a 2-compartment uptake and efflux model to monitor DDIs at the transporter-protein level, using the clinically relevant organic anion transporting polypeptide inhibitor rifampicin. The technique has the potential to be a novel alternative to other methods, allowing real-time changes in transporter DDIs to be measured directly in vivo.
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10 Years of Nephrogenic Systemic Fibrosis: A Comprehensive Analysis of Nephrogenic Systemic Fibrosis Reports Received by a Pharmaceutical Company from 2006 to 2016. Invest Radiol 2019; 53:541-550. [PMID: 29547493 PMCID: PMC6092103 DOI: 10.1097/rli.0000000000000462] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Objectives The aim of this study was to critically assess the evaluation and categorization process for nephrogenic systemic fibrosis (NSF) based on reports received by Bayer from 2006 to 2016. Materials and Methods A total of 779 NSF reports received by Bayer globally from 2006 to 2016 were included in the analysis. Arlington Medical Resources provided gadolinium-based contrast agent (GBCA) market share. Reports were conservatively categorized based on the Cowper/Girardi criteria. A statistical model simulated the impact of market share and market introduction on the number of unconfounded reports. Results For all reports, reported onset of disease ranged from 1996 and 2012. Of 779 reports, 325 involved a Bayer product only, 208 involved only products from other companies (or unknown GBCA), and 246 involved both Bayer and non-Bayer products. Most of all reports (86%) originated from the United States. Through 2006, Magnevist and Omniscan dominated the US market (>80% combined market share). All other GBCAs with fewer NSF reports comprised the remaining combined market share of less than 20% or were introduced after May 2007, after safety recommendations came into effect. A total of 563 reports (220 single-agent and 343 multiagent reports) involved Magnevist. In at least 150 of the 343 reports, a different GBCA (Omniscan, 118; OptiMARK, 15; MultiHance, 6; and macrocyclic agent, 11) showed the closest temporal relationship to onset of NSF-like symptoms. The simulation model demonstrated that patients receiving a GBCA with lower market share and late market introduction are less likely to be observed in an unconfounded setting. Conclusions Year of market introduction, as well as US market share in 2000 to 2007, greatly influenced the absolute number of NSF reports for each GBCA, their a priori probability to cause NSF, as well as their a priori probability to be associated with unconfounded cases of NSF. Variability in case interpretation and pharmacovigilance approaches also influence the absolute number of unconfounded cases and should therefore not be used for comparative risk assessments. This should be primarily based on objective product parameters such as structure, stability, pharmacokinetics, and dose.
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Shet NS, Flynn JF, Maloney E, Iyer RS. Use of Eovist in Pediatric Patients: Pearls and Pitfalls. Curr Probl Diagn Radiol 2019; 49:266-274. [PMID: 31047739 DOI: 10.1067/j.cpradiol.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Accepted: 04/02/2019] [Indexed: 12/25/2022]
Abstract
Magnetic resonance imaging is excellent at characterizing pediatric hepatobiliary pathology. Noncontrast MRI is helpful due to T2 hyperintensity associated with bile, but contrast enhancement offers additional means of lesional characterization. In particular, hepatocyte-specific contrast agents such as gadoxetate disodium (Eovist) exhibit partial hepatobiliary excretion which may be leveraged in these contexts. In this review, we will discuss gadoxetate disodium usage, including a sample-imaging protocol, and demonstrate applications and limitations in the pediatric population.
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Affiliation(s)
- Narendra S Shet
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC.
| | - John F Flynn
- Division of Diagnostic Imaging and Radiology; Children's National Health System; Washington, DC
| | - Ezekiel Maloney
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
| | - Ramesh S Iyer
- Department of Radiology; Seattle Children's Hospital; Seattle, WA
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Zech CJ, Schwenke C, Endrikat J. Diagnostic Efficacy and Safety of Gadoxetate Disodium vs Gadobenate Dimeglumine in Patients With Known or Suspected Focal Liver Lesions: Results of a Clinical Phase III Study. MAGNETIC RESONANCE INSIGHTS 2019; 12:1178623X19827976. [PMID: 30799932 PMCID: PMC6379790 DOI: 10.1177/1178623x19827976] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 12/30/2018] [Indexed: 12/15/2022]
Abstract
Purpose: The aim of this study is to evaluate the diagnostic efficacy and safety of
gadoxetate disodium vs gadobenate dimeglumine in patients with known or
suspected focal liver lesions. Methods: This was a prospective, multicenter, double-blind, randomized,
inter-individual Phase III study. The primary target—technical efficacy—was
already published. Here, secondary efficacy parameters—sensitivity and
specificity—and safety in specific patient populations are presented.
Patients with suspected or known focal liver lesions scheduled for
contrast-enhanced liver magnetic resonance imaging (MRI) were recruited and
categorized in 4 a priori specified subgroups: (1) all patients, (2)
patients with liver cancer (hepatocellular carcinoma [HCC]), (3) patients
with cirrhosis, and (4) patients with HCC + cirrhosis. Dual multi-detector
liver computed tomography (CT) served as standard of reference. Results: A total of 295 patients were included. While the overall increase in
sensitivity across all 4 patient groups was comparable for gadoxetate
disodium (increase from pre- to post-contrast ranging from 6.2% to 9.9%) and
gadobenate dimeglumine (ranging from −2.9% to 10.0%), significant
differences were seen for some of the subgroups. There was a significantly
higher increase in sensitivity for gadoxetate disodium in patients with HCC
(7%) and HCC + cirrhosis (12.8%) in comparison with gadobenate dimeglumine.
Specificity decreased for both agents: gadoxetate disodium by −2.8% to −6.3%
and gadobenate dimeglumine by −3.3% to −8.7%. Gadoxetate showed a
significantly lower loss of specificity in all subgroups. Safety was
comparable in both groups. Conclusions: Gadoxetate disodium proved to be an effective liver-specific MRI contrast
agent. Some distinct advantages over gadobenate dimeglumine were
demonstrated in patients with HCC and patients with HCC + liver cirrhosis
for sensitivity and specificity in liver lesion detection.
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Affiliation(s)
- Christoph J Zech
- Department for Radiology and Nuclear
Medicine, University Hospital Basel, Basel, Switzerland
| | | | - Jan Endrikat
- Bayer AG, Radiology, Berlin,
Germany
- Department of Gynecology, Obstetrics and
Reproductive Medicine, University Medical School of Saarland, Homburg/Saar,
Germany
- Jan Endrikat, Bayer AG, Radiology,
Müllerstr. 178, 13353 Berlin, Germany.
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Second shot arterial phase to overcome degraded hepatic arterial phase in liver MR imaging. Eur Radiol 2018; 29:2821-2829. [DOI: 10.1007/s00330-018-5897-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Revised: 10/23/2018] [Accepted: 11/19/2018] [Indexed: 12/12/2022]
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Young LK, Matthew SZ, Houston JG. Absence of potential gadolinium toxicity symptoms following 22,897 gadoteric acid (Dotarem®) examinations, including 3,209 performed on renally insufficient individuals. Eur Radiol 2018; 29:1922-1930. [PMID: 30276674 PMCID: PMC6420614 DOI: 10.1007/s00330-018-5737-z] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 08/14/2018] [Accepted: 08/28/2018] [Indexed: 12/12/2022]
Abstract
Objectives Recent safety concerns regarding gadolinium-based contrast agents (GdCAs) concluded with the suspension of some agents from the European market, yet a clinical consequence remains unknown. We used electronic health records to investigate the incidence of potential toxicity to gadoteric acid (Dotarem®) within our local population, including those with renal insufficiency (RI). Methods Data for patients who underwent contrast-enhanced MRI were identified, stratified by renal function at time of scan and retrospectively followed using routinely collected health data. Searches performed were: records of hypersensitivity reactions; diagnoses of nephrogenic systemic fibrosis (NSF); onset of chronic pain, a symptom that has been associated with NSF and the theorised gadolinium deposition disease (GDD); and post-contrast acute kidney injury (PC-AKI). Comparisons were made between patients and controls (those who underwent non-contrast scans) via chi-square and ANOVA statistical tests. Results Of the 22,897 contrast-enhanced MRI scans performed locally from 2004–2016 (adult, n = 22,325 and paediatric, n = 572), 14% were performed on patients with RI (30 ≤ eGFR < 60, n = 2,622; 15 ≤ eGFR < 30, n = 464; eGFR < 15, n = 123). Two adult patients (0.01%) suffered hypersensitivity reactions. Zero cases of NSF were reported, with an average follow-up time of 6.0 ± 2.5 years (range, 8 months–15 years). Analysis failed to highlight statistically higher rates of chronic pain onset post-MRI (adult: p = 0.777, paediatric: p = 0.578), or PC-AKI (adult: p = 0.566, paediatric: p = 0.841), in the patient groups compared to controls. Conclusions These data indicate that administration of gadoteric acid to RI patients does not result in a higher rate of signs or symptoms that may be associated with gadolinium toxicity when compared to controls. Key Points • Following 22,897 administrations of gadoteric acid to a local population, there was no association with symptoms that may be associated with gadolinium toxicity. • Zero cases of nephrogenic systemic fibrosis were reported following 3,209 gadoteric acid administrations to a cohort of renally insufficient patients. • A low number of hypersensitivity reactions were observed (0.01%) and no higher rate of chronic pain or post-contrast acute kidney injury were noted when compared with a control cohort of non-contrast-enhanced examinations.
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Affiliation(s)
- Laura K Young
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - Shona Z Matthew
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK
| | - J Graeme Houston
- Division of Molecular and Clinical Medicine, School of Medicine, University of Dundee, Ninewells Hospital and Medical School, Dundee, DD1 9SY, UK.
- Clinical Radiology, NHS Tayside, Ninewells Hospital and Medical School, Dundee, UK.
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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: 63] [Impact Index Per Article: 10.5] [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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Martin DR, Kalb B, Mittal A, Salman K, Vedantham S, Mittal PK. No Incidence of Nephrogenic Systemic Fibrosis after Gadobenate Dimeglumine Administration in Patients Undergoing Dialysis or Those with Severe Chronic Kidney Disease. Radiology 2018; 286:113-119. [PMID: 28731375 DOI: 10.1148/radiol.2017170102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Diego R. Martin
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Bobby Kalb
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Ankush Mittal
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Khalil Salman
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Srinivasan Vedantham
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Pardeep K. Mittal
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
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Bruce R, Wentland AL, Haemel AK, Garrett RW, Sadowski DR, Djamali A, Sadowski EA. Incidence of Nephrogenic Systemic Fibrosis Using Gadobenate Dimeglumine in 1423 Patients With Renal Insufficiency Compared With Gadodiamide. Invest Radiol 2017; 51:701-705. [PMID: 26885631 DOI: 10.1097/rli.0000000000000259] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the incidence of nephrogenic systemic fibrosis (NSF) before and after educational interventions, implementation of a clinical screening process, and change to gadobenate dimeglumine in patients who had an estimated glomerular filtration rate (eGFR) of 30 mL/min per 1.72 m or less. METHODS This is a Health Insurance Portability and Accountability Act compliant, institutional review board exempt study. Two periods were studied-July 2005 to June 2006, during which gadodiamide was utilized as our magnetic resonance (MR) contrast agent, and November 2006 to August 2014, during which gadobenate dimeglumine was used as our MR contrast agent in patients who had an eGFR 30 mL/min per 1.72 m or less. In addition to a change in the MR contrast agent, education of our staff physician to the risks of NSF with MR contrast agents and the implementation of a clinical screening process occurred. The rate of NSF before and after the interventions was compared using the χ test. RESULTS There was a statistically significant difference in the incidence of NSF in patients with an eGFR 30 mL/min per 1.72 m or less between the 2 periods: July 2005 to June 2006, 6 of 246 patients were diagnosed with NSF (P < 0.001), versus November 2006 to August 2014, 0 of 1423 patients were diagnosed with NSF. CONCLUSIONS Our data demonstrates a marked decrease in the incidence of NSF after education of our referring physicians, implementation of clinical screening process, and change to gadobenate dimeglumine from gadodiamide in patients with renal insufficiency. This approach potentially provides an acceptable risk-benefit profile for patients with renal insufficiency that required MR imaging for clinical care.
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Affiliation(s)
- Richard Bruce
- From the Departments of *Radiology, and †Medical Physics, University of Wisconsin, Madison, WI; ‡Department of Dermatology, University of California San Francisco, San Francisco, CA; §Department of Radiology, Saint Louis University, Saint Louis, MO; ∥Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, IL; Departments of ¶Medicine, and #Obstetrics and Gynecology, University of Wisconsin, Madison, WI
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Effects of serial macrocyclic-based contrast materials gadoterate meglumine and gadobutrol administrations on gadolinium-related dentate nuclei signal increases in unenhanced T1-weighted brain: a retrospective study in 158 multiple sclerosis (MS) patients. Radiol Med 2017; 123:125-134. [PMID: 28952018 DOI: 10.1007/s11547-017-0816-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To perform T1 signal intensity (SI) measurements in the dentate nuclei of adult patients with confirmed multiple sclerosis (MS) after serial administrations of the macrocyclic gadolinium-based contrast agents (GBCAs), gadoterate meglumine and gadobutrol. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and informed consent was waived. A review of our PACS database for the period from March 1, 2007 to July 31, 2016 revealed 158 confirmed MS patients who received exclusively either gadoterate meglumine (n = 81) or gadobutrol (n = 77) for diagnosis and follow-up. SI measurements on unenhanced T1-weighted images were performed on all scans of all patients and at regions of interest (ROIs) positioned on the dentate nucleus (DN) and pons. The dentate nucleus-to-pons (DNP) T1-SI ratio was subsequently calculated. Unpaired T test and regression analysis were used to evaluate statistical differences. RESULTS An increase in DNP was noted between the first and last MR examinations for both gadoterate meglumine (0.0032 ± 0.0216) and gadobutrol (0.0019 ± 0.0346). Although the differences were not statistically significant based across the entire patient population, visible T1 hyperintensity in the DN was noted in approximately one-third of all patients in each group that received at least five administrations of either GBCA. CONCLUSIONS SI increases on unenhanced T1-weighted images possibly indicative of gadolinium retention occur after serial administrations of the macrocyclic GBCAs, gadoterate meglumine and gadobutrol.
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Gale EM, Caravan P, Rao AG, McDonald RJ, Winfeld M, Fleck RJ, Gee MS. Gadolinium-based contrast agents in pediatric magnetic resonance imaging. Pediatr Radiol 2017; 47:507-521. [PMID: 28409250 DOI: 10.1007/s00247-017-3806-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/16/2016] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
Gadolinium-based contrast agents can increase the accuracy and expediency of an MRI examination. However the benefits of a contrast-enhanced scan must be carefully weighed against the well-documented risks associated with administration of exogenous contrast media. The purpose of this review is to discuss commercially available gadolinium-based contrast agents (GBCAs) in the context of pediatric radiology. We discuss the chemistry, regulatory status, safety and clinical applications, with particular emphasis on imaging of the blood vessels, heart, hepatobiliary tree and central nervous system. We also discuss non-GBCA MRI contrast agents that are less frequently used or not commercially available.
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Affiliation(s)
- Eric M Gale
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Caravan
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anil G Rao
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Robert J McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew Winfeld
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert J Fleck
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, MassGeneral Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
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Adverse Effects of Gadolinium-Based Contrast Agents: Changes in Practice Patterns. Top Magn Reson Imaging 2017; 25:163-9. [PMID: 27367314 DOI: 10.1097/rmr.0000000000000095] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Gadolinium-based contrast agents have been used for magnetic resonance imaging (MRI) examinations since the late 1980s with an excellent overall cumulative safety record. Initially favored for use in patients with renal impairment because of lack of significant nephrotoxic effect at clinical doses, in 2006, multiple reports convincingly linked the rare but serious disease nephrogenic systemic fibrosis to the administration of gadolinium-based contrast agents in patients with severe renal failure. This in turn led to new policies on administration of these agents, resulting in changes in practice patterns that have virtually resulted in the elimination of the disease after the year 2009. The purpose of this review is to summarize the factors that led to the emergence of nephrogenic systemic fibrosis, including the risk associated with different types of contrast agents based on their stability, and the changes in practice patterns and usage of gadolinium-based contrast agents in recent years that have been mainly driven by the discovery and association with nephrogenic systemic fibrosis. The article will conclude with a brief overview of new emerging safety concerns that could further impact the use of this class of contrast agents and impact practice patterns in the future.
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Abstract
Objective The aim of this study was to assess the potential risk of gadobutrol-enhanced magnetic resonance imaging (MRI) in patients with moderate to severe renal impairment for the development of nephrogenic systemic fibrosis (NSF). Materials and Methods We performed a prospective, international, multicenter, open-label study in 55 centers. Patients with moderate to severe renal impairment scheduled for any gadobutrol-enhanced MRI were included. All patients received a single intravenous bolus injection of gadobutrol at a dose of 0.1 mmol/kg body weight. The primary target variable was the number of patients who develop NSF within a 2-year follow-up period. Results A total of 908 patients were enrolled, including 586 with moderate and 284 with severe renal impairment who are at highest risk for developing NSF. The mean time since renal disease diagnosis was 1.83 and 5.49 years in the moderate and severe renal impairment cohort, respectively. Overall, 184 patients (20.3%) underwent further contrast-enhanced MRI with other gadolinium-based contrast agents within the 2-year follow-up. No patient developed symptoms conclusive of NSF. Conclusions No safety concerns with gadobutrol in patients with moderate to severe renal impairment were identified. There were no NSF cases.
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Fraum TJ, Ludwig DR, Bashir MR, Fowler KJ. Gadolinium-based contrast agents: A comprehensive risk assessment. J Magn Reson Imaging 2017; 46:338-353. [PMID: 28083913 DOI: 10.1002/jmri.25625] [Citation(s) in RCA: 229] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Accepted: 12/21/2016] [Indexed: 12/22/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) have been used in magnetic resonance imaging (MRI) since the 1980s and are now administered in up to 35% of all MRI examinations. While GBCAs were initially felt to carry minimal risk, the subsequent identification of GBCAs as the key etiologic factor in the development of nephrogenic systemic fibrosis (NSF) has raised concerns about the broader health impacts of gadolinium exposure. Clinicians, radiologists, and patients should be aware of the most up-to-date data pertaining to the risks of GBCA administration. Specific issues covered in this review article include immediate adverse reactions; pregnancy and lactation; and gadolinium deposition and toxicity, with a special focus on NSF. Practice recommendations based on the presented data, as well as current professional society guidelines, are provided for each section. LEVEL OF EVIDENCE 1 Technical Efficacy: Stage 5 J. MAGN. RESON. IMAGING 2017;46:338-353.
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Affiliation(s)
- Tyler J Fraum
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Daniel R Ludwig
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Durham, North Carolina, USA.,Center for Advanced Magnetic Resonance Development, Duke University Medical Center, Durham, North Carolina, USA
| | - Kathryn J Fowler
- Mallinckrodt Institute of Radiology, Washington University, Saint Louis, Missouri, USA
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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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Novel Dynamic Hepatic Magnetic Resonance Imaging Strategy Using Advanced Parallel Acquisition, Rhythmic Breath-Hold Technique, and Gadoxetate Disodium Enhancement. Invest Radiol 2016; 51:33-40. [DOI: 10.1097/rli.0000000000000203] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Starmans LWE, Hummelink MAPM, Rossin R, Kneepkens ECM, Lamerichs R, Donato K, Nicolay K, Grüll H. 89 Zr- and Fe-Labeled Polymeric Micelles for Dual Modality PET and T 1 -Weighted MR Imaging. Adv Healthc Mater 2015; 4:2137-2145. [PMID: 26333024 DOI: 10.1002/adhm.201500414] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2015] [Revised: 07/05/2015] [Indexed: 02/01/2023]
Abstract
In this study, a new 89 Zr- and Fe3+ -labeled micelle nanoplatform (89 Zr/Fe-DFO-micelles) for dual modality position emission tomography/magnetic resonance (PET/MR) imaging is investigated. The nanoplatform consists of self-assembling amphiphilic diblock copolymers that are functionalized with 89 Zr-deferoxamine (89 Zr-DFO) and Fe3+ -deferoxamine (Fe-DFO) for PET and MR purposes, respectively. 89 Zr displays favorable PET imaging characteristics with a 3.3 d half-life suitable for imaging long circulating nanoparticles. The nanoparticles are modified with Fe-DFO as MR T1 -contrast label instead of commonly used Gd3+ -based chelates. As these micelles are cleared by liver and spleen, any long term Gd- related toxicity such as nephrogenic systemic fibrosis is avoided. As a proof of concept, an in vivo PET/MR study in mice is presented showing tumor targeting of 89 Zr/Fe-DFO-micelles through the enhanced permeability and retention (EPR) effect of tumors, yielding high tumor-to-blood (10.3 ± 3.6) and tumor-to-muscle (15.3 ± 8.1) ratios at 48 h post injection. In vivo PET images clearly delineate the tumor tissue and show good correspondence with ex vivo biodistribution results. In vivo magnetic resonance imaging (MRI) allows visualization of the intratumoral distribution of the 89 Zr/Fe-DFO-micelles at high resolution. In summary, the 89 Zr/Fe-DFO-micelle nanoparticulate platform allows EPR-based tumor PET/MRI, and, furthermore, holds great potential for PET/MR image guided drug delivery.
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Affiliation(s)
- Lucas W. E. Starmans
- Biomedical Engineering; Eindhoven University of Technology; 5656 AE Eindhoven The Netherlands
| | | | - Raffaella Rossin
- Oncology Solutions; Philips Research; 5656 AE Eindhoven The Netherlands
| | - Esther C. M. Kneepkens
- Biomedical Engineering; Eindhoven University of Technology; 5656 AE Eindhoven The Netherlands
| | - Rolf Lamerichs
- Oncology Solutions; Philips Research; 5656 AE Eindhoven The Netherlands
| | - Katia Donato
- Oncology Solutions; Philips Research; 5656 AE Eindhoven The Netherlands
| | - Klaas Nicolay
- Biomedical Engineering; Eindhoven University of Technology; 5656 AE Eindhoven The Netherlands
| | - Holger Grüll
- Biomedical Engineering; Eindhoven University of Technology; 5656 AE Eindhoven The Netherlands
- Oncology Solutions; Philips Research; 5656 AE Eindhoven The Netherlands
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