Ranga Anju, Agarwal Yatish, Garg Kanika J
Department of Radio-diagnosis, VMMC and Safdarjung Hospital, New Delhi, India.
Indian J Radiol Imaging. 2017 Apr-Jun;27(2):141-147. doi: 10.4103/0971-3026.209212.
Despite being decked as the most prized compounds in the nugget box of contrast agents for clinical radiologists, and carrying an indisputable tag of safety of the US Food and Drug Administration for close to three decades, all may not be seemingly well with the family of gadolinium compounds. If the first signs of violations of in relation to gadolinium-based contrast agents (GBCAs) appeared in the millennium year with the first published report of skin fibrosis in patients with compromised renal function, the causal relationship between the development of nephrogenic systemic fibrosis (NSF) and GBCAs, first proposed by two European groups in 2006, further precluded their use in renocompromised patients. The toxicity, pharmacokinetics, and pharmacodynamics of GBCAs, however, has come under hawk-eyed scrutiny with recent reports that gadolinium tends to deposit cumulatively in the brain of patients with normal hepatobiliary function and intact blood-brain barrier. While the jury on the long-term hazard significance of this critical scientific finding is still out, the use of GBCAs must be guided by due clinical diligence, avoidance of repeated doses, and preferring GBCAs with the best safety profiles.
尽管钆化合物被临床放射科医生视为造影剂宝库中最珍贵的化合物，并且在美国食品药品监督管理局的认证下拥有近三十年无可争议的安全标签，但钆化合物家族的情况似乎并非一切都好。如果说在2000年，随着第一份关于肾功能受损患者皮肤纤维化的报告发表，出现了与钆基造影剂（GBCAs）相关的违规迹象，那么2006年两个欧洲研究小组首次提出的肾源性系统性纤维化（NSF）的发展与GBCAs之间的因果关系，进一步限制了它们在肾功能不全患者中的使用。然而，随着最近有报道称钆倾向于在肝胆功能正常且血脑屏障完整的患者大脑中累积沉积，GBCAs的毒性、药代动力学和药效学受到了密切关注。虽然关于这一关键科学发现的长期危害意义尚无定论，但GBCAs的使用必须以适当的临床谨慎为指导，避免重复给药，并优先选择安全性最佳的GBCAs。
