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Lattanzio SM, Imbesi F. Fibromyalgia associated with repeated gadolinium contrast-enhanced MRI examinations. Radiol Case Rep 2020; 15:534-541. [PMID: 32180856 PMCID: PMC7063147 DOI: 10.1016/j.radcr.2020.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Revised: 01/28/2020] [Accepted: 02/08/2020] [Indexed: 11/14/2022] Open
Abstract
We report a case of a fibromyalgia (FM) patient with an history of brain-cancer presenting signs and symptoms of gadolinium toxicity following repeated administrations of a macrocyclic contrast agent, Gadovist. In the present report, we provide evidence supporting the hypothesis of a causal relationship linking gadolinium deposition to a clinical manifestation of disease, namely fibromyalgia. We unravel a role for gadolinium in the still unknown etiology of fibromyalgia as a metal toxicity disorder. Contrast agents are routinely administered in a clinical context. It is thus possible that the patients are mistakenly believed to show complaint of their primary disease, whereas, in some instances, their symptoms are associated with gadolinium deposition.
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Affiliation(s)
- Silvia Maria Lattanzio
- Department of Biomedical Sciences, University of Padova, Via Marzolo 3, 35131, Padova, Italy
| | - Francesca Imbesi
- Neurological Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
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Bunz H, Tschritter O, Haap M, Riessen R, Heyne N, Artunc F. Elimination of Contrast Agent Gadobutrol with Sustained Low Efficiency Daily Dialysis Compared to Intermittent Hemodialysis. Kidney Blood Press Res 2019; 44:1363-1371. [PMID: 31751997 DOI: 10.1159/000502960] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 08/24/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND In patients with renal failure, gadolinium-based contrast agents (GBCA) can be removed by intermittent hemodialysis (iHD) to prevent possible toxic effects. There is no data on the efficacy of GBCA removal via sustained low efficiency daily dialysis (SLEDD) which is mainly used in intensive care unit (ICU) patients. METHODS We compared the elimination of the GBCA gadobutrol in 6 ICU patients treated with SLEDD (6-12 h, 90 L dialysate) with 7 normal ward inpatients treated with iHD (4 h, dialysate flow 500 mL/min). Both groups received 3 dialysis sessions on 3 consecutive days starting after the application of gadobutrol. Blood samples were drawn before and after each session and total dialysate, as well as urine was collected. Gadolinium (Gd) concentrations were measured using mass spectrometry and eliminated Gd was calculated from dialysate and urine. RESULTS The initial mean plasma Gd concentration was 385 ± 183 µM for the iHD and 270 ± 97 µM for the SLEDD group, respectively (p > 0.05). The Gd-reduction rate after the first dialysis session was 83 ± 9 and 67 ± 9% for the iHD and the SLEDD groups, respectively (p = 0.0083). The Gd-reduction rate after the second and third dialysis was 94-98 and 89-96% for the iHD and the SLEDD groups (p > 0.05). The total eliminated Gd was 89 ± 14 and 91 ± 4% of the dose in the iHD and the SLEDD groups, respectively (p > 0.05). Gd dialyzer clearance was 95 ± 22 mL/min and 79 ± 19 mL/min for iHD and SLEDD, respectively (p > 0.05). CONCLUSIONS Gd-elimination with SLEDD is equally effective as iHD and can be safely used to remove GBCA in ICU patients.
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Affiliation(s)
- Hanno Bunz
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany, .,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of Tübingen, Tübingen, Germany, .,German Center for Diabetes Research (DZD), University of Tübingen, Tübingen, Germany,
| | - Otto Tschritter
- Department of Emergency Medicine, St. Mary´s Hospital, Stuttgart, Germany
| | - Michael Haap
- Department of Internal Medicine, Internal Intensive Care Unit, Tübingen, Germany
| | - Reimer Riessen
- Department of Internal Medicine, Internal Intensive Care Unit, Tübingen, Germany
| | - Nils Heyne
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), University of Tübingen, Tübingen, Germany
| | - Ferruh Artunc
- Department of Internal Medicine, Division of Endocrinology, Diabetology, Vascular Medicine, Nephrology and Clinical Chemistry, University Hospital Tübingen, Tübingen, Germany.,Institute of Diabetes Research and Metabolic Diseases (IDM), Helmholtz Center Munich, University of Tübingen, Tübingen, Germany.,German Center for Diabetes Research (DZD), University of Tübingen, Tübingen, Germany
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Nachtigall LB, Karavitaki N, Kiseljak-Vassiliades K, Ghalib L, Fukuoka H, Syro LV, Kelly D, Fleseriu M. Physicians' awareness of gadolinium retention and MRI timing practices in the longitudinal management of pituitary tumors: a "Pituitary Society" survey. Pituitary 2019; 22:37-45. [PMID: 30456434 PMCID: PMC6697166 DOI: 10.1007/s11102-018-0924-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE In view of mounting attention related to possible brain retention of gadolinium-based contrast agents (GBCAs) in patients with normal renal function, our purpose was to detail results from a survey of pituitary experts to assess: 1) the timing interval and frequency of pituitary magnetic resonance imaging (MRI) following surgical and/or medical and/or radiation therapy of pituitary tumors, 2) awareness of the types of GBCAs used and their possible safety issues. METHODS The Pituitary Society Education Committee composed a survey with 12 multiple choice questions, 8 of which specifically addressed the time interval and frequency of MRI in the longitudinal management of pituitary tumors. The survey was distributed at two meetings; the International Pituitary Neurosurgeons Society conference in San Diego, CA, on February 18th, 2018, and the Pituitary Society Membership and Career Development Forum, Chicago, IL on March 18th, 2018. RESULTS There is consensus among pituitary endocrinologists and neurosurgeons that long-term repeated imaging is recommended in most pituitary tumors, although the precise strategy of timing varied depending on the specialist group and the specific clinical context of the adenoma. The data also suggest that International Pituitary Neurosurgeons Society neurosurgeons, as well as Pituitary Society neuroendocrinologists, are sometimes unaware of which contrast agents are used by their institution, and many are also unaware that evidence of long-term brain retention has been reported with the use of GBCAs in patients with normal function. CONCLUSIONS International pituitary endocrinologists and pituitary neurosurgeons experts suggest ongoing MRIs for the management of pituitary tumors; strategies vary based on clinical context, but also on individual experience and practice.
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Affiliation(s)
- Lisa B Nachtigall
- Neuroendocrine Unit, Massachusetts General Hospital, Harvard Medical School Boston, Boston, MA, USA
| | - Niki Karavitaki
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners, University of Birmingham, Birmingham, UK
| | - Katja Kiseljak-Vassiliades
- Division of Endocrinology, Metabolism and Diabetes, Department of Medicine, University of Colorado School of Medicine at Colorado Anschutz Medical Campus, Aurora, CO, USA
| | - Luma Ghalib
- Division of Endocrinology, Ohio State University, Columbus, OH, USA
| | - Hidenori Fukuoka
- Division of Diabetes and Endocrinology, Kobe University Hospital, Kobe, Japan
| | - Luis V Syro
- Department of Neurosurgery, Hospital Pablo Tobon Uribe and Clinica Medellin, Medellín, Colombia
| | - Daniel Kelly
- Pacific Neuroscience Institute & John Wayne Cancer Institute, Santa Monica, CA, USA
| | - Maria Fleseriu
- Departments of Medicine and Neurological Surgery, Northwest Pituitary Center, Oregon Health & Science University, Mail Code: CH8N, 3303 SW Bond Ave., Portland, OR, 97239, USA.
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Paschoal AM, Leoni RF, Dos Santos AC, Paiva FF. Intravoxel incoherent motion MRI in neurological and cerebrovascular diseases. Neuroimage Clin 2018; 20:705-714. [PMID: 30221622 PMCID: PMC6141267 DOI: 10.1016/j.nicl.2018.08.030] [Citation(s) in RCA: 48] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 08/27/2018] [Accepted: 08/30/2018] [Indexed: 12/20/2022]
Abstract
Intravoxel Incoherent Motion (IVIM) is a recently rediscovered noninvasive magnetic resonance imaging (MRI) method based on diffusion-weighted imaging. It enables the separation of the intravoxel signal into diffusion due to Brownian motion and perfusion-related contributions and provides important information on microperfusion in the tissue and therefore it is a promising tool for applications in neurological and neurovascular diseases. This review focuses on the basic principles and outputs of IVIM and details it major applications in the brain, such as stroke, tumor, and cerebral small vessel disease. A bi-exponential model that considers two different compartments, namely capillaries, and medium-sized vessels, has been frequently used for the description of the IVIM signal and may be important in those clinical applications cited before. Moreover, the combination of IVIM and arterial spin labeling MRI enables the estimation of water permeability across the blood-brain barrier (BBB), suggesting a potential imaging biomarker for disrupted-BBB diseases.
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Affiliation(s)
- André M Paschoal
- Inbrain Lab, Department de Física, FFCLRP, Universidade de São Paulo, São Carlos, SP, Brazil
| | - Renata F Leoni
- Inbrain Lab, Department de Física, FFCLRP, Universidade de São Paulo, São Carlos, SP, Brazil
| | - Antonio C Dos Santos
- Departamento de Clínica Médica, FMRP, Universidade de São Paulo, São Carlos, SP, Brazil
| | - Fernando F Paiva
- Instituto de Física de São Carlos, Universidade de São Paulo, São Carlos, SP, Brazil.
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