Falk Delgado Anna, Van Westen Danielle, Nilsson Markus, Knutsson Linda, Sundgren Pia C, Larsson Elna-Marie, Falk Delgado Alberto
Clinical neurosciences, Karolinska Institutet, Stockholm, Sweden.
Department of Neuroradiology, Karolinska University Hospital, Eugeniavägen 3, Solna, Stockholm, Sweden.
Insights Imaging. 2019 Aug 23;10(1):84. doi: 10.1186/s13244-019-0771-1.
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.
钆基造影剂（GBCAs）可提高病变检测率，并改善通过磁共振成像（MRI）研究的多种脑部病变的疾病特征描述。这些造影剂于20世纪80年代末推出，如今广泛应用。然而，一些非离子线性GBCAs与肾衰竭患者发生肾源性系统性纤维化有关。钆也已在深部脑结构中被发现，尽管其临床相关性尚不清楚。因此，国际医学磁共振学会的新指南提倡在临床和研究实践中谨慎使用GBCA。2017年，一些线性GBCAs被欧洲药品管理局（EMA）限制使用。本综述重点关注可作为GBCAs替代方法的非增强MRI技术。纳入了关于已成熟和新提出的非增强以及增强MRI方法诊断性能的临床研究。详细介绍了每种方法的优缺点及其诊断性能。本综述中讨论的非增强MRI包括动脉自旋标记（ASL）、时间飞跃（TOF）、相位对比（PC）、扩散加权成像（DWI）、磁共振波谱（MRS）、磁敏感加权成像（SWI）和酰胺质子转移（APT）成像。确定了十种常见疾病，针对这些疾病的研究报告了非增强和增强MRI的比较。这些特定疾病包括原发性脑肿瘤、转移瘤、脓肿、多发性硬化症以及血管疾病，如动脉瘤、动静脉畸形、动静脉瘘、颅内颈动脉闭塞性疾病、出血性和缺血性中风。一般来说，对于特定的诊断问题，非增强技术显示出与增强MRI相当的诊断性能。然而，一些诊断仍需要增强成像进行全面检查。
