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Oluwasola IE, Ahmad AL, Shoparwe NF, Ismail S. Gadolinium based contrast agents (GBCAs): Uniqueness, aquatic toxicity concerns, and prospective remediation. J Contam Hydrol 2022; 250:104057. [PMID: 36130428 DOI: 10.1016/j.jconhyd.2022.104057] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/25/2022] [Accepted: 08/06/2022] [Indexed: 06/15/2023]
Abstract
The current toxicity concerns of gadolinium-based contrast agents (GBCAs) have birthed the need to regulate and, sometimes restrict its clinical administration. However, tolerable concentration levels of Gd in the water sector have not been set. Therefore, the detection and speedy increase of the anthropogenic Gd-GBCAs in the various water bodies, including those serving as the primary source of drinking water for adults and children, is perturbing. Nevertheless, the strongly canvassed risk-benefit considerations and superior uniqueness of GBCAs compared to the other ferromagnetic metals guarantees its continuous administration for Magnetic resonance imaging (MRI) investigations regardless of the toxicity concerns. Unfortunately, findings have shown that both the advanced and conventional wastewater treatment processes do not satisfactorily remove GBCAs but rather risk transforming the chelated GBCAs to their free ionic metal (Gd 3+) through inadvertent degradation processes. This unintentional water processing-induced GBCA dechelation leads to the intricate pathway for unintentional human intake of Gd ion. Hence exposure to its probable ecotoxicity and several reported inimical effects on human health such as; digestive symptoms, twitching or weakness, cognitive flu, persistent skin diseases, body pains, acute renal and non-renal adverse reactions, chronic skin, and eyes changes. This work proposed an economical and manageable remediation technique for the potential remediation of Gd-GBCAs in wastewater, while a precautionary limit for Gd in public water and commercial drinks is advocated.
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Affiliation(s)
- Idowu Ebenezer Oluwasola
- School of Chemical Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Pulau Pinang, Malaysia; School of Science and Computer Studies, Food Technology Department, The Federal Polytechnic, Ado Ekiti, Ekiti State 360231, Nigeria.
| | - Abdul Latif Ahmad
- School of Chemical Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Pulau Pinang, Malaysia.
| | - Noor Fazliani Shoparwe
- Gold, Rare Earth, and Material Technopreneurship Centre (GREAT), Faculty of Bioengineering and Technology, Universiti Malaysia Kelantan, Jeli Campus, 17600 Jeli, Kelantan, Malaysia.
| | - Suzylawati Ismail
- School of Chemical Engineering, Engineering Campus, Universiti Sains Malaysia, Nibong Tebal 14300, Pulau Pinang, Malaysia.
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Green C, Jost G, Frenzel T, Boyken J, Schwenke C, Pietsch H. The Effect of Gadolinium-Based Contrast Agents on Longitudinal Changes of Magnetic Resonance Imaging Signal Intensities and Relaxation Times in the Aging Rat Brain. Invest Radiol 2022; Publish Ahead of Print. [PMID: 35125411 PMCID: PMC9172901 DOI: 10.1097/rli.0000000000000857] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The aim of the study was to investigate the possible influence of changes in the brain caused by age on relaxometric and relaxation time–weighted magnetic resonance imaging (MRI) parameters in the deep cerebellar nuclei (DCN) and the globus pallidus (GP) of Gd-exposed and control rats over the course of 1 year.
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Ranga A, Agarwal Y, Garg KJ. Gadolinium based contrast agents in current practice: Risks of accumulation and toxicity in patients with normal renal function. Indian J Radiol Imaging 2021; 27:141-147. [PMID: 28744073 PMCID: PMC5510310 DOI: 10.4103/0971-3026.209212] [Citation(s) in RCA: 43] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of primum non nocere in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood–brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.
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Affiliation(s)
- Anju Ranga
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Yatish Agarwal
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
| | - Kanika J Garg
- Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India
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Hannoun S, Kocevar G, Codjia P, Maucort-Boulch D, Cotton F, Vukusic S, Durand-Dubief F, Sappey-Marinier D. Signal Intensity Evaluation in the Dentate Nucleus and Subcortical Gray Matter : Effect of Several Administrations of Gadoterate Meglumine in Multiple Sclerosis. Clin Neuroradiol 2021; 32:677-685. [PMID: 33630120 DOI: 10.1007/s00062-021-00995-6] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 01/15/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Several studies reported gadolinium deposition in the dentate nuclei (DN) and the globus pallidus (GP) that was associated to linear GBCA administrations rather than macrocyclic. It is therefore imperative to evaluate and assess the safety of cumulative administration of gadoterate meglumine (macrocyclic). Thus, T1-weighted images (T1WI) of multiple sclerosis (MS) patients longitudinally followed for 4 years were retrospectively analyzed. METHODS In this study 44 patients, 10 with clinically isolated syndrome (CIS), 24 relapsing-remitting MS (RRMS) and 10 primary-progressive MS (PPMS) were examined every 6 months (first four scans) and then with a 1-year interval (last two scans). Image processing consisted in reorienting unenhanced T1WI to standard space, followed by B1 inhomogeneity correction. A patient-specific template was then generated to normalize T1WI signal intensity (SI) and segment the DN and subcortical GM structures. All structures were then transformed to each patient space in order to measure the SI in each region. The cerebellar peduncles (CP) and semi-oval (SO) white matter were then manually delineated and used as reference to calculate SI ratios in the DN and subcortical GM structures. A linear mixed-effect model was finally applied to longitudinally analyze SI variations. RESULTS The SI measurements performed in all structures showed no significant increases with the cumulative GBCA administration. CONCLUSION This study showed no significant SI increases within the DN and subcortical GM structures of longitudinally followed MS patients even with the cumulative administration of the macrocyclic GBCA gadoterate meglumine.
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Affiliation(s)
- Salem Hannoun
- Medical Imaging Sciences Program, Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
| | - Gabriel Kocevar
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Datascience pole, Seenovate, Lyon, France
| | - Pekes Codjia
- Service de Neurologie A, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | | | - François Cotton
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Service de Radiologie, Centre Hospitalier Lyon-Sud, Hospices Civils de Lyon, Pierre-Bénite, France
| | - Sandra Vukusic
- Service de Neurologie A, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Françoise Durand-Dubief
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France.,Service de Neurologie A, Hôpital Neurologique, Hospices Civils de Lyon, Bron, France
| | - Dominique Sappey-Marinier
- CREATIS-CNRS UMR5220 & INSERM U1206, INSA-Lyon, Université Claude Bernard Lyon 1, Université de Lyon, Lyon, France. .,CERMEP-Imagerie du Vivant, Université de Lyon, Bron, France.
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Michalik K, Beyer L, Zeman F, Wendl C, Rennert J, Fellner C, Stroszczynski C, Wiggermann P. Signal intensity in the dentate nucleus after cumulative dose of Gd-EOB-DTPA: First results of a prospective longitudinal study. Clin Hemorheol Microcirc 2020; 76:233-240. [PMID: 32925023 DOI: 10.3233/ch-209219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA) is a hepatocyte-specific, linear ionic contrast agent for MRI. In comparison to other linear contrast agents Gd-EOB-DTPA is excreted equally through liver and kidneys. This prospective longitudinal study investigates the signal intensity (SI) in the dentate nucleus (DN) on unenhanced T1-weighted images after repetitive application of Gd-EOB-DTPA. 46 patients were included into the study and 107 MRI examinations were performed. Statistical analysis of 25 patients showed no significant correlation between cumulative dose of Gd-EOB-DTPA and SI change and between the DN/Pons ratiolast and the mean DN/Pons ratiofirst. Subgroup analysis however revealed a significant correlation for one out of two readers. Gd-EOB-DTPA deposition could not be proven in the framework of this study.
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Affiliation(s)
| | - Lukas Beyer
- Department of Radiology, Hospital Potsdam, Potsdam, Germany
| | - Florian Zeman
- Center for Clinical Trials, University Hospital Regensburg, Regensburg, Germany
| | - Christina Wendl
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Janine Rennert
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
| | - Claudia Fellner
- Department of Radiology, University Hospital Regensburg, Regensburg, Germany
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Damme NM, Fernandez DP, Wang LM, Wu Q, Kirk RA, Towner RA, McNally JS, Hoffman JM, Morton KA. Analysis of retention of gadolinium by brain, bone, and blood following linear gadolinium-based contrast agent administration in rats with experimental sepsis. Magn Reson Med 2019; 83:1930-1939. [PMID: 31677194 DOI: 10.1002/mrm.28060] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/09/2019] [Accepted: 10/10/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE It is important to identify populations that may be vulnerable to the brain deposition of gadolinium (Gd) from MRI contrast agents. At intervals from 24 hours to 6 weeks following injection of a linear Gd contrast agent, the brain, blood and bone content of Gd were compared between control rats and those with experimental endotoxin-induced sepsis that results in neuroinflammation and blood-brain barrier disruption. METHODS Male rats were injected intraperitoneally with 10 mg/kg lipopolysaccharide. Control animals received no injection. Twenty-four hours later, 0.2 mmol/kg of gadobenate dimeglumine was injected intravenously. Brain, blood, and bone Gd levels were measured at 24 hours, 1 week, 3 weeks, and 6 weeks by inductively coupled plasma mass spectroscopy. RESULTS Blood Gd decreased rapidly between 24 hours and 1 week, and thereafter was undetectable, with no significant difference between lipopolysaccharide and control rats. Brain levels of Gd were significantly higher (4.29-2.36-fold) and bone levels slightly higher (1.35-1.11-fold) in lipopolysaccharide than control rats at all time points with significant retention at 6 weeks. CONCLUSION Experimental sepsis results in significantly higher deposition of Gd in the brain and bone in rats. While blood Gd clears rapidly, brain and bone retained substantial Gd even at 6 weeks following contrast injection.
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Affiliation(s)
- Nikolas M Damme
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Diego P Fernandez
- Department of Geology and Geophysics, University of Utah, Salt Lake City, Utah
| | - Li-Ming Wang
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Qi Wu
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Ryan A Kirk
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Rheal A Towner
- Advanced Magnetic Resonance Center, Oklahoma Medical Research Foundation, Oklahoma City, Oklahoma
| | - J Scott McNally
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - John M Hoffman
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
| | - Kathryn A Morton
- Department of Radiology and Imaging Sciences, University of Utah, Salt Lake City, Utah
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Hannoun S, Issa R, El Ayoubi NK, Haddad R, Baalbaki M, Yamout BI, Khoury SJ, Hourani R. Gadoterate Meglumine Administration in Multiple Sclerosis has no Effect on the Dentate Nucleus and the Globus Pallidus Signal Intensities. Acad Radiol 2019; 26:e284-e291. [PMID: 30527456 DOI: 10.1016/j.acra.2018.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 11/09/2018] [Accepted: 11/15/2018] [Indexed: 12/12/2022]
Abstract
RATIONALE AND OBJECTIVES Previous studies on possible accumulation of gadolinium-based contrast agents (GBCA) in the brain suggest that macrocyclic GBCA are less likely to accumulate than linear GBCA. However, conflicting results have been reported, especially in MS. The aim of this study is to investigate retrospectively the correlation between gadoterate-meglumine (macrocyclic GBCA) use and T1 signal intensity changes (SI) in the dentate nucleus and the GP on unenhanced T1-weighted images in a large cohort of MS patients. MATERIALS AND METHODS Unenhanced T1-weighted images of 232 MS patients who previously received multiple intravenous administrations of 0.1 mmol/kg of gadoterate-meglumine were reviewed. The change in T1 SI ratios of dentate nucleus/central pons (DN/CP) and globus pallidus/centrum semiovale (GP/CSO) was calculated between the first and last MRIs and correlated with age, number of injections, time interval between MRIs, disease duration, activity, and therapy. RESULTS DN/CP ratio showed no significant changes whereas the GP/CSO ratio showed a significant decrease (p < 0.0001) between the first and last MRIs. Multivariable analyses of both ratios, controlling for age, disease duration, and time interval between MRIs, showed no significant correlation between the number of gadolinium injections and the differences in DN/CP (standardized beta = -0.018, p = 0.811) or GP/CSO SI ratios (standardized beta = -0.049, p = 0.499). CONCLUSION Repeated administration of gadoterate-meglumine in MS patients did not result in increased T1 SI in the DN or the GP. The significant decrease of GP/CSO ratio between the first and last MRIs is not due to gadolinium accumulation but rather to varying MR parameters.
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Affiliation(s)
- Salem Hannoun
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Rayane Issa
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Nabil K El Ayoubi
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ribal Haddad
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Marwa Baalbaki
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Bassem I Yamout
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon
| | - Samia J Khoury
- Nehme and Therese Tohme Multiple Sclerosis Center, American University of Beirut Medical Center, Beirut, Lebanon; Abu-Haidar Neuroscience Institute, Faculty of Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Roula Hourani
- Department of Diagnostic Radiology, American University of Beirut Medical Center, Beirut, Lebanon.
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Ballet S, Desché P. Re: “Increased signal intensity in the unenhanced T1-weighted magnetic resonance in the brain after repeated administrations of a macrocyclic-ionic gadolinium-based contrast agent”. Journal of Surgery and Medicine 2019. [DOI: 10.28982/josam.602855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Boyken J, Frenzel T, Lohrke J, Jost G, Pietsch H. 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 2018; 53:278-85. [PMID: 29319556 DOI: 10.1097/RLI.0000000000000440] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [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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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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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Bhargava R, Persad ARL, Bhargava NK, Hawkes M. Multiple Administrations of Gadobutrol in the Pediatric Brain: No Change in T1 Signal at MRI. Radiology 2018; 289:204-209. [DOI: 10.1148/radiol.2018172988] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Ravi Bhargava
- From the Department of Diagnostic Imaging and Radiology, University of Alberta Hospital, 8215 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.B.); Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada (A.R.L.P.); and Departments of Science (N.K.B.) and Pediatrics (M.H.), University of Alberta, Edmonton, Canada
| | - Amit R. L. Persad
- From the Department of Diagnostic Imaging and Radiology, University of Alberta Hospital, 8215 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.B.); Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada (A.R.L.P.); and Departments of Science (N.K.B.) and Pediatrics (M.H.), University of Alberta, Edmonton, Canada
| | - Nikhilesh K. Bhargava
- From the Department of Diagnostic Imaging and Radiology, University of Alberta Hospital, 8215 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.B.); Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada (A.R.L.P.); and Departments of Science (N.K.B.) and Pediatrics (M.H.), University of Alberta, Edmonton, Canada
| | - Michael Hawkes
- From the Department of Diagnostic Imaging and Radiology, University of Alberta Hospital, 8215 112 St NW, Edmonton, AB, Canada T6G 2B7 (R.B.); Division of Neurosurgery, Department of Surgery, University of Saskatchewan, Saskatoon, Canada (A.R.L.P.); and Departments of Science (N.K.B.) and Pediatrics (M.H.), University of Alberta, Edmonton, Canada
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Guo BJ, Yang ZL, Zhang LJ. Gadolinium Deposition in Brain: Current Scientific Evidence and Future Perspectives. Front Mol Neurosci 2018; 11:335. [PMID: 30294259 PMCID: PMC6158336 DOI: 10.3389/fnmol.2018.00335] [Citation(s) in RCA: 131] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 08/27/2018] [Indexed: 01/18/2023] Open
Abstract
In the past 4 years, many publications described a concentration-dependent deposition of gadolinium in the brain both in adults and children, seen as high signal intensities in the globus pallidus and dentate nucleus on unenhanced T1-weighted images. Postmortem human or animal studies have validated gadolinium deposition in these T1-hyperintensity areas, raising new concerns on the safety of gadolinium-based contrast agents (GBCAs). Residual gadolinium is deposited not only in brain, but also in extracranial tissues such as liver, skin, and bone. This review summarizes the current evidence on gadolinium deposition in the human and animal bodies, evaluates the effects of different types of GBCAs on the gadolinium deposition, introduces the possible entrance or clearance mechanism of the gadolinium and potential side effects that may be related to the gadolinium deposition on human or animals, and puts forward some suggestions for further research.
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Affiliation(s)
- Bang J. Guo
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, China
| | - Zhen L. Yang
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
| | - Long J. Zhang
- Department of Medical Imaging, Jinling Hospital, Nanjing Clinical School, Southern Medical University, Nanjing, China
- Department of Medical Imaging, Jinling Hospital, Medical School of Nanjing University, Nanjing, China
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Malhotra A, LeSar B, Wu X, Durand D, Das N, Anzai Y, Sanelli P. Progressive T1 Shortening of the Dentate Nucleus in Patients With Multiple Sclerosis: Result of Multiple Administrations of Linear Gadolinium Contrast Agents Versus Intrinsic Disease. AJR Am J Roentgenol 2018; 211:1099-105. [PMID: 30160975 DOI: 10.2214/AJR.17.19155] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this article is to study the effect of the administration of multiple IV doses of gadolinium-based contrast agent on the intrinsic T1 hyperintensity in the dentate nucleus and globus pallidus in patients with multiple sclerosis (MS). MATERIALS AND METHODS A retrospective review of imaging in patients with relapsing-remitting MS was performed. Images of 20 patients who received four or more doses of gadolinium-based contrast agent were reviewed. Patients received the linear agent gadopentetate dimeglumine before 2011 and the macrocyclic agent gadobutrol from 2011 onward. Dentate nucleus-to-pons and globus pallidus-to-thalamus signal intensity (SI) ratios were evaluated. SI ratios were compared over time with multiple injections of gadolinium. Similar SI ratios were evaluated for six patients who received gadopentetate dimeglumine and then underwent multiple subsequent MRI studies without contrast agent administration. RESULTS The increase in the dentate nucleus-to-pons SI ratio after multiple administrations of the linear agent gadopentetate dimeglumine (mean = 1.44; SD = 2.50) was significantly higher than that with the macrocyclic agent gadobutrol (mean = -0.11; SD = 2.33) (p < 0.001). The globus pallidus-to-thalamus and dentate nucleus-to-CSF ratios also increased with multiple contrast injections over time, but the changes were not found to be statistically significant. The increase in SI in the dentate nucleus was not observed in patients who stopped receiving contrast injections, after showing a previous increase over time with gadolinium. CONCLUSION In patients with MS, SI within the dentate nucleus and globus pallidus increased on unenhanced T1-weighted images and was significantly greater with the administration of a linear agent than with a macrocyclic agent. This increase in SI over time is likely a reflection of gadolinium deposition and not due to intrinsic disease, as previously postulated.
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Abstract
Gadolinium-based contrast agents (GBCAs) are widely used in medical imaging, with greater than 300 million doses administered since their introduction. The risk of adverse reactions is very low, and GBCAs were thought to be very safe until the discovery of nephrogenic systemic fibrosis (NSF). Since that time, gadolinium has been found to deposit throughout the body, including the brain, where it is visible on non-contrast T1-weighted MR images in people with normal renal function. The clinical effects of this deposition remain unknown and may not exist. In this review the authors provide a comprehensive update on GBCAs and their potential risks, within a historical context and through the lens of a pediatric radiologist.
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Affiliation(s)
- Michael N Rozenfeld
- Department of Radiology, University of Arizona College of Medicine - Phoenix, 550 E. Van Buren St., Phoenix, AZ, 85004, USA.
| | - Daniel J Podberesky
- Nemours Children's Hospital, Nemours Children's Health System, University of Central Florida College of Medicine, Orlando, FL, USA
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18
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Splendiani A. 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] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2018] [Accepted: 03/13/2018] [Indexed: 11/25/2022]
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19
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Young JR, Qiao J, Orosz I, Salamon N, Franke MA, Kim HJ, Pope WB. 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; 28:4882-9. [PMID: 29744642 DOI: 10.1007/s00330-018-5464-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [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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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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21
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Garcia J, Liu SZ, Louie AY. Biological effects of MRI contrast agents: gadolinium retention, potential mechanisms and a role for phosphorus. Philos Trans A Math Phys Eng Sci 2017; 375:rsta.2017.0180. [PMID: 29038383 PMCID: PMC5647271 DOI: 10.1098/rsta.2017.0180] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 08/30/2017] [Indexed: 05/06/2023]
Abstract
No discussion of challenges for chemistry in molecular imaging would be complete without addressing the elephant in the room-which is that the purest of chemical compounds needs to interact with a biological system in a manner that does not perturb normal biology while still providing efficacious feedback to assist in diagnosis of disease. In the past decade, magnetic resonance imaging (MRI) agents long considered inert have produced adverse effects in certain patient populations under certain treatment regimens. More recently, inert blood pool agents have been found to deposit in the brain. Release of free metal is often suspected as the culprit but that hypothesis has yet to be validated. In addition, even innocuous agents can cause painful side effects during injection in some patients. In this brief review, we summarize known biological effects for gadolinium- and iron-based MRI contrast agents, and discuss some of the potential mechanisms for the observed biological effects, including the potential role of phosphorus imbalance, related to kidney disease or cancer, in destabilizing gadolinium-based chelates and precipitating free gadolinium.This article is part of the themed issue 'Challenges for chemistry in molecular imaging'.
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Affiliation(s)
- Joel Garcia
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Stephen Z Liu
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
| | - Angelique Y Louie
- Department of Biomedical Engineering, University of California, Davis, CA 95616, USA
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Abstract
In the 3 years since residual gadolinium-based contrast agent (GBCA) in the brain was first reported, much has been learned about its accumulation, including the pathway of GBCA entry into the brain, the brain distribution of GBCA and its excretion. Here we review recent progress in understanding the routes of gadolinium deposition in brain structures.
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Affiliation(s)
- Tomonori Kanda
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan
| | - Yudai Nakai
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan.,2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Akifumi Hagiwara
- 1 Department of Radiology, Kobe University School of Medicine, Hyogo, Japan.,2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Oba
- 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Keiko Toyoda
- 2 Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan.,3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
| | - Shigeru Furui
- 3 Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan
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Splendiani A, Perri M, Marsecano C, Vellucci V, Michelini G, Barile A, Di Cesare E. 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; 123:125-34. [PMID: 28952018 DOI: 10.1007/s11547-017-0816-9] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2017] [Accepted: 09/13/2017] [Indexed: 01/07/2023]
Abstract
PURPOSE To perform T1 signal intensity (SI) measurements in the dentate nuclei of adult patients with confirmed multiple sclerosis (MS) after serial administrations of the macrocyclic gadolinium-based contrast agents (GBCAs), gadoterate meglumine and gadobutrol. MATERIALS AND METHODS This retrospective study was approved by the institutional review board and informed consent was waived. A review of our PACS database for the period from March 1, 2007 to July 31, 2016 revealed 158 confirmed MS patients who received exclusively either gadoterate meglumine (n = 81) or gadobutrol (n = 77) for diagnosis and follow-up. SI measurements on unenhanced T1-weighted images were performed on all scans of all patients and at regions of interest (ROIs) positioned on the dentate nucleus (DN) and pons. The dentate nucleus-to-pons (DNP) T1-SI ratio was subsequently calculated. Unpaired T test and regression analysis were used to evaluate statistical differences. RESULTS An increase in DNP was noted between the first and last MR examinations for both gadoterate meglumine (0.0032 ± 0.0216) and gadobutrol (0.0019 ± 0.0346). Although the differences were not statistically significant based across the entire patient population, visible T1 hyperintensity in the DN was noted in approximately one-third of all patients in each group that received at least five administrations of either GBCA. CONCLUSIONS SI increases on unenhanced T1-weighted images possibly indicative of gadolinium retention occur after serial administrations of the macrocyclic GBCAs, gadoterate meglumine and gadobutrol.
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Perrotta G, Metens T, Absil J, Lemort M, Manto M. Absence of clinical cerebellar syndrome after serial injections of more than 20 doses of gadoterate, a macrocyclic GBCA: a monocenter retrospective study. J Neurol 2017; 264:2277-2283. [PMID: 28956156 DOI: 10.1007/s00415-017-8631-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 09/25/2017] [Indexed: 11/28/2022]
Abstract
Sound evidence of gadolinium accumulation in brain has been recently provided after repeated administrations of linear gadolinium-based contrast agents (GBCAs), especially at the cerebellum level. Although data regarding brain accumulation of macrocyclic GBCAs are more reassuring, there is now a genuine concern ("gadolinium-phobia") about possible long-term consequences of gadolinium deposits, especially in terms of cerebellar sequelae. We, therefore, questioned about the clinical impact of serial administration of gadoterate meglumine, a macrocyclic GBCA. In this retrospective study (2000-2016) of medical files of patients who received more than 20 administrations of gadoterate, we searched for cerebellar symptoms and signs developing during the regular follow-up. We reviewed medical files of ten patients (mean age 34.4 ± 20.8 years; 4 males, 6 females) who received 28.2 ± 5.3 doses of gadoterate (average total dose of GBCA 518 ± 226 ml; range 185-785 ml). Patients were examined by at least two medical specialists depending on initial diagnosis, and at least once by a neurosurgeon. Mean follow-up time was 91 months (range 49-168) and six out of ten patients experienced new symptoms or signs. No clinician reported the appearance of a rising cerebellar syndrome, nor newly appeared symptoms or signs suggested cerebellar toxicity. This retrospective clinical study shows no de novo clinical cerebellar syndrome following repeated administrations of gadoterate. Our results argue against a cerebellar toxicity of this macrocyclic agent. Still, confirmation in a larger number of subjects is required, as well as clinical studies concerning linear GBCAs whose structure and in vivo stability are distinct.
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Affiliation(s)
- Gaetano Perrotta
- Service de Neurologie, ULB-Hôpital Erasme, Route de Lennik, Brussels, Belgium
| | - Thierry Metens
- Service de Neuroimagerie, ULB-Hôpital Erasme, Route de Lennik, Brussels, Belgium
| | - Julie Absil
- Service de Neuroimagerie, ULB-Hôpital Erasme, Route de Lennik, Brussels, Belgium
| | - Marc Lemort
- Service de Radiologie, Institut Bordet, Brussels, Belgium
| | - Mario Manto
- FNRS, ULB-Hôpital Erasme, Route de Lennik 808, 1070, Brussels, Belgium.
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Endrikat J, Anzalone N. Gadobutrol in India-A Comprehensive Review of Safety and Efficacy. Magn Reson Insights 2017; 10:1178623X17730048. [PMID: 28932122 PMCID: PMC5598798 DOI: 10.1177/1178623x17730048] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Accepted: 08/11/2017] [Indexed: 02/02/2023]
Abstract
Gadobutrol is a gadolinium (Gd)-based contrast agent for magnetic resonance imaging (MRI). In India, gadobutrol is approved for MRI of the central nervous system (CNS), liver, kidneys, breast and for MR angiography for patients 2 years and older. The standard dose for all age groups is 0.1 mmol/kg body weight. The safety profile has been demonstrated in 42 clinical phase 2 to 4 studies (>6800 patients), 7 observational studies, and by assessing pharmacovigilance data of 29 million applications. Furthermore, studies in children, adults, and elderly and in patients with impaired liver or kidney function did not show any increased adverse event rate. Diagnostic efficacy was demonstrated in numerous studies and various indications, such as diseases of the CNS, peripheral and supra-aortic vessels, kidneys, liver, and breast.
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Affiliation(s)
- Jan Endrikat
- Radiology, Bayer AG, Berlin, Germany.,Department of Gynecology, Obstetrics and Reproductive Medicine, University Medical School of Saarland, Homburg, Germany
| | - Nicoletta Anzalone
- Department of Neuroradiology, Scientific Institute HS Raffaele, Milan, Italy
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Bjørnerud A, Vatnehol SAS, Larsson C, Due-Tønnessen P, Hol PK, Groote IR. Signal Enhancement of the Dentate Nucleus at Unenhanced MR Imaging after Very High Cumulative Doses of the Macrocyclic Gadolinium-based Contrast Agent Gadobutrol: An Observational Study. Radiology 2017; 285:434-444. [PMID: 28885891 DOI: 10.1148/radiol.2017170391] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Purpose To test for measurable visual enhancement of the dentate nucleus (DN) on unenhanced T1-weighted magnetic resonance (MR) images in a cohort of patients with a primary brain tumor who had not received linear gadolinium-based contrast agents (GBCAs) but had received many injections of macrocyclic GBCAs. Materials and Methods Seventeen patients with high-grade gliomas who had received 10-44 administrations of the macrocyclic GBCA gadobutrol (0.1 mmol/kg of body weight) were retrospectively included in this regional ethics committee-approved study. Two neuroradiologists inspected T1-weighted MR images with optimized window settings to visualize small differences in contrast at the baseline and at the last examination for the presence of visual DN signal enhancement. Signal intensity (SI) in the DN was normalized to the SI of the pons, and a one-sample t test was used to test for differences between baseline normalized SI (nSI) in the DN (nSIDN) and the average change in nSIDN of all postbaseline MR imaging sessions (ΔnSIDNavg) or the change in nSIDN from baseline to the last MR imaging session (ΔnSIDN). Linear and quadratic correlation analyses were used to examine the association between the number of macrocyclic GBCA administrations and ΔnSIDN or ΔnSIDNavg. Results The mean ± standard deviation number of macrocyclic GBCA administrations was 22.2 ± 10.6 administered throughout 706 days ± 454. Visually appreciable signal enhancement was observed in two patients who had received 37 and 44 macrocyclic GBCA injections. Mean ΔnSIDN was greater than zero (0.03 ± 0.05; P = .016), and there was a significant linear association between the number of macrocyclic GBCA injections and ΔnSIDN (r = 0.69, P = .002) and ΔnSIDNavg (r = 0.77, P < .001). Conclusion A small but statistically significant dose-dependent T1-weighted signal enhancement was observed in the DN after multiple macrocyclic GBCA injections. Visually appreciable enhancement in the DN was observed on contrast-optimized images in two patients who had received 37 and 44 standard doses of macrocyclic GBCAs. © RSNA, 2017 Online supplemental material is available for this article.
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Affiliation(s)
- Atle Bjørnerud
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Svein Are Sirirud Vatnehol
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Christopher Larsson
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Paulina Due-Tønnessen
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Per Kristian Hol
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
| | - Inge Rasmus Groote
- From the Department of Diagnostic Physics (A.B., C.L., I.R.G.), Intervention Centre (S.A.S.V., P.K.H.), and Department of Radiology (P.D.T.), Oslo University Hospital, Rikshospitalet, Sognsvannsveien 20, N-0372 Oslo, Norway; Faculty of Mathematics and Natural Sciences, Institute of Physics (A.B) and Faculty of Medicine, Institute of Clinical Medicine (P.K.H, C.L.), University of Oslo, Oslo, Norway
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Rossi Espagnet MC, Bernardi B, Pasquini L, Figà-Talamanca L, Tomà P, Napolitano A. Signal intensity at unenhanced T1-weighted magnetic resonance in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in children. Pediatr Radiol 2017; 47:1345-1352. [PMID: 28526896 DOI: 10.1007/s00247-017-3874-1] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 03/26/2017] [Accepted: 04/20/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND Few studies have been conducted on the relations between T1-weighted signal intensity changes in the pediatric brain following gadolinium-based contrast agent (GBCA) exposure. OBJECTIVE The purpose of this study is to investigate the effect of multiple administrations of a macrocyclic GBCA on signal intensity in the globus pallidus and dentate nucleus of the pediatric brain on unenhanced T1-weighted MR images. MATERIALS AND METHODS This retrospective study included 50 patients, mean age: 8 years (standard deviation: 4.8 years), with normal renal function exposed to ≥6 administrations of the same macrocyclic GBCA (gadoterate meglumine) and a control group of 59 age-matched GBCA-naïve patients. The globus pallidus-to-thalamus signal intensity ratio and dentate nucleus-to-pons signal intensity ratio were calculated from unenhanced T1-weighted images for both patients and controls. A mixed linear model was used to evaluate the effects on signal intensity ratios of the number of GBCA administrations, the time interval between administrations, age, radiotherapy and chemotherapy. T-test analyses were performed to compare signal intensity ratio differences between successive administrations and baseline MR signal intensity ratios in patients compared to controls. P-values were considered significant if <0.05. RESULTS A significant effect of the number of GBCA administrations on relative signal intensities globus pallidus-to-thalamus (F[8]=3.09; P=0.002) and dentate nucleus-to-pons (F[8]=2.36; P=0.021) was found. The relative signal intensities were higher at last MR examination than at baseline (P<0.001). CONCLUSION Quantitative analysis evaluation of globus pallidus:thalamus and dentate nucleus:pons of the pediatric brain demonstrated an increase after serial administrations of macrocyclic GBCA. Further research is necessary to fully understand GBCA pharmacokinetic in children.
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Affiliation(s)
- Maria Camilla Rossi Espagnet
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.
| | - Bruno Bernardi
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Luca Pasquini
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy.,Neuroradiology Unit, Azienda Ospedaliera Sant'Andrea, University Sapienza, Via di Grottarossa 1035, Rome, Italy
| | - Lorenzo Figà-Talamanca
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, 00165, Rome, Italy
| | - Paolo Tomà
- Department of Imaging, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, Rome, Italy
| | - Antonio Napolitano
- Enterprise Risk Management, Medical Physics Department, Ospedale Pediatrico Bambino Gesù, IRCCS, Piazza S. Onofrio 4, Rome, Italy
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Lee JY, Park JE, Kim HS, Kim SO, Oh JY, Shim WH, Jung SC, Choi CG, Kim SJ. Up to 52 administrations of macrocyclic ionic MR contrast agent are not associated with intracranial gadolinium deposition: Multifactorial analysis in 385 patients. PLoS One 2017; 12:e0183916. [PMID: 28859167 PMCID: PMC5578663 DOI: 10.1371/journal.pone.0183916] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 08/13/2017] [Indexed: 11/18/2022] Open
Abstract
PURPOSE To determine whether multiple repeated administrations of gadolinium-based macrocyclic ionic MR contrast agent (MICA) are associated with intracranial gadolinium deposition and identify the predisposing factors for deposition in various clinical situations. MATERIALS AND METHODS In this institutional review board-approved retrospective study, 385 consecutive patients who underwent MICA-enhanced MR imaging were enrolled. The dentate nucleus-to-pons (DN/P) and globus pallidus-to-thalamus (GP/Th) signal intensity (SI) ratios on unenhanced T1-weighted images were recorded by 2 independent readers and averaged. The mean DN/P and GP/Th SI ratio difference between the last and the first examinations were tested using the one-sample t-test. Student's t-test and stepwise regression analysis were used to identify the predisposing factors for deposition based on the number of administrations, time interval, hepatic and renal function, magnetic field strength, and chemo- or radiation therapy. RESULTS The mean DN/P SI ratio difference was not different from zero (P = .697), even in patients with ≥20 administrations (n = 33). Only patients with abnormal renal function showed an increase in the mean DN/P SI ratio difference (P = .019). The mean DN/P SI ratio difference was not associated with any predisposing factors. However, the mean GP/Th SI ratio difference showed decrease (P < .001), which was associated with age (P = .007), number of administrations (P = .01) and number of radiation therapy sessions (P = .022) on multivariate analysis. CONCLUSION Multiple repeated administrations of MICA were not associated with increased T1 signal intensity in deep brain nuclei suggestive of Gd deposition in patients with normal renal function.
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Affiliation(s)
- Ji Ye Lee
- Department of Radiology, Soonchunhyang University Bucheon Hospital, Wonmi-gu, Bucheon, Korea
| | - Ji Eun Park
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ho Sung Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
- * E-mail:
| | - Seon-Ok Kim
- Department of Clinical Epidemiology and Biostatistics, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Joo Young Oh
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Woo Hyun Shim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Seung Chai Jung
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Choong Gon Choi
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sang Joon Kim
- Department of Radiology and Research Institute of Radiology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Gulani V, Calamante F, Shellock FG, Kanal E, Reeder SB. Gadolinium deposition in the brain: summary of evidence and recommendations. Lancet Neurol 2017; 16:564-570. [PMID: 28653648 DOI: 10.1016/s1474-4422(17)30158-8] [Citation(s) in RCA: 492] [Impact Index Per Article: 70.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 03/16/2017] [Accepted: 05/02/2017] [Indexed: 12/13/2022]
Abstract
Emerging evidence has linked MRI signal changes in deep nuclei of the brain with repeated administration of gadolinium-based contrast agents. Gadolinium deposits have been confirmed in brain tissue, most notably in the dentate nuclei and globus pallidus. Although some linear contrast agents appear to cause greater MRI signal changes than some macrocyclic agents, deposition of gadolinium has also been observed with macrocyclic agents. However, the extent of gadolinium deposition varies between agents. Furthermore, the clinical significance of the retained gadolinium in the brain, if any, remains unknown. No data are available in human beings or animals to show adverse clinical effects due to the gadolinium deposition in the brain. On behalf of the International Society for Magnetic Resonance in Medicine, we present recommendations for the clinical and research use of gadolinium-based contrast agents. These recommendations might evolve as new evidence becomes available.
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Affiliation(s)
- Vikas Gulani
- Department of Radiology, Department of Urology, and Department of Biomedical Engineering, Case Comprehensive Cancer Center, Case Western Reserve University, and University Hospitals Case Medical Center, Cleveland, OH, USA.
| | - Fernando Calamante
- Florey Institute of Neuroscience and Mental Health, Heidelberg, VIC, Australia; Florey Department of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| | - Frank G Shellock
- Department of Radiology, Department of Medicine, and National Science Foundation Engineering Research Center, University of Southern California, Los Angeles, CA, USA
| | - Emanuel Kanal
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Scott B Reeder
- Department of Radiology, Department of Medical Physics, Department of Biomedical Engineering, Department of Medicine, and Department of Emergency Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
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Olchowy C, Cebulski K, Łasecki M, Chaber R, Olchowy A, Kałwak K, Zaleska-Dorobisz U. The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review. PLoS One 2017; 12:e0171704. [PMID: 28187173 DOI: 10.1371/journal.pone.0171704] [Citation(s) in RCA: 138] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2016] [Accepted: 01/23/2017] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND AND PURPOSE Gadolinium based contrast agents (GBCAs) are widely used in magnetic resonance imaging, but recently, high signal intensity in the cerebellum structures was reported after repeated administrations of contrast- enhanced magnetic resonance images. The aim of this systematic review was to investigate the association between increased signal intensity in the dentate nucleus and globus pallidus in the brain and repeated administrations of GBCAs. Additionally, we focused on possible short- and long-term consequences of gadolinium use in those patients. METHODS Systematic review of retrospective investigations in PubMed and Medline was performed in July 2016. Primary outcomes included the presence of increased signal intensity within the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in patients following administrations of GBCAs. Two independent reviewers were responsible for search and data extraction. RESULTS 25 publications satisfied inclusion criteria (19 magnetic resonance images analyses, 3 case reports; 3 autopsy studies). Magnetic resonance images of 1247 patients with increased signal intensity on unenhanced T1-weighted MR images were analyzed as well as tissue specimens from 27 patients. Signal intensity correlated positively with the exposure to GBCAs and was greater after serial administrations of linear nonionic than cyclic contrast agents. Gadolinium was detected in all tissue examinations. CONCLUSIONS High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance images were associated with previous administration of GBCAs. Signal intensity correlated negatively with stability of contrast agents. Clinical significance of gadolinium deposition in the brain remains unclear. There is a strong need for further research to identify type of gadolinium deposited in the brain as well as to gather knowledge about long-term consequences.
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Hoggard N, Roditi GH. T 1 hyperintensity on brain imaging subsequent to gadolinium-based contrast agent administration: what do we know about intracranial gadolinium deposition? Br J Radiol 2017; 90:20160590. [PMID: 27653560 PMCID: PMC5605029 DOI: 10.1259/bjr.20160590] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2016] [Revised: 09/13/2016] [Accepted: 09/19/2016] [Indexed: 11/05/2022] Open
Abstract
There is growing evidence for the accumulation of gadolinium (Gd) in patients administered with intravenous Gd-based contrast agents, even in the absence of renal impairment. This review of the literature will discuss what has been found to date in cadaveric human studies, clinical studies of patients and from animal models. Evidence for the potential route of entry into the brain will be examined. The current state of knowledge of effects of Gd accumulation in the brain is discussed. We will then discuss what the possible implications may be for the choice of Gd-based contrast agents in clinical practice.
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Affiliation(s)
- Nigel Hoggard
- Academic Unit of Radiology, INSIGNEO, University of Sheffield, Sheffield, UK
| | - Giles H Roditi
- Glasgow Royal Infirmary, University of Glasgow, Glasgow, UK
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Murata N, Murata K, Gonzalez-cuyar LF, Maravilla KR. Gadolinium tissue deposition in brain and bone. Magn Reson Imaging 2016; 34:1359-65. [DOI: 10.1016/j.mri.2016.08.025] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2016] [Revised: 08/23/2016] [Accepted: 08/29/2016] [Indexed: 11/19/2022]
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Jost G, Frenzel T, Lohrke J, Lenhard DC, Naganawa S, Pietsch H. Penetration and distribution of gadolinium-based contrast agents into the cerebrospinal fluid in healthy rats: a potential pathway of entry into the brain tissue. Eur Radiol 2016; 27:2877-2885. [PMID: 27832312 PMCID: PMC5486780 DOI: 10.1007/s00330-016-4654-2] [Citation(s) in RCA: 107] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Revised: 10/14/2016] [Accepted: 10/21/2016] [Indexed: 11/30/2022]
Abstract
Objective Signal hyperintensity on unenhanced MRI in certain brain regions has been reported after multiple administrations of some, but not all, gadolinium-based contrast agents (GBCAs). One potential initial pathway of GBCA entry into the brain, infiltration from blood into the cerebrospinal fluid (CSF), was systematically evaluated in this preclinical study. Methods GBCA infiltration and distribution in the CSF were investigated in healthy rats using repeated fluid-attenuated MRI up to 4 h after high-dose (1.8 mmol/kg) administration of six marketed and one experimental GBCA. Additionally, gadolinium measurements in CSF, blood and brain tissue samples (after 24 h) were performed using inductively coupled plasma mass spectrometry. Results Enhanced MRI signals in the CSF spaces with similar distribution kinetics were observed for all GBCAs. No substantial differences in the gadolinium concentrations among the marketed GBCAs were found in the CSF, blood or brain tissue. After 4.5 h, the concentration in the CSF was clearly higher than in blood but was almost completely cleared and lower than the brain tissue concentration after 24 h. Conclusions In contrast to the brain signal hyperintensities, no differences in penetration and distribution into the CSF of healthy rats exist among the marketed GBCAs. Key Points • Gadolinium-based contrast agents can cross the blood-CSF barrier. • Fluid-attenuated MRI shows GBCA distribution with CSF flow. • GBCA structure and physicochemical properties do not impact CSF penetration and distribution. • GBCA clearance from CSF was almost complete within 24 h in rats. • CSF is a potential pathway of GBCA entry into the brain.
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Affiliation(s)
- Gregor Jost
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany.
| | - Thomas Frenzel
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | - Jessica Lohrke
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
| | | | - Shinji Naganawa
- Department of Radiology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hubertus Pietsch
- MR and CT Contrast Media Research, Bayer Pharma AG, Muellerstrasse 178, 13353, Berlin, Germany
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Schlemm L, Chien C, Bellmann-Strobl J, Dörr J, Wuerfel J, Brandt AU, Paul F, Scheel M. Gadopentetate but not gadobutrol accumulates in the dentate nucleus of multiple sclerosis patients. Mult Scler 2016; 23:963-972. [PMID: 27679460 DOI: 10.1177/1352458516670738] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Background: Previous studies have postulated an association between dentate nucleus T1 hyperintensity and multiple sclerosis (MS)-related progressive neurodegeneration. Therefore, MS patients have been excluded from most studies investigating brain deposition of gadolinium-based contrast agents (GBCAs). Objective: To study the hypothesis that dentate nucleus T1 hyperintensity in MS patients is associated with GBCA administration. Methods: In a cohort of 97 MS patients, the dentate-to-pons signal intensity ratio (DPSIR) was calculated for 265 consecutive T1-weighted magnetic resonance (MR) scans (including sessions with and without the administration of GBCA). Patients exclusively received either gadopentetate dimeglumine (Gd-DTPA, linear) or gadobutrol (Gd-BT-DO3A, macrocyclic). Results: In patients receiving Gd-DTPA, DPSIR increased significantly between the first and the last scan (+0.009, p < 0.001), and following magnetic resonance imaging (MRI) with Gd-DTPA administration as compared to following an MRI without Gd-DTPA administration (+0.005 vs −0.001; p = 0.022). Additionally, there was a positive linear relationship between the number of Gd-DTPA administrations and the increase in DPSIR ( p = 0.017). No DPSIR increase was observed after Gd-BT-DO3A administration. Conclusion: Dentate nucleus T1 hyperintensity in MS patients is associated with Gd-DTPA (but not Gd-BT-DO3A) administration, suggesting an alternative explanation for the association of T1 hyperintensity with disease duration and severity.
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Affiliation(s)
- Ludwig Schlemm
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Claudia Chien
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Judith Bellmann-Strobl
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jan Dörr
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Wuerfel
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Medical Image Analysis Center (MIAC AG), Basel, Switzerland
| | - Alexander U Brandt
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Friedemann Paul
- Department of Neurology, Charité – Universitätsmedizin Berlin, Berlin, Germany/NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany/Experimental and Clinical Research Center, Max Delbrueck Center for Molecular Medicine and Charité – Universitätsmedizin Berlin, Berlin, Germany
| | - Michael Scheel
- NeuroCure Clinical Research Center, NeuroCure Cluster of Excellence, Charité – Universitätsmedizin Berlin, Berlin, Germany
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Robert P, Violas X, Grand S, Lehericy S, Idée JM, Ballet S, Corot C. Linear Gadolinium-Based Contrast Agents Are Associated With Brain Gadolinium Retention in Healthy Rats. Invest Radiol 2016; 51:73-82. [PMID: 26606549 DOI: 10.1097/RLI.0000000000000241] [Citation(s) in RCA: 174] [Impact Index Per Article: 21.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives The aim of this study was to evaluate Gd retention in the deep cerebellar nuclei (DCN) of linear gadolinium-based contrast agents (GBCAs) compared with a macrocyclic contrast agent. Materials and Methods The brain tissue retention of Gd of 3 linear GBCAs (gadobenate dimeglumine, gadopentetate dimeglumine, and gadodiamide) and a macrocyclic GBCA (gadoterate meglumine) was compared in healthy rats (n = 8 per group) that received 20 intravenous injections of 0.6 mmol Gd/kg (4 injections per week for 5 weeks). An additional control group with saline was included. T1-weighted magnetic resonance imaging was performed before injection and once a week during the 5 weeks of injections and for another 4 additional weeks after contrast period. Total gadolinium concentration was measured with inductively coupled plasma mass spectrometry. Blinded qualitative and quantitative evaluations of the T1 signal intensity in DCN were performed, as well as a statistical analysis on quantitative data. Results At completion of the injection period, all the linear contrast agents (gadobenate dimeglumine, gadopentetate dimeglumine, and gadodiamide) induced a significant increase in signal intensity in DCN, unlike the macrocyclic GBCA (gadoterate meglumine) or saline. The T1 hypersignal enhancement kinetic was fast for gadodiamide. Total Gd concentrations for the 3 linear GBCAs groups at week 10 were significantly higher in the cerebellum (1.21 ± 0.48, 1.67 ± 0.17, and 3.75 ± 0.18 nmol/g for gadobenate dimeglumine, gadopentetate dimeglumine, and gadodiamide, respectively) than with the gadoterate meglumine (0.27 ± 0.16 nmol/g, P < 0.05) and saline (0.09 ± 0.12 nmol/g, P < 0.05). No significant difference was observed between the macrocyclic agent and saline. Conclusions Repeated administrations of the linear GBCAs gadodiamide, gadobenate dimeglumine, and gadopentetate dimeglumine to healthy rats were associated with progressive and significant T1 signal hyperintensity in the DCN, along with Gd deposition in the cerebellum. This is in contrast with the macrocyclic GBCA gadoterate meglumine for which no effect was observed.
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Jost G, Lenhard DC, Sieber MA, Lohrke J, Frenzel T, Pietsch H. Signal Increase on Unenhanced T1-Weighted Images in the Rat Brain After Repeated, Extended Doses of Gadolinium-Based Contrast Agents: Comparison of Linear and Macrocyclic Agents. Invest Radiol 2016; 51:83-9. [PMID: 26606548 DOI: 10.1097/RLI.0000000000000242] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Objectives In this prospective preclinical study, we evaluated T1-weighted signal intensity in the deep cerebellar nuclei (CN) and globus pallidus (GP) up to 24 days after repeated administration of linear and macrocyclic gadolinium-based contrast agents (GBCAs) using homologous imaging and evaluation methods as in the recently published retrospective clinical studies. In a second part of the study, cerebrospinal fluid (CSF) spaces were evaluated for contrast enhancement by fluid-attenuated magnetic resonance imaging (MRI). Materials and Methods Sixty adult male Wistar-Han rats were randomly divided into a control and 5 GBCA groups (n = 10 per group). The administered GBCAs were gadodiamide, gadopentetate dimeglumine, and gadobenate dimeglumine (linear GBCAs) as well as gadobutrol and gadoterate meglumine (macrocyclic GBCAs) and saline (control). Over a period of 2 weeks, the animals received 10 intravenous injections at a dose of 2.5 mmol Gd/kg body weight, each on 5 consecutive days per week. Before GBCA administration, as well as 3 and 24 days after the last injection, a whole-brain MRI was performed using a standard T1-weighted 3-dimensional turbo spin echo sequence on a clinical 1.5 T scanner. The ratios of signal intensities in deep CN to pons (CN/Po) and GP to thalamus (GP/Th) were determined. For the evaluation of the CSF spaces, 18 additional rats were randomly divided into 6 groups (n = 3 per group) that received the same GBCAs as in the first part of the study. After MR cisternography for anatomical reference, a fluid-attenuated inversion recovery sequence was performed before and 1 minute after intravenous injection of a dose of 1 mmol Gd/kg body weight GBCA or saline. Results A significantly increased signal intensity ratio of CN/Po was observed 3 and 24 days after the last injection of gadodiamide and gadobenate dimeglumine. No significant changes were observed between the 2 time points. Gadopentetate dimeglumine injection led to a moderately elevated but statistically not significant CN/Po signal intensity ratio. No increased CN/Po signal intensity ratios were determined in the MRI scans of rats that received macrocyclic GBCAs gadobutrol and gadoterate meglumine or saline. The ratio of signal intensity in GP/Th was not elevated in any group injected with GBCAs or saline. Enhanced signal intensities of CSF spaces were observed in the postcontrast fluid-attenuated inversion recovery images of all animals receiving GBCAs but not for saline. Conclusions In this animal study in rats, increased signal intensity in the CN was found up to 24 days after multiple, extended doses of linear GBCAs. However, in contrast to clinical reports, the signal enhancement in the GP was not reproduced, demonstrating the limitations of this animal experiment. The elevated signal intensities remained persistent over the entire observation period. In contrast, no changes of signal intensities in either the CN or the GP were observed for macrocyclic GBCAs. However, all GBCAs investigated were able to pass the blood-CSF barrier in rats to a certain, not yet quantified extent.
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Eisele P, Alonso A, Szabo K, Ebert A, Ong M, Schoenberg SO, Gass A. Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis: An observational study. Medicine (Baltimore) 2016; 95:e4624. [PMID: 27684794 PMCID: PMC5265887 DOI: 10.1097/md.0000000000004624] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Recently, several studies reported increased signal intensity (SI) in the dentate nucleus (DN) after repeated application of gadolinium-based contrast agents (GBCAs), suggesting a deposition of gadolinium in this location. Patients with relapsing-remitting multiple sclerosis (RRMS) frequently show increased permeability of the blood-brain barrier as part of the inflammatory process in the brain parenchyma, which theoretically might increase the risk of gadolinium deposition. In this retrospective study, we investigated a possible increasing SI in the DN after repeated administrations of the macrocyclic contrast agent gadoterate meglumine.Forty-one RRMS patients (33 women, mean age 38 years) with at least 6 prior gadolinium-enhanced examinations (single dose gadoterate meglumine) were identified. A total of 279 unenhanced T1-weighted examinations were analyzed.SI ratio differences did not differ between the first and last MRI examination, neither for the DN-to-pons ratio (P = 0.594) nor for the DN-to-cerebellum ratio (P = 0.847). There was no correlation between the mean DN-to-pons, or between the mean DN-to-cerebellum SI ratio and the number of MRI examinations (P = 0.848 and 0.891), disease duration (P = 0.676 and 0.985), and expanded disability status scale (EDSS) (P = 0.639 and 0.945).We found no signal increases in the DN after a minimum of 6 injections of the macrocyclic GBCA gadoterate meglumine in RRMS patients. This warrants further investigations in regard to the true pathophysiologic basis of intracerebral gadolinium deposition.
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Affiliation(s)
| | | | | | | | - Melissa Ong
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
| | - Stefan O. Schoenberg
- Institute of Clinical Radiology and Nuclear Medicine, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany
| | - Achim Gass
- Department of Neurology
- Correspondence: Achim Gass, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1–3, 68167 Mannheim, Germany (e-mail: )
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Brown G. Letter to the Editor. J Med Imaging Radiat Sci 2016; 47:204-206. [DOI: 10.1016/j.jmir.2016.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Brown G. Lettre à la Rédactrice en chef. J Med Imaging Radiat Sci 2016; 47:206-208. [DOI: 10.1016/j.jmir.2016.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stojanov D, Aracki-Trenkic A, Benedeto-Stojanov D. Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status. Neuroradiology 2016; 58:433-41. [PMID: 26873830 DOI: 10.1007/s00234-016-1658-1] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Gadolinium-based contrast agents (GBCAs) have been used clinically since 1988 for contrast-enhanced magnetic resonance imaging (CE-MRI). Generally, GBCAs are considered to have an excellent safety profile. However, GBCA administration has been associated with increased occurrence of nephrogenic systemic fibrosis (NSF) in patients with severely compromised renal function, and several studies have shown evidence of gadolinium deposition in specific brain structures, the globus pallidus and dentate nucleus, in patients with normal renal function. METHODS Gadolinium deposition in the brain following repeated CE-MRI scans has been demonstrated in patients using T1-weighted unenhanced MRI and inductively coupled plasma mass spectroscopy. Additionally, rodent studies with controlled GBCA administration also resulted in neural gadolinium deposits. RESULTS Repeated GBCA use is associated with gadolinium deposition in the brain. This is especially true with the use of less-stable, linear GBCAs. In spite of increasing evidence of gadolinium deposits in the brains of patients after multiple GBCA administrations, the clinical significance of these deposits continues to be unclear. CONCLUSION Here, we discuss the current state of scientific evidence surrounding gadolinium deposition in the brain following GBCA use, and the potential clinical significance of gadolinium deposition. There is considerable need for further research, both to understand the mechanism by which gadolinium deposition in the brain occurs and how it affects the patients in which it occurs.
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Affiliation(s)
- Dragan Stojanov
- Faculty of Medicine, University of Nis, Bul. Dr. Zorana Djindjica 81, Nis, 18000, Serbia.
- Center for Radiology, Clinical Center Nis, Nis, Serbia.
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