Sherry AD, Caravan P, Lenkinski RE. Primer on gadolinium chemistry. J Magn Reson Imaging. 2009;30:1240-1248.
Brasch RC. Introduction to the gadolinium class. J Comp Assist Tomogr. 1993;17(suppl 1):S14-S18.
Hao D, Ai T, Goerner F, Hu X, Runge VM, Tweedle M. MRI contrast agents: basic chemistry and safety. J Magn Reson Imaging. 2012;36:1060-1071.
Brasch RC. New directions in the development of MR imaging contrast media. Radiology. 1992;183:1-11.
Chanyaputhipong J, Low SC, Chow PK. Gadoxetate acid-enhanced MR imaging for HCC: a review for clinicians. Int J Hepatol. 2011;2011:489342.
de Haën C, Gozzini L. Soluble-type hepatobiliary contrast agents for MR imaging. J Magn Reson Imaging. 1993;3:179-186.
Lewis M, Yanny S, Malcolm PN. Advantages of blood pool contrast agents in MR angiography: a pictorial review. J Med Imaging Radiat Oncol. 2012;56:187-191.
Pascolo L, Cupelli F, Anelli PL, et al. Molecular mechanisms for the hepatic uptake of magnetic resonance imaging contrast agents. Biochem Biophys Res Commun. 1999;257:746-752.
Reimer P, Schneider G, Schima W. Hepatobiliary contrast agents for contrast-enhanced MRI of the liver: properties, clinical development and applications. Eur Radiol. 2004;14:559-578.
Caravan P, Ellison JJ, McMurry TJ, Lauffer RB. Gadolinium(III) chelates as MRI contrast agents: structure, dynamics, and applications. Chem Rev. 1999;99:2293-2352.
Frenzel T, Lengsfeld P, Schirmer H, Hütter J, Weinmann HJ. Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C. Invest Radiol. 2008;43:817-828.
White GW, Gibby WA, Tweedle MF. Comparison of Gd(DTPA-BMA) (Omniscan) versus Gd(HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol. 2006;41:272-278.
Prince MR, Arnoldus C, Frisoli JK. Nephrotoxicity of high-dose gadolinium compared with iodinated contrast. J Magn Reson Imaging. 1996;6:162-166.
Cowper SE, Robin HS, Steinberg SM, Su LD, Gupta S, LeBoit PE. Scleromyxoedema-like cutaneous diseases in renal-dialysis patients. Lancet. 2000;356:1000-1001.
Grobner T. Gadolinium -- a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant. 2006;21:1104-1108.
Wahba IM, Simpson EL, White K. Gadolinium is not the only trigger for nephrogenic systemic fibrosis: insights from two cases and review of the recent literature. Am J Transplant. 2007;7:2425-2432.
Marckmann P, Skov L, Rossen K, et al. Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol. 2006;17:2359-2362.
Joffe P, Thomsen HS, Meusel M. Pharmacokinetics of gadodiamide injection in patients with severe renal insufficiency and patients undergoing hemodialysis or continuous ambulatory peritoneal dialysis. Acad Radiol. 1998;5:491-502.
Boyd AS, Zic JA, Abraham JL. Gadolinium deposition in nephrogenic fibrosing dermopathy. J Am Acad Dermatol. 2007;56:27-30.
High WA, Ayers RA, Chandler J, Zito G, Cowper SE. Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol. 2007;56:21-26.
Centers for Disease Control and Prevention (CDC). Nephrogenic fibrosing dermopathy associated with exposure to gadolinium-containing contrast agents -- St. Louis, Missouri, 2002-2006. MMWR Morb Mortal Wkly Rep. 2007;56:137-141.
Saitoh T, Hayasaka K, Tanaka Y, Kuno T, Nagura Y. Dialyzability of gadodiamide in hemodialysis patients. Radiat Med. 2006;24:445-451.
Thomsen HS. Nephrogenic systemic fibrosis: a serious late adverse reaction to gadodiamide. Eur Radiol. 2006;16:2619-2621.
American College of Radiology. Manual on Contrast Media. Version 9. 2013. http://www.acr.org/~/media/ACR/Documents/PDF/QualitySafety/Resources/Contrast%20Manual/2013_Contrast_Media.pdf. Accessed May 1, 2015.
Wang Y, Alkasab TK, Narin O, et al. Incidence of nephrogenic systemic fibrosis after adoption of restrictive gadolinium-based contrast agent guidelines. Radiology. 2011;260:105-111.
Altun E, Martin DR, Wertman R, Lugo-Somolinos A, Fuller ER, Semelka RC. Nephrogenic systemic fibrosis: change in incidence following a switch in gadolinium agents and adoption of a gadolinium policy -- report from two U.S. universities. Radiology. 2009;253:689-696.
Martin DR, Krishnamoorthy SK, Kalb B, et al. Decreased incidence of NSF in patients on dialysis after changing gadolinium contrast-enhanced MRI protocols. J Magn Reson Imaging. 2010;31:440-446.
Nelson KL, Gifford LM, Lauber-Huber C, Gross CA, Lasser TA. Clinical safety of gadopentetate dimeglumine. Radiology. 1995;196:439-443.
Jung JW, Kang HR, Kim MH, et al. Immediate hypersensitivity reaction to gadolinium-based MR contrast media. Radiology. 2012;264:414-422.
Prince MR, Zhang H, Zou Z, Staron RB, Brill PW. Incidence of immediate gadolinium contrast media reactions. AJR Am J Roentgenol. 2011;196:W138-W143.
Dillman JR, Ellis JH, Cohan RH, Strouse PJ, Jan SC. Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults. AJR Am J Roentgenol. 2007;189:1533-1538.
Hunt CH, Hartman RP, Hesley GK. Frequency and severity of adverse effects of iodinated and gadolinium contrast materials: retrospective review of 456,930 doses. AJR Am J Roentgenol. 2009;193:1124-1127.
Shellock FG, Parker JR, Pirovano G, et al. Safety characteristics of gadobenate dimeglumine: clinical experience from intra- and interindividual comparison studies with gadopentetate dimeglumine. J Magn Reson Imaging. 2006;24:1378-1385.
Rofsky NM, Pizzarello DJ, Weinreb JC, et al. Effect on fetal mouse development of exposure to MR imaging and gadopentetate dimeglumine. J Magn Reson Imaging. 1994;4:805-807.
Soltys RA. Summary of preclinical safety evaluation of gadoteridol injection. Invest Radiol 1992;27(suppl 1):S7-S11.
Marcos HB, Semelka RC, Worawattanakul S. Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology. 1997;205:493-496.
De Santis M, Straface G, Cavaliere AF, Carducci B, Caruso A. Gadolinium periconceptional exposure: pregnancy and neonatal outcome. Acta Obstet Gynecol Scand. 2007;86:99-101.
Spencer JA, Tomlinson AJ, Weston MJ, Lloyd SN. Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy. Clin Radiol. 2000;55:446-453.
ESUR Guidelines on Contrast Media, Version 8.1. http://www.esur.org/guidelines. Accessed May 1, 2015.
Jaffe TA, Miller CM, Merkle EM. Practice patterns in imaging of the pregnant patient with abdominal pain: a survey of academic centers. AJR Am J Roentgenol. 2007;189:1128-1134.
Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, et al. Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology. 2000;216:555-558.
Ersoy H, Rybicki FJ. Biochemical safety profiles of gadolinium-based extracellular contrast agents and nephrogenic systemic fibrosis. J Magn Reson Imaging. 2007;26:1190-1197.
Seale MK, Catalano OA, Saini S, Hahn PF, Sahani DV. Hepatobiliary-specific MR contrast agents: role in imaging the liver and biliary tree. Radiographics. 2009;29:1725-1748.
Chiandussi L, Juliani G, Greco F, Cravero D, Sardi G, Toscano G. Hepatic portography by direct catheterization of the portal vein through the round ligament of the liver (ligamentum teres). Am J Roentgenol Radium Ther Nucl Med. 1967;99:625-628.
Gandhi SN, Brown MA, Wong JG, Aguirre DA, Sirlin CB. MR contrast agents for liver imaging: what, when, how. Radiographics. 2006;26:1621-1636.
Kirchin MA, Pirovano GP, Spinazzi A. Gadobenate dimeglumine (Gd-BOPTA): an overview. Invest Radiol. 1998;33:798-809.
Jeong WK, Kim YK, Song KD, Choi D, Lim HK. The MR imaging diagnosis of liver diseases using gadoxetic acid: emphasis on hepatobiliary phase. Clin Mol Hepatol. 2013;19:360-366.
Krinsky GA, Lee VS, Theise ND, et al. Hepatocellular carcinoma and dysplastic nodules in patients with cirrhosis: prospective diagnosis with MR imaging and explantation correlation. Radiology. 2001;219:445-454.
Goodwin MD, Dobson JE, Sirlin CB, Lim BG, Stella DL. Diagnostic challenges and pitfalls in MR imaging with hepatocyte-specific contrast agents. Radiographics. 2011;31:1547-1568.
Park G, Kim YK, Kim CS, Yu HC, Hwang SB. Diagnostic efficacy of gadoxetic acid-enhanced MRI in the detection of hepatocellular carcinomas: comparison with gadopentetate dimeglumine. Br J Radiol. 2010;83:1010-1016.
American College of Radiology. Liver Imaging Reporting and Data System, version 2014. http://www.acr.org/Quality-Safety/Resources/LIRADS. Accessed May 1, 2015.
Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part I. development, growth, and spread: key pathologic and imaging aspects. Radiology. 2014;272:635-654.
Choi JY, Lee JM, Sirlin CB. CT and MR imaging diagnosis and staging of hepatocellular carcinoma: part II. Extracellular agents, hepatobiliary agents, and ancillary imaging features. Radiology. 2014;273:30-50.
Kim YK, Park G, Kim CS, Yu HC, Han YM. Diagnostic efficacy of gadoxetic acid-enhanced MRI for the detection and characterisation of liver metastases: comparison with multidetector-row CT. Br J Radiol. 2012;85:539-547.
Lizardi-Cervera J, Cuéllar-Gamboa L, Motola-Kuba D. Focal nodular hyperplasia and hepatic adenoma: a review. Ann Hepatol. 2006;5:206-211.
Mohajer K, Frydrychowicz A, Robbins JB, Loeffler AG, Reed TD, Reeder SB. Characterization of hepatic adenoma and focal nodular hyperplasia with gadoxetic acid. J Magn Reson Imaging. 2012;36:686-696.

CME

Understanding GBCAs to Optimize Outcomes

Authors: Jeffrey C. Weinreb, MD; Bobby Kalb, MD; Eugene Duke, MD; Diego R. Martin, MD, PhD; Shaun R. Best, MD; Vu Luong, MD; Claude Sirlin, MD
CME Released: 5/26/2015; Reviewed and Renewed: 5/26/2017
THIS ACTIVITY HAS EXPIRED FOR CREDIT
Valid for credit through: 5/26/2018

Target Audience and Goal Statement

This activity is intended for radiologists, oncologists, pediatricians, neurologists, cardiologists, hepatologists, and gastroenterologists.

The goal of this activity is to explore the role of gadolinium-based contrast agents (GBCAs) in the body and their application in magnetic resonance imaging (MRI).

Upon completion of this activity, participants will be able to:

Identify the properties of GBCAs that make them suitable for MRI
Compare properties of MRI contrast agents that influence their behavior in clinical applications and contribute to safety
Explain the function of gadolinium in the body during MRI

Disclosures

As an organization accredited by the ACCME, Medscape, LLC, requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines "relevant financial relationships" as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

Medscape, LLC, encourages Authors to identify investigational products or off-label uses of products regulated by the US Food and Drug Administration, at first mention and where appropriate in the content.

Authors

Jeffrey C. Weinreb, MD

Professor of Diagnostic Radiology; Director, MRI Service, Yale School of Medicine, New Haven, Connecticut

Disclosures

Disclosure: Jeffrey C. Weinreb, MD, has disclosed no relevant financial relationships.

Dr Weinreb does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Weinreb does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Bobby Kalb, MD

Associate Professor of Radiology, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona

Disclosures

Disclosure: Bobby Kalb, MD, has disclosed no relevant financial relationships.

Dr Kalb does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Kalb does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Eugene Duke, MD

Clinical Assistant, Department of Radiology, University of Arizona College of Medicine, Tucson, Arizona

Disclosures

Disclosure: Eugene Duke, MD, has disclosed no relevant financial relationships.

Dr Duke does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Duke does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Diego R. Martin, MD, PhD

Professor of Medicine; Head, Department of Medical Imaging, University of Arizona College of Medicine, Tucson, Arizona

Disclosures

Disclosure: Diego R. Martin, MD, PhD, has disclosed no relevant financial relationships.

Dr Martin does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Martin does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Shaun R. Best, MD

Fellow Physician, Department of Radiology, University of California, San Diego, La Jolla, California

Disclosures

Disclosure: Shaun R. Best, MD, has disclosed no relevant financial relationships.

Dr Best does intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Best does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Vu Luong, MD

Fellow, Department of Radiology, University of California, San Diego

Disclosures

Disclosure: Vu Luong, MD, has disclosed no relevant financial relationships.

Dr Luong does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Luong does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Claude B. Sirlin, MD

Professor of Radiology; Chief, Body Imaging and Abdominal MRI; Director, Liver Imaging Group, University of California, San Diego

Disclosures

Disclosure: Claude B. Sirlin, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer HealthCare Pharmaceuticals; VirtualScopics
Served as a speaker or a member of a speakers bureau for: Bayer HealthCare Pharmaceuticals
Received grants for clinical research from: GE Healthcare; Pfizer Inc; Siemens Healthcare Diagnostics Inc.

Dr Sirlin does not intend to discuss off-label uses of drugs, mechanical devices, biologics, or diagnostics approved by the FDA for use in the United States.

Dr Sirlin does not intend to discuss investigational drugs, mechanical devices, biologics, or diagnostics not approved by the FDA for use in the United States.

Steering Committee

William G. Bradley Jr, MD, PhD

Professor and Chair, Department of Radiology, University of California, San Diego

Disclosures

Disclosure: William G. Bradley Jr, MD, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Time Medical Systems, Inc.

Gillian M. Newstead, MD

Professor of Radiology (Retired); Director, Global Breast Imaging, University of Chicago, Chicago, Illinois

Disclosures

Disclosure: Gillian M. Newstead, MD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Bayer HealthCare Pharmaceuticals; Three Palm Software LLC
Received grants for clinical research from: Bayer HealthCare Pharmaceuticals; Philips Healthcare

Shreyas Vasanawala, MD, PhD

Associate Professor of Radiology, Stanford School of Medicine, Stanford, California

Disclosures

Disclosure: Shreyas Vasanawala, MD, PhD, has disclosed the following relevant financial relationships:
Served as an advisor or consultant for: Arterys
Received grants for clinical research from: GE Healthcare

Editor

Charlotte Warren

Scientific Director, Medscape, LLC

Disclosures

Disclosure: Charlotte Warren has disclosed no relevant financial relationships.

Bulk Contributor(s)

CME Reviewer

Nafeez Zawahir, MD

CME Clinical Director, Medscape, LLC

Disclosures

Disclosure: Nafeez Zawahir, MD, has disclosed no relevant financial relationships.

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For Physicians

Medscape, LLC is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Medscape, LLC designates this enduring material for a maximum of 1.5 AMA PRA Category 1 Credit(s)™ . Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Medscape, LLC staff have disclosed that they have no relevant financial relationships.

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This activity is designed to be completed within the time designated on the title page; physicians should claim only those credits that reflect the time actually spent in the activity. To successfully earn credit, participants must complete the activity online during the valid credit period that is noted on the title page. To receive AMA PRA Category 1 Credit™, you must receive a minimum score of 75% on the post-test.

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From Medscape Education Radiology

CME

Understanding GBCAs to Optimize Outcomes

Authors: Jeffrey C. Weinreb, MD; Bobby Kalb, MD; Eugene Duke, MD; Diego R. Martin, MD, PhD; Shaun R. Best, MD; Vu Luong, MD; Claude Sirlin, MDFaculty and Disclosures

THIS ACTIVITY HAS EXPIRED FOR CREDIT

CME Released: 5/26/2015; Reviewed and Renewed: 5/26/2017

Valid for credit through: 5/26/2018

processing....

中文文字稿

Contents of This CME Activity

All sections of this activity are required for credit.

Section 1. Overview of GBCAs: From the Molecular Level Up

Dr Weinreb reviews the properties of GBCAs.
Jeffrey C. Weinreb, MD

Section 2. Safety of GBCAs

Drs Kalb, Martin, and Duke examine the risks for nephrogenic systemic fibrosis and anaphylactic shock associated with GBCAs, as well as safety when used during pregnancy.
Bobby Kalb, MD; Eugene Duke, MD; Diego R. Martin, MD, PhD

Section 3. Clinical Applications and Considerations for the Use of GBCAs in MRI of the Liver

Experts discuss the complicated processes associated with imaging the liver.
Shaun R. Best, MD; Vu Luong, MD; Claude Sirlin, MD

Educational Impact Challenge

Assess your clinical knowledge by completing this brief survey. Answering these questions again after the activity will allow you to see what you learned and to compare your answers with those of your peers.

Page 1 of 6

CME Information

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The educational activity presented above may involve simulated case-based scenarios. The patients depicted in these scenarios are fictitious and no association with any actual patient is intended or should be inferred.

The material presented here does not necessarily reflect the views of Medscape, LLC, or companies that support educational programming on medscape.org. These materials may discuss therapeutic products that have not been approved by the US Food and Drug Administration and off-label uses of approved products. A qualified healthcare professional should be consulted before using any therapeutic product discussed. Readers should verify all information and data before treating patients or employing any therapies described in this educational activity.

References

Faculty and Disclosures

Authors

Jeffrey C. Weinreb, MD

Bobby Kalb, MD

Eugene Duke, MD

Diego R. Martin, MD, PhD

Shaun R. Best, MD

Vu Luong, MD

Claude B. Sirlin, MD

Steering Committee

William G. Bradley Jr, MD, PhD

Gillian M. Newstead, MD

Shreyas Vasanawala, MD, PhD

Editor

Charlotte Warren

CME Reviewer

Nafeez Zawahir, MD

CME

Understanding GBCAs to Optimize Outcomes

Target Audience and Goal Statement

Disclosures

Authors

Jeffrey C. Weinreb, MD

Bobby Kalb, MD

Eugene Duke, MD

Diego R. Martin, MD, PhD

Shaun R. Best, MD

Vu Luong, MD

Claude B. Sirlin, MD

Steering Committee

William G. Bradley Jr, MD, PhD

Gillian M. Newstead, MD

Shreyas Vasanawala, MD, PhD

Editor

Charlotte Warren

Bulk Contributor(s)

CME Reviewer

Nafeez Zawahir, MD

Accreditation Statements

For Physicians

Instructions for Participation and Credit

Understanding GBCAs to Optimize Outcomes

Contents of This CME Activity

Educational Impact Challenge

PDF Downloads

Transcript Downloads