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Yao X, Zhang H, Hu J, Lin X, Sun J, Kang J, Huang Z, Wang G, Tian X, Chen E, Ren K. Effects of Gadolinium Retention in the Brains of Type 2 Diabetic Rats after Repeated Administration of Gadolinium-Based MRI Contrast Agents on Neurobiology and NLRP3 Inflammasome Activation. J Magn Reson Imaging 2024; 60:2156-2170. [PMID: 38400842 DOI: 10.1002/jmri.29313] [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: 12/29/2023] [Revised: 02/08/2024] [Accepted: 02/08/2024] [Indexed: 02/26/2024] Open
Abstract
BACKGROUND The neurotoxic potential of gadolinium (Gd)-based contrast agents (GBCAs) retention in the brains of patients with type 2 diabetes mellitus (T2DM) is unclear. PURPOSE To determine the deposition and clearance of GBCAs in T2DM rats and the mechanism by which Gd enhances nucleotide-binding oligomerization domain-3 (NLRP3) inflammasome activation. STUDY TYPE Cross-sectional, prospective. ANIMAL MODEL 104 T2DM male Wistar rats. FIELD STRENGTH/SEQUENCE 9.4-T, T1-weighted fast spin echo sequence. ASSESSMENT T2DM (male Wistar rats, n = 52) and control group (healthy, male Wistar rats, n = 52) rats received saline, gadodiamide, Gd-diethylenetriaminepentaacetic acid, and gadoterate meglumine for four consecutive days per week for 7 weeks. The distribution and clearance of Gd in the certain brain were assessed by MRI (T1 signal intensity and relaxation rate R1, on the last day of each week), inductively coupled plasma mass-spectroscopy, ultraperformance liquid chromatography mass spectrometry, and transmission electron microscopy. Behavioral tests, histopathological features, and the effects of GBCAs on neuroinflammation were also analyzed. STATISTICAL TESTS One-way analysis of variance, bonferroni method, and unpaired t-test. A P-value <0.05 was considered statistically significant. RESULTS The movement distance and appearance time in the open field test of the T2DM rats in the gadodiamide group were significantly shorter than in the other groups. Furthermore, the expression of NLRP3, Pro-Caspase-1, interleukin-1β (IL-1β), and apoptosis-associated speck-like protein containing a CARD protein in neurons was significantly higher in the gadodiamide group than in the saline group, as shown by Western blot. Gadodiamide also induced differentiation of microglia into M1 type, decreased the neuronal mitochondrial membrane potential, and significantly increased neuronal apoptosis from flow cytometry. DATA CONCLUSION T2DM may affect both the deposition and clearance of GBCAs in the brain. Informed by the T2DM model, gadodiamide could mediate the neuroinflammatory response by NLRP3 inflammasome activation. LEVEL OF EVIDENCE 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Xiang Yao
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Haoran Zhang
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
| | - Jingyi Hu
- The Basic Medicine College of Lanzhou University, Lanzhou, China
| | - Xiaoning Lin
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Jin Sun
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Junlong Kang
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Zhichun Huang
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Guangsong Wang
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
| | - Xinhua Tian
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - E Chen
- Department of Neurosurgery, Zhongshan Hospital of Xiamen University, Xia Men, China
| | - Ke Ren
- Department of Radiology, Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
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Chaganti J. Editorial for "Effects of Gadolinium Retention in the Brains of Type 2 Diabetic Rats after Repeated Administration of Gadolinium-Based MRI Contrast Agents on Neurobiology and NLRP3 Inflammasome Activation". J Magn Reson Imaging 2024; 60:2171-2172. [PMID: 38460120 DOI: 10.1002/jmri.29347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 02/28/2024] [Indexed: 03/11/2024] Open
Affiliation(s)
- Joga Chaganti
- Department of Neuroradiology and ENT, Thomas Jefferson Hospital, Sydney Kimmel School of Medicine, Philadelphia, Pennsylvania, USA
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Bilgin B, Adam M, Hekim MG, Bulut F, Ozcan M. Gadolinium-based contrast agents aggravate mechanical and thermal hyperalgesia in a nitroglycerine-induced migraine model in male mice. Magn Reson Imaging 2024; 111:67-73. [PMID: 38604348 DOI: 10.1016/j.mri.2024.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Revised: 03/26/2024] [Accepted: 04/05/2024] [Indexed: 04/13/2024]
Abstract
In the diagnosis of migraine, which is a neurovascular disease, gadolinium-based contrast agents (GBCAs) are used to rule out more serious conditions. On the other hand, it remains unclear as a scientific gap whether GBCAs may trigger migraine-related pain. The aim of this study was to investigate the effect of GBCAs on mechanical and thermal pain behaviour in a nitroglycerin (NTG)-induced migraine model in mice. NTG (10 mg/kg) was administered intraperitoneally to adult (6-8weeks old) BALB/c mice 2 h before behavioral tests 5 times every other day on days 1st, 3rd, 5th and 9th to induce migraine model (N = 50). As GBCAs, gadobenate dimeglumine (linear-ionic), Gadodiamide (linear-nonionic), and gadobutrol (macrocyclic-nonionic) were delivered intravenously through the tail vein of mice for 5 days on test days. Mechanical pain threshold (plantar and facial withdrawal threshold) was evaluated by plantar von Frey and periorbital von Frey tests on days 1st, 5th, and 9th, and thermal pain threshold (latency) was evaluated by hot plate and cold plate tests on days 3rd and 7th. There was a statistically significant increase in mechanical and thermal hyperalgesia in NTG administered groups compared to the control group. Gadodiamide, gadobutrol and gadobenate dimeglumine administration significantly decreased latency, paw and facial withdrawal threshold (0.18 ± 0.05, 0.17 ± 0.07, 0.16 ± 0.09; 9th day values respectively) compared to NTG group (0.27 ± 0.05). The results of this in vivo study show that GBCAs produce effects that may trigger migraine attacks in migraine. It is recommended that these effects be further investigated and supported by further clinical studies.
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Affiliation(s)
- Batuhan Bilgin
- Gaziantep Islam Science and Technology University Faculty of Medicine, Department of Biophysics, Gaziantep, Turkey.
| | - Muhammed Adam
- Firat University Faculty of Medicine, Department of Biophysics, Elazig, Turkey
| | | | - Ferah Bulut
- Firat University Faculty of Medicine, Department of Biophysics, Elazig, Turkey
| | - Mete Ozcan
- Firat University Faculty of Medicine, Department of Biophysics, Elazig, Turkey
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Cunningham A, Kirk M, Hong E, Yang J, Howard T, Brearley A, Sáenz-Trevizo A, Krawchuck J, Watt J, Henderson I, Dokladny K, DeAguero J, Escobar GP, Wagner B. The safety of magnetic resonance imaging contrast agents. FRONTIERS IN TOXICOLOGY 2024; 6:1376587. [PMID: 39188505 PMCID: PMC11345262 DOI: 10.3389/ftox.2024.1376587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Accepted: 07/01/2024] [Indexed: 08/28/2024] Open
Abstract
Gadolinium-based contrast agents are increasingly used in clinical practice. While these pharmaceuticals are verified causal agents in nephrogenic systemic fibrosis, there is a growing body of literature supporting their role as causal agents in symptoms associated with gadolinium exposure after intravenous use and encephalopathy following intrathecal administration. Gadolinium-based contrast agents are multidentate organic ligands that strongly bind the metal ion to reduce the toxicity of the metal. The notion that cationic gadolinium dissociates from these chelates and causes the disease is prevalent among patients and providers. We hypothesize that non-ligand-bound (soluble) gadolinium will be exceedingly low in patients. Soluble, ionic gadolinium is not likely to be the initial step in mediating any disease. The Kidney Institute of New Mexico was the first to identify gadolinium-rich nanoparticles in skin and kidney tissues from magnetic resonance imaging contrast agents in rodents. In 2023, they found similar nanoparticles in the kidney cells of humans with normal renal function, likely from contrast agents. We suspect these nanoparticles are the mediators of chronic toxicity from magnetic resonance imaging contrast agents. This article explores associations between gadolinium contrast and adverse health outcomes supported by clinical reports and rodent models.
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Affiliation(s)
- Amy Cunningham
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Martin Kirk
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM, United States
| | - Emily Hong
- School of Medicine, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Jing Yang
- Department of Chemistry and Chemical Biology, University of New Mexico, Albuquerque, NM, United States
| | - Tamara Howard
- Cell Biology and Physiology, University of New Mexico Health Science Center, Albuquerque, NM, United States
| | - Adrian Brearley
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Angelica Sáenz-Trevizo
- Department of Earth and Planetary Sciences, University of New Mexico, Albuquerque, NM, United States
| | - Jacob Krawchuck
- Sandia National Laboratory, Center for Integrated Nanotechnologies, Albuquerque, NM, United States
| | - John Watt
- Los Alamos National Laboratory, Center for Integrated Nanotechnologies, Albuquerque, NM, United States
| | | | - Karol Dokladny
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
| | - Joshua DeAguero
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
| | - G. Patricia Escobar
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
| | - Brent Wagner
- Kidney Institute of New Mexico, University of New Mexico Health Science Center, Kidney Institute of New Mexico, Albuquerque, NM, United States
- New Mexico VA Healthcare System, Research Service, Albuquerque, NM, United States
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Yao X, Hu J, Wang G, Lin X, Sun J, Dong G, Kang J, Feng W, Xie B, Huang Y, Tian X, Chen E. Deposition of Gadolinium in the Central and Peripheral Nervous Systems and Its Effects on Sensory, Cognitive, and Athletic Implications after Multiple Injections of Gadolinium-Based Contrast Agents in Rats. AJNR Am J Neuroradiol 2024; 45:1153-1161. [PMID: 38991773 PMCID: PMC11383410 DOI: 10.3174/ajnr.a8295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 03/17/2024] [Indexed: 07/13/2024]
Abstract
BACKGROUND AND PURPOSE After repeat administration of gadolinium-based contrast agents (GBCAs), the association between gadolinium retention in the central and peripheral nervous systems and the main manifestations of myelopathy and progressive neurologic symptoms remains unclear. We investigated the effects of the repeat administration of GBCAs on gadolinium retention in the central and peripheral nervous systems and the sensory, cognitive, and athletic implications. MATERIALS AND METHODS Forty-eight male Wistar rats (6 weeks of age) were randomly divided into 4 experimental groups (12 rats in each group): the gadodiamide group (linear and nonionic GBCAs), the gadopentetate dimeglumine group (linear and ionic GBCAs), the gadoterate meglumine group (macrocyclic and ionic GBCAs), and the control group (0.9% saline solution). The brains of the rats were scanned using 9.4T MRI. Sensory behavioral tests were performed to assess the effect of GBCAs on pain sensitivity function. Gadolinium deposition in the brain, spinal cord, and peripheral nerves was determined by inductively coupled plasma mass-spectrometry. Transmission electron microscopy was used to observe the microscopic distribution of gadolinium after deposition in the spinal cord. The histopathologic features in the spinal cord were analyzed by H&E staining, Nissl staining, glial fibrillary acidic protein staining, and neuron-specific enolase staining after administration of GBCAs. RESULTS All GBCAs resulted in gadolinium deposition in the central and peripheral nerve tissues, with the highest deposition in the sciatic nerve tissue (mean, 62.86 [SD, 12.56] nmol/g). Decreased muscle power, impairment of spatial cognitive function power, and pain hypersensitivity to thermal and mechanical stimuli were observed after exposure to gadodiamide. At the spinal cord, transmission electron microscopy found that the region of gadolinium depositions had a spheric structure similar to "sea urchins" and was mainly located near the vascular basement membrane. CONCLUSIONS Multiple injections of GBCAs caused gadolinium deposition in the brain, spinal cord, and peripheral nerves, especially in the spinal cords of the gadodiamide group. Gadodiamide led to pain hypersensitivity and decreased muscle power and cognitive ability. For the patients who are hypersensitive to pain and need multiple MRI examinations, we recommend using macrocyclic GBCAs and the lowest dose possible.
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Affiliation(s)
- Xiang Yao
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Jingyi Hu
- The Basic Medicine College of Lanzhou University (J.H.), Lanzhou, China
| | - Guangsong Wang
- Department of Radiology (G.W.), Xiang'an Hospital of Xiamen University, School of Medicine, Xiamen University, Xia Men, China
| | - Xiaoning Lin
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Jin Sun
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Guijiang Dong
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Junlong Kang
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Wei Feng
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Bowen Xie
- Suining Jinghua Senior High School (B.X.), Xuzhou, China
| | - Yanlin Huang
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - Xinhua Tian
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
| | - E Chen
- From the Department of Neurosurgery (X.Y., X.L., J.S, G.D., J.K., W.F., Y.H., X.T., E.C.), Zhongshan Hospital of Xiamen University, School of Medcine, Xiamen University, XiaMen, China
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Semelka RC, Ramalho M. Near-cure in patients with Gadolinium deposition disease undergoing intravenous DTPA chelation. FRONTIERS IN TOXICOLOGY 2024; 6:1371131. [PMID: 39118832 PMCID: PMC11306197 DOI: 10.3389/ftox.2024.1371131] [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: 01/15/2024] [Accepted: 07/12/2024] [Indexed: 08/10/2024] Open
Abstract
Purpose To demonstrate and evaluate factors contributing to near-cures in patients with Gadolinium Deposition Disease (GDD) undergoing intravenous (IV) DTPA chelation. Methods Patients who had undergone or are currently undergoing DTPA chelation for GDD were included in this report based on their medical records that showed their perceived improvement was at least 80% back to normal. A survey was developed that included factors commonly reported by patients treated in one clinic to determine if these 'near-cured' (pre-MRI baseline health) individuals possessed certain factors and lacked others. The anonymized survey was emailed to these individuals by the principal treating physician, the only investigator not blinded to the subjects. This report describes clinical documentation of patient status and their underlying factors in individuals treated by the primary author, and no research was performed. The survey was sent to sixteen individuals; Fourteen patients completed it (10 females; 41.1 ± 11.2 y/o). Results The most common factor was the administration of ≤5 lifetime doses of a Gadolinium-Based Contrast Agents (GBCA) (12/14). Unconfounded agents triggering GDD were seen in nine subjects. Most subjects (12/14) initiated chelation in the first year after the causative GBCA, and most (11/14) underwent ≤10 chelations with DTPA. Good healthcare status prior to MRI was observed in 5 subjects. The majority (11/14) described their immune status as strong. Severe physical disability prior to chelation was seen in 1. Conclusion Subjects with GDD can experience near-cure with IV DTPA chelation. Factors surveyed that predict near-cure include the start of chelation in the first year, few GBCA administrations, and good health status before MRI with GBCA injection. Nonetheless, a few patients with predictors of less successful outcomes still experienced near-cure.
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Affiliation(s)
| | - Miguel Ramalho
- Department of Radiology, Hospital da Luz, Lisbon, Portugal
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Zhao L, Bao J, Wang X, Qiao X, Shen J, Zhang Y, Jin P, Ji Y, Zhang J, Su Y, Ji L, Li Z, Lu J, Hu C, Shen H, Tian J, Liu J. Detecting Adverse Pathology of Prostate Cancer With a Deep Learning Approach Based on a 3D Swin-Transformer Model and Biparametric MRI: A Multicenter Retrospective Study. J Magn Reson Imaging 2024; 59:2101-2112. [PMID: 37602942 DOI: 10.1002/jmri.28963] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/02/2023] [Accepted: 08/02/2023] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Accurately detecting adverse pathology (AP) presence in prostate cancer patients is important for personalized clinical decision-making. Radiologists' assessment based on clinical characteristics showed poor performance for detecting AP presence. PURPOSE To develop deep learning models for detecting AP presence, and to compare the performance of these models with those of a clinical model (CM) and radiologists' interpretation (RI). STUDY TYPE Retrospective. POPULATION Totally, 616 men from six institutions who underwent radical prostatectomy, were divided into a training cohort (508 patients from five institutions) and an external validation cohort (108 patients from one institution). FIELD STRENGTH/SEQUENCES T2-weighted imaging with a turbo spin echo sequence and diffusion-weighted imaging with a single-shot echo plane-imaging sequence at 3.0 T. ASSESSMENT The reference standard for AP was histopathological extracapsular extension, seminal vesicle invasion, or positive surgical margins. A deep learning model based on the Swin-Transformer network (TransNet) was developed for detecting AP. An integrated model was also developed, which combined TransNet signature with clinical characteristics (TransCL). The clinical characteristics included biopsy Gleason grade group, Prostate Imaging Reporting and Data System scores, prostate-specific antigen, ADC value, and the lesion maximum cross-sectional diameter. STATISTICAL TESTS Model and radiologists' performance were assessed using area under the receiver operating characteristic curve (AUC), sensitivity, and specificity. The Delong test was used to evaluate difference in AUC. P < 0.05 was considered significant. RESULTS The AUC of TransCL for detecting AP presence was 0.813 (95% CI, 0.726-0.882), which was higher than that of TransNet (0.791 [95% CI, 0.702-0.863], P = 0.429), and significantly higher than those of CM (0.749 [95% CI, 0.656-0.827]) and RI (0.664 [95% CI, 0.566-0.752]). DATA CONCLUSION TransNet and TransCL have potential to aid in detecting the presence of AP and some single adverse pathologic features. LEVEL OF EVIDENCE 4 TECHNICAL EFFICACY: Stage 4.
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Affiliation(s)
- Litao Zhao
- School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, China
- School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaomeng Qiao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yueyue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Pengfei Jin
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Yanting Ji
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
- Department of Radiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, China
| | - Ji Zhang
- Department of Radiology, The People's Hospital of Taizhou, Taizhou, China
| | - Yueting Su
- Department of Radiology, The People's Hospital of Taizhou, Taizhou, China
| | - Libiao Ji
- Department of Radiology, Changshu No.1 People's Hospital, Changshu, China
| | - Zhenkai Li
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Jian Lu
- Department of Urology, Peking University Third Hospital, Beijing, China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, China
| | - Jie Tian
- School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, China
| | - Jiangang Liu
- School of Engineering Medicine, Beihang University, Beijing, China
- Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, China
- Beijing Engineering Research Center of Cardiovascular Wisdom Diagnosis and Treatment, Beijing, China
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Versolatto S, Boccalon M, Guidolin N, Travagin F, Alessio E, Aime S, Balducci G, Giovenzana GB, Baranyai Z. [Gd(HB-DO3A)]: Equilibrium, Dissociation Kinetic and Structural Differences in a Simple Homolog of [Gd(HP-DO3A)] (Prohance ®). Chemistry 2024; 30:e202400344. [PMID: 38469901 DOI: 10.1002/chem.202400344] [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: 01/26/2024] [Revised: 03/10/2024] [Accepted: 03/11/2024] [Indexed: 03/13/2024]
Abstract
[Gd(HP-DO3A)] (gadoteridol) as an active compound of ProHance® is a widely employed contrast agent in clinical MRI scans in the last 30 years. Recent concerns about the long-term retention of gadolinium-based contrast agents (GBCAs) led to a deeper investigation of the structural features underlying the integrity of the paramagnetic metal complex. Several human and nonclinical studies have noted marked differences among the macrocyclic GBCAs, with the least retention of Gd traces and most rapid elimination consistently being reported for [Gd(HP-DO3A)]. It was deemed of interest to assess how minor structural/electronic changes associated to the ligand structure may affect basic properties of the metal complex with several [Gd(HP-DO3A)] analogues synthesized and characterized in the last years. We recently reported that the closest homolog of [Gd(HP-DO3A)], i. e.: [Gd(HB-DO3A)], in which a (±)-2-hydroxy-1-propyl pendant arm is replaced by a (±)-2-hydroxy-1-butyl moiety, showed a significantly different retention behaviour in the model interaction with collagen, despite the apparently very minor structural difference. In this paper we report a comprehensive study of the structural, thermodynamic, kinetic and relaxation properties of [Gd(HB-DO3A)], compared to the parent [Gd(HP-DO3A)] and to other closely related macrocyclic GBCAs to assess whether very minor structural changes can modulate the physico-chemical properties of Gd3+ complexes.
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Affiliation(s)
- Silvia Versolatto
- Dipartimento di Scienze Chimiche e Farmaceutiche Università di Trieste, Piazzale Europa 1, 34127, Trieste, TS, Italy
| | - Mariangela Boccalon
- Bracco Imaging Spa, CRB Trieste, AREA Science Park, 34149, Basovizza, TS, Italy
| | - Nicol Guidolin
- Bracco Imaging Spa, CRB Trieste, AREA Science Park, 34149, Basovizza, TS, Italy
| | - Fabio Travagin
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2/3, Novara, NO, 28100, Italy
| | - Enzo Alessio
- Dipartimento di Scienze Chimiche e Farmaceutiche Università di Trieste, Piazzale Europa 1, 34127, Trieste, TS, Italy
| | - Silvio Aime
- IRCCS SDN Research Institute Diagnostics and Nuclear SynLab, Via Emanuele Gianturco, 113, 80143, Napoli, NA, Italy
| | - Gabriele Balducci
- Dipartimento di Scienze Chimiche e Farmaceutiche Università di Trieste, Piazzale Europa 1, 34127, Trieste, TS, Italy
| | - Giovanni B Giovenzana
- Dipartimento di Scienze del Farmaco, Università del Piemonte Orientale, Largo Donegani 2/3, Novara, NO, 28100, Italy
| | - Zsolt Baranyai
- Bracco Imaging Spa, CRB Trieste, AREA Science Park, 34149, Basovizza, TS, Italy
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Ouyang M, Bao L. Gadolinium Contrast Agent Deposition in Children. J Magn Reson Imaging 2024. [PMID: 38597340 DOI: 10.1002/jmri.29389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Revised: 03/26/2024] [Accepted: 03/28/2024] [Indexed: 04/11/2024] Open
Abstract
Over the past few years, a large number of studies have evidenced increased signal intensity in the deep brain nuclei on unenhanced T1-MRI images achieved by the application of gadolinium-based contrast agents (GBCAs). The deposition of gadolinium in the brain, bone, and other tissues following administration of GBCAs has also been confirmed in histological studies in rodents and in necropsy studies in adults and children. Given the distinct physiological characteristics of children, this review focuses on examining the current research on gadolinium deposition in children, particularly studies utilizing novel methods and technologies. Furthermore, the article compares safety research findings of linear GBCAs and macrocyclic GBCAs in children, with the aim of offering clinicians practical guidance based on the most recent research outcomes. LEVEL OF EVIDENCE: 5 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Minglei Ouyang
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Li Bao
- Department of Radiology, West China Second University Hospital, Sichuan University, Chengdu, Sichuan, China
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Cai ZM, Li ZZ, Zhong NN, Cao LM, Xiao Y, Li JQ, Huo FY, Liu B, Xu C, Zhao Y, Rao L, Bu LL. Revolutionizing lymph node metastasis imaging: the role of drug delivery systems and future perspectives. J Nanobiotechnology 2024; 22:135. [PMID: 38553735 PMCID: PMC10979629 DOI: 10.1186/s12951-024-02408-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 03/18/2024] [Indexed: 04/02/2024] Open
Abstract
The deployment of imaging examinations has evolved into a robust approach for the diagnosis of lymph node metastasis (LNM). The advancement of technology, coupled with the introduction of innovative imaging drugs, has led to the incorporation of an increasingly diverse array of imaging techniques into clinical practice. Nonetheless, conventional methods of administering imaging agents persist in presenting certain drawbacks and side effects. The employment of controlled drug delivery systems (DDSs) as a conduit for transporting imaging agents offers a promising solution to ameliorate these limitations intrinsic to metastatic lymph node (LN) imaging, thereby augmenting diagnostic precision. Within the scope of this review, we elucidate the historical context of LN imaging and encapsulate the frequently employed DDSs in conjunction with a variety of imaging techniques, specifically for metastatic LN imaging. Moreover, we engage in a discourse on the conceptualization and practical application of fusing diagnosis and treatment by employing DDSs. Finally, we venture into prospective applications of DDSs in the realm of LNM imaging and share our perspective on the potential trajectory of DDS development.
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Affiliation(s)
- Ze-Min Cai
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Zi-Zhan Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Nian-Nian Zhong
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Lei-Ming Cao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Yao Xiao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Jia-Qi Li
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Fang-Yi Huo
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
| | - Bing Liu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China
| | - Chun Xu
- School of Dentistry, The University of Queensland, Brisbane, QLD, 4066, Australia
| | - Yi Zhao
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China
- Department of Prosthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Lang Rao
- Institute of Biomedical Health Technology and Engineering, Shenzhen Bay Laboratory, Shenzhen, 518132, China.
| | - Lin-Lin Bu
- State Key Laboratory of Oral & Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430072, China.
- Department of Oral & Maxillofacial Head Neck Oncology, School & Hospital of Stomatology, Wuhan University, Wuhan, 430079, Hubei, China.
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11
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Hummel L, Frenzel T, Boyken J, Pietsch H, Seeliger E. Comprehensive Analysis of the Spatial Distribution of Gadolinium, Iron, Manganese, and Phosphorus in the Brain of Healthy Rats After High-Dose Administrations of Gadodiamide and Gadobutrol. Invest Radiol 2024; 59:150-164. [PMID: 38157437 PMCID: PMC11441738 DOI: 10.1097/rli.0000000000001054] [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] [Indexed: 01/03/2024]
Abstract
OBJECTIVES After the administration of gadolinium-based contrast agents (GBCAs), residual gadolinium (Gd) has been detected in a few distinct morphological structures of the central nervous system (CNS). However, a systematic, comprehensive, and quantitative analysis of the spatial Gd distribution in the entire brain is not yet available. The first aim of this study is to provide this analysis in healthy rats after administration of high GBCA doses. The second aim is to assess the spatial distributions and possible Gd colocalizations of endogenous iron (Fe), manganese (Mn), and phosphorus (P). In addition, the presence of Gd in proximity to blood vessels was assessed by immunohistochemistry. MATERIALS AND METHODS Male rats were randomly assigned to 3 groups (n = 3/group): saline (control), gadodiamide (linear GBCA), and gadobutrol (macrocyclic GBCA) with cumulative Gd doses of 14.4 mmol/kg of body mass. Five weeks after the last administration, the brains were collected and cryosectioned. The spatial distributions of Gd, Fe, Mn, and P were analyzed in a total of 130 sections, each covering the brain in 1 of the 3 perpendicular anatomical orientations, using laser ablation coupled with inductively coupled plasma mass spectrometry. Quantitative spatial element maps were generated, and the concentrations of Gd, Fe, and Mn were measured in 31 regions of interest covering various distinct CNS structures. Correlation analyses were performed to test for possible colocalization of Gd, Fe, and Mn. The spatial proximity of Gd and blood vessels was studied using metal-tagged antibodies against von Willebrand factor with laser ablation coupled with inductively coupled plasma mass spectrometry. RESULTS After administration of linear gadodiamide, high Gd concentrations were measured in many distinct structures of the gray matter. This involved structures previously reported to retain Gd after linear GBCA, such as the deep cerebellar nuclei or the globus pallidus, but also structures that had not been reported so far including the dorsal subiculum, the retrosplenial cortex, the superior olivary complex, and the inferior colliculus. The analysis in all 3 orientations allowed the localization of Gd in specific subregions and layers of certain structures, such as the hippocampus and the primary somatosensory cortex. After macrocyclic gadobutrol, the Gd tissue concentration was significantly lower than after gadodiamide. Correlation analyses of region of interest concentrations of Gd, Fe, and Mn revealed no significant colocalization of Gd with endogenous Fe or Mn in rats exposed to either GBCA. Immunohistochemistry revealed a colocalization of Gd traces with vascular endothelium in the deep cerebellar nuclei after gadobutrol, whereas the majority of Gd was found outside the vasculature after gadodiamide. CONCLUSIONS In rats exposed to gadodiamide but not in rats exposed to gadobutrol, high Gd concentrations were measured in various distinct CNS structures, and structures not previously reported were identified to contain Gd, including specific subregions and layers with different cytoarchitecture and function. Knowledge of these distinct spatial patterns may pave the way for tailored functional neurological testing. Signs for the localization of the remaining Gd in the vascular endothelium were prominent for gadobutrol but not gadodiamide. The results also indicate that local transmetalation with endogenous Fe or Mn is unlikely to explain the spatial patterns of Gd deposition in the brain, which argues against a general role of these metals in local transmetalation and release of Gd ions in the CNS.
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12
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Cruz A, Pereira D, Batista S. [Use of Gadolinium in Follow-Up MRI of Multiple Sclerosis Patients: Current Recommendations]. ACTA MEDICA PORT 2024; 37:53-63. [PMID: 38183232 DOI: 10.20344/amp.20467] [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: 07/30/2023] [Accepted: 10/30/2023] [Indexed: 01/07/2024]
Abstract
Multiple sclerosis is the most frequent demyelinating disease of the central nervous system and is characterized by early onset and progressive disability. Magnetic resonance imaging, due to its high sensitivity and specificity in the detection of demyelinating lesions, is the most useful diagnostic test for this disease, with the administration of gadolinium-based contrast agents being an important contribution to imaging interpretation. Although contrast is essential for diagnostic purposes, its routine use in monitoring disease activity, response to treatment, and related complications is controversial. This article aims to collate current recommendations regarding the use of gadolinium in the imaging follow-up of multiple sclerosis and establish effective and safe guidelines for clinical practice. The literature review was conducted in PubMed, using the terms 'multiple sclerosis', 'magnetic resonance imaging' and 'gadolinium', or 'contrast media'. Articles published between January 2013 and January 2023 concerning the safety of gadolinium and the use of these contrast agents in follow-up scans of adult patients diagnosed with multiple sclerosis were selected. Although no biological or clinical consequences have been unequivocally attributed to the retention of gadolinium in the brain, which were mostly reported with linear agents, health authorities have been recommending the restriction of contrast to essential clinical circumstances. In multiple sclerosis, the detection of subclinical contrast-enhancing lesions with no corresponding new/ enlarging T2-WI lesions is rare and has a questionable impact on therapeutic decisions. On the other hand, gadolinium has a higher sensitivity in the differential diagnosis of relapses, in the detection of recent disease activity, before and after treatment initiation, and in patients with a large lesion burden or diffuse/confluent T2-WI lesions. Contrary to progressive multifocal leukoencephalopathy screening, monitoring of immune restitution inflammatory syndrome also benefits from the administration of gadolinium. It is feasible and safe to exclude gadolinium-based contrast agents from routine follow-up scans of multiple sclerosis, despite their additional contribution in specific clinical circumstances that should be acknowledged by the neurologist and neuroradiologist.
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Affiliation(s)
- Andreia Cruz
- Faculdade de Medicina. Universidade de Coimbra. Coimbra. Portugal
| | - Daniela Pereira
- Área Funcional de Neurorradiologia. Serviço de Imagem Médica. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
| | - Sónia Batista
- Faculdade de Medicina. Universidade de Coimbra. Coimbra; Serviço de Neurologia. Centro Hospitalar e Universitário de Coimbra. Coimbra. Portugal
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13
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Zhang X, Zhou B, Chen Y, Cai Z, Guo Y, Wei Z, Li S, Feng Y, Sedaghat S, Jang H. Evaluation of gadolinium deposition in cortical bone using three-dimensional ultrashort echo time quantitative susceptibility mapping: A preliminary study. NMR IN BIOMEDICINE 2024; 37:e5035. [PMID: 37721094 PMCID: PMC10726698 DOI: 10.1002/nbm.5035] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Revised: 08/15/2023] [Accepted: 08/17/2023] [Indexed: 09/19/2023]
Abstract
The aim of the current study was to investigate the feasibility of three-dimensional ultrashort echo time quantitative susceptibility mapping (3D UTE-QSM) for the assessment of gadolinium (Gd) deposition in cortical bone. To this end, 40 tibial bovine cortical bone specimens were divided into five groups then soaked in phosphate-buffered saline (PBS) solutions with five different Gd concentrations of 0, 0.4, 0.8, 1.2, and 1.6 mmol/L for 48 h. Additionally, eight rabbits were randomly allocated into three groups, consisting of a normal-dose macrocyclic gadolinium-based contrast agent (GBCA) group (n = 3), a high-dose macrocyclic GBCA group (n = 3), and a control group (n = 2). All bovine and rabbit tibial bone samples underwent magnetic resonance imaging (MRI) on a 3-T clinical MR system. A 3D UTE-Cones sequence was utilized to acquire images with five different echo times (i.e., 0.032, 0.2, 0.4, 0.8, and 1.2 ms). The UTE images were subsequently processed with the morphology-enabled dipole inversion algorithm to yield a susceptibility map. The average susceptibility was calculated in three regions of interest in the middle of each specimen, and the Pearson's correlation between the estimated susceptibility and Gd concentration was calculated. The bone samples soaked in PBS with higher Gd concentrations exhibited elevated susceptibility values. A mean susceptibility value of -2.47 ± 0.23 ppm was observed for bovine bone soaked in regular PBS, while the mean QSM value increased to -1.75 ± 0.24 ppm for bone soaked in PBS with the highest Gd concentration of 1.6 mmol/L. A strong positive correlation was observed between Gd concentrations and QSM values. The mean susceptibility values of rabbit tibial specimens in the control group, normal-dose GBCA group, and high-dose GBCA group were -4.11 ± 1.52, -3.85 ± 1.33, and -3.39 ± 1.35 ppm, respectively. In conclusion, a significant linear correlation between Gd in cortical bone and QSM values was observed. The preliminary results suggest that 3D UTE-QSM may provide sensitive noninvasive assessment of Gd deposition in cortical bone.
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Affiliation(s)
- Xiaodong Zhang
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- University of California, San Diego, San Diego, CA, United States
| | - Beibei Zhou
- The Third School of Clinical Medicine, Southern Medical University, Guangzhou, China
| | - Yanjun Chen
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
- University of California, San Diego, San Diego, CA, United States
| | - Zhenyu Cai
- University of California, San Diego, San Diego, CA, United States
| | - Yihao Guo
- School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Zhao Wei
- University of California, San Diego, San Diego, CA, United States
| | - Shisi Li
- Department of Radiology, Third Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Yanqiu Feng
- School of Biomedical Engineering, Guangdong Provincial Key Laboratory of Medical Image Processing, Southern Medical University, Guangzhou, China
| | - Sam Sedaghat
- University of California, San Diego, San Diego, CA, United States
| | - Hyungseok Jang
- University of California, San Diego, San Diego, CA, United States
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14
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Gietzen C, Pennig L, von Stein J, Guthoff H, Weiss K, Gertz R, Thürbach I, Bunck AC, Maintz D, Baldus S, Ten Freyhaus H, Hohmann C, von Stein P. Thoracic aorta diameters in Marfan patients: Intraindividual comparison of 3D modified relaxation-enhanced angiography without contrast and triggering (REACT) with transthoracic echocardiography. Int J Cardiol 2023; 390:131203. [PMID: 37480997 DOI: 10.1016/j.ijcard.2023.131203] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2023] [Revised: 07/14/2023] [Accepted: 07/19/2023] [Indexed: 07/24/2023]
Abstract
OBJECTIVE To compare the measurement of aortic diameters using a novel flow-independent MR-Angiography (3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT)) and transthoracic echocardiography (TTE) in Marfan syndrome (MFS) patients. MATERIAL AND METHODS This retrospective, single-center analysis included 46 examinations of 32 MFS patients (mean age 37.5 ± 11.3 years, 17 women, no prior aortic surgery) who received TTE and 3D modified REACT (ECG- and respiratory-triggering, Compressed SENSE factor 9 for acceleration of image acquisition) of the thoracic aorta. Aortic diameters (sinus of Valsalva (SV), sinotubular junction (STJ), and ascending aorta (AoA)) were independently measured by two cardiologists in TTE (leading-edge) and two radiologists in modified REACT (inner-edge, using multiplanar reconstruction). Intraclass correlation coefficient, Bland-Altman analyses, and Pearson's correlation (r) were used to assess agreement between observers and methods. RESULTS Interobserver correlation at the SV, STJ, and AoA were excellent for both, TTE (ICC = 0.95-0.98) and modified REACT (ICC = 0.99-1.00). There was no significant difference between TTE and modified REACT for diameters measured at the SV (39.24 ± 3.24 mm vs. 39.63 ± 3.76 mm; p = 0.26; r = 0.78) and the STJ (35.16 ± 4.47 mm vs. 35.37 ± 4.74 mm; p = 0.552; r = 0.87). AoA diameters determined by TTE were larger than in modified REACT (34.29 ± 5.31 mm vs. 30.65 ± 5.64 mm; p < 0.01; r = 0.74). The mean scan time of modified REACT was 05:06 min ± 02:47 min, depending on the patient's breathing frequency and heart rate. CONCLUSIONS Both TTE and modified REACT showed a strong correlation for all aortic levels; however, at the AoA, diameters were larger using TTE, mostly due to the limited field of view of the latter with measurements being closer to the aortic valve. Given the excellent interobserver correlation and the strong agreement with TTE, modified REACT represents an attractive method to depict the thoracic aorta in MFS patients.
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Affiliation(s)
- Carsten Gietzen
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jennifer von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henning Guthoff
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Roman Gertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Iris Thürbach
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Alexander C Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Stephan Baldus
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Henrik Ten Freyhaus
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Christopher Hohmann
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Philipp von Stein
- Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
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15
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Sharma P, Cheng J, Coulthard A. Where does the gadolinium go? A review into the excretion and retention of intravenous gadolinium. J Med Imaging Radiat Oncol 2023; 67:742-752. [PMID: 37665796 DOI: 10.1111/1754-9485.13581] [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: 06/23/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used in medical imaging. Most intravenously (IV) administered gadolinium is excreted via the kidneys, and pathological retention in renal failure leading to nephrogenic systemic fibrosis (NSF) is well described. More recently, retention of gadolinium in the body in the absence of renal disease has been identified, with unknown clinical consequences. Many patients are aware of this, either through the media or via comprehensive consent documentation. Some internet sites, without hard evidence, have suggested a constellation of possible symptoms associated with GBCA retention. Recent experience with patients ascribing symptoms to a contrast-enhanced MRI examination prompted this review of the fate of injected GBCA after MRI study, and of information available to patients online regarding gadolinium retention.
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Affiliation(s)
- Pranav Sharma
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Jeffrey Cheng
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - Alan Coulthard
- Department of Medical Imaging, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
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16
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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.
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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
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17
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Zhao L, Bao J, Qiao X, Jin P, Ji Y, Li Z, Zhang J, Su Y, Ji L, Shen J, Zhang Y, Niu L, Xie W, Hu C, Shen H, Wang X, Liu J, Tian J. Predicting clinically significant prostate cancer with a deep learning approach: a multicentre retrospective study. Eur J Nucl Med Mol Imaging 2023; 50:727-741. [PMID: 36409317 PMCID: PMC9852176 DOI: 10.1007/s00259-022-06036-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 11/06/2022] [Indexed: 11/22/2022]
Abstract
PURPOSE This study aimed to develop deep learning (DL) models based on multicentre biparametric magnetic resonance imaging (bpMRI) for the diagnosis of clinically significant prostate cancer (csPCa) and compare the performance of these models with that of the Prostate Imaging and Reporting and Data System (PI-RADS) assessment by expert radiologists based on multiparametric MRI (mpMRI). METHODS We included 1861 consecutive male patients who underwent radical prostatectomy or biopsy at seven hospitals with mpMRI. These patients were divided into the training (1216 patients in three hospitals) and external validation cohorts (645 patients in four hospitals). PI-RADS assessment was performed by expert radiologists. We developed DL models for the classification between benign and malignant lesions (DL-BM) and that between csPCa and non-csPCa (DL-CS). An integrated model combining PI-RADS and the DL-CS model, abbreviated as PIDL-CS, was developed. The performances of the DL models and PIDL-CS were compared with that of PI-RADS. RESULTS In each external validation cohort, the area under the receiver operating characteristic curve (AUC) values of the DL-BM and DL-CS models were not significantly different from that of PI-RADS (P > 0.05), whereas the AUC of PIDL-CS was superior to that of PI-RADS (P < 0.05), except for one external validation cohort (P > 0.05). The specificity of PIDL-CS for the detection of csPCa was much higher than that of PI-RADS (P < 0.05). CONCLUSION Our proposed DL models can be a potential non-invasive auxiliary tool for predicting csPCa. Furthermore, PIDL-CS greatly increased the specificity of csPCa detection compared with PI-RADS assessment by expert radiologists, greatly reducing unnecessary biopsies and helping radiologists achieve a precise diagnosis of csPCa.
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Affiliation(s)
- Litao Zhao
- School of Engineering Medicine, Beihang University, Beijing, 100191 China ,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, 100191 China ,School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191 China
| | - Jie Bao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006 Jiangsu China
| | - Xiaomeng Qiao
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006 Jiangsu China
| | - Pengfei Jin
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006 Jiangsu China
| | - Yanting Ji
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006 Jiangsu China ,Department of Radiology, The Affiliated Zhangjiagang Hospital of Soochow University, Zhangjiagang, 215638 Jiangsu China
| | - Zhenkai Li
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215028 Jiangsu China
| | - Ji Zhang
- Department of Radiology, The People’s Hospital of Taizhou, Taizhou, 225399 Jiangsu China
| | - Yueting Su
- Department of Radiology, The People’s Hospital of Taizhou, Taizhou, 225399 Jiangsu China
| | - Libiao Ji
- Department of Radiology, Changshu No.1 People’s Hospital, Changshu, 215501 Jiangsu China
| | - Junkang Shen
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 Jiangsu China
| | - Yueyue Zhang
- Department of Radiology, The Second Affiliated Hospital of Soochow University, Suzhou, 215004 Jiangsu China
| | - Lei Niu
- Department of Radiology, The People’s Hospital of Suqian, Suqian, 223812 Jiangsu China
| | - Wanfang Xie
- School of Engineering Medicine, Beihang University, Beijing, 100191 China ,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, 100191 China ,School of Biological Science and Medical Engineering, Beihang University, Beijing, 100191 China
| | - Chunhong Hu
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006 Jiangsu China
| | - Hailin Shen
- Department of Radiology, Suzhou Kowloon Hospital, Shanghai Jiaotong University School of Medicine, Suzhou, 215028 Jiangsu China
| | - Ximing Wang
- Department of Radiology, The First Affiliated Hospital of Soochow University, Suzhou, 215006 Jiangsu China
| | - Jiangang Liu
- School of Engineering Medicine, Beihang University, Beijing, 100191 China ,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, 100191 China
| | - Jie Tian
- School of Engineering Medicine, Beihang University, Beijing, 100191 China ,Key Laboratory of Big Data-Based Precision Medicine (Beihang University), Ministry of Industry and Information Technology of China, Beijing, 100191 China
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Shahid I, Joseph A, Lancelot E. Use of Real-Life Safety Data From International Pharmacovigilance Databases to Assess the Importance of Symptoms Associated With Gadolinium Exposure. Invest Radiol 2022; 57:664-673. [PMID: 35471204 PMCID: PMC9444285 DOI: 10.1097/rli.0000000000000880] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 03/03/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE Recent scientific publications have reported cases of patients who complained from a variety of symptoms after they received a gadolinium-based contrast agent (GBCA). The aim of this study was to appreciate the importance of these clinical manifestations in the overall population by assessing the weight of "symptoms associated with gadolinium exposure" (SAGE) among the bulk of safety experiences reported to major health authorities. MATERIALS AND METHODS Symptoms associated with gadolinium exposure were identified from a review of the scientific literature, and the corresponding preferred terms were searched in each system organ class (SOC) category recorded in the European and North American pharmacovigilance databases EudraVigilance (EV) and FDA Adverse Event Reporting System (FAERS), respectively. The numbers of SAGE per preferred term, and cumulatively per SOC, were recorded and their weights in the overall spectrum of adverse events (AEs) were determined for each GBCA. RESULTS The analysis of the selected AEs revealed a significantly higher SAGE weight for gadobenate dimeglumine (EV: 25.83%, FAERS: 32.24%) than for gadoteridol (EV: 15.51%; FAERS: 21.13%) and significantly lower SAGE weights for gadobutrol (EV: 7.75%; FAERS: 13.31%) and gadoterate meglumine (EV: 8.66%; FAERS: 12.99%). A similar ranking was found for most of the SOCs except for "nervous system disorders," probably owing to a limitation in the methods of data selection. Furthermore, this analysis showed a greater percentage of reports mentioning a decrease in the quality of life of the patients when they were exposed to gadobenate dimeglumine or gadoteridol than to gadobutrol or gadoterate meglumine. CONCLUSION This study showed that SAGE represent a significant percentage of the bulk of AEs reported to the health authorities for each GBCA. It provided real-life arguments suggesting that SAGE may be more prevalent with linear than macrocyclic GBCAs and that gadoteridol may present a higher SAGE risk than the other macrocyclic contrast agents.
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19
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Xue Y, Dewey BE, Zuo L, Han S, Carass A, Duan P, Remedios SW, Pham DL, Saidha S, Calabresi PA, Prince JL. Bi-directional Synthesis of Pre- and Post-contrast MRI via Guided Feature Disentanglement. SIMULATION AND SYNTHESIS IN MEDICAL IMAGING : ... INTERNATIONAL WORKSHOP, SASHIMI ..., HELD IN CONJUNCTION WITH MICCAI ..., PROCEEDINGS. SASHIMI (WORKSHOP) 2022; 13570:55-65. [PMID: 36326241 PMCID: PMC9623769 DOI: 10.1007/978-3-031-16980-9_6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
Magnetic resonance imaging (MRI) with gadolinium contrast is widely used for tissue enhancement and better identification of active lesions and tumors. Recent studies have shown that gadolinium deposition can accumulate in tissues including the brain, which raises safety concerns. Prior works have tried to synthesize post-contrast T1-weighted MRIs from pre-contrast MRIs to avoid the use of gadolinium. However, contrast and image representations are often entangled during the synthesis process, resulting in synthetic post-contrast MRIs with undesirable contrast enhancements. Moreover, the synthesis of pre-contrast MRIs from post-contrast MRIs which can be useful for volumetric analysis is rarely investigated in the literature. To tackle pre- and post- contrast MRI synthesis, we propose a BI-directional Contrast Enhancement Prediction and Synthesis (BICEPS) network that enables disentanglement of contrast and image representations via a bi-directional image-to-image translation(I2I)model. Our proposed model can perform both pre-to-post and post-to-pre contrast synthesis, and provides an interpretable synthesis process by predicting contrast enhancement maps from the learned contrast embedding. Extensive experiments on a multiple sclerosis dataset demonstrate the feasibility of applying our bidirectional synthesis and show that BICEPS outperforms current methods.
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Affiliation(s)
- Yuan Xue
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Blake E Dewey
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Lianrui Zuo
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
- Laboratory of Behavioral Neuroscience, National Institute on Aging, National Institutes of Health, Baltimore, MD 20892, USA
| | - Shuo Han
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Aaron Carass
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Peiyu Duan
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, MD 21287, USA
| | - Samuel W Remedios
- Department of Computer Science, Johns Hopkins University, Baltimore, MD 21218, USA
| | - Dzung L Pham
- Center for Neuroscience and Regenerative Medicine, Henry M. Jackson Foundation, Bethesda, MD 20817, USA
| | - Shiv Saidha
- Department of Neurology, Johns Hopkins School of Medicine,Baltimore, MD 21287, USA
| | - Peter A Calabresi
- Department of Neurology, Johns Hopkins School of Medicine,Baltimore, MD 21287, USA
| | - Jerry L Prince
- Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA
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20
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Effectiveness of ADC histogram analysis in the diagnosis of focal liver lesions; is a contrast agent necessary? MARMARA MEDICAL JOURNAL 2022. [DOI: 10.5472/marumj.1121815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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21
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Noda SM, Oztek MA, Stanescu AL, Maloney E, Shaw DWW, Iyer RS. Gadolinium retention: should pediatric radiologists be concerned, and how to frame conversations with families. Pediatr Radiol 2022; 52:345-353. [PMID: 33978802 DOI: 10.1007/s00247-021-04973-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 11/01/2020] [Accepted: 01/15/2021] [Indexed: 02/07/2023]
Abstract
Gadolinium retention in the brain and other organs has recently been identified by imaging and confirmed histologically. No direct clinical effects of gadolinium retention, which occurs after gadolinium-based contrast agent (GBCA) administration for MRI, have been scientifically accepted at this time. However, there is understandable concern among medical professionals and the public about the potential effects of gadolinium retention, particularly in the brain. Part of this concern might stem from the identification of nephrogenic systemic fibrosis caused by GBCAs in people with severe renal failure in 2006. This article briefly describes the characteristics of GBCAs; reviews and differentiates gadolinium retention, nephrogenic systemic fibrosis, and "gadolinium deposition disease" or "gadolinium toxicity"; and discusses societal guidelines and current usage in children. With the belief that GBCAs should not be withheld for appropriate indications in the absence of evidence of its potential risks, we offer a framework for determining when GBCA use is appropriate and suggestions for discussing its risks and benefits with children and their families.
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Affiliation(s)
- Sakura M Noda
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA. .,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA.
| | - Murat Alp Oztek
- Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ezekiel Maloney
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Dennis W W Shaw
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, M/S MA.7.220, P.O. Box 5731, Seattle, WA, 98145-5005, USA.,Department of Radiology, University of Washington School of Medicine, Seattle, WA, USA
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22
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Neal CH. Screening Breast MRI and Gadolinium Deposition: Cause for Concern? JOURNAL OF BREAST IMAGING 2022; 4:10-18. [PMID: 38422412 DOI: 10.1093/jbi/wbab074] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Indexed: 03/02/2024]
Abstract
Gadolinium-based contrast agents (GBCAs) have been used worldwide for over 30 years and have enabled lifesaving diagnoses. Contrast-enhanced breast MRI is frequently used as supplemental screening for women with an elevated lifetime risk of breast cancer. Data have emerged that indicate a fractional amount of administered gadolinium is retained in the bone, skin, solid organs, and brain tissues of patients with normal renal function, although there are currently no reliable data regarding the clinical or biological significance of this retention. Linear GBCAs are associated with a higher risk of gadolinium retention than macrocyclic agents. Over the course of their lives, screened women may receive high cumulative doses of GBCA. Therefore, as breast MRI screening utilization increases, thoughtful use of GBCA is indicated in this patient population.
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Affiliation(s)
- Colleen H Neal
- ProMedica Toledo Hospital, ProMedica Breast Care, Toledo, OH, USA
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23
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Goetzl EJ, Maecker HT, Rosenberg-Hasson Y, Koran LM. Altered Functional Mitochondrial Protein Levels in Plasma Neuron-Derived Extracellular Vesicles of Patients With Gadolinium Deposition. FRONTIERS IN TOXICOLOGY 2022; 3:797496. [PMID: 35295151 PMCID: PMC8915819 DOI: 10.3389/ftox.2021.797496] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/13/2021] [Indexed: 01/25/2023] Open
Abstract
The retention of the heavy metal, gadolinium, after a Gadolinium-Based Contrast Agent-assisted MRI may lead to a symptom cluster termed Gadolinium Deposition Disease. Little is known of the disorder's underlying pathophysiology, but a recent study reported abnormally elevated serum levels of pro-inflammatory cytokines compared to normal controls. As a calcium channel blocker in cellular plasma and mitochondrial membranes, gadolinium also interferes with mitochondrial function. We applied to sera from nine Gadolinium Deposition Disease and two Gadolinium Storage Condition patients newly developed methods allowing isolation of plasma neuron-derived extracellular vesicles that contain reproducibly quantifiable levels of mitochondrial proteins of all major classes. Patients' levels of five mitochondrial functional proteins were statistically significantly lower and of two significantly higher than the levels in normal controls. The patterns of differences between study patients and controls for mitochondrial dynamics and mitochondrial proteins encompassing neuronal energy generation, metabolic regulation, ion fluxes, and survival differed from those seen for patients with first episode psychosis and those with Major Depressive Disorder compared to their controls. These findings suggest that mitochondrial dysfunction due to retained gadolinium may play a role in causing Gadolinium Deposition Disease. Larger samples of both GDD and GSC patients are needed to allow not only testing the repeatability of our findings, but also investigation of relationships of specific mitochondrial protein deficiencies or excesses and concurrent cytokine, genetic, or other factors to GDD's neurological and cognitive symptoms. Studies of neuronal mitochondrial proteins as diagnostic markers or indicators of treatment effectiveness are also warranted.
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Affiliation(s)
- Edward J. Goetzl
- School of Medicine, University of California San Francisco, San Francisco, CA, United States
| | - Holden T. Maecker
- Human Immune Monitoring Center, Microbiology and Immunology, Stanford University Medical Center, Stanford, CA, United States
| | - Yael Rosenberg-Hasson
- Human Immune Monitoring Center, Microbiology and Immunology, Stanford University Medical Center, Stanford, CA, United States
| | - Lorrin M. Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University Medical Center, Stanford, CA, United States,*Correspondence: Lorrin M. Koran,
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24
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Maecker HT, Siebert JC, Rosenberg-Hasson Y, Koran LM, Ramalho M, Semelka RC. Dynamic Serial Cytokine Measurements During Intravenous Ca-DTPA Chelation in Gadolinium Deposition Disease and Gadolinium Storage Condition: A Pilot Study. Invest Radiol 2022; 57:71-76. [PMID: 34120127 PMCID: PMC8664920 DOI: 10.1097/rli.0000000000000803] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
PURPOSE The aim of this study was to investigate the feasibility of measuring early changes in serum cytokine levels after intravenous diethylenetriaminepentaacetic acid (Ca-DTPA) chelation in patients manifesting either gadolinium deposition disease (GDD) or gadolinium storage condition (GSC) and the possible usefulness of this method in further research. METHODS Four patients with recent-onset GDD (≤1 year) and 2 patients with long-standing GSC (4 and 9 years) underwent chelation with intravenous bolus administration of Ca-DTPA. Multiple blood draws were performed to measure serum cytokines: at T = 0 (before Ca-DTPA injection) and 1, 5, 10, 30, 60 minutes, and 24 hours after Ca-DTPA injection. Patients rated the severity of GDD symptom flare at 24 hours. The 24-hour urine Gd amounts were measured prechelation and for the 24 hours after chelation. Serum samples were analyzed blind to whether patients had GDD or GSC but with knowledge of the time points characterizing each sample. RESULTS Urine samples for both GDD and GSC patients showed increases in Gd postchelation. All GDD patients experienced flare reactions postchelation; the 2 GSC patients did not. Two cytokines, EGF and sCD40L, peaked at 30 minutes postchelation in at least 4 of the 6 participants. Three cytokines, ENA78/CXCL5, EOTAXIN/CCL11, and LEPTIN, peaked at 24 hours in at least 4 of the 6 participants. Two participants were high outliers for a large number of cytokines across time points. No clear distinction between GDD and GSC was apparent from the cytokine patterns, although differences were present. CONCLUSIONS This pilot study describes precise temporal resolution (in the range of minutes) after a cytokine-inciting event. Select cytokines exhibited peak values at different time points. At this preliminary stage of investigation, peak cytokine release seems to reflect the amount of Gd mobilized rather than the severity of the patient symptomatic reaction. Too few subjects were studied to support statistical analysis between GDD and GSC groups, although differences were observed through visual data analysis.
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Affiliation(s)
- Holden T Maecker
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | | | - Yael Rosenberg-Hasson
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | - Lorrin M Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
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25
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McDonald RJ, Weinreb JC, Davenport MS. Symptoms Associated with Gadolinium Exposure (SAGE): A Suggested Term. Radiology 2021; 302:270-273. [PMID: 34783590 DOI: 10.1148/radiol.2021211349] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
In this article, members of the American College of Radiology Committee on Drugs and Contrast Media propose a new term for symptoms reported after intravascular exposure to gadolinium-based contrast agents-Symptoms Associated with Gadolinium Exposure, or SAGE. This term is advocated in lieu of other proposed nomenclature that presumes a causal relationship that has not yet been scientifically verified. The purpose of this new term, SAGE, is to assist researchers and clinical providers in describing such symptoms without prematurely causally attributing them to a disease and to standardize reporting of these symptoms to allow for coherent interpretation of related studies.
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Affiliation(s)
- Robert J McDonald
- From the American College of Radiology, Reston, Va (R.J.M., J.C.W., M.S.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (J.C.W.); Departments of Radiology and Urology, Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (M.S.D.); and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Jeffrey C Weinreb
- From the American College of Radiology, Reston, Va (R.J.M., J.C.W., M.S.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (J.C.W.); Departments of Radiology and Urology, Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (M.S.D.); and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
| | - Matthew S Davenport
- From the American College of Radiology, Reston, Va (R.J.M., J.C.W., M.S.D.); Department of Radiology, Mayo Clinic, Rochester, Minn (R.J.M.); Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Conn (J.C.W.); Departments of Radiology and Urology, Michigan Medicine, 1500 E Medical Center Dr, B2-A209A, Ann Arbor, MI 48109 (M.S.D.); and Michigan Radiology Quality Collaborative, Ann Arbor, Mich (M.S.D.)
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26
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Kartamihardja AAP, Kumasaka S, Hilfi L, Kameo S, Koyama H, Tsushima Y. Biosorption of different gadolinium (Gd) complexes from water by Eichhornia crassipes (water hyacinth). INTERNATIONAL JOURNAL OF PHYTOREMEDIATION 2021; 24:893-901. [PMID: 34613832 DOI: 10.1080/15226514.2021.1984388] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Many studies have demonstrated the Eichhornia crassipes (water hyacinth) potency in removing heavy metals, but the plant's potential for sorption of gadolinium (Gd) has not yet been investigated. In this study, water hyacinth was grown in a glass container for 30 days with either GdCl3 or Gd-based contrast agent (GBCA; gadoterate) with water obtained from the Tone River. On the day 30, the Gd concentration in both the water and the plants was measured by mass spectrometry (ICP-MS). After 30 days, 98.5% of GdCl3 in the water had been absorbed by the roots, and 3.5% of Gd was transferred to the leaves. On the other hand, the water hyacinth roots absorbed only 12% of the gadoterate. When exposed to 5 mg/L of GdCl3, the roots of water hyacinth may effectively remove Gd ions in the aquatic environment, with no visible effect on the general health of the plant. However, the water hyacinth roots did not absorb GBCA. This may result in higher accumulation of Gd in the aqueous environment. The GBCA may be broken down by environmental factors and negatively affect the marine ecosystem.
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Affiliation(s)
- Achmad A P Kartamihardja
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
- Department of Nuclear Medicine and Molecular Imaging, Universitas Padjajaran, Bandung, Indonesia
| | - Soma Kumasaka
- Department of Diagnostic Radiology and Nuclear Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Lukman Hilfi
- Department of Public Health, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Satomi Kameo
- Department of Nutrition, College of Nutrition, Koshien University, Takarazuka, Hyogo, 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, Maebashi, Japan
- Division of Integrated Oncology Research, Gunma Initiative for Advanced Research, Maebashi, Japan
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27
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Affiliation(s)
- Michael F Tweedle
- From the Department of Radiology, The Ohio State University, 1216 Kinnear Rd, Office 1650, Columbus, OH 43212
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28
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Nelson KA, Thaker AA, Callen AL, Albach E, Timpone VM. New-onset seizures in adults: Low diagnostic yield of gadolinium contrast in initial brain MRI evaluation. J Neuroimaging 2021; 31:874-878. [PMID: 34110667 DOI: 10.1111/jon.12897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/19/2021] [Accepted: 05/26/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND AND PURPOSE The diagnostic utility of contrast MR-imaging in adult new-onset seizures without clinically suspected neoplasia or infection is not well defined in the literature. Imaging guidelines consider both contrast and noncontrast MR-imaging examinations appropriate in this clinical scenario. The purpose of this study was to evaluate the utility of contrast MR-sequences in evaluation of seizure in patients without suspicion for neoplasia or infection. METHODS Imaging and clinical data were reviewed for 103 consecutive patients admitted for phase-1 seizure monitoring with the following criteria: (1) MRI-brain performed with/without intravenous contrast; (2) no clinical suspicion for central nervous system (CNS) infection; and (3) no history of CNS neoplasia, or suspected metastatic disease. Readers designated cases as lesional or nonlesional. Lesional cases were further categorized as either visualized on noncontrast sequences only, contrast sequences only, or both. RESULTS 29/103 (28%) patients had epileptogenic lesions, 74/103 (72%) were nonlesional studies. 29/29 (100%) lesional abnormalities were detected on noncontrast sequences (sensitivity 100% [95 confidence interval (CI): 88-100], specificity 100% [95 CI: 95-100]). 23/29 (79.3%) lesional cases were visualized on both noncontrast and postcontrast sequences. 6/29 (20.7%) were visualized only on noncontrast sequences. No lesional cases were detected exclusively on postcontrast MR sequences. With an observed nonlesional extraneous contrast MR-imaging rate of 72%, estimated excess cost of contrast MR-imaging per 1000 patients using Medicare data was $103,680 USD. CONCLUSIONS Contrast MR-imaging has limited diagnostic utility in initial screening of adult new-onset seizure patients without clinically suspected neoplasia or infection. More judicious use of contrast MR-imaging in this patient population may reduce unnecessary exposure to gadolinium and lower associated healthcare costs.
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Affiliation(s)
- Kylan A Nelson
- School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Ashesh A Thaker
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Andrew L Callen
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Erik Albach
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Vincent M Timpone
- Department of Radiology, University of Colorado Hospital, Aurora, Colorado, USA
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29
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Maecker HT, Siebert JC, Rosenberg-Hasson Y, Koran LM, Ramalho M, Semelka RC. Acute Chelation Therapy-Associated Changes in Urine Gadolinium, Self-reported Flare Severity, and Serum Cytokines in Gadolinium Deposition Disease. Invest Radiol 2021; 56:374-384. [PMID: 33449576 PMCID: PMC8087628 DOI: 10.1097/rli.0000000000000752] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the following in patients who have undergone magnetic resonance imaging with gadolinium-based contrast agents (GBCAs) and meet the proposed diagnostic criteria for gadolinium deposition disease (GDD): (1) the effectiveness of chelation therapy (CT) with intravenous Ca-diethylenetriaminepentaacetic acid in removing retained gadolinium (Gd) and factors affecting the amount removed; (2) the frequency of CT-induced Flare, that is, GDD diagnostic symptom worsening, and factors affecting Flare intensity; (3) whether, as reported in a separate cohort, GDD patients' serum cytokine levels differ significantly from those in healthy normal controls and change significantly in response to CT; and (4) whether urine Gd, Flare reaction, and serum cytokine findings in GDD patients are mimicked in non-ill patients described as having gadolinium storage condition (GSC). MATERIALS AND METHODS Twenty-one GDD subjects and 3 GSC subjects underwent CT. Patients provided pre-CT and post-CT 24-hour urine samples for Gd content determination along with pre-CT and 24-hour post-CT serum samples for cytokine analysis. Patients rated potential Flare 24 hours after CT. Pre-CT and post-CT 24-hour urine Gd analyses and Luminex serum cytokine assays were performed blind to patients' GDD and GSC status and all other data except age and sex. Serum cytokine levels in a healthy normal control group of age- and sex-matched subjects drawn from Stanford influenza vaccination studies were measured once, contemporaneously with those of GDD and GSC patients, using the same Luminex assay. RESULTS Urine Gd amounts increased post-CT by 4 times or more after 87% of the 30 CT sessions. The most important factors appeared to be the time since the last GBCA dose and the cumulative dose received. Urine Gd amounts for GDD and GSC patients fell in the same ranges. All GDD patients, and no GSC patient, reported a Flare 24 hours post-CT. Linear regression found that Flare intensity was significantly predicted by a model including pre- and post-CT Gd amounts and the number of GBCA-enhanced magnetic resonance imaging. Post-CT, multiple cytokines showed strong positive relationships with GDD patients' Flare intensity in multivariable models. The pre-CT serum levels of 12 cytokines were significantly different in GDD patients compared with healthy flu vaccine controls. The small number of GSC patients precluded analogous statistical testing. Post-CT, GDD patients' serum levels of 20 cytokines were significantly decreased, and 2 cytokines significantly increased. These cytokines did not exhibit the same change pattern in the 3 GSC patients. The small number of GSC patients precluded statistical comparisons of GSC to GDD patients' results. CONCLUSIONS In this preliminary study, 24-hour urine Gd content increased markedly and similarly in GDD and GSC patients after Ca-diethylenetriaminepentaacetic acid CT. Post-CT Flare reaction developed only in GDD patients. The current study is the second finding significantly different serum cytokine levels in GDD patients compared with healthy normal controls. These differences and the difference between GDD and GSC patients' Flare and cytokine responses to CT suggest some inflammatory, immunologic, or other physiological differences in patients with GDD. Further research into the treatment and physiological underpinnings of GDD is warranted.
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Affiliation(s)
- Holden T Maecker
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | | | - Yael Rosenberg-Hasson
- From the Institute for Immunity, Transplantation, and Infection, Stanford University School of Medicine, Stanford, CA
| | - Lorrin M Koran
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Almada, Portugal
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Aminolroayaei F, Shahbazi‐Gahrouei D, Shahbazi‐Gahrouei S, Rasouli N. Recent nanotheranostics applications for cancer therapy and diagnosis: A review. IET Nanobiotechnol 2021; 15:247-256. [PMID: 34694670 PMCID: PMC8675832 DOI: 10.1049/nbt2.12021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Revised: 10/20/2020] [Accepted: 10/27/2020] [Indexed: 12/19/2022] Open
Abstract
Nanotheranostics has attracted much attention due to its widespread application in molecular imaging and cancer therapy. Molecular imaging using nanoparticles has attracted special attention in the diagnosis of cancer at early stages. With the progress made in nanotheranostics, studying drug release, accumulation in the target tissue, biodistribution, and treatment effectiveness are other important factors. However, according to the studies conducted in this regard, each nanoparticle has some advantages and limitations that should be examined and then used in clinical applications. The main goal of this review is to explore the recent advancements in nanotheranostics for cancer therapy and diagnosis. Then, it is attempted to present recent studies on nanotheranostics used as a contrast agent in various imaging modalities and a platform for cancer therapy.
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Affiliation(s)
- Fahimeh Aminolroayaei
- Department of Medical PhysicsSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
| | | | | | - Naser Rasouli
- Department of Medical PhysicsSchool of MedicineIsfahan University of Medical SciencesIsfahanIran
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Raczeck P, Fries P, Massmann A, Minko P, Frenzel F, Woerner T, Buecker A, Schneider GK. Diagnostic Performance of a Lower-dose Contrast-Enhanced 4D Dynamic MR Angiography of the Lower Extremities at 3 T Using Multisegmental Time-Resolved Maximum Intensity Projections. J Magn Reson Imaging 2021; 54:763-774. [PMID: 33825259 DOI: 10.1002/jmri.27631] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND For peripheral artery disease (PAD), MR angiography (MRA) is a well-established diagnostic modality providing morphologic and dynamic information comparable to digital subtraction angiography (DSA). However, relatively large amounts of contrast agents are necessary to achieve this. PURPOSE To evaluate the diagnostic accuracy of time-resolved 4D MR-angiography with interleaved stochastic trajectories (TWIST-MRA) by using maximum intensity projections (MIPs) of dynamic images acquired with reduced doses of contrast agent. STUDY TYPE Retrospective. POPULATION Forty adult PAD patients yielding 1088 artery segments. FIELD STRENGTH/SEQUENCE A 3.0 T, time-resolved 4D MR-angiography with TWIST-MRA and MIP of dynamic images. ASSESSMENT DSA was available in 14 patients (256 artery segments) and used as reference standard. Three-segmental MIP reconstructions of TWIST-images after administration of 3 mL of gadolinium-based contrast agent (Gadoteridol/Prohance®, 0.5 M) per anatomical level (pelvis, thighs, and lower legs) yielded 256 artery segments for correlation between MRA and DSA. Three independent observers rated image quality (scale: 1 [nondiagnostic] to 4 [excellent]) and the degree of venous overlay (scale: 0 [none] to 2 [significant]) for all segments. Diagnostic accuracy for the detection of >50% stenosis and artery occlusion was calculated for all observers. STATISTICAL TESTS Binary classification test (sensitivity, specificity, positive/negative predictive values, diagnostic accuracy). Intraclass correlation coefficients (ICCs), logistic regression analysis with comparison of areas under the receiver-operating-characteristics (ROC) curves (AUCs) with the DeLong method. Bland-Altman-comparison. RESULTS High diagnostic performance was achieved for the detection of >50% stenosis (sensitivity 92.9% [84.3-99.9% (95%-CI)] and specificity 98.5% [95.7-99.8% (95%-CI)]) and artery occlusion (sensitivity 93.1% [77.2-99.2% (95%-CI)] and specificity 99.1% [96.9-99.9% (95%-CI)]). Inter-reader agreement was excellent with ICC values ranging from 0.95 to 1.0 for >50% artery stenosis and occlusion. Image quality was good to excellent for both readers (3.41 ± 0.72, 3.33 ± 0.65, and 3.38 ± 0.61 [mean ± SD]) with good correlation between observer ratings (ICC 0.71-0.81). No significant venous overlay was observed (0.06 ± 0.24, 0.23 ± 0.43 and 0.11 ± 0.45 [mean ± SD]). DATA CONCLUSION MIPs of dynamic TWIST-MRA offer a promising diagnostic alternative necessitating only reduced amounts (50%) of gadolinium-based contrast agents for the entire runoff vasculature. EVIDENCE LEVEL 3 TECHNICAL EFFICACY: Stage 2.
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Affiliation(s)
- Paul Raczeck
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Peter Fries
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Alexander Massmann
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Peter Minko
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Felix Frenzel
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Tobias Woerner
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Arno Buecker
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
| | - Guenther K Schneider
- Clinic for Diagnostic and Interventional Radiology, Saarland University Medical Center, Homburg, Saarland, Germany
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Zhang Y, Bian T, Jiang R, Zhang Y, Zheng X, Li Z. Bionic chitosan-carbon imprinted aerogel for high selective recovery of Gd(Ⅲ) from end-of-life rare earth productions. JOURNAL OF HAZARDOUS MATERIALS 2021; 407:124347. [PMID: 33144020 DOI: 10.1016/j.jhazmat.2020.124347] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Revised: 10/13/2020] [Accepted: 10/19/2020] [Indexed: 06/11/2023]
Abstract
High selective recovery of Gd(Ⅲ) from end-of-life rare earth productions is essential for cleaner production. Chitosan(CS), a biomaterial, has shown excellent results in water treatment. The amino and hydroxyl groups on the surface of CS play a vital role in adsorbing metal ions. Polydopamine has good stability, strong water dispersibility, and excellent biocompatibility. As a bio-crosslinking agent, the amino and phenolic hydroxyl groups on its surface can be combined with metal ions to help the material absorb metal ions. This paper combines the active groups of biomimetic materials and the mechanical properties of new nanomaterials multi-walled carbon nanotubes and graphene oxide, and prepared a high-performance chitosan-based aerogel MWCNT-PDA-CS-GO through heat and mass transfer at low temperature and low pressure. The adsorption mechanism of MWCNT-PDA-CS-GO for Gd(Ⅲ) was analyzed through a series of characterization and adsorption experiments. At pH 7.0, the maximum adsorption capacity of aerogel for Gd(Ⅲ) reached 150.86 mg g-1. The relative selectivity of imprinted ions is 48.02 times higher than other ions. All the results indict MWCNT-PDA-CS-GO aerogel exhibits excellent selectivity and stability for effective recovery of Gd(Ⅲ).
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Affiliation(s)
- Yuzhe Zhang
- School of Environmental and Safety Engineering, Changzhou University, Changzhou 213164, PR China
| | - Tingting Bian
- School of Environmental and Safety Engineering, Changzhou University, Changzhou 213164, PR China
| | - Rong Jiang
- School of Environmental and Safety Engineering, Changzhou University, Changzhou 213164, PR China
| | - Yi Zhang
- School of Environmental and Safety Engineering, Changzhou University, Changzhou 213164, PR China
| | - Xudong Zheng
- School of Environmental and Safety Engineering, Changzhou University, Changzhou 213164, PR China; Jiangsu Engineering Research Center of Petrochemical Safety and Environmental Protection, Changzhou 213164, PR China.
| | - Zhongyu Li
- School of Environmental and Safety Engineering, Changzhou University, Changzhou 213164, PR China; Jiangsu Key Laboratory of Advanced Catalytic Materials and Technology, School of Petrochemical Engineering, Changzhou University, Changzhou 213164, PR China; Advanced Catalysis and Green Manufacturing Collaborative Innovation Center, Changzhou University, Changzhou 213164, PR China.
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Pennig L, Wagner A, Weiss K, Lennartz S, Huntgeburth M, Hickethier T, Maintz D, Naehle CP, Bunck AC, Doerner J. Comparison of a novel Compressed SENSE accelerated 3D modified relaxation-enhanced angiography without contrast and triggering with CE-MRA in imaging of the thoracic aorta. Int J Cardiovasc Imaging 2021; 37:315-329. [PMID: 32852711 PMCID: PMC7878228 DOI: 10.1007/s10554-020-01979-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 08/19/2020] [Indexed: 12/13/2022]
Abstract
To compare a novel Compressed SENSE accelerated ECG- and respiratory-triggered flow-independent 3D isotropic Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT) with standard non-ECG-triggered 3D contrast-enhanced magnetic resonance angiography (CE-MRA) for imaging of the thoracic aorta in patients with connective tissue diseases (CTD) or other aortic diseases using manual and semiautomatic measurement approaches. This retrospective, single-center analysis of 30 patients (June-December 2018) was conducted by two radiologists, who independently measured aortic diameters on modified REACT and CE-MRA using manual (Multiplanar-Reconstruction) and semiautomatic (Advanced Vessel Analysis) measurement tools on seven levels (inner edge): Aortic annulus and sinus, sinotubular junction, mid- and high-ascending aorta, aortic isthmus, and descending aorta. Bland-Altman analysis was conducted to evaluate differences between the mean values of aortic width and ICCs were calculated to assess interobserver agreement. For each level, image quality was evaluated on a four-point scale in consensus with Wilcoxon matched-pair test used to evaluate for differences between both MRA techniques. Additionally, evaluation time for each measurement technique was noted, which was compared applying one-way ANOVA. When comparing both imaging and measurement methods, CE-MRA (mean difference 0.24 ± 0.27 mm) and the AVA-tool (- 0.21 ± 0.15 mm) yielded higher differences compared to modified REACT (- 0.11 ± 0.11 mm) and the MPR-tool (0.07 ± 0.21 mm) for all measurement levels combined without yielding clinical significance. There was an excellent interobserver agreement between modified REACT and CE-MRA using both tools of measurement (ICC > 0.9). Modified REACT (average acquisition time 06:34 ± 01:36 min) provided better image quality from aortic annulus to mid-ascending aorta (p < 0.05), whereas at distal measurement levels, no significant differences were noted. Regarding time requirement, no statistical significance was found between both measurement techniques (p = 0.08). As a novel non-CE-MRA technique, modified REACT allows for fast imaging of the thoracic aorta with higher image quality in the proximal aorta than CE-MRA enabling a reliable measurement of vessel dimensions without the need for contrast agent. Thus, it represents a clinically suitable alternative for patients requiring repetitive imaging. Manual and semiautomatic measurement approaches provided comparable results without significant difference in time need.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | | | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
- Department of Radiology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, White 270, Boston, MA, 02114, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50937, Cologne, Germany
| | - Michael Huntgeburth
- Adult Congenital Heart Disease (ACHD) Center, Clinic III for Internal Medicine, Department of Cardiology, Heart Center, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany
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Fedotov A, Kurakin I, Fischer S, Vogl T, Prisner T, Denysenkov V. Increased flow rate of hyperpolarized aqueous solution for dynamic nuclear polarization-enhanced magnetic resonance imaging achieved by an open Fabry-Pérot type microwave resonator. MAGNETIC RESONANCE (GOTTINGEN, GERMANY) 2020; 1:275-284. [PMID: 37904825 PMCID: PMC10500708 DOI: 10.5194/mr-1-275-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 10/13/2020] [Indexed: 11/01/2023]
Abstract
A continuous flow dynamic nuclear polarization (DNP) employing the Overhauser effect at ambient temperatures can be used among other methods to increase sensitivity of magnetic resonance imaging (MRI). The hyperpolarized state of water protons can be achieved by flowing aqueous liquid through a microwave resonator placed directly in the bore of a 1.5 T MRI magnet. Here we describe a new open Fabry-Pérot resonator as DNP polarizer, which exhibits a larger microwave exposure volume for the flowing liquid in comparison with a cylindrical TE013 microwave cavity. The Fabry-Pérot resonator geometry was designed using quasi-optical theory and simulated by CST software. Performance of the new polarizer was tested by MRI DNP experiments on a TEMPOL aqueous solution using a blood-vessel phantom. The Fabry-Pérot resonator revealed a 2-fold larger DNP enhancement with a 4-fold increased flow rate compared to the cylindrical microwave resonator. This increased yield of hyperpolarized liquid allows MRI applications on larger target objects.
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Affiliation(s)
- Alexey Fedotov
- Institute of Applied Physics of the Russian Academy of Sciences,
Nizhny Novgorod, 603950, Russia
| | - Ilya Kurakin
- Institute of Applied Physics of the Russian Academy of Sciences,
Nizhny Novgorod, 603950, Russia
| | - Sebastian Fischer
- Institute of Diagnostic and Interventional Radiology, University
Hospital Frankfurt, Frankfurt am Main 60590, Germany
| | - Thomas Vogl
- Institute of Diagnostic and Interventional Radiology, University
Hospital Frankfurt, Frankfurt am Main 60590, Germany
| | - Thomas F. Prisner
- Institute of Physical and Theoretical Chemistry and Center of
Biomolecular Magnetic Resonance, Goethe University, Frankfurt am Main 60438, Germany
| | - Vasyl Denysenkov
- Institute of Physical and Theoretical Chemistry and Center of
Biomolecular Magnetic Resonance, Goethe University, Frankfurt am Main 60438, Germany
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Kanal E, Weinreb JC, Frischman C. Gadolinium Retention and Legal Risk Management: A Second Opinion. J Am Coll Radiol 2020; 17:1515-1519. [PMID: 32628900 DOI: 10.1016/j.jacr.2020.05.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 05/27/2020] [Accepted: 05/27/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Emanuel Kanal
- Chief, Division of Emergency Radiology; Director, Magnetic Resonance Services; Professor of Radiology and Neuroradiology, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
| | - Jeffrey C Weinreb
- Chief, MRI services, Yale-New Haven Hospital; Department of Radiology and Biomedical Imaging, Yale University School of Medicine, New Haven, Connecticut
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Alkhunizi SM, Fakhoury M, Abou-Kheir W, Lawand N. Gadolinium Retention in the Central and Peripheral Nervous System: Implications for Pain, Cognition, and Neurogenesis. Radiology 2020; 297:407-416. [DOI: 10.1148/radiol.2020192645] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Safia M. Alkhunizi
- From the Department of Anatomy, Cell Biology and Physiological Sciences (S.M.A., M.F., W.A., N.L.) and Department of Neurology (N.L.), Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh, Diana Tamari Sabbagh (DTS) Building, Bldg 130, John Kennedy St, Beirut 1107 2020, Lebanon
| | - Marc Fakhoury
- From the Department of Anatomy, Cell Biology and Physiological Sciences (S.M.A., M.F., W.A., N.L.) and Department of Neurology (N.L.), Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh, Diana Tamari Sabbagh (DTS) Building, Bldg 130, John Kennedy St, Beirut 1107 2020, Lebanon
| | - Wassim Abou-Kheir
- From the Department of Anatomy, Cell Biology and Physiological Sciences (S.M.A., M.F., W.A., N.L.) and Department of Neurology (N.L.), Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh, Diana Tamari Sabbagh (DTS) Building, Bldg 130, John Kennedy St, Beirut 1107 2020, Lebanon
| | - Nada Lawand
- From the Department of Anatomy, Cell Biology and Physiological Sciences (S.M.A., M.F., W.A., N.L.) and Department of Neurology (N.L.), Faculty of Medicine, American University of Beirut, PO Box 11-0236, Riad El-Solh, Diana Tamari Sabbagh (DTS) Building, Bldg 130, John Kennedy St, Beirut 1107 2020, Lebanon
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Ferumoxytol-Enhanced MRI Is Not Inferior to Gadolinium-Enhanced MRI in Detecting Intracranial Metastatic Disease and Metastasis Size. AJR Am J Roentgenol 2020; 215:1436-1442. [PMID: 33052739 DOI: 10.2214/ajr.19.22187] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE. The goal of this intraindividual comparison study was to investigate whether ferumoxytol-enhanced MRI is as effective as standard-of-care gadolinium-enhanced MRI in detecting intracranial metastatic disease. MATERIALS AND METHODS. We retrospectively reviewed all patients who underwent imaging as part of two ongoing ferumoxytol-enhanced and gadolinium-enhanced MRI protocol studies to compare the number and size of enhancing metastatic lesions. Two neuroradiologists independently measured enhancing metastases on ferumoxytol-enhanced MR images and on control gadolinium-enhanced MR images. The number and size of metastases were compared on an intraindividual basis. Primary diagnoses were recorded. A linear mixed-effects model was used to compare differences in cubic root of volume between gadolinium-enhanced and ferumoxytol-enhanced MRI. A signed rank test was used to evaluate differences between reviewers. RESULTS. MR images from 19 patients with brain metastases were analyzed (seven with lung cancer, three with breast cancer, three with melanoma, two with ovarian cancer, one with colon cancer, one with renal cell carcinoma, one with carcinoid tumor, and one with uterine cancer). Reviewer 1 identified 77 masses on ferumoxytol-enhanced MRI and 72 masses on gadolinium-enhanced MRI. Reviewer 2 identified 83 masses on ferumoxytol-enhanced MRI and 78 masses on gadolinium-enhanced MRI. For reviewer 1, ferumoxytol-enhanced MRI showed a mean tumor size measuring 1.1 mm larger in each plane compared with gadolinium-enhanced MRI (p = 0.1887). For reviewer 2, ferumoxytol-enhanced MRI showed a mean tumor size measuring 1.0 mm larger in each plane (p = 0.2892). No significant differences in number of metastases or tumor sizes were observed between contrast agents or reviewers. CONCLUSION. Intracranial metastatic disease detection with ferumoxytol-enhanced MRI was not inferior to detection with gadolinium-enhanced MRI. Ferumoxytol-enhanced MRI could improve workup and monitoring of patients with brain metastases if gadolinium-enhanced MRI is contraindicated.
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Wallnöfer EA, Thurner GC, Kremser C, Talasz H, Stollenwerk MM, Helbok A, Klammsteiner N, Albrecht-Schgoer K, Dietrich H, Jaschke W, Debbage P. Albumin-based nanoparticles as contrast medium for MRI: vascular imaging, tissue and cell interactions, and pharmacokinetics of second-generation nanoparticles. Histochem Cell Biol 2020; 155:19-73. [PMID: 33040183 DOI: 10.1007/s00418-020-01919-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2020] [Indexed: 12/14/2022]
Abstract
This multidisciplinary study examined the pharmacokinetics of nanoparticles based on albumin-DTPA-gadolinium chelates, testing the hypothesis that these nanoparticles create a stronger vessel signal than conventional gadolinium-based contrast agents and exploring if they are safe for clinical use. Nanoparticles based on human serum albumin, bearing gadolinium and designed for use in magnetic resonance imaging, were used to generate magnet resonance images (MRI) of the vascular system in rats ("blood pool imaging"). At the low nanoparticle doses used for radionuclide imaging, nanoparticle-associated metals were cleared from the blood into the liver during the first 4 h after nanoparticle application. At the higher doses required for MRI, the liver became saturated and kidney and spleen acted as additional sinks for the metals, and accounted for most processing of the nanoparticles. The multiple components of the nanoparticles were cleared independently of one another. Albumin was detected in liver, spleen, and kidneys for up to 2 days after intravenous injection. Gadolinium was retained in the liver, kidneys, and spleen in significant concentrations for much longer. Gadolinium was present as significant fractions of initial dose for longer than 2 weeks after application, and gadolinium clearance was only complete after 6 weeks. Our analysis could not account quantitatively for the full dose of gadolinium that was applied, but numerous organs were found to contain gadolinium in the collagen of their connective tissues. Multiple lines of evidence indicated intracellular processing opening the DTPA chelates and leading to gadolinium long-term storage, in particular inside lysosomes. Turnover of the stored gadolinium was found to occur in soluble form in the kidneys, the liver, and the colon for up to 3 weeks after application. Gadolinium overload poses a significant hazard due to the high toxicity of free gadolinium ions. We discuss the relevance of our findings to gadolinium-deposition diseases.
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Affiliation(s)
- E A Wallnöfer
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - G C Thurner
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - C Kremser
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - H Talasz
- Division of Clinical Biochemistry, Biocenter, Medical University of Innsbruck, Innrain 80-82, 6020, Innsbruck, Austria
| | - M M Stollenwerk
- Faculty of Health and Society, Biomedical Laboratory Science, University Hospital MAS, Malmö University, 205 06, Malmö, Sweden
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - A Helbok
- Department of Nuclear Medicine, Innsbruck Medical University, Anichstrasse 35, 6020, Innsbruck, Austria
| | - N Klammsteiner
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria
| | - K Albrecht-Schgoer
- Department of Pharmaceutical Technology, Institute of Pharmacy, Leopold-Franzens-University Innsbruck, Innrain 80-82/IV, 6020, Innsbruck, Austria
- Institute of Cell Genetics, Department for Pharmacology and Genetics, Medical University of Innsbruck, Peter-Mayr-Strasse 1a, 6020, Innsbruck, Austria
| | - H Dietrich
- Central Laboratory Animal Facilities, Innsbruck Medical University, Peter-Mayr-Strasse 4a, 6020, Innsbruck, Austria
| | - W Jaschke
- Department of Radiology, Medical University of Innsbruck, Anichstrasse 35, 6020, Innsbruck, Austria
| | - P Debbage
- Division of Histology and Embryology, Department of Anatomy, Histology and Embryology, Medical University of Innsbruck, Müllerstrasse 59, 6020, Innsbruck, Austria.
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Pennig L, Kabbasch C, Hoyer UCI, Lennartz S, Zopfs D, Goertz L, Laukamp KR, Wagner A, Grunz JP, Doerner J, Persigehl T, Weiss K, Borggrefe J. Relaxation-Enhanced Angiography Without Contrast and Triggering (REACT) for Fast Imaging of Extracranial Arteries in Acute Ischemic Stroke at 3 T. Clin Neuroradiol 2020; 31:815-826. [PMID: 33026511 PMCID: PMC8463375 DOI: 10.1007/s00062-020-00963-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/02/2020] [Indexed: 12/18/2022]
Abstract
Purpose To evaluate a novel flow-independent 3D isotropic REACT sequence compared with CE-MRA for the imaging of extracranial arteries in acute ischemic stroke (AIS). Methods This was a retrospective study of 35 patients who underwent a stroke protocol at 3 T including REACT (fixed scan time: 2:46 min) and CE-MRA of the extracranial arteries. Three radiologists evaluated scans regarding vessel delineation, signal, and contrast and assessed overall image noise and artifacts using 5-point scales (5: excellent delineation/no artifacts). Apparent signal- and contrast-to-noise ratios (aSNR/aCNR) were measured for the common carotid artery (CCA), internal carotid artery (ICA, C1 segment), and vertebral artery (V2 segment). Two radiologists graded the degree of proximal ICA stenosis. Results Compared to REACT, CE-MRA showed better delineation for the CCA and ICA (C1 and C2 segments) (median 5, range 2–5 vs. 4, range 3–5; P < 0.05). For the ICA (C1 and C2 segments), REACT provided a higher signal (5, range 3–5; P < 0.05/4.5, range 3–5; P > 0.05 vs. 4, range 2–5) and contrast (5, range 3–5 vs. 4, range 2–5; P > 0.05) than CE-MRA. The remaining segments of the blood-supplying vessels showed equal medians. There was no significant difference regarding artifacts, whereas REACT provided significantly lower image noise (4, range 3–5 vs. 4 range 2–5; P < 0.05) with a higher aSNR (P < 0.05) and aCNR (P < 0.05) for all vessels combined. For clinically relevant (≥50%) ICA stenosis, REACT achieved a detection sensitivity of 93.75% and a specificity of 100%. Conclusion Given its fast acquisition, comparable image quality to CE-MRA and high sensitivity and specificity for the detection of ICA stenosis, REACT was proven to be a clinically applicable method to assess extracranial arteries in AIS. Electronic supplementary material The online version of this article (10.1007/s00062-020-00963-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany.
| | - Christoph Kabbasch
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Ulrike Cornelia Isabel Hoyer
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Harvard Medical School, Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Cologne, Germany
| | - David Zopfs
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Lukas Goertz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Center for Neurosurgery, Department of General Neurosurgery, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Würzburg, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Thorsten Persigehl
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | | | - Jan Borggrefe
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
- Department of Radiology, Neuroradiology and Nuclear Medicine, Johannes Wesling University Hospital, Ruhr University Bochum, Bochum, Germany
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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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Tan EJ, Zhang S, Tirukonda P, Chong LR. REACT - A novel flow-independent non-gated non-contrast MR angiography technique using magnetization-prepared 3D non-balanced dual-echo dixon method: Preliminary clinical experience. Eur J Radiol Open 2020; 7:100238. [PMID: 32548214 PMCID: PMC7286964 DOI: 10.1016/j.ejro.2020.100238] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Revised: 05/22/2020] [Accepted: 05/23/2020] [Indexed: 12/29/2022] Open
Abstract
Flow-independent relaxation-based non-contrast MR angiography techniques yield good signal-to-noise ratio and high blood-tissue contrast, complementing non-contrast flow-dependent and contrast-enhanced MR angiography techniques in the assessment of vascular disorders. However, these techniques often suffer from imaging artifacts at high magnetic field strengths or across large fields-of-view. Relaxation-Enhanced Angiography without Contrast and Triggering (REACT) is a recently introduced flow-independent non-gated non-contrast three-dimensional MR angiography technique that has been developed to mitigate some of these issues. We present our initial experience with the clinical applications of REACT in imaging disorders of the central and peripheral vascular systems.
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Affiliation(s)
- Eu Jin Tan
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Shuo Zhang
- Philips Healthcare Singapore, 622 Lorong 1 Toa Payoh, Philips APAC Center Level 1, 319763, Singapore.,Philips DACH GmbH, Röntgenstraße 24-26, 22335, Hamburg, Germany
| | - Prasanna Tirukonda
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
| | - Le Roy Chong
- Department of Radiology, Changi General Hospital, 2 Simei Street 3, 529889, Singapore
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Gadolinium Deposition Disease: A New Risk Management Threat. J Am Coll Radiol 2020; 17:546-550. [DOI: 10.1016/j.jacr.2019.11.009] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2019] [Revised: 11/08/2019] [Accepted: 11/12/2019] [Indexed: 01/06/2023]
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Chin DD, Poon C, Trac N, Wang J, Cook J, Joo J, Jiang Z, Maria NSS, Jacobs RE, Chung EJ. Collagenase-Cleavable Peptide Amphiphile Micelles as a Novel Theranostic Strategy in Atherosclerosis. ADVANCED THERAPEUTICS 2020; 3:1900196. [PMID: 34295964 PMCID: PMC8294202 DOI: 10.1002/adtp.201900196] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Indexed: 11/10/2022]
Abstract
Atherosclerosis is an inflammatory disease characterized by plaques that can cause sudden myocardial infarction upon rupture. Such rupture-prone plaques have thin fibrous caps due to collagenase degradation, and a noninvasive diagnostic tool and targeted therapy that can identify and treat vulnerable plaques and may inhibit the onset of acute cardiac events. Toward this goal, monocyte-binding, collagenase-inhibiting, and gadolinium-modified peptide amphiphile micelles (MCG PAMs) are developed. Monocyte chemoattractant protein-1 (MCP-1) binds to C-C chemokine receptor-2 expressed on pathological cell types present within plaques. Through the peptide binding motif of MCP-1, MCG PAMs bind to monocytes and vascular smooth muscle cells in vitro. Moreover, using magnetic resonance imaging, MCG PAMs show enhanced targeting and successful detection of plaques in diseased mice in vivo and act as contrast agents for molecular imaging. Through the collagenase-cleaving peptide sequence of collagen [VPMS-MRGG], MCG PAMs can compete for collagenases that degrade the fibrous cap of plaques, providing therapy. MCG PAM-treated mice show increased fibrous cap thickness by 61% and 113% histologically compared to nontargeting micelle- or PBS-treated mice (p = 0.0075 and 0.001, respectively). Overall, this novel multimodal nanoparticle offers new theranostic opportunities for noninvasive diagnosis and treatment of atherosclerotic plaques.
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Affiliation(s)
- Deborah D Chin
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Christopher Poon
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Noah Trac
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Jonathan Wang
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Jackson Cook
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Johan Joo
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Zhangjingyi Jiang
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
| | - Naomi Sulit Sta Maria
- Department of Physiology and Neuroscience, Zilkha Neurogenetic, Institute and Keck School of Medicine, University of Southern California, Los Angeles 90033 CA, USA
| | - Russell E Jacobs
- Department of Physiology and Neuroscience, Zilkha Neurogenetic, Institute and Keck School of Medicine, University of Southern California, Los Angeles 90033 CA, USA
| | - Eun Ji Chung
- Department of Biomedical Engineering, University of Southern California, Los Angeles USC 90089 CA, USA
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Pennig L, Wagner A, Weiss K, Lennartz S, Grunz JP, Maintz D, Laukamp KR, Hickethier T, Naehle CP, Bunck AC, Doerner J. Imaging of the pulmonary vasculature in congenital heart disease without gadolinium contrast: Intraindividual comparison of a novel Compressed SENSE accelerated 3D modified REACT with 4D contrast-enhanced magnetic resonance angiography. J Cardiovasc Magn Reson 2020; 22:8. [PMID: 31969137 PMCID: PMC6977250 DOI: 10.1186/s12968-019-0591-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 12/05/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Patients with Congenital heart disease (CHD) require repetitive imaging of the pulmonary vasculature throughout their life. In this study, we compared a novel Compressed SENSE accelerated (factor 9) electrocardiogram (ECG)- and respiratory-triggered 3D modified Relaxation-Enhanced Angiography without Contrast and Triggering (modified REACT-non-contrast-enhanced magnetic resonance angiography (modified REACT-non-CE-MRA)) with standard non-ECG-triggered time-resolved 4D CE-MRA for imaging of the pulmonary arteries and veins in patients with CHD. METHODS This retrospective analysis of 25 patients (June 2018-April 2019) with known or suspected CHD was independently conducted by two radiologists executing measurements on modified REACT-non-CE-MRA and 4D CE-MRA on seven dedicated points (inner edge): Main pulmonary artery (MPA), right and left pulmonary artery, right superior and inferior pulmonary vein, left superior (LSPV) and inferior pulmonary vein. Image quality for arteries and veins was evaluated on a four-point scale in consensus. RESULTS Twenty-three of the 25 included patients presented a CHD. There was a high interobserver agreement for both methods of imaging at the pulmonary arteries (ICC ≥ 0.96); at the pulmonary veins, modified REACT-non-CE-MRA showed a slightly higher agreement, pronounced at LSPV (ICC 0.946 vs. 0.895). Measurements in 4D CE-MRA showed higher diameter values compared to modified REACT-non-CE-MRA, at the pulmonary arteries reaching significant difference (e.g. MPA: mean 0.408 mm, p = 0.002). Modified REACT-non-CE-MRA (average acquisition time 07:01 ± 02:44 min) showed significant better image quality than 4D CE-MRA at the pulmonary arteries (3.84 vs. 3.32, p < 0.001) and veins (3.32 vs. 2.72, p = 0.015). CONCLUSIONS Compressed SENSE accelerated (factor 9) ECG- and respiratory-triggered 3D modified REACT-non-CE-MRA allows for reliable and fast imaging of the pulmonary arteries and veins with higher image quality and slightly higher interobserver agreement than 4D CE-MRA without contrast agent and associated disadvantages. Therefore, it represents a clinically suitable technique for patients requiring repetitive imaging of the pulmonary vasculature, e.g. patients with CHD.
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Affiliation(s)
- Lenhard Pennig
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Anton Wagner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | | | - Simon Lennartz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
- Else Kröner Forschungskolleg Clonal Evolution in Cancer, University Hospital Cologne, Weyertal 115b, 50931 Cologne, Germany
| | - Jan-Peter Grunz
- Department of Diagnostic and Interventional Radiology, University Hospital Würzburg, Oberdürrbacher Straße 6, 97080 Würzburg, Germany
| | - David Maintz
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Kai Roman Laukamp
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Tilman Hickethier
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Claas Philip Naehle
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Alexander Christian Bunck
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
| | - Jonas Doerner
- Institute for Diagnostic and Interventional Radiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937 Cologne, Germany
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A Structured Survey on Adverse Events Occurring Within 24 Hours After Intravenous Exposure to Gadodiamide or Gadoterate Meglumine: A Controlled Prospective Comparison Study. Invest Radiol 2019; 54:191-197. [PMID: 30379729 DOI: 10.1097/rli.0000000000000528] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE This study compares the incidence of new-onset symptoms within 24 hours after enhanced magnetic resonance imaging (eMRI) with intravenous administration of gadodiamide or gadoterate meglumine compared with a control group undergoing unenhanced MRI (uMRI). MATERIALS AND METHODS A prospective cohort study (n = 1088 patients) was designed to assess the incidence of symptoms within 24 hours after administration of gadodiamide or gadoterate meglumine. The participants underwent a structured questionnaire by phone call before and 24 hours after the MRI scan to check for symptoms that were not present before the scan. The questionnaire included a list of active questions aimed to test the prevalence of symptoms that have been proposed in the debated definition of gadolinium deposition disease (GDD) and that we recorded in this study as GDD-like. In particular, the following symptoms and signs were tested: central torso pain, arm or leg pain, bone pain, headache, skin redness (any site of the body), fatigue, and mental confusion.Fisher exact test was used to test differences between groups with significance threshold set at P < 0.05. RESULTS Within the 24 hours after the MRI scan, 8.3% of patients reported at least one new-onset symptom in the uMRI group versus 17.4% in the gadodiamide eMRI versus 17.8% in the gadoterate meglumine eMRI group. The difference between the eMRI and the uMRI group was statistically significant (P < 0.001 for gadodiamide and P < 0.001 for gadoterate meglumine). There was not a different incidence of symptoms between the gadodiamide and the gadoterate meglumine eMRI groups. For gadodiamide, fatigue (P < 0.05) and dizziness (P < 0.05) were symptoms significantly more frequent than uMRI group; for gadoterate meglumine, fatigue (P < 0.01), mental confusion (P < 0.01), and diarrhea (P < 0.01) were significantly more frequent than uMRI group. CONCLUSIONS We found that the onset of new symptoms within 24 hours after exposure to gadolinium-based contrast agent was more frequent than after uMRI. Among GDD-like symptoms, fatigue and mental confusion were the most frequent symptoms reported after eMRI. The other GDD-like symptoms were not overreported after eMRI versus uMRI. Thus, these results are questioning the term GDD.
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Stability evaluation of Gd chelates for macromolecular MRI contrast agents. MAGNETIC RESONANCE MATERIALS IN PHYSICS BIOLOGY AND MEDICINE 2019; 33:527-536. [PMID: 31823277 DOI: 10.1007/s10334-019-00805-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/06/2019] [Accepted: 11/18/2019] [Indexed: 01/20/2023]
Abstract
OBJECTIVE We try to establish designs for the macromolecular agents possessing high Gd3+-chelating stability, because free Gd3+ ion released from Gd chelates is known as a risk factor to cause toxic side effects and a safety concern. MATERIALS AND METHODS We prepared three types of Gd-based macromolecular MRI contrast agents from a synthetic polymer (poly(glutamic acid) homopolymer or poly(ethylene glycol)-b-poly(lysine) block copolymer) and a chelating moiety (DO3A or DOTA) having two strategic designs for high chelate stability. Then, we examine the in vitro Gd3+-chelate stability of these macromolecular MRI contrast agents. RESULTS The prepared macromolecular agents exhibited the same or higher Gd3+-chelate stability as/than did Gd-DOTA that possesses the highest Gd3+-chelate stability among the approved small-MW Gd-chelate MRI contrast agent. DISCUSSION Our macromolecular design was considered to work well for high Gd3+-chelate stability.
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Zheng S, Zhang M, Bai H, He M, Dong L, Cai L, Zhao M, Wang Q, Xu K, Li J. Preparation of AS1411 Aptamer Modified Mn-MoS 2 QDs for Targeted MR Imaging and Fluorescence Labelling of Renal Cell Carcinoma. Int J Nanomedicine 2019; 14:9513-9524. [PMID: 31819447 PMCID: PMC6898992 DOI: 10.2147/ijn.s215883] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 11/25/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Early diagnosis of renal cell carcinoma is extremely significant for the effective treatment of kidney cancer. The development of AS1411 aptamer modified Mn-MoS2 QDs provides a promising fluorescence/magnetic resonance (MR) dual-modal imaging probe for the precise diagnosis of renal clear cell carcinoma. METHODS In this work, Mn-MoS2 QDs were synthesized through a simple "bottom-up" one-step hydrothermal method. AS1411 aptamer was modified on the Mn-MoS2 QDs to improve the specificity to renal cell carcinoma. The characteristics of Mn-MoS2 QDs were confirmed by transmission electronic microscopy (TEM), atomic force microscope (AFM), X-ray photoelectron spectrometer (XPS), photoluminescence (PL) emission spectra, etc. Cellular fluorescence labelling was investigated using the Mn-MoS2 QDs and AS1411-Mn-MoS2 QDs. The T1-weighted MR imaging was assessed by the in vitro MR cell imaging and in vivo MR imaging. Finally, the long-term toxicity of Mn-MoS2 QDs was investigated by the hematology and histological analysis. RESULTS The prepared Mn-MoS2 QDs exhibited excellent aqueous property, intense fluorescence, low toxicity, high quantum yield of 41.45% and high T1 relaxivity of 16.95 mM-1s-1. After conjugated with AS1411 aptamer, the AS1411-Mn-MoS2 QDs could specifically fluorescently label the renal carcinoma cells and present a specific MRI signal enhancement in the tumor region of mice bearing renal carcinoma tumors. Furthermore, Mn-MoS2 QDs revealed low toxicity to the mice via hematology and histological analysis. CONCLUSION These results demonstrated the potential of AS1411-Mn-MoS2 QD as a novel nanoprobe for targeted MR imaging and fluorescence labelling of renal cell carcinoma.
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Affiliation(s)
- Shaohui Zheng
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou221006, People’s Republic of China,School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China,Institute of Medical Imaging and Digital Medicine, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Min Zhang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Hongyan Bai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Meijuan He
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Lina Dong
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Lulu Cai
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Mingming Zhao
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Qi Wang
- School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou221006, People’s Republic of China,School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China,Institute of Medical Imaging and Digital Medicine, Xuzhou Medical University, Xuzhou221004, People’s Republic of China
| | - Jingjing Li
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Xuzhou221006, People’s Republic of China,School of Medical Imaging, Xuzhou Medical University, Xuzhou221004, People’s Republic of China,Institute of Medical Imaging and Digital Medicine, Xuzhou Medical University, Xuzhou221004, People’s Republic of China,Correspondence: Jingjing Li; Kai Xu Email ;
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Layne KA, Wood DM, Dargan PI. Gadolinium-based contrast agents – what is the evidence for ‘gadolinium deposition disease’ and the use of chelation therapy? Clin Toxicol (Phila) 2019; 58:151-160. [DOI: 10.1080/15563650.2019.1681442] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Kerry A. Layne
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - David M. Wood
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
| | - Paul I. Dargan
- General Medicine, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Clinical Toxicology, Guy’s and St Thomas’ NHS Foundation Trust, London, UK
- Faculty of Life Sciences and Medicine, King’s College London, London, UK
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