含钆造影剂脑内沉积的研究现状  

Gadolinium-based contrast agents deposition in the brain:current status

作　　者：刘金沙 伍建林[2] LIU Jinsha;WU Jianlin(Graduate School,Zunyi Medical University,Zunyi 563000,China;Department of Radiology,Zhongshan Hospital Affiliated to Dalian University,Dalian 116001,China)

机构地区：[1]遵义医科大学研究生院,贵州遵义563000 [2]大连大学附属中山医院放射科,辽宁大连116001

出　　处：《大连医科大学学报》2020年第4期366-371,共6页Journal of Dalian Medical University

摘　　要：含钆造影剂(gadolinium-based contrast agents,GBCAs)被广泛应用于磁共振增强检查,尤其是神经系统疾病的检测与诊断。过去多认为含钆造影剂是安全、稳定的,近年来又有新证据表明多次行MRI增强检查的患者,可能会出现脑深部核团,尤其是苍白球、齿状核T1WI信号的增高,并且信号改变的程度与既往钆对比剂使用次数以及GBCAs的化学结构显著相关,线性造影剂相对于大环类更易引起脑内钆沉积。目前有包括:载体介导机制、转运体介导机制和被动运输在内的多种沉积机制的猜想,而沉积的钆主要聚集在内皮细胞膜及血管壁上,神经元未见明显受累。此外,儿童等特殊人群以及血脑屏障的损伤,均可能是脑内钆沉积的风险性因素。现阶段关于沉积钆脑内清除的认识多基于动物实验基础上,有证据表明不同种类的造影剂清除率存在差异,而脑内沉积钆的清除率普遍较低。Gadolinium-based contrast agents(GBCAs)are widely used in magnetic resonance enhancement,especially in the detection and diagnosis of nervous system diseases.In the past,GBCAs were considered to be safe and stable.In recent years,new evidence has shown that patients undergoing multiple enhanced MRI examinations may have deep brain nuclei T1 WI signal changes,especially the globus pallidus and dentate nuclei.And the degree of signal change is significantly related to the number of GBCAs use in the past and the chemical structure of GBCAs.Compared with macrocyclics,linear contrast agents are more likely to cause gadolinium deposition in the brain.At present,there are many hypotheses about deposition mechanisms including carrier-mediated mechanism,transporter-mediated mechanism and passive transport.The deposited gadolinium mainly accumulates on endothelial cell membrane and blood vessel wall,and neurons are not significantly affected.In addition,special populations such as children and damage to the blood-brain barrier may be risk factors for gadolinium deposition in the brain.At current stage,the understanding of intracerebral clearance of deposited gadolinium is mostly based on animal experiments.There is evidence that the clearance rates of different types of GBCAs are different,and the clearance rate of cerebral deposits of gadolinium is generally low.

关 键 词：含钆造影剂 磁共振成像 钆沉积 脑 

分 类 号：R445.2[医药卫生—影像医学与核医学]