Runge Val M, Heverhagen Johannes T
From the Department of Diagnostic, Interventional, and Pediatric Radiology, University Hospital of Bern, Inselspital, University of Bern, Bern, Switzerland.
Invest Radiol. 2024 Feb 1;59(2):105-107. doi: 10.1097/RLI.0000000000001037. Epub 2023 Oct 20.
Next-generation gadolinium-based contrast agents (GBCAs), including both high relaxivity agents and targeted agents, and manganese-based agents with a high probably of commercial success are discussed in some depth. It is highly likely that gadopiclenol and gadoquatrane, both next-generation high relaxivity gadolinium-based compounds, will come in time to replace the current macrocyclic gadolinium chelates, despite the wide acceptance, very high safety profile, and high stability of the latter group. Current research has also made possible the development of 2 new targeted gadolinium chelates, which look very promising, with the potential to improve cancer detection (for both MT218 and ProCA32.collagen) as well as diseases of collagen (for the latter agent). Further work with manganese-based compounds, a topic left fallow for more than 20 years, has also now produced 2 agents with high potential for clinical use, one (manganese chloride tetrahydrate, administered orally) developed primarily for imaging of the liver and the other (Mn-PyC3A, administered intravenously) as a gadolinium-free replacement for the GBCAs. New detail has recently emerged regarding specific circumscribed subregions of the brain with specialized cytoarchitecture and functions in which high gadolinium concentrations are seen following injection of the linear agent gadodiamide. These findings pave the way for tailored functional neurological testing, specifically in patients at potential risk due to the continued wide use in many countries across the world of the linear GBCAs. The impact of artificial intelligence is also critically discussed, with its most likely applications being dose reduction and new clinical indications.
本文将深入探讨下一代基于钆的造影剂（GBCAs），包括高弛豫率造影剂和靶向造影剂，以及具有较高商业成功可能性的锰基造影剂。尽管目前的大环钆螯合物已被广泛接受、具有很高的安全性和稳定性，但下一代高弛豫率的基于钆的化合物钆吡醇和钆曲胺很有可能适时取代它们。目前的研究还促成了两种新型靶向钆螯合物的开发，它们前景十分广阔，有可能改善癌症检测（针对MT218和ProCA32.胶原蛋白）以及胶原蛋白疾病（针对后一种制剂）。对锰基化合物的进一步研究，这个已搁置20多年的课题，现在也产生了两种具有很高临床应用潜力的制剂，一种（口服四水合氯化锰）主要用于肝脏成像，另一种（静脉注射Mn-PyC3A）作为GBCAs的无钆替代品。最近出现了关于大脑特定界限分明的亚区域的新细节，这些亚区域具有特殊的细胞结构和功能，在注射线性制剂钆双胺后会出现高钆浓度。这些发现为定制功能性神经测试铺平了道路，特别是针对因线性GBCAs在世界许多国家持续广泛使用而处于潜在风险的患者。本文还批判性地讨论了人工智能的影响，其最有可能的应用是降低剂量和拓展新的临床适应症。
