Unique Protocol Identification Number: Gadolinium 1.0 Safety Evaluation of Linear and Macrocyclic Gadolinium-Based Contrast Agents for Patients with Mild to Moderate Renal Insufficiency Undergoing Enhanced Magnetic Resonance Imaging (Interventional Prospective Study) Clinical Trial Protocol Version number: V1.0 Version date: 2020-11 Catology Protocol Summary ............................................................................................................................ 2 Ⅰ. Sponsor Information ...................................................................................................................... 4 (Ⅰ) Name of sponsor .................................................................................................................. 4 (Ⅱ) Address of sponsor .............................................................................................................. 4 (Ⅲ) Contact information of sponsor ......................................................................................... 4 (Ⅳ) Relevant qualification documents of sponsor.................................................................... 4 Ⅱ. Purpose and contents of clinical trial ............................................................................................ 5 (Ⅰ) Purpose ................................................................................................................................. 5 (Ⅱ) Contents .............................................................................................................................. 5 Ⅲ. Background information of clinical trials ................................................................................... 5 Ⅳ. The characteristics and safety of the drug ................................................................................... 7 (Ⅰ) Characteristics of the drug ................................................................................................... 7 (Ⅱ) Safety data of clinical application so far ............................................................................. 8 Ⅴ. Indications, contraindications and precautions of drugs .............................................................. 9 Ⅵ. Overall design ............................................................................................................................. 9 (Ⅰ) Design of the trial ................................................................................................................. 9 (Ⅱ) Patient selection and withdrawal ...................................................................................... 10 (Ⅲ) Visit description ............................................................................................................... 11 (Ⅳ) Evaluation Standard ........................................................................................................ 13 Ⅶ. Trial quality control ................................................................................................................. 15 (Ⅰ) Quality Control .................................................................................................................. 15 (Ⅱ)Monitor .............................................................................................................................. 17 Ⅷ. Patient protection .................................................................................................................... 17 Ⅸ. Data management and statistical analysis ................................................................................. 17 (Ⅰ) Data management ............................................................................................................... 18 (Ⅱ)Statistical Analysis ............................................................................................................. 18 Ⅹ. Trial summary and results publication ....................................................................................... 19 1 Protocol Summary Safety Evaluation of Linear and Macrocyclic Gadolinium-Based Contrast Study Title Agents for Patients with Mild to Moderate Renal Insufficiency Undergoing Enhanced Magnetic Resonance Imaging Study Unit Lishui Central Hospital Study Type Interventional Time Perspective Prospective Gadodiamide Injection (OMNISCAN™), Study Drug Gadoteric Acid Meglumine Salt Injection (Jia Di Xian™) Brief Summary: The purpose of this study is to evaluate the safety of linear and macrocyclic gadolinium-based contrast agents for patients with mild to Study moderate renal insufficiency. The study will compare the incidence of Description adverse events of gadodiamide and gadoteric Acid Meglumine Salt for patients with mild to moderate renal insufficiency undergoing enhanced magnetic resonance imaging. Gadodiamide： Drug: Patients who have undergone Gadodiamide Injection contrast-enhanced MRI using (OMNISCAN™) Gadodiamide contrast agent for clinical purposes. Group/Cohort Gadoteric Acid Meglumine Salt： Drug: Patients who have undergone Gadoteric Acid Meglumine Salt contrast-enhanced MRI using Injection (Jia Di Xian™) Gadoteric Acid Meglumine Salt contrast agent for clinical purposes. Inclusion Criteria: 1. Patients aged 18 to 80 years old who require gadolinium-based CE-MRI; 2. Patients with renal function 30ml/min/1.73m2 ≤ eGFR ＜ Eligibility 90/min/1.73m2; Criteria 3. Patients who are able and willing to comply with the required inspection requirements. Exclusion Criteria: 1. Patient who experienced allergic reactions to previous gadolinium based contrast agents; 2 2. Patient who had used gadolinium based contrast agents within 3 months; 3. Patient with acute renal failure; 4. Patient who cannot comply with or cannot tolerate the necessary fluid replenishment procedures; 5. Patient with major mental illness, impaired consciousness or other diseases considered by researchers to affect observation. Primary Outcome indicators: Record the incidence of various adverse events; Secondary outcome indicators: Outcome 1. Changes of serum creatinine and inflammatory factors (TNF-α, hs-CRP, Measure IL-6) before and after CE-MRI 2. Patient skin examination and evaluation: evaluation of relevant indicators of skin biopsy (proliferation of fibroblasts in subcutaneous tissue, thickening of collagen fiber bundles) Enrollment 600 participants 3 Ⅰ. Sponsor Information (Ⅰ) Name of sponsor Jiansong, Ji (Ⅱ) Address of sponsor Lishui Central Hospital, No.289 Kuocang Road, Lishui City, Zhejiang Province (Ⅲ) Contact information of sponsor 0578-2285018 (Ⅳ) Relevant qualification documents of sponsor The relevant qualification documents of the sponsor will be provided in a separate letter. 4 Ⅱ. Purpose and contents of clinical trial (Ⅰ) Purpose To compare the incidence of adverse events of linear and macrocyclic gadolinium-based contrast agents for patients with mild to moderate renal insufficiency undergoing enhanced magnetic resonance imaging. (Ⅱ) Contents This trial is a prospective, interventional study. According to the requirements of the study, 600 cases of patients with mild to moderate renal insufficiency were enrolled. Gadodiamide and gadoteric acid meglumine salt were used for enhanced MRI. Observe the adverse reactions within 60 minutes of using the gadolinium contrast agents; follow up by telephone at 3, 6, 12, and 24 months after the inspection. Ⅲ. Background information of clinical trials The principle of Magnetic Resonance Imaging (MRI) relies on the magnetic field generated by water molecules in the human body. It has high resolution in soft tissues (such as the nervous system, parenchymal organs, and muscle tissue), and uses non-ionizing electromagnetic radiation. Known exposure risk, many imaging parameters (sequence, proton density, T1 and T2 relaxation time) and many other advantages, since it entered the clinic in the 1980s, it has been clinically proven to be a valuable imaging diagnostic method. In the early clinical practice, MRI was mainly used for unenhanced magnetic resonance imaging, and the value of Contrast Enhanced-Magnetic Resonance Imaging (CE-MRI) in the diagnosis of diseases was not recognized. In the later stage, due to CE-MRI in small lesions, inflammation, edema and tumor Such diagnostic advantages have become an important supplement to MRI. At least about 30% of disease MRI diagnosis requires injection of magnetic resonance contrast agents. In 2000, Cowper described the mucoedema-like sclerosis skin disease of renal dialysis patients in the Lancet magazine, that is, Nephrogenic Systemic Fibrosis (NSF). In 2006, Grobner 5 reported nephrogenic skin. The predisposing factor of disease or NSF may be gadolinium ion. In the same year, Marckmann discovered that NSF may be caused by the use of gadolinium diamine during MR examination. Due to the serious harm of NSF, foreign scholars began to pay explosive attention to the relationship between gadolinium contrast agent and NSF, and aroused clinical concern about the safety of gadolinium contrast agent. Subsequently, the European Society of Urology and Radiology (ESUR) classified gadolinium contrast agent as high-risk, medium-risk and low-risk , And use gadolinium contrast agent according to the classification of renal function. Since then, new reports of NSF have gradually decreased. Due to the long-term concern about the safety of gadolinium contrast agent, Dr. Tomonori Kanda published an article in the Journal of Radiology in Hyogo Cancer in 2014 and explained for the first time the relationship between T1 hyperintensity and gadolinium deposition