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Diagnostic value of alternative techniques to gadolinium-based contrast agents in MR neuroimaging: a comprehensive overview
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2019 (English)In: Insight into Imaging, ISSN 1869-4101, E-ISSN 1869-4101, Vol. 10, no 1, article id 84Article, review/survey (Refereed) Published
Abstract [en]

Gadolinium-based contrast agents (GBCAs) increase lesion detection and improve disease characterization for many cerebral pathologies investigated with MRI. These agents, introduced in the late 1980s, are in wide use today. However, some non-ionic linear GBCAs have been associated with the development of nephrogenic systemic fibrosis in patients with kidney failure. Gadolinium deposition has also been found in deep brain structures, although it is of unclear clinical relevance. Hence, new guidelines from the International Society for Magnetic Resonance in Medicine advocate cautious use of GBCA in clinical and research practice. Some linear GBCAs were restricted from use by the European Medicines Agency (EMA) in 2017.

This review focuses on non-contrast-enhanced MRI techniques that can serve as alternatives for the use of GBCAs. Clinical studies on the diagnostic performance of non-contrast-enhanced as well as contrast-enhanced MRI methods, both well established and newly proposed, were included. Advantages and disadvantages together with the diagnostic performance of each method are detailed. Non-contrast-enhanced MRIs discussed in this review are arterial spin labeling (ASL), time of flight (TOF), phase contrast (PC), diffusion-weighted imaging (DWI), magnetic resonance spectroscopy (MRS), susceptibility weighted imaging (SWI), and amide proton transfer (APT) imaging.

Ten common diseases were identified for which studies reported comparisons of non-contrast-enhanced and contrast-enhanced MRI. These specific diseases include primary brain tumors, metastases, abscess, multiple sclerosis, and vascular conditions such as aneurysm, arteriovenous malformation, arteriovenous fistula, intracranial carotid artery occlusive disease, hemorrhagic, and ischemic stroke.

In general, non-contrast-enhanced techniques showed comparable diagnostic performance to contrast-enhanced MRI for specific diagnostic questions. However, some diagnoses still require contrast-enhanced imaging for a complete examination.

Place, publisher, year, edition, pages
2019. Vol. 10, no 1, article id 84
Keywords [en]
Area under curve, Brain, Diagnostic performance, Gadolinium, Non-contrast-enhanced
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:uu:diva-392824DOI: 10.1186/s13244-019-0771-1ISI: 000482778900001PubMedID: 31444580OAI: oai:DiVA.org:uu-392824DiVA, id: diva2:1349952
Available from: 2019-09-10 Created: 2019-09-10 Last updated: 2019-10-16Bibliographically approved

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