For magnetic resonance, the established class of intravenous contrast media is the gadolinium-based contrast agents. In the 3 decades since initial approval, these have proven in general to be very ...safe for human administration. However, in 2006, a devastating late adverse reaction to administration of the less stable gadolinium-based contrast agents was identified, nephrogenic systemic fibrosis. The result of actions taken by the European Medicines Agency and the US Food and Drug Administration, stratifying the agents by risk and contraindicating specific agents in severe renal dysfunction, has led to no new cases being identified in North America or Europe. Subsequently, in 2014, long-term deposition in the brain of gadolinium was first shown, after administration of 2 nonionic linear chelates, gadodiamide, and gadopentetate dimeglumine. This has led to an intense focus on the question of in vivo distribution, possible dechelation, and subsequent deposition of gadolinium, together with substantial clarification of the phenomenon as well as stratification of the agents on this basis. This review focuses on 8 critical questions regarding gadolinium deposition in the brain and body, with the answers and discussion therein important for future regulatory decisions and clinical practice. It is now clear that dechelation of gadolinium occurs in vivo with the linear agents and is responsible for this phenomenon, with key experts in the field recommending, except where there is no suitable alternative, a shift in clinical practice from the linear to macrocyclic agents. In addition, on March 10, 2017, the Pharmacovigilance and Risk Assessment Committee of the European Medicines Agency recommended suspension of the marketing authorization for 4 linear gadolinium contrast agents-specifically Omniscan, Optimark, Magnevist, and MultiHance (gadodiamide, gadoversetamide, gadopentetate dimeglumine, and gadobenate dimeglumine)-for intravenous injection. Cited in the report was convincing evidence of gadolinium deposition in the brain months after injection of these linear agents. Primovist/Eovist (gadoxetic acid disodium) will remain available, being used at a lower dose for liver imaging, because it meets an important diagnostic need. In addition, a formulation of Magnevist for intra-articular injection will remain available because of its very low gadolinium concentration.
ABSTRACTThe established class of intravenous contrast media for magnetic resonance imaging is the gadolinium chelates, more generally referred to as the gadolinium-based contrast agents (GBCAs). ...These can be differentiated on the basis of stability in vivo, with safety and tolerability of the GBCAs dependent upon chemical and biologic inertness. This review discusses first the background in terms of development of these agents and safety discussions therein, and second their relative stability based both on in vitro studies and clinical observations before and including the advent of nephrogenic systemic fibrosis. This sets the stage for the subsequent focus of the review, the current knowledge regarding accumulation of gadolinium in the brain and specifically the dentate nucleus after intravenous administration of the GBCAs and differentiation among agents on this basis. The information available to date, from the initial conception of these agents in 1981 to the latest reports concerning safety, demonstrates a significant difference between the macrocyclic and linear chelates. The review concludes with a discussion of the predictable future, which includes, importantly, a reassessment of the use of the linear GBCAs or a subset thereof.
ABSTRACTThe issue of dechelation (transmetallation) in vivo after administration of the linear gadolinium-based contrast agents, and potential safety concerns, is considered on the basis of an ...extensive, focused literature review. Early indications of potential problems included the high level of excess ligand used in the formulation of 2 agents (indeed the 2 least stable thermodynamically) and interference with laboratory tests when blood was drawn from patients relatively soon after administration of these same agents. The advent of nephrogenic systemic fibrosis in the late 2000s raised additional major concerns.The correlation in 2014 of dentate nucleus hyperintensity on precontrast T1-weighted scans with multiple prior injections of linear gadolinium chelates, in patients with normal renal function, has driven subsequent research concerning dechelation of these agents in vivo. Unexpectedly high levels of gadolinium in the bone, skin, and liver have been found long term after administration, in animal models and in humans, although the latter data are limited. Bone may serve as a long-term reservoir, with a residual excretion phase for gadolinium after intravenous injection of the linear agents due to a subsequent slow release from bone. Many different patient populations could be vulnerable and potentially later develop clinical symptoms, although at this stage there are only limited data and small retrospective uncontrolled studies. Possible vulnerable populations include children, menopausal women, patients with osteoporosis (who are predisposed to fractures and often slow to heal or heal poorly), those receiving multiple doses, those with proinflammatory conditions, moderate renal dysfunction, or an undefined genetic predisposition. Of particular concern would be nephrogenic systemic fibrosis–like symptoms—including particularly pain and skin/joint symptoms, or disease related to the incorporation of gadolinium in hydroxyapatite in bone, in small subgroups of patients with a not yet defined propensity and/or cofactor. These concerns have led to withdrawal of the linear agents from the largest clinical market, Europe, with the exception of the hepatobiliary agents for delayed liver imaging, an indication that cannot be fulfilled by the current macrocyclic gadolinium chelates (for which these concerns do not apply).
Speed in Clinical Magnetic Resonance Runge, Val M; Richter, Johannes K; Heverhagen, Johannes T
Investigative radiology,
2017-January, 2017-Jan, 2017-1-00, 20170101, Letnik:
52, Številka:
1
Journal Article
Recenzirano
Odprti dostop
ABSTRACTThe relevant clinical accelerated magnetic resonance techniques that are available currently for routine patient examinations are reviewed, presenting and discussing the benefits therein when ...compared with more conventional scans. The focus is on clinical use and practicality, with the review divided into 3 sections. Improvements in 3-dimensional acquisition are first discussed, specifically controlled aliasing in parallel imaging results in higher acceleration, related radial techniques, and CAIPI-Dixon-TWIST-VIBE. Simultaneous multislice imaging is then reviewed, focusing on current implementation for 2-dimensional imaging, including both echo-planar and fast spin echo techniques. The final topic is that of sparse reconstruction (data sparsity), discussing the principles therein, challenges, and current applications. Guidance in terms of clinical use for accelerated techniques is provided, focusing on enabling faster and improved clinical scan results.
Decades of technical innovations have propelled musculoskeletal radiology through an astonishing evolution. New artificial intelligence and deep learning methods capitalize on many past innovations ...in magnetic resonance imaging (MRI) to reach unprecedented speed, image quality, and new contrasts. Similarly exciting developments in computed tomography (CT) include clinically applicable molecular specificity and substantially improved spatial resolution of musculoskeletal structures and diseases. This special issue of Investigative Radiology comprises a collection of expert summaries and reviews on the most impactful innovations and cutting-edge topics in musculoskeletal radiology, including radiomics and deep learning methods for musculoskeletal disease detection, high-resolution MR neurography, deep learning-driven ultra-fast musculoskeletal MRI, MRI-based synthetic CT, quantitative MRI, modern low-field MRI, 7.0 T MRI, dual-energy CT, cone beam CT, kinematic CT, and synthetic contrast generation in musculoskeletal MRI.
ABSTRACTNew next-generation low-field magnetic resonance imaging systems (operating in the range of 0.5 T) hold great potential for increasing access to clinical diagnosis and needed health care both ...in developed countries and worldwide. The relevant history concerning the choice of field strength, which resulted in 1.5 T still dominating today the number of installed systems, is considered, together with design advances possible because of interval developments, since low field was considered for clinical use in the 1980s, and current research. The potential impact of low-cost, advanced-generation low-field magnetic resonance imaging systems, properly designed, is high in terms of further dissemination of health care—across the gamut from industrial to developing countries—regardless of disease entity and anatomic region of involvement, with major niche applications likely as well.
ABSTRACTThe last 5 years of technological advances with major impact on clinical magnetic resonance (MR) are discussed, with greater emphasis on those that are most recent. These developments have ...already had a critical positive effect on clinical diagnosis and therapy and presage continued rapid improvements for the next 5 years. This review begins with a discussion of 2 topics that encompass the breadth of MR, in terms of anatomic applications, contrast media, and MR angiography. Subsequently, innovations are discussed by anatomic category, picking the areas with the greatest development, starting with the brain, moving forward to the liver and kidney, and concluding with the musculoskeletal system, breast, and prostate. Two final topics are then considered, which will likely, with time, become independent major fields in their own right, interventional MR and MR positron emission tomography (PET).The next decade will bring a new generation of MR contrast media, with research focused on substantial improvements (>100-fold) in relaxivity (contrast effect), thus providing greater efficacy, safety, and tissue targeting. Magnetic resonance angiography will see major advances because of the use of compressed sensing, in terms of spatial and temporal resolution, with movement away from nondynamic imaging. The breadth of available techniques and tissue contrast has greatly expanded in brain imaging, benefiting both from the introduction of new basic categories of imaging techniques, such as readout-segmented echo planar imaging and 3D fast spin echo imaging with variable flip angles, and from new refinements specific to anatomic areas, such as double inversion recovery and MP2RAGE. Liver imaging has benefited from the development of techniques to easily and rapidly assess lipid, and will see, overall, a marked improvement in the next 5 years from new techniques on the verge of clinical introduction, such as controlled aliasing in parallel imaging results in higher acceleration (CAIPIRINHA), with a substantial impact on both spatial resolution and scan time. Renal MR is benefiting from the application of blood-oxygen-level–dependent imaging, providing an assessment of renal function critical for the evaluation of chronic kidney disease. Techniques to reduce metal artifact are a major focus of development in musculoskeletal MR and are critical for the ever-increasing postsurgical and implant patient population, leading to markedly improved imaging of tissue adjacent to metal and diagnosis of infection, prosthesis loosening, and postsurgical complications such as fracture. In breast MR, scan techniques are continuing to evolve, and the impact of this examination on screening for and evaluation and treatment of breast carcinoma is substantial with continued expansion of indications. Prostate MR has benefited from multiparametric imaging and the application of diffusion-weighted imaging, the latter technique also now applied more generally in body imaging, with a substantial clinical impact, in particular for the detection of tumor lymph nodes. Interventional MR is still early in its development, although well established in many centers, possessing great potential in comparison with computed tomography (CT) because of superior soft-tissue contrast, real-time multiplanar imaging guidance and monitoring, the availability of temperature mapping, and the lack of ionizing radiation. And last but not least, MR-PET is in its infancy, with the first round of clinical units installed in the past 2 years and early clinical experience showing equivalence and, in some instances, superiority to PET-CT. As with the field of MR itself, which began when CT was already an established modality, MR-PET will likely, in the next decade, become an equivalent modality to PET-CT, if not begin to supplant the latter modality.
PDF
