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Ramalho J, Semelka R, Cruz J, Morais T, Ramalho M. T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: An observational study. RADIOLOGIA 2022; 64:397-406. [DOI: 10.1016/j.rxeng.2020.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/13/2020] [Indexed: 10/18/2022]
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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 2021; 27:58. [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/18/2021] [Accepted: 12/22/2021] [Indexed: 01/21/2023] Open
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
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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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Ramalho J, Semelka RC, Cruz J, Morais T, Ramalho M. T1 signal intensity in the dentate nucleus after the administration of the macrocyclic gadolinium-based contrast agent gadoterate meglumine: an observational study. RADIOLOGIA 2020; 64:S0033-8338(20)30112-0. [PMID: 33032813 DOI: 10.1016/j.rx.2020.07.003] [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: 05/07/2020] [Revised: 06/26/2020] [Accepted: 07/13/2020] [Indexed: 11/20/2022]
Abstract
INTRODUCTION AND AIMS Contradictory results have been reported about hyperintensity of the globus pallidus and/or dentate nucleus on unenhanced T1-weighted magnetic resonance (MR) images after exposure to various gadolinium-based contrast agents. This change in signal intensity varies with different gadolinium-based contrast agents. We aimed to determine whether signal intensity in the dentate nucleus is increased in unenhanced T1-weighted images in patients who have undergone multiple studies with the macrocyclic gadolinium-based contrast agent gadoterate meglumine. We thoroughly reviewed the literature to corroborate our results. MATERIALS AND METHODS We included patients who had undergone more than 10 MR studies with gadoterate meglumine. We quantitatively analyzed the signal intensity in unenhanced T1-weighted MR images measured in regions of interest placed in the dentate nucleus and the pons, and we calculated the dentate nucleus-to-pons signal intensity ratios and the differences between the ratio in the first MR study and the last MR study. We used t-tests to evaluate whether the differences between the signal intensity ratios were different from 0. We also analyzed the subgroups of patients who had been administered<15 and ≥15 doses of gadoterate meglumine. We used Pearson correlation to determine the relationships between the differences in the signal intensity ratios and the number of doses of gadoterate meglumine administered. RESULTS The 54 patients (26 men) had received a mean of 13.8±3.47 doses (range, 10-23 doses). The difference in the dentate nucleus-pons signal intensity ratio between the first and last MR study was -0.0275±0.1917 (not significantly different from 0; p=0.2968) in the entire group, -0.0357±0.2204 (not significantly different from 0; p=0.351 in the patients who had received <15 doses (n=34), and -0.0135±0.1332 (not significantly different from 0; p=0.655) in those who had received ≥15 doses (n=20). Differences in signal intensity ratios did not correlate significantly with the accumulated dose of gadoterate meglumine (P=0.9064; ρ=-0.0164 [95%]). CONCLUSIONS Receiving more than 10 doses of gadoterate meglumine was not associated with increased signal intensity in the dentate nucleus.
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Affiliation(s)
- J Ramalho
- Departamento de Neurorradiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - R C Semelka
- Dr. Richard Semelka. Empresa privada de consultoría
| | - J Cruz
- Departamento de Radiología, Hospital Garcia de Orta, EPE, Almada, Portugal; Departamento de Radiología, Hospital da Luz, Lisboa y Setúbal, Portugal
| | - T Morais
- Departamento de Neurorradiología, Centro Hospitalar Lisboa Central, Lisboa, Portugal
| | - M Ramalho
- Departamento de Radiología, Hospital Garcia de Orta, EPE, Almada, Portugal; Departamento de Radiología, Hospital da Luz, Lisboa y Setúbal, Portugal.
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Splendiani A, Corridore A, Torlone S, Martino M, Barile A, Di Cesare E, Masciocchi C. Visible T1-hyperintensity of the dentate nucleus after multiple administrations of macrocyclic gadolinium-based contrast agents: yes or no? Insights Imaging 2019; 10:82. [PMID: 31482392 PMCID: PMC6722174 DOI: 10.1186/s13244-019-0767-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 07/11/2019] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVES To investigate the appearance of visible dentate nucleus (DN) T1-hyperintensity and quantify changes in DN/pons (DN/P) signal intensity (SI) ratio in MS patients after the exclusive administration of macrocyclic GBCAs. MATERIALS AND METHODS One hundred forty-nine patients with confirmed MS were evaluated. Patients received at least two administrations of gadobutrol (n = 63), gadoterate (n = 57), or both (n = 29). Two experienced neuroradiologists in consensus evaluated unenhanced T1-weighted MR images from all examinations in each patient for evidence of visible DN hyperintensity. Thereafter, SI measurements were made in the left and right DN and pons on unenhanced T1-weighted images from the first and last scans. A two-sample t test compared the DN/P SI ratios for patients with and without visible T1-hyperintensity. RESULTS Visible T1-hyperintensity was observed in 42/149 (28.2%) patients (19 after gadobutrol only, 15 after gadoterate only, 8 after both), typically at the 4th or 5th follow-up exam at 3-4 years after the initial examination. Significant increases in DN/P SI ratio from first to last examination were determined for patients with visible T1-hyperintensity (0.998 ± 0.002 to 1.153 ± 0.016, p < 0.0001 for gadobutrol; 1.003 ± 0.004 to 1.110 ± 0.014, p < 0.0001 for gadoterate; 1.004 ± 0.011 to 1.163 ± 0.032, p = 0.0004 for both) but not for patients without visible T1-hyperintensity (p > 0.05; all groups). CONCLUSION Multiple injections of gadobutrol and/or gadoterate can lead to visible and quantifiable increases in DN/P SI ratio in some patients with MS.
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Affiliation(s)
- Alessandra Splendiani
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy.
| | - Antonella Corridore
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Silvia Torlone
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Milvia Martino
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Antonio Barile
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Ernesto Di Cesare
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
| | - Carlo Masciocchi
- Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, 67100, L'Aquila, Italy
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Age, But Not Repeated Exposure to Gadoterate Meglumine, Is Associated With T1- and T2-Weighted Signal Intensity Changes in the Deep Brain Nuclei of Pediatric Patients. Invest Radiol 2019; 54:537-548. [DOI: 10.1097/rli.0000000000000564] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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Forslin Y, Martola J, Bergendal Å, Fredrikson S, Wiberg MK, Granberg T. Gadolinium Retention in the Brain: An MRI Relaxometry Study of Linear and Macrocyclic Gadolinium-Based Contrast Agents in Multiple Sclerosis. AJNR Am J Neuroradiol 2019; 40:1265-1273. [PMID: 31248867 DOI: 10.3174/ajnr.a6112] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 05/20/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND AND PURPOSE Brain gadolinium retention is consistently reported for linear gadolinium-based contrast agents, while the results for macrocyclics are contradictory and potential clinical manifestations remain controversial. Furthermore, most previous studies are based on conventional T1-weighted MR imaging. We therefore aimed to quantitatively investigate longitudinal and transversal relaxation in the brain in relation to previous gadolinium-based contrast agent administration and explore associations with disability in multiple sclerosis. MATERIALS AND METHODS Eighty-five patients with MS and 21 healthy controls underwent longitudinal and transverse relaxation rate (R1 and R2) relaxometry. Patients were divided into linear, mixed, and macrocyclic groups based on previous gadolinium-based contrast agent administration. Neuropsychological testing was performed in 53 patients. The dentate nucleus, globus pallidus, caudate nucleus, and thalamus were manually segmented. Repeatability measures were also performed. RESULTS The relaxometry was robust (2.0% scan-rescan difference) and detected higher R1 (dentate nucleus, globus pallidus, caudate nucleus, thalamus) and R2 (globus pallidus, caudate nucleus) in patients receiving linear gadolinium-based contrast agents compared with controls. The number of linear gadolinium-based contrast agent administrations was associated with higher R1 and R2 in all regions (except R2 in the thalamus). No similar differences and associations were found for the macrocyclic group. Higher relaxation was associated with lower information-processing speed (dentate nucleus, thalamus) and verbal fluency (caudate nucleus, thalamus). No associations were found with physical disability or fatigue. CONCLUSIONS Previous linear, but not macrocyclic, gadolinium-based contrast agent administration is associated with higher relaxation rates in a dose-dependent manner. Higher relaxation in some regions is associated with cognitive impairment but not physical disability or fatigue in MS. The findings should be interpreted with care but encourage studies into gadolinium retention and cognition.
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Affiliation(s)
- Y Forslin
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden .,Departments of Radiology (Y.F., J.M., M.K.W., T.G.)
| | - J Martola
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology (Y.F., J.M., M.K.W., T.G.)
| | - Å Bergendal
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden
| | - S Fredrikson
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Neurology (S.F.), Karolinska University Hospital, Stockholm, Sweden
| | - M K Wiberg
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology (Y.F., J.M., M.K.W., T.G.).,Department of Medical and Health Sciences (M.K.W.), Division of Radiological Sciences, Linköping University, Linköping, Sweden
| | - T Granberg
- From the Department of Clinical Neuroscience (Y.F., J.M., Å.B., S.F., M.K.W., T.G.), Karolinska Institutet, Stockholm, Sweden.,Departments of Radiology (Y.F., J.M., M.K.W., T.G.)
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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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Schöckel L, Balzer T, Pietsch H. [Increased signal intensities and gadolinium levels in the brain after administration of gadolinium-based MR contrast agents : Clinical observations and results from preclinical research]. Radiologe 2019; 59:359-368. [PMID: 30887087 DOI: 10.1007/s00117-019-0511-z] [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: 10/27/2022]
Abstract
BACKGROUND Numerous clinical MRI studies have been published that describe an association between the repeated administration of (linear) gadolinium-based contrast agents and increased signal intensity in certain brain areas. In November 2017, the European Commission suspended the use of some of these contrast agents. OBJECTIVES The background for this decision, both regulatory and scientific, are presented and discussed. MATERIALS AND METHODS The regulatory decisions are evaluated and the clinical and preclinical literature is discussed. RESULTS Differences in the structure and stability of gadolinium-based contrast agent molecules explain the observed increased signal intensities in individual brain regions (e. g. dentate nucleus) after administration of multiple doses of linear contrast agents. This phenomenon was not observed after administration of multiple doses of macrocyclic contrast agents. Preclinical studies have confirmed these results. CONCLUSION To date, no clinical symptoms have been confirmed to be associated with the increased signal intensity or gadolinium presence in the brain.
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Affiliation(s)
- L Schöckel
- Pharmaceuticals Division, Medical & Clinical Affairs Radiology, Bayer AG, Berlin, Deutschland
| | - T Balzer
- Pharmaceuticals, Medical & Clinical Affairs Radiology, Bayer U.S. LLC, 100 Bayer Boulevard, 07981, Whippany, NJ, USA.
| | - H Pietsch
- Research & Development, Pharmaceuticals, MR and CT Contrast Media Research, Bayer AG, Berlin, Deutschland
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Gadolinium Accumulation in the Deep Cerebellar Nuclei and Globus Pallidus After Exposure to Linear but Not Macrocyclic Gadolinium-Based Contrast Agents in a Retrospective Pig Study With High Similarity to Clinical Conditions. Invest Radiol 2019; 53:278-285. [PMID: 29319556 PMCID: PMC5902136 DOI: 10.1097/rli.0000000000000440] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objective The aim of this retrospective study was to determine the gadolinium (Gd) concentration in different brain areas in a pig cohort that received repeated administration of Gd-based contrast agents (GBCAs) at standard doses over several years, comparable with a clinical setting. Material and Methods Brain tissue was collected from 13 Göttingen mini pigs that had received repeated intravenous injections of gadopentetate dimeglumine (Gd-DTPA; Magnevist) and/or gadobutrol (Gadovist). The animals have been included in several preclinical imaging studies since 2008 and received cumulative Gd doses ranging from 7 to 129 mmol per animal over an extended period. Two animals with no history of administration of GBCA were included as controls. Brain autopsies were performed not earlier than 8 and not later than 38 months after the last GBCA application. Tissues from multiple brain areas including cerebellar and cerebral deep nuclei, cerebellar and cerebral cortex, and pons were analyzed for Gd using inductively coupled plasma mass spectrometry. Results Of the 13 animals, 8 received up to 48 injections of gadobutrol and Gd-DTPA and 5 received up to 29 injections of gadobutrol only. In animals that had received both Gd-DTPA and gadobutrol, a median (interquartile range) Gd concentration of 1.0 nmol/g tissue (0.44-1.42) was measured in the cerebellar nuclei and 0.53 nmol/g (0.29-0.62) in the globus pallidus. The Gd concentration in these areas in gadobutrol-only animals was 50-fold lower with median concentrations of 0.02 nmol/g (0.01-0.02) for cerebellar nuclei and 0.01 nmol/g (0.01-0.01) for globus pallidus and was comparable with control animals with no GBCA history. Accordingly, in animals that received both GBCAs, the amount of residual Gd correlated with the administered dose of Gd-DTPA (P ≤ 0.002) but not with the total Gd dose, consisting of Gd-DTPA and gadobutrol. The Gd concentration in cortical tissue and in the pons was very low (≤0.07 nmol/g tissue) in all animals analyzed. Conclusion Multiple exposure to macrocyclic gadobutrol is not associated with Gd deposition in brain tissue of healthy pigs. A single additional administration of linear Gd-DTPA is sufficient for Gd accumulation in the nucleus dentatus and globus pallidus, underlining the importance of obtaining a complete GBCA history in clinical studies.
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Le Fur M, Caravan P. The biological fate of gadolinium-based MRI contrast agents: a call to action for bioinorganic chemists. Metallomics 2019; 11:240-254. [PMID: 30516229 PMCID: PMC6486840 DOI: 10.1039/c8mt00302e] [Citation(s) in RCA: 83] [Impact Index Per Article: 16.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Gadolinium-based contrast agents (GBCAs) are widely used with clinical magnetic resonance imaging (MRI), and 10 s of millions of doses of GBCAs are administered annually worldwide. GBCAs are hydrophilic, thermodynamically stable and kinetically inert gadolinium chelates. In clinical MRI, 5-10 millimoles of Gd ion is administered intravenously and the GBCA is rapidly eliminated intact primarily through the kidneys into the urine. It is now well-established that the Gd3+ ion, in some form(s), is partially retained in vivo. In patients with advanced kidney disease, there is an association of Gd retention with nephrogenic systemic fibrosis (NSF) disease. However Gd is also retained in the brain, bone, skin, and other tissues in patients with normal renal function, and the presence of Gd can persist months to years after the last administration of a GBCA. Regulatory agencies are restricting the use of specific GBCAs and inviting health care professionals to evaluate the risk/benefit ratio prior to using GBCAs. Despite the growing number of studies investigating this issue both in animals and humans, the biological distribution and the chemical speciation of the residual gadolinium are not fully understood. Is the GBCA retained in its intact form? Is the Gd3+ ion dissociated from its chelator, and if so, what is its chemical form? Here we discuss the current state of knowledge regarding the issue of Gd retention and describe the analytical and spectroscopic methods that can be used to investigate the Gd speciation. Many of the physical methods that could be brought to bear on this problem are in the domain of bioinorganic chemistry and we hope that this review will serve to inspire this community to take up this important problem.
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Affiliation(s)
- Mariane Le Fur
- The Athinoula A. Martinos Center for Biomedical Imaging, The Institute for Innovation in Imaging, Massachusetts General Hospital and Harvard Medical School, 149 Thirteenth Street, Charlestown, Massachusetts 02129, USA.
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12
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Jost G, Frenzel T, Boyken J, Lohrke J, Nischwitz V, Pietsch H. Long-term Excretion of Gadolinium-based Contrast Agents: Linear versus Macrocyclic Agents in an Experimental Rat Model. Radiology 2019; 290:340-348. [DOI: 10.1148/radiol.2018180135] [Citation(s) in RCA: 71] [Impact Index Per Article: 14.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Gregor Jost
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Thomas Frenzel
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Janina Boyken
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Jessica Lohrke
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Volker Nischwitz
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
| | - Hubertus Pietsch
- From the Department of MR and CT Contrast Media Research, Bayer, Muellerstr 178, Berlin 13353, Germany (G.J., T.F., J.L., H.P.); Institute of Physiology, Charité, Berlin, Germany (J.B.); and Forschungszentrum Juelich, Juelich, Germany (V.N.)
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El-Khatib AH, Radbruch H, Trog S, Neumann B, Paul F, Koch A, Linscheid MW, Jakubowski N, Schellenberger E. Gadolinium in human brain sections and colocalization with other elements. NEUROLOGY-NEUROIMMUNOLOGY & NEUROINFLAMMATION 2018; 6:e515. [PMID: 30568993 PMCID: PMC6278849 DOI: 10.1212/nxi.0000000000000515] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/16/2018] [Accepted: 09/06/2018] [Indexed: 11/30/2022]
Affiliation(s)
- Ahmed H El-Khatib
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Helena Radbruch
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Sabrina Trog
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Boris Neumann
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Friedemann Paul
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Arend Koch
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Michael W Linscheid
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Norbert Jakubowski
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
| | - Eyk Schellenberger
- Department of Chemistry (A.H.E.-K., S.T., M.W.L.), Humboldt-Universität zu Berlin, Germany; Pharmaceutical Analytical Chemistry Department (A.H.E.-K.), Faculty of pharmacy, Ain Shams University, Cairo, Egypt; Bundesanstalt für Materialforschung und -prüfung (BAM) (A.H.E.-K., N.J.), Berlin, Germany; Department of Neuropathology (H.R., A.K.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Proteome Factory AG (B.N.), Berlin, Germany; Institute of Pharmacology (B.N.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; NeuroCure Clinical Research Unit Charité-Universitätsmedizin Berlin (F.P.), Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; Clinical and Experimental Multiple Sclerosis Research Center (F.P.), Department of Neurology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health; and Department of Radiology (E.S.), Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany
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Signal Changes in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Magnetic Resonance Images After Intrathecal Administration of Macrocyclic Gadolinium Contrast Agent. Invest Radiol 2018; 53:535-540. [DOI: 10.1097/rli.0000000000000472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Young JR, Pope WB, Bobinski M. Gadolinium Deposition within the Pediatric Brain: No Increased Intrinsic T1-Weighted Signal Intensity within the Dentate Nucleus following the Administration of a Minimum of 4 Doses of the Macrocyclic Agent Gadoteridol. AJNR Am J Neuroradiol 2018; 39:1604-1608. [PMID: 30093477 DOI: 10.3174/ajnr.a5748] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 06/05/2018] [Indexed: 01/21/2023]
Abstract
BACKGROUND AND PURPOSE Our aim was to evaluate whether serial administration of the macrocyclic gadolinium-based contrast agent gadoteridol in children is associated with T1-weighted hyperintensity within the dentate nucleus, an imaging surrogate for gadolinium deposition. MATERIALS AND METHODS We identified a retrospective cohort of 10 patients younger than 18 years of age who underwent between 4 and 8 gadoteridol-enhanced MR imaging examinations of the brain from 2016 to 2017. For comparison, we identified a retrospective cohort of 9 pediatric patients who each underwent 6 gadodiamide-enhanced MR imaging examinations. For each examination, both dentate nuclei were contoured on unenhanced images and the mean dentate-to-pons signal intensity ratio was calculated. Dentate-to-pons signal intensity ratios from the first and last scans were compared using paired t tests. RESULTS In the gadoteridol group, there was no significant change in the mean dentate-to-pons signal intensity ratio from the first to the last scan (0.99 versus 0.99, P = .59). In the gadodiamide group, there was a significant increase in the mean dentate-to-pons signal intensity ratio from the first to the last scan (0.99 versus 1.10, P = .001). CONCLUSIONS Repeat administration of the macrocyclic gadolinium-based contrast agent gadoteridol in children was not associated with T1-weighted dentate hyperintensity, while the repeat administration of the linear gadolinium-based contrast agent gadodiamide was associated with T1-weighted dentate hyperintensity, presumably due to gadolinium deposition.
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Affiliation(s)
- J R Young
- From the Department of Radiology (J.R.Y., M.B.), University of California Davis School of Medicine, Sacramento, California
| | - W B Pope
- Department of Radiology (W.B.P.), David Geffen School of Medicine at University of California at Los Angeles, Los Angeles, California
| | - M Bobinski
- From the Department of Radiology (J.R.Y., M.B.), University of California Davis School of Medicine, Sacramento, California
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16
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Reply to: RE: effects of serial macrocyclic-based contrast materials gadoterate meglumine and gadobutrol administrations on gadolinium-related dentate nuclei signal increases in unenhanced T1-weighted brain—a retrospective study in 158 multiple sclerosis (MS) patients. Radiol Med 2018; 123:535-537. [DOI: 10.1007/s11547-018-0876-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/13/2018] [Indexed: 11/25/2022]
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17
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Gadolinium deposition within the paediatric brain: no increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of a minimum of four doses of the macrocyclic agent gadobutrol. Eur Radiol 2018; 28:4882-4889. [PMID: 29744642 DOI: 10.1007/s00330-018-5464-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 03/18/2018] [Accepted: 04/05/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To determine whether repeated administration of the macrocyclic gadolinium-based contrast agent (GBCA) gadobutrol in children is associated with T1-weighted hyperintensity within the dentate nucleus, an imaging surrogate for gadolinium deposition. METHODS With institutional review board approval, we identified a cohort of eight patients aged 18 years or younger who underwent at least four gadobutrol-enhanced magnetic resonance imaging (MRI) examinations of the brain from 2013 to 2017. For comparison, we identified a cohort of 19 patients who underwent at least four gadopentetate dimeglumine-enhanced MRI examinations. For each examination, both dentate nuclei were contoured on unenhanced images; the mean dentate-to-pons signal intensity (DN-P SI) ratio was calculated. DN-P SI ratios from the first and last MRI exams were compared using Wilcoxon signed ranks tests and linear regression analyses. RESULTS In the gadobutrol cohort, there was no significant change in the mean DN-P SI ratio from the first to the last scan (1.02 vs 1.02, p = 1.00). In the gadopentetate dimeglumine cohort, there was a significant increase in the mean DN-P SI ratio from the first to the last scan (1.05 vs 1.13, p = 0.003). After controlling for potentially confounding variables, the change in DN-P SI ratio from the first to the last scan was significantly lower for patients in the gadobutrol group than in the gadopentetate dimeglumine group (β = -0.08, p = 0.04). CONCLUSIONS Repeated administration of the macrocyclic GBCA gadobutrol in children was not associated with T1-weighted dentate hyperintensity, while the repeated administration of the linear GBCA gadopentetate dimeglumine was associated with T1-weighted dentate hyperintensity, presumably due to gadolinium deposition. KEY POINTS • Gadolinium-based contrast agents are routinely used in magnetic resonance imaging. • Repeated administration of the macrocyclic agent gadobutrol in children was not associated with T1-weighted dentate hyperintensity.
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18
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Pullicino R, Radon M, Biswas S, Bhojak M, Das K. A Review of the Current Evidence on Gadolinium Deposition in the Brain. Clin Neuroradiol 2018. [PMID: 29523896 DOI: 10.1007/s00062-018-0678-0] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Over the past 3 years, gadolinium-based contrast agents have been linked to MRI signal changes in the brain, which have been found to be secondary to gadolinium deposition in the brain, particularly in the dentate nuclei and globus pallidus even in patients having an intact blood-brain barrier and a normal renal function. This tends to occur more in linear agents than with macrocyclic agents. Nonetheless, there has been no significant evidence that this has any clinical consequence. We reviewed the current evidence related to this new phenomenon and the precautionary approach taken by regulatory agencies.
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Affiliation(s)
- Richard Pullicino
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK.
| | - Mark Radon
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Shubhabrata Biswas
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Maneesh Bhojak
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
| | - Kumar Das
- Neuroradiology Department, The Walton Centre NHS Foundation Trust, Lower Lane, L9 7LJ, Liverpool, UK
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19
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Bolles GM, Yazdani M, Stalcup ST, Creeden SG, Collins HR, Nietert PJ, Roberts DR. Development of High Signal Intensity within the Globus Pallidus and Dentate Nucleus following Multiple Administrations of Gadobenate Dimeglumine. AJNR Am J Neuroradiol 2018; 39:415-420. [PMID: 29348135 DOI: 10.3174/ajnr.a5510] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Accepted: 10/30/2017] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Previous studies have evaluated various gadolinium based contrast agents and their association with gadolinium retention, however, there is a discrepancy in the literature concerning the linear agent gadobenate dimeglumine. Our aim was to determine whether an association exists between the administration of gadobenate dimeglumine and the development of intrinsic T1-weighted signal in the dentate nucleus and globus pallidus. MATERIALS AND METHODS In this single-center, retrospective study, the signal intensity of the globus pallidus, dentate nucleus, thalamus, and middle cerebellar peduncle was measured on unenhanced T1-weighted images in 29 adult patients who had undergone multiple contrast MRIs using exclusively gadobenate dimeglumine (mean, 10.1 ± 3.23 doses; range, 6-18 doses). Two neuroradiologists, blinded to the number of prior gadolinium-based contrast agent administrations, separately placed ROIs within the globi pallidi, thalami, dentate nuclei, and middle cerebellar peduncles on the last MR imaging examinations. The correlations between the globus pallidus:thalamus and the dentate nucleus:middle cerebellar peduncle signal intensity ratios with the number of gadolinium-based contrast agent administrations and cumulative dose were tested with either 1-tailed Pearson or Spearman correlations. A priori, P < .05 was considered statistically significant. RESULTS Both the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the number of gadolinium-based contrast agent administrations (r = 0.39, P = .017, and r = 0.58, P = .001, respectively). Additionally, the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncle ratios showed significant correlation with the cumulative dose of gadobenate dimeglumine (r = 0.48, P = .004, and r = 0.43, P = .009, respectively). Dentate nucleus hyperintensity was qualitatively present on the last MR imaging in 79.3%-86.2% of patients and in all patients who had received >10 doses. CONCLUSIONS At high cumulative doses (commonly experienced by patients, for example, with neoplastic disease), gadobenate dimeglumine is associated with an increase in the globus pallidus:thalamus and dentate nucleus:middle cerebellar peduncles signal intensity ratios.
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Affiliation(s)
- G M Bolles
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - M Yazdani
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - S T Stalcup
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - S G Creeden
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - H R Collins
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
| | - P J Nietert
- Department of Public Health Sciences (P.J.N.), Medical University of South Carolina, Charleston, South Carolina
| | - D R Roberts
- From the Department of Radiology and Radiological Sciences (G.M.B., M.Y., S.T.S., S.G.C., H.R.C., D.R.R.), Department of Neuroradiology
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