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Dingenen E, Segers D, De Maeseneer H, Van Gysel D. Sturge-Weber syndrome: an update for the pediatrician. World J Pediatr 2024; 20:435-443. [PMID: 38658498 DOI: 10.1007/s12519-024-00809-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 03/27/2024] [Indexed: 04/26/2024]
Abstract
BACKGROUND Sturge-Weber syndrome (SWS) is a rare congenital neurocutaneous disorder characterized by the simultaneous presence of both cutaneous and extracutaneous capillary malformations. SWS usually presents as a facial port-wine birthmark, with a varying presence of leptomeningeal capillary malformations and ocular vascular abnormalities. The latter may lead to significant neurological and ocular morbidity such as epilepsy and glaucoma. SWS is most often caused by a somatic mutation involving the G protein subunit alpha Q or G protein subunit alpha 11 gene causing various alterations in downstream signaling pathways. We specifically conducted a comprehensive review focusing on the current knowledge of clinical practices, the latest pathophysiological insights, and the potential novel therapeutic avenues they provide. DATA SOURCES A narrative, non-systematic review of the literature was conducted, combining expert opinion with a balanced review of the available literature. A search of PubMed, Google Scholar and Embase was conducted, using keywords "Sturge-Weber Syndrome" OR "SWS", "Capillary malformations", "G protein subunit alpha 11" OR "G protein subunit alpha Q". RESULTS One of the hallmark features of SWS is the presence of a port-wine birthmark at birth, and forehead involvement is most indicative for SWS. The most common ocular manifestations of SWS are glaucoma and choroidal hemangioma. Glaucoma presents in either in infancy (0-3 years of age) or later in life. Neurological complications are common in SWS, occurring in about 70%-80% of patients, with seizures being the most common one. SWS significantly impacts the quality of life for patients and their families, and requires a multidisciplinary approach for diagnosis and treatment. Currently, no disease-modifying therapies exist, and treatment is mostly focused on symptoms or complications as they arise. CONCLUSIONS: SWS remains a complex and heterogeneous disorder. Further research is needed to optimize diagnostic and therapeutic strategies, and to translate insights from molecular pathogenesis to clinical practice.
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Affiliation(s)
- Emilie Dingenen
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Damien Segers
- Ghent University Faculty of Medicine and Health Sciences, Ghent, Belgium
| | - Hannelore De Maeseneer
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium
| | - Dirk Van Gysel
- Department of Pediatrics, O.L.Vrouw Hospital Aalst, Moorselbaan 164, 9300, Aalst, Belgium.
- Interdisciplinary Unit of Pediatric Dermatology, Vrije Universiteit Brussel (VUB), Universitair Ziekenhuis Brussel (UZ Brussel), Brussels, Belgium.
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2
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Amini A, Shayganfar A, Amini Z, Ostovar L, HajiAhmadi S, Chitsaz N, Rabbani M, Kafieh R. Deep learning for discrimination of active and inactive lesions in multiple sclerosis using non-contrast FLAIR MRI: A multicenter study. Mult Scler Relat Disord 2024; 87:105642. [PMID: 38703520 DOI: 10.1016/j.msard.2024.105642] [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: 11/10/2023] [Revised: 02/18/2024] [Accepted: 04/20/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Within the domain of multiple sclerosis (MS), the precise discrimination between active and inactive lesions bears immense significance. Active lesions are enhanced on T1-weighted MRI images after administration of gadolinium-based contrast agents, which brings about associated complexities. This study investigates the potential of deep learning to differentiate between active and inactive lesions in MS using non-contrast FLAIR-type MRI data, presenting a non-invasive alternative to conventional gadolinium-based MRI methods. METHODS The dataset encompasses 9097 lesion images collected from 130 MS patients across four distinct imaging centers, with post-contrast T1-weighted images as the benchmark reference. We initially identified and labeled the lesions and carefully selected corresponding regions of interest (ROIs). These ROIs were employed as inputs for a convolutional neural network (CNN) to predict lesion status. Also, transfer learning was utilized, incorporating 12 pre-trained CNN models. Subsequently, an ensemble technique was applied to 3 of best models, followed by a systematic comparison of the results. RESULTS Through a 5-fold cross-validation, our custom designed network exhibited an average accuracy of 85 %, a sensitivity of 95 %, a specificity of 75 %, and an AUC value of 0.90. Among the pre-trained models, ResNet50 emerged as the most effective, achieving a specificity of 58 %, an accuracy of 75 %, a sensitivity of 91 %, and an AUC value of 0.81. Our comprehensive evaluations encompassed the receiver operating characteristic curve, precision-recall curve, and confusion matrix analyses. CONCLUSION The findings underscore the efficacy of the proposed CNN, trained on FLAIR MRI data ROIs, in accurately discerning active and inactive lesions without reliance on contrast agents. Our multicenter study of 130 patients with diverse imaging devices outperforms the other single-center studies, achieving superior sensitivity and specificity. Unlike studies using multiple modalities, our exclusive use of FLAIR images streamlines the process, and our streamlined approach, excluding conventional pre-processing, demonstrates efficiency. The external validation conducted on diverse datasets, coupled with the analysis of dilated masks, underscores the adaptability and efficacy of our custom CNN model in discerning between active and inactive lesions.
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Affiliation(s)
- AmirAbbas Amini
- School of Advanced Technologies in Medicine, Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Azin Shayganfar
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Zahra Amini
- School of Advanced Technologies in Medicine, Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Leila Ostovar
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Somayeh HajiAhmadi
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Navid Chitsaz
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Masoud Rabbani
- Department of Radiology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Raheleh Kafieh
- Department of Engineering, Durham University, Durham, UK.
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3
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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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4
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Yen TYC, Abbasi AZ, He C, Lip HY, Park E, Amini MA, Adissu HA, Foltz W, Rauth AM, Henderson J, Wu XY. Biocompatible and bioactivable terpolymer-lipid-MnO 2 Nanoparticle-based MRI contrast agent for improving tumor detection and delineation. Mater Today Bio 2024; 25:100954. [PMID: 38304342 PMCID: PMC10832465 DOI: 10.1016/j.mtbio.2024.100954] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2023] [Revised: 12/22/2023] [Accepted: 01/13/2024] [Indexed: 02/03/2024] Open
Abstract
Early and precise detection of solid tumor cancers is critical for improving therapeutic outcomes. In this regard, magnetic resonance imaging (MRI) has become a useful tool for tumor diagnosis and image-guided therapy. However, its effectiveness is limited by the shortcomings of clinically available gadolinium-based contrast agents (GBCAs), i.e. poor tumor penetration and retention, and safety concerns. Thus, we have developed a novel nanoparticulate contrast agent using a biocompatible terpolymer and lipids to encapsulate manganese dioxide nanoparticles (TPL-MDNP). The TPL-MDNP accumulated in tumor tissue and produced paramagnetic Mn2+ ions, enhancing T1-weight MRI contrast via the reaction with H2O2 rich in the acidic tumor microenvironment. Compared to the clinically used GBCA, Gadovist®1.0, TPL-MDNP generated stronger T1-weighted MR signals by over 2.0-fold at 30 % less of the recommended clinical dose with well-defined tumor delineation in preclinical orthotopic tumor models of brain, breast, prostate, and pancreas. Importantly, the MRI signals were retained for 60 min by TPL-MDNP, much longer than Gadovist®1.0. Biocompatibility of TPL-MDNP was evaluated and found to be safe up to 4-fold of the dose used for MRI. A robust large-scale manufacturing process was developed with batch-to-batch consistency. A lyophilization formulation was designed to maintain the nanostructure and storage stability of the new contrast agent.
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Affiliation(s)
- Tin-Yo C. Yen
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Azhar Z. Abbasi
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Chungsheng He
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Ho-Yin Lip
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Elliya Park
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | - Mohammad A. Amini
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
| | | | - Warren Foltz
- STTARR Innovation Centre, Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, M5G 2M9, Canada
| | - Andrew M. Rauth
- Departments of Medical Biophysics and Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
- Princess Margaret Cancer Center, University Health Network, Toronto, Ontario, Canada
| | - Jeffrey Henderson
- Departments of Medical Biophysics and Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Xiao Yu Wu
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, ON, Canada
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5
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Wentworth BJ, Khot R, Caldwell SH. The Many Faces of Primary Sclerosing Cholangitis: Controversy Abounds. Dig Dis Sci 2023; 68:3514-3526. [PMID: 37358638 DOI: 10.1007/s10620-023-08003-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2022] [Accepted: 03/10/2023] [Indexed: 06/27/2023]
Abstract
Primary sclerosing cholangitis (PSC) is notoriously challenging to manage given its heterogeneity with regard to diagnosis, management, and progression. The lack of disease-modifying therapy and variable rate of onset of cirrhosis, portal hypertension-related decompensating events, jaundice, pruritus, biliary complications, and need for liver transplantation is deeply unsettling to clinicians and patients alike. Recent updated practice guidance by the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver endeavored to highlight some of these challenges. However, these references only briefly address clinical dilemmas that providers face on a daily basis. This review aims to further discuss these controversial topics, including providing insight into the utility of ursodeoxycolic acid, the significance of alkaline phosphatase normalization, when to consider PSC variants and mimickers, and the implications of continuous hepatobiliary malignancy screening. In particular, there has been a growing body of literature raising concern about repeat exposure to gadolinium-containing contrast. Patients with PSC are potentially at risk for large lifetime exposure to gadolinium related to frequent magnetic resonance imaging scans and whether this carries any negative long-term adverse effects remains unknown.
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Affiliation(s)
- Brian J Wentworth
- Division of Gastroenterology and Hepatology, School of Medicine, University of Virginia, PO Box 800708, Charlottesville, VA, 22908, USA.
| | - Rachita Khot
- Department of Radiology and Medical Imaging, University of Virginia Health System, Charlottesville, VA, USA
| | - Stephen H Caldwell
- Division of Gastroenterology and Hepatology, School of Medicine, University of Virginia, PO Box 800708, Charlottesville, VA, 22908, USA
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6
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Cananau C, Forslin Y, Bergendal Å, Sjöström H, Fink K, Ouellette R, Wiberg MK, Fredrikson S, Granberg T. MRI detection of brain gadolinium retention in multiple sclerosis: Magnetization transfer vs. T1-weighted imaging. J Neuroimaging 2023; 33:247-255. [PMID: 36599653 DOI: 10.1111/jon.13079] [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: 07/23/2022] [Revised: 11/22/2022] [Accepted: 12/20/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND AND PURPOSE Evidence of brain gadolinium retention has affected gadolinium-based contrast agent usage. It is, however, unclear to what extent macrocyclic agents are retained and whether their in vivo detection may necessitate nonconventional MRI. Magnetization transfer (MT) could prove suitable to detect gadolinium-related signal changes since dechelated gadolinium ions bind to macromolecules. Therefore, this study aimed to investigate associations of prior gadolinium administrations with MT and T1 signal abnormalities. METHODS A cohort of 23 persons with multiple sclerosis (MS) (18 females, 5 males, 57 ± 8.0 years) with multiple past gadolinium administrations (median 6, range 3-12) and 23 age- and sex-matched healthy controls underwent 1.5 Tesla MRI with MT, T1-weighted 2-dimensional spin echo, and T1-weighted 3-dimensional gradient echo. The signal intensity index was assessed by MRI in gadolinium retention predilection sites. RESULTS There were dose-dependent associations of the globus pallidus signal on gradient echo (r = .55, p < .001) and spin echo (r = .38, p = .013) T1-weighted imaging, but not on MT. Relative to controls, MS patients had higher signal intensity index in the dentate nucleus on T1-weighted gradient echo (1.037 ± 0.040 vs. 1.016 ± 0.023, p = .04) with a similar trend in the globus pallidus on T1-weighted spin echo (1.091 ± 0.034 vs. 1.076 ± 0.014, p = .06). MT detected no group differences. CONCLUSIONS Conventional T1-weighted imaging provided dose-dependent associations with gadolinium administrations in MS, while these could not be detected with 2-dimensional MT. Future studies could explore newer MT techniques like 3D and inhomogenous MT. Notably, these associations were identified with conventional MRI even though most patients had not received gadolinium administrations in the preceding 9 years, suggestive of long-term retention.
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Affiliation(s)
- Carmen Cananau
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Yngve Forslin
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Radiology, Karolinska University Hospital, Stockholm, Sweden
| | - Åsa Bergendal
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Sjöström
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden
| | - Katharina Fink
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Center of Neurology, Academic Specialist Center, Stockholm Health Services, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Russell Ouellette
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Maria Kristoffersen Wiberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
| | - Sten Fredrikson
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neurology, Karolinska University Hospital, Stockholm, Sweden
| | - Tobias Granberg
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.,Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden
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7
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Su M, Chen Y, Jia L, Zhang Z. Camptothecin-Loaded and Manganese Dioxide-Coated Polydopamine Nanomedicine Used for Magnetic Resonance Imaging Diagnosis and Chemo-Photothermal Therapy for Lung Cancer. Int J Nanomedicine 2022; 17:6687-6705. [PMID: 36597434 PMCID: PMC9805739 DOI: 10.2147/ijn.s359300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Accepted: 11/08/2022] [Indexed: 12/29/2022] Open
Abstract
Introduction Camptothecin (CPT) is a cytotoxic quinolone alkaloid (isolated from a traditional Chinese medicine Camptotheca acuminata), used for the treatment of various malignancies, which inhibits DNA topoisomerase I (Topo I). However, its drawbacks, such as poor water solubility, stability, and highly toxic side effects, limit its clinical application. Therefore, CPT needs to be prepared as a nanomedicine to improve solubility, reduce side effects, and synergize with other therapies to improve efficacy. Methods In this work, we constructed CPT NPs (nanoparticles), which were CPT-loaded and manganese dioxide (MnO2)-coated polydopamine (PDA) nanomedicine. In vitro, we explored the antitumor effect including CPT NPs-induced cell proliferation inhibition, apoptosis and ferroptosis for tumor cell lines. In vivo, we established LLC tumor-bearing mice model to evaluate their tumor imaging and anticancer effects. Results CPT NPs improve the water solubility and stability of CPT and reduce its toxic effects. It has good biocompatibility, excellent photothermal conversion ability for photothermal therapy (PTT) and pH release in the tumor microenvironment. It can inhibit tumor cell proliferation, induce apoptosis and result in ferroptosis of tumor cells. More significantly, this nanomedicine can provide information for the location and diagnosis of tumors via magnetic resonance imaging. In general, the nanomedicine integrated with diagnosis and treatment has excellent anticancer effect. Discussion Altogether, this nanomedicine possesses the ability to diagnose and therapy through magnetic resonance imaging and chemo-photothermal therapy, respectively. In addition, the integrated diagnosis and treatment nanomedicine has potential clinical application prospects through treating lung cancer with high efficiency and low side effect. It can support the construction of related nano-delivery systems.
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Affiliation(s)
- Mingliang Su
- Cancer Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Yukun Chen
- Cancer Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
| | - Lijun Jia
- Cancer Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China,Correspondence: Lijun Jia; Zhanxia Zhang, Email ;
| | - Zhanxia Zhang
- Cancer Institute, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai, 200032, People’s Republic of China
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8
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Liachenko SM, Sadovova NV, Tripp A, Ghorai S, Patri AK, Hanig JP, Cohen JE, Krefting I. Optimization of Detection of Gadodiamide Brain Retention in Rats Using Quantitative T 2 Mapping and Intraperitoneal Administration. J Magn Reson Imaging 2022; 56:1499-1504. [PMID: 35278003 DOI: 10.1002/jmri.28149] [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: 12/14/2021] [Revised: 02/24/2022] [Accepted: 02/25/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Currently, the gadolinium retention in the brain after the use of contrast agents is studied by T1 -weighted magnetic resonance imaging (MRI) (T1 w) and T1 mapping. The former does not provide easily quantifiable data and the latter requires prolonged scanning and is sensitive to motion. T2 mapping may provide an alternative approach. Animal studies of gadolinium retention are complicated by repeated intravenous (IV) dosing, whereas intraperitoneal (IP) injections might be sufficient. HYPOTHESIS T2 mapping will detect the changes in the rat brain due to gadolinium retention, and IP administration is equivalent to IV for long-term studies. STUDY TYPE Prospective longitudinal. ANIMAL MODEL A total of 31 Sprague-Dawley rats administered gadodiamide IV (N = 8) or IP (N = 8), or saline IV (N = 6) or IP (N = 9) 4 days per week for 5 weeks. FIELD STRENGTH/SEQUENCES A 7 T, T1 w, and T2 mapping. ASSESSMENT T2 relaxation and image intensities in the deep cerebellar nuclei were measured pre-treatment and weekly for 5 weeks. Then brains were assessed for neuropathology (N = 4) or gadolinium content using inductively coupled plasma mass spectrometry (ICP-MS, N = 12). STATISTICAL TESTS Repeated measures analysis of variance with post hoc Student-Newman-Keuls tests and Hedges' effect size. RESULTS Gadolinium was detected by both approaches; however, T2 mapping was more sensitive (effect size 2.32 for T2 vs. 0.95 for T1 w), and earlier detection (week 3 for T2 vs. week 4 for T1 w). ICP-MS confirmed the presence of gadolinium (3.076 ± 0.909 nmol/g in the IV group and 3.948 ± 0.806 nmol/g in the IP group). There was no significant difference between IP and IV groups (ICP-MS, P = 0.109; MRI, P = 0.696). No histopathological abnormalities were detected in any studied animal. CONCLUSION T2 relaxometry detects gadolinium retention in the rat brain after multiple doses of gadodiamide irrespective of the route of administration. EVIDENCE LEVEL 1 TECHNICAL EFFICACY: Stage 1.
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Affiliation(s)
- Serguei M Liachenko
- Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Natalya V Sadovova
- Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Arnold Tripp
- Division of Neurotoxicology, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Suman Ghorai
- Nanotechnology Core Facility, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Anil K Patri
- Nanotechnology Core Facility, National Center for Toxicological Research, U.S. Food and Drug Administration, Jefferson, Arkansas, USA
| | - Joseph P Hanig
- Office of Pharmaceutical Quality, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland, USA
| | - Jonathan E Cohen
- Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland, USA
| | - Ira Krefting
- Office of New Drugs, Center for Drug Evaluation and Research, U.S. Food and Drug Administration, White Oak, Maryland, USA
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Bhushan S, Noble C, Balouch F, Lewindon P, Lampe G, Hodgkinson P, McGill J, Ee L. Hepatocellular carcinoma requiring liver transplantation in hereditary tyrosinemia type 1 despite nitisinone therapy and α1-fetoprotein normalization. Pediatr Transplant 2022; 26:e14334. [PMID: 35698261 DOI: 10.1111/petr.14334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Revised: 05/23/2022] [Accepted: 05/26/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Hereditary tyrosinemia type 1 is a rare metabolic condition associated with an increased risk of hepatocellular carcinoma. Nitisinone (2-[2-nitro-4-trifluoromethylbenzoyl]-1,3-cyclohexanedione, NTBC) treatment has reduced but not eliminated the risk. The delayed initiation of nitisinone treatment, and persistently abnormal α1-fetoprotein (AFP) levels are recognized to be risk factors for late-onset hepatocellular carcinoma. We report three children diagnosed and treated with nitisinone since infancy who developed hepatocellular carcinoma despite long-term normalization of AFP. METHODS A retrospective review of all patients with tyrosinemia on nitisinone managed at our center was undertaken. Patient demographics, age at diagnosis, duration of therapy, timing of AFP normalization, and radiographic imaging findings were noted. RESULTS Three patients at our center with tyrosinemia type 1 developed hepatocellular carcinoma 9-13 years after diagnosis despite long-term nitisinone therapy and normalization of AFP. Two patients developed new nodules on imaging with an elevation of AFP leading to the diagnosis and subsequent liver transplant. The third patient proceeded with liver transplant because of a very nodular liver and increasing splenomegaly despite normal AFP and no change in surveillance gadoxetate magnetic resonance imaging. Early hepatocellular carcinoma was found in her liver explant. All three patients were cirrhotic at diagnosis. CONCLUSIONS Patients with hereditary tyrosinemia type 1, especially those already cirrhotic at diagnosis, remain at high risk of developing hepatocellular carcinoma despite long-term nitisinone therapy and AFP normalization, and warrant close monitoring and surveillance.
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Affiliation(s)
- Shreya Bhushan
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Charlton Noble
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Fariha Balouch
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Peter Lewindon
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Guy Lampe
- Department of Anatomical Pathology, Central Laboratory Pathology Queensland, Herston, Queensland, Australia
| | - Peter Hodgkinson
- Queensland Liver Transplant Service, Princess Alexandra Hospital and Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Jim McGill
- Department of Chemical Pathology, Central Laboratory Pathology Queensland, Herston, Queensland, Australia
| | - Looi Ee
- Department of Gastroenterology, Hepatology and Liver Transplantation, Queensland Children's Hospital, Brisbane, Queensland, Australia
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10
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Mohammadzadeh M, Kolahi S, Mehrabi Nejad MM, Firouznia K, Naghibi H, Mohammadzadeh A, Shakiba M, Mohebi F, Komaki H, Sharifian H, Hashemi H, Harirchian MH, Azimi A, Adin ME, Yousem DM. Does Gadolinium Deposition Lead to Metabolite Alteration in the Dentate Nucleus? An MRS Study in Patients with MS. AJNR Am J Neuroradiol 2022; 43:1403-1410. [PMID: 36574329 PMCID: PMC9575534 DOI: 10.3174/ajnr.a7623] [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: 02/03/2022] [Accepted: 07/01/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Repeat contrast-enhanced MR imaging exposes patients with relapsing-remitting MS to frequent administration of gadolinium-based contrast agents. We aimed to investigate the potential metabolite and neurochemical alterations of visible gadolinium deposition on unenhanced T1WI in the dentate nucleus using MRS. MATERIALS AND METHODS This prospective study was conducted in a referral university hospital from January 2020 to July 2021. The inclusion criteria for case and control groups were as follows: 1) case: patients with relapsing-remitting MS, visible gadolinium deposition in the dentate nucleus (ribbon sign), >5 contrast-enhanced MR images obtained; 2) control 1: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, >5 contrast-enhanced MR images obtained; 3) control 2: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, <5 contrast-enhanced-MR images obtained; and 4) control 3: adult healthy individuals, with no contrast-enhanced MR imaging. Dentate nucleus and pontine single-voxel 12 × 12 × 12 MRS were analyzed using short TEs. RESULTS Forty participants (10 per group; 27 [67.5%] female; mean age, 35.6 [SD, 9.6] years) were enrolled. We did not detect any significant alteration in the levels of NAA and choline between the studied groups. The mean concentrations of mIns were 2.7 (SD, 0.73) (case), 1.5 (SD, 0.8) (control 1), 2.4 (SD, 1.2) (control 2), and 1.7 (SD, 1.2) (control 3) (P = .04). The mean concentration of Cr and mIns (P = .04) and the relative metabolic concentration (dentate nucleus/pons) of lipid 1.3/Cr (P = .04) were significantly higher in the case-group than in healthy individuals (controls 1-3). Further analyses compared the case group with cumulative control 1 and 2 groups and showed a significant increase in lactate (P = .02), lactate/Cr (P = .04), and Cr (dentate nucleus/pons) (P = .03) in the case group. CONCLUSIONS Although elevated concentrations of Cr, lactate, mIns, and lipid in the dentate nucleus of the case group indicate a metabolic disturbance, NAA and choline levels were normal, implying no definite neuronal damage.
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Affiliation(s)
- M Mohammadzadeh
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - S Kolahi
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - M-M Mehrabi Nejad
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - K Firouznia
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - H Naghibi
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - A Mohammadzadeh
- Department of Radiology (A.M.), Iran University of Medical Sciences, Tehran, Iran
| | - M Shakiba
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - F Mohebi
- Hass School of Business (F.M.), University of California, Berkeley, Berkeley, California
| | - H Komaki
- Khoury College of Computer Sciences (H.K.), Northeastern University, Boston, Massachusetts
| | - H Sharifian
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - H Hashemi
- From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.)
| | - M H Harirchian
- Neurology (M.H.H., A.A.), Tehran University of Medical Sciences, Tehran, Iran
| | - A Azimi
- Neurology (M.H.H., A.A.), Tehran University of Medical Sciences, Tehran, Iran
| | - M E Adin
- Department of Radiology and Biomedical Imaging (M.E.A.), Yale School of Medicine, New Haven, Connecticut
| | - D M Yousem
- Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland
- Department of Radiology (D.M.Y.), Johns Hopkins University School of Medicine, Baltimore, Maryland
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11
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Girard N, Vidal V, Dangouloff Ros V, Blauwblomme T, Naggara O. Noninvasive Follow-up Imaging of Ruptured Pediatric Brain AVMs Using Arterial Spin-Labeling. AJNR Am J Neuroradiol 2022; 43:1363-1368. [PMID: 36007951 PMCID: PMC9451641 DOI: 10.3174/ajnr.a7612] [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: 02/02/2022] [Accepted: 06/28/2022] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Brain AVMs represent the main etiology of pediatric intracranial hemorrhage. Noninvasive imaging techniques to monitor the treatment effect of brain AVMs remain an unmet need. In a large cohort of pediatric ruptured brain AVMs, we aimed to investigate the role of arterial spin-labeling for the longitudinal follow-up during treatment and after complete obliteration by analyzing CBF variations across treatment sessions. MATERIALS AND METHODS Consecutive patients with ruptured brain AVMs referred to a pediatric quaternary care center were prospectively included in a registry that was retrospectively queried for children treated between 2011 and 2019 with unimodal or multimodal treatment (surgery, radiosurgery, embolization). We included children who underwent an arterial spin-labeling sequence before and after treatment and a follow-up DSA. CBF variations were analyzed in univariable analyses. RESULTS Fifty-nine children with 105 distinct treatment sessions were included. The median CBF variation after treatment was -43 mL/100 mg/min (interquartile range, -102-5.5), significantly lower after complete nidal surgical resection. Following radiosurgery, patients who were healed on the last DSA follow-up demonstrated a greater CBF decrease on intercurrent MR imaging, compared with patients with a persisting shunt at last follow-up (mean, -62 [SD, 61] mL/100 mg/min versus -17 [SD, 40.1] mL/100 mg/min; P = .02). In children with obliterated AVMs, recurrences occurred in 12% and resulted in a constant increase in CBF (mean, +89 [SD, 77] mL/100 mg/min). CONCLUSIONS Our results contribute data on the role of noninvasive arterial spin-labeling monitoring of the response to treatment or follow-up after obliteration of pediatric AVMs. Future research may help to better delineate how arterial spin-labeling can assist in decisions regarding the optimal timing for DSA.
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Affiliation(s)
- J F Hak
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - G Boulouis
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - B Kerleroux
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
| | - S Benichi
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - S Stricker
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
| | - F Gariel
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (F.G.), University Hospital of Bordeaux, Bordeaux, France
| | - L Garzelli
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
| | - P Meyer
- Pediatric Neurointensive Care Unit (P.M.)
| | - M Kossorotoff
- Department of Pediatric Neurology (M.K.), Assistance Publique-Hôpitaux de Paris, Hôpital Universitaire, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - N Boddaert
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - N Girard
- Departments of Neuroradiology (N.G.)
| | - V Vidal
- Radiology (V.V.), University Hospital La Timone Hospital, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - V Dangouloff Ros
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Université de Paris (N.B., V.D.R.), L'Institut National de la Santé et de la Recherche Médicale, ERL, Paris, France
- Institut Imagine (N.B., V.D.R.),Université de Paris,Unité Mixte de Recherche 1163, Paris, France
| | - T Blauwblomme
- Department of Pediatric Neurosurgery (S.B., S.S., T.B.), Institut Imagine, L'Institut National de la Santé et de la Recherche Médicale, Unité Mixte de Recherche 1163, Assistance Publique-Hôpitaux de Paris, Necker Hospital-Sick Children, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
| | - O Naggara
- From the Department of Pediatric Radiology (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., O.N.)
- Department of Neuroradiology (J.F.H., G.B., B.K., O.N.), GHU Paris, Paris, France
- L'Institut National de la Santé et de la Recherche Médicale, University Hospital Group Paris, 1266, IMA-BRAIN (J.F.H., G.B., B.K., O.N.), Université de Paris, Paris, France
- INSERM U894, French Center for Pediatric Stroke (M.K., T.B., O.N.), L'Institut National de la Santé et de la Recherche Médicale, Paris, France
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12
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Safety considerations related to intravenous contrast agents in pediatric imaging. Pediatr Radiol 2022:10.1007/s00247-022-05470-z. [PMID: 35941280 DOI: 10.1007/s00247-022-05470-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 05/25/2022] [Accepted: 07/22/2022] [Indexed: 10/15/2022]
Abstract
Intravenous contrast media are used in MRI, CT and US studies for anatomical evaluation and lesion characterization. Safety is always of paramount importance when administering any contrast media to children, and it is important for radiologists and ordering providers to be knowledgeable of the safety profiles and potential adverse events that can occur. This manuscript reviews the frequency and types of adverse events associated with intravenous contrast agents reported in the pediatric literature. Overall, intravenous contrast agents are very safe to use in children. However, familiarity with how to treat and prevent these uncommon events is crucial in preventing poor outcomes. In addition, an understanding of gadolinium deposition in tissues can help facilitate conversations with concerned physicians and parents. This review provides a concise yet comprehensive reference for radiologists and ordering providers on intravenous contrast safety considerations in the pediatric patient.
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13
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Dempsey PJ, Delaney FT, Geoghegan T, Lawler L, Bolster F. MR imaging of acute abdominal pain in pregnancy. Br J Radiol 2022; 95:20211114. [PMID: 35604640 PMCID: PMC10162063 DOI: 10.1259/bjr.20211114] [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: 10/04/2021] [Revised: 01/06/2022] [Accepted: 02/02/2022] [Indexed: 11/05/2022] Open
Abstract
Abdominal pain in pregnancy is a diagnostic challenge with many potential aetiologies. Diagnostic imaging is a valuable tool in the assessment of these patients, with ultrasound commonly employed first line. MRI is an excellent problem-solving adjunct to ultrasound and has many advantages in terms of improved spatial resolution and soft tissue characterisation. This pictorial review aims to outline the role of MRI in the work up of acute abdominal pain in pregnancy and provide imaging examples of pathologies which may be encountered.
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Affiliation(s)
| | | | - Tony Geoghegan
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Leo Lawler
- Mater Misericordiae University Hospital, Dublin, Ireland
| | - Ferdia Bolster
- Mater Misericordiae University Hospital, Dublin, Ireland
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14
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Ozturk K, Nascene D. Diffusion Tensor Imaging of the Dentate Nucleus After Repeated Administration of Gadobutrol in Children. CEREBELLUM (LONDON, ENGLAND) 2022; 21:657-664. [PMID: 34453283 DOI: 10.1007/s12311-021-01324-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/22/2021] [Indexed: 06/13/2023]
Abstract
This study aimed to investigate possible signal changes in the dentate nucleus (DN) on diffusion tensor imaging (DTI) after administration of gadobutrol in a pediatric cohort. Total of 50 pediatric patients (mean age: 6.2 ± 4.3 years) with normal renal function exposed exclusively to the macrocyclic GBCA (mcGBCA) gadobutrol and 50 age- and sex-matched control patients with nonpathological neuroimaging findings (and no GBCA administration). Mean diffusivity (MD) and fractional anisotropy (FA) values were determined in the DN. A paired t test was performed to compare FA, MD values, and DN-to-middle cerebral peduncle (MCP) T1WI SI ratios between children exposed to gadobutrol and controls. Pearson correlation analysis was conducted to determine any correlation between FA and MD values as well as T1WI SI ratios and confounding parameters. The mean FA values of DN was significantly lower in children with mcGBCA than in the control group (p < 0.001; non-GBCA group, 0.299 ± 0.03; mcGBCA group, 0.254 ± 0.05), but no significant difference of the T1WI SI ratio was noted between the mcGBCA group (0.946 ± 0.06) and the control group (0.963 ± 0.05; p = 0.336). There was also a significant MD value difference between mcGBCA group and control group (p < 0.001; non-GBCA group, 0.152 ± 0.02 × 10-3 mm2/s; mcGBCA group, 0.173 ± 0.03 × 10-3 mm2/s). A significant correlation was identified between FA/MD values and the number of mcGBCA administration (FA; correlation coefficient = - 0.355, p = 0.011 and MD; correlation coefficient = 0.334, p = 0.018). The administration of the gadobutrol was associated with higher MD and lower FA values in DN suggesting a difference in cerebellar tissue integrity between children exposed to mcGBCAs and control group.
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Affiliation(s)
- Kerem Ozturk
- Division of Neuroradiology, Department of Radiology, University of Minnesota, B-226 Mayo Memorial Building, MMC 292, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA.
| | - David Nascene
- Division of Neuroradiology, Department of Radiology, University of Minnesota, B-226 Mayo Memorial Building, MMC 292, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA
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15
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Ozturk K, Nascene D. Dentate nucleus signal intensity changes on T1-weighted MRI after repeated administrations of linear and macrocyclic gadolinium-based contrast agents: a pediatric intraindividual case-control study. Acta Radiol 2022; 63:914-922. [PMID: 34018821 DOI: 10.1177/02841851211018809] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND An association between consecutive administrations of macrocyclic gadolinium-based contrast agent (mcGBCA) gadobutrol and linear (L)-GBCA gadopentetate dimeglumine and gadolinium retention in the pediatric brain remains incompletely understood. PURPOSE To compare signal intensity (SI) changes in the dentate nucleus (DN) on unenhanced T1-weighted imaging (T1WI) in children who obtained mcGBCA gadobutrol with those who had previously received L-GBCA gadopentetate dimeglumine. MATERIAL AND METHODS This retrospective study included 27 children who received L-GBCA gadopentetate dimeglumine followed by mcGBCA gadobutrol and two different control groups matched for age and sex for both periods, each involving 27 individuals with no GBCA administration from January 2010 to January 2020. DN-to-middle cerebellar peduncle (MCP) SI ratios on T1WI were determined. A repeated-measures ANOVA was performed to compare the T1WI SI ratio between children exposed to GBCA in each of the two periods and controls. Pearson correlation analysis was conducted to determine any correlation between SI ratios and confounding parameters. RESULTS T1WI SI ratio was significantly higher in those who had only L-GBCA (1.005±0.087) or subsequent mcGBCA gadobutrol (1.002±0.104) than in control groups 1 (0.927±0.041; P<0.001) and 2 (0.930±0.041; P=0.002), respectively, but no significant difference of the T1WI SI ratio was noted between L-GBCA period and subsequent mcGBCA gadobutrol period (P=0.917). T1WI SI ratios and the L-GBCA administration number revealed a modest but significant correlation (correlation coefficient=0.034; P=0.016). CONCLUSION Previous administration of gadopentetate dimeglumine is associated with increased T1WI SI in the DN, while subsequent administration of gadobutrol does not demonstrate any additional SI increase in the pediatric brain.
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Affiliation(s)
- Kerem Ozturk
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
| | - David Nascene
- Department of Radiology, University of Minnesota, Minneapolis, MN, USA
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16
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Cui Z, Ren G, Cai R, Wu C, Shi H, Wang X, Zhu M. MRI-based texture analysis for differentiate between pediatric posterior fossa ependymoma type A and B. Eur J Radiol 2022; 152:110288. [DOI: 10.1016/j.ejrad.2022.110288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/01/2022] [Accepted: 03/28/2022] [Indexed: 11/03/2022]
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17
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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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Dong J, Li S, Li L, Liang S, Zhang B, Meng Y, Zhang X, Zhang Y, Zhao S. Differentiation of paediatric posterior fossa tumours by the multiregional and multiparametric MRI radiomics approach: a study on the selection of optimal multiple sequences and multiregions. Br J Radiol 2022; 95:20201302. [PMID: 34767476 PMCID: PMC8722235 DOI: 10.1259/bjr.20201302] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVE To evaluate the diagnostic performance of a radiomics model based on multiregional and multiparametric MRI to classify paediatric posterior fossa tumours (PPFTs), explore the contribution of different MR sequences and tumour subregions in tumour classification, and examine whether contrast-enhanced T1 weighted (T1C) images have irreplaceable added value. METHODS This retrospective study of 136 PPFTs extracted 11,958 multiregional (enhanced, non-enhanced, and total tumour) features from multiparametric MRI (T1- and T2 weighted, T1C, fluid-attenuated inversion recovery, and diffusion-weighted images). These features were subjected to fast correlation-based feature selection and classified by a support vector machine based on different tasks. Diagnostic performances of multiregional and multiparametric MRI features, different sequences, and different tumoral regions were evaluated using multiclass and one-vs-rest strategies. RESULTS The established model achieved an overall area under the curve (AUC) of 0.977 in the validation cohort. The performance of PPFTs significantly improved after replacing T1C with apparent diffusion coefficient maps added into the plain scan sequences (AUC from 0.812 to 0.917). When oedema features were added to contrast-enhancing tumour volume, the performance did not significantly improve. CONCLUSION The radiomics model built by multiregional and multiparametric MRI features allows for the excellent distinction of different PPFTs and provides valuable references for the rational adoption of MR sequences. ADVANCES IN KNOWLEDGE This study emphasized that T1C has limited added value in predicting PPFTs and should be cautiously adopted. Selecting optimal MR sequences may help guide clinicians to better allocate acquisition sequences and reduce medical costs.
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Affiliation(s)
- Jie Dong
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | - Suxiao Li
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | - Lei Li
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | | | - Bin Zhang
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | - Yun Meng
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Xiaofang Zhang
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
| | - Yong Zhang
- Department of Magnetic Resonance, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, P.R. China
| | - Shujun Zhao
- School of Physics and Microelectronics, Zhengzhou University, Zhengzhou, P.R. China
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19
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Al-Muhanna A. Gadolinium retention after contrast-enhanced magnetic resonance imaging: A narratative review. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:12-18. [PMID: 35283709 PMCID: PMC8869263 DOI: 10.4103/sjmms.sjmms_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/01/2021] [Accepted: 12/28/2021] [Indexed: 11/04/2022] Open
Abstract
Over the past five years, several studies have reported deposition and retention of gadolinium in the brain after administration of gadolinium-based contrast agents (GBCAs) during radiological procedures. Patients with renal insufficiency cannot filter gadolinium efficiently; however, gadolinium is also retained in the brain of some adults and pediatrics with no renal impairment. In the literature, data is mostly available from retrospective magnetic resonance imaging (MRI) studies, where gadolinium deposition may be indirectly measured by evaluating changes in T1 signal intensity in the brain tissues, particularly in the deep gray matter such as the dentate nucleus and/or globus pallidus. Many pathological studies have reported a direct correlation between T1 signal changes and gadolinium deposition in human and animal autopsy specimens, which raised concerns on the use of GBCAs, particularly with linear chelators. The association between gadolinium accumulation and occurrence of physical and neurological side effects or neurotoxic damage has not yet been conclusively demonstrated. Studies have also observed that gadolinium is deposited in the extracranial tissues, such as the liver, skin, and bone, of patients with normal kidney function. This narrative review describes the effects of different types of GBCAs in relation to gadolinium deposition, evaluates current evidence on gadolinium deposition in various tissues of the human body, and summarizes the current recommendations regarding the use of GBCAs.
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Do QN, Lenkinski RE, Tircso G, Kovacs Z. How the Chemical Properties of GBCAs Influence Their Safety Profiles In Vivo. MOLECULES (BASEL, SWITZERLAND) 2021; 27:molecules27010058. [PMID: 35011290 PMCID: PMC8746842 DOI: 10.3390/molecules27010058] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 01/21/2023]
Abstract
The extracellular class of gadolinium-based contrast agents (GBCAs) is an essential tool for clinical diagnosis and disease management. In order to better understand the issues associated with GBCA administration and gadolinium retention and deposition in the human brain, the chemical properties of GBCAs such as relative thermodynamic and kinetic stabilities and their likelihood of forming gadolinium deposits in vivo will be reviewed. The chemical form of gadolinium causing the hyperintensity is an open question. On the basis of estimates of total gadolinium concentration present, it is highly unlikely that the intact chelate is causing the T1 hyperintensities observed in the human brain. Although it is possible that there is a water-soluble form of gadolinium that has high relaxitvity present, our experience indicates that the insoluble gadolinium-based agents/salts could have high relaxivities on the surface of the solid due to higher water access. This review assesses the safety of GBCAs from a chemical point of view based on their thermodynamic and kinetic properties, discusses how these properties influence in vivo behavior, and highlights some clinical implications regarding the development of future imaging agents.
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Affiliation(s)
- Quyen N. Do
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; (Q.N.D.); (R.E.L.)
| | - Robert E. Lenkinski
- Department of Radiology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA; (Q.N.D.); (R.E.L.)
| | - Gyula Tircso
- Department of Physical Chemistry Debrecen, University of Debrecen, Egyetem tér 1, H-4032 Debrecen, Hungary;
| | - Zoltan Kovacs
- Advanced Imaging Research Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA
- Correspondence: ; Tel.: +1-214-645-5002
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21
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Åkesson M, Lehti L, Leander P, Sterner G, Wassélius J. Long-term safety of Gadofosveset in clinical practice. Magn Reson Imaging 2021; 86:70-73. [PMID: 34848324 DOI: 10.1016/j.mri.2021.11.011] [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: 08/16/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to systematically search for long-term complications, including Nephrogenic Systemic Fibrosis (NSF), in patients who were previously administered the gadolinium-based contrast agent Gadofosveset at our institute. MATERIALS AND METHODS All patients who were administered Gadofosveset at our institute between 2006 and 2009 were identified in our Radiological Information System (RIS). Clinical data such as cause of death during follow-up, and dermatological or nephrological diseases were systematically searched for in electronic patient records (EPR). RESULTS During 2006-2009, Gadofosveset was administered a total of 67 times to 62 patients. One patient was unavailable for follow-up. The remaining 61 patients were followed up for up to 14 (median 12) years based on RIS and EPR data. There were 13 deaths among the 61 patients, all assessed as unrelated to Gadofosveset administration. No dermatological or renal disease suggestive of NSF, or potentially related to Gadofosveset administration, was found. At the time of examination, six patients were diagnosed with various stages of renal insufficiency, three of whom were on hemodialysis. Another three patients were diagnosed with renal insufficiency during the follow-up period, but none of these diagnoses were suspected to be related to the administration of Gadofosveset. CONCLUSIONS Based on the results of this retrospective safety analysis of up to 14 years following 1-2 exposures, we conclude that Gadofosveset in clinical practice is safe in the long-term.
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Affiliation(s)
- Michael Åkesson
- Department of Clinical Sciences Lund, Lund University, Sweden
| | - Leena Lehti
- Department of Clinical Sciences Lund, Lund University, Sweden; Vascular Center, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Peter Leander
- Department of Clinical Sciences Lund, Lund University, Sweden; Department of Radiology, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Gunnar Sterner
- Department of Clinical Sciences Lund, Lund University, Sweden; Department of Nephrology and Transplantation, Skåne University Hospital Lund/Malmö, Lund, Sweden
| | - Johan Wassélius
- Department of Clinical Sciences Lund, Lund University, Sweden; Vascular Center, Skåne University Hospital Lund/Malmö, Lund, Sweden.
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22
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Towbin AJ, Zhang B, Dillman JR. Evaluation of the effect of multiple administrations of gadopentetate dimeglumine or gadoterate meglumine on brain T1-weighted hyperintensity in pediatric patients. Pediatr Radiol 2021; 51:2568-2580. [PMID: 34286351 DOI: 10.1007/s00247-021-05134-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2020] [Revised: 04/22/2021] [Accepted: 06/10/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Repeated administrations of linear gadolinium-based contrast media (GBCM) are associated with T1-weighted (T1-W) signal intensity change in brain structures. OBJECTIVE The purpose of this study was to compare different brain structures in children after unconfounded, repeated administrations of either a macrocyclic or linear GBCM. MATERIALS AND METHODS We performed a retrospective cohort study, identifying subjects with ≥5 unconfounded administrations of gadoterate meglumine. We matched subjects with repeated administrations of gadopentetate dimeglumine to the gadoterate meglumine arm based on the number of unconfounded GBCM administrations. Two reviewers drew regions of interest on 27 structures in and around the brain. We recorded demographic, modality and study parameters and evaluated them to determine whether they were associated with T1-W signal intensity (SI) changes. Linear mixed effects models evaluated the relationships between the number of GBCM doses and T1-W SI ratio. Finally, we identified differences in the rate of T1-W SI ratio change among individuals using a linear mixed effects model with random slope. RESULTS We included a total of 52 patients (age range at first MRI: 6.0 months to 17.1 years), 26 in each arm. We detected a significant change in the T1-W SI ratio with repeated administrations of GBCM in one location in the gadoterate meglumine arm and in four locations in the gadopentetate dimeglumine arm. Patient gender and age were not associated with T1-W SI change. Modality vendor, imaging sequence and field strength were variably associated with a systematic difference in the ability to detect a T1-W SI change. Finally, linear mixed effects model with random slope showed that there were individual differences in the slope of SI change at various structures among individuals for both arms. This effect was present in more brain structures in the gadopentetate dimeglumine arm (14 vs. 8). CONCLUSION There is a significant change in the T1-W SI ratio over time in multiple brain structures after repeated gadopentetate dimeglumine administrations. This effect was only seen in one ratio after repeated administrations of gadoterate meglumine. There are individual differences in the rate of change of SI ratios over time after repeated administration of gadopentetate dimeglumine and gadoterate meglumine, suggesting that individual differences are present.
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Affiliation(s)
- Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
| | - Bin Zhang
- Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA
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23
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Zhang H, Zhou J, Peng Y. Amide Proton Transfer-Weighted MR Imaging of Pediatric Central Nervous System Diseases. Magn Reson Imaging Clin N Am 2021; 29:631-641. [PMID: 34717850 DOI: 10.1016/j.mric.2021.06.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Amide proton transfer-weighted (APTw) imaging is a molecular MR imaging technique that can detect the concentration of the amide protons in mobile cellular proteins and peptides or a pH change in vivo. Previous studies have indicated that APTw MR imaging can be used to detect malignant brain tumors, stroke, and other neurologic diseases, although the clinical application in pediatric patients remains limited. The authors briefly introduce the basic principles of APTw imaging. Then, they review early clinical applications of this approach to pediatric central nervous system diseases, including pediatric brain development, hypoxic-ischemic encephalopathy, intracranial infection, and brain tumors.
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Affiliation(s)
- Hong Zhang
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China
| | - Jinyuan Zhou
- Division of MR Research, Department of Radiology, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Park 336, Baltimore, MD 21287, USA
| | - Yun Peng
- Department of Radiology, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, 56 Nan Li Shi Road, Xi Cheng District, Beijing, 100045, China.
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24
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Behr GG, Zheng J, Capanu M, Price AP. Is IV contrast necessary for MRI follow-up in children with abdominal neuroblastoma? Clin Imaging 2021; 79:259-264. [PMID: 34157502 PMCID: PMC10017112 DOI: 10.1016/j.clinimag.2021.06.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2020] [Revised: 05/21/2021] [Accepted: 06/11/2021] [Indexed: 01/25/2023]
Abstract
PURPOSE The safety of multiple doses of gadolinium-based MRI IV contrast has recently been called in to question. While the long-term safety is being investigated, here, we seek to determine if there is added value to the use of IV contrast for improving detection of tumoral recurrences in children with a history of abdominal neuroblastoma. METHODS This is a retrospective review of children who underwent abdominal MRI with gadolinium contrast. One radiologist reviewer determined presence or absence of tumor, both before and after administration of IV contrast material and documented level of confidence when a finding was encountered. Change in reader confidence after the use of contrast was measured and fraction of missed lesions on pre-contrast was calculated. Liver and spleen lesions were documented separately. RESULTS 453 MRI scans in 110 unique patients were reviewed. 65 patients were documented to have a total of 125 lesions, excluding liver, spleen and bones. There were 23 instances of contrast altering the radiologist's confidence and one lesion was missed without the use of contrast. Among liver and spleen, several hepatic lesions were seen only after contrast, but all were benign lesions. CONCLUSION In selected patients who are undergoing MRI for neuroblastoma, it may be reasonable to forgo the use of IV contrast.
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Affiliation(s)
- Gerald G Behr
- Dept. Radiology, Memorial Sloan Kettering Cancer Center, United States of America.
| | - Junting Zheng
- Dept. of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, United States of America
| | - Marinela Capanu
- Dept. of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, United States of America
| | - Anita P Price
- Dept. Radiology, Memorial Sloan Kettering Cancer Center, United States of America
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25
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Hak JF, Boulouis G, Kerleroux B, Benichi S, Stricker S, Gariel F, Garzelli L, Meyer P, Kossorotoff M, Boddaert N, Vidal V, Girard N, Dangouloff Ros V, Brunelle F, Blauwblomme T, Naggara O. Arterial Spin Labeling for the Etiological Workup of Intracerebral Hemorrhage in Children. Stroke 2021; 53:185-193. [PMID: 34517772 DOI: 10.1161/strokeaha.120.032690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND AND PURPOSE Pediatric nontraumatic intracerebral hemorrhage accounts for half of stroke in children. Early diagnostic of the causative underlying lesion is the first step toward prevention of hemorrhagic recurrence. We aimed to investigate the performance of arterial spin labeling sequence (ASL) in the acute phase etiological workup for the detection of an arteriovenous shunt (AVS: including malformation and fistula), the most frequent cause of pediatric nontraumatic intracerebral hemorrhage. METHODS Children with a pediatric nontraumatic intracerebral hemorrhage between 2011 and 2019 enrolled in a prospective registry were retrospectively included if they had undergone ASL-magnetic resonance imaging before any etiological treatment. ASL sequences were reviewed using cerebral blood flow maps by 2 raters for the presence of an AVS. The diagnostic performance of ASL was compared with admission computed tomography angiography, other magnetic resonance imaging sequences including contrast-enhanced sequences and subsequent digital subtraction angiography. RESULTS A total of 121 patients with pediatric nontraumatic intracerebral hemorrhage were included (median age, 9.9 [interquartile range, 5.8-13]; male sex 48.8%) of whom 76 (63%) had a final diagnosis of AVS. Using digital subtraction angiography as an intermediate reference, visual ASL inspection had a sensitivity and a specificity of, respectively, 95.9% (95% CI, 88.5%-99.1%) and 79.0% (95% CI, 54.4%-94.0%). ASL had a sensitivity, specificity, and accuracy of 90.2%, 97.2%, and 92.5%, respectively for the detection of the presence of an AVS, with near perfect interrater agreement (κ=0.963 [95% CI, 0.912-1.0]). The performance of ASL alone was higher than that of other magnetic resonance imaging sequences, individually or combined, and higher than that of computed tomography angiography. CONCLUSIONS ASL has strong diagnostic performance for the detection of AVS in the initial workup of intracerebral hemorrhage in children. If our findings are confirmed in other settings, ASL may be a helpful diagnostic imaging modality for patients with pediatric nontraumatic intracerebral hemorrhage. REGISTRATION URL: https://www.clinicaltrials.gov; Unique identifiers: 3618210420, 2217698.
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Affiliation(s)
- Jean François Hak
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Grégoire Boulouis
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Basile Kerleroux
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
| | - Sandro Benichi
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France
| | - Sarah Stricker
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France
| | - Florent Gariel
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Department of Neuroradiology, University Hospital of Bordeaux, France (F.G.)
| | - Lorenzo Garzelli
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Philippe Meyer
- Pediatric Neuro ICU (P.M.), University hospital Necker-Enfants-malades, Paris, France
| | - Manoelle Kossorotoff
- French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Department of Pediatric Neurology (M.K.), AP-HP, University hospital Necker-Enfants-malades, Paris, France
| | - Nathalie Boddaert
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Vincent Vidal
- Department of Radiology (V.V.), University Hospital La Timone Hospital, AP-HM, Marseille, France
| | - Nadine Girard
- the Department of Neuroradiology (N.G.), University Hospital La Timone Hospital, AP-HM, Marseille, France
| | - Volodia Dangouloff Ros
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Francis Brunelle
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Thomas Blauwblomme
- The Department of Pediatric Neurosurgery, Institut Imagine, INSERM UMR 1163 (S.B., S.S., T.B.), University hospital Necker-Enfants-malades, Paris, France.,French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France
| | - Olivier Naggara
- Department of Pediatric Radiology UMR 1163, Institut Imagine, INSERM U1000, (J.F.H., G.B., B.K., F.G., L.G., N.B., V.D.R., F.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,French Center for Pediatric Stroke, INSERM U894 (M.K., T.B., O.N.), University hospital Necker-Enfants-malades, Paris, France.,Université de Paris, INSERM UMR 1266 IMA-BRAIN, Department of Interventional Neuroradiology, GHU Paris, France (J.F.H., G.B., B.K., O.N.)
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Kong Y, Zhang S, Wang J, Han C, Yu N, Liu Q, Wang W, Xu K. Potential toxicity evaluation and comparison within multiple mice organs after repeat injections of linear versus macrocyclic gadolinium-based contrast agents: A comprehensive and time course study. Toxicol Lett 2021; 350:152-161. [PMID: 34311048 DOI: 10.1016/j.toxlet.2021.07.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/18/2021] [Accepted: 07/21/2021] [Indexed: 11/29/2022]
Abstract
As nephrogenic systemic fibrosis (NSF) and increased signal intensities in deep cerebellar nuclei (DCN) were successively discovered in renal insufficiency patients and healthy persons after gadolinium-based contrast agents (GBCAs) exposure, an awareness of potential toxicity with GBCAs exposure has been heightening. Herein, we performed a multi-organ/tissue toxicity assessment after different GBCAs administration with a large number of samples, and long-term, time-course schedule investigation. ICR mice were randomized to five exposure groups (n = 42/group) and received intravenous injection of GBCAs (2.5 mmol Gd/kg) or saline four time a week for 5 consecutive weeks. Gadolinium concentration detection, sensory tests, histological and hematological analyses were performed at corresponding timepoints (4th or 6th or 10th week). Our results showed that (i) gadodiamide could cause reversible vacuolar changes in the renal tubular epithelial cells, which appeared at 6th week and recovered at 10th week, and severe skin lesion in mice tail with consecutive injection for 10 weeks, that (ii) linear GBCAs (gadodiamide and gadopentetate dimeglumine) markedly elevated heat hyperalgesia and white blood cells of mice at 6th week and most of these changes could recovery at 10th week, and that (iii) linear GBCAs exhibited more gadolinium retention in multi-organ/tissue versus macrocyclic GBCAs and in most case, linear GBCAs showed faster accumulation and regression speed in examined tissues than macrocyclic GBCAs excepting gadodiamide in skin which showed slowest regression speed. Collectively, macrocyclic GBCAs presents more stable, lower propensity to release Gd and safer profiles versus linear GBCAs.
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Affiliation(s)
- Ying Kong
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Shuai Zhang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China; School of Medical Imaging, Xuzhou Medical University, Jiangsu, Xuzhou, 221004, PR China
| | - Jiali Wang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Cuiping Han
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China; School of Medical Imaging, Xuzhou Medical University, Jiangsu, Xuzhou, 221004, PR China
| | - Nana Yu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Qi Liu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Wentao Wang
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China
| | - Kai Xu
- Department of Radiology, Affiliated Hospital of Xuzhou Medical University, Jiangsu, Xuzhou, 221006, PR China.
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A retrospective cohort evaluation of the effect of multiple administrations of gadopentetate dimeglumine on brain magnetic resonance imaging T1-weighted signal. Pediatr Radiol 2021; 51:457-470. [PMID: 33399985 DOI: 10.1007/s00247-020-04860-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Gadolinium deposition occurs following repeated administration of gadolinium-based contrast media. However, few studies have evaluated factors that lead to increased detection of deposition or the individual differences among patients. OBJECTIVE To measure the effect of repeated dosages of gadopentetate dimeglumine on pediatric brains and to determine the factors that influence signal intensity changes. MATERIALS AND METHODS A retrospective study evaluated magnetic resonance imaging (MRI) in patients <18 years of age who received >5 doses of gadopentetate dimeglumine. Regions of interest were placed in 30 locations in the brain on axial precontrast T1 images. Signal intensity ratios were evaluated throughout the brain. The effect of increasing gadopentetate dimeglumine exposure on signal intensity ratios was assessed using linear mixed models adjusted for gender, age, imaging sequence type (fast spin echo or gradient echo), MRI manufacturer (General Electric, Philips or Siemens), and field strength (1.5 tesla [T] or 3 T). Finally, the variance of the random slope in the linear mixed models was tested to determine if there were differences in the rate of signal intensity ratio change among individuals. RESULTS Fifty patients (M:F=25:25; mean age at first imaging: 6.4 years) with a mean of 21.5 gadopentetate dimeglumine administrations (range: 6-86) were included. There were significant increases in T1 signal in the globus pallidus, dentate nucleus and pulvinar with an increasing number of contrast administrations. Patient gender, age, and MRI field strength were not associated with changing signal intensity ratios. However, MRI sequence type and vendor significantly impacted some measured signal intensity ratios. Finally, significant differences in the slopes of the ratios were present among patients for multiple locations. CONCLUSION Repeated administration of gadopentetate dimeglumine is associated with T1 hyperintense signal in the dentate nucleus, globus pallidus and pulvinar. Detection is significantly affected by MRI sequence type and scanner vendor. Even when accounting for these differences, there are individual differences in the slope of signal intensity change suggesting a patient-level effect influences gadolinium deposition.
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28
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Lattanzio SM. Toxicity associated with gadolinium-based contrast-enhanced examinations. AIMS BIOPHYSICS 2021. [DOI: 10.3934/biophy.2021015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
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29
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Zaki N, Parra D, Wells Q, Chew JD, George-Durrett K, Pruthi S, Soslow J. Assessment of gadolinium deposition in the brain tissue of pediatric and adult congenital heart disease patients after contrast enhanced cardiovascular magnetic resonance. J Cardiovasc Magn Reson 2020; 22:82. [PMID: 33267835 PMCID: PMC7713146 DOI: 10.1186/s12968-020-00676-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 09/22/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Contrast enhanced magnetic resonance imaging (MRI) is an important tool for the assessment of extracardiac vasculature and myocardial viability. Gadolinium (Gd) brain deposition after contrast enhanced MRI has recently been described and resulted in a warning issued by the United States Food and Drug Administration. However, the prevalence of brain deposition in children and adults with congenital heart disease (CHD) undergoing cardiovascular magnetic resonance (CMR) is unclear. We hypothesized that Gd exposure as part of one or more CMRs would lead to a low rate of brain deposition in pediatric and adult CHD patients. METHODS We queried our institutional electronic health record for all pediatric and adult CHD patients who underwent contrast enhanced CMR from 2005 to 2018 and had a subsequent brain MRI. Cases were age- and gender-matched to controls who were never exposed to Gd and underwent brain MRIs. The total number of contrast enhanced MRIs, type of Gd, and total Gd dose were determined. Brain MRIs were reviewed by a neuroradiologist for evidence of Gd deposition using qualitative and quantitative assessment. Quantitative assessment was performed using the dentate nucleus to pons signal intensity ratio (dp-SIR) on T1 weighted imaging. Continuous variables were analyzed using Mann-Whitney U and Spearman rank correlation tests. Normal SIR was defined as the 95% CI of the control population dp-SIR. RESULTS Sixty-two cases and 62 controls were identified. The most contrast enhanced MRIs in a single patient was five and the largest lifetime dose of Gd that any patient received was 0.75 mmol/kg. There was no significant difference in the mean dp-SIR of cases and controls (p = 0.11). The dp-SIR was not correlated with either the lifetime dose of Gd (rs = 0.21, p = 0.11) or the lifetime number of contrast enhanced studies (rs = 0.21, p = 0.11). Two cases and 2 controls had dp-SIRs above the upper bound of the 95% confidence interval for the control group. One case had qualitative imaging-based evidence of Gd deposition in the brain but had a dp-SIR within the normal range. CONCLUSION In our cohort of pediatric and adult CHD patients undergoing contrast enhanced CMR, there was a low incidence of qualitative and no significant quantitative imaging-based evidence of Gd brain deposition.
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Affiliation(s)
- Neil Zaki
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA.
| | - David Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Quinn Wells
- Departments of Medicine and Pharmacology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Joshua D Chew
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Kristen George-Durrett
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Sumit Pruthi
- Department of Radiology and Radiological Sciences, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Jonathan Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
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Effect of at Least 10 Serial Gadobutrol Administrations on Brain Signal Intensity Ratios on T1-Weighted MRI in Children: A Matched Case-Control Study. AJR Am J Roentgenol 2020; 217:753-760. [PMID: 33112200 DOI: 10.2214/ajr.20.24536] [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: 12/29/2022]
Abstract
BACKGROUND. An association is recognized between linear gadolinium-based contrast agents (GBCAs) and intracranial gadolinium retention in children. The relation between macrocyclic GBCAs and gadolinium retention remains incompletely understood. OBJECTIVE. The purpose of this study was to assess whether 10 or more administrations of the macrocyclic GBCA gadobutrol are associated with increased signal intensity (SI) in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MRI of children and to explore clinical variables potentially associated with T1 hyperintensity. METHODS. The case group consisted of 25 children (13 boys, 12 girls; mean age, 7 ± 4 years; range, 2-18 years) who underwent at least 10 (mean, 15 ± 6; range, 10-34) contrast-enhanced MRI examinations exclusively with gadobutrol. The control group consisted of 25 age- and sex-matched patients undergoing MRI who had never been exposed to gadolinium. Two observers in consensus using a 3-point scale assessed visual T1 hyperintensity in the DN and GP. One observer placed ROIs on T1-weighted images to mark the DN, GP, middle cerebellar peduncle (MCP), and pulvinar of the thalamus bilaterally to compute mean DN-to-MCP and GP-to-thalamus SI ratios. SI ratios were compared between the macrocyclic GBCA and control groups. In the macrocyclic GBCA group, Pearson correlation analysis was conducted between SI ratios and clinical variables. ROI measurements were repeated by the original reader and an independent reader, and interobserver and intraobserver agreement were computed by means of Lin concordance correlation coefficient (ρc). RESULTS. No patient had visual T1 hyperintensity in the DN or GP. No significant difference between the macrocyclic GBCA and control groups was observed for DN-to-MCP SI ratio (0.95 ± 0.05 vs 0.95 ± 0.03; p = .67) or GP-to-thalamus SI ratio (1.05 ± 0.06 vs 1.04 ± 0.06; p = .65). In the macrocyclic GBCA group, no significant correlation was observed between DN-to-MCP SI ratio or GP-to-thalamus SI ratio and age (r = 0.355, p = .08; r = 0.167, p = .42), number of contrast-enhanced MRI examinations (r = 0.247, p = .23; r = 0.203, p = .33), mean time between examinations (r = 0.193, p = .36; r = 0.047, p = .82), or cumulative macrocyclic GBCA dose (r = 0.434, p = .07; r = 0.270, p = .19). Interobserver and intraobserver agreement was substantial for DN-to-MCP SI and GP-to-TH SI ratios (ρc = 0.931-0.974). CONCLUSION. Ten or more serial gadobutrol administrations were not associated with T1 hyperintensity in the DN or GP of children. CLINICAL IMPACT. Selection of gadobutrol as an MRI contrast agent may reduce risk of gadolinium retention in children. The findings may help guide practices for GBCA administration to children.
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Gaillard AL, Crombé A, Jecko V, Bessou P, Havez M, Pédespan JM, Van Gils J, Chateil JF. Magnetic resonance imaging diagnosis of subependymal giant cell astrocytomas in follow-up of children with tuberous sclerosis complex: should we always use contrast enhancement? Pediatr Radiol 2020; 50:1397-1408. [PMID: 32671416 DOI: 10.1007/s00247-020-04707-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 03/08/2020] [Accepted: 05/05/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND Subependymal giant cell astrocytomas (SEGAs) arise in 10-26% of tuberous sclerosis complex (TSC) patients. SEGAs cause obstructive hydrocephalus and increase morbi-mortality. It is recommended that TSC patients be followed with contrast enhanced magnetic resonance imaging (CE-MRI), but repetitive use of gadolinium-based contrast-agents (GBCAs) may cause organ deposits. OBJECTIVE To compare the diagnostic performances of non-CE- and CE-MRI to differentiate SEGAs from subependymal nodules in TSC patients during follow-up. MATERIALS AND METHODS Thirty-five TSC patients (median age: 2.4 years) were enrolled in this retrospective single-center study from September 2007 to January 2019. Inclusion criteria were a certain diagnosis of TSC and at least three follow-up brain MRIs with GBCA injection. Two consecutive MRI scans per patient were selected and anonymized. Three radiologists performed a blinded review of non-enhanced and enhanced MRI sequences during different sessions. The diagnostic performances were compared (sensitivity, specificity, positive/negative predictive values, accuracy, inter/intra-observer agreements). RESULTS The accuracies for detecting SEGAs were good and similar between the non-enhanced and enhanced MRI sequences. The sensitivity and specificity of non-CE-MRI to diagnose SEGA ranged from 75% to 100% and from 94% to 100%, respectively. The differences in numbers of false-positive and false-negative patients between non-CE- and CE-MRI never exceeded one case. Nodules size >10 mm, location near the Monro foramen, hydrocephalus and modifications between two consecutive MRI scans were significantly associated with the diagnosis of SEGA for the three readers (all P-values <0.05). Inter- and intra-observer agreements were also excellent for non-enhanced and enhanced MRI sequences (kappa=0.85-1 and 0.81-0.93, respectively). CONCLUSION The performances of non-enhanced and enhanced MRI sequences are comparable for detecting SEGAs, questioning the need for systematic GBCA injections for TSC patients.
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Affiliation(s)
| | - Amandine Crombé
- Department of Diagnostic and Interventional Oncologic Imaging, Institut Bergonié, Bordeaux, France.,University of Bordeaux, Bordeaux, France
| | - Vincent Jecko
- Department of Neurosurgery, CHU Bordeaux, Bordeaux, France
| | - Pierre Bessou
- Unit of Pediatric Imaging, Pellegrin Hospital, Bordeaux, France
| | - Marion Havez
- Unit of Pediatric Imaging, Pellegrin Hospital, Bordeaux, France
| | | | | | - Jean-François Chateil
- Unit of Pediatric Imaging, Pellegrin Hospital, Bordeaux, France. .,University of Bordeaux/CNRS, CRMSB, UMR 5536, F-33076, Bordeaux, France.
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Omori T, Nakamori S, Fujimoto N, Ishida M, Kitagawa K, Ichikawa Y, Kumagai N, Kurita T, Imanaka-Yoshida K, Hiroe M, Sakuma H, Ito M, Dohi K. Myocardial Native T 1 Predicts Load-Independent Left Ventricular Chamber Stiffness In Patients With HFpEF. JACC Cardiovasc Imaging 2020; 13:2117-2128. [PMID: 32771571 DOI: 10.1016/j.jcmg.2020.05.030] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 05/12/2020] [Accepted: 05/15/2020] [Indexed: 11/20/2022]
Abstract
OBJECTIVES This study sought to evaluate the potential of cardiac magnetic resonance T1 mapping to detect load-independent left ventricular (LV) chamber stiffness by histological confirmation. BACKGROUND Accurate noninvasive diagnosis of LV diastolic dysfunction in heart failure with preserved ejection fraction (HFpEF) remains challenging. METHODS Nineteen HFpEF patients (14 female, 65 ± 16 years of age) without primary cardiomyopathy were prospectively enrolled. Cine, late gadolinium enhancement cardiac magnetic resonance, and triple-slice T1 mapping using a modified Look-Locker inversion recovery sequence were performed at 3-T. Extracellular volume (ECV) was quantified from pre- and post-contrast T1 values of the blood and myocardium with hematocrit correction. LV stiffness constant (beta) was assessed by calculating the slope of the end-diastolic pressure-volume relationship curve during vena cava occlusion. Biopsy samples were used for quantification of collagen volume fraction (CVF) and myocardial cell size. RESULTS Six patients showed focal scar on late gadolinium enhancement. There was no significant difference in histological CVF between patients with and without focal myocardial scarring (p = 0.2). Septal ECV rather than native T1 was a better surrogate marker for detecting histological CVF (r = 0.54; p = 0.02, and r = 0.44; p = 0.06, respectively). Global native T1 and ECV, but not native T1 and ECV in the septal myocardium, correlated well with the beta of passive LV stiffness, and had similar ability for predicting LV stiffness to histological CVF (r = 0.54, 0.50, 0.53, all p < 0.05, respectively). When the beta ≥0.054 was considered as moderately increased LV stiffness, global native T1 ≥1,362 ms provided 88% sensitivity and 64% specificity with the C-statistic of 0.81 (95% confidence interval: 0.56 to 0.95). CONCLUSIONS Myocardial native T1 provides comparable ability in predicting LV stiffness to ECV and histological CVF and may be useful for monitoring patients with HFpEF who have renal dysfunction, allergy to gadolinium, or wheezing that can simulate asthma. Our feasibility study shows the potential of native T1 to allow for insight of heterogeneous pathophysiology and better risk stratification of HFpEF.
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Affiliation(s)
- Taku Omori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Shiro Nakamori
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan.
| | - Naoki Fujimoto
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Masaki Ishida
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kakuya Kitagawa
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Yasutaka Ichikawa
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Naoto Kumagai
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Tairo Kurita
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | | | - Michiaki Hiroe
- Research Center for Matrix Biology, Mie University, Mie, Japan
| | - Hajime Sakuma
- Department of Radiology, Mie University Graduate School of Medicine, Mie, Japan
| | - Masaaki Ito
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
| | - Kaoru Dohi
- Department of Cardiology and Nephrology, Mie University Graduate School of Medicine, Mie, Japan
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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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Amide Proton Transfer-Weighted (APTw) Imaging of Intracranial Infection in Children: Initial Experience and Comparison with Gadolinium-Enhanced T1-Weighted Imaging. BIOMED RESEARCH INTERNATIONAL 2020; 2020:6418343. [PMID: 32509865 PMCID: PMC7251435 DOI: 10.1155/2020/6418343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 03/21/2020] [Accepted: 04/25/2020] [Indexed: 12/05/2022]
Abstract
Purpose To evaluate the performance of amide proton transfer-weighted (APTw) imaging against the reference standard of gadolinium-enhanced T1-weighted imaging (Gd-T1w) in children with intracranial infection. Materials and Methods Twenty-eight pediatric patients (15 males and 13 females; age range 1-163 months) with intracranial infection were recruited in this study. 2D APTw imaging and conventional MR sequences were conducted using a 3 T MRI scanner. Kappa (κ) statistics and the McNemar test were performed to determine whether the hyperintensity on APTw was related to the enhancement on Gd-T1w. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of APTw imaging to predict lesion enhancement were calculated. Result In twelve patients with brain abscesses, the enhancing rim of the abscesses on the Gd-T1w images was consistently hyperintense on the APTw images. In eight patients with viral encephalitis, three showed slight spotted gadolinium enhancement, while the APTw image also showed a slight spotted high signal. Five of these patients showed no enhancement on Gd-T1w and isointensity on the APTw image. In eleven patients with meningitis, increased APTw signal intensities were clearly visible in gadolinium-enhancing meninges. Sixty infectious lesions (71%) showed enhancement on Gd-T1w images. The sensitivity and specificity of APTw were 93.3% (56/60) and 91.7% (22/24). APTw demonstrated excellent agreement (κ = 0.83) with Gd-T1w, with no significant difference (P = 0.69) in detection of infectious lesions. Conclusions These initial data show that APTw MRI is a noninvasive technique for the detection and characterization of intracranial infectious lesions. APTw MRI enabled similar detection of infectious lesions to Gd-T1w and may provide an injection-free means of evaluation of intracranial infection.
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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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Nakamori S, Fahmy A, Jang J, El-Rewaidy H, Neisius U, Berg S, Goddu B, Pierce P, Rodriguez J, Hauser T, Ngo LH, Manning WJ, Nezafat R. Changes in Myocardial Native T1 and T2 After Exercise Stress. JACC Cardiovasc Imaging 2020; 13:667-680. [DOI: 10.1016/j.jcmg.2019.05.019] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Revised: 05/07/2019] [Accepted: 05/10/2019] [Indexed: 02/01/2023]
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Brain tissue gadolinium retention in pediatric patients after contrast-enhanced magnetic resonance exams: pathological confirmation. Pediatr Radiol 2020; 50:388-396. [PMID: 31989188 DOI: 10.1007/s00247-019-04535-w] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/31/2019] [Accepted: 09/10/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND Retained gadolinium from gadolinium-based contrast agents (GBCAs) used in MR exams has been inferred based on signal changes on serial brain MRI and subsequently demonstrated pathologically in adults. Retention has been similarly inferred in children but pathological demonstration in pediatric patients is limited. The long-term effects of retained gadolinium are unknown but are potentially of greater concern in children given their increased vulnerability from continuing development and their expected longer period of exposure. Several factors can influence gadolinium retention. In adults as well as in children, greater accumulation has been demonstrated based on MR signal changes with linear compared with macrocyclic gadolinium chelates, attributed to lower chelate affinity with linear agents. Effects of age at exposure on retention are unknown, while differences in GBCA washout rates are still under investigation and might affect gadolinium retention relative to time of GBCA administration. OBJECTIVE The purpose of this study was to confirm whether gadolinium brain deposits are present in pediatric patients who received GBCAs and to quantify the amounts present. MATERIALS AND METHODS Brain autopsy specimens from 10 pediatric patients between 1 year and 13 years of age who underwent at least one contrast-enhanced MR exam were analyzed for elemental gadolinium using inductively coupled plasma mass spectrometry. Brain samples included white matter, basal ganglia (putamen, globus pallidus), thalamus, dentate nucleus and tumor tissue as available. Type and dose of contrast agent, number and timing of contrast-enhanced MR exams and renal function (estimated glomerular filtration rate [eGFR]) were documented for each child. RESULTS Patient exposures ranged from 1 dose to 20 doses of GBCAs including both macrocyclic and linear ionic agents. Gadolinium was found to be present in brain tissue in all children and was generally highest in the globus pallidus. Those who received only macrocyclic agents showed lower levels of gadolinium retention. CONCLUSION This study demonstrates pathological confirmation of gadolinium retention in brain tissue of a series of pediatric patients exposed to GBCAs including not only linear ionic agents but also macrocyclic agents with both nonionic and ionic compounds. The distribution and deposition levels in this small pediatric population are comparable with the findings in adults. While the clinical significance of these deposits remains unknown, at this point it would be prudent to exert caution and avoid unnecessary use of GBCAs in pediatric patients.
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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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Dillman JR, Davenport MS. Gadolinium retention - 5 years later…. Pediatr Radiol 2020; 50:166-167. [PMID: 31975183 DOI: 10.1007/s00247-019-04540-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 09/05/2019] [Accepted: 09/16/2019] [Indexed: 11/25/2022]
Affiliation(s)
- Jonathan R Dillman
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave., ML 5031, Cincinnati, OH, 45229, USA.
- Department of Radiology, University of Cincinnati College of Medicine, Cincinnati, OH, USA.
| | - Matthew S Davenport
- Departments of Radiology and Urology, Michigan Medicine, Ann Arbor, MI, USA
- Michigan Radiology Quality Collaborative, Ann Arbor, MI, USA
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Enterline DS, Martin KW, Parmar HA, Triulzi FM, Colosimo C. Safety and Diagnostic Efficacy of Gadobenate Dimeglumine in MRI of the Brain and Spine of Neonates and Infants. AJNR Am J Neuroradiol 2019; 40:2001-2009. [PMID: 31727753 DOI: 10.3174/ajnr.a6319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 09/18/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND AND PURPOSE Contrast-enhanced MR imaging provides essential information for pediatric imaging applications. We evaluated gadobenate dimeglumine for contrast-enhanced MR imaging of infants younger than 2 years of age. MATERIALS AND METHODS Ninety children younger than 2 years of age (including 55 children younger than 1 year) who underwent enhanced MR imaging of the CNS with gadobenate dimeglumine at 0.1 mmol/kg body weight ± 25% by volume were retrospectively enrolled at 2 imaging centers. Safety data were assessed for adverse events and, when available, vital signs and electrocardiogram and clinical laboratory values obtained from 48 hours before until 48 hours after the MR imaging examination. The efficacy of gadobenate dimeglumine-enhanced MR imaging was evaluated prospectively by 3 blinded, unaffiliated readers in terms of the accuracy of combined pre- and postcontrast images relative to precontrast images alone for differentiation of tumor from non-neoplastic disease and the correct diagnosis of specific disease. Differences were tested using the McNemar test. A possible effect of dose on diagnostic accuracy was assessed using the Fisher exact test. RESULTS Nine nonserious adverse events were reported for 8 (8.8%) patients. Five adverse events occurred in patients 12 months of age or older. All events occurred at least 24 hours after gadobenate dimeglumine administration, and in each case, the investigating radiologist considered that there was no reasonable possibility of a relationship to gadobenate dimeglumine. No clinically meaningful changes in vital signs, electrocardiogram results, or laboratory parameters were reported. Accurate differentiation of tumor from non-neoplastic disease and exact matching of each specific MR imaging-determined diagnosis with the on-site final diagnosis were achieved in significantly more patients by each reader following evaluation of combined pre- and postcontrast images relative to precontrast images alone (91.0%-94.4% versus 75.3%-87.6%, P < .04, and 66.3%-73.0% versus 52.8%-58.4%, P < .02, respectively). No significant differences (P > .133) in diagnostic accuracy were noted between patients receiving ≤0.08 mmol/kg of gadobenate dimeglumine and patients receiving >0.08 mmol/kg of gadobenate dimeglumine. CONCLUSIONS Gadobenate dimeglumine is safe and effective for pediatric MR imaging.
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Affiliation(s)
- D S Enterline
- From the Department of Radiology (D.S.E.), Duke University, Durham, North Carolina
| | - K W Martin
- Department of Diagnostic Imaging (K.W.M.), University of California, San Francisco, Benioff Children's Hospital, Oakland, California
| | - H A Parmar
- Department of Radiology (H.A.P.), University of Michigan, C.S. Mott Children's Hospital, Ann Arbor, Michigan
| | - F M Triulzi
- Department of Neuroradiology (F.M.T.), Fondazione Istituto di Ricovero e Cura a Carattere Scientifico Cà Granda Ospedale Maggiore Policlinic, Milan, Italy
| | - C Colosimo
- Radiodiagnostica e Neuroradiologia (C.C.), Institute of Radiology, Fondazione Policlinico Universitario 'A. Gemelli', Università Cattolica del Sacro Cuore, Rome, Italy
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Topcuoglu ED, Topcuoglu OM, Semiz Oysu A, Bukte Y. Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case-Control Study. J Magn Reson Imaging 2019; 51:1471-1477. [PMID: 31665554 DOI: 10.1002/jmri.26954] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 09/15/2019] [Accepted: 09/16/2019] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Accumulation of macrocyclic gadolinium agents in children's brains remain to be determined. PURPOSE To demonstrate whether there is an intracranial macrocyclic gadolinium deposition after multiple contrast-enhanced MRI with gadoterate meglumine in a pediatric population. STUDY TYPE Retrospective case-control. POPULATION In all, 45 children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the study group and 45 healthy children (age range: 5-17 years; mean, 13.7 ± 3.4 years) for the control group. FIELD STRENGTH/SEQUENCE T1 - and T2 -weighted axial images on a 1.5T scanner. ASSESSMENT Children with at least three enhanced brain MRIs and an age- and sex-matched control group with an unenhanced brain MRIs were compared in terms of T1 signal intensity (SI). All patients in the study group received gadoterate meglumine intravenously (0.1 mmol/kg). SI measurements were made by drawing six regions of interest (ROIs): dentate nuclei (DN), pons, globus pallidi (GP), frontal white matter (FWM), thalamus (T), clivus, and cerebrospinal fluid (CSF) for both groups on unenhanced T1 -weighted images. STATISTICAL TESTS Student's t-test was used for comparison of SI. The Pearson correlation was calculated for the correlation between the SI and the number of gadolinium administrations. RESULTS A significant difference was detected between two groups for DN/CSF, pons/CSF, GP/CSF, thalamus/CSF, and FWM/CSF (P < 0.001, P < 0.001, P = 0.002, P = 0.002, P = 0.024, respectively). There was no significant difference between the two groups for clivus/CSF (P = 0.15). A good correlation between the number of gadoterate meglumine administrations and the SI for DN/CSF, pons/CSF, GP/CSF, and T/CSF (r = 0.80, r = 0.73, r = 0.91, and r = 0.90, respectively) was found. DATA CONCLUSION A significant T1 SI increase reflecting gadolinium retention in the brain was detected for children with at least three gadoterate meglumine administrations in this series. The number of administrations correlated well with the increased SI. LEVEL OF EVIDENCE 3 Technical Efficacy Stage: 5 J. Magn. Reson. Imaging 2020;51:1471-1477.
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Affiliation(s)
- Elif Dilara Topcuoglu
- University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | | | - Aslihan Semiz Oysu
- University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
| | - Yasar Bukte
- University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey
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Does Age Interfere With Gadolinium Toxicity and Presence in Brain and Bone Tissues?: A Comparative Gadoterate Versus Gadodiamide Study in Juvenile and Adult Rats. Invest Radiol 2019; 54:61-71. [PMID: 30394964 PMCID: PMC6310471 DOI: 10.1097/rli.0000000000000517] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The main objective of the study was to assess the effect of age on target tissue total gadolinium (Gd) retention after repeated administration of gadodiamide (linear) or gadoterate (macrocyclic) Gd-based contrast agent (GBCA) in rats. The secondary objective was to assess the potential developmental and long-term consequences of GBCA administration during neonatal and juvenile periods. MATERIALS AND METHODS A total of 20 equivalent human clinical doses (cumulated dose, 12 mmol Gd/kg) of either gadoterate or gadodiamide were administered concurrently by the intravenous route to healthy adult and juvenile rats. Saline was administered to juvenile rats forming the control group. In juvenile rats, the doses were administered from postnatal day 12, that is, once the blood-brain barrier is functional as in humans after birth. The tests were conducted on 5 juvenile rats per sex and per group and on 3 adult animals per sex and per group. T1-weighted magnetic resonance imaging of the cerebellum was performed at 4.7 T during both the treatment and treatment-free periods. Behavioral tests were performed in juvenile rats. Rats were euthanatized at 11 to 12 weeks (ie, approximately 3 months) after the last administration. Total Gd concentrations were measured in plasma, skin, bone, and brain by inductively coupled plasma mass spectrometry. Cerebellum samples from the juvenile rats were characterized by histopathological examination (including immunohistochemistry for glial fibrillary acidic protein or GFAP, and CD68). Lipofuscin pigments were also studied by fluorescence microscopy. All tests were performed blindly on randomized animals. RESULTS Transient skin lesions were observed in juvenile rats (5/5 females and 2/4 males) and not in adult rats having received gadodiamide. Persisting (up to completion of the study) T1 hyperintensity in the deep cerebellar nuclei (DCNs) was observed only in gadodiamide-treated rats. Quantitatively, a slightly higher progressive increase in the DCN/brain stem ratio was observed in adult rats compared with juvenile rats, whereas no difference was noted visually. In all tissues, total Gd concentrations were higher (10- to 30-fold higher) in the gadodiamide-treated groups than in the gadoterate groups. No age-related differences were observed except in bone marrow where total Gd concentrations in gadodiamide-treated juvenile rats were higher than those measured in adults and similar to those measured in cortical bone tissue. No significant treatment-related effects were observed in histopathological findings or in development, behavior, and biochemistry parameters. However, in the elevated plus maze test, a trend toward an anxiogenic effect was observed in the gadodiamide group compared with other groups (nonsignificant). Moreover, in the balance beam test, a high number of trials were excluded in the gadodiamide group because rats (mainly males) did not completely cross the beam, which may also reflect an anxiogenic effect. CONCLUSIONS No T1 hyperintensity was observed in the DCN after administration of the macrocyclic GBCA gadoterate regardless of age as opposed to administration of the linear GBCA gadodiamide. Repeated administration of gadodiamide in neonatal and juvenile rats resulted in similar total Gd retention in the skin, brain, and bone to that in adult rats with sex having no effect, whereas Gd distribution in bone marrow was influenced by age. Further studies are required to assess the form of the retained Gd and to investigate the potential risks associated with Gd retention in bone marrow in juvenile animals treated with gadodiamide. Regardless of age, total Gd concentration in the brain and bone was 10- to 30-fold higher after administration of gadodiamide compared with gadoterate.
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The Effects of Gadolinium-Based Contrast Agents on the Cerebellum: from Basic Research to Neurological Practice and from Pregnancy to Adulthood. THE CEREBELLUM 2019; 17:247-251. [PMID: 29196974 DOI: 10.1007/s12311-017-0903-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Gadolinium (Gd)-based contrast agents (GBCAs) are used in magnetic resonance imaging (MRI) to increase the diagnostic yield. Current reports using animal models or human subjects have shown that GBCAs may be deposited in brain including the cerebellum. Although further studies may be required to clarify the toxicity of GBCAs, we should be more cautious to use these agents particularly in patients who more likely to have repeated enhanced MRI along their lifespan. In this editorial, current studies to clarify the toxicity of GBCAs in the cerebellum are introduced.
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Rowe SK, Rodriguez D, Cohen E, Grundy R, Morgan PS, Jaspan T, Dineen RA. Switching from linear to macrocyclic gadolinium‐based contrast agents halts the relative T
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‐Weighted signal increase in deep gray matter of children with brain tumors: A retrospective study. J Magn Reson Imaging 2019; 51:288-295. [DOI: 10.1002/jmri.26831] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 05/24/2019] [Indexed: 01/07/2023] Open
Affiliation(s)
- Selene K. Rowe
- RadiologyNottingham University Hospitals, Queen's Medical Centre Nottingham UK
| | - Daniel Rodriguez
- Medical Physics and Clinical EngineeringNottingham University Hospitals, Queen's Medical Centre Nottingham UK
| | - Ellie Cohen
- RadiologyNottingham University Hospitals, Queen's Medical Centre Nottingham UK
| | - Richard Grundy
- Children's Brain Tumour Research CentreNottingham University Hospitals, Queen's Medical Centre Nottingham UK
| | - Paul S. Morgan
- Medical Physics and Clinical EngineeringNottingham University Hospitals, Queen's Medical Centre Nottingham UK
| | - Tim Jaspan
- RadiologyNottingham University Hospitals, Queen's Medical Centre Nottingham UK
| | - Robert A. Dineen
- RadiologyNottingham University Hospitals, Queen's Medical Centre Nottingham UK
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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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Blumfield E, Swenson DW, Iyer RS, Stanescu AL. Gadolinium-based contrast agents - review of recent literature on magnetic resonance imaging signal intensity changes and tissue deposits, with emphasis on pediatric patients. Pediatr Radiol 2019; 49:448-457. [PMID: 30923876 DOI: 10.1007/s00247-018-4304-8] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2018] [Revised: 09/01/2018] [Accepted: 10/31/2018] [Indexed: 12/29/2022]
Abstract
Gadolinium has been used as a base for contrast agents in MRI for the last three decades. Numerous studies over the last 4 years have reported increased signal intensity in deep brain nuclei in non-contrast MRI images following gadolinium-based contrast agent (GBCA) administration. Pathology studies performed on adults and children, and rodent necropsy studies have also shown gadolinium deposition in brain and other tissues after GBCA administration. The purpose of this review was to summarize and discuss the knowledge gained from these reports and the relevance for imaging pediatric patients.
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Affiliation(s)
- Einat Blumfield
- Department of Radiology, Children's Hospital of Montefiore, Albert Einstein College of Medicine, 111E 210th St, Bronx, NY, 10461, USA.
| | - David W Swenson
- Department of Diagnostic Imaging, Alpert Medical School of Brown University, Rhode Island Hospital/Hasbro Children's Hospital, Providence, RI, USA
| | - Ramesh S Iyer
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
| | - A Luana Stanescu
- Department of Radiology, Seattle Children's Hospital, University of Washington School of Medicine, Seattle, WA, USA
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Marsault P, Ducassou S, Menut F, Bessou P, Havez-Enjolras M, Chateil JF. Diagnostic performance of an unenhanced MRI exam for tumor follow-up of the optic pathway gliomas in children. Neuroradiology 2019; 61:711-720. [DOI: 10.1007/s00234-019-02198-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 03/07/2019] [Indexed: 12/15/2022]
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Jülich K, Neuberger I, Sahin M, Takeoka M, Pinto A, Prabhu SP. Yield of Emergent Neuroimaging in Patients With Sturge-Weber Syndrome Presenting With Acute Neurologic Symptoms. J Child Neurol 2019; 34:17-21. [PMID: 30378435 DOI: 10.1177/0883073818801635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND/AIMS Seizures, strokelike episodes, and headaches are common complications in patients with Sturge-Weber syndrome. Based on our experience, we hypothesized that patients with Sturge-Weber syndrome have frequent urgent neuroimaging studies when presenting acutely to the emergency department. In this study, we aimed to determine the incidence of acute imaging studies in this patient population and to evaluate the prevalence of findings such as acute intracranial hemorrhagic or ischemic strokes. METHODS To determine the frequency and yield of brain imaging, we conducted a retrospective chart analysis in patients with Sturge-Weber syndrome who presented to Boston Children's Hospital with acute neurologic symptoms between 1996 and 2016. RESULTS We reviewed 136 encounters of patients with Sturge-Weber syndrome. In 73 of 136 encounters (53.7%), patients underwent a total of 89 imaging studies, consisting of 47 head computed tomographies (CTs) and 42 brain magnetic resonance images (MRIs). Twenty-two percent of patients imaged underwent both CT and MRI scanning of the brain. Patients with strokelike episodes or headaches were more likely to be imaged compared to patients presenting with seizures (89.7% and 100% vs 34.4%, respectively). None of the neuroimaging studies showed acute hemorrhagic or ischemic strokes. CONCLUSIONS Acute neurologic manifestations of Sturge-Weber syndrome frequently lead to urgent neuroimaging. In our cohort, there was no imaging evidence of acute hemorrhagic or ischemic strokes. In addition, emergent imaging in patients presenting with breakthrough seizures did not result in meaningful changes in management.
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Affiliation(s)
- Kristina Jülich
- 1 Department of Neurology Boston Children's, Boston Children's Hospital, Boston, MA, USA.,2 Department of Neurology, Dell Medical School, Austin, TX
| | - Ilana Neuberger
- 3 Department of Radiology, Boston Children's Hospital, Boston, MA, USA.,4 Department of Radiology, Colorado Children's Hospital, Aurora, CO, USA
| | - Mustafa Sahin
- 1 Department of Neurology Boston Children's, Boston Children's Hospital, Boston, MA, USA
| | - Masanori Takeoka
- 1 Department of Neurology Boston Children's, Boston Children's Hospital, Boston, MA, USA
| | - Anna Pinto
- 1 Department of Neurology Boston Children's, Boston Children's Hospital, Boston, MA, USA
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Non-contrast-enhanced magnetic resonance angiography for detecting crossing renal vessels in infants and young children: comparison with contrast-enhanced angiography and surgical findings. Pediatr Radiol 2019; 49:105-113. [PMID: 30284006 DOI: 10.1007/s00247-018-4252-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2018] [Revised: 07/20/2018] [Accepted: 08/30/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND Knowing that ureteropelvic junction obstruction is due to a crossing renal vessel is essential in choosing the appropriate surgical treatment. OBJECTIVE To evaluate the diagnostic accuracy of non-contrast magnetic resonance (MR) angiography in identifying crossing renal vessels in children younger than 4 years old with unilateral hydronephrosis. MATERIALS AND METHODS A retrospective review of preoperative MR urography of children with unilateral hydronephrosis was conducted by two independent readers. The presence or absence of crossing renal vessels was identified and compared with surgical findings. RESULTS Twenty-nine patients were included. The disagreement between MR angiography with and without contrast enhancement in detecting a crossing renal vessel was 8%. The disagreement between non-contrast-enhanced MR and surgical findings was 17%. The disagreement between contrast-enhanced MR angiography and surgical findings was 25%. The balanced triggered angiography without contrast enhancement had a sensitivity of 70% (95% confidence interval [CI]: 35-93%) and a specificity of 93% (95% CI: 66-100%). Contrast-enhanced MR angiography had a sensitivity of 56% (95% CI: 21-86%) and a specificity of 91%. (95% CI: 59-100%). CONCLUSION MR without contrast enhancement may be a reliable, valid and safe alternative to contrast-enhanced MR angiography for identifying crossing renal vessels.
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