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Gadolinium depositions after the application of the hepatospecific gadolinium-based contrast agent gadoxetate disodium

  • Soung Y. Kim
    Affiliations
    Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
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  • Martin H. Maurer
    Affiliations
    Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
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  • Johannes K. Richter
    Affiliations
    Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland
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  • Johannes T. Heverhagen
    Affiliations
    Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland

    Radiology Laboratory, Department of BioMedical Research, University of Bern, Bern, Switzerland
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  • Ingrid B. Boehm
    Correspondence
    Corresponding author at: Department of Diagnostic, Interventional, and Pediatric Radiology, Inselspital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland.
    Affiliations
    Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, University of Bern, Bern, Switzerland

    Radiology Laboratory, Department of BioMedical Research, University of Bern, Bern, Switzerland
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Published:September 29, 2017DOI:https://doi.org/10.1016/j.ejim.2017.09.033
      Gadolinium-based contrast agents (GBCAs) are widely used in clinical magnetic resonance imaging (MRI). Since their approval for clinical use in 1988, the frequency of GBCA application has steadily expanded, and now it is estimated that more than 40 million doses of GBCAs are given worldwide each year [
      • Runge V.M.
      Critical questions regarding gadolinium deposition in the brain and body after injections of the gadolinium-based contrast agents, safety, and clinical recommendations in consideration of the Ema's pharmacovigilance and risk assessment committee recommendation for suspension of the marketing authorizations for 4 linear agents.
      ]. Overall, the tolerability of GBCAs was shown to be excellent with severe serious adverse reactions in only a small proportion of about 0.03% of all patients [
      • Kanal E.
      • Tweedle M.F.
      Residual or retained gadolinium: practical implications for radiologists and our patients.
      ]. However, over a decade ago, it became evident that patients with severe renal insufficiency (chronic kidney disease (CKD) stages 5 and 6) may acquire nephrogenic systemic fibrosis (NSF) [
      • Grobner T.
      Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis?.
      ]. NSF reactions were triggered by Gd after multiple applications of various GBCAs and involved the skin, lung, liver, bone and muscles for example [
      • Grobner T.
      Gadolinium—a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis?.
      ,
      • Gibby W.A.
      • Gibby K.A.
      • Gibby W.A.
      Comparison of Gd DTPA-BMA (Omniscan) versus Gd HP-DO3A (ProHance) retention in human bone tissue by inductively coupled plasma atomic emission spectroscopy.
      ]. Since 2009, only few new cases of NSF have been reported [
      • Elmholdt T.R.
      • Jørgensen B.
      • Ramsing M.
      • Pedersen M.
      • Olesen A.B.
      Two cases of nephrogenic systemic fibrosis after exposure to the macrocyclic compound gadobutrol.
      ], which is widely attributed to the use of the minimal necessary doses of the GBCAs and to the reduction of the use of GBCAs in patients with severe kidney disease and renal failure [
      • Heverhagen J.T.
      • Krombach G.A.
      • Gizewski E.
      Application of extracellular gadolinium-based MRI contrast agents and the risk of nephrogenic systemic fibrosis.
      ].

      Keywords

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