Gadolinium Contrast Agents for CNS Imaging: Current Concepts and Clinical Evidence

Abstract

SUMMARY:The aim of this article was to review the properties of the various gadolinium-based contrast agents used for CNS imaging along with the clinical evidence and published data that highlight the impact these different properties can have on diagnostic performance. In addition, approaches to optimizing image acquisition that take into account the different properties of specific gadoliniumbased contrast agents and an extensive review of the safety profiles of the various agents are presented. ABBREVIATIONS:CE ϭ contrast-enhanced; CNR ϭ contrast-to-noise ratio; GBCA ϭ gadolinium-based contrast agent; Gd ϭ gadolinium; NSF ϭ nephrogenic systemic fibrosis; rCBV ϭ relative cerebral blood volume; rCBF ϭ relative cerebral blood flow O f the 9 gadolinium-based contrast agents (GBCAs) approved by the United States FDA for contrast-enhanced (CE) MR imaging, 7 (gadoterate meglumine, Dotarem, Guerbet, Aulnay-sous-Bois, France; gadobutrol, Gadavist, Bayer HealthCare Pharmaceuticals, Wayne, New Jersey; gadopentetate dimeglumine, Magnevist, Bayer HealthCare; gadobenate dimeglumine, MultiHance, Bracco Diagnostics, Princeton, New Jersey; gadodiamide, Omniscan, GE Healthcare, Milwaukee, Wisconsin; gadoversetamide, OptiMARK, Covidien, Dublin, Ireland; gadoteridol, ProHance, Bracco Diagnostics) are approved specifically for CE-MR imaging of the CNS. Although numerous studies published in high-ranking peerreviewed journals have confirmed the safety and efficacy of the 7 GBCAs approved for CNS imaging, differences among these agents and the impact these differences may have on diagnostic sensitivity and clinical decision-making remain underappreciated and sometimes misunderstood.The aim of this article was to review the properties of the various GBCAs used for CNS imaging together with the clinical evidence and published data that highlight the impact these different properties can have on diagnostic performance. In addition, approaches to optimizing image acquisition that take into account the different properties of specific GBCAs and an extensive review of the safety profiles of the various agents will be presented.For the purposes of the present review, brand names rather than chemical names have been used throughout to refer to the various GBCAs. Although chemical names would ordinarily be used in a review article such as this, it was thought that because the actual practitioners of MR imaging are typically more familiar with brand names than with chemical names, the use of brand names would help avoid the possibility of obfuscation and thereby enhance clarity in this field. Moreover, because generic formulations of these agents are not available in the United States, these brand names are clinically relevant designations. We have therefore elected to specifically use the same brand names for the various agents with which the reader will be most familiar. GBCAS: WHAT THEY ARE AND WHAT THEY DOAs a heavy metal in the lanthanide series, elemental free gadolinium (Gd) is toxic to humans. GBCAs are formed by chelation of gadolin...

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