Preliminary experience with intravenous gadoxetate disodium as a craniospinal MR contrast agent

Alexander M. McKinney, Rakhee Gawande, Parham Pezeshk, Charles L. Truwit, Jeffrey B. Rykken

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction Gadoxetate disodium is a gadolinium-based contrast agent (GBCA) typically used for body imaging, as about 50% of its excretion is via the liver. Its use for craniospinal MRI has not been reported. Materials and methods Over a 3 years period, 31 adults underwent postcontrast MRI using gadoxetate disodium, each of whom had a relative contraindication to a GBCA, but a GBCA was deemed necessary by the clinical service to direct therapy. Postcontrast T1WI included either gradient-echo (GET1WI, n = 12) or spin-echo (SET1WI, n = 13) imaging. The contraindication in 29 patients was stage 3-5 chronic kidney disease (CKD) or acute kidney injury (AKI); the other two had normal kidney function, but a history of a reaction to another GBCA (vomiting in one and hypersensitivity in the other). Over a 3 years period, in those patients in whom a GBCA was both deemed necessary and had an estimated GFR (eGFR) of <40 ml/min/1.73 m2 (i.e., stage 3-5 CKD), both informed consent and nephrology consultation was obtained. A 10 ml dose was given for cranial (n = 23), spinal (n = 9), and neck/face MRI (n = 3), as well as craniocervical MRA (n = 6). Three neuroradiologists separately evaluated for normal enhancement in 11 structures. The contrast enhancing percentage (CE%) was measured in 3 structures, and in enhancing lesions, if present. Results The pre-MRI eGFR was not significantly different from that at 30-90 days (p = 0.522) in the 23 patients with an available eGFR at >90 days post-MRI; no patients developed acute kidney injury post-MRI, nor nephrogenic systemic fibrosis. Of the 11 intracranial structures scored, the superior sagittal sinus, pituitary stalk, and atrial choroid plexus enhanced in all 23 patients who underwent brain MRI, with CE%'s of 171.0%, 73.0%, and 69.8%, respectively. The number of patients with enhancing lesions were 3/23 brain MRI's, 8/9 spinal MRI's, 3/3 neck MRI's, and 2/6 craniocervical MRA/MRV's. In 9 spinal MRI's, the basivertebral plexus CE% was 213.7%; in the 7 with spondylodiscitis, the CE% measured 125.8% in enhancing epidural tissue, with a contrast-to-noise ratio (CNR) of 98.0%. Conclusion This preliminary report describes the use of gadoxetate disodium as an alternative GBCA for craniospinal MRI and MRA in the renally impaired, but its efficacy in this regard must be further evaluated prospectively.

Original languageEnglish (US)
Pages (from-to)2539-2547
Number of pages9
JournalEuropean Journal of Radiology
Volume84
Issue number12
DOIs
StatePublished - Jan 1 2015

Fingerprint

Gadolinium
Contrast Media
Acute Kidney Injury
Nephrogenic Fibrosing Dermopathy
Superior Sagittal Sinus
Discitis
Choroid Plexus
Brain
Pituitary Gland
Chronic Renal Insufficiency
Vomiting
Noise
gadolinium ethoxybenzyl DTPA
Hypersensitivity
Neck
Kidney
Liver

Keywords

  • Gadolinium contrast
  • Gadoxetate disodium
  • MRI

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Medicine(all)

Cite this

Preliminary experience with intravenous gadoxetate disodium as a craniospinal MR contrast agent. / McKinney, Alexander M.; Gawande, Rakhee; Pezeshk, Parham; Truwit, Charles L.; Rykken, Jeffrey B.

In: European Journal of Radiology, Vol. 84, No. 12, 01.01.2015, p. 2539-2547.

Research output: Contribution to journalArticle

McKinney, Alexander M. ; Gawande, Rakhee ; Pezeshk, Parham ; Truwit, Charles L. ; Rykken, Jeffrey B. / Preliminary experience with intravenous gadoxetate disodium as a craniospinal MR contrast agent. In: European Journal of Radiology. 2015 ; Vol. 84, No. 12. pp. 2539-2547.
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AU - Rykken, Jeffrey B.

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N2 - Introduction Gadoxetate disodium is a gadolinium-based contrast agent (GBCA) typically used for body imaging, as about 50% of its excretion is via the liver. Its use for craniospinal MRI has not been reported. Materials and methods Over a 3 years period, 31 adults underwent postcontrast MRI using gadoxetate disodium, each of whom had a relative contraindication to a GBCA, but a GBCA was deemed necessary by the clinical service to direct therapy. Postcontrast T1WI included either gradient-echo (GET1WI, n = 12) or spin-echo (SET1WI, n = 13) imaging. The contraindication in 29 patients was stage 3-5 chronic kidney disease (CKD) or acute kidney injury (AKI); the other two had normal kidney function, but a history of a reaction to another GBCA (vomiting in one and hypersensitivity in the other). Over a 3 years period, in those patients in whom a GBCA was both deemed necessary and had an estimated GFR (eGFR) of <40 ml/min/1.73 m2 (i.e., stage 3-5 CKD), both informed consent and nephrology consultation was obtained. A 10 ml dose was given for cranial (n = 23), spinal (n = 9), and neck/face MRI (n = 3), as well as craniocervical MRA (n = 6). Three neuroradiologists separately evaluated for normal enhancement in 11 structures. The contrast enhancing percentage (CE%) was measured in 3 structures, and in enhancing lesions, if present. Results The pre-MRI eGFR was not significantly different from that at 30-90 days (p = 0.522) in the 23 patients with an available eGFR at >90 days post-MRI; no patients developed acute kidney injury post-MRI, nor nephrogenic systemic fibrosis. Of the 11 intracranial structures scored, the superior sagittal sinus, pituitary stalk, and atrial choroid plexus enhanced in all 23 patients who underwent brain MRI, with CE%'s of 171.0%, 73.0%, and 69.8%, respectively. The number of patients with enhancing lesions were 3/23 brain MRI's, 8/9 spinal MRI's, 3/3 neck MRI's, and 2/6 craniocervical MRA/MRV's. In 9 spinal MRI's, the basivertebral plexus CE% was 213.7%; in the 7 with spondylodiscitis, the CE% measured 125.8% in enhancing epidural tissue, with a contrast-to-noise ratio (CNR) of 98.0%. Conclusion This preliminary report describes the use of gadoxetate disodium as an alternative GBCA for craniospinal MRI and MRA in the renally impaired, but its efficacy in this regard must be further evaluated prospectively.

AB - Introduction Gadoxetate disodium is a gadolinium-based contrast agent (GBCA) typically used for body imaging, as about 50% of its excretion is via the liver. Its use for craniospinal MRI has not been reported. Materials and methods Over a 3 years period, 31 adults underwent postcontrast MRI using gadoxetate disodium, each of whom had a relative contraindication to a GBCA, but a GBCA was deemed necessary by the clinical service to direct therapy. Postcontrast T1WI included either gradient-echo (GET1WI, n = 12) or spin-echo (SET1WI, n = 13) imaging. The contraindication in 29 patients was stage 3-5 chronic kidney disease (CKD) or acute kidney injury (AKI); the other two had normal kidney function, but a history of a reaction to another GBCA (vomiting in one and hypersensitivity in the other). Over a 3 years period, in those patients in whom a GBCA was both deemed necessary and had an estimated GFR (eGFR) of <40 ml/min/1.73 m2 (i.e., stage 3-5 CKD), both informed consent and nephrology consultation was obtained. A 10 ml dose was given for cranial (n = 23), spinal (n = 9), and neck/face MRI (n = 3), as well as craniocervical MRA (n = 6). Three neuroradiologists separately evaluated for normal enhancement in 11 structures. The contrast enhancing percentage (CE%) was measured in 3 structures, and in enhancing lesions, if present. Results The pre-MRI eGFR was not significantly different from that at 30-90 days (p = 0.522) in the 23 patients with an available eGFR at >90 days post-MRI; no patients developed acute kidney injury post-MRI, nor nephrogenic systemic fibrosis. Of the 11 intracranial structures scored, the superior sagittal sinus, pituitary stalk, and atrial choroid plexus enhanced in all 23 patients who underwent brain MRI, with CE%'s of 171.0%, 73.0%, and 69.8%, respectively. The number of patients with enhancing lesions were 3/23 brain MRI's, 8/9 spinal MRI's, 3/3 neck MRI's, and 2/6 craniocervical MRA/MRV's. In 9 spinal MRI's, the basivertebral plexus CE% was 213.7%; in the 7 with spondylodiscitis, the CE% measured 125.8% in enhancing epidural tissue, with a contrast-to-noise ratio (CNR) of 98.0%. Conclusion This preliminary report describes the use of gadoxetate disodium as an alternative GBCA for craniospinal MRI and MRA in the renally impaired, but its efficacy in this regard must be further evaluated prospectively.

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