Abstract
PurposeTo quantitate gadolinium deposits in gliomas and adjacent normal brain specimens, and to evaluate their association with tumor contrast enhancement and the type of gadolinium-based contrast agent (GBCA) used.MethodsA total of 69 patients with primary glioma who underwent contrast-enhanced magnetic resonance imaging (MRI) prior to surgery were included in this retrospective study. Gadolinium was measured from histologically viable tumor, normal brain, and necrosis within the sample, when available, using inductively coupled plasma mass spectrometry (ICP-MS). Tumor contrast enhancement was categorized as none, minimal, or noticeable. Differences in gadolinium deposits by contrast enhancement and GBCA type were assessed.ResultsSeven patients received linear GBCA and 62 macrocyclic, respectively. At the time of surgery, gadolinium deposits were detected in 39 out of 69 (57%) tumor samples, 8 out of 13 (62%) normal brain, and 12 out of 14 (86%) necrotic specimens. Gadolinium was detected in both enhancing and non-enhancing tumors, but was greatest in gliomas with noticeable enhancement (p = 0.02). Administration of linear agents gadodiamide and gadopentetate dimeglumine resulted in significantly higher tumor gadolinium relative to macrocyclic gadoterate meglumine (p < 0.01 and p < 0.05, respectively). Normal brain and necrosis also showed higher gadolinium after exposure to linear gadodiamide (both p < 0.05). In multivariate regression, GBCA type (linear/macrocyclic) was the most powerful predictor of tumor gadolinium retention (p < 0.001).ConclusionGadolinium can be detected in both enhancing and non-enhancing gliomas, neighboring normal brain, and necrosis. Gadolinium retention is higher after exposure to linear GBCAs compared with the macrocyclic gadoterate meglumine.
Highlights
Gadolinium is a heavy metal employed by the standard contrast agents used for magnetic resonance imaging (MRI) due to its paramagnetic nature
Chelators used in gadolinium-based contrast agents (GBCAs) can be classified as either linear or macrocyclic, of which the latter are superior in stability [1]
Sixty patients received only one GBCA dose, and nine patients received two to three doses prior to surgery and with evidence of the tumor occurring in the brain MRI
Summary
Gadolinium is a heavy metal employed by the standard contrast agents used for MRI due to its paramagnetic nature. Free gadolinium ion (Gd3+), is highly toxic. To decrease its toxicity and increase elimination from the body, Gd3+ is bound to organic chelating agents. Chelators used in gadolinium-based contrast agents (GBCAs) can be classified as either linear or macrocyclic, of which the latter are superior in stability (especially the kinetic stability) [1]. Deposition of gadolinium in the liver, kidney, and bone of mice and rats after exposure to linear GBCAs was reported already in the 1990s [3]. Both linear and macrocyclic GBCAs have been used in routine clinical practice for almost 30 years with no other serious adverse effects
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