Gadolinium-Based Contrast Agent Use, Their Safety, and Practice Evolution

Do, Catherine; DeAguero, Joshua; Brearley, A. J.; Trejo, Xochitl; Howard, Tamara; Escobar, G. Patricia; Wagner, Brent

doi:10.34067/kid.0000272019

Cited by 64 publications

(72 citation statements)

References 31 publications

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“…Although gadolinium can be retained in the kidneys after GBCA administration, there is a concern that reduced clearance of GBCAs by the kidneys due to renal dysfunction, could result in increased residence time of GBCAs in the body and subsequent higher retention of gadolinium. Proximal tubular vacuolation has been demonstrated in animals treated with GBCAs (Elmståhl et al 2007 ; McDonald et al 2017b ; Do et al 2020 ). This vacuolation phenomenon presents as lipid rich vacuoles with electron dense structures, with gadolinium deposits lining the lipid deposits in the renal proximal tubule (Do et al 2020 ).…”

Section: Toxicological Effects Of Gadolinium-based Contrast Agentsmentioning

confidence: 99%

Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration

Davies¹,

Siebenhandl-Wolff²,

Tranquart³

et al. 2022

Arch Toxicol

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Gadolinium-based contrast agents (GBCAs) have transformed magnetic resonance imaging (MRI) by facilitating the use of contrast-enhanced MRI to allow vital clinical diagnosis in a plethora of disease that would otherwise remain undetected. Although over 500 million doses have been administered worldwide, scientific research has documented the retention of gadolinium in tissues, long after exposure, and the discovery of a GBCA-associated disease termed nephrogenic systemic fibrosis, found in patients with impaired renal function. An understanding of the pharmacokinetics in humans and animals alike are pivotal to the understanding of the distribution and excretion of gadolinium and GBCAs, and ultimately their potential retention. This has been well studied in humans and more so in animals, and recently there has been a particular focus on potential toxicities associated with multiple GBCA administration. The purpose of this review is to highlight what is currently known in the literature regarding the pharmacokinetics of gadolinium in humans and animals, and any toxicity associated with GBCA use.

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Section: Toxicological Effects Of Gadolinium-based Contrast Agentsmentioning

confidence: 99%

Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration

Davies¹,

Siebenhandl-Wolff²,

Tranquart³

et al. 2022

Arch Toxicol

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“…In addition to traditional treatment of allergy, IVIG is also effective for treating life-threatening non-IgEmediated allergy. In previous studies, high-dose IVIG has been used as an anti-in ammatory agent for the treatment of allergic diseases [4]. IVIG potentiates the effects of steroids by increasing steroid-binding a nity to the glucocorticoid receptor and reducing the number of circulating neutrophils by up regulating their apoptosis [5].…”

Section: Discussionmentioning

confidence: 99%

Gadobutrol-induced acute respiratory distress syndrome rescued by intravenous immunoglobulin and extracorporeal membrane oxygenation

Chen¹,

Hsu²,

Chen³

et al. 2021

Preprint

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BackgroundGadobutrol-induced life-threatening allergies, such as acute respiratory distress syndrome (ARDS), is rarely reported. The severe allergies publishing in previous literature report involves IgE and tryptase-mediated immune responses. Gadobutrol-related non-IgE-mediated allergy has not been reported.Case presentationA 39-year-old woman underwent Gadobutrol-contrast magnetic resonance imaging of both lower limbs for clinically suspected vasculitis. One hour after injection of 8 ml Gadobutrol, the patient developed dizziness without respiratory symptoms. Eight hours after the contrast injection, she exhibited vomiting, dyspnea, and rapid progression of edema. She visited the emergency room, where chest imaging showed increased infiltration in both lungs. Arterial blood gas analysis revealed hypoxemia when she was given 100% inspired oxygen. The patient was admitted to intensive care unit and received inotropic agents. Extracorporeal membrane oxygenation was applied due to the diagnosis of ARDS and persistent hypoxia after using mechanical ventilation. Systemic intravenous glucocorticoid and antihistamine were prescribed for allergic reaction. Contrast-relevant non-IgE-mediated allergy was confirmed by detailed medical record and laboratory data. An additional 2 days of intravenous immunoglobulin was prescribed. By 3 days after admission, the patient’s shock and acute respiratory distress syndrome had responded great. She was discharged 13 days after admission.ConclusionsHere, we present the first case of gadobutrol-induced non-IgE-mediated allergy complicated by ARDS. This condition was successfully rescued by dual therapy of venovenous extracorporeal membrane oxygenation and intravenous immunoglobulin without any complications.

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“…This fact is of importance in selected groups of patients such as those with a history of allergy to gadolinium, patients with impaired renal function at risk for nephrogenic systemic fibrosis, and since patients with VMs will need multiple surveillance, to minimize the potential risk of intracranial gadolinium deposition. Despite no clear clinical symptoms that have been related to this deposition of gadolinium at the dentate nucleus and basal ganglia, there is a strong recommendation to justify and minimize the use of gadolinium to those circumstances where it is needed for diagnostic purposes 79,80 …”

Section: Advanced Mri Approach To Vms Evaluationmentioning

confidence: 99%

Conventional and advanced MRI evaluation of brain vascular malformations

Martín-Noguerol

Concepción-Aramendía

Lim

et al. 2021

Journal of Neuroimaging

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Vascular malformations (VMs) of the central nervous system (CNS) include a wide range of pathological conditions related to intra and extracranial vessel abnormalities. Although some VMs show typical neuroimaging features, other VMs share and overlap pathological and neuroimaging features that hinder an accurate differentiation between them. Hence, it is not uncommon to misclassify different types of VMs under the general heading of arteriovenous malformations. Thorough knowledge of the imaging findings of each type of VM is mandatory to avoid these inaccuracies. Conventional MRI sequences, including MR angiography, have allowed the evaluation of CNS VMs without using ionizing radiation. Newer MRI techniques, such as susceptibility‐weighted imaging, black blood sequences, arterial spin labeling, and 4D flow imaging, have an added value of providing physiopathological data in real time regarding the hemodynamics of VMs. Beyond MR images, new insights using 3D printed models are being incorporated as part of the armamentarium for a noninvasive evaluation of VMs. In this paper, we briefly review the pathophysiology of CNS VMs, focusing on the MRI findings that may be helpful to differentiate them. We discuss the role of each conventional and advanced MRI sequence for VMs assessment and provide some insights about the value of structured reports of 3D printing to evaluate VMs.

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Gadolinium-Based Contrast Agent Use, Their Safety, and Practice Evolution

Cited by 64 publications

References 31 publications

Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration

Gadolinium: pharmacokinetics and toxicity in humans and laboratory animals following contrast agent administration

Gadobutrol-induced acute respiratory distress syndrome rescued by intravenous immunoglobulin and extracorporeal membrane oxygenation

Conventional and advanced MRI evaluation of brain vascular malformations

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