Deng Xiaojuan, Liu Shaojun, Li Zhiyong, Guan Xinyu, Jia Min, Yang Jian
Department of Radiology, The Third Affiliated Hospital of Chongqing Medical University, Chongqing, 401120, People's Republic of China.
College of Biomedical Engineering, Chongqing Medical University, Chongqing, 400016, People's Republic of China.
Discov Nano. 2025 Aug 18;20(1):142. doi: 10.1186/s11671-025-04325-4.
Cerebral ischemic diseases remain a significant clinical challenge, necessitating advancements in imaging technologies to improve diagnosis and therapeutic monitoring. This review highlights the limitations of gadolinium-based contrast agents (GBCAs), particularly their nephrotoxicity and limited specificity, and explores the emerging role of manganese- and iron-based MRI contrast agents as promising alternatives. Manganese-based agents demonstrate exceptional sensitivity to neuronal activity and metabolic changes, making them highly effective for assessing functional and cellular dynamics. Meanwhile, iron-based agents leverage their superparamagnetic properties to enhance ischemic lesion detection, particularly in T-weighted imaging. However, the clinical translation of these novel agents faces significant challenges, including biosafety concerns, suboptimal targeting efficiency, and the need for multimodal integration to improve diagnostic precision. Future research should focus on the development of low-toxicity, biodegradable contrast agents with enhanced targeting capabilities, the application of artificial intelligence for probe optimization, and the creation of theranostic nanoprobes that combine imaging with targeted therapy. Additionally, rigorous clinical validation and the establishment of standardized protocols will be critical for integrating these agents into routine practice. These advancements hold the potential to revolutionize ischemic stroke diagnosis and enable precision neuroimaging, driving the broader adoption of novel MRI contrast agents in clinical workflows.
脑缺血性疾病仍然是一项重大的临床挑战，需要成像技术取得进展以改善诊断和治疗监测。本综述强调了钆基造影剂（GBCAs）的局限性，尤其是它们的肾毒性和有限的特异性，并探讨了锰基和铁基MRI造影剂作为有前景的替代物的新兴作用。锰基造影剂对神经元活动和代谢变化表现出非凡的敏感性，使其在评估功能和细胞动态方面非常有效。同时，铁基造影剂利用其超顺磁性特性来增强缺血性病变的检测，特别是在T加权成像中。然而，这些新型造影剂的临床转化面临重大挑战，包括生物安全性问题、靶向效率欠佳以及需要多模态整合以提高诊断精度。未来的研究应专注于开发具有增强靶向能力的低毒性、可生物降解的造影剂，应用人工智能优化探针，以及创建将成像与靶向治疗相结合的诊疗纳米探针。此外，严格的临床验证和标准化方案的建立对于将这些造影剂纳入常规实践至关重要。这些进展有可能彻底改变缺血性中风的诊断，并实现精准神经成像，推动新型MRI造影剂在临床工作流程中得到更广泛的应用。
