Does MR arthrography cause intracranial gadolinium deposition?

Bunnell, Katherine M; Hemke, Robert; Husseini, Jad S.; Torriani, Martin; Huang, Susie Y.; Bredella, Miriam A.

doi:10.1007/s00256-020-03380-5

Cited by 8 publications

(4 citation statements)

References 34 publications

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“…In a routine MR arthrogram, contrast dose in a knee is approximately 20 to 40 ml of a 1:200 dilution of the same GBCA, around 100-times less than that of IV administration. It is therefore not surprising that two recent studies were unable to detect retained Gd in the brain using T1-weighted signal on MRI in patients who had received only one to three MR arthrograms [ 15 , 16 ]. In our study, intracranial Gd retention was detected using ICP-MS only following IA injection of undiluted gadodiamide.…”

Section: Discussionmentioning

confidence: 99%

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Gadolinium retention within multiple rat organs after intra-articular administration of gadolinium-based contrast agents

et al. 2021

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Objective To characterize the extent of retention and biodistribution of gadolinium (Gd) following intra-articular (IA) injection of linear and macrocyclic gadolinium-based contrast agents (GBCAs) into the knee joint of a rat model. Materials and methods Fifteen Wistar rats were divided into five groups and underwent fluoroscopically-guided injections of both knee joints of (1) clinical 1:200 dilution (low dose, LD) gadodiamide (linear GBCA), (2) LD gadobutrol (macrocyclic GBCA), (3) undiluted (high dose, HD) gadodiamide, (4) HD gadobutrol, and (5) saline. Gd concentrations were quantified by inductively coupled plasma mass spectrometry in (1) blood and urine samples obtained over a 72 h period and (2) knee joint tissues, brain, kidney, and bone marrow at 3 days post-injection. Results Both HD and LD gadodiamide and gadobutrol were rapidly absorbed from the joint with peak serum and urine concentration at 1 h post-injection, with relatively faster clearance of gadobutrol. All GBCA-exposed groups had detectable levels of Gd in the joint tissues, bone marrow, and/or kidneys (median tissue gadolinium range: 0.1–71 μg Gd/g tissue), with higher amounts observed with gadodiamide versus gadobutrol. Retention within brain tissues was only detected following HD gadodiamide administration but not LD gadodiamide nor HD or LD gadobutrol. Conclusion There was rapid systemic absorption, redistribution, and widespread multi-organ retention of Gd following IA injection of both linear and macrocyclic GBCAs, despite substantial amounts of urinary excretion. Higher concentrations of Gd were observed with administration of gadodiamide compared to gadobutrol in most tissues and biofluids.

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Section: Discussionmentioning

confidence: 99%

“…Two recent clinical studies [ 15 , 16 ] attempted to ascertain if MR arthrography resulted in intracranial Gd retention. Both looked for T1-weighted signal abnormalities on MR brain exams, similar to prior IV GBCA studies, following one to three IA injections of GBCAs.…”

Section: Introductionmentioning

confidence: 99%

Gadolinium retention within multiple rat organs after intra-articular administration of gadolinium-based contrast agents

et al. 2021

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“…In one pre-clinical study using rats, detectable levels of gadolinium were present in joint tissues, bone marrow, and/or kidneys following intra-articular injection of both linear and macrocyclic GBCAs, though the clinical significance of this remains unknown [ 33 ]. Intra-cranial gadolinium deposition has not been shown after intra-articular administration of GBCAs at clinical doses in either pre-clinical models [ 33 ] or on patient brain MRI exams [ 34 , 35 ].…”

Section: Technical Considerationsmentioning

confidence: 99%

SSR white paper: guidelines for utilization and performance of direct MR arthrography

Chang,

Bencardino,

French

et al. 2023

Skeletal Radiol

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Objective Direct magnetic resonance arthrography (dMRA) is often considered the most accurate imaging modality for the evaluation of intra-articular structures, but utilization and performance vary widely without consensus. The purpose of this white paper is to develop consensus recommendations on behalf of the Society of Skeletal Radiology (SSR) based on published literature and expert opinion. Materials and methods The Standards and Guidelines Committee of the SSR identified guidelines for utilization and performance of dMRA as an important topic for study and invited all SSR members with expertise and interest to volunteer for the white paper panel. This panel was tasked with determining an outline, reviewing the relevant literature, preparing a written document summarizing the issues and controversies, and providing recommendations. Results Twelve SSR members with expertise in dMRA formed the ad hoc white paper authorship committee. The published literature on dMRA was reviewed and summarized, focusing on clinical indications, technical considerations, safety, imaging protocols, complications, controversies, and gaps in knowledge. Recommendations for the utilization and performance of dMRA in the shoulder, elbow, wrist, hip, knee, and ankle/foot regions were developed in group consensus. Conclusion Although direct MR arthrography has been previously used for a wide variety of clinical indications, the authorship panel recommends more selective application of this minimally invasive procedure. At present, direct MR arthrography remains an important procedure in the armamentarium of the musculoskeletal radiologist and is especially valuable when conventional MRI is indeterminant or results are discrepant with clinical evaluation.

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“…Although intra-articular injection of gadolinium-containing contrast agents is not Food and Drug Administration approved, it is routinely performed as an “off-label” technique. With recent concerns regarding the safety of gadolinium-containing contrast agents, it is comforting to know that studies have not shown significant intracranial gadolinium deposition following MR arthrography [ 6 , 7 ]. A variety of anterior- and posterior-based approaches may be used utilising fluoroscopic or ultrasound guidance.…”

Section: Techniquementioning

confidence: 99%

Magnetic resonance imaging of the shoulder

et al. 2020

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The aim of this article is to review the use of magnetic resonance imaging (MRI) for the evaluation of shoulder pain, which is a common clinical complaint of the musculoskeletal system. MRI is an essential auxiliary tool to evaluate these patients because of its high resolution and high sensitivity in depicting the soft tissues. This article will review the imaging technique, normal imaging anatomy, and most common imaging findings of disorders of tendons, labrum, and ligaments of the shoulder. It will also discuss common systemic diseases that manifest in the shoulder as well as disorders of the acromioclavicular joint and bursae. New advances and research in MRI have provided additional potential uses for evaluating shoulder derangements.

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Does MR arthrography cause intracranial gadolinium deposition?

Cited by 8 publications

References 34 publications

Gadolinium retention within multiple rat organs after intra-articular administration of gadolinium-based contrast agents

Gadolinium retention within multiple rat organs after intra-articular administration of gadolinium-based contrast agents

SSR white paper: guidelines for utilization and performance of direct MR arthrography

Magnetic resonance imaging of the shoulder

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