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Wamelink IJHG, Azizova A, Booth TC, Mutsaerts HJMM, Ogunleye A, Mankad K, Petr J, Barkhof F, Keil VC. Brain Tumor Imaging without Gadolinium-based Contrast Agents: Feasible or Fantasy? Radiology 2024; 310:e230793. [PMID: 38319162 PMCID: PMC10902600 DOI: 10.1148/radiol.230793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 08/07/2023] [Accepted: 08/14/2023] [Indexed: 02/07/2024]
Abstract
Gadolinium-based contrast agents (GBCAs) form the cornerstone of current primary brain tumor MRI protocols at all stages of the patient journey. Though an imperfect measure of tumor grade, GBCAs are repeatedly used for diagnosis and monitoring. In practice, however, radiologists will encounter situations where GBCA injection is not needed or of doubtful benefit. Reducing GBCA administration could improve the patient burden of (repeated) imaging (especially in vulnerable patient groups, such as children), minimize risks of putative side effects, and benefit costs, logistics, and the environmental footprint. On the basis of the current literature, imaging strategies to reduce GBCA exposure for pediatric and adult patients with primary brain tumors will be reviewed. Early postoperative MRI and fixed-interval imaging of gliomas are examples of GBCA exposure with uncertain survival benefits. Half-dose GBCAs for gliomas and T2-weighted imaging alone for meningiomas are among options to reduce GBCA use. While most imaging guidelines recommend using GBCAs at all stages of diagnosis and treatment, non-contrast-enhanced sequences, such as the arterial spin labeling, have shown a great potential. Artificial intelligence methods to generate synthetic postcontrast images from decreased-dose or non-GBCA scans have shown promise to replace GBCA-dependent approaches. This review is focused on pediatric and adult gliomas and meningiomas. Special attention is paid to the quality and real-life applicability of the reviewed literature.
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Affiliation(s)
- Ivar J. H. G. Wamelink
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Aynur Azizova
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Thomas C. Booth
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Henk J. M. M. Mutsaerts
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Afolabi Ogunleye
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Kshitij Mankad
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Jan Petr
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Frederik Barkhof
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
| | - Vera C. Keil
- From the Department of Radiology and Nuclear Medicine, Amsterdam
University Medical Center, VUMC Site, De Boelelaan 1117, Amsterdam 1081 HV, the
Netherlands (I.J.H.G.W., A.A., H.J.M.M.M., J.P., F.B., V.C.K.); Department of
Imaging and Biomarkers, Cancer Center Amsterdam, Amsterdam, the Netherlands
(I.J.H.G.W., A.A., H.J.M.M.M., V.C.K.); School of Biomedical Engineering and
Imaging Sciences, King’s College London, London, United Kingdom (T.C.B.);
Department of Neuroradiology, King’s College Hospital, NHS Foundation
Trust, London, UK (T.C.B.); Department of Brain Imaging, Amsterdam Neuroscience,
Amsterdam, the Netherlands (H.J.M.M.M., F.B., V.C.K.); Department of Radiology,
Lagos State University Teaching Hospital, Ikeja, Nigeria Radiology (A.O.);
Department of Radiology, Great Ormond Street Hospital for Children, NHS
Foundation Trust, London, United Kingdom (K.M.); Institute of
Radiopharmaceutical Cancer Research, Helmholtz-Zentrum Dresden-Rossendorf,
Dresden, Germany (J.P.); and Queen Square Institute of Neurology and Centre for
Medical Image Computing, University College London, London, United Kingdom
(F.B.)
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