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Vergauwen E, Vanbinst AM, Brussaard C, Janssens P, De Clerck D, Van Lint M, Houtman AC, Michel O, Keymolen K, Lefevere B, Bohler S, Michielsen D, Jansen AC, Van Velthoven V, Gläsker S. Central nervous system gadolinium accumulation in patients undergoing periodical contrast MRI screening for hereditary tumor syndromes. Hered Cancer Clin Pract 2018; 16:2. [PMID: 29312473 PMCID: PMC5756358 DOI: 10.1186/s13053-017-0084-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Accepted: 12/28/2017] [Indexed: 12/17/2022] Open
Abstract
Background Patients with hereditary tumor syndromes undergo periodical magnetic resonance imaging (MRI) screening with Gadolinium contrast. Gadolinium accumulation has recently been described in the central nervous system after repeated administrations. The prevalence and rate of accumulation in different subgroups of patients are unknown. Neither are the mechanism nor clinical impact. This may cause uncertainty about the screening. To explore the prevalence and rate of Gadolinium accumulation in different subgroups, we retrospectively analyzed MRIs of patients with von Hippel-Lindau disease (VHL) and Tuberous Sclerosis Complex (TSC). Methods We determined the prevalence and rate of accumulation in the dentate nucleus and globus pallidus on unenhanced T1-weighted MRI from VHL and TSC patients. We compared the signal intensities of these regions to the signal intensity of the pons. We evaluated the impact of number of MRIs, kidney function and liver function on Gadolinium accumulation. Results Twenty eight VHL patients and 24 TSC patients were included. The prevalence of accumulation in the dentate nucleus and globus pallidus increased linearly according to number of Gadolinium enhanced MRIs and was higher in the VHL group (100%). A significant linear correlation between number of MRIs and increased signal intensity was observed in the VHL group. Conclusions Gadolinium accumulation occurs in almost all patients undergoing contrast MRI screening after >5 MRIs. We advocate a screening protocol for patients with hereditary tumor syndromes that minimizes the Gadolinium dose. This can be accomplished by using a single administration to simultaneously screen for brain, spine and/or abdominal lesions, using an MRI protocol focused on either VHL- or TSC-specific lesions. Higher prevalence and rate of accumulation in VHL patients may be explained by the typical vascular leakage accompanying central nervous system hemangioblastomas.
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Affiliation(s)
- Evelynn Vergauwen
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | | | - Carola Brussaard
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Peter Janssens
- Department of Nephrology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dieter De Clerck
- Department of Nephrology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Michel Van Lint
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Anne C Houtman
- Department of Ophthalmology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Olaf Michel
- Department of Otorhinolaryngology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Kathelijn Keymolen
- Department of Genetics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Bieke Lefevere
- Department of Psychology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Susanne Bohler
- Department of Psychology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Dirk Michielsen
- Department of Urology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Anna C Jansen
- Department of Pediatrics, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Vera Van Velthoven
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
| | - Sven Gläsker
- Department of Neurosurgery, Universitair Ziekenhuis Brussel, Laarbeeklaan 101, 1090 Brussels, Belgium
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Rogosnitzky M, Branch S. Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms. Biometals 2016; 29:365-76. [PMID: 27053146 PMCID: PMC4879157 DOI: 10.1007/s10534-016-9931-7] [Citation(s) in RCA: 433] [Impact Index Per Article: 54.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Accepted: 03/30/2016] [Indexed: 11/01/2022]
Abstract
Gadolinium chelates are widely used as contrast media for magnetic resonance imaging. The approved gadolinium-based contrast agents (GBCAs) have historically been considered safe and well tolerated when used at recommended dosing levels. However, for nearly a decade, an association between GBCA administration and the development of nephrogenic systemic fibrosis (NSF) has been recognized in patients with severe renal impairment. This has led to modifications in clinical practices aimed at reducing the potential and incidence of NSF development. Newer reports have emerged regarding the accumulation of gadolinium in various tissues of patients who do not have renal impairment, including bone, brain, and kidneys. Despite the observations of gadolinium accumulation in tissues regardless of renal function, very limited clinical data regarding the potential for and mechanisms of toxicity is available. This significant gap in knowledge warrants retrospective cohort study efforts, as well as prospective studies that involve gadolinium ion (Gd(3+)) testing in patients exposed to GBCA. This review examines the potential biochemical and molecular basis of gadolinium toxicity, possible clinical significance of gadolinium tissue retention and accumulation, and methods that can limit gadolinium body burden.
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Affiliation(s)
- Moshe Rogosnitzky
- MedInsight Research Institute, Baltimore, MD, 21202, USA. .,Center for Drug Repurposing, Ariel University, 40700, Ariel, Israel.
| | - Stacy Branch
- MedInsight Research Institute, Baltimore, MD, 21202, USA
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