Signal changes in enhanced T1-weighted images related to gadolinium retention: A three-time-point imaging study

Safety of Gadoterate Meglumine: A Review of 35 Years of Clinical Use and More Than 170 Million Doses

AIM

The aim of this review was to evaluate the safety profile of gadoterate meglumine from published literature and pharmacovigilance reports of adverse drug reactions (ADRs) encompassing 35 years of clinical use and more than 170 million administered doses.

MATERIALS AND METHODS

A review of published literature up to December 31, 2024 was performed through a search in Embase and PubMed databases. The analysis focused on current safety concerns associated with gadolinium-based contrast agents, the hypersensitivity reactions (HSRs), nephrogenic systemic fibrosis (NSF), gadolinium accumulation, and symptoms associated with gadolinium exposure.

RESULTS

A total of 62 publications reporting safety results for gadoterate meglumine were included. Age ranged from a few weeks to 103 years, including patients with all stages of renal impairment. The incidence of HSRs was reported in 17 studies and ranged from <0.01% to 0.58%. Occurrence of NSF was analyzed in 9 studies; to date, no confirmed unconfounded case of NSF diagnosis has been associated with gadoterate meglumine use. Regarding gadolinium presence in the body, 17 studies did not show any significant signal intensity increase in the deep brain in patients after up to 53 exposures, while 4 showed some signal intensity increase in specific subgroups after repeated exposure, but without any clinical symptoms. Symptoms associated with gadolinium exposure have been described in 8 studies, although no causal relationship with gadolinium deposition was established. Safety data obtained from pharmacovigilance monitoring showed an incidence of adverse reactions in 8 cases per 100,000 patients exposed. The most frequently reported adverse reactions were urticaria, nausea, and vomiting (0.001% each), while the incidence of HSRs was less than 0.00035%. No unconfounded NSF reports were received.

CONCLUSIONS

Clinical evidence from the published data and pharmacovigilance monitoring demonstrated that gadoterate meglumine is a safe magnetic resonance imaging contrast agent for all age groups in a variety of approved indications throughout the whole body, including in patients with renal impairment.

Gadolinium deposition in the brain is related to various contrast agents: a matched case-control study

AIM

To assess the relationship between gadolinium deposition in the brain and various gadolinium-based contrast agents (GBCAs) and to explore confounding variables.

METHODS

The study group included 87 patients with multiple enhanced brain magnetic resonance imaging (MRI) examinations of which 48 patients were in the linear GBCA group (33 patients in gadopentetate dimeglumine group and 15 patients in gadobenate dimeglumine group) and 39 patients in the macrocyclic GBCA group (22 patients in gadobutrol group and 17 patients in gadoterate meglumine group). The control group included 87 normal participants who were matched regarding age, sex, MRI machine and imaging sequences to the study cohort. T1 signal intensity (SI) ratios of the dentate nucleus to the pons (DN/pons) and of the globus pallidus to the frontal white matter (GP/FWM) in both groups were calculated and compared. The relationships between SI ratios and confounding variables were analysed.

RESULTS

Significant differences were detected between two linear GBCA groups and control groups in T1 SI ratios of the DN/pons and GP/FWM (all p<0.001). There were no differences for two the macrocyclic GBCA groups compared with matching control groups (all p>0.05). T1 SI ratios of the linear GBCA group were significantly higher than those of the macrocyclic GBCA group (p<0.001). In the linear GBCA group, the T1 SI ratios of the DN/pons correlated moderately positively with the number of GBCA administrations (r=0.643, p<0.001), and MRI machine and sequence used.

CONCLUSIONS

Increased T1 SI could be observed after repeated administrations of linear GBCA. T1 SI of the DN correlated with the number of linear GBCA administrations, and detection might be affected by MRI machine and sequence.