Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates
Gadolinium Retention: A Research Roadmap from the 2018 NIH/ACR/RSNA Workshop on Gadolinium Chelates
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DOI：
10.1148/radiol.2018181151
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发表时间：
2018-11-01
期刊：
影响因子：
19.7
通讯作者：
Kressel, Herbert Y.
中科院分区：
文献类型：
--
作者：
McDonald, Robert J.;Levine, Deborah;Kressel, Herbert Y.
基于Gd的造影剂(GBCA)使磁共振成像发生了革命性的变化，使医生能够获得关键的挽救生命的医学信息，而这些信息通常是其他成像方式无法获得的。自1988年首次批准以来，全球已有超过4.5亿剂GBCA静脉注射，具有极其良好的药理安全性；然而，最近的信息引发了人们对GBCA安全性的新担忧。越来越多的证据表明，人体组织中有Gd的长期滞留。此外，一小部分患者将一系列症状归因于GBCA暴露，尽管这些症状与GBCA给药或Gd滞留的关联尚未被科学研究证实。尽管有证据表明，大环GBCA比线性GBCA显示更少的Gd保留，但Gd保留的安全影响尚不清楚。这些保留的Gd物种的机制和化学形式，以及这些保留的Gd物种的生物活性和临床重要性仍然知之甚少，并强调了进一步研究的必要性。2018年2月，在马里兰州贝塞斯达的国立卫生研究院举行了一次国际会议，讨论目前关于Gd保留的文献和知识差距，优先考虑未来的研究举措，以更好地了解这一现象，并促进合作的标准化研究。最重要的优先事项是确定(A)是否对人体组织的功能产生不利影响，(B)是否与疾病的短期或长期临床表现有因果关系，以及(C)脆弱人群，如儿童，患临床疾病的风险是否更大。研究路线图的目的是突出不为人所知的重要信息，并确定所需研究的优先次序。(C)RSNA，2018年
Gadolinium-based contrast agents (GBCAs) have revolutionized MRI, enabling physicians to obtain crucial life-saving medical information that often cannot be obtained with other imaging modalities. Since initial approval in 1988, over 450 million intravenous GBCA doses have been administered worldwide, with an extremely favorable pharmacologic safety profile; however, recent information has raised new concerns over the safety of GBCAs. Mounting evidence has shown there is long-term retention of gadolinium in human tissues. Further, a small subset of patients have attributed a constellation of symptoms to GBCA exposure, although the association of these symptoms with GBCA administration or gadolinium retention has not been proven by scientific investigation. Despite evidence that macrocyclic GBCAs show less gadolinium retention than linear GBCAs, the safety implications of gadolinium retention are unknown. The mechanism and chemical forms of gadolinium retention, as well as the biologic activity and clinical importance of these retained gadolinium species, remain poorly understood and underscore the need for additional research. In February 2018, an international meeting was held in Bethesda, Md, at the National Institutes of Health to discuss the current literature and knowledge gaps about gadolinium retention, to prioritize future research initiatives to better understand this phenomenon, and to foster collaborative standardized studies. The greatest priorities are to determine (a) if gadolinium retention adversely affects the function of human tissues, (b) if retention is causally associated with short-or long-term clinical manifestations of disease, and (c) if vulnerable populations, such as children, are at greater risk for experiencing clinical disease. The purpose of the research roadmap is to highlight important information that is not known and to identify and prioritize needed research. (c) RSNA, 2018