Sugiura Takumi, Okumura Kenichiro, Sasaki Motomitsu, Matsumoto Junichi, Ogi Takahiro, Yoneda Norihide, Kitao Azusa, Kozaka Kazuto, Koda Wataru, Kobayashi Satoshi, Gabata Toshifumi
Department of Radiology, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Ishikawa, Japan.
Department of Radiology, Nakamura Hospital, Echizen, Fukui, Japan.
PLoS One. 2022 Mar 18;17(3):e0265588. doi: 10.1371/journal.pone.0265588. eCollection 2022.
In the arterial phase of gadoxetate disodium administration for dynamic MRI, transient severe motion (TSM) sometimes occurs, making image evaluation difficult. This study was to identify risk factors for TSM in a clinical study, and confirm them and investigate the cause in an animal study.
A retrospective, single-center, observational study included patients who underwent dynamic MRI using gadoxetate disodium for the first time from April 2016 to September 2019 and free-breathing MRI was performed. Differences in clinical characteristics and laboratory tests between the presence and absence of TSM were examined. Animal experiments were conducted in 50 rats; gadoxetate disodium was injected into three sites (distal inferior vena cava (IVC), ascending aorta, and descending aorta) to identify the organ which triggers respiratory irregularities. Phosphate-buffered saline and gadopentetate dimeglumine were also injected into the distal IVC. In addition, to evaluate the effect of albumin, gadoxetate disodium was diluted with phosphate-buffered saline or 5% human serum albumin and injected into the ascending aorta. The time course of the respiratory rate was monitored and evaluated.
20 of 51 (39.2%) patients showed TSM. On multivariable analysis, a low albumin level was an independent risk factor (P = .035). Gadoxetate disodium administration caused significant tachypnea compared to gadopentetate dimeglumine or PBS (an elevation of 16.6 vs 3.0 or 4.3 breaths/min; both P < .001) in rats. The starting time of tachypnea was earlier with injection into the ascending aorta than into the descending aorta (10.3 vs 17.9 sec; P < .001) and the distal IVC (vs 15.6 sec; P < .001). With dilution with albumin instead of phosphate-buffered saline, tachypnea was delayed and suppressed (9.9 vs 13.0 sec; P < .001, 24.1 vs 17.0 breaths/min; P = .031).
A low albumin level is a risk factor for TSM, which could be caused by the effect of gadoxetate disodium on the head and neck region.
在使用钆塞酸二钠进行动态磁共振成像（MRI）的动脉期，有时会出现短暂性严重运动（TSM），这使得图像评估变得困难。本研究旨在在一项临床研究中确定TSM的危险因素，并在动物研究中对其进行确认并探究原因。
一项回顾性、单中心观察性研究纳入了2016年4月至2019年9月首次使用钆塞酸二钠进行动态MRI且进行了自由呼吸MRI的患者。检查了出现和未出现TSM的患者在临床特征和实验室检查方面的差异。对50只大鼠进行了动物实验；将钆塞酸二钠注入三个部位（下腔静脉远端、升主动脉和降主动脉）以确定引发呼吸不规则的器官。还将磷酸盐缓冲盐水和钆喷酸葡胺注入下腔静脉远端。此外，为了评估白蛋白的作用，将钆塞酸二钠用磷酸盐缓冲盐水或5%人血清白蛋白稀释后注入升主动脉。监测并评估呼吸频率的时间进程。
51例患者中有20例（39.2%）出现TSM。多变量分析显示，低白蛋白水平是一个独立危险因素（P = 0.035）。与钆喷酸葡胺或磷酸盐缓冲盐水相比，给大鼠注射钆塞酸二钠会导致明显的呼吸急促（分别升高16.6次/分钟，而钆喷酸葡胺或磷酸盐缓冲盐水为3.0次/分钟或4.3次/分钟；P均<0.001）。注入升主动脉时呼吸急促的起始时间比注入降主动脉（10.3秒对17.9秒；P < 0.001）和下腔静脉远端（对15.6秒；P < 0.001）更早。用白蛋白而非磷酸盐缓冲盐水稀释后，呼吸急促延迟且受到抑制（9.9秒对13.0秒；P < 0.001，24.1次/分钟对17.0次/分钟；P = 0.031）。
低白蛋白水平是TSM的一个危险因素，这可能是由于钆塞酸二钠对头颈部区域的作用所致。
