931 results on '"GADOLINIUM"'
Search Results
2. Contrast Media-driven Anthropogenic Gadolinium: Knowns and Unknowns.
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Lenkinski RE and Rofsky NM
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- Magnetic Resonance Imaging, Contrast Media, Gadolinium, Water Pollution, Chemical
- Abstract
Gadolinium-based contrast agents (GBCAs) have augmented the capabilities of MRI, which has led to their widespread and increasing use in radiology practice. GBCAs are introduced into the environment through disposal of unused product and elimination after intravenous injection, both primarily via liquid dispersion into the environment. This human introduction of gadolinium into the environment, referred to as anthropogenic gadolinium, is associated with the detection of gadolinium in water systems, raising concerns for potential adverse impact and prompting certain mitigation actions. This article summarizes the existing knowledge and problem scope, conveys the relevant underlying chemical principles of chelate dissociation, and offers an inferred perspective that the magnitude of the problem is most unlikely to cause human harm. The merits and limitations regarding possible mitigation tactics, such as collecting urine after GBCA administration, use of lower-dose high-relaxivity macrocyclic GBCAs, and the option for virtual contrast-enhanced examinations, will be discussed. Finally, the potential for monitoring gadolinium uptake in bone will be presented, and recommendations for future research will be offered. © RSNA, 2024 See also the article by Ibrahim et al in this issue. See also the article by McKee et al in this issue.
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- 2024
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3. Brain Tumor Imaging without Gadolinium-based Contrast Agents: Feasible or Fantasy?
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Wamelink IJHG, Azizova A, Booth TC, Mutsaerts HJMM, Ogunleye A, Mankad K, Petr J, Barkhof F, and Keil VC
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- Adult, Humans, Child, Contrast Media, Gadolinium, Fantasy, Artificial Intelligence, Magnetic Resonance Imaging, Meningioma, Brain Neoplasms diagnostic imaging, Glioma diagnostic imaging, Meningeal Neoplasms
- Abstract
Gadolinium-based contrast agents (GBCAs) form the cornerstone of current primary brain tumor MRI protocols at all stages of the patient journey. Though an imperfect measure of tumor grade, GBCAs are repeatedly used for diagnosis and monitoring. In practice, however, radiologists will encounter situations where GBCA injection is not needed or of doubtful benefit. Reducing GBCA administration could improve the patient burden of (repeated) imaging (especially in vulnerable patient groups, such as children), minimize risks of putative side effects, and benefit costs, logistics, and the environmental footprint. On the basis of the current literature, imaging strategies to reduce GBCA exposure for pediatric and adult patients with primary brain tumors will be reviewed. Early postoperative MRI and fixed-interval imaging of gliomas are examples of GBCA exposure with uncertain survival benefits. Half-dose GBCAs for gliomas and T2-weighted imaging alone for meningiomas are among options to reduce GBCA use. While most imaging guidelines recommend using GBCAs at all stages of diagnosis and treatment, non-contrast-enhanced sequences, such as the arterial spin labeling, have shown a great potential. Artificial intelligence methods to generate synthetic postcontrast images from decreased-dose or non-GBCA scans have shown promise to replace GBCA-dependent approaches. This review is focused on pediatric and adult gliomas and meningiomas. Special attention is paid to the quality and real-life applicability of the reviewed literature., (© RSNA, 2024.)
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- 2024
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4. Gadolinium Presence in Rat Skin: Assessment of Histopathologic Changes Associated with Small Fiber Neuropathy.
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Boyken J, Lohrke J, Treu A, Neddens J, Jost G, Ulbrich HF, Balzer T, Frenzel T, Prokesch M, Thuss U, and Pietsch H
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- Animals, Rats, Contrast Media, Body Weight, Gadolinium, Small Fiber Neuropathy, Heterocyclic Compounds, Organometallic Compounds, Gadolinium DTPA
- Abstract
Background The presence of gadolinium traces in the skin after administration of gadolinium-based contrast agents (GBCAs) raised safety concerns regarding a potential association with small fiber neuropathy (SFN). Purpose To investigate signs of SFN in rat foot pads by quantification of the intraepidermal nerve fiber density (IENFD) after multiple GBCA administrations and to evaluate gadolinium concentration, chemical species, and clearance. Materials and Methods Fifty rats received eight intravenous injections of either gadodiamide, gadobutrol, gadoterate, gadoteridol (8 × 0.6 mmol per kilogram of body weight), or saline (1.2 mL per kilogram of body weight), within 2 weeks and were sacrificed 5 days or 5 weeks after the last injection. IENFD was determined with protein gene product (PGP) 9.5 immunofluorescent staining and blinded and automated image analysis. The gadolinium and GBCA concentrations were measured with inductively coupled plasma mass spectrometry (ICP-MS), laser ablation ICP-MS, and matrix-assisted laser desorption/ionization mass spectrometry imaging (MALDI MSI). P values were calculated using linear contrasts of model analysis. Results The IENFD (measured as geometric mean [SD] and in number of nerve fibers per millimeter of epidermis) was not significantly altered after 5 days (saline, 8.4 [1.1]; gadobutrol, 9.7 [1.2]; gadoterate, 9.2 [1.2]; gadoteridol, 9.9 [1.3]; gadodiamide, 10.5 [1.2]) or 5 weeks (saline, 19.7 [1.4]; gadobutrol, 16.4 [1.6]; gadoterate, 14.3 [1.6]; gadoteridol, 22.2 [1.8]; gadodiamide, 17.9 [1.4]). Gadolinium skin concentrations were highest for gadodiamide after 5 days (16.0 nmol/g [1.1]) and 5 weeks (10.6 nmol/g [1.2], -33%). Macrocyclic agents were lower at 5 days (gadoteridol, 2.6 nmol/g [1.2]; gadobutrol, 2.7 nmol/g [1.1]; and gadoterate, 2.3 nmol/g [1.2]) and efficiently cleared after 5 weeks (gadoteridol, -95%; gadobutrol and gadoterate, -96%). The distribution of gadolinium and IENF did not visually overlap. For macrocyclic agents, gadolinium was found in sweat glands and confirmed to be intact chelate. Conclusion There were no signs of SFN in rat foot pads using multiple dosing regimens at two time points after administration of GBCAs. Macrocyclic GBCAs exhibited lower levels of gadolinium in the skin and were effectively eliminated within 5 weeks compared with linear gadodiamide, and intact macrocyclic GBCA was detected in sweat glands. © RSNA, 2024 Supplemental material is available for this article. See also the editorial by Clement in this issue.
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- 2024
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5. Small Fiber Neuropathy and Gadolinium-based Contrast Agents: No Association Found in Rats.
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Clement O
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- Animals, Rats, Contrast Media, Gadolinium, Small Fiber Neuropathy
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- 2024
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6. Long-term Gadolinium Retention in the Healthy Rat Brain: Comparison between Gadopiclenol, Gadobutrol, and Gadodiamide
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Sabrina K. I. Funke, Cécile Factor, Marlène Rasschaert, Lena Lezius, Michael Sperling, Uwe Karst, and Philippe Robert
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Gadolinium DTPA ,Male ,Rats, Sprague-Dawley ,Iron ,Organometallic Compounds ,Animals ,Brain ,Contrast Media ,Female ,Gadolinium ,Radiology, Nuclear Medicine and imaging ,Azabicyclo Compounds ,Rats - Abstract
Background Safety concerns caused by gadolinium retention call for the development of high-relaxivity gadolinium-based contrast agents (GBCAs) allowing minimal dosing. Purpose To investigate brain gadolinium retention in healthy rats after exposure to gadopiclenol (Elucirem, Guerbet; macrocyclic GBCA) compared with gadobutrol (Gadovist or Gadavist, Bayer; macrocyclic GBCA) and gadodiamide (Omniscan, GE Healthcare; linear GBCA) over 1 year. Materials and Methods In this study conducted between May 2018 and April 2020, 9-week-old healthy Sprague Dawley rats received five injections of either gadopiclenol, gadobutrol, or gadodiamide (2.4 mmol of gadolinium per kilogram of body weight for each), or saline (control animals) over a period of 5 weeks. Rats were randomly assigned to different groups (six female and six male rats per group). MRI examinations were performed before euthanasia at 1, 3, 5, or 12 months after the last injection. Brains were sampled to determine the total gadolinium content via inductively coupled plasma mass spectrometry (ICP-MS), to characterize gadolinium species with size exclusion chromatography (SEC)-ICP-MS, and to perform elemental mapping with laser ablation (LA)-ICP-MS. Mann-Whitney tests were performed on pairwise comparisons of the same time points. Results For both macrocyclic agents, no T1 signal hyperintensities were observed in the cerebellum, and approximately 80% of gadolinium washout was found between 1 month (gadobutrol, 0.30 nmol/g; gadopiclenol, 0.37 nmol/g) and 12 months (gadobutrol, 0.062 nmol/g; gadopiclenol, 0.078 nmol/g). After 12 months, only low-molecular-weight gadolinium species were detected in the soluble fraction. Gadodiamide led to significantly higher gadolinium concentrations after 1 month in the cerebellum (gadodiamide, 2.65 nmol/g
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- 2022
7. Deep Learning–based Post Hoc CT Denoising for Myocardial Delayed Enhancement
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Tatsuya Nishii, Takuma Kobayashi, Hironori Tanaka, Akiyuki Kotoku, Yasutoshi Ohta, Yoshiaki Morita, Kensuke Umehara, Junko Ota, Hiroki Horinouchi, Takayuki Ishida, and Tetsuya Fukuda
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Male ,Deep Learning ,Myocardium ,Contrast Media ,Humans ,Gadolinium ,Radiology, Nuclear Medicine and imaging ,Tomography, X-Ray Computed ,Aged ,Retrospective Studies - Abstract
Background To improve myocardial delayed enhancement (MDE) CT, a deep learning (DL)-based post hoc denoising method supervised with averaged MDE CT data was developed. Purpose To assess the image quality of denoised MDE CT images and evaluate their diagnostic performance by using late gadolinium enhancement (LGE) MRI as a reference. Materials and methods MDE CT data obtained by averaging three acquisitions with a single breath hold 5 minutes after the contrast material injection in patients from July 2020 to October 2021 were retrospectively reviewed. Preaveraged images obtained in 100 patients as inputs and averaged images as ground truths were used to supervise a residual dense network (RDN). The original single-shot image, standard averaged image, RDN-denoised original (DL
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- 2022
8. Cardiac MRI Features and Prognostic Value in Immune Checkpoint Inhibitor–induced Myocarditis
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Farah Cadour, Jennifer Cautela, Stanislas Rapacchi, Arthur Varoquaux, Paul Habert, François Arnaud, Alexis Jacquier, Alexandra Meilhac, Franck Paganelli, Nathalie Lalevée, Ugo Scemama, Franck Thuny, Hôpital de la Timone [CHU - APHM] (TIMONE), Centre recherche en CardioVasculaire et Nutrition = Center for CardioVascular and Nutrition research (C2VN), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Institut National de Recherche pour l’Agriculture, l’Alimentation et l’Environnement (INRAE), Hôpital de la Conception [CHU - APHM] (LA CONCEPTION), and Hôpital Saint-Joseph [Marseille]
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Adult ,Male ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Gadolinium ,Prognosis ,Magnetic Resonance Imaging ,[SHS]Humanities and Social Sciences ,Myocarditis ,Predictive Value of Tests ,Neoplasms ,Humans ,Radiology, Nuclear Medicine and imaging ,Immune Checkpoint Inhibitors ,ComputingMilieux_MISCELLANEOUS ,Aged ,Retrospective Studies - Abstract
International audience; Background: Cardiac MRI features are not well-defined in immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M), a severe complication of ICI therapy in patients with cancer.Purpose: To analyze the cardiac MRI features of ICI-M and to explore their prognostic value in major adverse cardiovascular events (MACE).Materials and Methods: In this retrospective study from May 2017 to January 2020, cardiac MRI findings (including late gadolinium enhancement [LGE], T1 and T2 mapping, and extracellular volume fraction [ECV] z scores) of patients with ICI-M were compared with those of patients with cancer scheduled to receive ICI therapy (pre-ICI group) and patients with viral myocarditis. As a secondary objective, the potential value of cardiac MRI for predicting MACE in patients with ICI-M by using Cox proportional hazards models was explored.Results: Thirty-three patients with ICI-M (mean age +/- standard deviation, 68 years +/- 14; 23 men) were compared with 21 patients scheduled to receive to ICI therapy (mean age, 65 years +/- 14; 14 men) and 85 patients with viral myocarditis (mean age, 32 years +/- 13; 67 men). Compared with the pre-ICI group, patients with ICI-M showed higher global native T1, ECV, and T2 z scores (0.03 +/- 0.85 vs 1.79 +/- 1.93 [P < .001]; 1.34 +/- 0.57 vs 2.59 +/- 1.97 [P = .03]; and -0.76 +/- 1.41 vs 0.88 +/- 1.96 [P = .002], respectively), and LGE was more frequently observed (27 of 33 patients [82%] vs two of 21 [10%]; P < .001). LGE was less frequent in patients with ICI-M than those with viral myocarditis (27 of 33 patients [82%] vs 85 of 85 [100%]; P < .001) but was more likely to involve the septal segments (16 of 33 patients [48%] vs 25 of 85 [29%]; P < .001) and midwall layer (11 of 33 patients [33%] vs two of 85 [2%]; P < .001). Septal LGE was the only cardiac MRI predictor of MACE at 1 year even after adjustment for peak troponin (adjusted hazard ratio, 2.7 [95% CI: 1.1, 6.7]; P = .03).Conclusion: Cardiac MRI features of immune checkpoint inhibitor (ICI)-induced myocarditis (ICI-M) seem to differ from those in patients scheduled to receive ICIs and patients with viral myocarditis. Septal late gadolinium enhancement might be a predictor of major cardiovascular events in patients with ICI-M.
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- 2022
9. Allergic-like Hypersensitivity Reactions to Gadolinium-based Contrast Agents: An 8-year Cohort Study of 154 539 Patients
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Yoon Hae Ahn, Dong Yoon Kang, Soo-Been Park, Hyun Hwa Kim, Hyun Jee Kim, Ga-Yoon Park, Soon-Ho Yoon, Young-Hun Choi, Suh Young Lee, and Hye-Ryun Kang
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Cohort Studies ,Drug Hypersensitivity ,Iodine Compounds ,Contrast Media ,Humans ,Gadolinium ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies - Abstract
Background With the widespread use of gadolinium-based contrast agents (GBCAs), the incidence of allergic-like hypersensitivity reactions (HSRs) to GBCAs is increasing. Research on the incidence and risk factors for HSRs to GBCAs is needed for their safe use. Purpose To determine the incidence of acute and delayed reactions to GBCAs and to discuss the risk factors and strategies for the prevention of HSRs to GBCAs. Materials and Methods All cases of HSRs to contrast media that occurred at the Seoul National University Hospital from July 1, 2012, to June 30, 2020, were assessed. Information including age, sex, GBCA type, onset, and severity of HSRs was retrospectively analyzed. Results Among the 331070 cases of GBCA exposure in 154539 patients, 1304 cases of HSRs (0.4%) were reported. Acute HSRs accounted for 1178 cases (0.4%), while 126 cases (0.04%) were delayed HSRs. While both premedication (odds ratio [OR] = 0.7
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- 2022
10. New Insights into the Pharmacology and Biodistribution of Gadolinium-based Contrast Agents.
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Tweedle MF
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- Humans, Tissue Distribution, Contrast Media, Gadolinium
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- 2023
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11. Neurologic Effects of Gadolinium Retention in the Brain after Gadolinium-based Contrast Agent Administration
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Jennifer Ayers-Ringler, Jennifer S. McDonald, Margaret A. Connors, Cody R. Fisher, Susie Han, Daniel R. Jakaitis, Bradley Scherer, Gabriel Tutor, Katheryn M. Wininger, Daying Dai, Doo-Sup Choi, Jeffrey L. Salisbury, Paul J. Jannetto, Joshua A. Bornhorst, Ram Kadirvel, David F. Kallmes, and Robert J. McDonald
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Male ,Models, Animal ,Animals ,Brain ,Contrast Media ,Radiology, Nuclear Medicine and imaging ,Administration, Intravenous ,Gadolinium ,Rats, Wistar ,Rats ,Original Research - Abstract
BACKGROUND: Concerns over the neurotoxic potential of retained gadolinium in brain tissues after intravenous gadolinium-based contrast agent (GBCA) administration have led to pronounced worldwide use changes, yet the clinical sequelae of gadolinium retention remain undefined. PURPOSE: To assess clinical and neurologic effects and potential neurotoxicity of gadolinium retention in rats after administration of various GBCAs. MATERIALS AND METHODS: From March 2017 through July 2018, 183 male Wistar rats received 20 intravenous injections of 2.5 mmol per kilogram of body weight (80 human equivalent doses) of various GBCAs (gadodiamide, gadobenate, gadopentetate, gadoxetate, gadobutrol, gadoterate, and gadoteridol) or saline over 4 weeks. Rats were evaluated 6 and 34 weeks after injection with five behavioral tests, and inductively coupled plasma mass spectrometry, transmission electron microscopy, and histopathology were performed on urine, serum, cerebrospinal fluid (CSF), basal ganglia, dentate nucleus, and kidney samples. Dunnett post hoc test and Wilcoxon rank sum test were used to compare differences between treatment groups. RESULTS: No evidence of differences in any behavioral test was observed between GBCA-exposed rats and control animals at either 6 or 34 weeks (P = .08 to P = .99). Gadolinium concentrations in both neuroanatomic locations were higher in linear GBCA-exposed rats than macrocyclic GBCA-exposed rats at 6 and 34 weeks (P < .001). Gadolinium clearance over time varied among GBCAs, with gadobutrol having the largest clearance (median: 62% for basal ganglia, 70% for dentate) and gadodiamide having no substantial clearance. At 34 weeks, gadolinium was largely cleared from the CSF and serum of gadodiamide-, gadobenate-, gadoterate-, and gadobutrol-exposed rats, especially for the macrocyclic agents (range: 70%–98% removal for CSF, 34%–94% removal for serum), and was nearly completely removed from urine (range: 96%–99% removal). Transmission electron microscopy was used to detect gadolinium foci in linear GBCA-exposed brain tissue, but no histopathologic differences were observed for any GBCA. CONCLUSION: In this rat model, no clinical evidence of neurotoxicity was observed after exposure to linear and macrocyclic gadolinium-based contrast agents at supradiagnostic doses. © RSNA, 2022 Online supplemental material is available for this article.
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- 2023
12. Symptoms Associated with Gadolinium Exposure (SAGE): A Suggested Term
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Matthew S. Davenport, Robert J. McDonald, and Jeffrey C. Weinreb
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medicine.medical_specialty ,business.industry ,Gadolinium ,SAGE ,fungi ,Contrast Media ,chemistry.chemical_element ,United States ,Term (time) ,Drug Hypersensitivity ,chemistry ,Terminology as Topic ,medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,business ,Societies, Medical - Abstract
In this article, members of the American College of Radiology Committee on Drugs and Contrast Media propose a new term for symptoms reported after intravascular exposure to gadolinium-based contrast agents-Symptoms Associated with Gadolinium Exposure, or SAGE. This term is advocated in lieu of other proposed nomenclature that presumes a causal relationship that has not yet been scientifically verified. The purpose of this new term, SAGE, is to assist researchers and clinical providers in describing such symptoms without prematurely causally attributing them to a disease and to standardize reporting of these symptoms to allow for coherent interpretation of related studies.
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- 2022
13. Effects of Gadolinium Deposition in the Brain on Motor or Behavioral Function: A Mouse Model
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Yusuke Inoue, Minoru Tsuji, Akira Kunimatsu, Kazuya Miyagawa, Kuni Ohtomo, Haruto Sugawara, Hiroshi Takeda, Kohei Takahashi, Shigeru Kiryu, Osamu Abe, Hiroyuki Akai, Koichiro Yasaka, Atsumi Mochida-Saito, and Kazuhiro Kurokawa
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business.industry ,Gadolinium ,media_common.quotation_subject ,chemistry.chemical_element ,chemistry ,Biophysics ,Medicine ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,sense organs ,skin and connective tissue diseases ,business ,Deposition (chemistry) ,media_common - Abstract
Repeated injection of gadolinium-based contrast agents did not cause any motor or behavioral changes, whether the agents were linear or macrocyclic.
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- 2021
14. Diagnosis of low-grade chondrosarcoma.
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Crim, JR and Seeger, LL
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Cartilage ,Humans ,Chondrosarcoma ,Bone Neoplasms ,Gadolinium ,Meglumine ,Pentetic Acid ,Gadolinium DTPA ,Organometallic Compounds ,Drug Combinations ,Contrast Media ,Magnetic Resonance Imaging ,Image Enhancement ,Research Design ,Adult ,Female ,Radiography ,BONE NEOPLASMS ,BONE NEOPLASMS ,MR ,CARTILAGE ,MR ,DEVILS ADVOCATE ,SARCOMA ,MR ,CARTILAGE ,Nuclear Medicine & Medical Imaging ,Medical and Health Sciences - Published
- 1993
15. Use of Intravenous Gadolinium-based Contrast Media in Patients with Kidney Disease and the Risk of Nephrogenic Systemic Fibrosis: Radiology In Training
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Matthew S. Davenport and Mostafa Alabousi
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medicine.medical_specialty ,business.industry ,medicine.medical_treatment ,Gadolinium ,chemistry.chemical_element ,medicine.disease ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,chemistry ,Male patient ,030220 oncology & carcinogenesis ,Nephrogenic systemic fibrosis ,medicine ,Radiology, Nuclear Medicine and imaging ,In patient ,Radiology ,business ,Dialysis ,Kidney disease - Abstract
A 66-year-old male patient with end-stage chronic kidney disease undergoing maintenance dialysis and with a history of group I intravenous gadolinium-based contrast media (GBCM) administration presented with clinical and pathologic findings consistent with nephrogenic systemic fibrosis. A summary of the evidence and recommendations for use of intravenous GBCM in patients with kidney disease is presented. © RSNA, 2021.
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- 2021
16. A New Generation of Gadolinium-based MRI Contrast Agents: Higher Relaxivity, Lower Dose.
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Bashir MR and Thomas KL
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- Humans, Magnetic Resonance Imaging, Contrast Media, Gadolinium
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- 2023
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17. Dark-Blood Late Gadolinium Enhancement: A Major Advance for Cardiac MRI
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Nadine Kawel-Boehm and Jens Bremerich
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Dogs ,Infarction ,Humans ,Animals ,Contrast Media ,Radiology, Nuclear Medicine and imaging ,Gadolinium ,Papillary Muscles ,Magnetic Resonance Imaging - Published
- 2022
18. Myocardial Injury Pattern at MRI in COVID-19 Vaccine-Associated Myocarditis
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Matteo Fronza, Paaladinesh Thavendiranathan, Victor Chan, Gauri Rani Karur, Jacob A. Udell, Rachel M. Wald, Rachel Hong, and Kate Hanneman
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Adult ,Male ,COVID-19 Vaccines ,Adolescent ,Myocardium ,COVID-19 ,Contrast Media ,Magnetic Resonance Imaging, Cine ,Gadolinium ,Stroke Volume ,Middle Aged ,Ventricular Function, Left ,Myocarditis ,Young Adult ,Humans ,Radiology, Nuclear Medicine and imaging ,Female ,BNT162 Vaccine ,2019-nCoV Vaccine mRNA-1273 ,Retrospective Studies - Abstract
Background There are limited data on the pattern and severity of myocardial injury in patients with COVID-19 vaccination-associated myocarditis. Purpose To describe myocardial injury following COVID-19 vaccination and to compare these findings to other causes of myocarditis. Materials and Methods In this retrospective cohort study, consecutive adult patients with myocarditis with at least one T1-based and at least one T2-based abnormality at cardiac MRI performed at a tertiary referral hospital from December 2019 to November 2021 were included. Patients were classified into one of three groups: myocarditis following COVID-19 vaccination, myocarditis following COVID-19 illness, and other myocarditis not associated with COVID-19 vaccination or illness. Results Of the 92 included patients, 21 (23%) had myocarditis following COVID-19 vaccination (mean age, 31 years ± 14 [SD]; 17 men; messenger RNA-1273 in 12 [57%] and BNT162b2 in nine [43%]). Ten of 92 (11%) patients had myocarditis following COVID-19 illness (mean age, 51 years ± 14; three men) and 61 of 92 (66%) patients had other myocarditis (mean age, 44 years ± 18; 36 men). MRI findings in the 21 patients with vaccine-associated myocarditis included late gadolinium enhancement (LGE) in 17 patients (81%) and left ventricular dysfunction in six (29%). Compared with other causes of myocarditis, patients with vaccine-associated myocarditis had a higher left ventricular ejection fraction and less extensive LGE, even after controlling for age, sex, and time from symptom onset to MRI. The most frequent location of LGE in all groups was subepicardial at the basal inferolateral wall, although septal involvement was less common in vaccine-associated myocarditis. At short-term follow-up (median, 22 days [IQR, 7-48 days]), all patients with vaccine-associated myocarditis were asymptomatic with no adverse events. Conclusion Cardiac MRI demonstrated a similar pattern of myocardial injury in vaccine-associated myocarditis compared with other causes, although abnormalities were less severe, with less frequent septal involvement and no adverse events over the short-term follow-up. © RSNA, 2022
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- 2022
19. Three-dimensional High-Resolution Dark-Blood Late Gadolinium Enhancement Imaging for Improved Atrial Scar Evaluation.
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Si D, Wu Y, Xiao J, Qin X, Guo R, Liu B, Ning Z, Yin J, Gao P, Liu Y, Yang D, Cheng K, Chen T, Cheng Z, Lin X, Fang Q, Herzka DA, and Ding H
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- Humans, Male, Middle Aged, Contrast Media, Gadolinium, Myocardium pathology, Magnetic Resonance Imaging methods, Imaging, Three-Dimensional methods, Cicatrix diagnostic imaging, Atrial Fibrillation diagnostic imaging, Atrial Fibrillation surgery, Atrial Fibrillation pathology
- Abstract
Background Radiofrequency ablation (RFA) is a widely used treatment for atrial fibrillation, reducing the risk of cardiac arrhythmia. Detailed visualization and quantification of atrial scarring has the potential to improve preprocedural decision-making and postprocedural prognosis. Conventional bright-blood late gadolinium enhancement (LGE) MRI can help detect atrial scars; however, its suboptimal myocardium to blood contrast inhibits accurate scar estimation. Purpose To develop and test a free-breathing LGE cardiac MRI approach that simultaneously provides high-spatial-resolution dark-blood and bright-blood images for improved atrial scar detection and quantification. Materials and Methods A free-breathing, independent navigator-gated, dark-blood phase-sensitive inversion recovery (PSIR) sequence with whole-heart coverage was developed. Two coregistered high-spatial-resolution (1.25 × 1.25 × 3 mm
3 ) three-dimensional (3D) volumes were acquired in an interleaved manner. The first volume combined inversion recovery and T2 preparation to achieve dark-blood imaging. The second volume functioned as the reference for phase-sensitive reconstruction with built-in T2 preparation for improved bright-blood contrast. The proposed sequence was tested in prospectively enrolled participants who had undergone RFA for atrial fibrillation (mean time since RFA, 89 days ± 26 [SD]) from October 2019 to October 2021. Image contrast was compared with conventional 3D bright-blood PSIR images using the relative signal intensity difference. Furthermore, native scar area quantification obtained from both imaging approaches was compared with measurements obtained with electroanatomic mapping (EAM) as the reference standard. Results A total of 20 participants (mean age, 62 years ± 9; 16 male) who underwent RFA for atrial fibrillation were included. The proposed PSIR sequence successfully acquired 3D high-spatial-resolution volumes in all participants, with a mean scan time of 8.3 minutes ± 2.4. The developed PSIR sequence improved scar to blood contrast compared with conventional PSIR sequence (mean contrast, 0.60 arbitrary units [au] ± 0.18 vs 0.20 au ± 0.19, respectively; P < .01) and correlated with EAM regarding scar area quantification ( r = 0.66 [ P < .01] vs r = 0.13 [ P = .63]). Conclusion In participants who had undergone RFA for atrial fibrillation, an independent navigator-gated dark-blood PSIR sequence produced high-spatial-resolution dark-blood and bright-blood images with improved image contrast and native scar quantification compared with conventional bright-blood images. © RSNA, 2023 Supplemental material is available for this article.- Published
- 2023
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20. Cardiac MRI: State of the Art.
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Rajiah PS, François CJ, and Leiner T
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- Humans, Artificial Intelligence, Gadolinium, Magnetic Resonance Imaging methods, Heart, Contrast Media, Cardiovascular Diseases
- Abstract
Cardiac MRI plays an important role in the evaluation of cardiovascular diseases (CVDs), including ischemic heart disease, cardiomyopathy, valvular disease, congenital disease, pericardial disease, and masses. Large multicenter trials have shown the positive impact of MRI-based management on outcomes in several CVDs. These results have made MRI an indispensable technique in the evaluation of these diseases, and cardiac MRI has an important role in multisociety guidelines. MRI is the reference standard for quantification of ventricular volumes and function. Flow imaging enables accurate quantification of flow and velocities through valves, shunts, and surgical conduits or baffles. Late gadolinium enhancement and parametric mapping techniques enable tissue characterization and yield prognostic information. In the past decade, cardiac MRI technology has seen rapid advances in both hardware and sequences. Multiple novel sequences, such as parametric mapping and four-dimensional flow, are increasingly being incorporated into routine clinical practice. Acceleration strategies have matured, allowing faster acquisition of cardiac MRI sequences in patients with arrhythmia and poor breath holding. Challenges of cardiac MRI at high-field-strength magnets and in patients with indwelling cardiac devices or severe renal dysfunction have been mitigated. Artificial intelligence techniques are decreasing the complexity of MRI acquisition and postprocessing. This article reviews the current state of the art and emerging techniques in cardiac MRI., (© RSNA, 2023.)
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- 2023
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21. Cardiac MRI to Predict Sudden Cardiac Death Risk in Dilated Cardiomyopathy.
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Li Y, Xu Y, Li W, Guo J, Wan K, Wang J, Xu Z, Han Y, Sun J, and Chen Y
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- Adolescent, Adult, Aged, Aged, 80 and over, Humans, Male, Middle Aged, Young Adult, Contrast Media, Death, Sudden, Cardiac, Gadolinium, Magnetic Resonance Imaging adverse effects, Predictive Value of Tests, Prospective Studies, Risk Assessment, Risk Factors, Stroke Volume, Ventricular Function, Left, Cardiomyopathy, Dilated
- Abstract
Background Sudden cardiac death (SCD) is one of the leading causes of death in individuals with nonischemic dilated cardiomyopathy (DCM). However, the risk stratification of SCD events remains challenging in clinical practice. Purpose To determine whether myocardial tissue characterization with cardiac MRI could be used to predict SCD events and to explore a SCD stratification algorithm in nonischemic DCM. Materials and Methods In this prospective single-center study, adults with nonischemic DCM who underwent cardiac MRI between June 2012 and August 2020 were enrolled. SCD-related events included SCD, appropriate implantable cardioverter-defibrillator shock, and resuscitation after cardiac arrest. Competing risk regression analysis and Kaplan-Meier analysis were performed to identify the association of myocardial tissue characterization with outcomes. Results Among the 858 participants (mean age, 48 years; age range, 18-83 years; 603 men), 70 (8%) participants experienced SCD-related events during a median follow-up of 33.0 months. In multivariable competing risk analysis, late gadolinium enhancement (LGE) (hazard ratio [HR], 1.87; 95% CI: 1.07, 3.27; P = .03), native T1 (per 10-msec increase: HR, 1.07; 95% CI: 1.04, 1.11; P < .001), and extracellular volume fraction (per 3% increase: HR, 1.26; 95% CI: 1.11, 1.44; P < .001) were independent predictors of SCD-related events after adjustment of systolic blood pressure, atrial fibrillation, and left ventricular ejection fraction. An SCD risk stratification category was developed with a combination of native T1 and LGE. Participants with a native T1 value 4 or more SDs above the mean (1382 msec) had the highest annual SCD-related events rate of 9.3%, and participants with a native T1 value 2 SDs below the mean (1292 msec) and negative LGE had the lowest rate of 0.6%. This category showed good prediction ability (C statistic = 0.74) and could be used to discriminate SCD risk and competing heart failure risk. Conclusion Myocardial tissue characteristics derived from cardiac MRI were independent predictors of sudden cardiac death (SCD)-related events in individuals with nonischemic dilated cardiomyopathy and could be used to stratify participants according to different SCD risk categories. Clinical trial registration no. ChiCTR1800017058 © RSNA, 2023 Supplemental material is available for this article. See also the editorial by Sakuma in this issue.
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- 2023
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22. AI Cardiac MRI Scar Analysis Aids Prediction of Major Arrhythmic Events in the Multicenter DERIVATE Registry.
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Ghanbari F, Joyce T, Lorenzoni V, Guaricci AI, Pavon AG, Fusini L, Andreini D, Rabbat MG, Aquaro GD, Abete R, Bogaert J, Camastra G, Carigi S, Carrabba N, Casavecchia G, Censi S, Cicala G, De Cecco CN, De Lazzari M, Di Giovine G, Di Roma M, Focardi M, Gaibazzi N, Gismondi A, Gravina M, Lanzillo C, Lombardi M, Lozano-Torres J, Masi A, Moro C, Muscogiuri G, Nese A, Pradella S, Sbarbati S, Schoepf UJ, Valentini A, Crelier G, Masci PG, Pontone G, Kozerke S, and Schwitter J
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- Male, Humans, Aged, Stroke Volume, Retrospective Studies, Magnetic Resonance Imaging, Cine methods, Gadolinium, Ventricular Function, Left, Magnetic Resonance Imaging methods, Registries, Artificial Intelligence, Predictive Value of Tests, Cicatrix, Contrast Media
- Abstract
Background Scar burden with late gadolinium enhancement (LGE) cardiac MRI (CMR) predicts arrhythmic events in patients with postinfarction in single-center studies. However, LGE analysis requires experienced human observers, is time consuming, and introduces variability. Purpose To test whether postinfarct scar with LGE CMR can be quantified fully automatically by machines and to compare the ability of LGE CMR scar analyzed by humans and machines to predict arrhythmic events. Materials and Methods This study is a retrospective analysis of the multicenter, multivendor CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy (DERIVATE) registry. Patients with chronic heart failure, echocardiographic left ventricular ejection fraction (LVEF) of less than 50%, and LGE CMR were recruited (from January 2015 through December 2020). In the current study, only patients with ischemic cardiomyopathy were included. Quantification of total, dense, and nondense scars was carried out by two experienced readers or a Ternaus network, trained and tested with LGE images of 515 and 246 patients, respectively. Univariable and multivariable Cox analyses were used to assess patient and cardiac characteristics associated with a major adverse cardiac event (MACE). Area under the receiver operating characteristic curve (AUC) was used to compare model performances. Results In 761 patients (mean age, 65 years ± 11, 671 men), 83 MACEs occurred. With use of the testing group, univariable Cox-analysis found New York Heart Association class, left ventricle volume and/or function parameters (by echocardiography or CMR), guideline criterion (LVEF of ≤35% and New York Heart Association class II or III), and LGE scar analyzed by humans or the machine-learning algorithm as predictors of MACE. Machine-based dense or total scar conferred incremental value over the guideline criterion for the association with MACE (AUC: 0.68 vs 0.63, P = .02 and AUC: 0.67 vs 0.63, P = .01, respectively). Modeling with competing risks yielded for dense and total scar (AUC: 0.67 vs 0.61, P = .01 and AUC: 0.66 vs 0.61, P = .005, respectively). Conclusion In this analysis of the multicenter CarDiac MagnEtic Resonance for Primary Prevention Implantable CardioVerter DebrillAtor ThErapy (DERIVATE) registry, fully automatic machine learning-based late gadolinium enhancement analysis reliably quantifies myocardial scar mass and improves the current prediction model that uses guideline-based risk criteria for implantable cardioverter defibrillator implantation. ClinicalTrials.gov registration no.: NCT03352648 Published under a CC BY 4.0 license. Supplemental material is available for this article.
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- 2023
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23. The Quest to Reduce the Use of Gadolinium-based Contrast Agents: AI May Provide a Solution.
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Bahl M
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- Humans, Radiography, Magnetic Resonance Imaging methods, Machine Learning, Contrast Media, Gadolinium
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- 2023
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24. Prognostic Value of Cardiac MRI and FDG PET in Cardiac Sarcoidosis: A Systematic Review and Meta-Analysis.
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Aitken M, Davidson M, Chan MV, Urzua Fresno C, Vasquez LI, Huo YR, McAllister BJ, Broncano J, Thavendiranathan P, McInnes MDF, Iwanochko MR, Balter M, Moayedi Y, Farrell A, and Hanneman K
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- Adult, Humans, Fluorodeoxyglucose F18, Prognosis, Contrast Media, Gadolinium, Magnetic Resonance Imaging, Cardiomyopathies diagnostic imaging, Myocarditis, Sarcoidosis diagnostic imaging
- Abstract
Background There is no consensus regarding the relative prognostic value of cardiac MRI and fluorodeoxyglucose (FDG) PET in cardiac sarcoidosis. Purpose To perform a systematic review and meta-analysis of the prognostic value of cardiac MRI and FDG PET for major adverse cardiac events (MACE) in cardiac sarcoidosis. Materials and Methods In this systematic review, MEDLINE, Ovid Epub, CENTRAL, Embase, Emcare, and Scopus were searched from inception until January 2022. Studies that evaluated the prognostic value of cardiac MRI or FDG PET in adults with cardiac sarcoidosis were included. The primary outcome of MACE was assessed as a composite including death, ventricular arrhythmia, and heart failure hospitalization. Summary metrics were obtained using random-effects meta-analysis. Meta-regression was used to assess covariates. Risk of bias was assessed using the Quality in Prognostic Studies, or QUIPS, tool. Results Thirty-seven studies were included (3489 patients with mean follow-up of 3.1 years ± 1.5 [SD]); 29 studies evaluated MRI (2931 patients) and 17 evaluated FDG PET (1243 patients). Five studies directly compared MRI and PET in the same patients (276 patients). Left ventricular late gadolinium enhancement (LGE) at MRI and FDG uptake at PET were both predictive of MACE (odds ratio [OR], 8.0 [95% CI: 4.3, 15.0] [ P < .001] and 2.1 [95% CI: 1.4, 3.2] [ P < .001], respectively). At meta-regression, results varied by modality ( P = .006). LGE (OR, 10.4 [95% CI: 3.5, 30.5]; P < .001) was also predictive of MACE when restricted to studies with direct comparison, whereas FDG uptake (OR, 1.9 [95% CI: 0.82, 4.4]; P = .13) was not. Right ventricular LGE and FDG uptake were also associated with MACE (OR, 13.1 [95% CI: 5.2, 33] [ P < .001] and 4.1 [95% CI: 1.9, 8.9] [ P < .001], respectively). Thirty-two studies were at risk for bias. Conclusion Left and right ventricular late gadolinium enhancement at cardiac MRI and fluorodeoxyglucose uptake at PET were predictive of major adverse cardiac events in cardiac sarcoidosis. Limitations include few studies with direct comparison and risk of bias. Systematic review registration no. CRD42021214776 (PROSPERO) © RSNA, 2023 Supplemental material is available for this article .
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- 2023
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25. Myocardial Characterization with Extracellular Volume Mapping with a First-Generation Photon-counting Detector CT with MRI Reference.
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Aquino GJ, O'Doherty J, Schoepf UJ, Ellison B, Byrne J, Fink N, Zsarnoczay E, Wolf EV, Allmendinger T, Schmidt B, Flohr T, Baruah D, Suranyi P, Varga-Szemes A, and Emrich T
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- Male, Adult, Humans, Prospective Studies, Reproducibility of Results, Tomography, X-Ray Computed methods, Magnetic Resonance Imaging methods, Contrast Media, Gadolinium
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Background Photon-counting detector (PCD) CT provides comprehensive spectral data with every acquisition, but studies evaluating myocardial extracellular volume (ECV) quantification with use of PCD CT compared with an MRI reference remain lacking. Purpose To compare ECV quantification for myocardial tissue characterization between a first-generation PCD CT system and cardiac MRI. Materials and Methods In this single-center prospective study, adults without contraindication to iodine-based contrast media underwent same-day cardiac PCD CT and MRI with native and postcontrast T1 mapping and late gadolinium enhancement for various clinical indications for cardiac MRI (the reference standard) between July 2021 and January 2022. Global and midventricular ECV were assessed with use of three methods: single-energy PCD CT, dual-energy PCD CT, and MRI T1 mapping. Quantitative comparisons among all techniques were performed. Correlation and reliability between different methods of ECV quantification were assessed with use of the Pearson correlation coefficient ( r ) and the intraclass correlation coefficient. Results The final sample included 29 study participants (mean age ± SD, 54 years ± 17; 15 men). There was a strong correlation of ECV between dual- and single-energy PCD CT ( r = 0.91, P < .001). Radiation dose was 40% lower with dual-energy versus single-energy PCD CT (volume CT dose index, 10.1 mGy vs 16.8 mGy, respectively; P < .001). In comparison with MRI, dual-energy PCD CT showed strong correlation ( r = 0.82 and 0.91, both P < .001) and good to excellent reliability (intraclass correlation coefficients, 0.81 and 0.90) for midventricular and global ECV quantification, but it overestimated ECV by approximately 2%. Single-energy PCD CT showed similar relationship with MRI but underestimated ECV by 3%. Conclusion Myocardial tissue characterization with photon-counting detector CT-based quantitative extracellular volume analysis showed a strong correlation to MRI. © RSNA, 2023 Supplemental material is available for this article.
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- 2023
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26. Molecular MRI of the Immuno-Metabolic Interplay in a Rabbit Liver Tumor Model: A Biomarker for Resistance Mechanisms in Tumor-targeted Therapy?
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John J. Walsh, MingDe Lin, Julius Chapiro, Annemarie Boustani, Richard Bucala, Daniel Coman, S. Nahum Goldberg, Vasily Pekurovsky, Jessica G Santana, Nikhil Joshi, Lucas Christoph Adam, Isabel Schobert, Fahmeed Hyder, Xuchen Zhang, Ruth R. Montgomery, Lynn Jeanette Savic, Lin Leng, Luzie A. Doemel, and James S. Duncan
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Male ,Carcinoma, Hepatocellular ,Liver tumor ,medicine.medical_treatment ,Contrast Media ,Gadolinium ,Article ,Antibodies ,030218 nuclear medicine & medical imaging ,Tumor targeted ,03 medical and health sciences ,Liver Neoplasms, Experimental ,0302 clinical medicine ,Immune system ,Tumor Microenvironment ,Animals ,Medicine ,Radiology, Nuclear Medicine and imaging ,Molecular mri ,Chemoembolization, Therapeutic ,business.industry ,food and beverages ,Immunotherapy ,medicine.disease ,Magnetic Resonance Imaging ,Molecular Imaging ,Liver ,030220 oncology & carcinogenesis ,Cancer research ,Biomarker (medicine) ,Rabbits ,business ,Liver cancer ,Biomarkers - Abstract
BACKGROUND: The immuno-metabolic interplay has gained interest for determining and targeting immunosuppressive tumor micro-environments that remain a barrier to current immuno-oncologic therapies in hepatocellular carcinoma. PURPOSE: To develop molecular MRI tools to reveal resistance mechanisms to immuno-oncologic therapies caused by the immuno-metabolic interplay in a translational liver cancer model. MATERIALS AND METHODS: A total of 21 VX2 liver tumor–bearing New Zealand white rabbits were used between October 2018 and February 2020. Rabbits were divided into three groups. Group A (n = 3) underwent intra-arterial infusion of gadolinium 160 ((160)Gd)–labeled anti–human leukocyte antigen–DR isotope (HLA-DR) antibodies to detect antigen-presenting immune cells. Group B (n = 3) received rhodamine-conjugated superparamagnetic iron oxide nanoparticles (SPIONs) intravenously to detect macrophages. These six rabbits underwent 3-T MRI, including T1- and T2-weighted imaging, before and 24 hours after contrast material administration. Group C (n = 15) underwent extracellular pH mapping with use of MR spectroscopy. Of those 15 rabbits, six underwent conventional transarterial chemoembolization (TACE), four underwent conventional TACE with extracellular pH– buffering bicarbonate, and five served as untreated controls. MRI signal intensity distribution was validated by using immunohistochemistry staining of HLA-DR and CD11b, Prussian blue iron staining, fluorescence microscopy of rhodamine, and imaging mass cytometry (IMC) of gadolinium. Statistical analysis included Mann-Whitney U and Kruskal-Wallis tests. RESULTS: T1-weighted MRI with (160)Gd-labeled antibodies revealed localized peritumoral ring enhancement, which corresponded to gadolinium distribution detected with IMC. T2-weighted MRI with SPIONs showed curvilinear signal intensity representing selective peritumoral deposition in macrophages. Extracellular pH–specific MR spectroscopy of untreated liver tumors showed acidosis (mean extracellular pH, 6.78 ± 0.09) compared with liver parenchyma (mean extracellular pH, 7.18 ± 0.03) (P = .008) and peritumoral immune cell exclusion. Normalization of tumor extracellular pH (mean, 6.96 ± 0.05; P = .02) using bicarbonate during TACE increased peri- and intratumoral immune cell infiltration (P = .002). CONCLUSION: MRI in a rabbit liver tumor model was used to visualize resistance mechanisms mediated by the immuno-metabolic interplay that inform susceptibility and response to immuno-oncologic therapies, providing a therapeutic strategy to restore immune permissiveness in liver cancer.
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- 2020
27. Dentate Nucleus Signal Intensity Increases Following Repeated Gadobenate Dimeglumine Administrations: A Retrospective Analysis
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Emanuel Kanal, Nghi C Nguyen, Lucas G Cummin, and Theodore T Molnar
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Adult ,Gadolinium DTPA ,Male ,medicine.medical_treatment ,Gadolinium ,Contrast Media ,chemistry.chemical_element ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Retrospective analysis ,Humans ,Radiology, Nuclear Medicine and imaging ,GADOBENATE DIMEGLUMINE ,Craniotomy ,Aged ,Retrospective Studies ,business.industry ,Cerebral peduncle ,Retrospective cohort study ,Middle Aged ,Image Enhancement ,Magnetic Resonance Imaging ,Dentate nucleus ,Cerebellar Nuclei ,chemistry ,030220 oncology & carcinogenesis ,Female ,Signal intensity ,business ,Nuclear medicine - Abstract
Background Increased cerebral signal intensity (SI) has been reported in patients undergoing MRI with gadolinium-based contrast agents (GBCAs). Published data on gadobenate dimeglumine have been somewhat contradictory. Purpose To evaluate the relationship between dosage of gadobenate dimeglumine and SI change at MRI following multiple gadobenate dimeglumine administrations. Materials and Methods In this retrospective study, patients referred for clinically indicated brain MRI from January 2006 through May 2016 were evaluated for inclusion. Eligible patients were between 18 and 90 years old at their baseline brain MRI and had never received a GBCA, had undergone three or more MRI examinations with gadobenate dimeglumine, and had the baseline scan and another brain MRI scan available for comparison. The primary group consisted of patients with four or fewer supratentorial lesions smaller than 3 cm who underwent axial T1-weighted MRI at 1.5 T. One patient had also undergone prior radiation therapy. The secondary group consisted of patients with a history of brain radiation therapy or craniotomy who underwent 1.5-T and 3-T same-plane T1-weighted MRI (in any order). The SI for up to eight brain MRI examinations per patient was measured, and relative SI changes from baseline to interval scans were calculated. A subgroup analysis was performed to assess the gadobenate dimeglumine washout since the last gadolinium exposure. All patients had normal renal and liver functions. Linear mixed regression analyses were performed for variables with P < .05. Results In 43 patients (14 men, 29 women; median age, 49 years; age range, 25-73 years), the dentate nucleus (DN)-to-middle cerebral peduncle (MCP) SI ratio showed a mean increase of 6.7% ± 3.9 in the primary group and 4.0% ± 2.7 in the secondary group (both P < .001) following the administration of 134 mL ± 141 gadobenate dimeglumine over 55 months ± 35.2. The DN/MCP SI ratio increased linearly with the amount of gadobenate dimeglumine, with a mean increase of 0.015% ± 0.004 per 1 mL of gadobenate dimeglumine (R2 = 0.3, P < .001). Conclusion In patients receiving multiple doses of gadobenate dimeglumine, a linear relationship existed between gadobenate dimeglumine administrations and an increase in the dentate nucleus-to-middle cerebral peduncle signal intensity ratio at MRI. © RSNA, 2020 See also the editorial by McDonald and Kallmes in this issue.
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- 2020
28. MRI T1 Mapping in Hypertrophic Cardiomyopathy: Evaluation in Patients Without Late Gadolinium Enhancement and Hemodynamic Obstruction
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Yong Jiang, Jinghan Huang, Jing Xu, Arlene Sirajuddin, Gang Yin, Lei Song, Shuang Li, Shihua Zhao, Baiyan Zhuang, and Minjie Lu
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Male ,medicine.medical_specialty ,Cardiomyopathy ,Contrast Media ,Hemodynamics ,Gadolinium ,Left ventricular hypertrophy ,030218 nuclear medicine & medical imaging ,03 medical and health sciences ,0302 clinical medicine ,Predictive Value of Tests ,Internal medicine ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,cardiovascular diseases ,Retrospective Studies ,Original Research ,Ejection fraction ,business.industry ,Hypertrophic cardiomyopathy ,Reproducibility of Results ,Heart ,Retrospective cohort study ,Middle Aged ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Predictive value of tests ,cardiovascular system ,Cardiology ,Female ,Myocardial fibrosis ,business - Abstract
BACKGROUND: The value of native myocardial T1 mapping and extracellular volume (ECV) fraction in patients who have hypertrophic cardiomyopathy (HCM) but no late gadolinium enhancement (LGE) and no hemodynamic obstruction are currently unknown. PURPOSE: To evaluate myocardial fibrosis in patients with nonobstructive HCM and no LGE by using native myocardial T1 mapping and ECV fraction and to study their relationships to left ventricular (LV) function and LV hypertrophy. MATERIALS AND METHODS: Patients with HCM who underwent cardiac MRI between 2012 and 2015 were retrospectively evaluated. Patients were included if they had no LGE at MRI, LV ejection fraction greater than or equal to 45%, and no LV outflow tract obstruction. Healthy participants had similar age and sex distribution. Native myocardial T1 and ECV were measured with MRI. RESULTS: A total of 258 patients with HCM (mean age ± standard deviation, 49 years ± 15; 74% men) and 122 healthy participants (mean age, 50 years ± 14; 76% men) were evaluated. Native myocardial T1 was longer and ECV fraction was higher in the patients with HCM relative to the healthy participants (mean native T1, 950 msec ± 48 vs 913 msec ± 46; mean ECV, 24.5% ± 2.8 vs 23.0% ± 2.7; both P < .001). Maximum T1 and ECV values correlated strongly with LV mass index for the entire patient cohort with HCM (both r = 0.86; P < .001) and for the subgroups (r = 0.86 and 0.85 for interventricular septal group and r = 0.88 and 0.86 for apical group; all P < .001). CONCLUSION: Prolonged myocardial T1 and elevated extracellular volume in hypertrophic cardiomyopathy suggests diffuse myocardial fibrosis, even in the absence of regionally apparent late gadolinium enhancement and hemodynamic obstruction, and is associated with left ventricular hypertrophy. © RSNA, 2019 See also the editorial by Bluemke and Lima in this issue.
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- 2020
29. Nonhomogeneous Gadolinium Retention in the Cerebral Cortex after Intravenous Administration of Gadolinium-based Contrast Agent in Rats and Humans
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Ning Hua, Patrick T. Kiernan, Olga Minaeva, Bertrand R. Huber, Xiuping Liu, Ann C. McKee, Juliet A. Moncaster, Hernan Jara, Allison Griffin, Jorge A. Soto, Ali Guermazi, Audrey M. Hildebrandt, Asim Mian, Lawrence L. Latour, Chad Farris, Laney Evers, Erich S. Franz, Sarah E. Chancellor, Katharine J. Babcock, Victor E. Alvarez, Nicola Lupoli, Lee E. Goldstein, and Stephan W. Anderson
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Adult ,Gadolinium DTPA ,Male ,Gadolinium ,Contrast Media ,chemistry.chemical_element ,Hippocampus ,Anterior commissure ,Corpus callosum ,Mass Spectrometry ,030218 nuclear medicine & medical imaging ,Rats, Sprague-Dawley ,White matter ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,Original Research ,Cerebral Cortex ,Neocortex ,business.industry ,Allocortex ,Middle Aged ,Magnetic Resonance Imaging ,Rats ,medicine.anatomical_structure ,chemistry ,Cerebral cortex ,030220 oncology & carcinogenesis ,Models, Animal ,Administration, Intravenous ,Female ,Nuclear medicine ,business - Abstract
BACKGROUND: Gadolinium retention after repeated gadolinium-based contrast agent (GBCA) exposure has been reported in subcortical gray matter. However, gadolinium retention in the cerebral cortex has not been systematically investigated. PURPOSE: To determine whether and where gadolinium is retained in rat and human cerebral cortex. MATERIALS AND METHODS: The cerebral cortex in Sprague-Dawley rats treated with gadopentetate dimeglumine (three doses over 4 weeks; cumulative gadolinium dose, 7.2 mmol per kilogram of body weight; n = 6) or saline (n = 6) was examined with antemortem MRI. Two human donors with repeated GBCA exposure (three and 15 doses; 1 and 5 months after exposure), including gadopentetate dimeglumine, and two GBCA-naive donors were also evaluated. Elemental brain maps (gadolinium, phosphorus, zinc, copper, iron) for rat and human brains were constructed by using laser ablation inductively coupled plasma mass spectrometry. RESULTS: Gadopentetate dimeglumine–treated rats showed region-, subregion-, and layer-specific gadolinium retention in the neocortex (anterior cingulate cortex: mean gadolinium concentration, 0.28 µg ∙ g(−1) ± 0.04 [standard error of the mean]) that was comparable (P > .05) to retention in the allocortex (mean gadolinium concentration, 0.33 µg ∙ g(−1) ± 0.04 in piriform cortex, 0.24 µg ∙ g(−1) ± 0.04 in dentate gyrus, 0.17 µg ∙ g(−1) ± 0.04 in hippocampus) and subcortical structures (0.47 µg ∙ g(−1) ± 0.10 in facial nucleus, 0.39 µg ∙ g(−1) ± 0.10 in choroid plexus, 0.29 µg ∙ g(−1) ± 0.05 in caudate-putamen, 0.26 µg ∙ g(−1) ± 0.05 in reticular nucleus of the thalamus, 0.24 µg ∙ g(−1) ± 0.04 in vestibular nucleus) and significantly greater than that in the cerebellum (0.17 µg ∙ g(−1) ± 0.03, P = .01) and white matter tracts (anterior commissure: 0.05 µg ∙ g(−1) ± 0.01, P = .002; corpus callosum: 0.05 µg ∙ g(−1) ± 0.02, P = .001; cranial nerve: 0.02 µg ∙ g(−1) ± 0.01, P = .004). Retained gadolinium colocalized with parenchymal iron. T1-weighted MRI signal intensification was not observed. Gadolinium retention was detected in the cerebral cortex, pia mater, and pia-ensheathed leptomeningeal vessels in two GBCA-exposed human brains but not in two GBCA-naive human brains. CONCLUSION: Repeated gadopentetate dimeglumine exposure is associated with gadolinium retention in specific regions, subregions, and layers of cerebral cortex that are critical for higher cognition, affect, and behavior regulation, sensorimotor coordination, and executive function. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Kanal in this issue.
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- 2020
30. Contrast-to-Dose Relationship of Gadopiclenol, an MRI Macrocyclic Gadolinium-based Contrast Agent, Compared with Gadoterate, Gadobenate, and Gadobutrol in a Rat Brain Tumor Model
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Sébastien Ballet, Véronique Vives, Claire Corot, Stéphane Kremer, Anne-Laure Grindel, Gaëlle Louin, Guillaume Bierry, and Philippe Robert
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media_common.quotation_subject ,Gadolinium ,Contrast Media ,chemistry.chemical_element ,Sensitivity and Specificity ,030218 nuclear medicine & medical imaging ,Gadobutrol ,Gadolinium-based Contrast Agent ,03 medical and health sciences ,Meglumine ,0302 clinical medicine ,Text mining ,Heterocyclic Compounds ,Organometallic Compounds ,Animals ,Contrast (vision) ,Medicine ,Radiology, Nuclear Medicine and imaging ,media_common ,Dose-Response Relationship, Drug ,Brain Neoplasms ,business.industry ,Brain ,Glioma ,Image Enhancement ,Rat brain ,Magnetic Resonance Imaging ,Rats ,Disease Models, Animal ,chemistry ,030220 oncology & carcinogenesis ,business ,Nuclear medicine ,Azabicyclo Compounds ,medicine.drug - Abstract
Background Detection of cerebral lesions at MRI may benefit from a chemically stable and more sensitively detected gadolinium-based contrast agent (GBCA). Gadopiclenol, a macrocyclic GBCA with at least twofold higher relaxivity, is currently undergoing clinical trials in humans. Purpose To determine the relationship between MRI contrast enhancement and the injected dose of gadopiclenol in a glioma rat model compared with those of conventional GBCA at label dose. Materials and Methods Between April and July 2012, 32 rats implanted with C6 glioma received two intravenous injections at a 24-hour interval. The injections were randomly selected among five doses of gadopiclenol (0.025, 0.05, 0.075, 0.1, and 0.2 mmol/kg) and three reference GBCAs (gadoterate meglumine, gadobutrol, and gadobenate dimeglumine) at 0.1 mmol/kg. MRI tumor enhancement was assessed on T1-weighted images before and up to 30 minutes after injection. Two blinded radiologists visually and qualitatively scored contrast enhancement, border delineation, and visualization of tumor morphology. Quantitatively, variations in contrast-to-noise ratio (ΔCNR) between tumor and contralateral parenchyma were calculated at each time point and were compared for each treatment at 5 minutes by using a mixed model after normality test. Results A total of 24 rats underwent the complete protocol (
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- 2020
31. First-Trimester Exposure to Gadolinium-based Contrast Agents: A Utilization Study of 4.6 Million U.S. Pregnancies
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Erica Radden, Kate Gelperin, Corinne Woods, Carolyn McCloskey, Steven T. Bird, Mayura Shinde, Ira Krefting, Patty Greene, Leyla Sahin, Tamara Johnson, Elnara Fazio-Eynullayeva, and Karen B. Bleich
- Subjects
Adult ,medicine.medical_specialty ,Gadolinium ,media_common.quotation_subject ,Contrast Media ,chemistry.chemical_element ,Pelvis ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Pregnancy ,Abdomen ,Humans ,Medicine ,Contrast (vision) ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,media_common ,business.industry ,Obstetrics ,Brain ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,United States ,Pregnancy Trimester, First ,First trimester ,chemistry ,030220 oncology & carcinogenesis ,Female ,business ,Live Birth - Abstract
BackgroundThe safety of gadolinium-based contrast agent (GBCA) exposure during pregnancy has not been established, and the use of GBCAs during pregnancy is not recommended unless it is essential to the health of the woman or fetus.PurposeTo examine the prevalence of GBCA exposure in a large sample of pregnancies resulting in a live birth.Materials and MethodsThe Sentinel Distributed Database was used to retrospectively identify U.S. pregnancies that resulted in live births between 2006 and 2017 from 16 data partners. The main outcome was the prevalence of MRI procedures with and without GBCAs, sorted by anatomic location and trimester, among pregnant and matched comparator women.ResultsAmong 4 692 744 pregnancies resulting in a live birth, we identified 6879 exposures to GBCAs in 5457 pregnancies, representing one contrast-enhanced MRI examination per 860 pregnancies (0.12% of all pregnancies). Most contrast-enhanced MRI examinations were performed in the head (
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- 2019
32. Myeloperoxidase Molecular MRI Reveals Synergistic Combination Therapy in Murine Experimental Autoimmune Neuroinflammation
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Xiaoyuan Feng, Gregory R. Wojtkiewicz, Cuihua Wang, John W. Chen, Muhammad Ali, Yue Wu, Zhenwei Yao, Yoshiko Iwamoto, Benjamin Pulli, Anning Li, and Jing-Hui Li
- Subjects
medicine.medical_specialty ,Encephalomyelitis, Autoimmune, Experimental ,Myeloid ,Combination therapy ,Encephalomyelitis ,Contrast Media ,Gadolinium ,Gastroenterology ,030218 nuclear medicine & medical imaging ,Lesion ,Mice ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,medicine ,Animals ,Radiology, Nuclear Medicine and imaging ,Glatiramer acetate ,Peroxidase ,Aniline Compounds ,biology ,business.industry ,Multiple sclerosis ,Experimental autoimmune encephalomyelitis ,Brain ,Glatiramer Acetate ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Disease Models, Animal ,medicine.anatomical_structure ,030220 oncology & carcinogenesis ,Myeloperoxidase ,biology.protein ,Drug Therapy, Combination ,Female ,Saline Solution ,medicine.symptom ,business ,Immunosuppressive Agents ,medicine.drug - Abstract
Background Despite advances in immunomodulatory agents, most current therapies for multiple sclerosis target lymphocytes or lymphocytic function. However, therapy response may be less than optimal due to demyelination and axonal damage caused by myeloid cells. Purpose To determine if myeloperoxidase (MPO) molecular MRI can evaluate whether combination therapy targeting both lymphoid and myeloid inflammation can improve autoimmune neuroinflammation compared with either drug alone, even at suboptimal doses. Materials and Methods Four groups of 94 female mice (8-10 weeks old) were induced with experimental autoimmune encephalomyelitis (EAE) from August 2, 2016, to March 30, 2018, and divided into saline control (n = 22), 4-aminobenzoic acid hydrazide (ABAH) therapy group (n = 19), glatiramer acetate (GA) therapy group (n = 22), and combination therapy group (n = 31). Mice were administered suboptimal doses of ABAH, an irreversible inhibitor of MPO; GA, a first-line multiple sclerosis drug; both ABAH and GA; or saline (control). Mice were imaged with bis-5-hydroxytryptamide-diethylenetriaminepentaacetate gadolinium (hereafter, MPO-Gd) MRI. One-way analysis of variance, two-way analysis of variance, Kurskal-Wallis, and log-rank tests were used. P < .05 was considered to indicate statistical significance. Results The combination-treated group showed delayed disease onset (day 11.3 vs day 9.8 for ABAH, day 10.4 for GA, day 9.9 for control; P < .05) and reduced disease severity (clinical score during the acute exacerbation period of 1.8 vs 3.8 for ABAH, 3.1 for GA, 3.9 for control; P < .05). The combination-treated group demonstrated fewer MPO-positive lesions (30.2 vs 73.7 for ABAH, 64.8 for GA, 67.2 for control; P < .05), smaller MPO-positive lesion volume (16.7 mm3 vs 65.2 mm3 for ABAH, 69.9 mm3 for GA, 66.0 mm3 for control; P < .05), and lower intensity of MPO-Gd lesion activation ratio (0.7 vs 1.9 for ABAH, 3.2 for GA, 2.3 for control; P < .05). Reduced disease severity in the combination group was confirmed at histopathologic analysis, where MPO expression (1779 vs 2673 for ABAH, 2898 for GA; P < .05) and demyelination (5.3% vs 9.0% for ABAH, 10.6% for GA; P < .05) were ameliorated. Conclusion Myeloperoxidase molecular MRI can track the treatment response from immunomodulatory drugs even if the drug does not directly target myeloperoxidase, and establishes that combination therapy targeting both myeloid and lymphocytic inflammation is effective for murine autoimmune neuroinflammation, even at suboptimal doses. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Walczak in this issue.
- Published
- 2019
33. The Clinical Significance of Cardiac MRI Late Gadolinium Enhancement in Hypertrophic Cardiomyopathy
- Author
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Kate Hanneman
- Subjects
medicine.medical_specialty ,business.industry ,Hypertrophic cardiomyopathy ,Contrast Media ,Gadolinium ,Cardiomyopathy, Hypertrophic ,medicine.disease ,Magnetic Resonance Imaging ,Radiography ,Internal medicine ,Cardiology ,Medicine ,Late gadolinium enhancement ,Humans ,Radiology, Nuclear Medicine and imaging ,Clinical significance ,business - Published
- 2021
34. Practical Messages from Large Database Studies of Contrast Media Reactions
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David F. Kallmes and Jennifer M. McDonald
- Subjects
Cohort Studies ,Hypersensitivity ,Contrast Media ,Humans ,Gadolinium ,Radiology, Nuclear Medicine and imaging ,Data Management - Published
- 2022
35. Gadolinium Retention: What Do We Know?
- Author
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Olivier Clément
- Subjects
medicine.medical_specialty ,business.industry ,Gadolinium ,MEDLINE ,chemistry.chemical_element ,Contrast Media ,Magnetic Resonance Imaging ,chemistry ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,Radiology ,business - Published
- 2021
36. Does Brain Gadolinium Deposition Have Clinical Consequence? Lessons from Animal Studies
- Author
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John Chen
- Subjects
Animals ,Brain ,Contrast Media ,Radiology, Nuclear Medicine and imaging ,Gadolinium - Published
- 2021
37. Cardiac MRI Risk Stratification for Dilated Cardiomyopathy with Left Ventricular Ejection Fraction of 35% or Higher.
- Author
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Li S, Wang Y, Yang W, Zhou D, Zhuang B, Xu J, He J, Yin G, Fan X, Wu W, Sharma P, Sirajuddin A, Arai AE, Zhao S, and Lu M
- Subjects
- Male, Humans, Adult, Stroke Volume, Retrospective Studies, Contrast Media, Cicatrix, Gadolinium, Magnetic Resonance Imaging, Risk Factors, Death, Sudden, Cardiac, Risk Assessment, Prognosis, Predictive Value of Tests, Ventricular Function, Left, Cardiomyopathy, Dilated complications, Cardiomyopathy, Dilated diagnostic imaging
- Abstract
Background Studies over the past 15 years have demonstrated that a considerable number of patients with dilated cardiomyopathy (DCM) who died from sudden cardiac death (SCD) had a left ventricular (LV) ejection fraction (LVEF) of 35% or higher. Purpose To identify clinical and cardiac MRI risk factors for adverse events in patients with DCM and LVEF of 35% or higher. Materials and Methods In this retrospective study, consecutive patients with DCM and LVEF of 35% or higher who underwent cardiac MRI between January 2010 and December 2017 were included. The primary end point was a composite of SCD or aborted SCD. The secondary end point was a composite of all-cause mortality, heart transplant, or hospitalization for heart failure. The risk factors for the primary and secondary end points were identified with multivariable Cox analysis. Results A total of 466 patients with DCM and LVEF of 35% or higher (mean age, 44 years ± 14 [SD]; 358 men) were included. During a mean follow-up of 79 months ± 30 (SD) (range, 7-143 months), 40 patients reached the primary end point and 61 reached the secondary end point. In the adjusted analysis, age (hazard ratio [HR], 1.03 per year [95% CI: 1.00, 1.05]; P = .04), family history of SCD (HR, 3.4 [95% CI: 1.3, 8.8]; P = .01), New York Heart Association (NYHA) class III or IV (HR vs NYHA class I or II, 2.1 [95% CI: 1.1, 3.9]; P = .02), and myocardial scar at late gadolinium enhancement (LGE) MRI greater than or equal to 7.1% of the LV mass (HR, 4.4 [95% CI: 2.4, 8.3]; P < .001) were associated with SCD or aborted SCD. For the composite secondary end point, LGE greater than or equal to 7.1% of the LV mass (HR vs LGE <7.1%, 2.0 [95% CI: 1.2, 3.4]; P = .01), left atrial maximum volume index, and reduced global longitudinal strain were independent predictors. Conclusion For patients with dilated cardiomyopathy and left ventricular (LV) ejection fraction of 35% or higher, cardiac MRI-defined myocardial scar greater than or equal to 7.1% of the LV mass was associated with sudden cardiac death (SCD) or aborted SCD. © RSNA, 2022 Online supplemental material is available for this article.
- Published
- 2023
- Full Text
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38. Elemental Imaging of Long-term Gadolinium Retention in Rodent Femur.
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Funke SKI, Factor C, Rasschaert M, Robert P, van Dijk NWM, Hußock M, Sperling M, and Karst U
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- Humans, Rats, Male, Female, Animals, Rodentia, Gadolinium, Brain metabolism, Gadolinium DTPA, Magnetic Resonance Imaging, Femur, Contrast Media, Organometallic Compounds
- Abstract
Background The use of gadolinium-based contrast agents (GBCAs) is linked to gadolinium retention in the skeleton of healthy individuals. The mechanism of gadolinium incorporation into bone tissue is not fully understood and requires spatially resolved analysis to locate the gadolinium. Purpose To compare the quantitative distribution of gadolinium retained over time in rodent femur following the administration of gadodiamide and gadobutrol at three different time points. Materials and Methods In this animal study conducted between May 2018 and April 2020, 108 9-week-old healthy rats were repeatedly injected with either gadodiamide, gadobutrol, or saline solution and were killed 1, 3, or 12 months after the last injection. The femurs of six female and six male rats per each group and time point were collected. Quantitative elemental imaging of gadolinium in longitudinal thin sections was performed on one sample per sex with use of laser ablation inductively coupled plasma mass spectrometry (ICP-MS). Gadolinium concentration was determined with use of ICP-MS on the samples of all animals (six per group). Mann-Whitney U tests were applied on pairwise comparisons to determine potential sex effect and GBCA effect on gadolinium concentrations. Results The highest gadolinium retention was observed in the gadodiamide group (concentration, 97-200 nmol · g
-1 ), exceeding the mean concentration in the gadobutrol group (6.5-17 nmol · g-1 ). However, the gadolinium distribution pattern was similar for both contrast agents, showing prominent gadolinium retention at endosteal surfaces, in the bone marrow, and in small tissue pores. Gadolinium distribution in cortical bone changed over time, initially showing a thin rim of higher concentration close to the periosteum, which appeared to grow wider and move toward the interior of the femur over 1 year. Conclusion For both gadolinium-based contrast agents, gadolinium retention in rat bone was initially located close to the periosteum and bone cavities and changed with bone remodeling processes. The relevance to long-term storage of gadolinium in humans remains to be determined. © RSNA, 2022 Online supplemental material is available for this article.- Published
- 2023
- Full Text
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39. Gadolinium Deposition in the Rat Brain Measured with Quantitative MRI versus Elemental Mass Spectrometry.
- Author
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Hua N, Minaeva O, Lupoli N, Franz ES, Liu X, Moncaster JA, Babcock KJ, Jara H, Tripodis Y, Guermazi A, Soto JA, Anderson SW, and Goldstein LE
- Subjects
- Rats, Female, Animals, Rats, Sprague-Dawley, Gadolinium DTPA, Contrast Media, Meglumine, Magnetic Resonance Imaging methods, Brain, Mass Spectrometry, Gadolinium, Organometallic Compounds
- Abstract
Background T1-weighted MRI and quantitative longitudinal relaxation rate (R1) mapping have been used to evaluate gadolinium retention in the brain after gadolinium-based contrast agent (GBCA) administration. Whether MRI measures accurately reflect gadolinium regional distribution and concentration in the brain remains unclear. Purpose To compare gadolinium retention in rat forebrain measured with in vivo quantitative MRI R1 and ex vivo laser ablation inductively coupled plasma mass spectrometry (LA-ICP-MS) mapping after gadobenate, gadopentetate, gadodiamide, or gadobutrol administration. Materials and Methods Adult female Sprague-Dawley rats were randomly assigned to one of five groups (eight per group) and administered gadobenate, gadopentetate, gadodiamide, gadobutrol (2.4 mmol/kg per week for 5 weeks), or saline (4.8 mL/kg per week for 5 weeks). MRI R1 mapping was performed at baseline and 1 week after the final injection to determine R1 and ΔR1. Postmortem brains from the same rats were analyzed with LA-ICP-MS elemental mapping to determine regional gadolinium concentrations. Student t tests were performed to compare results between GBCA and saline groups. Results Rats that were administered gadobenate showed gadolinium-related MRI ΔR1 in 39.5% of brain volume (ΔR1 = 0.087 second
-1 ± 0.051); gadopentetate, 20.6% (ΔR1 = 0.069 second-1 ± 0.018); gadodiamide, 5.4% (ΔR1 = 0.055 second-1 ± 0.019); and gadobutrol, 2.2% (ΔR1 = 0.052 second-1 ± 0.041). Agent-specific gadolinium-related ΔR1 was detected in multiple forebrain regions (neocortex, hippocampus, dentate gyrus, thalamus, and caudate-putamen) in rats treated with gadobenate or gadopentetate, whereas rats treated with gadodiamide showed gadolinium-related ΔR1 in caudate-putamen. By contrast, LA-ICP-MS elemental mapping showed a similar regional distribution pattern of heterogeneous retained gadolinium in the forebrain of rats treated with gadobenate, gadopentetate, or gadodiamide, with the average gadolinium concentration of 0.45 μg · g-1 ± 0.07, 0.50 μg · g-1 ± 0.10, and 0.60 μg · g-1 ± 0.11, respectively. Low levels (0.01 μg · g-1 ± 0.00) of retained gadolinium were detected in the forebrain of gadobutrol-treated rats. Conclusion Differences in in vivo MRI longitudinal relaxation rate versus ex vivo elemental mass spectrometry measures of retained gadolinium in rat forebrains suggest that some forms of retained gadolinium may escape detection with MRI. © RSNA, 2022 Online supplemental material is available for this article.- Published
- 2023
- Full Text
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40. Myocardial Fibrosis at Cardiac MRI Helps Predict Adverse Clinical Outcome in Patients with Mitral Valve Prolapse.
- Author
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Figliozzi S, Georgiopoulos G, Lopes PM, Bauer KB, Moura-Ferreira S, Tondi L, Mushtaq S, Censi S, Pavon AG, Bassi I, Servato ML, Teske AJ, Biondi F, Filomena D, Pica S, Torlasco C, Muraru D, Monney P, Quattrocchi G, Maestrini V, Agati L, Monti L, Pedrotti P, Vandenberk B, Squeri A, Lombardi M, Ferreira AM, Schwitter J, Aquaro GD, Chiribiri A, Rodríguez Palomares JF, Yilmaz A, Andreini D, Florian A, Leiner T, Abecasis J, Badano LP, Bogaert J, and Masci PG
- Subjects
- Humans, Female, Middle Aged, Retrospective Studies, Contrast Media, Gadolinium, Mitral Valve, Magnetic Resonance Imaging, Fibrosis, Death, Sudden, Cardiac, Mitral Valve Prolapse complications, Mitral Valve Insufficiency, Cardiomyopathies, Ventricular Dysfunction, Left
- Abstract
Background Patients with mitral valve prolapse (MVP) may develop adverse outcomes even in the absence of mitral regurgitation or left ventricular (LV) dysfunction. Purpose To investigate the prognostic value of mitral annulus disjunction (MAD) and myocardial fibrosis at late gadolinium enhancement (LGE) cardiac MRI in patients with MVP without moderate-to-severe mitral regurgitation or LV dysfunction. Materials and Methods In this longitudinal retrospective study, 118 144 cardiac MRI studies were evaluated between October 2007 and June 2020 at 15 European tertiary medical centers. Follow-up was from the date of cardiac MRI examination to June 2020; the minimum and maximum follow-up intervals were 6 months and 156 months, respectively. Patients were excluded if at least one of the following conditions was present: cardiomyopathy, LV ejection fraction less than 40%, ischemic heart disease, congenital heart disease, inflammatory heart disease, moderate or worse mitral regurgitation, participation in competitive sport, or electrocardiogram suggestive of channelopathies. In the remainder, cardiac MRI studies were reanalyzed, and patients were included if they were aged 18 years or older, MVP was diagnosed at cardiac MRI, and clinical information and electrocardiogram monitoring were available within 3 months from cardiac MRI examination. The end point was a composite of adverse outcomes: sustained ventricular tachycardia (VT), sudden cardiac death (SCD), or unexplained syncope. Multivariable Cox regression analysis was performed. Results A total of 474 patients (mean age, 47 years ± 16 [SD]; 244 women) were included. Over a median follow-up of 3.3 years, 18 patients (4%) reached the study end point. LGE presence (hazard ratio, 4.2 [95% CI: 1.5, 11.9]; P = .006) and extent (hazard ratio, 1.2 per 1% increase [95% CI: 1.1, 1.4]; P = .006), but not MAD presence ( P = .89), were associated with clinical outcome. LGE presence had incremental prognostic value over MVP severity and sustained VT and aborted SCD at baseline (area under the receiver operating characteristic curve, 0.70 vs 0.62; P = .03). Conclusion In contrast to mitral annulus disjunction, myocardial fibrosis determined according to late gadolinium enhancement at cardiac MRI was associated with adverse outcome in patients with mitral valve prolapse without moderate-to-severe mitral regurgitation or left ventricular dysfunction. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Gerber in this issue.
- Published
- 2023
- Full Text
- View/download PDF
41. Quantitative Susceptibility Mapping Is Superior to T1-weighted Imaging for Detecting and Measuring Gadolinium
- Author
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Yi Wang and Martin R. Prince
- Subjects
medicine.diagnostic_test ,business.industry ,Gadolinium ,Follow up studies ,Brain ,chemistry.chemical_element ,Magnetic resonance imaging ,Quantitative susceptibility mapping ,Magnetic Resonance Imaging ,Nuclear magnetic resonance ,Text mining ,chemistry ,Organometallic Compounds ,medicine ,T1 weighted ,Radiology, Nuclear Medicine and imaging ,business ,Follow-Up Studies - Published
- 2020
42. A Reality Check on Intrathecal Gadolinium-based Contrast Agents
- Author
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Emanuel Kanal
- Subjects
medicine.diagnostic_test ,business.industry ,media_common.quotation_subject ,Gadolinium ,chemistry.chemical_element ,Magnetic resonance imaging ,Intrathecal ,Reality check ,chemistry ,Contrast (vision) ,Medicine ,Radiology, Nuclear Medicine and imaging ,business ,Nuclear medicine ,media_common - Published
- 2020
43. Comparison of Human Tissue Gadolinium Retention and Elimination between Gadoteridol and Gadobenate
- Author
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Masahiro Kobayashi, Nozomu Murata, Luis F. Gonzalez-Cuyar, Daniel S. Hippe, Kenneth R. Maravilla, Swati Rane Levendovszky, Kiyoko Murata, Makoto Hasegawa, and Desiree A. Marshall
- Subjects
Adult ,Male ,Gadolinium ,chemistry.chemical_element ,Contrast Media ,Multiple dosing ,Bone and Bones ,030218 nuclear medicine & medical imaging ,White matter ,03 medical and health sciences ,0302 clinical medicine ,Meglumine ,Heterocyclic Compounds ,Cadaver ,Organometallic Compounds ,Medicine ,Humans ,Radiology, Nuclear Medicine and imaging ,GADOBENATE DIMEGLUMINE ,Aged ,Skin ,Aged, 80 and over ,Gadoteridol ,business.industry ,Spectrophotometry, Atomic ,Single type ,Brain ,Middle Aged ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,Female ,Nuclear medicine ,business ,medicine.drug - Abstract
Background Linear gadolinium-based contrast agents (GBCAs) are known to be retained at higher levels of gadolinium than macro-cyclic GBCAs. However, very little is known regarding their relative elimination rates and retained fraction of injected gadolinium. Purpose To quantify and compare gadolinium retention and elimination rates in human brain tissue, skin, and bone obtained from cadavers exposed to single-agent administration of either gadoteridol (macrocyclic GBCA) or gadobenate dimeglumine (linear GBCA). Materials and Methods Autopsy cases from August 2014 to July 2019 of patients exposed to a single type of GBCA, either gadoteridol or gadobenate dimeglumine, either single or multiple doses, were included. Gadolinium levels in the brain, skin, and bone were analyzed with inductively coupled plasma mass spectrometry. Linear regression was used to compare gadolinium retention between agents and estimate elimination rates of the retained gadolinium using the time between last injection and death. Results Twenty-eight cadavers with gadoteridol exposure and nine with gadobenate dimeglumine exposure were identified (22 men; age range, 19-83 years). The median gadolinium retention of gadobenate dimeglumine was 3.0-6.5 times higher than that of gadoteridol in the brain (P < .02), 4.4 times higher in bone (P = .002), and 2.9 times higher in skin (P = .05). Gadolinium retention in the globus pallidus (GP), dentate nucleus (DN), white matter (WM), bone, and skin decreased with time elapsed from last administration to death in both the gadobenate dimeglumine (GP: -3% per twofold increase in time, P = .69; DN: -2%, P = .83; WM: -20%, P = .01; bone: -22%, P = .07; skin: -47%, P < .001) and gadoteridol (GP: -17%, P = .11; DN: -16%, P = .15; WM: -30%, P < .001; bone: -11%, P = .16; skin: -24%, P = .01) groups (P values for elimination are compared with a null hypothesis of no elimination). Conclusion The linear agent gadobenate dimeglumine retains several-fold higher levels of gadolinium in the brain and bone compared with the macrocyclic agent gadoteridol. Nonzero elimination of retained gadolinium was detected in the white matter and skin for both agents. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Tweedle in this issue.
- Published
- 2021
44. Left Atrial Fibrosis Assessed with Cardiac MRI in Patients with Paroxysmal and Those with Persistent Atrial Fibrillation
- Author
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Yu Whan Oh, Younghoon Kim, Jong Il Choi, Sung Ho Hwang, Jaemin Shim, and Dong Kyu Lee
- Subjects
Adult ,Male ,medicine.medical_specialty ,Contrast Media ,Gadolinium ,030218 nuclear medicine & medical imaging ,Young Adult ,03 medical and health sciences ,0302 clinical medicine ,Left atrial ,Fibrosis ,Internal medicine ,Atrial Fibrillation ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Heart Atria ,cardiovascular diseases ,Young adult ,Antrum ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Atrial fibrillation ,Retrospective cohort study ,Odds ratio ,Middle Aged ,Image Enhancement ,medicine.disease ,Magnetic Resonance Imaging ,Confidence interval ,030220 oncology & carcinogenesis ,cardiovascular system ,Cardiology ,Female ,business - Abstract
Background Electrophysiology studies have demonstrated that left atrial late gadolinium enhancement (LGE) is associated with the chronicity of atrial fibrillation (AF). To date, cardiac MRI has been used to assess the extent of atrial LGE but not the distribution pattern of LGE in the left atrium. Purpose To determine whether the MRI pattern of left atrial fibrosis is associated with the chronicity of AF. Materials and Methods This retrospective study included patients with AF who underwent LGE MRI between June 2017 and May 2018. The presence of left atrial LGE was assessed at nine left atrial segments; the extent was determined by the number of segments involved. According to the chronicity of AF, patients were separated into paroxysmal AF (PAF) and persistent AF (PeAF) groups. The location and extent of left atrial LGE were compared between PAF and PeAF by using the χ2 test and logistic regression analysis. Results Of the 195 patients (mean age, 55 years ± 10 [standard deviation], 161 men), 74 (38%) had PAF and 121 (62%) had PeAF. Of all patients, 114 (58.4%) had at least one left atrial LGE segment. The mean number of LGE segments was higher (1.4 ± 1.1 vs 0.6 ± 0.7, P = .002) in the PeAF group than in the PAF group. The incidence of LGE at the left inferior pulmonary vein (LIPV) antrum was higher in the PeAF group than in the PAF group (39.2% [29 of 74] vs 7.4% [nine of 121]; P < .001). In multivariable analysis, LGE at the LIPV antrum was independently associated with PeAF (odds ratio = 4.2; 95% confidence interval: 1.7, 10.5; P < .001). Conclusion The presence of fibrosis assessed with late gadolinium enhancement MRI of the left inferior pulmonary vein antrum was associated with persistent atrial fibrillation. © RSNA, 2019 Online supplemental material is available for this article. See also the editorial by Almeida in this issue.
- Published
- 2019
45. Accuracy of Unenhanced MRI in the Detection of New Brain Lesions in Multiple Sclerosis
- Author
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Matthias Bussas, Benedikt Wiestler, Jan S. Kirschke, Haike Zhang, Hanni Wiestler, Muna-Miriam Hoshi, Bernhard Hemmer, Mark Mühlau, Paul Eichinger, Simon Schön, Viola Pongratz, Claus Zimmer, and Achim Berthele
- Subjects
Adult ,Male ,Multiple Sclerosis ,Intraclass correlation ,media_common.quotation_subject ,Contrast Media ,Gadolinium ,Fluid-attenuated inversion recovery ,030218 nuclear medicine & medical imaging ,Lesion ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Contrast (vision) ,Medicine ,Radiology, Nuclear Medicine and imaging ,Retrospective Studies ,media_common ,Brain Diseases ,business.industry ,Multiple sclerosis ,Subtraction ,Brain ,Retrospective cohort study ,Middle Aged ,medicine.disease ,Magnetic Resonance Imaging ,030220 oncology & carcinogenesis ,Brain lesions ,Female ,medicine.symptom ,business ,Nuclear medicine - Abstract
Background Administration of a gadolinium-based contrast material is widely considered obligatory for follow-up imaging of patients with multiple sclerosis (MS). However, advances in MRI have substantially improved the sensitivity for detecting new or enlarged lesions in MS. Purpose To investigate whether the use of contrast material has an effect on the detection of new or enlarged MS lesions and, consequently, the assessment of interval progression. Materials and Methods In this retrospective study based on a local prospective observational cohort, 507 follow-up MR images obtained in 359 patients with MS (mean age, 38.2 years ± 10.3; 246 women, 113 men) were evaluated. With use of subtraction maps, nonenhanced images (double inversion recovery [DIR], fluid-attenuated inversion recovery [FLAIR]) and contrast material-enhanced (gadoterate meglumine, 0.1 mmol/kg) T1-weighted images were separately assessed for new or enlarged lesions in independent readings by two readers blinded to each other's findings and to clinical information. Primary outcome was the percentage of new or enlarged lesions detected only on contrast-enhanced T1-weighted images and the assessment of interval progression. Interval progression was defined as at least one new or unequivocally enlarged lesion on follow-up MR images. Results Of 507 follow-up images, 264 showed interval progression, with a total of 1992 new or enlarged and 207 contrast-enhancing lesions. Four of these lesions (on three MR images) were retrospectively detected on only the nonenhanced images, corresponding to 1.9% (four of 207) of the enhancing and 0.2% (four of 1992) of all new or enlarged lesions. Nine enhancing lesions were not detected on FLAIR-based subtraction maps (nine of 1442, 0.6%). In none of the 507 images did the contrast-enhanced sequences reveal interval progression that was missed in the readouts of the nonenhanced sequences, with use of either DIR- or FLAIR-based subtraction maps. Interrater agreement was high for all three measures, with intraclass correlation coefficients of 0.91 with FLAIR, 0.94 with DIR, and 0.99 with contrast-enhanced T1-weighted imaging. Conclusion At 3.0 T, use of a gadolinium-based contrast agent at follow-up MRI did not change the diagnosis of interval disease progression in patients with multiple sclerosis. © RSNA, 2019 See also the editorial by Saindane in this issue.
- Published
- 2019
46. Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates
- Author
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Paula Jacobs, Deborah Levine, Howard A. Rowley, Kenneth R. Maravilla, Michael F. Tweedle, Martin R. Prince, Emanuel Kanal, Matthew S. Davenport, Robert J. McDonald, Robert E. Lenkinski, James H. Ellis, Jeffrey C. Weinreb, and Herbert Y. Kressel
- Subjects
medicine.medical_specialty ,Gadolinium ,Contrast Media ,chemistry.chemical_element ,Medical information ,Disease ,030218 nuclear medicine & medical imaging ,Imaging modalities ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Animals ,Humans ,Radiology, Nuclear Medicine and imaging ,Intensive care medicine ,Societies, Medical ,Original Research ,business.industry ,Research ,Clinical disease ,United States ,Additional research ,Safety profile ,National Institutes of Health (U.S.) ,chemistry ,Radiology ,business ,030217 neurology & neurosurgery - Abstract
Gadolinium-based contrast agents (GBCAs) have revolutionized MRI, enabling physicians to obtain crucial life-saving medical information that often cannot be obtained with other imaging modalities. Since initial approval in 1988, over 450 million intravenous GBCA doses have been administered worldwide, with an extremely favorable pharmacologic safety profile; however, recent information has raised new concerns over the safety of GBCAs. Mounting evidence has shown there is long-term retention of gadolinium in human tissues. Further, a small subset of patients have attributed a constellation of symptoms to GBCA exposure, although the association of these symptoms with GBCA administration or gadolinium retention has not been proven by scientific investigation. Despite evidence that macrocyclic GBCAs show less gadolinium retention than linear GBCAs, the safety implications of gadolinium retention are unknown. The mechanism and chemical forms of gadolinium retention, as well as the biologic activity and clinical importance of these retained gadolinium species, remain poorly understood and underscore the need for additional research. In February 2018, an international meeting was held in Bethesda, Md, at the National Institutes of Health to discuss the current literature and knowledge gaps about gadolinium retention, to prioritize future research initiatives to better understand this phenomenon, and to foster collaborative standardized studies. The greatest priorities are to determine (a) if gadolinium retention adversely affects the function of human tissues, (b) if retention is causally associated with short- or long-term clinical manifestations of disease, and (c) if vulnerable populations, such as children, are at greater risk for experiencing clinical disease. The purpose of the research roadmap is to highlight important information that is not known and to identify and prioritize needed research. ©RSNA, 2018 Online supplemental material is available for this article .
- Published
- 2018
47. Brain Irradiation and Gadobutrol Administration in Pediatric Patients with Brain Tumors: Effect on MRI Brain Signal Intensity
- Author
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Marvin D. Nelson, Mary Baron Nelson, Steven Cen, Benita Tamrazi, Chia-Shang J. Liu, and Girish Dhall
- Subjects
Male ,Adolescent ,Gadolinium ,Contrast Media ,chemistry.chemical_element ,Globus Pallidus ,030218 nuclear medicine & medical imaging ,Gadobutrol ,03 medical and health sciences ,0302 clinical medicine ,Image Interpretation, Computer-Assisted ,Organometallic Compounds ,Humans ,Medicine ,Radiology, Nuclear Medicine and imaging ,Irradiation ,Mri brain ,Child ,Brain Neoplasms ,business.industry ,Magnetic Resonance Imaging ,Dentate nucleus ,Cerebellar Nuclei ,chemistry ,Child, Preschool ,Female ,Signal intensity ,Nuclear medicine ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
Purpose To determine whether treatment affects MRI signal intensity in pediatric patients with primary brain tumors independent of the administration of macrocyclic gadolinium-based contrast agents (GBCAs). Materials and Methods This retrospective, single-center study included 78 patients (mean age, 7.7 years ± 5.4) with primary brain tumors who underwent macrocyclic GBCA-enhanced MRI from 2015 to 2018. Three groups were compared: (a) patients who had undergone radiation therapy (37 patients, 26 of whom had undergone concurrent chemotherapy), (b) patients who had undergone chemotherapy only (17 patients), and (c) patients who had received no treatment ("no-treatment group," 24 patients). The signal intensity in the globus pallidus (GP), thalamus, dentate nucleus (DN), and pons was measured on unenhanced T1-weighted images. GP-to-thalamus and DN-to-pons signal intensity ratios were compared among groups with analysis of variance by using the Kruskal-Wallis test, followed by post hoc pairwise tests with Tukey adjustment, and were analyzed relative to group, total cumulative doses of GBCA, age, and sex with multivariable linear models. Results The mean number of GBCA-enhanced MRI examinations in the radiation therapy, chemotherapy-only, and no-treatment groups was 7.11, 7.29, and 4.96, respectively (P.01 for the radiation therapy and chemotherapy groups compared with the no-treatment group). The DN-to-pons ratio in the radiation therapy group was higher than that in both the no-treatment group and the chemotherapy-only group (P.01 for both). There was no significant difference in the DN-to-pons ratios between the chemotherapy-only group and the no-treatment group (P = .99). The GP-to-thalamus ratios did not differ among all three groups (P = .09). There was no dose-dependent effect of GBCA on the DN-to-pons and GP-to-thalamus ratios when adjusting for the effects of treatment (P = .21 and P = .38, respectively). Conclusion Brain irradiation contributes to a higher dentate nucleus signal intensity in pediatric patients with brain tumor independent of the administration of macrocyclic gadolinium-based contrast agents. © RSNA, 2018.
- Published
- 2018
48. Dark-Blood Late Gadolinium Enhancement: A Major Advance for Cardiac MRI.
- Author
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Kawel-Boehm N and Bremerich J
- Subjects
- Humans, Animals, Dogs, Papillary Muscles, Magnetic Resonance Imaging, Infarction, Gadolinium, Contrast Media
- Published
- 2022
- Full Text
- View/download PDF
49. Long-term Gadolinium Retention in the Healthy Rat Brain: Comparison between Gadopiclenol, Gadobutrol, and Gadodiamide.
- Author
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Funke SKI, Factor C, Rasschaert M, Lezius L, Sperling M, Karst U, and Robert P
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- Animals, Azabicyclo Compounds, Brain diagnostic imaging, Brain metabolism, Contrast Media, Female, Gadolinium DTPA, Iron metabolism, Male, Rats, Rats, Sprague-Dawley, Gadolinium, Organometallic Compounds
- Abstract
Background Safety concerns caused by gadolinium retention call for the development of high-relaxivity gadolinium-based contrast agents (GBCAs) allowing minimal dosing. Purpose To investigate brain gadolinium retention in healthy rats after exposure to gadopiclenol (Elucirem, Guerbet; macrocyclic GBCA) compared with gadobutrol (Gadovist or Gadavist, Bayer; macrocyclic GBCA) and gadodiamide (Omniscan, GE Healthcare; linear GBCA) over 1 year. Materials and Methods In this study conducted between May 2018 and April 2020, 9-week-old healthy Sprague Dawley rats received five injections of either gadopiclenol, gadobutrol, or gadodiamide (2.4 mmol of gadolinium per kilogram of body weight for each), or saline (control animals) over a period of 5 weeks. Rats were randomly assigned to different groups (six female and six male rats per group). MRI examinations were performed before euthanasia at 1, 3, 5, or 12 months after the last injection. Brains were sampled to determine the total gadolinium content via inductively coupled plasma mass spectrometry (ICP-MS), to characterize gadolinium species with size exclusion chromatography (SEC)-ICP-MS, and to perform elemental mapping with laser ablation (LA)-ICP-MS. Mann-Whitney tests were performed on pairwise comparisons of the same time points. Results For both macrocyclic agents, no T1 signal hyperintensities were observed in the cerebellum, and approximately 80% of gadolinium washout was found between 1 month (gadobutrol, 0.30 nmol/g; gadopiclenol, 0.37 nmol/g) and 12 months (gadobutrol, 0.062 nmol/g; gadopiclenol, 0.078 nmol/g). After 12 months, only low-molecular-weight gadolinium species were detected in the soluble fraction. Gadodiamide led to significantly higher gadolinium concentrations after 1 month in the cerebellum (gadodiamide, 2.65 nmol/g; P < .001 vs both macrocyclics) combined with only 15% washout after 12 months (gadodiamide, 2.25 nmol/g) and with gadolinium detected bound to macromolecules. Elemental bioimaging enabled visualization of gadolinium deposition patterns colocalized with iron. Conclusion Gadopiclenol and gadobutrol demonstrated similar in vivo distribution and washout of gadolinium in the healthy rat brain, markedly differing from gadodiamide up to 12 months after the last injection. © RSNA, 2022 Online supplemental material is available for this article .
- Published
- 2022
- Full Text
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50. Deep Learning-based Post Hoc CT Denoising for Myocardial Delayed Enhancement.
- Author
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Nishii T, Kobayashi T, Tanaka H, Kotoku A, Ohta Y, Morita Y, Umehara K, Ota J, Horinouchi H, Ishida T, and Fukuda T
- Subjects
- Aged, Gadolinium, Humans, Male, Myocardium, Retrospective Studies, Tomography, X-Ray Computed methods, Contrast Media, Deep Learning
- Abstract
Background To improve myocardial delayed enhancement (MDE) CT, a deep learning (DL)-based post hoc denoising method supervised with averaged MDE CT data was developed. Purpose To assess the image quality of denoised MDE CT images and evaluate their diagnostic performance by using late gadolinium enhancement (LGE) MRI as a reference. Materials and methods MDE CT data obtained by averaging three acquisitions with a single breath hold 5 minutes after the contrast material injection in patients from July 2020 to October 2021 were retrospectively reviewed. Preaveraged images obtained in 100 patients as inputs and averaged images as ground truths were used to supervise a residual dense network (RDN). The original single-shot image, standard averaged image, RDN-denoised original (DL
original ) image, and RDN-denoised averaged (DLave ) image of holdout cases were compared. In 40 patients, the CT value and image noise in the left ventricular cavity and myocardium were assessed. The segmental presence of MDE in the remaining 40 patients who underwent reference LGE MRI was evaluated. The sensitivity, specificity, and accuracy of each type of CT image and the improvement in accuracy achieved with the RDN were assessed using odds ratios (ORs) estimated with the generalized estimation equation. Results Overall, 180 patients (median age, 66 years [IQR, 53-74 years]; 107 men) were included. The RDN reduced image noise to 28% of the original level while maintaining equivalence in the CT values ( P < .001 for all). The sensitivity, specificity, and accuracy of the original images were 77.9%, 84.4%, and 82.3%, of the averaged images were 89.7%, 87.9%, and 88.5%, of the DLoriginal images were 93.1%, 87.5%, and 89.3%, and of the DLave images were 95.1%, 93.1%, and 93.8%, respectively. DLoriginal images showed improved accuracy compared with the original images (OR, 1.8 [95% CI: 1.2, 2.9]; P = .011) and DLave images showed improved accuracy compared with the averaged images (OR, 2.0 [95% CI: 1.2, 3.5]; P = .009). Conclusion The proposed denoising network supervised with averaged CT images reduced image noise and improved the diagnostic performance for myocardial delayed enhancement CT. © RSNA, 2022 Online supplemental material is available for this article. See also the editorial by Vannier and Wang in this issue.- Published
- 2022
- Full Text
- View/download PDF
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