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Rasschaert M, Weller RO, Schroeder JA, Brochhausen C, Idée JM. Retention of Gadolinium in Brain Parenchyma: Pathways for Speciation, Access, and Distribution. A Critical Review. J Magn Reson Imaging 2020; 52:1293-1305. [PMID: 32246802 PMCID: PMC7687192 DOI: 10.1002/jmri.27124] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/05/2020] [Accepted: 02/06/2020] [Indexed: 12/21/2022] Open
Abstract
The unexpected appearance of T1 hyperintensities, mostly in the dentate nucleus and the globus pallidus, during nonenhanced MRI was reported in 2014. This effect is associated with prior repeated administrations of gadolinium (Gd)‐based contrast agents (GBCAs) in patients with a functional blood–brain barrier (BBB). It is widely assumed that GBCAs do not cross the intact BBB, but the observation of these hypersignals raises questions regarding this assumption. This review critically discusses the mechanisms of Gd accumulation in the brain with regard to access pathways, Gd species, tissue distribution, and subcellular location. We propose the hypothesis that there is early access of Gd species to cerebrospinal fluid, followed by passive diffusion into the brain parenchyma close to the cerebral ventricles. When accessing areas rich in endogenous metals or phosphorus, the less kinetically stable GBCAs would dissociate, and Gd would bind to endogenous macromolecules, and/or precipitate within the brain tissue. It is also proposed that Gd species enter the brain parenchyma along penetrating cortical arteries in periarterial pial‐glial basement membranes and leave the brain along intramural peri‐arterial drainage (IPAD) pathways. Lastly, Gd/GBCAs may access the brain parenchyma directly from the blood through the BBB in the walls of capillaries. It is crucial to distinguish between the physiological distribution and drainage pathways for GBCAs and the possible dissociation of less thermodynamically/kinetically stable GBCAs that lead to long‐term Gd deposition in the brain. Level of Evidence 5. Technical Efficacy Stage 3.
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Affiliation(s)
| | - Roy O Weller
- Neuropathology, Faculty of Medicine University of Southampton, Southampton General Hospital, Southampton, UK
| | - Josef A Schroeder
- Institute of Pathology, University of Regensburg, Regensburg, Germany
| | | | - Jean-Marc Idée
- Guerbet, Research and Innovation Division, Aulnay-sous-Bois, France
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Costelloe CM, Amini B, Madewell JE. Risks and Benefits of Gadolinium-Based Contrast-Enhanced MRI. Semin Ultrasound CT MR 2020; 41:170-182. [DOI: 10.1053/j.sult.2019.12.005] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Costelloe CM, Amini B, Madewell JE. WITHDRAWN: Risks and Benefits of Gadolinium-Based Contrast Enhanced MRI. Semin Ultrasound CT MR 2020; 41:260-274. [PMID: 32446435 DOI: 10.1053/j.sult.2020.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
The Publisher regrets that this article is an accidental duplication of an article that has already been published in [Seminars in Ultrasound, CT, and MRI, 41/2 (2020) 170–182], https://dx.doi.org/10.1053/j.sult.2019.12.005. The duplicate article has therefore been withdrawn. The full Elsevier Policy on Article Withdrawal can be found at https://www.elsevier.com/about/our-business/policies/article-withdrawal
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Affiliation(s)
- Colleen M Costelloe
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Behrang Amini
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
| | - John E Madewell
- Division of Diagnostic Imaging, University of Texas MD Anderson Cancer Center, Houston, TX
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Gadolinium deposition in the brain of dogs after multiple intravenous administrations of linear gadolinium based contrast agents. PLoS One 2020; 15:e0227649. [PMID: 32012163 PMCID: PMC6996830 DOI: 10.1371/journal.pone.0227649] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 12/22/2019] [Indexed: 01/24/2023] Open
Abstract
Objective To determine the effect of a linear gadolinium-based contrast agent (GBCA) on the signal intensity (SI) of the deep cerebellar nuclei (DCN) in a retrospective clinical study on dogs after multiple magnetic resonance (MR) examinations with intravenous injections of gadodiamide and LA-ICP-MS analysis of a canine cerebellum after gadodiamide administration. Animals 15 client-owned dogs of different breeds and additionally 1 research beagle dog cadaver. Procedures In the retrospective study part, 15 dogs who underwent multiple consecutive MR imaging examinations with intravenous injection of linear GBCA gadodiamide were analyzed. SI ratio differences on unenhanced T1-weighted MR images before and after gadodiamide injections was calculated by subtracting SI ratios between DCN and pons of the first examination from the ratio of the last examination. Additionally, 1 research beagle dog cadaver was used for LA-ICP-MS (Laser ablation inductively coupled plasma mass spectrometry) analysis of gadolinium in the cerebellum as an add-on to another animal study. Descriptive and non-parametrical statistical analysis was performed and a p-value of < 0.05 was considered significant. Results No statistically significant differences of SI ratios, between DCN and pons, were detectable based on unenhanced T1-weighted MR images. LA-ICP-MS analyses showed between 1.5 to 2.5 μg gadolinium/g tissue in the cerebellum of the examined dog, 35 months after the last of 3 MRI examination with gadodiamide (two examinations at a dose of 1 x 0.1mmol/kg, last examination at a dose of 3 x 0.05mmol/kg). Conclusion and clinical relevance Although the retrospective MRI study did not indicate any visible effect of SI increase after multiple gadodiamide exposures, further studies based on LA-ICP-MS showed that the optical threshold was not reached for a potential visible effect. Gadolinium was detectable at a level of 1.5 to 2.5 μg gadolinium/g tissue by using LA-ICP-MS in the cerebellum 35 months after last MRI examination. The general importance of gadolinium retention of subvisible contents requires further investigation.
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The gadolinium hypothesis for fibromyalgia and unexplained widespread chronic pain. Med Hypotheses 2019; 129:109240. [PMID: 31371082 DOI: 10.1016/j.mehy.2019.109240] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/26/2019] [Accepted: 05/19/2019] [Indexed: 02/01/2023]
Abstract
Fibromyalgia (FM) is a chronic, painful, heterogeneous, and common disorder carrying a substantial socio-economical burden. It lacks effective cures and its aetiology is still unknown. There exists evidence for central and peripheral neurological contribution to the symptoms but grasping the real source of abnormal nervous system sensitization remains an ongoing challenge. There exists an association between an injury/trauma and the onset of the symptoms, but a causal relationship has not been yet sufficiently supported by scientific evidence. I postulate a role for gadolinium-based contrast agents and retention of gadolinium in the body. This conjecture breaks the hypothesis of a direct role for a physical injury/trauma per se in favour of an indirect one by the subsequent diagnostic procedures. It creates a new link between retention of gadolinium in the body and painful conditions as FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness. Experimental evidence demonstrates possible retention of gadolinium species in human body, still lacking conclusive answers on their pathological consequences. Notwithstanding, there exist some initial data that report unexplained chronic widespread pain and symptoms of FM in those patients: they are suggestive for pathological consequences associated with gadolinium retention. Besides clear compelling symptoms overlapping, biochemical findings are provided to sustain the hypothesis of a role for gadolinium in the disease process focusing on neurotransmitters, endogenous metal cations, cytokines, and muscle tissue. Experimental findings strongly support the hypothesis of impairment at the cellular, intracellular, and systemic levels in FM. And these data are highly compatible with collateral effects associated with the interference of the gadolinium ion and its pharmaceutical chelates into biochemical pathways in vivo. The hypothesis presented in this article, along with the support of scientific evidence, links FM and unexplained chronic widespread pain reported after a trauma, surgery, or medical illness to retention of gadolinium in the body. If the hypothesis is confirmed, it could improve diagnosis and prevention, while providing a ground for development of new treatments.
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Chehabeddine L, Al Saleh T, Baalbaki M, Saleh E, Khoury SJ, Hannoun S. Cumulative administrations of gadolinium-based contrast agents: risks of accumulation and toxicity of linear vs macrocyclic agents. Crit Rev Toxicol 2019; 49:262-279. [DOI: 10.1080/10408444.2019.1592109] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Lara Chehabeddine
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Tala Al Saleh
- Department of Physics, American University of Beirut, Beirut, Lebanon
| | - Marwa Baalbaki
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Eman Saleh
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J. Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
- Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Choi JW, Moon WJ. Gadolinium Deposition in the Brain: Current Updates. Korean J Radiol 2018; 20:134-147. [PMID: 30627029 PMCID: PMC6315073 DOI: 10.3348/kjr.2018.0356] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used for enhancement in MR imaging and have long been considered safe when administered at recommended doses. However, since the report that nephrogenic systemic fibrosis is linked to the use of GBCAs in subjects with severe renal diseases, accumulating evidence has suggested that GBCAs are not cleared entirely from our bodies; some GBCAs are deposited in our tissues, including the brain. GBCA deposition in the brain is mostly linked to the specific chelate structure of the GBCA: linear GBCAs were responsible for brain deposition in almost all reported studies. This review aimed to summarize the current knowledge about GBCA brain deposition and discuss its clinical implications.
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Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
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Quattrocchi CC, Ramalho J, van der Molen AJ, Rovira À, Radbruch A. Standardized assessment of the signal intensity increase on unenhanced T1-weighted images in the brain: the European Gadolinium Retention Evaluation Consortium (GREC) Task Force position statement. Eur Radiol 2018; 29:3959-3967. [PMID: 30413951 DOI: 10.1007/s00330-018-5803-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2018] [Revised: 08/29/2018] [Accepted: 09/25/2018] [Indexed: 10/27/2022]
Abstract
After the initial report in 2014 on T1-weighted (T1w) hyperintensity of deep brain nuclei following serial injections of linear gadolinium-based contrast agents (GBCAs), a multitude of studies on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain have been published. The vast majority of these studies found a signal intensity (SI) increase for linear GBCAs in the brain-first and foremost in the dentate nucleus-while no SI increase was found for macrocyclic GBCAs. However, the scientific debate about this finding is kept alive by the fact that SI differences do not unequivocally represent the amount of gadolinium retained. Since the study design of the SI measurement in various brain structures is relatively simple, MRI studies investigating gadolinium-dependent T1w hyperintensity are currently conducted at multiple institutions worldwide. However, methodological mistakes may result in flawed conclusions. In this position statement, we assess the methodological basis of the published retrospective studies and define quality standards for future studies to give guidance to the scientific community and to help identify studies with potentially flawed methodology and misleading results. KEY POINTS: • A multitude of studies has been published on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain. • The gadolinium-dependent T1w hyperintensity in the brain depends on patient's history, types of GBCAs used (i.e., linear vs. macrocyclic GBCAs) and MR imaging setup and protocols. • Quality standards for the design of future studies are needed to standardize methodology and avoid potentially misleading results from retrospective studies.
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Affiliation(s)
- Carlo C Quattrocchi
- Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and Surgery, Università Campus Bio-Medico di Roma, via Alvaro del Portillo 21, 00128, Rome, Italy.
| | - Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisbon, Portugal
| | - Aart J van der Molen
- Department of Radiology, C2-S, Leiden University Medical Center, Albinusdreef 2, NL-2333 ZA, Leiden, The Netherlands
| | - Àlex Rovira
- Section of Neuroradiology Vall d'Hebron University Hospital, Passeig de la Vall d'Hebron, 119-129, 08035, Barcelona, Spain
| | - Alexander Radbruch
- Department of Radiology, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Pullicino R, Radon M, Biswas S, Bhojak M, Das K. A Review of the Current Evidence on Gadolinium Deposition in the Brain. Clin Neuroradiol 2018. [PMID: 29523896 DOI: 10.1007/s00062-018-0678-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the past 3 years, gadolinium-based contrast agents have been linked to MRI signal changes in the brain, which have been found to be secondary to gadolinium deposition in the brain, particularly in the dentate nuclei and globus pallidus even in patients having an intact blood-brain barrier and a normal renal function. This tends to occur more in linear agents than with macrocyclic agents. Nonetheless, there has been no significant evidence that this has any clinical consequence. We reviewed the current evidence related to this new phenomenon and the precautionary approach taken by regulatory agencies.
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Affiliation(s)
- Richard Pullicino
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK.
| | - Mark Radon
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Shubhabrata Biswas
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Maneesh Bhojak
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Kumar Das
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
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Manto M, Perrotta G. Toxic-induced cerebellar syndrome: from the fetal period to the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2018; 155:333-352. [DOI: 10.1016/b978-0-444-64189-2.00022-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Garcia J, Liu SZ, Louie AY. Biological effects of MRI contrast agents: gadolinium retention, potential mechanisms and a role for phosphorus. PHILOSOPHICAL TRANSACTIONS. SERIES A, MATHEMATICAL, PHYSICAL, AND ENGINEERING SCIENCES 2017; 375:rsta.2017.0180. [PMID: 29038383 PMCID: PMC5647271 DOI: 10.1098/rsta.2017.0180] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/06/2023]
Abstract
No discussion of challenges for chemistry in molecular imaging would be complete without addressing the elephant in the room-which is that the purest of chemical compounds needs to interact with a biological system in a manner that does not perturb normal biology while still providing efficacious feedback to assist in diagnosis of disease. In the past decade, magnetic resonance imaging (MRI) agents long considered inert have produced adverse effects in certain patient populations under certain treatment regimens. More recently, inert blood pool agents have been found to deposit in the brain. Release of free metal is often suspected as the culprit but that hypothesis has yet to be validated. In addition, even innocuous agents can cause painful side effects during injection in some patients. In this brief review, we summarize known biological effects for gadolinium- and iron-based MRI contrast agents, and discuss some of the potential mechanisms for the observed biological effects, including the potential role of phosphorus imbalance, related to kidney disease or cancer, in destabilizing gadolinium-based chelates and precipitating free gadolinium.This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.
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Affiliation(s)
- Joel Garcia
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Stephen Z Liu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Angelique Y Louie
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
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Kanda T, Nakai Y, Hagiwara A, Oba H, Toyoda K, Furui S. Distribution and chemical forms of gadolinium in the brain: a review. Br J Radiol 2017; 90:20170115. [PMID: 28749164 DOI: 10.1259/bjr.20170115] [Citation(s) in RCA: 43] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
In the 3 years since residual gadolinium-based contrast agent (GBCA) in the brain was first reported, much has been learned about its accumulation, including the pathway of GBCA entry into the brain, the brain distribution of GBCA and its excretion. Here we review recent progress in understanding the routes of gadolinium deposition in brain structures.
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Affiliation(s)
- Tomonori Kanda
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan
| | - Yudai Nakai
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan.,2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akifumi Hagiwara
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan.,2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Oba
- 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiko Toyoda
- 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeru Furui
- 3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
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Abstract
Clinicians, radiologists, and patients should be aware of the most up-to-date data on the risks of gadolinium-based contrast agent (GBCA) administration. In this review, we discuss in vivo gadolinium retention, particularly brain tissue retention, and potential toxic effects. GBCA pharmacokinetics and biodistribution are reviewed briefly. Based on the more recent published literature and society guidelines, general safety recommendations for clinical practice are provided.
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Affiliation(s)
- Joana Ramalho
- Department of Neuroradiology, Centro Hospitalar de Lisboa Central, Rua José António Serrano, 1150-199 Lisboa, Portugal.
| | - Miguel Ramalho
- Department of Radiology, Hospital Garcia de Orta, Avenida Torrado da Silva, 2805-267 Almada, Portugal
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Gadolinium retention in the body: what we know and what we can do. Radiol Med 2017; 122:589-600. [PMID: 28361260 DOI: 10.1007/s11547-017-0757-3] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Accepted: 03/21/2017] [Indexed: 01/08/2023]
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Tedeschi E, Cocozza S, Borrelli P, Ugga L, Morra VB, Palma G. Longitudinal Assessment of Dentate Nuclei Relaxometry during Massive Gadobutrol Exposure. Magn Reson Med Sci 2017; 17:100-104. [PMID: 28367903 PMCID: PMC5760240 DOI: 10.2463/mrms.cr.2016-0137] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
We report the assessment of Dentate Nuclei (DN) R1 (1/T1) and R2* (1/T2*) values in a patient with relapsing-remitting Multiple Sclerosis, exposed to 22 standard (0.1 mmol/kg) doses of gadobutrol, who underwent eight relaxometric MR measurements within 2 years. DN R1 did not significantly increase nor correlated with cumulative gadobutrol administration, even after a total dose of 130 ml. Likewise, DN R2* relaxometry remained unchanged. In conclusion, massive gadobutrol exposure did not induce significant DN relaxometry changes.
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Affiliation(s)
- Enrico Tedeschi
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II"
| | - Sirio Cocozza
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II"
| | | | - Lorenzo Ugga
- Department of Advanced Biomedical Sciences, Neuroradiology Unit, University "Federico II"
| | - Vincenzo Brescia Morra
- Department of Neurosciences, Reproductive and Odonto-stomatological Sciences, University "Federico II"
| | - Giuseppe Palma
- Institute of Biostructure and Bioimaging, National Research Council
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