Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms.
Gadolinium-based contrast agent toxicity: a review of known and proposed mechanisms.
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DOI：
10.1007/s10534-016-9931-7
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发表时间：
2016-06
期刊：
影响因子：
--
通讯作者：
Branch S
中科院分区：
文献类型：
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作者：
Rogosnitzky M;Branch S
螯合物被广泛用作磁共振成像的造影剂。历来认为，在推荐剂量水平下使用时，已获批准的格拉基造影剂(GBCA)是安全且耐受性良好的。然而，近十年来，在有严重肾损害的患者中，GBCA的应用与肾源性系统性纤维化(NSF)的发展之间的关系已经被认识到。这导致了临床实践的修改，旨在减少NSF发展的可能性和发生率。有更新的报道表明，没有肾损害的患者的各种组织，包括骨、脑和肾脏中，都有Gd的蓄积。尽管无论肾功能如何，都可以观察到Gd在组织中的蓄积，但关于毒性的可能性和机制的临床数据非常有限。这种知识上的显著差距需要回顾队列研究的努力，以及涉及暴露于GBCA的患者的Gd3+测试的前瞻性研究。本文综述了Gd毒性的潜在生化和分子基础，Gd组织滞留和蓄积的可能临床意义，以及限制Gd体内负荷的方法。
Gadolinium chelates are widely used as contrast media for magnetic resonance imaging. The approved gadolinium-based contrast agents (GBCAs) have historically been considered safe and well tolerated when used at recommended dosing levels. However, for nearly a decade, an association between GBCA administration and the development of nephrogenic systemic fibrosis (NSF) has been recognized in patients with severe renal impairment. This has led to modifications in clinical practices aimed at reducing the potential and incidence of NSF development. Newer reports have emerged regarding the accumulation of gadolinium in various tissues of patients who do not have renal impairment, including bone, brain, and kidneys. Despite the observations of gadolinium accumulation in tissues regardless of renal function, very limited clinical data regarding the potential for and mechanisms of toxicity is available. This significant gap in knowledge warrants retrospective cohort study efforts, as well as prospective studies that involve gadolinium ion (Gd3+) testing in patients exposed to GBCA. This review examines the potential biochemical and molecular basis of gadolinium toxicity, possible clinical significance of gadolinium tissue retention and accumulation, and methods that can limit gadolinium body burden.