Gadolinium-containing Contrast Media Research Articles

The pharmacological economic analysis of application of magnetic resonance contrast mediums containing gadolinium in case of multiple sclerosis

The MS Excel calculator was applied to estimate costs and analyze impact on the budget under treatment of multiple sclerosis exacerbations, that were diagnosed using various gadolinium-containing contrast mediums. The direct medical costs for diagnostics with gadolinium-containing contrast medium and hospitalization due to exacerbation in accordance with mandatory medical insurance system were taken into account. At the expense of reducing number of multiple sclerosis exacerbations due to the use of single-molar gadolinium-containing contrast medium (gadobutrol) as compared with semi-polar gadolinium-containing contrast medium (gadodiamide, gadoteric acid and gadoteridol) in 1000 patients it is possible to reduce financial expenses from 1,968,642 to 7,175,520 RUB. The cost of magnetic resonance imaging diagnostics with contrast enhancement and treatment of multiple sclerosis exacerbations increases in the series: gadobutrol < gadodiamide (Jodas Expoim) < gadodiamide (GE Health Care) < gadoteridol < gadoteric acid.

Clinical, MRI and histopathological findings in a dog with distemper meningomyelitis

A 14‐month‐old female entire German Shepherd dog presented with a five‐day history of acute onset, progressive, non‐ambulatory paraparesis, with lateralisation to the right. The neurolocalisation was to the L4‐S1 spinal cord segments. MRI of the thoracic, lumbar and sacral spinal cord revealed multifocal, ill‐defined, T2‐weighted hyperintense, intramedullary lesions, which were moderately contrast‐enhancing, becoming more defined and ovoid to nodular after injection of gadolinium‐containing contrast medium. The lesions affected both white and grey matter and were lateralised mainly to the right side. PCR tests on blood and cerebrospinal fluid were positive for canine distemper virus (CDV). Despite intensive treatment, the dog developed myoclonus and severe fever and was humanely euthanased. Postmortem examination confirmed the presence of spinal cord lesions consistent with CDV. Distemper rarely presents with clinical signs of myelopathy exclusively and there is a scarcity of description of MRI findings of distemper meningomyelitis in the literature.

Monitoring geriatric dogs after intravenous gadolinium-containing contrast media administration for magnetic resonance imaging

Monitoring geriatric dogs after intravenous gadolinium-containing contrast media administration for magnetic resonance imaging

Non-invasive quantification of age-related changes in the vertebral endplate in rats using in vivo DCE-MRI

BackgroundSmall animal models that can mimic degenerative disc disease (DDD) are commonly used to examine DDD progression. However, assessments such as histological studies and macroscopic measurements do not allow for longitudinal studies because they can only be completed after the animal is sacrificed. Dynamic contrast-enhanced MRI (DCE-MRI) may provide a reliable, non-invasive in vivo method for detecting the progression.MethodsThe present study investigated the progression of changes in lumbar discs and the effect of endplate conditions on diffusion into the lumbar discs of aging sand rats after intravenous administration of gadolinium-containing contrast medium through the tail vein. Contrast enhancement was measured in the lumbar intervertebral discs on each image. The results were compared with those from conventional histological characterizations.ResultsT2-weighted images revealed that with aging, the shape of L3–L4, L4–L5, L5–L6, and L6–S1 nucleus pulposus (NP) became irregular, while the mean areas, signal intensities, and T2 values of the NP were significantly decreased. Each of the observed disc changes demonstrated a progressive increase in phase during 2-min scout scans. Post-contrast MRI showed impaired endplate nutritional diffusion to the disc with aging, enhancement was significantly greater in young animals than in old animals. Endplate calcification or sclerosis was histologically confirmed; histologic score was correlated with the age. We found the histological score of the endplate negatively corresponded to the DCE-MRI results.ConclusionsDCE-MRI studies offer a non-invasive in vivo method for investigating the progress of diffusion into the discs and the functional conditions of the endplate. We conclude that quantitative DCE-MRI can identify the severity of disc degeneration and efficiently reflect the progression of vertebral endplate changes in the aging sand rat lumbar spine via the NP contrast enhancement patterns.

An Infrasellar Craniopharyngioma Involving the Sphenoid Sinus and Clivus

An Infrasellar Craniopharyngioma Involving the Sphenoid Sinus and Clivus

L’imagerie médicale diagnostique est-elle iatrogène ?

Imaging is an indispensable element of modern medicine but is not without risk. Low-dose irradiation due to spinal, abdominal, pelvic or cardiac radiography, and the increasing use of CT carries an additional, albeit moderate risk of cancer. Iodinated and gadolinium-containing contrast media, besides their direct toxicity, can trigger hypersensitivity and allergic-like reactions. Spinal and articular diagnostic injections can also lead to complications. This article reviews the direct iatrogenicity of diagnostic imaging and current efforts to limit it through the use of new radiological systems, lower-dose CT non ionic contrast media, and alternative imaging techniques. The authors also examine the less known but more frequent problem of indirect iatrogenesis, which is highly dependent on the quality of the imaging personnel and technique. Finally, we propose some legislative solutions to this problem.

Measurement of glomerular filtration rate using dynamic magnetic resonance imaging in patients with chronic kidney disease

Determination of glomerular filtration rate (GFR) using plasma disappearance curves requires the injection of a filtration marker and repeated timed blood collections. Gadolinium-containing contrast media are excreted exclusively by glomerular filtration and could provide a novel approach to quantifying GFR using magnetic resonance (MR) imaging. The aim of this study was to demonstrate the feasibility of measuring GFR by the clearance of gadolinium-containing contrast medium in patients with chronic kidney disease (CKD). Informed consent was obtained from stable CKD patients in stages 1, 2 or 3 (n=16; 5 women, 11 men; median age 54 years). GFR was measured after a bolus injection of gadobutrol (4 mL, approximately 0.05 mmol/kg) and calculated from the washout of the signal intensity obtained over the liver. The obtained MR-GFR was compared with simultaneously measured plasma clearance of inulin and gadobutrol. Technical failure occurred in 2 patients. The mean obtained MR-GFR was 71 ± 25 (SD) mL/min per 1.73 m² and agreed well with the mean inulin-GFR (70 ± 24 mL/min per 1.73 m²). Pearson's correlation coefficient was r=0.91. The mean of the paired differences was 1 ± 10 mL/min per 1.73 m² and not significantly different from zero. GFR obtained from gadobutrol plasma clearance also agreed well with inulin-GFR and MR-GFR (r=0.92 and r=0.75, respectively). We describe a novel method of determining GFR from MR imaging using a low dose of gadobutrol in patients with reduced GFR that enables the absolute quantification of GFR after routine contrast-enhanced MR imaging.

Gadolinium-containing contrast media

Gadolinium-containing contrast media

ヨード造影剤やＧｄキレート剤の副作用に係る今日的諸問題

Diagnostic imaging modalities have evolved significantly with the development of iodine-containing X-ray contrast media and gadolinium-based MRI contrast agents. Gadolinium-containing contrast media are widely employed as a contrast agent for MRI and have been generally considered to be safe. Nephrogenic systemic fibrosis has been reported as a severe progressive disorder related to the administration of gadolinium-chelate agents in patients with renal insufficiency, since 2006. NSF causes fibrosis of the skin and connective tissue throughout the body. The exact pathophysiolosy of NSF remains uncertain and no clearly effective therapies exist for NSF so far. Since 2007, the FDA has asked manufactures to include a boxed warning on the product labeling of all gadolinium-based MR contrast agents. In this article, we introduce the nephrogenic systemic fibrosis in addition to iodine-containing contrast induced nephropathy.

Progressive arm and leg stiffness in a patient with chronic renal impairment

A 60-year-old white woman with a history of breast cancer, autoimmune hemolytic anemia, type 2 diabetes mellitus, peripheral vascular disease, and chronic renal insufficiency presented with stiffness in her arms and legs of 3 months' duration. She had undergone multiple MRI and magnetic resonance angiography examinations with gadolinium-containing contrast media over the last 2 years. Complete physical examination including thorough skin examination; laboratory examinations including CBC, urinalysis, serum creatinine, protein electrophoresis and C-reactive protein; antinuclear antibody assay; Westergren erythrocyte sedimentation rate; and an excisional skin biopsy. Nephrogenic systemic fibrosis (also known as nephrogenic fibrosing dermopathy). Symptomatic treatment, physical therapy, and a brief trial of imatinib mesylate.

Frequency and Severity of Acute Allergic-Like Reactions to Gadolinium-Containing IV Contrast Media in Children and Adults

The purpose of our study was to determine the frequency and severity of acute allergic-like reactions to i.v.-administered gadolinium-containing contrast media in children and adults. Pediatric (younger than 19 years) and adult department of radiology contrast material reaction forms involving patients who experienced acute allergic-like reactions to gadolinium-containing contrast media from January 1, 2001, through December 31, 2006, were retrospectively evaluated for the specific types of acute allergic-like reactions, reaction management, and patient outcomes. Relevant patient medical information, including documentation of prior gadolinium- or iodine-containing contrast material reaction, premedication before acute allergic-like reaction to i.v. gadolinium-containing contrast material, previous allergic reactions to substances other than contrast media, and history of asthma, was obtained by reviewing electronic medical records. Seventy-eight thousand three hundred fifty-three (65,009 adult and 13,344 pediatric) i.v. administrations of gadolinium-containing contrast material were performed during the study period. Acute allergic-like reactions were documented after 54 injections (reaction frequency, 0.07%). Forty-eight reactions involved adult patients (adult reaction frequency, 0.07%), and six reactions occurred in pediatric patients (pediatric reaction frequency, 0.04%). Forty (74%) acute allergic-like reactions were mild, 10 (19%) were moderate, and four (7%) were severe. No gadolinium-containing contrast material-related death occurred during the study period. Twenty-six (50%) of 52 patients had one or more presumed risk factors for contrast material reaction. Adult and pediatric acute allergic-like reactions to i.v.-administered gadolinium-containing contrast media are rare. Most of these reactions are mild; however, moderate and severe reactions that require immediate management do occur.

Nephrogene systemische Fibrose - eine neue interdisziplinäre Herausforderung

Nephrogenic systemic fibrosis (NSF) - previously termed nephrogenic fibrosis dermopathy - is a newly recognized disorder occurring only in patients with renal failure. Exposure to gadolinium-containing contrast agents used for magnetic resonance imaging has been associated with subsequent development of NSF. This disease is characterised by swelling and tightening of the skin, mostly at the limbs. In addition, internal organs may be involved, which may ultimately cause death in rare cases. Skin biopsy showing fibrous tissue and spindle cells positive for CD34, and factor XIIIa as well as CD68-positive macrophages confirms the diagnosis. The main therapeutic goal is restoration of renal function by renal transplantation or recovery from acute renal failure, whenever possible. There are few data regarding other measures. The best available evidence for some therapeutic effect relates to physiotherapy and extracorporal photopheresis. Gadodiamide and gadopentetate-dimeglumin must not be used in stage 4 and 5 renal failure. Other gadolinium-containing contrast media must be used with extreme caution in patients with advanced renal failure.

Indikationen und Kontraindikationen kontrastmittelverstärkter MRT- und CT-Untersuchungen in der Schwangerschaft

There are no reports about negative effects on the fetus of the application of gadolinium-containing contrast media to pregnant mothers. Iodine-containing contrast media may lead to a transient hypothyroidism in the newborn. This will be detected with certainty by the neonatal TSH screening. Iodine- or gadolinium-containing contrast media may be used in pregnant women if indispensable. In the gut of breastfed children less than 1% of the recommended pediatric doses of contrast media are found after both types of contrast media have been given to their mothers. Therefore there are no reasons against the use of contrast media during the nursing period.

Nephrogenic systemic fibrosis/nephrogenic fibrosing dermopathy: A decade-old disease

Nephrogenic systemic fibrosis, also known as nephrogenic fibrosing dermopathy, is a rare fibrosing disorder of skin and internal organs that occurs in the context of renal insufficiency, particularly in those who have undergone dialysis. It was first described in 1997 in the United States. The first non Western series was reported from Kolkata, India in 2005 the etiology is unknown. High-dose erythropoietin and use of gadolinium-containing contrast media are currently acknowledged to be important risk factors. The pathogenesis is multifactorial. The current hypothesis supports the role of circulating fibroblast precursors (fibrocytes) and the elaboration of circulating fibrogenic factors ( e.g., transforming growth factor beta 1). The clinical characteristics resemble scleromyxedema with a typical distribution pattern of its own. The histopathological hallmarks are spindle-shaped cells in the background of dermal fibrosis and deposition of collagen and mucin. Dual immunolabelling with CD34 and procollagen is diagnostic. There are no standard, specific and universally satisfactory treatments. The natural history is progressive with systemic manifestations conferring a poor outcome.

Contrast Agent for Intrathecal Gadolinium Administration

Contrast Agent for Intrathecal Gadolinium AdministrationSait Albayram, Aysegul Gunduz and Harun ÖzerAudio Available | Share

Actual clinical use of gadolinium-chelates for non-MRI applications.

For many years, alternatives to iodinated X-ray contrast media have been sought. Of the contrast media investigated to date, only CO(2) and the gadolinium-chelates have been shown to be viable alternatives for selected X-ray examinations. Therefore, we have reviewed the general literature and that specific for gadopentetate (Magnevist) in particular, since this agent has been studied the most. This review indicates that diagnostic CT examinations can be achieved following the intravenous administration of gadolinium-containing contrast media (CM) for evaluation of aortic abnormalities. Gadolinium-containing CM at the dose approved for MR imaging are not useful for CT evaluation of the abdominal parenchymal organs. Intravenous/intraarterial injections have also been used in a variety of angiographic and interventional procedures. Image quality, however, is generally inferior to iodinated contrast media. Gadolinium-containing CM require no special handling and can be administered by hand injection or via conventional angiographic automated injectors with the same flow rates and pressures as are used with iodinated contrast media. For CT, a peripheral bolus injection of a diluted gadolinium agent (1:1 with saline) of 60-90 ml at 3-5 ml/s is usually performed. Similar to all other gadolinium-chelates, the non-MRI use of gadopentetate (Magnevist) is not approved by regulatory agencies. However, the literature suggests that a dose of 0.3-0.4 mmol/kg b.w. has been safely administered for CT as well as for angiography and interventional procedures intravenously and intraarterially. Even at this dose, though, this results in a relatively small overall volume to be injected, which limits utility somewhat.