1
|
Melbourne A, Schabel MC, David AL, Roberts VHJ. Magnetic resonance imaging of placental intralobule structure and function in a preclinical nonhuman primate model†. Biol Reprod 2024; 110:1065-1076. [PMID: 38442734 PMCID: PMC11180614 DOI: 10.1093/biolre/ioae035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 01/25/2024] [Accepted: 03/04/2024] [Indexed: 03/07/2024] Open
Abstract
Although the central role of adequate blood flow and oxygen delivery is known, the lack of optimized imaging modalities to study placental structure has impeded our understanding of its vascular function. Magnetic resonance imaging is increasingly being applied in this field, but gaps in knowledge remain, and further methodological developments are needed. In particular, the ability to distinguish maternal from fetal placental perfusion and the understanding of how individual placental lobules are functioning are lacking. The potential clinical benefits of developing noninvasive tools for the in vivo assessment of blood flow and oxygenation, two key determinants of placental function, are tremendous. Here, we summarize a number of structural and functional magnetic resonance imaging techniques that have been developed and applied in animal models and studies of human pregnancy over the past decade. We discuss the potential applications and limitations of these approaches. Their combination provides a novel source of contrast to allow analysis of placental structure and function at the level of the lobule. We outline the physiological mechanisms of placental T2 and T2* decay and devise a model of how tissue composition affects the observed relaxation properties. We apply this modeling to longitudinal magnetic resonance imaging data obtained from a preclinical pregnant nonhuman primate model to provide initial proof-of-concept data for this methodology, which quantifies oxygen transfer and placental structure across and between lobules. This method has the potential to improve our understanding and clinical management of placental insufficiency once validation in a larger nonhuman primate cohort is complete.
Collapse
Affiliation(s)
- Andrew Melbourne
- School of Biomedical Engineering and Imaging Sciences, King’s College London, London, UK
- Department of Obstetrics and Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA
- Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, Utah, USA
| | - Anna L David
- Department of Obstetrics and Maternal Fetal Medicine, Elizabeth Garrett Anderson Institute for Women’s Health, University College London, London, UK
| | - Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Portland, OR, USA
| |
Collapse
|
2
|
Rovira À, Doniselli FM, Auger C, Haider L, Hodel J, Severino M, Wattjes MP, van der Molen AJ, Jasperse B, Mallio CA, Yousry T, Quattrocchi CC. Use of gadolinium-based contrast agents in multiple sclerosis: a review by the ESMRMB-GREC and ESNR Multiple Sclerosis Working Group. Eur Radiol 2024; 34:1726-1735. [PMID: 37658891 DOI: 10.1007/s00330-023-10151-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/06/2023] [Accepted: 07/12/2023] [Indexed: 09/05/2023]
Abstract
Magnetic resonance imaging (MRI) is the most sensitive technique for detecting inflammatory demyelinating lesions in multiple sclerosis (MS) and plays a crucial role in diagnosis and monitoring treatment effectiveness, and for predicting the disease course. In clinical practice, detection of MS lesions is mainly based on T2-weighted and contrast-enhanced T1-weighted sequences. Contrast-enhancing lesions (CEL) on T1-weighted sequences are related to (sub)acute inflammation, while new or enlarging T2 lesions reflect the permanent footprint from a previous acute inflammatory demyelinating event. These two types of MRI features provide redundant information, at least in regular monitoring of the disease. Due to the concern of gadolinium deposition after repetitive injections of gadolinium-based contrast agents (GBCAs), scientific organizations and regulatory agencies in Europe and North America have proposed that these contrast agents should be administered only if clinically necessary. In this article, we provide data on the mode of action of GBCAs in MS, the indications of the use of these agents in clinical practice, their value in MS for diagnostic, prognostic, and monitoring purposes, and their use in specific populations (children, pregnant women, and breast-feeders). We discuss imaging strategies that achieve the highest sensitivity for detecting CELs in compliance with the safety regulations established by different regulatory agencies. Finally, we will briefly discuss some alternatives to the use of GBCA for detecting blood-brain barrier disruption in MS lesions. CLINICAL RELEVANCE STATEMENT: Although use of GBCA at diagnostic workup of suspected MS is highly valuable for diagnostic and prognostic purposes, their use in routine monitoring is not mandatory and must be reduced, as detection of disease activity can be based on the identification of new or enlarging lesions on T2-weighted images. KEY POINTS: • Both the EMA and the FDA state that the use of GBCA in medicine should be restricted to clinical scenarios in which the additional information offered by the contrast agent is required. • The use of GBCA is generally recommended in the diagnostic workup in subjects with suspected MS and is generally not necessary for routine monitoring in clinical practice. • Alternative MRI-based approaches for detecting acute focal inflammatory MS lesions are not yet ready to be used in clinical practice.
Collapse
Affiliation(s)
- Àlex Rovira
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain.
| | - Fabio M Doniselli
- Neuroradiology Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Milan, Italy
| | - Cristina Auger
- Section of Neuroradiology, Department of Radiology, University Hospital Vall d'Hebron, Autonomous University of Barcelona, Barcelona, Spain
| | - Lukas Haider
- Department of Biomedical Imaging and Image Guided Therapy, Medical University of Vienna, Vienna, Austria
- Queen Square Multiple Sclerosis Centre, Department of Neuroinflammation, UCL Queen Square Institute of Neurology, University College London, London, UK
| | - Jerome Hodel
- Department of Radiology, Groupe Hospitalier Paris-Saint Joseph, Paris, France
| | | | - Mike P Wattjes
- Department of Diagnostic and Interventional Neuroradiology, Hannover Medical School, Hannover, Germany
| | | | - Bas Jasperse
- Department of Radiology and Nuclear Medicine, MS Center Amsterdam, Amsterdam University Medical Center, Amsterdam, Netherlands
| | - Carlo A Mallio
- Fondazione Policlinico Universitario Campus Bio-Medico, Rome, Italy
- Research Unit of Radiology, Department of Medicine and Surgery, Università Campus Bio-Medico Di Roma, Rome, Italy
| | - Tarek Yousry
- Lysholm Department of Neuroradiology, UCLH National Hospital for Neurology and Neurosurgery, Neuroradiological Academic Unit, UCL Institute of Neurology, London, UK
| | - Carlo C Quattrocchi
- Centre for Medical Sciences CISMed, University of Trento, Trento, Italy
- Radiology, Multizonal Unit of Rovereto and Arco, APSS Provincia Autonoma Di Trento, Trento, Italy
| |
Collapse
|
3
|
Gomez EN, Ahmed TM, Macura K, Fishman EK, Vaught AJ. CT angiography for characterization of advanced placenta accreta spectrum: indications, risks, and benefits. Abdom Radiol (NY) 2024; 49:842-854. [PMID: 37987857 DOI: 10.1007/s00261-023-04105-7] [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: 07/19/2023] [Revised: 10/12/2023] [Accepted: 10/18/2023] [Indexed: 11/22/2023]
Abstract
Placenta accreta spectrum disorder (PASD) encompasses various types of abnormal placentation in which chorionic villi directly adhere to or invade the myometrium. The incidence of PASD has dramatically risen in the US over the past 3 decades owing to the increased rates of patients undergoing cesarean sections. While PASD remains a significant cause of maternal morbidity and mortality, accurate prenatal identification and characterization of PASD is associated with improved outcomes. Although ultrasound is the first-line imaging modality in the evaluation of PASD, with MRI serving as an adjunct, computed tomography angiography (CTA) may also offer unique diagnostic advantages in cases of advanced PASD by providing superior visualization of placental and abdominopelvic vasculature and enabling the creation of comprehensive vascular maps to roadmap complex surgical interventions. This paper represents the first evaluation of CTA as a diagnostic tool and operative planning aid in this context. Appropriate indications and diagnostic advantages of CTA in this setting are reviewed, and key multimodal imaging features of normal and abnormal placentation are highlighted.
Collapse
Affiliation(s)
- Erin N Gomez
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA.
| | - Taha M Ahmed
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Katarzyna Macura
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Elliot K Fishman
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, JHOC 3150, 601 N Caroline St, Baltimore, MD, 21287, USA
| | - Arthur J Vaught
- Division of Maternal Fetal Medicine, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, Baltimore, MD, 21205, USA
| |
Collapse
|
4
|
Tarui T, Gimovsky AC, Madan N. Fetal neuroimaging applications for diagnosis and counseling of brain anomalies: Current practice and future diagnostic strategies. Semin Fetal Neonatal Med 2024; 29:101525. [PMID: 38632010 PMCID: PMC11156536 DOI: 10.1016/j.siny.2024.101525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
Advances in fetal brain neuroimaging, especially fetal neurosonography and brain magnetic resonance imaging (MRI), allow safe and accurate anatomical assessments of fetal brain structures that serve as a foundation for prenatal diagnosis and counseling regarding fetal brain anomalies. Fetal neurosonography strategically assesses fetal brain anomalies suspected by screening ultrasound. Fetal brain MRI has unique technological features that overcome the anatomical limits of smaller fetal brain size and the unpredictable variable of intrauterine motion artifact. Recent studies of fetal brain MRI provide evidence of improved diagnostic and prognostic accuracy, beginning with prenatal diagnosis. Despite technological advances over the last several decades, the combined use of different qualitative structural biomarkers has limitations in providing an accurate prognosis. Quantitative analyses of fetal brain MRIs offer measurable imaging biomarkers that will more accurately associate with clinical outcomes. First-trimester ultrasound opens new opportunities for risk assessment and fetal brain anomaly diagnosis at the earliest time in pregnancy. This review includes a case vignette to illustrate how fetal brain MRI results interpreted by the fetal neurologist can improve diagnostic perspectives. The strength and limitations of conventional ultrasound and fetal brain MRI will be compared with recent research advances in quantitative methods to better correlate fetal neuroimaging biomarkers of neuropathology to predict functional childhood deficits. Discussion of these fetal sonogram and brain MRI advances will highlight the need for further interdisciplinary collaboration using complementary skills to continue improving clinical decision-making following precision medicine principles.
Collapse
Affiliation(s)
- Tomo Tarui
- Pediatric Neurology, Pediatrics, Hasbro Children's Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA.
| | - Alexis C Gimovsky
- Maternal Fetal Medicine, Obstetrics and Gynecology, Women & Infants Hospital of Rhode Island, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Neel Madan
- Neuroradiology, Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
5
|
Coyte RM, Darrah T, Olesik J, Barrett E, O'Connor TG, Brunner J, Love T, Perez-D'Gregorio R, Wang HZ, Aleksunes LM, Buckley B, Doherty C, Miller RK. Gadolinium during human pregnancy following administration of gadolinium chelate before pregnancy. Birth Defects Res 2023; 115:1264-1273. [PMID: 37334869 DOI: 10.1002/bdr2.2209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 05/18/2023] [Accepted: 05/31/2023] [Indexed: 06/21/2023]
Abstract
Gadolinium (Gd), a toxic rare earth element, has been shown to dissociate from chelating agents and bioaccumulate within tissues, raising concerns about the possibility of their remobilization during pregnancy with subsequent free Gd exposures to developing fetuses. Gd chelates are among the most commonly used magnetic resonance imaging (MRI) contrast agents. This investigation was undertaken after the detection of elevated Gd (800-1000× higher than the usual rare earth element levels) in preliminary unpublished studies from the placentae of subjects in the NIH ECHO/UPSIDE Rochester Cohort Study and unpublished studies from placentae analyzed in formalin-fixed placental specimens from Surgical Pathology at the University of Rochester. Fifteen pregnancies with elevated Gd were studied (12 first pregnancies and 3 second pregnancies). Maternal bloods were collected from all three trimesters, maternal, and cord (fetal) bloods at delivery as well as placental tissue. Breastmilk was also collected from selected mothers. It was determined that Gd was present in maternal bloods from all three trimesters, and in cord bloods and breastmilk in both first and second pregnancies. These results emphasize the need to fully appreciate the implications of pre-pregnancy exposure to Gd chelates and its potential effects on maternal and fetal health.
Collapse
Affiliation(s)
- Rachel M Coyte
- School of Earth Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Thomas Darrah
- School of Earth Sciences, The Ohio State University, Columbus, Ohio, USA
- Global Water Institute, The Ohio State University, Columbus, Ohio, USA
| | - John Olesik
- School of Earth Sciences, The Ohio State University, Columbus, Ohio, USA
| | - Emily Barrett
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Biostatistics and Epidemiology, Rutgers School of Public Health; Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Thomas G O'Connor
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Psychiatry, University of Rochester, School of Medicine and Dentistry, Rochester, New York, USA
- Department of Neuroscience, University of Rochester, School of Medicine and Dentistry, Rochester, New York, USA
| | - Jessica Brunner
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Tanzy Love
- Department of Biostatistics and Computational Biology, University of Rochester, Rochester, New York, USA
| | - Rogelio Perez-D'Gregorio
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Henry Z Wang
- Department of Imaging Science, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Lauren M Aleksunes
- Department of Pharmacology and Toxicology, Rutgers University, Piscataway, New Jersey, USA
| | - Brian Buckley
- Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Cathleen Doherty
- Environmental and Occupational Health Sciences Institute, Piscataway, New Jersey, USA
| | - Richard K Miller
- Department of Obstetrics and Gynecology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Pathology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
- Department of Environmental Medicine, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| |
Collapse
|
6
|
Mervak BM, Sakala MD. Beyond the AJR: In Utero Exposure to Gadolinium-Based Contrast Agents May Not Increase Rates of Stillbirth or Neonatal Death or ICU Admission. AJR Am J Roentgenol 2023; 221:280. [PMID: 36598097 DOI: 10.2214/ajr.22.28891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- Benjamin M Mervak
- Department of Radiology, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| | - Michelle D Sakala
- Department of Radiology, Michigan Medicine, 1500 E Medical Center Dr, Ann Arbor, MI 48109
| |
Collapse
|
7
|
Wilson RC, Lo JO, Romero Jimenez G, Lindner JR, Slayden OD, Roberts VHJ. Utilizing Contrast-Enhanced Ultrasonography with Phosphatidylserine Microbubbles to Detect Placental Inflammation in Rhesus Macaques. Molecules 2023; 28:2894. [PMID: 37049657 PMCID: PMC10096139 DOI: 10.3390/molecules28072894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 04/14/2023] Open
Abstract
The ability to comprehensively monitor physiological and detect pathophysiologic processes early during pregnancy can reduce maternal and fetal morbidity and mortality. Contrast-enhanced ultrasound (CEUS) is a non-invasive imaging technology that utilizes the acoustic detection of microbubbles to examine vascular spaces. Furthermore, microbubbles conjugated to specific compounds can focus studies on precise physiological pathways. We hypothesized that CEUS with phosphatidylserine microbubbles (MB-PS) could be employed to monitor placental inflammation. We tested this hypothesis in rhesus macaques (Macaca mulatta), a translational and relevant animal model of human placental health. As placental inflammation impacts many at-risk pregnancies, we performed CEUS with MB-PS in pregnant macaques fed a high-fat diet (e.g., a western-style diet, WSD) in the presence or absence of testosterone (T) to mimic the increased risk of polycystic ovary syndrome and subfertility. We have previously demonstrated a placental inflammation phenotype in this model, and, thus, we related the MB-PS CEUS signal intensity to placental inflammation markers: selectin p and angiopoietins. Testosterone exposure increased the MB-PS signal in the placental microcirculation on the maternal side compared to control animals. We found that T increased placental weight and decreased angiopoietin 2 (ANGPT2) immunoreactivity. Furthermore, a significant inverse correlation was found between MB-PS signal and ANGPT2. This indicated that CEUS with MB-PS can be used to monitor placental parameters. We propose that CEUS with MB-PS could aid in the identification of pregnancies at risk of placental vascular compromise.
Collapse
Affiliation(s)
- Rachel C. Wilson
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Jamie O. Lo
- Department of Obstetrics and Gynecology, Oregon Health and Science University, Portland, OR 97239, USA
| | - Gabriel Romero Jimenez
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Jonathan R. Lindner
- Cardiovascular Division, University of Virginia Medical Center, Charlottesville, VA 22903, USA
| | - Ov D. Slayden
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| | - Victoria H. J. Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Beaverton, OR 97006, USA
| |
Collapse
|
8
|
Watson RE, Yu L. Safety Considerations in MRI and CT. Continuum (Minneap Minn) 2023; 29:27-53. [PMID: 36795872 DOI: 10.1212/con.0000000000001213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
OBJECTIVE MRI and CT are indispensable imaging modalities for the evaluation of patients with neurologic disease, and each is particularly well suited to address specific clinical questions. Although both of these imaging modalities have excellent safety profiles in clinical use as a result of concerted and dedicated efforts, each has potential physical and procedural risks that the practitioner should be aware of, which are described in this article. LATEST DEVELOPMENTS Recent advancements have been made in understanding and reducing safety risks with MR and CT. The magnetic fields in MRI create risks for dangerous projectile accidents, radiofrequency burns, and deleterious interactions with implanted devices, and serious patient injuries and deaths have occurred. Ionizing radiation in CT may be associated with shorter-term deterministic effects on biological tissues at extremely high doses and longer-term stochastic effects related to mutagenesis and carcinogenesis at low doses. The cancer risk of radiation exposure in diagnostic CT is considered extremely low, and the benefit of an appropriately indicated CT examination far outweighs the potential risk. Continuing major efforts are centered on improving image quality and the diagnostic power of CT while concurrently keeping radiation doses as low as reasonably achievable. ESSENTIAL POINTS An understanding of these MRI and CT safety issues that are central to contemporary radiology practice is essential for the safe and effective treatment of patients with neurologic disease.
Collapse
|
9
|
Lo JO, Schabel MC, Gaffney J, Lewandowski KS, Kroenke CD, Roberts CT, Scottoline BP, Frias AE, Sullivan EL, Roberts VHJ. Impaired placental hemodynamics and function in a non-human primate model of gestational protein restriction. Sci Rep 2023; 13:841. [PMID: 36646824 PMCID: PMC9842719 DOI: 10.1038/s41598-023-28051-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/11/2023] [Indexed: 01/18/2023] Open
Abstract
Maternal malnutrition increases fetal and neonatal morbidity, partly by affecting placental function and morphology, but its impact on placental hemodynamics are unknown. Our objective was to define the impact of maternal malnutrition on placental oxygen reserve and perfusion in vivo in a rhesus macaque model of protein restriction (PR) using advanced imaging. Animals were fed control (CON, 26% protein), 33% PR diet (17% protein), or a 50% PR diet (13% protein, n = 8/group) preconception and throughout pregnancy. Animals underwent Doppler ultrasound and fetal biometry followed by MRI at gestational days 85 (G85) and 135 (G135; term is G168). Pregnancy loss rates were 0/8 in CON, 1/8 in 33% PR, and 3/8 in 50% PR animals. Fetuses of animals fed a 50% PR diet had a smaller abdominal circumference (G135, p < 0.01). On MRI, placental blood flow was decreased at G135 (p < 0.05) and placental oxygen reserve was reduced (G85, p = 0.05; G135, p = 0.01) in animals fed a 50% PR diet vs. CON. These data demonstrate that a 50% PR diet reduces maternal placental perfusion, decreases fetal oxygen availability, and increases fetal mortality. These alterations in placental hemodynamics may partly explain human growth restriction and stillbirth seen with severe PR diets in the developing world.
Collapse
Affiliation(s)
- Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L458, Portland, OR, 97239, USA. .,Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA.
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA
| | - Jessica Gaffney
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Katherine S Lewandowski
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Christopher D Kroenke
- Advanced Imaging Research Center, Oregon Health and Science University, Portland, OR, USA.,Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Charles T Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA.,Division of Cardiometabolic Health, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| | - Brian P Scottoline
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA.,Department of Pediatrics, Oregon Health and Science University, Portland, OR, USA
| | - Antonio E Frias
- Department of Obstetrics and Gynecology, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code L458, Portland, OR, 97239, USA
| | - Elinor L Sullivan
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA.,Department of Psychiatry, Oregon Health and Science University, Portland, OR, USA
| | - Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, OR, USA
| |
Collapse
|
10
|
Seiter DP, Nguyen SM, Morgan TK, Mao L, Dudley DM, O’connor DH, Murphy ME, Ludwig KD, Chen R, Dhyani A, Zhu A, Schotzko ML, Brunner KG, Shah DM, Johnson KM, Golos TG, Wieben O. Ferumoxytol dynamic contrast enhanced magnetic resonance imaging identifies altered placental cotyledon perfusion in rhesus macaques†. Biol Reprod 2022; 107:1517-1527. [PMID: 36018823 PMCID: PMC9752971 DOI: 10.1093/biolre/ioac168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/12/2022] [Accepted: 08/19/2022] [Indexed: 11/13/2022] Open
Abstract
Identification of placental dysfunction in early pregnancy with noninvasive imaging could be a valuable tool for assessing maternal and fetal risk. Dynamic contrast enhanced (DCE) magnetic resonance imaging (MRI) can be a powerful tool for interrogating placenta health. After inoculation with Zika virus or sham inoculation at gestation age (GA) 45 or 55 days, animals were imaged up to three times at GA65, GA100, and GA145. DCE MRI images were acquired at all imaging sessions using ferumoxytol, an iron nanoparticle-based contrast agent, and analyzed for placental intervillous blood flow, number of perfusion domains, and perfusion domain volume. Cesarean section was performed at GA155, and the placenta was photographed and dissected for histopathology. Photographs were used to align cotyledons with estimated perfusion domains from MRI, allowing comparison of estimated cotyledon volume to pathology. Monkeys were separated into high and low pathology groups based on the average number of pathologies present in the placenta. Perfusion domain flow, volume, and number increased through gestation, and total blood flow increased with gestation for both low pathology and high pathology groups. A statistically significant decrease in perfusion domain volume associated with pathology was detected at all gestational ages. Individual perfusion domain flow comparisons demonstrated a statistically significant decrease with pathology at GA100 and GA145, but not GA65. Since ferumoxytol is currently used to treat anemia during human pregnancy and as an off-label MRI contrast agent, future transition of this work to human pregnancy may be possible.
Collapse
Affiliation(s)
- Daniel P Seiter
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Sydney M Nguyen
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Terry K Morgan
- Department of Pathology, Oregon Health & Science University, Portland, OR, USA
| | - Lu Mao
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, USA
| | - Dawn M Dudley
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - David H O’connor
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Pathology and Laboratory Medicine, University of Wisconsin-Madison, Madison, WI, USA
| | - Megan E Murphy
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kai D Ludwig
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Ruiming Chen
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
| | - Archana Dhyani
- Department of Computer Science, University of Wisconsin-Madison, Madison, WI, USA
| | - Ante Zhu
- Department of Biomedical Engineering, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Michele L Schotzko
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin G Brunner
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
| | - Dinesh M Shah
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin M Johnson
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| | - Thaddeus G Golos
- Department of Comparative Biosciences, University of Wisconsin-Madison, Madison, WI, USA
- Wisconsin National Primate Research Center, University of Wisconsin-Madison, Madison, WI, USA
- Department of Obstetrics & Gynecology, University of Wisconsin-Madison, Madison, WI, USA
| | - Oliver Wieben
- Department of Medical Physics, University of Wisconsin-Madison, Madison, WI, USA
- Department of Radiology, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
11
|
Zhang X. Magnetic resonance imaging of the monkey fetal brain in utero. INVESTIGATIVE MAGNETIC RESONANCE IMAGING 2022; 26:177-190. [PMID: 36937817 PMCID: PMC10019598 DOI: 10.13104/imri.2022.26.4.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Non-human primates (NHPs) are the closest living relatives of the human and play a critical role in investigating the effects of maternal viral infection and consumption of medicines, drugs, and alcohol on fetal development. With the advance of contemporary fast MRI techniques with parallel imaging, fetal MRI is becoming a robust tool increasingly used in clinical practice and preclinical studies to examine congenital abnormalities including placental dysfunction, congenital heart disease (CHD), and brain abnormalities non-invasively. Because NHPs are usually scanned under anesthesia, the motion artifact is reduced substantially, allowing multi-parameter MRI techniques to be used intensively to examine the fetal development in a single scanning session or longitudinal studies. In this paper, the MRI techniques for scanning monkey fetal brains in utero in biomedical research are summarized. Also, a fast imaging protocol including T2-weighted imaging, diffusion MRI, resting-state functional MRI (rsfMRI) to examine rhesus monkey fetal brains in utero on a clinical 3T scanner is introduced.
Collapse
Affiliation(s)
- Xiaodong Zhang
- EPC Imaging Center and Division of Neuropharmacology and Neurologic Diseases, Emory National Primate Research Center, Emory University, Atlanta, Georgia, 30329, USA
| |
Collapse
|
12
|
Lee D, Sohn J, Kirichenko A. Quantifying Liver Heterogeneity via R2*-MRI with Super-Paramagnetic Iron Oxide Nanoparticles (SPION) to Characterize Liver Function and Tumor. Cancers (Basel) 2022; 14:cancers14215269. [PMID: 36358689 PMCID: PMC9653969 DOI: 10.3390/cancers14215269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Revised: 10/18/2022] [Accepted: 10/20/2022] [Indexed: 11/22/2022] Open
Abstract
Simple Summary Super-paramagnetic iron oxide nanoparticles (SPIONs) are phagocytized by the hepatic Kupffer cells (KC) in the liver and shorten MRI signals within the volume of functional liver parenchyma (FLP) where KCs are found. However, malignant tumors lacking KCs exhibit minimal signal change, resulting in increasing liver heterogeneity. This study investigates whether SPIONs improve liver heterogeneity on R2*-MRI to characterize FLP and non-FLP (i.e., tumor, hepatic vessels, liver fibrosis and scarring associated with hepatic cirrhosis, prior liver-directed therapies or hepatic resection). By using SPIONs, liver heterogeneity was improved across two MRI sessions with and without an intravenous SPION injection, and the volume of FLP was identified in our auto-contouring tool. This is a desirable technique for achieving more accurate characterizations of liver function and tumors during radiation treatment planning. Abstract The use of super-paramagnetic iron oxide nanoparticles (SPIONs) as an MRI contrast agent (SPION-CA) can safely label hepatic macrophages and be localized within hepatic parenchyma for T2*- and R2*-MRI of the liver. To date, no study has utilized the R2*-MRI with SPIONs for quantifying liver heterogeneity to characterize functional liver parenchyma (FLP) and hepatic tumors. This study investigates whether SPIONs enhance liver heterogeneity for an auto-contouring tool to identify the voxel-wise functional liver parenchyma volume (FLPV). This was the first study to directly evaluate the impact of SPIONs on the FLPV in R2*-MRI for 12 liver cancer patients. By using SPIONs, liver heterogeneity was improved across pre- and post-SPION MRI sessions. On average, 60% of the liver [range 40–78%] was identified as the FLPV in our auto-contouring tool with a pre-determined threshold of the mean R2* of the tumor and liver. This method performed well in 10 out of 12 liver cancer patients; the remaining 2 needed a longer echo time. These results demonstrate that our contouring tool with SPIONs can facilitate the heterogeneous R2* of the liver to automatically characterize FLP. This is a desirable technique for achieving more accurate FLPV contouring during liver radiation treatment planning.
Collapse
Affiliation(s)
- Danny Lee
- Radiation Oncology, Allegheny Health Network, Pittsburgh, PA 15012, USA
- Radiologic Sciences, Drexel University College of Medicine, Philadelphia, PA 19104, USA
- Correspondence: ; Tel.: +1-412-359-4589
| | - Jason Sohn
- Radiation Oncology, Allegheny Health Network, Pittsburgh, PA 15012, USA
- Radiologic Sciences, Drexel University College of Medicine, Philadelphia, PA 19104, USA
| | - Alexander Kirichenko
- Radiation Oncology, Allegheny Health Network, Pittsburgh, PA 15012, USA
- Radiologic Sciences, Drexel University College of Medicine, Philadelphia, PA 19104, USA
| |
Collapse
|
13
|
Winterstein AG, Thai TN, Nduaguba S, Smolinski NE, Wang X, Sahin L, Krefting I, Gelperin K, Bird ST, Rasmussen SA. Risk of fetal or neonatal death or neonatal intensive care unit admission associated with gadolinium magnetic resonance imaging exposure during pregnancy. Am J Obstet Gynecol 2022; 228:465.e1-465.e11. [PMID: 36241080 DOI: 10.1016/j.ajog.2022.10.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 09/30/2022] [Accepted: 10/05/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Concerns have been raised about prenatal exposure to magnetic resonance imaging with gadolinium-based contrast agents because of nonclinical findings of gadolinium retention in fetal tissue and 1 population-based study reporting an association with adverse pregnancy outcomes. OBJECTIVE This study aimed to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death and neonatal intensive care unit admission. STUDY DESIGN We constructed a retrospective cohort of >11 million Medicaid-covered pregnancies between 1999 and 2014 to evaluate the association between prenatal magnetic resonance imaging exposure with and without gadolinium-based contrast agents and fetal and neonatal death (primary endpoint) and neonatal intensive care unit admissions (secondary endpoint). Medicaid claims data were linked to medical records, Florida birth and fetal death records, and the National Death Index to validate the outcomes and gestational age estimates. Pregnancies with multiples, concurrent cancer, teratogenic drug exposure, magnetic resonance imaging focused on fetal or pelvic evaluation, undetermined gadolinium-based contrast agent use, or those preceded by or contemporaneous with congenital anomaly diagnoses were excluded. We adjusted for potential confounders with standardized mortality ratio weighting using propensity scores. RESULTS Among 5991 qualifying pregnancies, we found 11 fetal or neonatal deaths in the gadolinium-based contrast agent magnetic resonance imaging group (1.4%) and 73 in the non-gadolinium-based contrast agent magnetic resonance imaging group (1.4%) with an adjusted relative risk of 0.73 (95% confidence interval, 0.34-1.55); the neonatal intensive care unit admission adjusted relative risk was 1.03 (0.76-1.39). Sensitivity analyses investigating the timing of magnetic resonance imaging or repeat magnetic resonance imaging exposure during pregnancy and simulating the impact of exposure misclassification corroborated these results. CONCLUSION This study addressed the safety concerns related to prenatal exposure to gadolinium-based contrast agents used in magnetic resonance imaging and the risk thereof on fetal and neonatal death or the need for neonatal intensive care unit admission. Although the results on fatal or severe acute effects are reassuring, the impact on subacute outcomes was not evaluated.
Collapse
Affiliation(s)
- Almut G Winterstein
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL.
| | - Thuy N Thai
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Faculty of Pharmacy, Ho Chi Minh City University of Technology (HUTECH), Ho Chi Minh City, Vietnam
| | - Sabina Nduaguba
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Nicole E Smolinski
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL; Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL
| | - Xi Wang
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Leyla Sahin
- Division of Pediatrics and Maternal Health, Office of New Drugs, Center for Drug Evaluation and Research (CDER), Food and Drug Administration (FDA), Silver Spring, MD
| | - Ira Krefting
- Division of Imaging and Radiation Medicine, Office of New Drugs, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD
| | - Kate Gelperin
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Steven T Bird
- Division of Epidemiology, Office of Surveillance and Epidemiology, CDER, FDA, Silver Spring, MD
| | - Sonja A Rasmussen
- Center for Drug Evaluation and Safety (CoDES), University of Florida, Gainesville, FL; Department of Epidemiology, College of Medicine and College of Public Health and Health Professions, University of Florida, Gainesville, FL; Departments of Pediatrics, College of Medicine, University of Florida, Gainesville, FL; Obstetrics and Gynecology, College of Medicine, University of Florida, Gainesville, FL
| |
Collapse
|
14
|
Role of MRI and CT in the Evaluation of Headache in Pregnancy and the Postpartum Period. Neurol Clin 2022; 40:661-677. [PMID: 35871790 DOI: 10.1016/j.ncl.2022.02.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Approximately 35% of acute headaches in pregnant women are secondary to an underlying condition. Headaches are also common in the postpartum period where they occur in 30% to 40% of patients. The majority of secondary headaches are due to hypertensive disorders: preeclampsia-eclampsia, posterior reversible encephalopathy syndrome, and acute arterial hypertension. Other causes include reversible cerebral vasoconstriction syndrome and pituitary apoplexy, as well as life-threatening conditions such as cerebral venous thrombosis. In this article, we review general recommendations for imaging the pregnant patients and discuss the imaging findings of common causes of headaches in pregnancy and the postpartum period.
Collapse
|
15
|
Boere I, Lok C, Poortmans P, Koppert L, Painter R, Vd Heuvel-Eibrink MM, Amant F. Breast cancer during pregnancy: epidemiology, phenotypes, presentation during pregnancy and therapeutic modalities. Best Pract Res Clin Obstet Gynaecol 2022; 82:46-59. [PMID: 35644793 DOI: 10.1016/j.bpobgyn.2022.05.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Revised: 05/02/2022] [Accepted: 05/02/2022] [Indexed: 11/02/2022]
Abstract
Although it is uncommon in general, breast cancer is the most commonly diagnosed cancer during pregnancy. While treatment for pregnant patients should adhere to treatment guidelines for non-pregnant patients, there exist specific considerations concerning diagnosis, staging, oncological treatment, and obstetrical care. Imaging and staging are preferably performed using breast ultrasound and mammography. Other ionizing radiation imaging modalities, including computed tomography (CT) and Positron Emission Tomography/ Computed Tomography (PET/CT), can be selectively performed when the estimated benefit for the mother outweighs the risks to the foetus, e.g., when the results will change clinical management. MRI is appropriate to stage for distant disease on the indication. Breast cancer during pregnancy is less often hormone receptor-positive and more frequently triple-negative breast cancer compared to age-matched controls. The basic principle is that women should receive state-of-the-art oncological treatment without delay if possible and that the pregnancy should be maintained as long as possible. Treatment strategy should be multidisciplinary defined, carefully weighing the selection, sequence, and timing of treatment modalities depending on patient-, tumour-, and pregnancy-related characteristics, as well as patient preferences. Initiating cancer treatment during pregnancy often decreases the risks of early delivery and prematurity. Breast cancer surgery is possible during all trimesters. Radiotherapy is possible during pregnancy in the first half of pregnancy. Chemotherapy can be safely administered starting from 12 weeks of gestational age, but endocrine and HER2 targeted therapy are contraindicated throughout the whole pregnancy. Importantly, foetal growth should be monitored and long-term follow-up of the children is encouraged in dedicated centres.
Collapse
Affiliation(s)
- Ingrid Boere
- Department of Medical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - Christianne Lok
- Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Philip Poortmans
- Iridium Network and University of Antwerp, Faculty of Medicine and Health Sciences, Wilrijk-Antwerp, Belgium
| | - Linetta Koppert
- Department of Surgical Oncology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rebecca Painter
- Princess Máxima Center for Pediatric Oncology, Utrecht, the Netherlands
| | - Marry M Vd Heuvel-Eibrink
- Department of Obstetrics and Gynecology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, the Netherlands
| | - Frederic Amant
- Center for Gynecological Oncology Amsterdam (CGOA), Antoni van Leeuwenhoek - Netherlands Cancer Institute, Amsterdam, the Netherlands; Gynecologic Oncology, UZ Leuven, Belgium
| |
Collapse
|
16
|
Gadolinium in Medical Imaging—Usefulness, Toxic Reactions and Possible Countermeasures—A Review. Biomolecules 2022; 12:biom12060742. [PMID: 35740867 PMCID: PMC9221011 DOI: 10.3390/biom12060742] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 05/21/2022] [Accepted: 05/23/2022] [Indexed: 12/29/2022] Open
Abstract
Gadolinium (Gd) is one of the rare-earth elements. The properties of its trivalent cation (Gd3+) make it suitable to serve as the central ion in chelates administered intravenously to patients as a contrast agent in magnetic resonance imaging. Such Gd-chelates have been used for more than thirty years. During the past decades, knowledge has increased about potential harmful effects of Gd-chelates in patients with severe renal dysfunction. In such patients, there is a risk for a potentially disabling and lethal disease, nephrogenic systemic fibrosis. Restricting the use of Gd-chelates in persons with severely impaired renal function has decreased the occurrence of this toxic effect in the last decade. There has also been an increasing awareness of Gd-retention in the body, even in patients without renal dysfunction. The cumulative number of doses given, and the chemical structure of the chelate given, are factors of importance for retention in tissues. This review describes the chemical properties of Gd and its medically used chelates, as well as its toxicity and potential side effects related to injection of Gd-chelates.
Collapse
|
17
|
How Could Nanomedicine Improve the Safety of Contrast Agents for MRI during Pregnancy? SCI 2022. [DOI: 10.3390/sci4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Pregnancy is a delicate state, during which timely investigation of possible physiological anomalies is essential to reduce the risk of maternal and fetal complications. Medical imaging encompasses different technologies to image the human body for the diagnosis, course of treatment management, and follow-up of diseases. Ultrasound (US) is currently the imaging system of choice for pregnant patients. However, sonographic evaluations can be non-effective or give ambiguous results. Therefore, magnetic resonance imaging (MRI), due to its excellent tissue penetration, the possibility of acquisition of three-dimensional anatomical information, and its high spatial resolution, is considered a valid diagnostical alternative. Nevertheless, currently employed contrast agents to improve the MRI image quality are harmful to the fetus. Because of their ability to cross the placenta, their use on pregnant patients is avoided. This review will firstly recapitulate the most common non-obstetrical, obstetrical, and fetal indications for magnetic resonance imaging on pregnant women. Fetal safety risks, due to the use of strong magnetic fields and exogenous contrast agents, will be presented. Then, possible advantages of nanostructured contrast agents compared to current molecular ones are explored. Nanosystems’ characteristics affecting contrast efficiency, and their potential for improving contrast-enhanced MRI’s safety in pregnant women, are discussed. Lastly, promising examples of nanoparticles as safer alternatives to current MRI contrast agents in pregnancy are discussed.
Collapse
|
18
|
Yao X, Zhang H, Shi D, Li Y, Guo Q, Yu Z, Wang S, Ren K. Gadolinium Retention in the Brain of Mother and Pup Mouse: Effect of Pregnancy and Repeated Administration of
Gadolinium‐Based
Contrast Agents. J Magn Reson Imaging 2022; 56:835-845. [PMID: 35166409 PMCID: PMC9541727 DOI: 10.1002/jmri.28086] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 01/17/2022] [Accepted: 01/18/2022] [Indexed: 01/26/2023] Open
Abstract
Background The association of repeated administration of gadolinium‐based contrast agents (GBCAs) with the gadolinium (Gd) retention in the brains of mother and fetus remains unclear. Purpose To investigate the effects of pregnancy and repeated administration of GBCAs on Gd retention in the brains of mother and pup mice. Study type Cross‐sectional cohort toxicity study. Animal Model From gestational days 16–19, pregnant (n = 48) BALB/c mice. Field Strength A 9.4 T and fast spin echo sequence. Assessment Half of the mother mice (n = 24) were killed at postnatal day 1 (P1) for inductively coupled plasma mass spectrometry (ICP‐MS) and transmission electron microscopy (TEM). Besides the ICP‐MS and TEM, four pups were randomly selected from each mother and killed at P1 for ultraperformance liquid chromatography mass spectrometry (UPLC‐MS) and Nissl staining. Statistical Tests One‐way analysis of variance and unpaired t‐test. Results In the group of gadodiamide, retention of Gd in the brains of pregnant mice was significantly lower than that of nonpregnant mice in the area of the deep cerebellar nuclei (DCN) (10.35 ± 2.16 nmol/g vs. 18.74 ± 3.65 nmol/g). Retention of Gd in the DCN of pups whose mothers were administered gadoterate meglumine was significantly lower than that of pups whose mothers were administered gadodiamide (0.21 ± 0.09 nmol/g vs. 6.15 ± 3.21 nmol/g) at P1. In mice treated with gadodiamide, most of the retained Gd in the brain tissue was insoluble (19.5% ± 9.5% of the recovered amount corresponded to the intact complex in the DCN). Data Conclusion In different brain areas of the mother and pup mice, the retention of Gd after gadoterate meglumine administration was lower than that of gadodiamide and gadopentetate dimeglumine administration, and almost all the detected Gd in pups' brains was intact soluble GBCAs. Evidence Level 1 Technical Efficacy Stage 2
Collapse
Affiliation(s)
- Xiang Yao
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Haoran Zhang
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Dafa Shi
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Yanfei Li
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Qiu Guo
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Ziyang Yu
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Siyuan Wang
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| | - Ke Ren
- Department of Radiology Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University Xiamen China
| |
Collapse
|
19
|
MRI in Pregnancy and Precision Medicine: A Review from Literature. J Pers Med 2021; 12:jpm12010009. [PMID: 35055324 PMCID: PMC8778056 DOI: 10.3390/jpm12010009] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 12/11/2021] [Accepted: 12/15/2021] [Indexed: 12/29/2022] Open
Abstract
Magnetic resonance imaging (MRI) offers excellent spatial and contrast resolution for evaluating a wide variety of pathologies, without exposing patients to ionizing radiations. Additionally, MRI offers reproducible diagnostic imaging results that are not operator-dependent, a major advantage over ultrasound. MRI is commonly used in pregnant women to evaluate, most frequently, acute abdominal and pelvic pain or placental abnormalities, as well as neurological or fetal abnormalities, infections, or neoplasms. However, to date, our knowledge about MRI safety during pregnancy, especially about the administration of gadolinium-based contrast agents, which are able to cross the placental barrier, is still limited, raising concerns about possible negative effects on both the mother and the health of the fetus. Contrast agents that are unable to cross the placenta in a way that is safe for the fetus are desirable. In recent years, some preclinical studies, carried out in rodent models, have evaluated the role of long circulating liposomal nanoparticle-based blood-pool gadolinium contrast agents that do not penetrate the placental barrier due to their size and therefore do not expose the fetus to the contrast agent during pregnancy, preserving it from any hypothetical risks. Hence, we performed a literature review focusing on contrast and non-contrast MRI use during pregnancy.
Collapse
|
20
|
Andescavage N, Limperopoulos C. Emerging placental biomarkers of health and disease through advanced magnetic resonance imaging (MRI). Exp Neurol 2021; 347:113868. [PMID: 34562472 DOI: 10.1016/j.expneurol.2021.113868] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 09/09/2021] [Accepted: 09/19/2021] [Indexed: 12/12/2022]
Abstract
Placental dysfunction is a major cause of fetal demise, fetal growth restriction, and preterm birth, as well as significant maternal morbidity and mortality. Infant survivors of placental dysfunction are at elevatedrisk for lifelong neuropsychiatric morbidity. However, despite the significant consequences of placental disease, there are no clinical tools to directly and non-invasively assess and measure placental function in pregnancy. In this work, we will review advanced MRI techniques applied to the study of the in vivo human placenta in order to better detail placental structure, architecture, and function. We will discuss the potential of these measures to serve as optimal biomarkers of placental dysfunction and review the evidence of these tools in the discrimination of health and disease in pregnancy. Efforts to advance our understanding of in vivo placental development are necessary if we are to optimize healthy pregnancy outcomes and prevent brain injury in successive generations. Current management of many high-risk pregnancies cannot address placental maldevelopment or injury, given the standard tools available to clinicians. Once accurate biomarkers of placental development and function are constructed, the subsequent steps will be to introduce maternal and fetal therapeutics targeting at optimizing placental function. Applying these biomarkers in future studies will allow for real-time assessments of safety and efficacy of novel interventions aimed at improving maternal-fetal well-being.
Collapse
Affiliation(s)
- Nickie Andescavage
- Developing Brain Institute, Department of Radiology, Children's National, Washington DC, USA; Department of Neonatology, Children's National, Washington DC, USA
| | | |
Collapse
|
21
|
Deloison B, Arthuis C, Benchimol G, Balvay D, Bussieres L, Millischer AE, Grévent D, Butor C, Chalouhi G, Mahallati H, Hélénon O, Tavitian B, Clement O, Ville Y, Siauve N, Salomon LJ. Human placental perfusion measured using dynamic contrast enhancement MRI. PLoS One 2021; 16:e0256769. [PMID: 34473740 PMCID: PMC8412340 DOI: 10.1371/journal.pone.0256769] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 08/15/2021] [Indexed: 11/19/2022] Open
Abstract
Objectives To evaluate the feasibility of dynamic contrast enhanced magnetic resonance imaging (DCE MRI) and measure values of in vivo placental perfusion in women. Methods This study was part of the Placentimage trial (NCT01092949). Gadolinium-chelate (Gd) enhanced dynamic MRI was performed two days before termination of pregnancies at 16 to 34 weeks gestational age (GA). Quantitative analysis was performed using one-compartment intravascular modeling. DCE perfusion parameters were analyzed across GA and were compared in IUGR and AGA fetuses. Results 134 patients were enrolled. After quality control check, 62 DCE MRI were analyzed including 48 and 14 pregnancies with normal and abnormal karyotypes, respectively. Mean placental blood flow was 129±61 mL/min/100ml in cases with normal karyotypes. Fetuses affected by IUGR (n = 13) showed significantly lower total placental blood flow values than AGA fetuses (n = 35) (F total = 122±88 mL/min versus 259±34 mL/min, p = 0.002). DCE perfusion parameters showed a linear correlation with GA. Conclusions Measuring placental perfusion in vivo is possible using DCE MRI. Although this study has many limitations it gives us the first DCE MRI values that provide a potential standard for future research into placental perfusion methods and suggests that placental functional parameters are altered in IUGR pregnancies.
Collapse
Affiliation(s)
- Benjamin Deloison
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Chloé Arthuis
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- Service de Gynécologie-Obstétrique, Hôpital mère-enfant, CHU Nantes, Nantes, France
| | - Gabriel Benchimol
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Daniel Balvay
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Laurence Bussieres
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Anne-Elodie Millischer
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - David Grévent
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Cécile Butor
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Gihad Chalouhi
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Houman Mahallati
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Olivier Hélénon
- Service de Radiologie, Hôpital Necker Enfants Malades, Assistance Publique-Hôpitaux de Paris (APHP), Paris, France
| | - Bertrand Tavitian
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Olivier Clement
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
| | - Yves Ville
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
| | - Nathalie Siauve
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
- Service de Radiologie, Hôpital Louis Mourier, Assistance Publique-Hôpitaux de Paris (APHP), Colombes, France
| | - Laurent Julien Salomon
- Service de Gynécologie-Obstétrique, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
- EA fetus 7328 and LUMIERE platform, Université Paris Descartes, Paris, France
- INSERM, U970, Paris Cardiovascular Research Center–PARCC, Sorbonne Paris Cité, Paris, France
- * E-mail:
| |
Collapse
|
22
|
MR Imaging Safety Considerations of Gadolinium-Based Contrast Agents: Gadolinium Retention and Nephrogenic Systemic Fibrosis. Magn Reson Imaging Clin N Am 2021; 28:497-507. [PMID: 33040991 DOI: 10.1016/j.mric.2020.06.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) have revolutionized of MR imaging, enabling physicians to obtain life-saving medical information that often cannot be obtained with unenhanced MR imaging or other imaging modalities. Since regulatory approval in 1988, more than 450 million intravenous GBCA doses have been administered worldwide, with an extremely favorable pharmacologic safety profile. Recent evidence has demonstrated, however, that a small fraction of Gd is retained in human tissues. No direct correlation between Gd retention and clinical effects has been confirmed; however, a subset of patients have attributed various symptoms to GBCA exposure. This review details current knowledge regarding GBCA safety.
Collapse
|
23
|
Nguyen SM, Wiepz GJ, Schotzko M, Simmons HA, Mejia A, Ludwig KD, Zhu A, Brunner K, Hernando D, Reeder SB, Wieben O, Johnson K, Shah D, Golos TG. Impact of ferumoxytol magnetic resonance imaging on the rhesus macaque maternal-fetal interface†. Biol Reprod 2021; 102:434-444. [PMID: 31511859 DOI: 10.1093/biolre/ioz181] [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: 06/03/2019] [Revised: 08/05/2019] [Accepted: 09/03/2019] [Indexed: 01/26/2023] Open
Abstract
Ferumoxytol is a superparamagnetic iron oxide nanoparticle used off-label as an intravascular magnetic resonance imaging (MRI) contrast agent. Additionally, ferumoxytol-uptake by macrophages facilitates detection of inflammatory sites by MRI through ferumoxytol-induced image contrast changes. Therefore, ferumoxytol-enhanced MRI holds great potential for assessing vascular function and inflammatory response, critical to determine placental health in pregnancy. This study sought to assess the fetoplacental unit and selected maternal tissues, pregnancy outcomes, and fetal well-being after ferumoxytol administration. In initial developmental studies, seven pregnant rhesus macaques were imaged with or without ferumoxytol administration. Pregnancies went to term with vaginal delivery and infants showed normal growth rates compared to control animals born the same year that did not undergo MRI. To determine the impact of ferumoxytol on the maternal-fetal interface (MFI), fetal well-being, and pregnancy outcome, four pregnant rhesus macaques at ~100 gestational day underwent MRI before and after ferumoxytol administration. Collection of the fetoplacental unit and selected maternal tissues was performed 2-3 days following ferumoxytol administration. A control group that did not receive ferumoxytol or MRI was used for comparison. Iron levels in fetal and MFI tissues did not differ between groups, and there was no significant difference in tissue histopathology with or without exposure to ferumoxytol, and no effect on placental hormone secretion. Together, these results suggest that the use of ferumoxytol and MRI in pregnant rhesus macaques does not negatively impact the MFI and can be a valuable experimental tool in research with this important animal model.
Collapse
Affiliation(s)
- Sydney M Nguyen
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA.,Obstetrics & Gynecology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin, USA
| | - Gregory J Wiepz
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA
| | - Michele Schotzko
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA
| | - Heather A Simmons
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA
| | - Andres Mejia
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA
| | - Kai D Ludwig
- Medical Physics, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Ante Zhu
- Biomedical Engineering, University of Wisconsin Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Kevin Brunner
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA.,Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Diego Hernando
- Medical Physics, University of Wisconsin Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Scott B Reeder
- Medical Physics, University of Wisconsin Madison, Madison, Wisconsin, USA.,Biomedical Engineering, University of Wisconsin Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA.,Emergency Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA.,Medicine, University of Wisconsin Madison, Madison, Wisconsin, USA, and
| | - Oliver Wieben
- Medical Physics, University of Wisconsin Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Kevin Johnson
- Medical Physics, University of Wisconsin Madison, Madison, Wisconsin, USA.,Radiology, University of Wisconsin Madison, Madison, Wisconsin, USA
| | - Dinesh Shah
- Obstetrics & Gynecology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin, USA
| | - Thaddeus G Golos
- Wisconsin National Primate Research Center (WNPRC), Madison, Wisconsin, USA.,Obstetrics & Gynecology, University of Wisconsin Madison School of Medicine, Madison, Wisconsin, USA.,Comparative Biosciences, University of Wisconsin Madison, Madison, Wisconsin, USA
| |
Collapse
|
24
|
Laissy JP, Siauve N, Dossier A, Lancelot E. Transient Signal Intensity Enhancement in the Amniotic Fluid After Administration of a Macrocyclic Gadolinium Chelate to a Pregnant Woman. J Magn Reson Imaging 2021; 54:669-671. [PMID: 33768662 DOI: 10.1002/jmri.27607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 03/05/2021] [Accepted: 03/09/2021] [Indexed: 11/09/2022] Open
Affiliation(s)
- Jean-Pierre Laissy
- Department of Radiology, University Hospital Val de Seine, INSERM UMR 1148, Bichat Hospital, Paris, France.,Department of Internal Medicine, University Hospital Val de Seine, Paris, France.,INSERM UMR 1148, Bichat Hospital, Paris, 75018, France
| | - Nathalie Siauve
- Department of Radiology, University Hospital Val de Seine, INSERM UMR 1148, Bichat Hospital, Paris, France.,Department of Internal Medicine, University Hospital Val de Seine, Paris, France
| | - Antoine Dossier
- Department of Radiology, University Hospital Val de Seine, INSERM UMR 1148, Bichat Hospital, Paris, France.,Department of Internal Medicine, University Hospital Val de Seine, Paris, France
| | | |
Collapse
|
25
|
Zhang Q, Dai X, Zhang H, Zeng Y, Luo K, Li W. Recent advances in development of nanomedicines for multiple sclerosis diagnosis. Biomed Mater 2021; 16:024101. [PMID: 33472182 DOI: 10.1088/1748-605x/abddf4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Multiple sclerosis (MS) is a neurodegenerative disease with a high morbidity and disease burden. It is characterized by the loss of the myelin sheath, resulting in the disruption of neuron electrical signal transmissions and sensory and motor ability deficits. The diagnosis of MS is crucial to its management, but the diagnostic sensitivity and specificity are always a challenge. To overcome this challenge, nanomedicines have recently been employed to aid the diagnosis of MS with an improved diagnostic efficacy. Advances in nanomedicine-based contrast agents in magnetic resonance imaging scanning of MS lesions, and nanomedicine-derived sensors for detecting biomarkers in the cerebrospinal fluid biopsy, or analyzing the composition of exhaled breath gas, have demonstrated the potential of using nanomedicines in the accurate diagnosis of MS. This review aims to provide an overview of recent advances in the application of nanomedicines for the diagnosis of MS and concludes with perspectives of using nanomedicines for the development of safe and effective MS diagnostic nanotools.
Collapse
Affiliation(s)
- Qin Zhang
- Department of Radiology, Department of Postgraduate Students, and Department of Respiratory and Critical Care Medicine, West China Hospital, Sichuan University, Chengdu 610041, People's Republic of China. West China School of Medicine, Sichuan University, Chengdu 610041, People's Republic of China. These authors contributed equally to this work
| | | | | | | | | | | |
Collapse
|
26
|
Contrast-Enhanced Ultrasound for Assessing Abdominal Conditions in Pregnancy. ACTA ACUST UNITED AC 2020; 56:medicina56120675. [PMID: 33302381 PMCID: PMC7762549 DOI: 10.3390/medicina56120675] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 12/03/2020] [Accepted: 12/04/2020] [Indexed: 02/07/2023]
Abstract
Background and objectives: Native ultrasound is the most common imaging modality in obstetrics. The use of contrast-enhanced ultrasound (CEUS) during pregnancy has not been officially approved by leading societies for obstetrics and ultrasound. The present study aims to monitor the safety and diagnostic performance of CEUS for assessing abdominal issues in five pregnant women. Materials and Methods: Five pregnant patients who underwent a total of 11 CEUS examinations between June 2020 and October 2020 were included (mean age: 34 years; mean time of pregnancy: 21 weeks). All CEUS scans were interpreted by one experienced consultant radiologist (EFSUMB Level 3). Results: Upon contrast application, no maternal nor fetal adverse effects were observed. Moreover, no fetal contrast enhancement was observed in any patient. CEUS helped to diagnose renal angiomyolipoma, pyelonephritis, necrotic uterine fibroid, gallbladder polyp, and superior mesenteric vein thrombosis. Conclusions: In our study, off-label use of CEUS showed an excellent safety profile allowing the avoidance of ionizing radiation exposure as well as contrast agents in case of CT or use of gadolinium-based contrast agents in case of MRI. CEUS is a promising diagnostic instrument for facilitating clinical decision-making and improving the management of pregnant women.
Collapse
|
27
|
Abstract
MRI is a powerful diagnostic tool with excellent soft tissue contrast that uses nonionizing radiation. These advantages make MRI an appealing modality for imaging the pregnant patient; however, specific risks inherent to the magnetic resonance environment must be considered. MRI may be performed without and/or with intravenous contrast, which adds further fetal considerations. The risks of MRI with and without intravenous contrast are reviewed as they pertain to the pregnant or lactating patient and to the fetus and nursing infant. Relevant issues for gadolinium-based contrast agents and ultrasmall paramagnetic iron oxide particles are reviewed.
Collapse
Affiliation(s)
- Jason T Little
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA
| | - Candice A Bookwalter
- Department of Radiology, Mayo Clinic, 200 First Street Southwest, Rochester, MN 55905, USA.
| |
Collapse
|
28
|
Lum M, Tsiouris AJ. MRI safety considerations during pregnancy. Clin Imaging 2020; 62:69-75. [PMID: 32109683 DOI: 10.1016/j.clinimag.2020.02.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2019] [Revised: 02/11/2020] [Accepted: 02/18/2020] [Indexed: 12/12/2022]
Abstract
The use of magnetic resonance imaging (MRI) during pregnancy is on the rise due its ability to provide detailed cross-sectional anatomy without ionizing radiation. Despite the favorable radiation profile, theoretically concerns regarding the safety of MRI and gadolinium-based contrast agent (GBCA) administration have been raised. Currently there are no studies that have shown any attributable harms of MRI during any trimester of pregnancy although prospective and longitudinal studies are lacking. GBCA administration may be associated with a slightly higher rate of neonatal death, although this is based on a single, large cohort study. Understanding the available evidence regarding MRI safety during pregnancy in the context of current society guidelines will help the radiologist serve as a valuable resource to patients and referring providers.
Collapse
Affiliation(s)
- Mark Lum
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America.
| | - A John Tsiouris
- Department of Radiology, New York Presbyterian Hospital, Weill Cornell Medical Center, 525 E 68th St, New York, NY 10065, United States of America
| |
Collapse
|
29
|
Zhu A, Reeder SB, Johnson KM, Nguyen SM, Fain SB, Bird IM, Golos TG, Wieben O, Shah DM, Hernando D. Quantitative ferumoxytol-enhanced MRI in pregnancy: A feasibility study in the nonhuman primate. Magn Reson Imaging 2020; 65:100-108. [PMID: 31655139 PMCID: PMC6956847 DOI: 10.1016/j.mri.2019.10.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 10/14/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To assess the feasibility of ferumoxytol-enhanced MRI in pregnancy with a nonhuman primate model. MATERIALS AND METHODS In this prospective study, eleven pregnant rhesus macaques at day 98 ± 5 of gestation were divided into three groups, untreated control (UC) (n = 3), saline control (SC) (n = 4) and interleukin 1 beta (IL-1β) treated (IT) (n = 4), which were administered with either saline or IL-1β into the amniotic fluid. All animals were imaged at multiple time points before and after ferumoxytol administration (4 mg/kg). Longitudinal R2* and susceptibility of tissues were obtained using region-of-interest analysis and the longitudinal changes were assessed using linear mixed models and Student's t-test. RESULTS In fetuses, a slope of 0.3 s-1/day (P = 0.008), 0.00 ppm/day (P = 0.699) and - 0.2 s-1/day (P = 0.023) was observed in liver R2*, liver susceptibility, and lung R2*, respectively. In placentas, R2* and susceptibility increased immediately after ferumoxytol administration (P < 0.001) and decreased to baseline within two days. The mean change from baseline showed no significant difference between the SC group and the IT group at all scan time points. In maternal livers, R2* increased immediately after ferumoxytol administration, further increased at one-day, and then decreased but remained elevated (P < 0.001). The mean change from baseline showed no significant difference between the SC group and the IT group at all scan time points. CONCLUSIONS This work demonstrates the feasibility of quantitative ferumoxytol-enhanced MRI to measure dynamics of ferumoxytol delivery and washout in the placenta. Stable MRI measurements indicated no evidence of iron deposition in fetal tissues of nonhuman primates after maternal ferumoxytol exposure.
Collapse
Affiliation(s)
- Ante Zhu
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA; Department of Radiology, University of Wisconsin, Madison, WI, USA
| | - Scott B Reeder
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA; Department of Radiology, University of Wisconsin, Madison, WI, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA; Department of Medicine, University of Wisconsin, Madison, WI, USA; Department of Emergency Medicine, University of Wisconsin, Madison, WI, USA
| | - Kevin M Johnson
- Department of Radiology, University of Wisconsin, Madison, WI, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Sydney M Nguyen
- Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI, USA; Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Sean B Fain
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA; Department of Radiology, University of Wisconsin, Madison, WI, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Ian M Bird
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Thaddeus G Golos
- Wisconsin National Primate Research Center, University of Wisconsin, Madison, WI, USA; Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA; Department of Comparative Biosciences, University of Wisconsin, Madison, WI, USA
| | - Oliver Wieben
- Department of Radiology, University of Wisconsin, Madison, WI, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA
| | - Dinesh M Shah
- Department of Obstetrics and Gynecology, University of Wisconsin, Madison, WI, USA
| | - Diego Hernando
- Department of Biomedical Engineering, University of Wisconsin, Madison, WI, USA; Department of Radiology, University of Wisconsin, Madison, WI, USA; Department of Medical Physics, University of Wisconsin, Madison, WI, USA; Department of Electrical and Computer Engineering, University of Wisconsin, Madison, WI, USA.
| |
Collapse
|
30
|
Bird ST, Gelperin K, Sahin L, Bleich KB, Fazio-Eynullayeva E, Woods C, Radden E, Greene P, McCloskey C, Johnson T, Shinde M, Krefting I. First-Trimester Exposure to Gadolinium-based Contrast Agents: A Utilization Study of 4.6 Million U.S. Pregnancies. Radiology 2019; 293:193-200. [PMID: 31429682 DOI: 10.1148/radiol.2019190563] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BackgroundThe safety of gadolinium-based contrast agent (GBCA) exposure during pregnancy has not been established, and the use of GBCAs during pregnancy is not recommended unless it is essential to the health of the woman or fetus.PurposeTo examine the prevalence of GBCA exposure in a large sample of pregnancies resulting in a live birth.Materials and MethodsThe Sentinel Distributed Database was used to retrospectively identify U.S. pregnancies that resulted in live births between 2006 and 2017 from 16 data partners. The main outcome was the prevalence of MRI procedures with and without GBCAs, sorted by anatomic location and trimester, among pregnant and matched comparator women.ResultsAmong 4 692 744 pregnancies resulting in a live birth, we identified 6879 exposures to GBCAs in 5457 pregnancies, representing one contrast-enhanced MRI examination per 860 pregnancies (0.12% of all pregnancies). Most contrast-enhanced MRI examinations were performed in the head (n = 3499), although pelvic and abdominal MRI constituted 22.3% (n = 1536) of all contrast-enhanced MRI examinations during pregnancy. The majority (70.2%) of GBCA exposures occurred during the first trimester, with a 4.3-fold greater prevalence compared with that in the second trimester and a 5.1-fold greater prevalence compared with that in the third trimester.ConclusionThis study identified higher rates of gadolinium-based contrast agent (GBCA) exposure during the first few weeks of pregnancy compared with the later weeks of pregnancy, suggesting inadvertent exposure to GBCAs might occur before pregnancy is recognized.© RSNA, 2019Online supplemental material is available for this article.See also the editorial by Kallmes and Watson in this issue.
Collapse
Affiliation(s)
- Steven T Bird
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Kate Gelperin
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Leyla Sahin
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Karen B Bleich
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Elnara Fazio-Eynullayeva
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Corinne Woods
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Erica Radden
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Patty Greene
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Carolyn McCloskey
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Tamara Johnson
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Mayura Shinde
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| | - Ira Krefting
- From the Food and Drug Administration, Center for Drug Evaluation and Research, Office of Pharmacovigilance and Epidemiology, Division of Epidemiology (S.T.B., K.G., C.W., P.G, C.M), Office of New Drugs, Division of Pediatric and Maternal Health (L.S., E.R., T.J.), and Division of Medical Imaging Products (K.B.B, I.K), 10903 New Hampshire Ave, Silver Spring, MD 20903; and Harvard Medical School and Harvard Pilgrim Health Care, Boston, Mass (E.F., M.S.)
| |
Collapse
|
31
|
Woodward PJ, Kennedy A, Einerson BD. Is There a Role for MRI in the Management of Placenta Accreta Spectrum? CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2019. [DOI: 10.1007/s13669-019-00266-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
32
|
Use of Magnetic Resonance Imaging in Evaluating Fetal Brain and Abdomen Malformations during Pregnancy. ACTA ACUST UNITED AC 2019; 55:medicina55020055. [PMID: 30781564 PMCID: PMC6410250 DOI: 10.3390/medicina55020055] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2018] [Revised: 01/06/2019] [Accepted: 02/11/2019] [Indexed: 01/07/2023]
Abstract
Magnetic resonance imaging (MRI) is used as a clarifying technique after a high-resolution ultrasound examination during pregnancy. Combining ultrasound with MRI, additional diagnostic information is obtained or ultrasound diagnosis is frequently corrected. High spatial resolution provides accurate radiological imaging of internal organs and widens possibilities for detecting perinatal development disorders. The safety of MRI and the use of intravenous contrast agent gadolinium are discussed in this article. There is no currently available evidence that MRI is harmful to the fetus, although not enough research has been carried out to prove enduring safety. MRI should be performed when the benefit outweighs the potential side effects. The narrative review includes several clinical cases of fetal MRI performed in Vilnius University Hospital Santaros Clinics.
Collapse
|
33
|
Gadolinium as an Emerging Microcontaminant in Water Resources: Threats and Opportunities. GEOSCIENCES 2019. [DOI: 10.3390/geosciences9020093] [Citation(s) in RCA: 52] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
As a result of high doses of paramagnetic gadolinium (Gd) chelates administered in magnetic resonance imaging (MRI) exams, their unmetabolized excretion, and insufficient removal in wastewater treatment plants (WWTPs), large amounts of anthropogenic Gd (Gdanth) are released into surface water. The upward trend of gadolinium-based contrast agent (Gd-CA) administrations is expected to continue growing and consequently higher and higher anthropogenic Gd concentrations are annually recorded in water resources, which can pose a great threat to aquatic organisms and human beings. In addition, the feasibility of Gd retention in patients administered with Gd-CAs repeatedly, and even potentially fatal diseases, including nephrogenic systemic fibrosis (NSF), due to trace amounts of Gd have recently arisen severe health concerns. Thus, there is a need to investigate probable adverse health effects of currently marketed Gd-CAs meticulously and to modify the actual approach in using Gd contrast media in daily practice in order to minimize unknown possible health risks. Furthermore, the employment of enhanced wastewater treatment processes that are capable of removing the stable contrast agents, and the evaluation of the ecotoxicity of Gd chelates and human exposure to these emerging contaminants through dermal and ingestion pathways deserve more attention. On the other hand, point source releases of anthropogenic Gd into the aquatic environment presents the opportunity to assess surface water—groundwater interactions and trace the fate of wastewater plume as a proxy for the potential presence of other microcontaminants associated with treated wastewater in freshwater and marine systems.
Collapse
|
34
|
Rozenfeld MN, Podberesky DJ. Gadolinium-based contrast agents in children. Pediatr Radiol 2018; 48:1188-1196. [PMID: 30078039 DOI: 10.1007/s00247-018-4165-1] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Revised: 01/29/2018] [Accepted: 05/15/2018] [Indexed: 02/08/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) are widely used in medical imaging, with greater than 300 million doses administered since their introduction. The risk of adverse reactions is very low, and GBCAs were thought to be very safe until the discovery of nephrogenic systemic fibrosis (NSF). Since that time, gadolinium has been found to deposit throughout the body, including the brain, where it is visible on non-contrast T1-weighted MR images in people with normal renal function. The clinical effects of this deposition remain unknown and may not exist. In this review the authors provide a comprehensive update on GBCAs and their potential risks, within a historical context and through the lens of a pediatric radiologist.
Collapse
Affiliation(s)
- Michael N Rozenfeld
- Department of Radiology, University of Arizona College of Medicine - Phoenix, 550 E. Van Buren St., Phoenix, AZ, 85004, USA.
| | - Daniel J Podberesky
- Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
| |
Collapse
|
35
|
Taketomi-Takahashi A, Tsushima Y. In Utero Exposure to Gadolinium-based Contrast Agents. Radiology 2018; 288:633-635. [DOI: 10.1148/radiol.2018180147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ayako Taketomi-Takahashi
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-15 Showa-machi, Maebashi, Gunma 371-8511, Japan
| |
Collapse
|
36
|
Salati JA, Roberts VHJ, Schabel MC, Lo JO, Kroenke CD, Lewandowski KS, Lindner JR, Grove KL, Frias AE. Maternal high-fat diet reversal improves placental hemodynamics in a nonhuman primate model of diet-induced obesity. Int J Obes (Lond) 2018; 43:906-916. [PMID: 30006583 PMCID: PMC6330251 DOI: 10.1038/s41366-018-0145-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 05/16/2018] [Accepted: 05/27/2018] [Indexed: 12/17/2022]
Abstract
BACKGROUND In a Japanese macaque model of diet-induced obesity, we have previously demonstrated that consumption of a high-fat, "Western-style" diet (WSD) is associated with placental dysfunction and adverse pregnancy outcomes, independent of an obese maternal phenotype. Specifically, we have reported decreased uterine placental blood flow and increased inflammation with maternal WSD consumption. We also previously investigated the use of a promising therapeutic intervention that mitigated the adverse placental effects of a WSD but had unexpected detrimental effects on fetal pancreatic development. Thus, the objective of the current study was to determine whether simple preconception diet reversal (REV) would improve placental function. METHODS Female Japanese macaques were divided into three groups: REV animals (n = 5) were switched from a chronic WSD (36% fat) to a low fat, CON diet (14% fat) prior to conception and throughout pregnancy. The CON (n = 6) and WSD (n = 6) cohorts were maintained on their respective diets throughout pregnancy. Maternal body weight and composition were regularly assessed and advanced noninvasive imaging was performed at midgestation (gestational day 90, G90, or 0.5 of gestation, where full term is G175), and G129, 1 day prior to C-section delivery at G130 (0.75 of gestation). Imaging studies comprised Doppler ultrasound (US), contrast-enhanced US, and dynamic contrast-enhanced magnetic resonance imaging to assess uteroplacental hemodynamics and maternal-side placental perfusion. RESULTS Dietary intervention resulted in significant maternal weight loss prior to pregnancy, and improved lean to fat mass ratio. By advanced imaging we demonstrated that a chronic WSD led to decreased blood flow velocity in the intervillous space, delayed blood flow transfer through the maternal spiral arteries, and reduced total placental blood flow compared to CON fed animals. Dietary reversal ameliorated these concerning derangements, restoring these hemodynamic parameters to CON levels. CONCLUSIONS Preconception dietary modification has beneficial effects on the maternal metabolic phenotype, and results in improved placental hemodynamics.
Collapse
Affiliation(s)
- Jennifer A Salati
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 S W Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Victoria H J Roberts
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, 97006, USA.
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, 3181 S W Sam Jackson Park Rd, Portland, OR, 97239, USA.,Utah Center for Advanced Imaging Research, University of Utah, Salt Lake City, UT, 84112, USA
| | - Jamie O Lo
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 S W Sam Jackson Park Rd, Portland, OR, 97239, USA
| | - Christopher D Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University, 3181 S W Sam Jackson Park Rd, Portland, OR, 97239, USA.,Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, 505 NW 185th Ave, Beaverton, OR, 97006, USA
| | - Katherine S Lewandowski
- Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, 97006, USA
| | - Jonathan R Lindner
- Knight Cardiovascular Institute, Oregon Health & Science University, 3303 S W Bond Ave., Portland, OR, 97239, USA.,Division of Cardiometabolic Health, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, 97006, USA
| | - Kevin L Grove
- Novo Nordisk Research Center, 530 Fairview Ave N #5000, Seattle, WA, 98109, USA
| | - Antonio E Frias
- Department of Obstetrics & Gynecology, Oregon Health & Science University, 3181 S W Sam Jackson Park Rd, Portland, OR, 97239, USA.,Division of Reproductive and Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, 505 NW 185th Ave, Beaverton, OR, 97006, USA
| |
Collapse
|
37
|
Clases D, Sperling M, Karst U. Analysis of metal-based contrast agents in medicine and the environment. Trends Analyt Chem 2018. [DOI: 10.1016/j.trac.2017.12.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
|
38
|
Terón I, Eng MS, Katz JM. Causes and Treatment of Acute Ischemic Stroke During Pregnancy. Curr Treat Options Neurol 2018; 20:21. [PMID: 29785465 DOI: 10.1007/s11940-018-0506-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
PURPOSE OF REVIEW Treatment recommendations for pregnancy associated ischemic stroke are scarce. This may be due to the fact that, in general, obstetricians tend not to make recommendations for stroke patients and neurologists are not commonly involved in the care of pregnant women. Herein, we review the multiple etiologies of ischemic stroke during pregnancy, considerations for diagnostic testing, and acute treatment and prevention options, including associated risks specific to the pregnant and puerperal state. RECENT FINDINGS Intravenous tissue plasminogen activator (tPA) and endovascular thrombectomy have been used successfully to treat pregnant women with acute ischemic stroke. Recent national guidelines recommend considering tPA use during pregnancy for moderate and severe strokes if the potential benefits offset the risks of uterine hemorrhage. Pregnancy-associated ischemic stroke is rare, but can be devastating, and recanalization therapy should not be systematically withheld. Women who are at risk for stroke should be followed carefully, and providers caring for pregnant women should be educated regarding stroke signs and symptoms. Many of the standard post stroke diagnostic modalities may be used safely in pregnancy, and primary and secondary stroke prevention therapy must be tailored to avoid fetal toxicity.
Collapse
Affiliation(s)
- Ina Terón
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.
| | | | - Jeffrey M Katz
- Department of Neurology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, 300 Community Drive, 9 Tower, Manhasset, NY, 11030, USA.,Department of Radiology, North Shore University Hospital and Zucker School of Medicine at Hofstra/Northwell, and Feinstein Institute for Medical Research, Hempstead, NY, 11549, USA
| |
Collapse
|
39
|
Pasquini L, Napolitano A, Visconti E, Longo D, Romano A, Tomà P, Rossi Espagnet MC. Gadolinium-Based Contrast Agent-Related Toxicities. CNS Drugs 2018; 32:229-240. [PMID: 29508245 DOI: 10.1007/s40263-018-0500-1] [Citation(s) in RCA: 71] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
In recent years, gadolinium-based contrast agents have been associated with different types of toxicity. In particular, nephrogenic systemic fibrosis, a progressive sclerotic-myxedematous systemic disease of unknown etiology, is related to gadolinium-based contrast agent administration in patients with kidney dysfunction. More recently, evidence of magnetic resonance signal intensity changes on pre-contrast T1-weighted images after multiple gadolinium-based contrast agent administrations resulted in the hypothesis of gadolinium brain accumulation in patients with normal renal function, subsequently confirmed in pathological samples. However, there is limited current data and further investigations are necessary before drawing definite conclusions on the clinical consequences of gadolinium-based contrast agent accumulation in human tissues and particularly in the brain. Gadolinium-based contrast agent-related toxicity appears connected to molecular stability, which varies together with the pharmacokinetic properties of the compound and depends on the individual characteristics of the subject. During a lifetime, the physiological changes occurring in the human body may influence its interaction with gadolinium-based contrast agents: the integrity and developmental stage of the organs has an effect on the dynamics of gadolinium-based contrast agent distribution and excretion, thus leading to different possible mechanisms of deposition and toxicity. Therefore, the aim of this work is to discuss the pharmacokinetics and pharmacodynamics of gadolinium-based contrast agents, with a special focus on the brain, and to explore potential predominant gadolinium-based contrast agent-related toxicity in two cornerstone periods of the human life cycle: fetal/neonatal and adulthood/aged.
Collapse
Affiliation(s)
- Luca Pasquini
- Neuroradiology Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.
| | - Antonio Napolitano
- Medical Physics Unit, Risk Management Enterprise, Bambino Gesù Children's Hospital, Rome, Italy
| | | | - Daniela Longo
- Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Andrea Romano
- Neuroradiology Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.,Department of Odontostomatological and Maxillo-Facial Sciences, Sapienza University, Rome, Italy
| | - Paolo Tomà
- Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| | - Maria Camilla Rossi Espagnet
- Neuroradiology Unit, Sant'Andrea Hospital, Via di Grottarossa 1035, 00189, Rome, Italy.,Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, Rome, Italy
| |
Collapse
|
40
|
|
41
|
Prola-Netto J, Woods M, Roberts VHJ, Sullivan EL, Miller CA, Frias AE, Oh KY. Gadolinium Chelate Safety in Pregnancy: Barely Detectable Gadolinium Levels in the Juvenile Nonhuman Primate after in Utero Exposure. Radiology 2017; 286:122-128. [PMID: 28873045 DOI: 10.1148/radiol.2017162534] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Purpose To determine whether gadolinium remains in juvenile nonhuman primate tissue after maternal exposure to intravenous gadoteridol during pregnancy. Materials and Methods Gravid rhesus macaques and their offspring (n = 10) were maintained, as approved by the institutional animal care and utilization committee. They were prospectively studied as part of a pre-existing ongoing research protocol to evaluate the effects of maternal malnutrition on placental and fetal development. On gestational days 85 and 135, they underwent placental magnetic resonance imaging after intravenous gadoteridol administration. Amniocentesis was performed on day 135 prior to administration of the second dose of gadoteridol. After delivery, the offspring were followed for 7 months. Tissue samples from eight different organs and from blood were harvested from each juvenile macaque. Gadolinium levels were measured by using inductively coupled plasma mass spectrometry. Results Gadolinium concentration in the amniotic fluid was 0.028 × 10-5 %ID/g (percentage injected dose per gram of tissue) 50 days after administration of one gadoteridol dose. Gadolinium was most consistently detected in the femur (mean, 2.5 × 10-5 %ID/g; range, [0.81-4.1] × 10-5 %ID/g) and liver (mean, 0.15 × 10-5 %ID/g; range, [0-0.26] × 10-5 %ID/g). Levels were undetectable in the remaining sampled tissues, with the exception of one juvenile skin sample (0.07 × 10-5 %ID/g), one juvenile spleen sample (0.039 × 10-5 %ID/g), and one juvenile brain (0.095 × 10-5 %ID/g) and kidney (0.13 × 10-5 %ID/g) sample. Conclusion The presence of gadoteridol in the amniotic fluid after maternal injection enables confirmation that it crosses the placenta. Extremely low levels of gadolinium are found in juvenile macaque tissues after in utero exposure to two doses of gadoteridol, indicating that a very small amount of gadolinium persists after delivery. © RSNA, 2017.
Collapse
Affiliation(s)
- Joao Prola-Netto
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Mark Woods
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Victoria H J Roberts
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Elinor L Sullivan
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Christina Ann Miller
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Antonio E Frias
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| | - Karen Y Oh
- From the Departments of Radiology (J.P.N., K.Y.O.), Neurology (J.P.N.), and Obstetrics and Gynecology, Division of Maternal Fetal Medicine (A.E.F.), and Advanced Imaging Research Center (M.W.), Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Room L603, Portland, OR 97239; Divisions of Reproductive and Developmental Sciences (V.H.J.R., A.E.F.) and Neurosciences (E.L.S.), Oregon National Primate Research Center, Oregon Health and Science University, Beaverton, Ore; and Department of Chemistry, Portland State University, Portland, Ore (M.W., C.A.M.)
| |
Collapse
|
42
|
Erdene K, Nakajima T, Kameo S, Khairinisa MA, Lamid-Ochir O, Tumenjargal A, Koibuchi N, Koyama H, Tsushima Y. Organ retention of gadolinium in mother and pup mice: effect of pregnancy and type of gadolinium-based contrast agents. Jpn J Radiol 2017; 35:568-573. [PMID: 28730467 DOI: 10.1007/s11604-017-0667-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 07/11/2017] [Indexed: 11/25/2022]
Affiliation(s)
- Khongorzul Erdene
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Takahito Nakajima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Satomi Kameo
- Department of Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Miski Aghnia Khairinisa
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Oyunbold Lamid-Ochir
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Amartuvshin Tumenjargal
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Noriyuki Koibuchi
- Department of Integrative Physiology, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Hiroshi Koyama
- Department of Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Yoshito Tsushima
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
- Research Program for Diagnostic and Molecular Imaging, Division of Integrated Oncology Research, Gunma University Initiative for Advanced Research (GIAR), Maebashi, Gunma, Japan
| |
Collapse
|
43
|
Goischke HK. Safety assessment of gadolinium-based contrast agents (GBCAs) requires consideration of long-term adverse effects in all human tissues. Mult Scler J Exp Transl Clin 2017; 3:2055217317704450. [PMID: 28607758 PMCID: PMC5408503 DOI: 10.1177/2055217317704450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
|
44
|
Lo JO, Schabel MC, Roberts VHJ, Wang X, Lewandowski KS, Grant KA, Frias AE, Kroenke CD. First trimester alcohol exposure alters placental perfusion and fetal oxygen availability affecting fetal growth and development in a non-human primate model. Am J Obstet Gynecol 2017; 216:302.e1-302.e8. [PMID: 28153658 PMCID: PMC5334435 DOI: 10.1016/j.ajog.2017.01.016] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Revised: 12/22/2016] [Accepted: 01/13/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Prenatal alcohol exposure leads to impaired fetal growth, brain development, and stillbirth. Placental impairment likely contributes to these adverse outcomes, but the mechanisms and specific vasoactive effects of alcohol that links altered placental function to impaired fetal development remain areas of active research. OBJECTIVE Recently, we developed magnetic resonance imaging techniques in nonhuman primates to characterize placental blood oxygenation through measurements of T2* and perfusion using dynamic contrast-enhanced magnetic resonance imaging. The objective of this study was to evaluate the effects of first-trimester alcohol exposure on macaque placental function and to characterize fetal brain development in vivo. STUDY DESIGN Timed-pregnant Rhesus macaques (n=12) were divided into 2 groups: control (n=6) and ethanol exposed (n=6). Animals were trained to self-administer orally either 1.5 g/kg/d of a 4% ethanol solution (equivalent to 6 drinks/d) or an isocaloric control fluid from preconception until gestational day 60 (term is G168). All animals underwent Doppler ultrasound scanning followed by magnetic resonance imaging that consisted of T2* and dynamic contrast-enhanced measurements. Doppler ultrasound scanning was used to measure uterine artery and umbilical vein velocimetry and diameter to calculate uterine artery volume blood flow and placental volume blood flow. After noninvasive imaging, animals underwent cesarean delivery for placenta collection and fetal necropsy at gestational day 110 (n=6) or 135 (n=6). RESULTS Fetal weight and biparietal diameter were significantly smaller in ethanol-exposed animals compared with control animals at gestational day 110. By Doppler ultrasound scanning, placental volume blood flow was significantly lower (P=.04) at gestational day 110 in ethanol-exposed vs control animals. A significant reduction in placental blood flow was evident by dynamic contrast-enhanced magnetic resonance imaging. As we demonstrated recently, T2* values vary throughout the placenta and reveal gradients in blood deoxyhemoglobin concentration that range from highly oxygenated blood (long T2*) proximal to spiral arteries to highly deoxygenated blood (short T2*). Distributions of T2*throughout the placenta show significant global reduction in T2* (and hence high blood deoxyhemoglobin concentration) in ethanol-exposed vs control animals at gestational day 110 (P=.02). Fetal brain measurements indicated impaired growth and development at gestational day 110, but less so at gestational day 135 in ethanol-exposed vs control animals. CONCLUSION Chronic first-trimester ethanol exposure significantly reduces placental perfusion and oxygen supply to the fetal vasculature later in pregnancy. These perturbations of placental function are associated with fetal growth impairments. However, differences between ethanol-exposed and control animals in placental function and fetal developmental outcomes were smaller at gestational day 135 than at gestational day 110. These findings are consistent with placental adaptation to early perturbations that allow for compensated placental function and maintenance of fetal growth.
Collapse
Affiliation(s)
- Jamie O Lo
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR.
| | - Matthias C Schabel
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR
| | - Victoria H J Roberts
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Xiaojie Wang
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Katherine S Lewandowski
- Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Kathleen A Grant
- Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Antonio E Frias
- Department of Obstetrics and Gynecology, Oregon Health & Science University, Portland, OR; Division of Reproductive & Developmental Sciences, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| | - Christopher D Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University, Portland, OR; Division of Neuroscience, Oregon National Primate Research Center, Oregon Health & Science University, Beaverton, OR
| |
Collapse
|
45
|
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.
Collapse
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
| |
Collapse
|
46
|
Millischer AE, Salomon LJ, Porcher R, Brasseur-Daudruy M, Gourdier AL, Hornoy P, Silvera S, Loisel D, Tsatsaris V, Delorme B, Boddaert N, Ville Y, Sentilhes L. Magnetic resonance imaging for abnormally invasive placenta: the added value of intravenous gadolinium injection. BJOG 2016; 124:88-95. [DOI: 10.1111/1471-0528.14164] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2016] [Indexed: 11/26/2022]
Affiliation(s)
- A-E Millischer
- Service de Radiologie; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
- EAfetus 7328; Université Paris Descartes; Paris France
| | - LJ Salomon
- EAfetus 7328; Université Paris Descartes; Paris France
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Descartes; Paris France
| | - R Porcher
- Service de Statistiques; Hôpital Hotel-Dieu; Assistance Publique-Hôpitaux de Paris; Paris France
| | - M Brasseur-Daudruy
- Service de Gynécologie-Obstétrique; Hôpital Universitaire de Rouen; Rouen France
| | - A-L Gourdier
- Service de Radiologie; Hôpital Universitaire d'Angers; Angers France
| | - P Hornoy
- Service de Radiologie Cochin-Port Royal; Assistance Publique-Hôpitaux de Paris; Paris France
| | - S Silvera
- Service de Radiologie Cochin-Port Royal; Assistance Publique-Hôpitaux de Paris; Paris France
| | - D Loisel
- Service de Radiologie; Hôpital Universitaire d'Angers; Angers France
| | - V Tsatsaris
- Service de Gynécologie-Obstétrique; Hôpital Cochin-Port Royal; Assistance Publique-Hôpitaux de Paris; Paris France
| | - B Delorme
- Service de Radiologie; Hôpital Universitaire d'Angers; Angers France
| | - N Boddaert
- Service de Radiologie; Hôpital Necker Enfants Malades; Assistance Publique-Hôpitaux de Paris (APHP); Paris France
| | - Y Ville
- EAfetus 7328; Université Paris Descartes; Paris France
- Service de Gynécologie-Obstétrique; Hôpital Necker-Enfants Malades; Assistance Publique-Hôpitaux de Paris (AP-HP); Université Paris Descartes; Paris France
| | - L Sentilhes
- Service de Gynécologie-Obstétrique; Hôpital Universitaire Bordeaux; Bordeaux France
| |
Collapse
|
47
|
|
48
|
Chen R, Ling D, Zhao L, Wang S, Liu Y, Bai R, Baik S, Zhao Y, Chen C, Hyeon T. Parallel Comparative Studies on Mouse Toxicity of Oxide Nanoparticle- and Gadolinium-Based T1 MRI Contrast Agents. ACS NANO 2015; 9:12425-12435. [PMID: 26567968 DOI: 10.1021/acsnano.5b05783] [Citation(s) in RCA: 110] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Magnetic resonance imaging (MRI) contrast agents with high relaxivity are highly desirable because they can significantly increase the accuracy of diagnosis. However, they can be potentially toxic to the patients. In this study, using a mouse model, we investigate the toxic effects and subsequent tissue damage induced by three T1 MRI contrast agents: gadopentetate dimeglumine injection (GDI), a clinically used gadolinium (Gd)-based contrast agent (GBCAs), and oxide nanoparticle (NP)-based contrast agents, extremely small-sized iron oxide NPs (ESIONs) and manganese oxide (MnO) NPs. Biodistribution, hematological and histopathological changes, inflammation, and the endoplasmic reticulum (ER) stress responses are evaluated for 24 h after intravenous injection. These thorough assessments of the toxic and stress responses of these agents provide a panoramic description of safety concerns and underlying mechanisms of the toxicity of contrast agents in the body. We demonstrate that ESIONs exhibit fewer adverse effects than the MnO NPs and the clinically used GDI GBCAs, providing useful information on future applications of ESIONs as potentially safe MRI contrast agents.
Collapse
Affiliation(s)
- Rui Chen
- CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China , Beijing 100190, P. R. China
| | - Daishun Ling
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University , Hangzhou 310058, P. R. China
- Key Laboratory of Biomedical Engineering of the Ministry of Education, Zhejiang University , Hangzhou 310058, P. R. China
- Center for Nanoparticle Research, Institute for Basic Science (IBS) , Seoul 151-742, Korea
- School of Chemical and Biological Engineering, Seoul National University , Seoul 151-742, Korea
| | - Lin Zhao
- CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China , Beijing 100190, P. R. China
| | - Shuaifei Wang
- Zhejiang Province Key Laboratory of Anti-Cancer Drug Research, College of Pharmaceutical Sciences, Zhejiang University , Hangzhou 310058, P. R. China
| | - Ying Liu
- CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China , Beijing 100190, P. R. China
| | - Ru Bai
- CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China , Beijing 100190, P. R. China
| | - Seungmin Baik
- Center for Nanoparticle Research, Institute for Basic Science (IBS) , Seoul 151-742, Korea
- School of Chemical and Biological Engineering, Seoul National University , Seoul 151-742, Korea
| | - Yuliang Zhao
- CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China , Beijing 100190, P. R. China
| | - Chunying Chen
- CAS Key Lab for Biomedical Effects of Nanomaterials and Nanosafety, National Center for Nanoscience and Technology of China , Beijing 100190, P. R. China
| | - Taeghwan Hyeon
- Center for Nanoparticle Research, Institute for Basic Science (IBS) , Seoul 151-742, Korea
- School of Chemical and Biological Engineering, Seoul National University , Seoul 151-742, Korea
| |
Collapse
|
49
|
Schabel MC, Roberts VHJ, Lo JO, Platt S, Grant KA, Frias AE, Kroenke CD. Functional imaging of the nonhuman primate Placenta with endogenous blood oxygen level-dependent contrast. Magn Reson Med 2015; 76:1551-1562. [PMID: 26599502 DOI: 10.1002/mrm.26052] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Revised: 10/22/2015] [Accepted: 10/23/2015] [Indexed: 02/05/2023]
Abstract
PURPOSE To characterize spatial patterns of T2* in the placenta of the rhesus macaque (Macaca mulatta), to correlate these patterns with placental perfusion determined using dynamic contrast-enhanced MRI (DCE-MRI), and to evaluate the potential for using the blood oxygen level-dependent effect to quantify placental perfusion without the use of exogenous contrast reagent. METHODS MRI was performed on three pregnant rhesus macaques at gestational day 110. Multiecho spoiled gradient echo measurements were used to compute maps of T2*. Spatial maxima in these maps were compared with foci of early enhancement determined by DCE-MRI. RESULTS Local maxima in T2* maps were strongly correlated with spiral arteries identified by DCE-MRI, with mean spatial separations ranging from 2.34 to 6.11 mm in the three animals studied. Spatial patterns of R2* ( = 1/ T2*) within individual placental lobules can be quantitatively analyzed using a simple model to estimate fetal arterial oxyhemoglobin concentration [Hbo,f] and a parameter viPS/Φ, reflecting oxygen transport to the fetus. Estimated mean values of [Hbo,f] ranged from 4.25 mM to 4.46 mM, whereas viPS/Φ ranged from 2.80 × 105 cm-3 to 1.61 × 106 cm-3 . CONCLUSIONS Maternal spiral arteries show strong spatial correlation with foci of extended T2* observed in the primate placenta. A simple model of oxygen transport accurately describes the spatial dependence of R2* within placental lobules and enables assessment of placental function and oxygenation without requiring administration of an exogenous contrast reagent. Magn Reson Med 76:1551-1562, 2016. © 2015 International Society for Magnetic Resonance in Medicine.
Collapse
Affiliation(s)
- M C Schabel
- Advanced Imaging Research Center, Oregon Health & Science University.,Utah Center for Advanced Imaging Research, University of Utah
| | - V H J Roberts
- Division of Diabetes, Obesity & Metabolism, Oregon Health & Science University
| | - J O Lo
- Division of Diabetes, Obesity & Metabolism, Oregon Health & Science University
| | - S Platt
- Division of Neuroscience, Oregon National Primate Research Center
| | - K A Grant
- Division of Neuroscience, Oregon National Primate Research Center.,Department of Behavioral Neuroscience, Oregon Health & Science University
| | - A E Frias
- Division of Diabetes, Obesity & Metabolism, Oregon Health & Science University.,Division of Developmental & Reproductive Sciences, Oregon National Primate Research Center.,Department of Obstetrics & Gynecology, Oregon Health & Science University
| | - C D Kroenke
- Advanced Imaging Research Center, Oregon Health & Science University.,Division of Neuroscience, Oregon National Primate Research Center.,Department of Behavioral Neuroscience, Oregon Health & Science University
| |
Collapse
|