磁共振钆对比剂体内分布与沉积研究现状

Distribution and deposition of magnetic resonance gadolinium contrast agents in body: current status

磁共振增强检查因钆对比剂高弛豫率的特点,在临床疾病的诊断与鉴别诊断中广泛应用。在美国,每年有超过1000万患者进行磁共振增强检查,占全部磁共振检查的40%～50%,被认为是非常安全的检查方法。但很多文献报道肾功能不全患者注射钆对比剂和肾源性系统纤维化(nephrogenic systemic fibrosis,NSF)密切相关,发现皮肤、体内部分脏器器官、骨组织内存在钆沉积现象。近几年,更多文献报道了在肾功能正常患者的颅内部分特殊结构存在钆沉积现象,尤其是苍白球和齿状核,多次注射钆对比剂后可发现其明显的T1信号增高表现,但其机制及临床意义尚不清楚。作者回顾国内外关于磁共振钆对比剂应用的文献,总结其不同分类及危险等级、体内的分布与沉积现状、可能的发生机制及临床意义等,为临床钆对比剂的选择应用提供有力的帮助。

Contrast-enhanced Magnetic resonance imaging（CE-MRI） is widely used in diagnosis and differential diagnosis diseases due to the high relaxation rate of gadolinium contrast agent. In the United States, more than 10 million patients accounting for 40%-50% of all MRI examinations undergoing CE-MRI which is considered as a safety method. But many literatures have reported that gadolinium contrast agent administration have been associated with nephrogenic systemic fibrosis（NSF） in whom with severely compromised renal function, some found that gadolinium could deposite in the skin, some organs and bone tissues. Recently, more studies have shown obviously evidence that gadolinium may deposit in some specific brain structures who with nomal renal function, such as globus pallidus and dentate nucleus. After repeated CE-MRI examinations we could find higher signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images. However, its mechanism and clinical significances remain to be unclear. Therefore, this paper will review the literatures on the application of magnetic resonance gadolinium contrast agent, summarizing the classifications and risk levels, biodistribution and deposition, possible mechanism and clinical significance, providing a powerful reference in selection of gadolinium contrast in clinic.