Benefits and Detriments of Gadolinium from Medical Advances to Health and Ecological Risks

Comparison of 3T MR arthrography and 3T MRI in intra-articular hip pathology: a cost-analysis

BACKGROUND

MR arthrography (MRA) has previously been the radiological gold standard for investigating labral and chondral lesions of the hip joint. In recent years, 3T MRI has demonstrated comparable accuracy, being adopted as the first-line imaging investigation in many institutions.

AIMS

We compare the associated increased cost and radiation dose of the fluoroscopic component of the MRA compared to MRI.

METHODS

In this retrospective review over 2 years, 120 patients (mean age 27.3 years ± 13.2, range 8-67) underwent 3T MRA or non-contrast 3T MRI. Three musculoskeletal radiologists reported the data independently. Primary objectives included cost-comparison between each and radiation dose of the fluoroscopic component of the MRA. Secondary objectives included comparing detection of pathology involving the acetabular labrum, femoral cartilage, and acetabular cartilage.

RESULTS

Then, 58 (48%) underwent 3T MRA and 62 (52%) patients underwent 3T MRI. The added cost of the fluoroscopic injection prior to MRA was €116.31/patient, equating to €7211.22 savings/year. MRA was associated with a small radiation dose of 0.003 mSv.

CONCLUSIONS

Transitioning from 3T MRA to 3T MRI in the investigation of intra-articular hip pathology increases cost savings and reduces radiation dose.

Contrast Media-driven Anthropogenic Gadolinium: Knowns and Unknowns

Gadolinium-based contrast agents (GBCAs) have augmented the capabilities of MRI, which has led to their widespread and increasing use in radiology practice. GBCAs are introduced into the environment through disposal of unused product and elimination after intravenous injection, both primarily via liquid dispersion into the environment. This human introduction of gadolinium into the environment, referred to as anthropogenic gadolinium, is associated with the detection of gadolinium in water systems, raising concerns for potential adverse impact and prompting certain mitigation actions. This article summarizes the existing knowledge and problem scope, conveys the relevant underlying chemical principles of chelate dissociation, and offers an inferred perspective that the magnitude of the problem is most unlikely to cause human harm. The merits and limitations regarding possible mitigation tactics, such as collecting urine after GBCA administration, use of lower-dose high-relaxivity macrocyclic GBCAs, and the option for virtual contrast-enhanced examinations, will be discussed. Finally, the potential for monitoring gadolinium uptake in bone will be presented, and recommendations for future research will be offered. © RSNA, 2024 See also the article by Ibrahim et al in this issue. See also the article by McKee et al in this issue.

Gadolinium Effects on Liposome Fluidity and Size Depend on the Headgroup and Side Chain Structure of Key Mammalian Brain Lipids

The lanthanide metal gadolinium has been used in the healthcare industry as a paramagnetic contrast agent for years. Gadolinium deposition in brain tissue and kidneys has been reported following gadolinium-based contrast agent administration to patients undergoing MRI. This study demonstrates the detrimental effects of gadolinium exposure at the level of the cell membrane. Biophysical analysis using fluorescence spectroscopy and dynamic light scattering illustrates differential interactions of gadolinium ions with key classes of brain membrane lipids, including phosphatidylcholines and sphingomyelins, as well as brain polar extracts and biomimetic brain model membranes. Electrostatic attraction to negatively charged lipids like phosphatidylserine facilitates metal complexation but zwitterionic phosphatidylcholine and sphingomyelin interaction was also significant, leading to membrane rigidification and increases in liposome size. Effects were stronger for fully saturated over monounsaturated acyl chains. The metal targets key lipid classes of brain membranes and these biophysical changes could be very detrimental in biological membranes, suggesting that the potential negative impact of gadolinium contrast agents will require more scientific attention.

Comparison between Variable-Selection Algorithms in PLS Regression with Near-Infrared Spectroscopy to Predict Selected Metals in Soil

Soil is one of the Earth's most important natural resources. The presence of metals can decrease environmental quality if present in excessive amounts. Analyzing soil metal contents can be costly and time consuming, but near-infrared (NIR) spectroscopy coupled with chemometric tools can offer an alternative. The most important multivariate calibration method to predict concentrations or physical, chemical or physicochemical properties as a chemometric tool is partial least-squares (PLS) regression. However, a large number of irrelevant variables may cause problems of accuracy in the predictive chemometric models. Thus, stochastic variable-selection techniques, such as the Firefly algorithm by intervals in PLS (FFiPLS), can provide better solutions for specific problems. This study aimed to evaluate the performance of FFiPLS against deterministic PLS algorithms for the prediction of metals in river basin soils. The samples had their spectra collected from the region of 1000-2500 nm. Predictive models were then built from the spectral data, including PLS, interval-PLS (iPLS), successive projections algorithm for interval selection in PLS (iSPA-PLS), and FFiPLS. The chemometric models were built with raw data and preprocessed data by using different methods such as multiplicative scatter correction (MSC), standard normal variate (SNV), mean centering, adjustment of baseline and smoothing by the Savitzky-Golay method. The elliptical joint confidence region (EJCR) used in each chemometric model presented adequate fit. FFiPLS models of iron and titanium obtained a relative prediction deviation (RPD) of more than 2. The chemometric models for determination of aluminum obtained an RPD of more than 2 in the preprocessed data with SNV, MSC and baseline (offset + linear) and with raw data. The metals Be, Gd and Y failed to obtain adequate models in terms of residual prediction deviation (RPD). These results are associated with the low values of metals in the samples. Considering the complexity of the samples, the relative error of prediction (REP) obtained between 10 and 25% of the values adequate for this type of sample. Root mean square error of calibration and prediction (RMSEC and RMSEP, respectively) presented the same profile as the other quality parameters. The FFiPLS algorithm outperformed deterministic algorithms in the construction of models estimating the content of Al, Be, Gd and Y. This study produced chemometric models with variable selection able to determine metals in the Ipojuca River watershed soils using reflectance-mode NIR spectrometry.

Noninvasive treatment of psoriasis and skin rejuvenation using an akermanite-type narrowband emitting phosphor

Psoriasis is a noncontagious, long-lasting skin infection that affects many people around the world. Numerous therapeutic artificial treatments are available for the treatment of psoriasis, such as photodynamic therapy using broadband ultraviolet (UV) lamps, which have harmful effects on human skin. Similarly, the natural healing systems such as sunlight have a higher risk of sunburn and can cause dangerous forms of skin cancer. Significant light emission of a specific wavelength (in the UV range), and phosphor-based devices demonstrate the effectiveness of treating psoriasis without damaging the skin. Gd3+ -doped calcium magnesium silicate [Ca2 MgSi2 O7 :Gd3+ ,(CMS:Gd3+ )] phosphor is one of the ideal phosphors that emit specific narrow UV wavelengths for curing psoriasis and is in great demand in the field of dermatology. Photoluminescence analysis at room temperature (~25°C) shows that the synthesized CMS:Gd3+ phosphor emits narrowband UV-B light with a peak intensity at 314 nm. Comparative studies of the standard action spectrum of psoriasis with the emission spectrum of the CMS:Gd3+ phosphor show that the synthesized phosphor was the most suitable material for treating a variety of diseases, including psoriasis, vitiligo, type-1 diabetes, dental disease, sleep and mood disorders, and other skin diseases.

Yeast Deletomics to Uncover Gadolinium Toxicity Targets and Resistance Mechanisms

Among the rare earth elements (REEs), a crucial group of metals for high-technologies. Gadolinium (Gd) is the only REE intentionally injected to human patients. The use of Gd-based contrasting agents for magnetic resonance imaging (MRI) is the primary route for Gd direct exposure and accumulation in humans. Consequently, aquatic environments are increasingly exposed to Gd due to its excretion through the urinary tract of patients following an MRI examination. The increasing number of reports mentioning Gd toxicity, notably originating from medical applications of Gd, necessitates an improved risk-benefit assessment of Gd utilizations. To go beyond toxicological studies, unravelling the mechanistic impact of Gd on humans and the ecosystem requires the use of genome-wide approaches. We used functional deletomics, a robust method relying on the screening of a knock-out mutant library of Saccharomyces cerevisiae exposed to toxic concentrations of Gd. The analysis of Gd-resistant and -sensitive mutants highlighted the cell wall, endosomes and the vacuolar compartment as cellular hotspots involved in the Gd response. Furthermore, we identified endocytosis and vesicular trafficking pathways (ESCRT) as well as sphingolipids homeostasis as playing pivotal roles mediating Gd toxicity. Finally, tens of yeast genes with human orthologs linked to renal dysfunction were identified as Gd-responsive. Therefore, the molecular and cellular pathways involved in Gd toxicity and detoxification uncovered in this study underline the pleotropic consequences of the increasing exposure to this strategic metal.

Intracellular bioaccumulation of the rare earth element Gadolinium in ciliate cells resulting in biogenic particle formation and excretion

Ciliates are abundant unicellular organisms capable of resisting high concentrations of metal ions in the environment caused by various anthropogenic activities. Understanding the cellular pathways involved in resistance to and detoxification of elements is required to predict the impact of ciliates on environmental element cycles. Here, we investigated the so far unknown process of tolerance, cellular uptake and bioaccumulation of the emerging rare earth element gadolinium (Gd) in the common ciliate Tetrahymena pyriformis. Gd treatment results in the intracellular formation and excretion of biogenic Gd-containing particles. This cellular process effectively removes dissolved Gd from the organic growth medium by 53.37% within 72 h. Based on light and electron microscopic observations, we postulate a detoxification pathway: Cells take up toxic Gd³⁺ ions from the medium by endocytosis, process them into stable Gd-containing particles within food vacuoles, and exocytose them. Stable biogenic particles can be isolated, which are relatively homogeneous and have a diameter of about 3 µm. They consist of the elements Gd, C, O, P, Na, Mg, K, and Ca. These findings broaden the view of metal ion accumulation by protists and are of relevance to understand environmental elemental cycles and may inspire approaches for metal recovery or bioremediation.

Augmented T1 -weighted steady state magnetic resonance imaging

T₁ contrasts obtained using short-TR incoherent steady state gradient echo (GRE) methods are generally suboptimal, to which non-T₁ factors in the signals play a major part. In this work, we proposed an augmented T₁ -weighted (aT₁ W) method to extract the signal ratio between routine GRE T₁ W and proton density-weighted signals that effectively removes the non-T₁ effects from the original T₁ W signals, including proton density, T₂ * decay, and coil sensitivity. A recently proposed multidimensional integration (MDI) technique was incorporated in the aT₁ W calculation for better signal-to-noise ratio (SNR) performance. For comparison between aT₁ W and T₁ W results, Monte Carlo noise analysis was performed via simulation and on scanned data, and region-of-interest (ROI) analysis and comparison was performed on the system phantom. For brain scans, the image contrast, noise behavior, and SNR of aT₁ W images were compared with routine GRE and inversion-recovery-based T₁ W images. The proposed aT₁ W method yielded saliently improved T₁ contrasts (potentially > 30% higher contrast-to-noise ratio [CNR]) than routine GRE T₁ W images. Good spatial homogeneity and signal consistency as well as high SNR/CNR were achieved in aT₁ W images using the MDI technique. For contrast-enhanced (CE) imaging, aT₁ W offered stronger post-CE contrast and better boundary delineation than T₁ MPRAGE images while using a shorter scan time.

A perspective on the role of lanthanides in biology: Discovery, open questions and possible applications

Because of their use in high technologies like computers, smartphones and renewable energy applications, lanthanides (belonging to the group of rare earth elements) are essential for our daily lives. A range of applications in medicine and biochemical research made use of their photo-physical properties. The discovery of a biological role for lanthanides has boosted research in this new field. Several methanotrophs and methylotrophs are strictly dependent on the presence of lanthanides in the growth medium while others show a regulatory response. After the first demonstration of a lanthanide in the active site of the XoxF-type pyrroloquinoline quinone methanol dehydrogenases, follow-up studies showed the same for other pyrroloquinoline quinone-containing enzymes. In addition, research focused on the effect of lanthanides on regulation of gene expression and uptake mechanism into bacterial cells. This review briefly describes the discovery of the role of lanthanides in biology and focuses on open questions in biological lanthanide research and possible application of lanthanide-containing bacteria and enzymes in recovery of these special elements.

One-Step Preparation of Highly Stable Copper-Zinc Ferrite Nanoparticles in Water Suitable for MRI Thermometry

Superparamagnetic ferrite nanoparticles coated with a polymer layer are widely used for biomedical applications. The objective of this work is to design nanoparticles as a magnetic resonance imaging (MRI) temperature-sensitive contrast agent. Copper-zinc ferrite nanoparticles coated with a poly(ethylene glycol) (PEG) layer are synthesized using a one-step thermal decomposition method in a polymer matrix. The resulting nanoparticles are stable in water and biocompatible. Using Mössbauer spectroscopy and magnetometry, it was determined that the grown nanoparticles exhibit superparamagnetic properties. Embedding these particles into an agarose gel resulted in significant modification of water proton relaxation times T ₁, T ₂, and T ₂* determined by nuclear magnetic resonance measurements. The results of the spin-echo T ₂-weighted MR images of an aqueous phantom with embedded Cu_0.08Zn_0.54Fe_2.38O₄ nanoparticles in the presence of a strong temperature gradient show a strong correlation between the temperature and the image intensity. The presented results support the hypothesis that CuZn ferrite nanoparticles can be used as a contrast agent for MRI thermometry.

Propidium uptake and ATP release in A549 cells share similar transport mechanisms

The lipid bilayer of eukaryotic cells' plasma membrane is almost impermeable to small ions and large polar molecules, but its miniscule basal permeability in intact cells is poorly characterized. This report describes the intrinsic membrane permeability of A549 cells toward the charged molecules propidium (Pr²⁺) and ATP^4-. Under isotonic conditions, we detected with quantitative fluorescence microscopy, a continuous low-rate uptake of Pr (∼150 × 10^-21 moles (zmol)/h/cell, [Pr]_o = 150 μM, 32°C). It was stimulated transiently but strongly by 66% hypotonic cell swelling reaching an influx amplitude of ∼1500 (zmol/h)/cell. The progressive Pr uptake with increasing [Pr]_o (30, 150, and 750 μM) suggested a permeation mechanism by simple diffusion. We quantified separately ATP release with custom wide-field-of-view chemiluminescence imaging. The strong proportionality between ATP efflux and Pr²⁺ influx during hypotonic challenge, and the absence of stimulation of transmembrane transport following 300% hypertonic shock, indicated that ATP and Pr travel the same conductive pathway. The fluorescence images revealed a homogeneously distributed intracellular uptake of Pr not consistent with high-conductance channels expressed at low density on the plasma membrane. We hypothesized that the pathway consists of transiently formed water pores evenly spread across the plasma membrane. The abolition of cell swelling-induced Pr uptake with 500 μM gadolinium, a known modulator of membrane fluidity, supported the involvement of water pores whose formation depends on the membrane fluidity. Our study suggests an alternative model of a direct permeation of ATP (and other molecules) through the phospholipid bilayer, which may have important physiological implications.

Fast and automated monitoring of gadolinium-based contrast agents in surface waters

Gadolinium-based contrast agents (GBCAs) are frequently used for magnetic resonance imaging to improve image contrast. These inert complexes are excreted unmetabolized from the human body and pass through wastewater treatment plants almost unaffected, leading to a significant release of anthropogenic Gd into the environment. However, long-term ecotoxicological effects of GBCAs are mainly unknown and thus powerful methods of speciation analysis are required to monitor their distribution and fate in aquatic systems. In this work, a rapid and efficient monitoring method was developed utilizing a fully automated single platform system for total metal analysis and syringe-driven chromatography in combination with inductively coupled plasma-mass spectrometry (ICP-MS). An anion-exchange chromatography (IC) method was developed and applied to achieve a rapid separation and sensitive detection of the five complexes Gd-HP-DO3A, Gd-BT-DO3A, Gd-DOTA, Gd-DTPA, and Gd-BOPTA that are commonly administered in the European Union. Furthermore, the use of an automated inline-dilution function allowed a fast-external calibration from single stock standards. A chromatographic run time of less than 2 min and species-specific detection limits between 11 and 19 pmol L^-1 on a quadrupole ICP-MS proved to be competitive compared to previously published methods, but without the use of aerosol desolvation and/or sector field ICP-MS to enhance sensitivity. The automated IC-ICP-MS method was applied for quantitative GBCA monitoring in a multitude of surface water samples that were obtained in the German state of North Rhine-Westphalia. The complexes Gd-HP-DO3A, Gd-BT-DO3A, and Gd-DOTA, were detected and quantified. In addition, the occurrence of an unidentified Gd species was observed for one of the sampled river systems.

Synthesis of Bis(Carboranyl)amides 1,1'-μ-(CH2NH(O)C(CH2)n-1,2-C2B10H11)2 (n = 0, 1) and Attempt of Synthesis of Gadolinium Bis(Dicarbollide)

Bis(carboranyl)amides 1,1'-μ-(CH2NH(O)C(CH2)n-1,2-C2B10H11)2 (n = 0, 1) were prepared by the reactions of the corresponding carboranyl acyl chlorides with ethylenediamine. Crystal molecular structure of 1,1'-μ-(CH2NH(O)C-1,2-C2B10H11)2 was determined by single crystal X-ray diffraction. Treatment of bis(carboranyl)amides 1,1'-μ-(CH2NH(O)C(CH2)n-1,2-C2B10H11)2 with ammonium or cesium fluoride results in partial deboronation of the ortho-carborane cages to the nido-carborane ones with formation of [7,7'(8')-μ-(CH2NH(O)C(CH2)n-7,8-C2B9H11)2]2-. The attempted reaction of [7,7'(8')-μ-(CH2NH(O)CCH2-7,8-C2B9H11)2]2- with GdCl3 in 1,2-dimethoxy- ethane did not give the expected metallacarborane. The stability of different conformations of Gd-containing metallacarboranes has been estimated by quantum-chemical calculations using [3,3-μ-DME-3,3'-Gd(1,2-C2B9H11)2]- as a model. It was found that in the most stable conformation the CH groups of the dicarbollide ligands are in anti,anti-orientation with respect to the DME ligand, while any rotation of the dicarbollide ligand reduces the stability of the system. This makes it possible to rationalize the design of carborane ligands for the synthesis of gadolinium metallacarboranes on their base.