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To Be Alarmed Or Not Be Alarmed Over Gadolinium Contrast Agent Revelations? That Is the Question

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To Be Alarmed Or Not Be Alarmed Over Gadolinium Contrast Agent Revelations? That Is the Question ECR TODAY 2017 EUROPEAN CONGRESS OF RADIOLOGY DAILY NEWS FROM EUROPE’S LEADING IMAGING MEETING | FRIDAY, MARCH 3, 2017 7 9 17 25 HIGHLIGHTS CLINICAL CORNER TECHNOLOGY & RESEARCH COMMUNITY NEWS Facial genetics and forensics Radiation dose concerns in Manufacturers provide glimpse European Radiology: take centre stage paediatric cases propel PET/ into CT’s bright and 25 years of excellence at ECR MRI into more widespread dynamic future clinical use BY KATRINA MEGGET To be alarmed or not be alarmed over gadolinium contrast agent revelations? That is the question. The medical imaging community should not develop a gadolinium phobia while waiting for guidance from regulators over controversial gadolinium contrast agents. This is the opinion of Dr. Howard Rowley, Joseph Sackett Professor of Radiology at the University of Wisconsin, U.S., who will speak at today’s key session on MRI contrast agents. “There is understandable concern community was drawing parallels around the recent discovery that but gadolinium is, and should be, between gadolinium deposition gadolinium deposits in the body – a expected to deposit in various tissues and nephrogenic systemic fibrosis finding that has rattled radiologists. in the body and, based on what we (NSF), which is unrelated. Such par- Gadolinium is a toxic heavy metal know about other metals, it’s not a allels are unfounded, he continued. not normally found in the body, but case for alarm. It doesn’t necessarily “The important point is this is diffe- when chelated to reduce toxicity, it imply a toxic effect,” he told ECR Today rent to NSF, which can cause tissue becomes a powerful contrast agent in advance of the congress. injury and harm. But we shouldn’t for MRI scans and has vastly impro- Other metals critical for normal infer similar mechanisms in the ved the imaging of body organs and physiology have also been found body between the two.” tissues. It has been used success- to deposit in the body, and this can The debate has become heated fully for years, with eight agents provide insight into the ‘imaging as unanswered questions abound approved for use. However, the ele- A B curiosity’ seen with gadolinium, and confusion reigns, with pressure ment has found itself in the middle he explained. Animal and human on regulators to decide a position of a scientific controversy after it Two images of a patient prior to (A) and after (B) nine injections autopsies have shown, to date, no on contrast agents. Overall, the was discovered that patients with of the linear gadolinium-based contrast agent Magnevist. The tissue injury at the sites where risk/benefit ratio was still largely renal failure who had been admi- image prior to injection shows no hyperintensities displayed in gadolinium deposits, he added. “At in favour of using gadolinium, but nistered gadolinium for scans were the dentate nucleus, while a clear signal intensity increase in the the levels of tissue deposition we’re Rowley acknowledged more rese- at increased risk of developing the dentate nucleus becomes visible after nine injections of Magnevist. seeing, it’s not toxic and there are no arch and observation were requi- condition NSF, which involves the (Provided by Dr. Alexander Radbruch, head of neuro-oncologic symptoms associated with them.” red, adding there is cause for cau- thickening and scarring of the skin imaging, University Hospital Heidelberg, Germany) Rowley, who is president of the tion but not alarm. and internal organs. American Society or Neuroradio- At today’s session, he intends to logy, is concerned the radiology speak about the preclinical data continued on page 3 myESR.org #ECR2017 Hitachi Medical Systems Europe Holding AG, Switzerland ECR TODAY | FRIDAY, MARCH 3, 2017 HIGHLIGHTS 3 continued from page 1 definitive, proven associated sym- tain agents. Or they could remove groups based on the strength of Regulators are faced with a tough ptoms”, despite several papers sug- some agents from the market. In chelation. Instead, he suggested that decision. In the meantime, radiolo- Further research has since revea- gesting symptoms associated with Europe, the EMA is likely to pursue radiologists view all agents as sour- gists will be waiting. Today’s session led that some of the agents can gadolinium deposition. Secondly, one of the two latter courses.” ces of deposition and consider all should provide clarity on the current undergo dechelation in patients with the radiology community is arguing The problem is there is no easy variables and specific applications landscape and thinking on gadolini- normal renal function, resulting in over which of the approved agents answer, he said. For example, where when choosing which agent to use. um-based contrast agents with an gadolinium deposits in the brain are implicated in gadolinium depo- do the regulators draw the line bet- “It would be premature to con- overview of the research to date, as and other body tissue. The findings sition and how they should be trea- ween agents if they were to place clude one agent is better or safer well as a discussion on dealing with have shocked the imaging commu- ted by the regulators. restrictions, and were they to go for over another. I don’t think the data the challenges facing radiologists nity – what had been go-to contrast The agents can be classified into the third option, how would they are there yet,” he said. using these contrast agents. agents are now being viewed with three general groups, Runge explained: decide which agents to remove and some caution. With studies thin on the non-ionic linear agents (Omniscan in what time frame? Furthermore, the ground and numerous unanswe- and OptiMARK), which are more likely could the manufacturers of the Special Focus Session red questions, radiologists have been to undergo dechelation and have been remaining agents increase supply left confused over how to approach implicated in gadolinium deposition; to meet the shortfall in the market? Friday, March 3, 16:00–17:30, Room M 4 the eight approved agents. Both the the ionic linear agents with medium “These are not insignificant pro- SF 12c Gadolinium contrast agents: a Yin and Yang story European Medicines Agency (EMA) stability (Magnevist, MultiHance, Pri- blems,” said Runge, who will review and the U.S. Food and Drug Adminis- movist); and the macrocyclic agents the published clinical papers in » Chairman’s introduction tration (FDA) are expected to clarify (Dotarem, Gadavist, ProHance), which today’s session. “The question most B. Hamm; Berlin/DE the situation and provide guidelines are the most stable and least likely to likely comes back to the agents » Latest preclinical data on gadolinium deposition for use in 2017. dechelate. in the middle – should they be H.A. Rowley; Madison, WI/US The issue has become contro- “The regulators could do one of withdrawn or be limited? This is » Current clinical situation based on published data versial for two main reasons, said three things,” he explained. “They an ongoing discussion by medical V. Runge; Berne/CH Prof. Val Runge, professor of radio- could do nothing – say it’s too early authorities across the world.” » What is the position of the regulatory authorities? logy and physician at Bern Univer- and recommend more studies. They Rowley, however, is of a different O. Clément; Paris/FR sity Hospital, Switzerland. Firstly, could take an intermediate position mindset, believing it is unhelpful to he said, “at this time, there are no where they put restrictions on cer- segregate the different agents into » Panel discussion: After all that, what are you doing? BY MÉLISANDE ROUGER Specialist in new imaging technologies to deliver honorary lecture today In recognition of his achie- of radiology at UMC Utrecht, the Prof. Prokop has authored more multislice CT of the body. He has vements in new imaging Netherlands. than 250 articles in peer-reviewed served on several industry advisory technologies, particularly in He received his bachelor of scientific journals, 50 book chap- boards and scientific committees, cardiovascular and thoracic science in physics from Phil- ters, 300 scientific abstracts, and and has served as vice chairman of applications, Professor Math- ipps-Universität Marburg and 300 invited lectures. He has also the Dutch Radiological Society. ias Prokop from Nijmegen, the trained as a radiologist at Hanover published a textbook on spiral and Netherlands, has been invi- Medical School in Germany. In 1998 ted to deliver the Josef Lissner he was appointed associate profes- Honorary Lecture ‘The future sor of radiology at the University Honoraray Lecture of CT: from hardware to software’ of Vienna Medical School, Austria. Professor Mathias Prokop from today at the ECR. His main research interests are Friday, March 3, 13:00–13:30, Room A Nijmegen, the Netherlands, Mathias Prokop is head of the body imaging with a special focus Josef Lissner Honorary Lecture will deliver the Josef Lissner department of radiology and nuc- on multislice CT and new imaging Honorary Lecture today at lear medicine at Radboud Uni- technologies in cardiovascular and » The future of CT: from hardware to software 13:00 in Room A. versity Nijmegen and professor thoracic applications. Mathias Prokop; Nijmegen/NL DON’T MISS TOMORROW’S JOINT ESR AND CIRSE SESSION ON INTERVENTIONAL PROCEDURES! Saturday, March 4, 08:30–10:00, Room Z Joint Session of the ESR and the CIRSE (Cardiovascular and Interventional Radiological Society of Europe) Interventional procedures: clinical patient management Moderators: E. Brountzos; Athens/GR L. Donoso; Barcelona/ES » Chairmen’s introduction E. Brountzos; Athens/GR L. Donoso; Barcelona/ES » BEFORE: pre-intervention procedures and protocols C. Binkert; Winterthur/CH » DURING: patient management, communication, time out procedure ... J.I. Bilbao; Pamplona/ES » AFTER: patient follow up and discharge procedures O.M. van Delden; Amsterdam/NL » The role of radiographers and nurses in the interventional radiology suite: tasks and duties C.
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