Actual clinical use of gadolinium-chelates for non-MRI applications

Abstract

For many years, alternatives to iodinated X-ray contrast media have been sought. Of the contrast media investigated to date, only CO(2) and the gadolinium-chelates have been shown to be viable alternatives for selected X-ray examinations. Therefore, we have reviewed the general literature and that specific for gadopentetate (Magnevist) in particular, since this agent has been studied the most. This review indicates that diagnostic CT examinations can be achieved following the intravenous administration of gadolinium-containing contrast media (CM) for evaluation of aortic abnormalities. Gadolinium-containing CM at the dose approved for MR imaging are not useful for CT evaluation of the abdominal parenchymal organs. Intravenous/intraarterial injections have also been used in a variety of angiographic and interventional procedures. Image quality, however, is generally inferior to iodinated contrast media. Gadolinium-containing CM require no special handling and can be administered by hand injection or via conventional angiographic automated injectors with the same flow rates and pressures as are used with iodinated contrast media. For CT, a peripheral bolus injection of a diluted gadolinium agent (1:1 with saline) of 60-90 ml at 3-5 ml/s is usually performed. Similar to all other gadolinium-chelates, the non-MRI use of gadopentetate (Magnevist) is not approved by regulatory agencies. However, the literature suggests that a dose of 0.3-0.4 mmol/kg b.w. has been safely administered for CT as well as for angiography and interventional procedures intravenously and intraarterially. Even at this dose, though, this results in a relatively small overall volume to be injected, which limits utility somewhat.

Contrast Medium-Induced Nephropathy (CIN) Gram-Iodine/GFR Ratio to Predict CIN and Strategies to Reduce Contrast Medium Doses

“…Thus, a gadolinium (Gd) CM may be used as an x-ray CM. Before the advent of nephrogenic systemic fibrosis (NSF) (Thomsen, 2009), some investigators reported on the use of Gd-CM in a variety of diagnostic angiographic and interventional procedures (Spinosa et al, 2002;Strunk & Schild, 2004) including PCA (Barcin et al, 2006;Briguori et al, 2006;Gupta & Uretsky, 2005;Sarkis et al, 2003;Voss et al, 2004) in patients at risk of CIN due to its perceived non-nephrotoxicity (Prince et al, 1996). However, the non-nephrotoxicity of Gd-CM has been proved wrong (Buhaescu & Izzedine, 2008;Ergun et al, 2006;Sam et al, 2003).…”

In Vivo mouse imaging and spectroscopy in drug discovery

“…For the tissue targets, liver, spleen, lymph nodes and the blood pool, efficient contrast-enhancing compounds have been described that utilize different active transport systems or passive diffusion-limiting molecular sizes. The agents include water-soluble metal chelates (122)(123)(124), iodinated polymeric compounds, and contrast-agent-carrying liposomes (125)(126)(127).…”

“…In the clinics, correlative studies using combinations of imaging methods, most notably MR and CT imaging, are often performed on the same patient to improve the accuracy of diagnosis or assess the efficacy of treatment routines. For instance, commercially available gadolinium-containing MR agents have been used for CT imaging, but limitations associated with the dosage and costs have prevented their widespread use (123,124). Liposomebased multimodal contrast agents for CT and MRI with prolonged contrast enhancement in vivo have been proposed for cardiovascular imaging as well as image registration and guidance applications in radiation therapy (146).…”

Gadolinium contrast media are more nephrotoxic than iodine media. The importance of osmolality in direct renal artery injections

“…Gadolinium contrast media (Gd-CM), primarily intended for magnetic resonance imaging (MRI), are regarded by many as a less or even non-nephrotoxic alternative to iodine CM (I-CM) in patients with renal impairment undergoing x-ray angiography (XRA), and computed tomography (CT) [1][2][3][4][5][6][7][8], though this view has no scientific support. There are no human studies comparing their nephrotoxic effects at volumes and concentrations resulting in the same x-ray attenuation [9,10].…”