Use Of Gadopentetate Dimeglumine Research Articles

Rectal Use of Gadopentetate Dimeglumine for Anastomotic Leak Evaluation in Patients with Sensitivity to Iodinated Contrast Media

Rectal Use of Gadopentetate Dimeglumine for Anastomotic Leak Evaluation in Patients with Sensitivity to Iodinated Contrast Media

Transmetallation and gadolinium: Do low iron stores prevent the development of nephrogenic systemic fibrosis in high‐risk end‐stage renal disease patients?

Nephrogenic systemic fibrosis (NSF) is a systemic disorder that occurs in patients with renal failure and manifests as a thickening of the skin and flexion contractures of the joints. The etiology may involve an exposure to a gadolinium (Gd)-based magnetic resonance contrast agent. It has been proposed that in hemodialysis (HD) patients, iron mobilization (decreased total iron-binding capacity, increased iron level, and transferrin oversaturation) causes a transmetallation reaction and the release of free Gd from its chelator with the deposition of both Gd and iron in the affected tissues leading to fibrosis. The objective of this study was to investigate whether the use of gadopentetate dimeglumine leads to iron mobilization and to the development of NSF in HD patients. A retrospective chart analysis of 236 HD patients was performed and patients who had received a Gd-containing contrast agent were selected for analysis of their iron studies before and after the Gd exposure. A total of 25 patients were identified as having had a magnetic resonance imaging study and all were administered gadopentetate dimeglumine and no patients had any signs or symptoms suggestive of NSF. Six patients had the appropriate iron studies, which showed no statistically significant difference in the serum iron, total iron-binding capacity, ferritin, or transferrin saturation before and after exposure to gadopentetate dimeglumine. Our data suggest that the use of gadopentetate dimeglumine in HD patients did not cause iron mobilization and transmetallation therefore may partially explain the lack of development of NSF seen in our patient population.

Notes on “Characteristics of Gadolinium-DTPA Complex: A Potential NMR Contrast Agent”

1433 dopentetate dimeglumine. This agent was an early obvious choice for development, if one knew the requirements and had sufficient foresight. The gadolinium ion is the most effective of the paramagnetic metals in terms of T1 relaxation and thus enhancement effect. The gadopentetate dimeglumine complex is extremely stable, and the chelate by itself (di­ ethylenetriamine pentaacetic acid) was al­ ready commercially available in bulk quan­ tity for human use. The years 1983 and 1984 were busy ones for the field. A 1983 article in AJR [6] reviewed progress in the field, presenting primary findings and concluding “IV contrast agents may make possible the differentiation of tumor from surrounding edema in the brain, a problem that continues to confront NMR imaging.” At the 1983 meeting of the Radiological Society of North America, Speck and Weinmann described the first use of gadopentetate dimeglumine in a healthy volunteer, an experiment performed at the clinical site of Professor Roland Felix in Berlin [7]. Uniform enhancement of the bladder had been visualized after a dose of only 0.8 mL. Clinical studies were begun at the Hammersmith Hospital in London at the end of 1983 [8], and Weinmann’s seminal publication appeared in March 1984. Weinmann concluded, as subsequently con­ firmed in the 20 years of clinical expe rience with this agent, that “the combination of strong proton relaxation, in vivo stability, rapid urinary excretion, and high tolerance favors the further development and the potential clinical application of gadolinium– DTPA as a contrast enhancer in MRI” [1]. In June 1984, an oral presentation (published in 1985) described the in vivo use (in the same animal model that had been used for iodinated agents in CT for this purpose in 1979) and improved lesion sensitivity and specificity of MRI with gadopentetate dimeglumine [9]. Notes on “Characteristics of Gadolinium–DTPA Complex: A Potential NMR Contrast Agent”

Contrast Agent for Intrathecal Gadolinium Administration

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

Intratumor heterogeneity in blood perfusion in orthotopic human melanoma xenografts assessed by dynamic contrast‐enhanced magnetic resonance imaging

To determine the intratumor heterogeneity in blood perfusion of orthotopic human melanoma xenografts by use of gadopentetate dimeglumine (Gd-DTPA)-based dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). Orthotopic xenografts of an amelanotic human melanoma cell line (A-07) were scanned sagittally, coronally, and axially in three subsequent DCE-MRI sessions, using spoiled gradient recalled sequences, a voxel size of 0.31x0.62x2.0 mm3, and an interleaving acquisition method to avoid slice gaps. Tumor images of E . F (E is initial extraction fraction and F is perfusion) were produced by subjecting the DCE-MRI data to Kety analysis. E . F was used as a parameter for tumor blood perfusion, since E for Gd-DTPA is close to unity in A-07 tumors. All A-07 tumors subjected to investigation showed anisotropic radial heterogeneity in blood perfusion. The blood perfusion was low in the center of the tumors and increased toward the tumor periphery in the cranial, dorsal, caudal, and ventral directions, but not in the lateral and medial directions. In addition, 9 of 10 tumors showed blood perfusion hot spots in central or nonperipheral regions. The hot spots differed significantly between tumors in size, shape, location, and intensity, and appeared to be governed by stochastic processes. This heterogeneity superimposed the radial heterogeneity, but did not overshadow it in any tumor. Orthotopic human melanoma xenografts show significant intratumor heterogeneity in blood perfusion. This heterogeneity is made up of two distinctly different components, one stochastic and one nonstochastic radial component. The radial component is anisotropic and dominant and is superimposed by the stochastic component.

Detection and Localization of Proteinuria by Dynamic Contrast-Enhanced Magnetic Resonance Imaging Using MS325

After renal transplantation, persistent glomerular disease affecting the native kidneys typically causes albuminuria, at least for a period of time, making it difficult to determine in a noninvasive fashion whether proteinuria originates in the native kidneys or the renal allograft. To address this problem, dynamic contrast-enhanced magnetic resonance imaging (MRI) using gadolinium (Gd)-based albumin-bound blood pool contrast agent (MS325) to localize proteinuria was investigated. Glomerular proteinuria was induced in Sprague-Dawley rats by intravenous injection of puromycin aminonucleoside (PAN), whereas control rats received physiologic saline vehicle. Both groups of animals underwent a 40-min dynamic contrast-enhanced MRI using radio frequency spoiled gradient echo imaging sequence after injection of Gd-labeled MS325. Contrast uptake and clearance curves for cortex and medulla were determined from acquired MR images. Compared with controls, proteinuric rats exhibited significantly lower elimination rate constants. The use of gadopentetate dimeglumine (Gd-DTPA) as a contrast agent showed smaller and less specific differences between proteinuric and control groups. In rats with one proteinuric kidney (PAN-treated) and one normal kidney (transplanted from a normal rat), MRI using MS325 was able to differentiate between the two kidneys. The results suggest that MRI with an albumin-bound blood pool contrast agent may be a useful noninvasive way to localize proteinuria. If this technique can be successfully applied in human patients, it may allow for the localization of proteinuria after kidney transplant and thereby provide a noninvasive way to detect disease affecting the renal allograft.

Use of gadopentetate dimeglumine as a contrast agent for percutaneous transluminal renal angioplasty and stent placement

Percutaneous transluminal renal angioplasty and stent placement was performed successfully in a patient with renal artery stenosis and renal insufficiency using gadopentetate dimeglumine and carbon dioxide as radiographic contrast agents. No iodinated contrast material was used for the procedure.

Osteomyelitis of the diabetic foot: MR imaging-pathologic correlation.

To evaluate the efficacy of magnetic resonance (MR) imaging for the diagnosis of osteomyelitis in the diabetic foot by using anatomic and histologic studies of the resected tissue as a standard of reference. Thirteen diabetic patients with high clinical suspicion of osteomyelitis underwent a total of 15 MR examinations before surgery. Correlation was made between MR findings and the histologic features of the resected tissue, which included 57 bones. Maximum signal intensity on the T2-weighted or short inversion time inversion-recovery images of the bones was due to osteomyelitis (prospective sensitivity, 90%; specificity, 71%). Eighteen bones with increased signal intensity showed only edema of the marrow. The range of signal intensity in edema overlapped that in osteomyelitis but was lower. The use of gadopentetate dimeglumine improved delineation of soft-tissue inflammatory masses, but this contrast material was not useful in distinguishing osteomyelitis from edema. Marrow edema cannot be reliably distinguished from osteomyelitis with MR imaging. Gadopentetate dimeglumine is of limited use. Some previously published false-positive reports of osteomyelitis were most likely due to edema of the marrow. MR imaging is useful in planning surgery of the infected diabetic foot, as it enables reliable distinction between normal and abnormal areas.

Malignant tumors of the heart and great vessels: MR imaging appearance.

Fortunately, primary tumors of the heart and great vessels are rare. These primary tumors include angiosarcoma, malignant fibrous histiocytoma, high-grade and pleomorphic sarcoma, and paraganglioma with pericardial and myocardial invasion. Symptoms are often nonspecific and include chest pain and dyspnea. Although these tumors are often diagnosed with echocardiography and computed tomography, magnetic resonance (MR) imaging currently appears to be the imaging modality of choice because of its diverse capabilities, which include multiplanar imaging for excellent anatomic definition of the heart, pericardium, mediastinum, and lungs; improved morphologic differentiation between tumor tissue and surrounding cardiovascular, mediastinal, or pulmonary tissues; dynamic imaging with a gated cine-loop acquisition; and assessment of tissue perfusion. The use of gadopentetate dimeglumine is helpful in achieving tumor enhancement on MR images but is not required. MR imaging is also useful in assessing tumor response to surgery, radiation therapy, and chemotherapy.

Failure of gadopentetate dimeglumine-enhanced, high-resolution magnetic resonance imaging to differentiate among melanin-containing skin tumors.

We evaluated the diagnostic potential of gadopentetate dimeglumine-enhanced, high-resolution magnetic resonance (MR) imaging to differentiate benign from malignant melanin-containing skin tumors. Forty-five patients were prospectively examined using high-resolution MR imaging at 1.5 T using a 2.5-cm surface coil. For tumor assessment, T1-weighted and T2-weighted transverse spin-echo sequences were acquired. After intravenous administration of gadopentetate dimeglumine (0.1 mmol/kg), the T1-weighted transverse sequence was repeated. Contrast enhancement was quantitatively determined as the percentage increase of signal intensity. Histologic findings were correlated using the Wilcoxon signed-ranks test. The quality of contrast enhancement was assessed by three independent investigators who were unaware of the patients' history and histologic data. The signal-to-noise ratio (SNR) was calculated in the T2-weighted sequence. Significance was tested using the Wilcoxon signed-ranks test. In all tumors, contrast enhancement was visually discernible. Half of the cases were enhanced inhomogeneously. The percentage of contrast enhancement did not correlate with histologic findings. Malignant melanomas could not be differentiated from benign melanocytic nevi with the use of gadopentetate dimeglumine. Determination of the SNR in T2-weighted sequences revealed no significant difference for histologic subgroups or tumor type. Gadopentetate dimeglumine-enhanced MR imaging does not differentiate malignant melanomas from benign melanocytic nevi. Determination of the SNR in the T2-weighted sequences revealed no significant difference for histologic subgroups.

Combined intrauterine and ovarian pregnancy mimicking ovarian malignant tumor: imaging findings.

In a 41 -year-old para 3 gravida 4 woman an adnexal mass was palpable on routine checkup in the 8th week of gestation. On followup, the mass was found to have enlarged rapidly. The woman complained of increasing abdominal pain, loss of weight, and vomiting. On admission in the 11th week of gestation, she was cachectic and anemic, with hen abdomen distended and tender. Elevated serum levels of carcinoembryogenic antigen 125 (CA 125) supported the diagnosis of an ovarian malignant tumor during pregnancy. Endovaginal sonography and colon Doppler examination showed the intrauterine pregnancy intact. A large mass was found oniginating from the left ovary (Fig. iA). Small amounts of free fluid were also seen. The intact early pregnancy suggested the use of MR rather than CT for preoperative staging of the suspected ovarian cancer (Fig. 1B-D). Although no evidence ofteratogenicity exists to date, the use of gadopentetate dimeglumine is not routinely recommended in pregnant women, so we preferred not to use contrast material in this case. Because of its inhomogeneous architecture and its heterogeneous signal intensity pattern indicating bleeding within the mass, and the presence of hemorrhagic ascites and bowel obstruction, the diagnosis of a malignant ovarian tumor was suggested. Laparotomy was done 2 days later. A conglomerate tumor, mainly consisting of a large hematoma, was found to extend from the left ovary to the sigmoid colon and the pelvic wall. Multiple fnozen sections from solid areas of the mass indicated placental structures with hemorrhage. Small-bowel obstruction was found to be due to multipIe adhesions of bowel loops in the left pelvic region. Histologic and histochemical workup of the resected tumor showed a large, partly organized blood clot surrounded by placental (trophoblast) tissue originating from ovarian stroma. The intact trophoblast cells showed a high activity of the beta subunit of human chorionic gonadotropin (13-HCG). No fetal structures were detected. Both the ectopic and the intrauterine pregnancy seemed to originate from the same menstrual cycle. This is supported by the fact that a preexisting 13-HCG-producing trophoblast (either ectopic or orthotopic) would have effectively prevented a second ovulation. Accordingly, a final diagnosis of double-ovum pregnancy with orthotopic and ectopic ovarian nidation was established. Although the embryoblast ofthe ovarian gestation must have died during early pregnancy-possibly due to malnutrition-there still was vital trophoblast tissue with considerable production of (3-HCG. The clinically apparent tumor growth had been caused by extensive hemorrhage into the ectopic pregnancy.

Central nervous system tumor, infection, and infarction: detection with gadolinium-enhanced magnetization transfer MR imaging.

To quantitatively measure the degree of contrast enhancement of central nervous system (CNS) tumor, infection, and infarction by means of magnetization transfer (MT) magnetic resonance (MR) imaging. T1-weighted MR images obtained before and after administration of contrast material with and without MT in 14 patients with CNS tumors were evaluated by means of a contrast-to-noise ratio (C/N). Another 72 patients with a variety of lesions underwent contrast material-enhanced T1-weighted MR imaging prospectively with and without MT; C/N was also evaluated. All lesions had a higher C/N on T1-weighted postcontrast MT images than on conventional images. C/N was 65 +/- 5 (mean +/- standard error) for MT and 42 +/- 4 for conventional images. C/N improved by a factor of 1.6-2.1 in the three disease categories. In intracranial tumors, the MT technique itself did not contribute significantly (P < .001) to the increase in C/N in the absence of gadopentetate dimeglumine. In fact, the C/N was lower for nonenhanced T1-weighted MT images. Concurrent use of gadopentetate dimeglumine and MT results in a statistically significant (P < .001) increase in C/N in CNS tumor, infection, and infarction.

Gadopentetate-dimeglumine-enhanced MR imaging of osteonecrosis and osteochondritis dissecans of the elbow: initial experience

Magnetic resonance imaging (MRI) was performed on seven patients with aseptic osteonecrosis (n = 4) and osteochondritis dissecans (OCD; n = 3) of the elbow. Precontrast MRI was superior to plain radiographs, which did not show any abnormality in three cases of osteonecrosis. On gadopentetate-dimeglumine-enhanced T1-weighted images, which were obtained in three patients with osteonecrosis and three patients with OCD, all cases of osteonecrosis demonstrated homogeneous enhancement of the lesions. All cases of OCD were diagnosed on plain radiographs. On MRI one showed significant enhancement of the loose body. In another case an incompletely enhancing loose body was surrounded by a diffusely enhancing region. In the third patient only a small marginal enhancement of the defect was observed. Our results suggest that MRI can improve the accuracy in diagnosis of aseptic osteonecrosis of the elbow. The use of gadopentetate dimeglumine allows the viability of the lesions or the loose bodies to be demonstrated and reparative tissue to be detected.

Gadolinium-enhanced T1-weighted versus T2-weighted imaging of scrotal disorders: is there an indication for MR imaging?

To evaluate the use of gadopentetate dimeglumine in magnetic resonance (MR) imaging of scrotal disorders, the clinical, ultrasound, and MR imaging data of 29 patients (age range, 19-75 years) with various intra- and extratesticular disorders were retrospectively analyzed. T1- and T2-weighted spin-echo images (T1-T2 group) were compared with T1-weighted spin-echo images before and after intravenous administration of gadopentetate dimeglumine (T1-Gd group). A receiver operating characteristic (ROC) analysis of the findings was undertaken. Better contrast between tumor and parenchyma and a clearer demonstration of the tunica albuginea were noted in the T1-T2 group (although not of diagnostic relevance). ROC analysis revealed no differences between the two imaging groups in the diagnosis of tumor, trauma, hydrocele, or hemorrhage; however, epididymitis was diagnosed more easily with contrast enhancement (0.8834 vs 0.7759, P = .04) and the diagnosis of orchitis was expressed more strongly (0.8221 vs 0.7184, P = .17). Four of the five observers were more confident in making the diagnosis with contrast enhancement. With MR imaging, the diagnosis was correctly suggested in three patients in whom clinical and ultrasound data were inconclusive. Gadolinium-enhanced MR imaging gives additional information in scrotal disorders and facilitates diagnosis. It may be helpful when findings at physical examination and ultrasound differ and when plain T1- and T2-weighted images are equivocal.

Cystic masses in the floor of the mouth: value of MR imaging in planning surgery.

The purpose of this study was to determine the value of preoperative MR imaging for planning the best surgical approach for excising cystic masses in the floor of the mouth. In addition, different sequences and slice orientations were compared in order to develop a standard MR examination technique for this purpose. Eleven patients with cystic masses in the floor of the mouth were prospectively examined with MR imaging after palpation and sonography. The imaging protocol included T1- and T2-weighted spin-echo sequences, both unenhanced and contrast enhanced. The exact topographic relationship of these cysts to the surrounding muscles and the value of different MR techniques were analyzed. The mylohyoid muscle, which serves as a key structure in determining the exact position of a cystic mass, was visualized in all cases. T2-weighted images facilitated the primary diagnosis of cystic lesions, whereas T1-weighted images allowed the best visualization of anatomic details. Use of gadopentetate dimeglumine did not provide significant diagnostic information. Coronal and axial slices provided the best visualization of the topographic relationship of cyst and muscles. Sagittal slices were helpful only for midline lesions. In two cases, the choice between the intraoral and the cervical surgical approach was altered by MR imaging findings. MR imaging facilitates exact visualization of the location and extent of cystic lesions in the floor of the mouth and is useful for determining their relationship to the surrounding muscles. We conclude that MR imaging is an important adjunct to palpation and sonography in planning the best surgical approach.

Reactive soft-tissue mass associated with osteoid osteoma: correlation of MR imaging features with pathologic findings.

The authors retrospectively reviewed three cases of histologically documented osteoid osteoma in which magnetic resonance (MR) imaging was performed prior to surgical excision. In all three cases, MR imaging demonstrated abnormal signal intensity characteristics, and use of gadopentetate dimeglumine resulted in enhancement. These findings correlated with a reactive soft-tissue mass with myxomatous change, as well as with cell-depleted, juxtanidal bone marrow that contained proteinaceous material. These MR imaging findings can easily be confused with those of a malignant tumor or osteomyelitis.

MR imaging of the brain in patients with AIDS: value of routine use of i.v. gadopentetate dimeglumine.

A prospective study was conducted to explore the value of routine administration of IV gadopentetate dimeglumine for MR imaging of the brain in patients with AIDS. Over a 19-month period, MR images of the brain in 51 consecutive AIDS patients were obtained routinely both with and without IV gadopentetate dimeglumine. Unenhanced and contrast-enhanced images from the resulting 63 studies were viewed together. Findings were classified into one or more of three categories: normal, mass or focal lesions, or white matter disease. The number of focal or mass lesions was recorded. Lesion conspicuity on the unenhanced and enhanced images was compared. Ventricular enlargement was also graded. Available medical records and laboratory data of the patients were reviewed. Of the 63 MR studies reviewed, 39 (62%) were abnormal. In no case was a normal unenhanced MR study rendered abnormal after the administration of gadopentetate dimeglumine. Overall, T2-weighted images showed twice as many focal or mass lesions than contrast-enhanced T1-weighted images did. Most lesions detected on the T2-weighted images did not show enhancement with contrast material. White matter disease was the most common abnormality detected. The group of patients with white matter disease also had the highest occurrence of ventriculomegaly. Our study does not support the routine use of gadopentetate dimeglumine for MR imaging of the brain in patients with AIDS. Our experience emphasizes the importance of a normal T2-weighted image.

Laryngospasm after administration of gadopentetate dimeglumine

Few serious adverse reactions associated with the use of gadopentetate dimeglumine in magnetic resonance imaging have been reported. The present case involves an 8-year-old girl who developed laryngospasm after administration of gadopentetate dimeglumine.

Gadolinium-enhanced magnetization transfer contrast imaging of intracranial tumors.

The magnetization transfer contrast (MTC) technique was used in low-field-strength (0.1 T) magnetic resonance (MR) imaging of 28 patients with intracranial tumors. MTC images were generated with an off-resonance, low-power radio-frequency pulse applied during the interpulse delay period of a gradient-echo partial-saturation sequence (TR msec/TE msec = 200/20). Images in the presence and absence of the MTC pulse were concurrently acquired before and after injection of gadopentetate dimeglumine at a dose of 0.1 mmol/kg. The contrast agent enhanced 27 of 28 tumors. Application of the MTC pulse improved the contrast-to-noise ratio (C/N) between tumor and normal white matter in 26 of 28 cases on the preinjection images and in 25 of 28 cases on the postinjection images. On the gadolinium-enhanced images, the mean C/N was 2.6 +/- 1.7 without the MTC pulse and 3.2 +/- 1.9 with the MTC pulse. The greatest contrast improvement with the MTC technique was obtained in tumors showing the strongest paramagnetic enhancement. The results indicate that MTC can improve contrast between normal brain and some intracranial neoplasms. The use of gadopentetate dimeglumine generally intensified this effect.

MR imaging of tuberous sclerosis: pathogenesis of this phakomatosis, use of gadopentetate dimeglumine, and literature review.

Findings on cranial magnetic resonance (MR) images were correlated with known histopathologic findings in 42 patients with tuberous sclerosis (TS), 17 of whom received gadopentetate dimeglumine, to extend the range of signs on MR images. Four neuroradiologists recorded the number, sites, configurations, and relative signal intensities of intracranial abnormalities. White matter lesions, found in 39 patients (93%), showed four distinct patterns: (a) straight or curvilinear bands extending radially from the ventricle through the cerebral mantle toward the cortex, (b) wedge-shaped lesions, (c) nonspecific conglomerate foci, and (d) cerebellar radial bands. It is concluded that cortical tubers, white matter lesions, subependymal nodules, and sub-ependymal giant cell astrocytomas (SGCAs) may be enhanced after administration of gadopenetetate dimeglumine. Enhancement of a TS lesion does not indicate neoplastic transformation into SGCA. Imaging surveillance every 12 months appears indicated during the peak ages (8-18 years) of occurrence of SGCA. The appearance of white matter lesions supports the theory that the cerebral lesions of TS may be caused by disordered migration of dysgenetic cells.