Gadolinium Deposition in Human Brain Tissues after Contrast-enhanced MR Imaging in Adult Patients without Intracranial Abnormalities
Gadolinium Deposition in Human Brain Tissues after Contrast-enhanced MR Imaging in Adult Patients without Intracranial Abnormalities
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DOI：
10.1148/radiol.2017161595
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发表时间：
2017-11-01
期刊：
影响因子：
19.7
通讯作者：
Eckel, Laurence J.
中科院分区：
文献类型：
--
作者：
McDonald, Robert J.;McDonald, Jennifer S.;Eckel, Laurence J.
目的：通过研究具有正常脑病理特征的成年患者，确定静脉注射钆对比剂（GBCA）暴露后颅内异常患者神经组织中的钆沉积是否可能与血脑屏障完整性相关。材料和方法：在获得生前同意和机构审查委员会批准后，作者比较了死后神经元组织样本 样本取自 2005 年至 2014 年间接受过 4 至 18 次钆增强磁共振 (MR) 检查的 5 名患者（对照组）和 10 名从未接受过钆增强磁共振 (MR) 检查的患者（对照组），这些患者一生中至少接受过一次 MR 检查。对照组的所有患者均接受钆双胺治疗。采集齿状核、脑桥、苍白球和丘脑的神经元组织，并使用电感耦合等离子体质谱 (ICP-MS)、具有能量色散 X 射线光谱的透射电子显微镜和光学显微镜进行分析，以量化、定位和评估钆沉积的影响。 结果：来自四个区域的组织 暴露于 gadodi-awmide 的患者的神经解剖区域每克组织含有 0.1-19.4 μg 钆，存在统计学上显着的剂量依赖性关系（苍白球：rho = 0.90，P = .04）。相比之下，对照组患者的钆水平用 ICP-MS 检测不到。尸检时所有患者的脑部病理特征均正常。对照组3例患者MR检查显示肾功能处于临界状态（估计肾小球滤过率45 mL/min/1.73 m(2)）和肝胆功能障碍。对照组中的钆沉积局限于毛细血管内皮和神经元间质，在两种情况下，位于细胞核内。结论：GBCA给药后，在不存在可能影响血脑屏障通透性的颅内异常的情况下，发生在神经组织中的钆沉积。这些发现挑战了目前对这些造影剂的生物分布及其安全性的理解。 (C) 北美放射学会，2017
Purpose: To determine whether gadolinium deposits in neural tissues of patients with intracranial abnormalities following intravenous gadolinium-based contrast agent (GBCA) exposure might be related to blood-brain barrier integrity by studying adult patients with normal brain pathologic characteristics.Materials and Methods: After obtaining antemortem consent and institutional review board approval, the authors compared postmortem neuronal tissue samples from five patients who had undergone four to 18 gadolinium-enhanced magnetic resonance (MR) examinations between 2005 and 2014 (contrast group) with samples from 10 gadolinium-naive patients who had undergone at least one MR examination during their lifetime (control group). All patients in the contrast group had received gadodiamide. Neuronal tissues from the dentate nuclei, pons, globus pallidus, and thalamus were harvested and analyzed with inductively coupled plasma mass spectrometry (ICP-MS), transmission electron microscopy with energy-dispersive x-ray spectroscopy, and light microscopy to quantify, localize, and assess the effects of gadolinium deposition.Results: Tissues from the four neuroanatomic regions of gadodi-awmide-exposed patients contained 0.1-19.4 mu g of gadolinium per gram of tissue in a statistically significant dose-dependent relationship (globus pallidus: rho = 0.90, P = .04). In contradistinction, patients in the control group had un-detectable levels of gadolinium with ICP-MS. All patients had normal brain pathologic characteristics at autopsy. Three patients in the contrast group had borderline renal function (estimated glomerular filtration rate,45 mL/min/1.73 m(2)) and hepatobiliary dysfunction at MR examination. Gadolinium deposition in the contrast group was localized to the capillary endothelium and neuronal interstitium and, in two cases, within the nucleus of the cell.Conclusion: Gadolinium deposition in neural tissues after GBCA administration occurs in the absence of intracranial abnormalities that might affect the permeability of the blood-brain barrier. These findings challenge current understanding of the biodistribution of these contrast agents and their safety. (C) RSNA, 2017