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Vymazal J, Rulseh AM. MRI contrast agents and retention in the brain: review of contemporary knowledge and recommendations to the future. Insights Imaging 2024; 15:179. [PMID: 39060665 PMCID: PMC11282029 DOI: 10.1186/s13244-024-01763-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Gadolinium-based contrast agents (GBCA) were introduced with high expectations for favorable efficacy, low nephrotoxicity, and minimal allergic-like reactions. Nephrogenic systemic fibrosis and proven gadolinium retention in the body including the brain has led to the restriction of linear GBCAs and a more prudent approach regarding GBCA indication and dosing. In this review, we present the chemical, physical, and clinical aspects of this topic and aim to provide an equanimous and comprehensive summary of contemporary knowledge with a perspective of the future. In the first part of the review, we present various elements and compounds that may serve as MRI contrast agents. Several GBCAs are further discussed with consideration of their relaxivity, chelate structure, and stability. Gadolinium retention in the brain is explored including correlation with the presence of metalloprotein ferritin in the same regions where visible hyperintensity on unenhanced T1-weighted imaging occurs. Proven interaction between ferritin and gadolinium released from GBCAs is introduced and discussed, as well as the interaction of other elements with ferritin; and manganese in patients with impaired liver function or calcium in Fahr disease. We further present the concept that only high-molecular-weight forms of gadolinium can likely visibly change signal intensity on unenhanced T1-weighted imaging. Clinical data are also presented with respect to potential neurological manifestations originating from the deep-brain nuclei. Finally, new contrast agents with relatively high relaxivity and stability are introduced. CRITICAL RELEVANCE STATEMENT: GBCA may accumulate in the brain, especially in ferritin-rich areas; however, no adverse neurological manifestations have been detected in relation to gadolinium retention. KEY POINTS: Gadolinium currently serves as the basis for MRI contrast agents used clinically. No adverse neurological manifestations have been detected in relation to gadolinium retention. Future contrast agents must advance chelate stability and relativity, facilitating lower doses.
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Affiliation(s)
- Josef Vymazal
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, Prague, 150 30, Czech Republic
| | - Aaron M Rulseh
- Department of Radiology, Na Homolce Hospital, Roentgenova 2, Prague, 150 30, Czech Republic.
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2
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Cheong BYC, Wilson JM, Preventza OA, Muthupillai R. Gadolinium-Based Contrast Agents: Updates and Answers to Typical Questions Regarding Gadolinium Use. Tex Heart Inst J 2022; 49:482255. [PMID: 35612906 DOI: 10.14503/thij-21-7680] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents have expanded the diagnostic usefulness and capability of magnetic resonance imaging. Despite their highly favorable safety profile, these agents have been associated with nephrogenic systemic fibrosis in a small number of patients who have advanced kidney disease. Recently, trace amounts of gadolinium deposition in the brain and other organs have been reported after contrast exposure, even in patients with normal renal function. In this review, we provide a brief overview of recent updates and discuss typical clinical situations related to the use of gadolinium-based contrast agents.
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Affiliation(s)
- Benjamin Y C Cheong
- Department of Cardiology, Texas Heart Institute, Houston, Texas.,Department of Cardiovascular Radiology, Texas Heart Institute, Houston, Texas
| | - James M Wilson
- Houston Methodist DeBakey Heart & Vascular Center, Houston, Texas
| | - Ourania A Preventza
- Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.,Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Texas
| | - Raja Muthupillai
- Department of Cardiovascular Radiology, Texas Heart Institute, Houston, Texas.,University of Houston College of Medicine, Houston, Texas
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3
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So YH, Lee W, Park EA, Kim PK. Investigation of the Characteristics of New, Uniform, Extremely Small Iron-Based Nanoparticles as T1 Contrast Agents for MRI. Korean J Radiol 2021; 22:1708-1718. [PMID: 34402245 PMCID: PMC8484154 DOI: 10.3348/kjr.2020.1455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Revised: 04/06/2021] [Accepted: 05/10/2021] [Indexed: 11/21/2022] Open
Abstract
Objective The purpose of this study was to evaluate the magnetic resonance (MR) characteristics and applicability of new, uniform, extremely small iron-based nanoparticles (ESIONs) with 3–4-nm iron cores using contrast-enhanced magnetic resonance angiography (MRA). Materials and Methods Seven types of ESIONs were used in phantom and animal experiments with 1.5T, 3T, and 4.7T scanners. The MR characteristics of the ESIONs were evaluated via phantom experiments. With the ESIONs selected by the phantom experiments, animal experiments were performed on eight rabbits. In the animal experiments, the in vivo kinetics and enhancement effect of the ESIONs were evaluated using half-diluted and non-diluted ESIONs. The between-group differences were assessed using a linear mixed model. A commercially available gadolinium-based contrast agent (GBCA) was used as a control. Results All ESIONs showed a good T1 shortening effect and were applicable for MRA at 1.5T and 3T. The relaxivity ratio of the ESIONs increased with increasing magnetic field strength. In the animal experiments, the ESIONs showed peak signal intensity on the first-pass images and persistent vascular enhancement until 90 minutes. On the 1-week follow-up images, the ESIONs were nearly washed out from the vascular structures and organs. The peak signal intensity on the first-pass images showed no significant difference between the non-diluted ESIONs with 3-mm iron cores and GBCA (p = 1.000). On the 10-minutes post-contrast images, the non-diluted ESIONs showed a significantly higher signal intensity than did the GBCA (p < 0.001). Conclusion In the phantom experiments, the ESIONs with 3–4-nm iron oxide cores showed a good T1 shortening effect at 1.5T and 3T. In the animal experiments, the ESIONs with 3-nm iron cores showed comparable enhancement on the first-pass images and superior enhancement effect on the delayed images compared to the commercially available GBCA at 3T.
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Affiliation(s)
- Young Ho So
- Department of Radiology, SMG-SNU Boramae Medical Center, Seoul, Korea.,Department of Radiology, Seoul National University College of Medicine, Seoul, Korea
| | - Whal Lee
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea.,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Korea.
| | - Eun Ah Park
- Department of Radiology, Seoul National University College of Medicine, Seoul, Korea.,Department of Radiology, Seoul National University Hospital, Seoul, Korea
| | - Pan Ki Kim
- Department of Radiology and Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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4
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Management of the Incidental Liver Lesion. Am J Gastroenterol 2021; 116:855-861. [PMID: 33298700 DOI: 10.14309/ajg.0000000000001089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
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5
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Ahmad F, Treanor L, McGrath TA, Walker D, McInnes MD, Schieda N. Safety of Off‐Label Use of Ferumoxtyol as a Contrast Agent for
MRI
: A Systematic Review and Meta‐Analysis of Adverse Events. J Magn Reson Imaging 2020; 53:840-858. [DOI: 10.1002/jmri.27405] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Revised: 10/04/2020] [Accepted: 10/06/2020] [Indexed: 12/13/2022] Open
Affiliation(s)
- Faraz Ahmad
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
| | - Lee Treanor
- Faculty of Medicine University of Ottawa Ottawa Ontario Canada
| | | | - Daniel Walker
- Department of Radiology University of Ottawa Ottawa Ontario Canada
| | - Matthew D.F. McInnes
- University of Ottawa Department of Radiology and Epidemiology Ottawa Ontario Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
| | - Nicola Schieda
- University of Ottawa Department of Radiology and Epidemiology Ottawa Ontario Canada
- Clinical Epidemiology Program Ottawa Hospital Research Institute Ottawa Ontario Canada
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6
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Rudnick MR, Wahba IM, Leonberg-Yoo AK, Miskulin D, Litt HI. Risks and Options With Gadolinium-Based Contrast Agents in Patients With CKD: A Review. Am J Kidney Dis 2020; 77:517-528. [PMID: 32861792 DOI: 10.1053/j.ajkd.2020.07.012] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 07/01/2020] [Indexed: 01/19/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) improve the diagnostic capabilities of magnetic resonance imaging. Although initially believed to be without major adverse effects, GBCA use in patients with severe chronic kidney disease (CKD) was demonstrated to cause nephrogenic systemic fibrosis (NSF). Restrictive policies of GBCA use in CKD and selective use of GBCAs that bind free gadolinium more strongly have resulted in the virtual elimination of NSF cases. Contemporary studies of the use of GBCAs with high binding affinity for free gadolinium in severe CKD demonstrate an absence of NSF. Despite these observations and the limitations of contemporary studies, physicians remain concerned about GBCA use in severe CKD. Concerns of GBCA use in severe CKD are magnified by recent observations demonstrating gadolinium deposition in brain and a possible systemic syndrome attributed to GBCAs. Radiologic advances have resulted in several new imaging modalities that can be used in the severe CKD population and that do not require GBCA administration. In this article, we critically review GBCA use in patients with severe CKD and provide recommendations regarding GBCA use in this population.
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Affiliation(s)
- Michael R Rudnick
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA.
| | - Ihab M Wahba
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA; Corporal Michael J Crescenz Philadelphia Veterans Affairs Hospital Philadelphia, PA
| | - Amanda K Leonberg-Yoo
- Division of Nephrology, Perelman School of Medicine at the University of Pennsylvania, PA
| | - Dana Miskulin
- Division of Nephrology, Tufts University School of Medicine, Boston, MA
| | - Harold I Litt
- Department of Radiology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
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7
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Lunyera J, Mohottige D, Alexopoulos AS, Campbell H, Cameron CB, Sagalla N, Amrhein TJ, Crowley MJ, Dietch JR, Gordon AM, Kosinski AS, Cantrell S, Williams JW, Gierisch JM, Ear B, Goldstein KM. Risk for Nephrogenic Systemic Fibrosis After Exposure to Newer Gadolinium Agents: A Systematic Review. Ann Intern Med 2020; 173:110-119. [PMID: 32568573 PMCID: PMC7847719 DOI: 10.7326/m20-0299] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The risk for nephrogenic systemic fibrosis (NSF) after exposure to newer versus older gadolinium-based contrast agents (GBCAs) remains unclear. PURPOSE To synthesize evidence about NSF risk with newer versus older GBCAs across the spectrum of kidney function. DATA SOURCES MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, and Web of Science for English-language references from inception to 5 March 2020. STUDY SELECTION Randomized controlled trials, cohort studies, and case-control studies that assessed NSF occurrence after GBCA exposure. DATA EXTRACTION Data were abstracted by 1 investigator and verified by a second. Investigator pairs assessed risk of bias by using validated tools. DATA SYNTHESIS Of 32 included studies, 20 allowed for assessment of NSF risk after exposure to newer GBCAs and 12 (11 cohort studies and 1 case-control study) allowed for comparison of NSF risk between newer and older GBCAs. Among 83 291 patients exposed to newer GBCAs, no NSF cases developed (exact 95% CI, 0.0001 to 0.0258 case). Among the 12 studies (n = 118 844) that allowed risk comparison between newer and older GBCAs, 37 NSF cases developed after exposure to older GBCAs (exact CI, 0.0001 to 0.0523 case) and 4 occurred (3 confounded) after exposure to newer GBCAs (exact CI, 0.0018 to 0.0204 case). Data were scant for patients with acute kidney injury or those at risk for chronic kidney disease. LIMITATIONS Study heterogeneity prevented meta-analysis. Risk of bias was high in most studies because of inadequate exposure and outcome ascertainment. CONCLUSION Although NSF occurrence after exposure to newer GBCAs is very rare, the relatively scarce data among patients with acute kidney injury and those with risk factors for chronic kidney disease limit conclusions about safety in these populations. PRIMARY FUNDING SOURCE U.S. Department of Veterans Affairs. (PROSPERO: CRD42019135783).
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Affiliation(s)
- Joseph Lunyera
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Dinushika Mohottige
- Duke University School of Medicine and Duke University Medical Center, Durham, North Carolina (D.M.)
| | - Anastasia-Stefania Alexopoulos
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Hilary Campbell
- Margolis Center for Health Policy at Duke University, Durham, North Carolina (H.C.)
| | - C Blake Cameron
- Duke University School of Medicine, Durham, North Carolina (J.L., C.B.C.)
| | - Nicole Sagalla
- Durham Veterans Affairs Health Care System and Duke University School of Medicine, Durham, North Carolina (N.S.)
| | - Timothy J Amrhein
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Matthew J Crowley
- Duke University Medical Center and Durham Veterans Affairs Health Care System, Durham, North Carolina (A.A., T.J.A., M.J.C.)
| | - Jessica R Dietch
- Stanford University and Veterans Affairs Palo Alto Health Care System, Palo Alto, California (J.R.D.)
| | - Adelaide M Gordon
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Andrzej S Kosinski
- Duke University Medical Center and Duke Clinical Research Institute, Durham, North Carolina (A.S.K.)
| | - Sarah Cantrell
- Duke University School of Medicine and Duke University Medical Center Library and Archives, Durham, North Carolina (S.C.)
| | - John W Williams
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
| | - Jennifer M Gierisch
- Duke University School of Medicine, Durham Veterans Affairs Health Care System, and Duke University, Durham, North Carolina (J.M.G.)
| | - Belinda Ear
- Durham Veterans Affairs Health Care System, Durham, North Carolina (A.M.G., B.E.)
| | - Karen M Goldstein
- Duke University School of Medicine and Durham Veterans Affairs Health Care System, Durham, North Carolina (J.W.W., K.M.G.)
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8
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Kanal E, Patton TJ, Krefting I, Wang C. Nephrogenic Systemic Fibrosis Risk Assessment and Skin Biopsy Quantification in Patients with Renal Disease following Gadobenate Contrast Administration. AJNR Am J Neuroradiol 2020; 41:393-399. [PMID: 32115422 DOI: 10.3174/ajnr.a6448] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 12/18/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND AND PURPOSE Nephrogenic systemic fibrosis following administration of intravenous gadobenate during MR imaging is rare. This study aimed to analyze any nephrogenic systemic fibrosis-related risks and quantify skin gadolinium levels in patients with impaired renal function but without nephrogenic systemic fibrosis who had received gadobenate. MATERIALS AND METHODS In this retrospective study with a prospective skin biopsy phase, patients with estimated glomerular filtration rates of <60 mL/min/1.73 m2 undergoing contrast-enhanced MR imaging from July 2007 through June 2014 were screened for nephrogenic systemic fibrosis using a questionnaire. This was highly sensitive but not specific and reliably excluded nephrogenic systemic fibrosis if responses to at least 6 of the 8 questions were negative. If no nephrogenic systemic fibrosis was detected, a skin biopsy was requested. RESULTS Of 2914 patients who met these criteria, 1988 were excluded for various reasons. Of the remaining 926 patients, 860 were screened negative for nephrogenic systemic fibrosis. Of these, 17 (2%) had estimated glomerular filtration rates of <15 mL/min/1.73 m2, 51 (6%) had levels of 15 < 30 mL/min/1.73 m2, 234 (27%) had levels of 30 < 45 mL/min/1.73 m2, and 534 (62%) had levels of 45 < 60 mL/min/1.73 m2. Of the 66 who were not cleared of nephrogenic systemic fibrosis by the questionnaire, 6 patients were evaluated by a dermatologist and confirmed not to have nephrogenic systemic fibrosis (no biopsy required). CONCLUSIONS A diagnosis of nephrogenic systemic fibrosis was excluded in 860 patients with impaired renal function who were followed up and received gadobenate during MR imaging. In 14 such patients who underwent at least 1 gadobenate-enhanced MR imaging examination and did not have nephrogenic systemic fibrosis, gadolinium levels in the skin were exceedingly low.
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Affiliation(s)
- E Kanal
- Departments of Radiology (E.K.)
| | - T J Patton
- Dermatology (T.J.P.), University of Pittsburgh Medical Center and University of Pittsburgh, Pittsburgh, Pennsylvania
| | - I Krefting
- Division of Medical Imaging and Radiation Medicine (I.K.)
| | - C Wang
- Office of Pharmacovigilance and Epidemiology (C.W.), US Food and Drug Administration, Silver Spring, Maryland
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9
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Incidence of nephrogenic systemic fibrosis after administration of gadoteric acid in patients on renal replacement treatment. Magn Reson Imaging 2020; 70:1-4. [PMID: 32112811 DOI: 10.1016/j.mri.2020.02.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/20/2020] [Accepted: 02/21/2020] [Indexed: 11/21/2022]
Abstract
PURPOSE Nephrogenic system fibrosis (NSF) is a rare complication detected in patients with renal insufficiency exposed to gadolinium-based contrast agents (GBCAs). The aim of our study is to evaluate the prevalence of NSF in a cohort of patients on renal replacement treatment who underwent GBCA-enhanced magnetic resonance imaging (MRI). METHOD We retrospectively reviewed all the charts of kidney transplant (KT) recipients, patients on hemodialysis (HD) and peritoneal dialysis (PD) who received a uniform protocol for contrast material enhanced-MRI with gadoteric acid at our center from January 2004 to December 2017. RESULTS Three-hundred forty-four patients (44.1% on HD, 11.3% on PD and 44.4% KT recipients) underwent 551 gadoteric acid-enhanced MRI. The median age of the patients was 58 years (IQR, 45-70 years) and 65.1% were men. Sixty-three patients (18.3%) had skin punch biopsy after integumentary assessment performed by a dermatologist. No cases of NSF were detected after a median follow-up of 4.5 years (IQR, 1.9-8.2 years). During this period of observation, 116 (33.7%) patients died and 11 (3.1%) were lost at follow-up. CONCLUSIONS None of the patients exposed to gadoteric acid developed NSF. Our results, in line with more recent studies, suggest that the use of gadoteric acid, a macrocyclic GBCA, appears safe even in chronic kidney disease (CKD) patients receiving dialysis.
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10
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Woolen SA, Shankar PR, Gagnier JJ, MacEachern MP, Singer L, Davenport MS. Risk of Nephrogenic Systemic Fibrosis in Patients With Stage 4 or 5 Chronic Kidney Disease Receiving a Group II Gadolinium-Based Contrast Agent: A Systematic Review and Meta-analysis. JAMA Intern Med 2020; 180:223-230. [PMID: 31816007 PMCID: PMC6902198 DOI: 10.1001/jamainternmed.2019.5284] [Citation(s) in RCA: 143] [Impact Index Per Article: 35.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
IMPORTANCE Risk of nephrogenic systemic fibrosis (NSF) to individual patients with stage 4 or 5 chronic kidney disease (CKD; defined as estimated glomerular filtration rate of <30 mL/min/1.73 m2) who receive a group II gadolinium-based contrast agent (GBCA) is not well understood or summarized in the literature. OBJECTIVE To assess the pooled risk of NSF in patients with stage 4 or 5 CKD receiving a group II GBCA. DATA SOURCES A health sciences informationist searched the Ovid (MEDLINE and MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citation, and Daily and Versions), Embase, Cochrane Central Register of Controlled Trials, Web of Science, and Open Grey databases from inception to January 29, 2019, yielding 2700 citations. STUDY SELECTION Citations were screened for inclusion in a multistep process. Agreement for final cohort inclusion was determined by 2 blinded screeners using Cohen κ. Inclusion criteria consisted of stage 4 or 5 CKD with or without dialysis, administration of an unconfounded American College of Radiology classification group II GBCA (gadobenate dimeglumine, gadobutrol, gadoterate meglumine, or gadoteridol), and incident NSF as an outcome. Conference abstracts, retracted manuscripts, narrative reviews, editorials, case reports, and manuscripts not reporting total group II GBCA administrations were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was performed for all studies by a single investigator, including publication details, study design and time frame, patient characteristics, group II GBCA(s) administered, total exposures for patients with stage 4 or stage 5 CKD, total cases of unconfounded NSF, reason for GBCA administration, follow-up duration, loss to follow-up, basis for NSF screening, and diagnosis. MAIN OUTCOMES AND MEASURES Pooled incidence of NSF and the associated upper bound of a 2-sided 95% CI (risk estimate) for the pooled data and each of the 4 group II GBCAs. RESULTS Sixteen unique studies with 4931 patients were included (κ = 0.68) in this systematic review and meta-analysis. The pooled incidence of NSF was 0 of 4931 (0%; upper bound of 95% CI, 0.07%). The upper bound varied owing to different sample sizes for gadobenate dimeglumine (0 of 3167; upper bound of 95% CI, 0.12%), gadoterate meglumine (0 of 1204; upper bound of 95% CI, 0.31%), gadobutrol (0 of 330; upper bound of 95% CI, 1.11%), and gadoteridol (0 of 230; upper bound of 95% CI, 1.59%). CONCLUSIONS AND RELEVANCE This study's findings suggest that the risk of NSF from group II GBCA administration in stage 4 or 5 CKD is likely less than 0.07%. The potential diagnostic harms of withholding group II GBCA for indicated examinations may outweigh the risk of NSF in this population. TRIAL REGISTRATION PROSPERO identifier: CRD42019123284.
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Affiliation(s)
- Sean A Woolen
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor
| | - Prasad R Shankar
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor
| | - Joel J Gagnier
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor.,Department of Epidemiology, University of Michigan, Ann Arbor
| | | | - Lisa Singer
- Dana-Farber Cancer Institute, Department of Radiation Oncology, Brigham and Women's Hospital, Boston, Massachusetts
| | - Matthew S Davenport
- Department of Radiology, University of Michigan, Ann Arbor.,Michigan Radiology Quality Collaborative, University of Michigan, Ann Arbor.,Department of Urology, Michigan Medicine, Ann Arbor
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11
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Chang EH, Tan HJ, Nielsen M. Management of small renal masses in patients with chronic kidney disease: Perspectives from a nephrologist. Urol Oncol 2019; 38:533-536. [PMID: 31889616 DOI: 10.1016/j.urolonc.2019.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 11/04/2019] [Accepted: 11/08/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Emily H Chang
- Division of Nephrology, UNC Kidney Center, Chapel Hill, NC.
| | - Hung-Jui Tan
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Matthew Nielsen
- Department of Urology, Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
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12
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Enterline DS, Martin KW, Parmar HA, Triulzi FM, Colosimo C. Safety and Diagnostic Efficacy of Gadobenate Dimeglumine in MRI of the Brain and Spine of Neonates and Infants. AJNR Am J Neuroradiol 2019; 40:2001-2009. [PMID: 31727753 DOI: 10.3174/ajnr.a6319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced MR imaging provides essential information for pediatric imaging applications. We evaluated gadobenate dimeglumine for contrast-enhanced MR imaging of infants younger than 2 years of age. MATERIALS AND METHODS Ninety children younger than 2 years of age (including 55 children younger than 1 year) who underwent enhanced MR imaging of the CNS with gadobenate dimeglumine at 0.1 mmol/kg body weight ± 25% by volume were retrospectively enrolled at 2 imaging centers. Safety data were assessed for adverse events and, when available, vital signs and electrocardiogram and clinical laboratory values obtained from 48 hours before until 48 hours after the MR imaging examination. The efficacy of gadobenate dimeglumine-enhanced MR imaging was evaluated prospectively by 3 blinded, unaffiliated readers in terms of the accuracy of combined pre- and postcontrast images relative to precontrast images alone for differentiation of tumor from non-neoplastic disease and the correct diagnosis of specific disease. Differences were tested using the McNemar test. A possible effect of dose on diagnostic accuracy was assessed using the Fisher exact test. RESULTS Nine nonserious adverse events were reported for 8 (8.8%) patients. Five adverse events occurred in patients 12 months of age or older. All events occurred at least 24 hours after gadobenate dimeglumine administration, and in each case, the investigating radiologist considered that there was no reasonable possibility of a relationship to gadobenate dimeglumine. No clinically meaningful changes in vital signs, electrocardiogram results, or laboratory parameters were reported. Accurate differentiation of tumor from non-neoplastic disease and exact matching of each specific MR imaging-determined diagnosis with the on-site final diagnosis were achieved in significantly more patients by each reader following evaluation of combined pre- and postcontrast images relative to precontrast images alone (91.0%-94.4% versus 75.3%-87.6%, P < .04, and 66.3%-73.0% versus 52.8%-58.4%, P < .02, respectively). No significant differences (P > .133) in diagnostic accuracy were noted between patients receiving ≤0.08 mmol/kg of gadobenate dimeglumine and patients receiving >0.08 mmol/kg of gadobenate dimeglumine. CONCLUSIONS Gadobenate dimeglumine is safe and effective for pediatric MR imaging.
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Affiliation(s)
- D S Enterline
- From the Department of Radiology (D.S.E.), Duke University, Durham, North Carolina
| | - K W Martin
- Department of Diagnostic Imaging (K.W.M.), University of California, San Francisco, Benioff Children's Hospital, Oakland, California
| | - H A Parmar
- Department of Radiology (H.A.P.), University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - F M Triulzi
- Department of Neuroradiology (F.M.T.), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinic, Milan, Italy
| | - C Colosimo
- Radiodiagnostica e Neuroradiologia (C.C.), Institute of Radiology, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
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13
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Abstract
Gadolinium (Gd)-based contrast agents have been routinely used worldwide in diagnostic MRI since 1988. All routinely applied contrast agents for clinical use were considered extremely safe with regard to tolerance, adverse effects and diagnostic efficacy and when used at Food and Drug Administration-approved doses. With the identification of Gd-associated disorders, namely nephrogenic systemic fibrosis and adverse reactions, and in the longer term Gd-retention in the brain, this view changed and led to the withdrawal or restriction of approval of linear Gd chelates in Europe. Even though Gd deposition in different human body areas was described very early, recently published literature of intracerebral accumulation of contrast agents as well as deposition in bone have created surprising attention. Not only was the fact of Gd deposition in the body well known for many years, but there is currently no clinical evidence of patient symptoms and no resulting health issues of patients have been observed yet. The expression "gadolinium deposition disease" has been termed by active patient advocacy groups with an online presence with reports of individual members stating a broad spectrum of disorders yielding a large symptom complex after administration of Gd-based contrast agents without evidence of any pre-existing or otherwise underlying disease process which could explain the mentioned disorder.
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14
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Bisla JK, Saranathan M, Martin DR, Arif-Tiwari H, Kalb BT. MR Imaging Evaluation of the Kidneys in Patients with Reduced Kidney Function. Magn Reson Imaging Clin N Am 2019; 27:45-57. [DOI: 10.1016/j.mric.2018.09.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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15
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Gondalia R, Vernuccio F, Marin D, Bashir MR. The role of MR imaging in the assessment of renal allograft vasculature. Abdom Radiol (NY) 2018; 43:2589-2596. [PMID: 29700591 DOI: 10.1007/s00261-018-1611-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Renal allograft dysfunction after transplantation is a relatively common occurrence with various potential etiologies. Vascular etiologies are of particular importance as early surgical or minimally invasive intervention can, in some cases, salvage the graft. Diagnosis of vascular pathology resulting in allograft dysfunction requires a thorough workup, of which imaging is a key component. Generally, ultrasound is the first-line imaging modality. More recently, MRI has been shown to be an effective and safe modality for diagnosis of vascular pathology after renal transplantation, particularly for diagnosis of transplant renal artery stenosis. This review will summarize imaging modalities that are most commonly used in evaluating vascular pathology after renal transplantation, with a focus on the various contrast- and non-contrast-enhanced MR techniques described in the literature and used at our institution. Of particular interest is the relatively recent utilization of the non-gadolinium containing iron-based contrast agent, ferumoxytol, in time-resolved contrast-enhanced MR angiography.
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Affiliation(s)
- Raj Gondalia
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC, 27710, USA.
| | - Federica Vernuccio
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC, 27710, USA
- Section of Radiology -Di.Bi.Med, University Hospital "Paolo Giaccone", 90129, Palermo, Italy
| | - Daniele Marin
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC, 27710, USA
| | - Mustafa R Bashir
- Department of Radiology, Duke University Medical Center, Box 3808 Erwin Road, Durham, NC, 27710, USA
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16
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Abstract
The increase in serendipitous detection of solid renal masses on imaging has not resulted in a reduction in mortality from renal cell carcinoma. Consequently, efforts for improved lesion characterization have been pursued and incorporated into management algorithms for distinguishing clinically significant tumors from those with favorable histology or benign conditions. Although diagnostic imaging strategies have evolved for optimized lesion detection, distinction between benign tumors and both indolent and aggressive malignant neoplasms remain an important diagnostic challenge. Recent advances in cross-sectional imaging have expanded the role of these tests in the noninvasive characterization of solid renal tumors.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology; UT Southwestern Medical Center, 2201 Inwood Road, Suite 210, Dallas, TX 75390, USA.
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol CB, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: A Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can J Kidney Health Dis 2018; 5:2054358118778573. [PMID: 29977584 PMCID: PMC6024496 DOI: 10.1177/2054358118778573] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Accepted: 03/31/2018] [Indexed: 12/29/2022] Open
Abstract
PURPOSE OF REVIEW Use of gadolinium-based contrast agents (GBCA) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCA are absolutely contraindicated in AKI, category G4 and G5 CKD (estimated glomerular filtration rate [eGFR] < 30 mL/min/1.73 m2), and dialysis-dependent patients is outdated and may limit access to clinically necessary contrast-enhanced magnetic resonance imaging (MRI) examinations. This review and clinical practice guideline addresses the discrepancy between existing Canadian guidelines regarding use of GBCA in renal impairment and NSF. SOURCES OF INFORMATION Published literature (including clinical trials, retrospective cohort series, review articles, and case reports), online registries, and direct manufacturer databases were searched for reported cases of NSF by class and specific GBCA and exposed patient population. METHODS A comprehensive review was conducted identifying cases of NSF and their association to class of GBCA, specific GBCA used, patient, and dose (when this information was available). Based on the available literature, consensus guidelines were developed by an expert panel of radiologists and nephrologists. KEY FINDINGS In patients with category G2 or G3 CKD (eGFR ≥ 30 and < 60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with category G4 or G5 CKD (eGFR < 30 mL/min/1.73 m2) or on dialysis, administration of GBCA should be considered individually and alternative imaging modalities utilized whenever possible. If GBCA are necessary, newer GBCA may be administered with patient consent obtained by a physician (or their delegate) citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, those with category G4 or G5 CKD, or those on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCA. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCA is recommended. LIMITATIONS Limited available literature (number of injections and use in renal impairment) regarding the use of gadoxetate disodium. Limited, but growing and generally high-quality, number of clinical trials evaluating GBCA administration in renal impairment. Limited data regarding the topic of Gadolinium deposition in the brain, particularly as it related to patients with renal impairment. IMPLICATIONS In patients with AKI and category G4 and G5 CKD (eGFR < 30 mL/min/1.73 m2) and in dialysis-dependent patients who require GBCA-enhanced MRI, GBCA can be administered with exceedingly low risk of causing NSF when using macrocyclic agents and newer linear agents at routine doses.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Jason I. Blaichman
- Faculty of Medicine, Department of Radiology, University of British Columbia, Vancouver, Canada
| | - Andreu F. Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
- Neuroradiology Section, MRI Modality Lead, Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Québec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children’s Hospital of Eastern Ontario, Clinical Epidemiology Program and the University of Ottawa, Ontario, Canada
| | | | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ontario, Canada
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18
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Schieda N, Blaichman JI, Costa AF, Glikstein R, Hurrell C, James M, Jabehdar Maralani P, Shabana W, Tang A, Tsampalieros A, van der Pol C, Hiremath S. Gadolinium-Based Contrast Agents in Kidney Disease: Comprehensive Review and Clinical Practice Guideline Issued by the Canadian Association of Radiologists. Can Assoc Radiol J 2018; 69:136-150. [PMID: 29706252 DOI: 10.1016/j.carj.2017.11.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2017] [Accepted: 11/13/2017] [Indexed: 01/04/2023] Open
Abstract
Use of gadolinium-based contrast agents (GBCAs) in renal impairment is controversial, with physician and patient apprehension in acute kidney injury (AKI), chronic kidney disease (CKD), and dialysis because of concerns regarding nephrogenic systemic fibrosis (NSF). The position that GBCAs are absolutely contraindicated in AKI, CKD stage 4 or 5 (estimated glomerular filtration rate [eGFR] <30 mL/min/1.73 m2) and dialysis-dependent patients is outdated, and may limit access to clinically necessary contrast-enhanced MRI examinations. Following a comprehensive review of the literature and reported NSF cases to date, a committee of radiologists and nephrologists developed clinical practice guidelines to assist physicians in making decisions regarding GBCA administrations. In patients with mild-to-moderate CKD (eGFR ≥30 and <60 mL/min/1.73 m2), administration of standard doses of GBCA is safe and no additional precautions are necessary. In patients with AKI, with severe CKD (eGFR <30 mL/min/1.73 m2), or on dialysis, administration of GBCAs should be considered individually and alternative imaging modalities utilized whenever possible. If GBCAs are necessary, newer GBCAs may be administered with patient consent obtained by a physician (or their delegate), citing an exceedingly low risk (much less than 1%) of developing NSF. Standard GBCA dosing should be used; half or quarter dosing is not recommended and repeat injections should be avoided. Dialysis-dependent patients should receive dialysis; however, initiating dialysis or switching from peritoneal to hemodialysis to reduce the risk of NSF is unproven. Use of a macrocyclic ionic instead of macrocyclic nonionic GBCA or macrocyclic instead of newer linear GBCA to further prevent NSF is unproven. Gadopentetate dimeglumine, gadodiamide, and gadoversetamide remain absolutely contraindicated in patients with AKI, with stage 4 or 5 CKD, or on dialysis. The panel agreed that screening for renal disease is important but less critical when using macrocyclic and newer linear GBCAs. Monitoring for and reporting of potential cases of NSF in patients with AKI or CKD who have received GBCAs is recommended.
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Affiliation(s)
- Nicola Schieda
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada.
| | - Jason I Blaichman
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Andreu F Costa
- Department of Diagnostic Radiology, Queen Elizabeth II Health Sciences Centre and Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rafael Glikstein
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada; Brain and Mind Research Institute, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
| | - Casey Hurrell
- Canadian Association of Radiologists, Ottawa, Ontario, Canada
| | - Matthew James
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada; Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Wael Shabana
- Department of Medical Imaging, The Ottawa Hospital, University of Ottawa, Ottawa, Ontario, Canada
| | - An Tang
- Department of Radiology, Radio-oncology and Nuclear Medicine, University of Montreal, Montreal, Quebec, Canada; Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM), Montreal, Quebec, Canada
| | - Anne Tsampalieros
- Division of Nephrology, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada; Clinical Epidemiology Program, University of Ottawa, Ottawa, Ontario, Canada
| | - Christian van der Pol
- Department of Radiology, Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA
| | - Swapnil Hiremath
- Division of Nephrology, Department of Medicine and Kidney Research Centre, Ottawa Hospital Research Institute, University of Ottawa, Ottawa, Ontario, Canada
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19
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Rahatli FK, Donmez FY, Kibaroglu S, Kesim C, Haberal KM, Turnaoglu H, Agildere AM. Does renal function affect gadolinium deposition in the brain? Eur J Radiol 2018; 104:33-37. [PMID: 29857863 DOI: 10.1016/j.ejrad.2018.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Accepted: 04/16/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Was to compare T1 signal intensity ratios of dentate nucleus to cerebellar white matter (DN/cerebellum), dentate nucleus to pons (DN/pons) and globus pallidus to thalamus (GP/thalamus) in patients with normal renal function and in patients on chronic hemodialysis. To find out if renal function affects the deposition of gadolinium in brain after administration of linear gadolinium based contrast agents (GBCA). METHODS Seventy eight contrast enhanced brain MRIs (Magnetic Resonance Imaging) with linear GBCA of 13 patients on chronic hemodialysis and 13 patients with normal renal function retrospectively evaluated. The DN/pons, DN/cerebellum and GP/thalamus signal intensity ratios were measured from each brain MRI on unenhanced axial T1 weighted images. RESULTS In hemodialysis group statistically significant increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus were found between the first and the last brain MRIs (p = .001). The increase in the signal intensity ratios of DN/pons, DN/cerebellum and GP/thalamus between the first and the last brain MRIs in control group were not significant (p > 0.05). The signal intensity increase in DN and globus pallidus were significantly higher in hemodialysis group than control group (p < 0.05). CONCLUSIONS Patients on hemodialysis had significantly higher DN and GP signal intensity increase compared to the patients with normal renal function. Renal function affects the rate of gadolinium deposition in the brain after administration of linear GBCA.
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Affiliation(s)
- Feride Kural Rahatli
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | | | - Seda Kibaroglu
- Baskent University, Faculty of Medicine, Department of Neurology, Ankara, Turkey.
| | - Cagri Kesim
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Kemal Murat Haberal
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
| | - Hale Turnaoglu
- Baskent University, Faculty of Medicine, Department of Radiology, Ankara, Turkey.
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20
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Bolles GM, Yazdani M, Stalcup ST, Creeden SG, Collins HR, Nietert PJ, Roberts DR. Development of High Signal Intensity within the Globus Pallidus and Dentate Nucleus following Multiple Administrations of Gadobenate Dimeglumine. AJNR Am J Neuroradiol 2018; 39:415-420. [PMID: 29348135 DOI: 10.3174/ajnr.a5510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/30/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have evaluated various gadolinium based contrast agents and their association with gadolinium retention, however, there is a discrepancy in the literature concerning the linear agent gadobenate dimeglumine. Our aim was to determine whether an association exists between the administration of gadobenate dimeglumine and the development of intrinsic T1-weighted signal in the dentate nucleus and globus pallidus. MATERIALS AND METHODS In this single-center, retrospective study, the signal intensity of the globus pallidus, dentate nucleus, thalamus, and middle cerebellar peduncle was measured on unenhanced T1-weighted images in 29 adult patients who had undergone multiple contrast MRIs using exclusively gadobenate dimeglumine (mean, 10.1 ± 3.23 doses; range, 6-18 doses). Two neuroradiologists, blinded to the number of prior gadolinium-based contrast agent administrations, separately placed ROIs within the globi pallidi, thalami, dentate nuclei, and middle cerebellar peduncles on the last MR imaging examinations. The correlations between the globus pallidus:thalamus and the dentate nucleus:middle cerebellar peduncle signal intensity ratios with the number of gadolinium-based contrast agent administrations and cumulative dose were tested with either 1-tailed Pearson or Spearman correlations. A priori, P < .05 was considered statistically significant. RESULTS Both the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the number of gadolinium-based contrast agent administrations (r = 0.39, P = .017, and r = 0.58, P = .001, respectively). Additionally, the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the cumulative dose of gadobenate dimeglumine (r = 0.48, P = .004, and r = 0.43, P = .009, respectively). Dentate nucleus hyperintensity was qualitatively present on the last MR imaging in 79.3%-86.2% of patients and in all patients who had received >10 doses. CONCLUSIONS At high cumulative doses (commonly experienced by patients, for example, with neoplastic disease), gadobenate dimeglumine is associated with an increase in the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncles signal intensity ratios.
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Affiliation(s)
- G M Bolles
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - M Yazdani
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - S T Stalcup
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - S G Creeden
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - H R Collins
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - P J Nietert
- Department of Public Health Sciences (P.J.N.), Medical University of South Carolina, Charleston, South Carolina
| | - D R Roberts
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
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21
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Prince MR, Weinreb JC. Notice of Withdrawal: MR Imaging and Gadolinium: Reassessing the Risk of Nephrogenic Systemic Fibrosis in Patients with Severe Renal Disease. Radiology 2018; 286:120-121. [PMID: 29261455 DOI: 10.1148/radiol.2017172255] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
This editorial has been withdrawn from publication by the authors in conjunction with the withdrawal of the highlighted manuscript (see https://doi.org/10.1148/radiol.2017170102).
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Affiliation(s)
- Martin R Prince
- From the Department of Radiology, Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (M.R.P.); Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.); and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (J.C.W.)
| | - Jeffrey C Weinreb
- From the Department of Radiology, Weill Cornell Medicine, 416 E 55th St, New York, NY 10022 (M.R.P.); Department of Radiology, Columbia University College of Physicians and Surgeons, New York, NY (M.R.P.); and Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (J.C.W.)
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22
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Martin DR, Kalb B, Mittal A, Salman K, Vedantham S, Mittal PK. No Incidence of Nephrogenic Systemic Fibrosis after Gadobenate Dimeglumine Administration in Patients Undergoing Dialysis or Those with Severe Chronic Kidney Disease. Radiology 2018; 286:113-119. [PMID: 28731375 DOI: 10.1148/radiol.2017170102] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Diego R. Martin
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Bobby Kalb
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Ankush Mittal
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Khalil Salman
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Srinivasan Vedantham
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
| | - Pardeep K. Mittal
- From the Department of Medical Imaging, University of Arizona College of Medicine, Banner University Medical Center, 1501 N Campbell Ave, PO Box 245067 Tucson, AZ 85724 (D.R.M., B.K., K.S., S.V.); and Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Ga (A.M., P.K.M.)
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23
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Bruce R, Wentland AL, Haemel AK, Garrett RW, Sadowski DR, Djamali A, Sadowski EA. Incidence of Nephrogenic Systemic Fibrosis Using Gadobenate Dimeglumine in 1423 Patients With Renal Insufficiency Compared With Gadodiamide. Invest Radiol 2017; 51:701-705. [PMID: 26885631 DOI: 10.1097/rli.0000000000000259] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE The purpose of this study was to assess the incidence of nephrogenic systemic fibrosis (NSF) before and after educational interventions, implementation of a clinical screening process, and change to gadobenate dimeglumine in patients who had an estimated glomerular filtration rate (eGFR) of 30 mL/min per 1.72 m or less. METHODS This is a Health Insurance Portability and Accountability Act compliant, institutional review board exempt study. Two periods were studied-July 2005 to June 2006, during which gadodiamide was utilized as our magnetic resonance (MR) contrast agent, and November 2006 to August 2014, during which gadobenate dimeglumine was used as our MR contrast agent in patients who had an eGFR 30 mL/min per 1.72 m or less. In addition to a change in the MR contrast agent, education of our staff physician to the risks of NSF with MR contrast agents and the implementation of a clinical screening process occurred. The rate of NSF before and after the interventions was compared using the χ test. RESULTS There was a statistically significant difference in the incidence of NSF in patients with an eGFR 30 mL/min per 1.72 m or less between the 2 periods: July 2005 to June 2006, 6 of 246 patients were diagnosed with NSF (P < 0.001), versus November 2006 to August 2014, 0 of 1423 patients were diagnosed with NSF. CONCLUSIONS Our data demonstrates a marked decrease in the incidence of NSF after education of our referring physicians, implementation of clinical screening process, and change to gadobenate dimeglumine from gadodiamide in patients with renal insufficiency. This approach potentially provides an acceptable risk-benefit profile for patients with renal insufficiency that required MR imaging for clinical care.
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Affiliation(s)
- Richard Bruce
- From the Departments of *Radiology, and †Medical Physics, University of Wisconsin, Madison, WI; ‡Department of Dermatology, University of California San Francisco, San Francisco, CA; §Department of Radiology, Saint Louis University, Saint Louis, MO; ∥Division of Dermatology, John H. Stroger Jr Hospital of Cook County, Chicago, IL; Departments of ¶Medicine, and #Obstetrics and Gynecology, University of Wisconsin, Madison, WI
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24
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Alexander LF, Harri P, Little B, Moreno CC, Mittal PK. Magnetic Resonance Imaging of Primary Hepatic Malignancies in Patients With and Without Chronic Liver Disease: A Pictorial Review. Cureus 2017; 9:e1539. [PMID: 28989828 PMCID: PMC5628780 DOI: 10.7759/cureus.1539] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Primary hepatic malignancies are less common than metastatic diseases, but a recognition of these lesions is important for diagnosis and treatment planning. Magnetic resonance imaging (MRI) provides the most imaging information to diagnose lesions noninvasively and to narrow differential diagnoses. This paper reviews the imaging findings of chronic liver disease and primary hepatic malignancies, including hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (CCA), epithelioid hemangioendothelioma, hepatic angiosarcoma, and primary hepatic lymphoma. Clinical and MRI features are reviewed to improve the readers’ recognition of these tumors, allowing for a narrower differential diagnosis when liver masses are encountered on abdominal imaging.
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Affiliation(s)
- Lauren F Alexander
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Peter Harri
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Brent Little
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Courtney C Moreno
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
| | - Pardeep K Mittal
- Department of Radiology and Imaging Sciences, Emory University School of Medicine
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25
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Schneider GK, Stroeder J, Roditi G, Colosimo C, Armstrong P, Martucci M, Buecker A, Raczeck P. T1 Signal Measurements in Pediatric Brain: Findings after Multiple Exposures to Gadobenate Dimeglumine for Imaging of Nonneurologic Disease. AJNR Am J Neuroradiol 2017. [PMID: 28642266 DOI: 10.3174/ajnr.a5270] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Signal intensity increases possibly suggestive of gadolinium retention have recently been reported on unenhanced T1-weighted images of the pediatric brain following multiple exposures to gadolinium-based MR contrast agents. Our aim was to determine whether T1 signal changes suggestive of gadolinium deposition occur in the brains of pediatric nonneurologic patients after multiple exposures to gadobenate dimeglumine. MATERIALS AND METHODS Thirty-four nonneurologic patients (group 1; 17 males/17 females; mean age, 7.18 years) who received between 5 and 15 injections (mean, 7.8 injections) of 0.05 mmol/kg of gadobenate during a mean of 2.24 years were compared with 24 control patients (group 2; 16 males/8 females; mean age, 8.78 years) who had never received gadolinium-based contrast agents. Exposure to gadobenate was for diagnosis and therapy monitoring. Five blinded readers independently determined the signal intensity at ROIs in the dentate nucleus, globus pallidus, pons, and thalamus on unenhanced T1-weighted spin-echo images from both groups. Unpaired t tests were used to compare signal-intensity values and dentate nucleus-pons and globus pallidus-thalamus signal-intensity ratios between groups 1 and 2. RESULTS Mean signal-intensity values in the dentate nucleus, globus pallidus, pons, and thalamus of gadobenate-exposed patients ranged from 366.4 to 389.2, 360.5 to 392.9, 370.5 to 374.9, and 356.9 to 371.0, respectively. Corresponding values in gadolinium-based contrast agent-naïve subjects were not significantly different (P > .05). Similarly, no significant differences were noted by any reader for comparisons of the dentate nucleus-pons signal-intensity ratios. One reader noted a difference in the mean globus pallidus-thalamus signal-intensity ratios (1.06 ± 0.006 versus 1.02 ± 0.009, P = .002), but this reflected nonsignificantly higher T1 signal in the thalamus of control subjects. The number of exposures and the interval between the first and last exposures did not influence signal-intensity values. CONCLUSIONS Signal-intensity increases potentially indicative of gadolinium deposition are not seen in pediatric nonneurologic patients after multiple exposures to low-dose gadobenate.
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Affiliation(s)
- G K Schneider
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
| | - J Stroeder
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
| | - G Roditi
- Department of Radiology (G.R., P.A.), National Health Service Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - C Colosimo
- Institute of Radiology (C.C., M.M.), Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - P Armstrong
- Department of Radiology (G.R., P.A.), National Health Service Greater Glasgow and Clyde, Glasgow Royal Infirmary, Glasgow, Scotland, UK
| | - M Martucci
- Institute of Radiology (C.C., M.M.), Radiodiagnostica e Neuroradiologia, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
| | - A Buecker
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
| | - P Raczeck
- From the Department of Diagnostic and Interventional Radiology (G.K.S., J.S., A.B., P.R.), Saarland University Medical Center, Homburg/Saar, Germany
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Gale EM, Caravan P, Rao AG, McDonald RJ, Winfeld M, Fleck RJ, Gee MS. Gadolinium-based contrast agents in pediatric magnetic resonance imaging. Pediatr Radiol 2017; 47:507-521. [PMID: 28409250 DOI: 10.1007/s00247-017-3806-0] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2016] [Revised: 11/16/2016] [Accepted: 02/10/2017] [Indexed: 12/17/2022]
Abstract
Gadolinium-based contrast agents can increase the accuracy and expediency of an MRI examination. However the benefits of a contrast-enhanced scan must be carefully weighed against the well-documented risks associated with administration of exogenous contrast media. The purpose of this review is to discuss commercially available gadolinium-based contrast agents (GBCAs) in the context of pediatric radiology. We discuss the chemistry, regulatory status, safety and clinical applications, with particular emphasis on imaging of the blood vessels, heart, hepatobiliary tree and central nervous system. We also discuss non-GBCA MRI contrast agents that are less frequently used or not commercially available.
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Affiliation(s)
- Eric M Gale
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Peter Caravan
- Department of Radiology, The Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Anil G Rao
- Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA
| | - Robert J McDonald
- Department of Radiology, College of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Matthew Winfeld
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Robert J Fleck
- Department of Pediatric Radiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Michael S Gee
- Division of Pediatric Imaging, Department of Radiology, MassGeneral Hospital for Children, Harvard Medical School, 55 Fruit St., Ellison 237, Boston, MA, 02114, USA.
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Abstract
Detection of solid renal masses has increased, although it has not resulted in significant mortality reduction from renal cell carcinoma. Efforts for improved lesion characterization have been pursued and incorporated in management algorithms, in order to distinguish clinically significant tumors from favorable or benign conditions. Concurrently, imaging methods have produced evidence supporting their role as useful tools not only in lesion detection but also characterization. In addition, newer modalities, such as contrast-enhanced ultrasonography, and advanced applications of MR imaging, are being investigated. This article reviews the current role of different imaging methods in the characterization of solid renal masses.
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Affiliation(s)
- Fernando U Kay
- Department of Radiology, UT Southwestern Medical Center, Harry Hines 5323, 2201 Inwood Road, Dallas, TX 75390, USA
| | - Ivan Pedrosa
- Department of Radiology and Advanced Imaging Research Center, UT Southwestern Medical Center, Harry Hines 5323, 2201 Inwood Road, Dallas, TX 75390, USA.
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Conlin CC, Oesingmann N, Bolster B, Huang Y, Lee VS, Zhang JL. Renal plasma flow (RPF) measured with multiple-inversion-time arterial spin labeling (ASL) and tracer kinetic analysis: Validation against a dynamic contrast-enhancement method. Magn Reson Imaging 2016; 37:51-55. [PMID: 27864008 DOI: 10.1016/j.mri.2016.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 11/14/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To propose and validate a method for accurately quantifying renal plasma flow (RPF) with arterial spin labeling (ASL). MATERIALS AND METHODS The proposed method employs a tracer-kinetic approach and derives perfusion from the slope of the ASL difference signal sampled at multiple inversion-times (TIs). To validate the method's accuracy, we performed a HIPAA-compliant and IRB-approved study with 15 subjects (9 male, 6 female; age range 24-73) to compare RPF estimates obtained from ASL to those from a more established dynamic contrast-enhanced (DCE) MRI method. We also investigated the impact of TI-sampling density on the accuracy of estimated RPF. RESULTS Good agreement was found between ASL- and DCE-measured RPF, with a mean difference of 9±30ml/min and a correlation coefficient R=0.92 when ASL signals were acquired at 16 TIs and a mean difference of 9±57ml/min and R=0.81 when ASL signals were acquired at 5 TIs. RPF estimated from ASL signals acquired at only 2 TIs (400 and 1200ms) showed a low correlation with DCE-measured values (R=0.30). CONCLUSION The proposed ASL method is capable of measuring RPF with an accuracy that is comparable to DCE MRI. At least 5 TIs are recommended for the ASL acquisition to ensure reliability of RPF measurements.
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Affiliation(s)
- Christopher C Conlin
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S Wasatch Drive, Rm 3100, Salt Lake City, UT 84112, USA.
| | - Niels Oesingmann
- Siemens Medical Solutions, Inc., 660 First Avenue, 4th Floor, New York, NY 10016, USA.
| | - Bradley Bolster
- Siemens Medical Solutions, Inc., 729 Arapeen Drive, Salt Lake City, UT 84108, USA.
| | - Yufeng Huang
- Division of Nephrology, Department of Internal Medicine, University of Utah, 30 N 1900 E, Rm 4R312, Salt Lake City, UT 84132, USA.
| | - Vivian S Lee
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA.
| | - Jeff L Zhang
- Department of Radiology and Imaging Sciences, University of Utah, 729 Arapeen Drive, Salt Lake City, UT 84108, USA; Department of Bioengineering, University of Utah, 36 S Wasatch Drive, Rm 3100, Salt Lake City, UT 84112, USA.
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30
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Crisi G, Filice S, Erb G, Bozzetti F. Effectiveness of a high relaxivity contrast agent administered at half dose in dynamic susceptibility contrast MRI of brain gliomas. J Magn Reson Imaging 2016; 45:500-506. [PMID: 27373976 DOI: 10.1002/jmri.25370] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2016] [Accepted: 06/17/2016] [Indexed: 11/11/2022] Open
Abstract
PURPOSE To determine whether half of the approved dose of gadobenate dimeglumine (MultiHance) is as effective as a full dose of gadoterate meglumine (Dotarem) for qualitative and quantitative cerebral blood volume (CBV) perfusion evaluation at 3T in patients with brain gliomas. MATERIALS AND METHODS We enrolled 65 adult patients in an interindividual comparative study. Patients were randomized to one of two study arms: 33 patients received 0.1 mmol/kg body weight (bw) of gadoterate, 32 patients received 0.05 mmol/kg bw of gadobenate. The patients underwent identical examinations at 3T. Arterial input function (AIF), tissue function (TF), and the maximum tumor CBV (CBV_T) were obtained from each patient. The quality of the CBV maps were independently reviewed by two neuroradiologists blinded to the administered contrast agent. RESULTS The administration of a half dose of gadobenate led to a roughly 40% reduction in signal drop compared to that achieved with a full dose of gadoterate (P values for AIF and TF maximum and integral were <0.01); quantitative and qualitative assessment of CBV maps revealed no difference between contrast agents (P values for CBV_T of high- and low-grade gliomas, image quality evaluation were 0.87, 0.48, >0.65, respectively) CONCLUSION: The CBV maps obtained with a half dose gadobenate (0.05 mmol/kg bw) are of comparable diagnostic quality as the corresponding images acquired with a full dose of gadoterate (0.1 mmol/kg bw). LEVEL OF EVIDENCE 2 J. Magn. Reson. Imaging 2017;45:500-506.
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Affiliation(s)
- Girolamo Crisi
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
| | - Silvano Filice
- Department of Medical Physics, University Hospital of Parma, Parma, Italy
| | - Gunter Erb
- Bracco Group, Medical and Regulatory Affairs, Konstanz, Germany
| | - Francesca Bozzetti
- Department of Neuroradiology, University Hospital of Parma, Parma, Italy
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Luna A, Pahwa S, Bonini C, Alcalá-Mata L, Wright KL, Gulani V. Multiparametric MR Imaging in Abdominal Malignancies. Magn Reson Imaging Clin N Am 2016; 24:157-186. [PMID: 26613880 PMCID: PMC4974463 DOI: 10.1016/j.mric.2015.08.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Modern MR imaging protocols can yield both anatomic and functional information for the assessment of hepatobiliary and pancreatic malignancies. Diffusion-weighted imaging is fully integrated into state-of-the-art protocols for tumor detection, characterization, and therapy monitoring. Hepatobiliary contrast agents have gained ground in the evaluation of focal liver lesions during the last years. Perfusion MR imaging is expected to have a central role for monitoring therapy in body tumors treated with antivascular drugs. Approaches such as Magnetic resonance (MR) elastography and (1)H-MR spectroscopy are still confined to research centers, but with the potential to grow in a short time frame.
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Affiliation(s)
- Antonio Luna
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain; Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA.
| | - Shivani Pahwa
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | | | - Lidia Alcalá-Mata
- Department of Radiology, Health Time, Carmelo Torres 2, Jaén 23006, Spain
| | - Katherine L Wright
- Department of Radiology, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
| | - Vikas Gulani
- Department of Radiology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Urology, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA; Department of Biomedical Engineering, Case Comprehensive Cancer Center, University Hospitals of Cleveland, Case Western Reserve University, Cleveland, OH, USA
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Kanda T, Oba H, Toyoda K, Kitajima K, Furui S. Brain gadolinium deposition after administration of gadolinium-based contrast agents. Jpn J Radiol 2015; 34:3-9. [PMID: 26608061 DOI: 10.1007/s11604-015-0503-5] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 11/09/2015] [Indexed: 01/05/2023]
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Vaneckova M, Herman M, Smith MP, Mechl M, Maravilla KR, Weichet J, Spampinato MV, Žižka J, Wippold FJ, Baima JJ, Babbel R, Bültmann E, Huang RY, Buhk JH, Bonafé A, Colosimo C, Lui S, Kirchin MA, Shen N, Pirovano G, Spinazzi A. The Benefits of High Relaxivity for Brain Tumor Imaging: Results of a Multicenter Intraindividual Crossover Comparison of Gadobenate Dimeglumine with Gadoterate Meglumine (The BENEFIT Study). AJNR Am J Neuroradiol 2015; 36:1589-98. [PMID: 26185325 DOI: 10.3174/ajnr.a4468] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 06/08/2015] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Gadobenate dimeglumine (MultiHance) has higher r1 relaxivity than gadoterate meglumine (Dotarem) which may permit the use of lower doses for MR imaging applications. Our aim was to compare 0.1- and 0.05-mmol/kg body weight gadobenate with 0.1-mmol/kg body weight gadoterate for MR imaging assessment of brain tumors. MATERIALS AND METHODS We performed crossover, intraindividual comparison of 0.1-mmol/kg gadobenate with 0.1-mmol/kg gadoterate (Arm 1) and 0.05-mmol/kg gadobenate with 0.1-mmol/kg gadoterate (Arm 2). Adult patients with suspected or known brain tumors were randomized to Arm 1 (70 patients) or Arm 2 (107 patients) and underwent 2 identical examinations at 1.5 T. The agents were injected in randomized-sequence order, and the 2 examinations were separated by 2-14 days. MR imaging scanners, imaging sequences (T1-weighted spin-echo and T1-weighted high-resolution gradient-echo), and acquisition timing were identical for the 2 examinations. Three blinded readers evaluated images for diagnostic information (degree of definition of lesion extent, lesion border delineation, visualization of lesion internal morphology, contrast enhancement) and quantitatively for percentage lesion enhancement and lesion-to-background ratio. Safety assessments were performed. RESULTS In Arm 1, a highly significant superiority (P < .002) of 0.1-mmol/kg gadobenate was demonstrated by all readers for all end points. In Arm 2, no significant differences (P > .1) were observed for any reader and any end point, with the exception of percentage enhancement for reader 2 (P < .05) in favor of 0.05-mmol/kg gadobenate. Study agent-related adverse events were reported by 2/169 (1.2%) patients after gadobenate and by 5/175 (2.9%) patients after gadoterate. CONCLUSIONS Significantly superior morphologic information and contrast enhancement are demonstrated on brain MR imaging with 0.1-mmol/kg gadobenate compared with 0.1-mmol/kg gadoterate. No meaningful differences were recorded between 0.05-mmol/kg gadobenate and 0.1-mmol/kg gadoterate.
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Affiliation(s)
- M Vaneckova
- From the Charles University in Prague (M.V.), First Faculty of Medicine and General University Hospital, Prague, Czech Republic
| | - M Herman
- University Hospital Olomouc (M.H.), Olomouc, Czech Republic
| | - M P Smith
- Beth Israel Deaconess Medical Center (M.P.S.), Boston, Massachusetts
| | - M Mechl
- Faculty of Medicine (M.M.), University Hospital Brno, Masaryk University, Brno, Czech Republic
| | - K R Maravilla
- MR Research Laboratory (K.R.M.), University of Washington, Seattle, Washington
| | - J Weichet
- Na Homolce Hospital (J.W.), Prague, Czech Republic
| | - M V Spampinato
- Department of Radiology and Radiological Science (M.V.S.), Medical University of South Carolina, Charleston, South Carolina
| | - J Žižka
- University Faculty of Medicine in Hradec Králové (J.Ž.), University Hospital Hradec Králové and Charles University in Prague, Prague, Czech Republic
| | - F J Wippold
- Mallinckrodt Institute of Radiology (F.J.W.), Washington University School of Medicine, St. Louis, Missouri
| | - J J Baima
- Clinical Radiologists, S.C. (J.J.B.), Springfield, Illinois
| | - R Babbel
- Good Samaritan Regional Medical Center (R.B.), Corvallis, Oregon
| | - E Bültmann
- Institute of Diagnostic and Interventional Neuroradiology (E.B.), Hannover, Germany
| | - R Y Huang
- Harvard Medical School (R.Y.H.), Brigham and Women's Hospital, Boston, Massachusetts
| | - J-H Buhk
- University Medical Center Hamburg Eppendorf (J.-H.B.), Hamburg, Germany
| | - A Bonafé
- Hopital Gui de Chauliac (A.B.), Montpellier, France
| | - C Colosimo
- Policlinico "Agostino Gemelli" (C.C.), Rome, Italy
| | - S Lui
- West China Hospital of Sichuan University (S.L.), Chengdu, Sichuan, China
| | - M A Kirchin
- Global Medical & Regulatory Affairs (M.A.K.), Bracco Imaging S.p.A., Milan, Italy
| | - N Shen
- Global Medical & Regulatory Affairs (N.S., G.P., A.S.), Bracco Diagnostics, Monroe, New Jersey
| | - G Pirovano
- Global Medical & Regulatory Affairs (N.S., G.P., A.S.), Bracco Diagnostics, Monroe, New Jersey
| | - A Spinazzi
- Global Medical & Regulatory Affairs (N.S., G.P., A.S.), Bracco Diagnostics, Monroe, New Jersey
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Low-dose gadobenate dimeglumine-enhanced MRI of the kidney for the differential diagnosis of localized renal lesions. Radiol Med 2015; 120:1100-11. [PMID: 26088468 PMCID: PMC4646924 DOI: 10.1007/s11547-015-0548-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 04/28/2015] [Indexed: 02/06/2023]
Abstract
Objective To evaluate low-dose gadobenate dimeglumine-enhanced MRI for the differential diagnosis of malignant renal tumors. Methods Sixty-two consecutive patients with unclear diagnosis at MDCT/ultrasound underwent dynamic CE-MRI of the kidneys with 0.05 mmol/kg gadobenate dimeglumine. Retrospective image evaluation was performed by two blinded readers. Lesion diagnosis at CE-MRI was correlated with findings from histology following tumor resection or from imaging follow-up after at least 1 year. Assessments were performed of diagnostic quality and level of diagnostic information. Results Thirty-nine (63 %) patients were correctly diagnosed with malignant lesions (36 with RCC, 2 with renal metastases, 1 with lymphoma) while 14 (22.6 %) patients were correctly diagnosed with benign (n = 12) or no (n = 2) lesions. Eight patients were considered false positive (5 with oncocytoma, 3 with atypical AML) and 1 patient false negative (atypical RCC). The sensitivity, specificity, accuracy, PPV, and NPV for the diagnosis of malignant renal lesions were 97.5 % (39/40), 63.6 % (14/22), 85.5 % (53/62), 83.0 % (39/47), and 93.3 % (14/15), respectively. Images were excellent in 60 and good in 2 patients. Minimal artifacts that did not compromise diagnosis were noted in 4/62 patients. Conclusion Low-dose gadobenate dimeglumine-enhanced MRI is effective for the differential diagnosis of malignant renal tumors.
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