磁共振钆对比剂有关安全性研究现状  

Research status of Gadolinium-based contrast on safety

作　　者：袁思殊 夏黎明[1] 杨朝霞 乔金晗 YUAN Sishu;XIA Liming;YANG Zhaoxia;QIAO Jinhan(Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院,武汉430030

出　　处：《磁共振成像》2020年第8期717-720,共4页Chinese Journal of Magnetic Resonance Imaging

摘　　要：MRI已成为当今临床广泛应用的影像学检查方法,其中增强MRI具有更加重要的临床意义。自1988年美国食品药品监督管理局批准第一个钆对比剂(Gadoliniumbased contrast agent,GBCA)以来,其使用超过30年。世界范围内增强MRI超过3亿人次。一直以来,GBCA因其相对较低的不良反应发生率,被认为是一种安全性较高的对比剂。随着对于GBCA的广泛使用以及深入了解,其安全性成为临床医生的关注焦点。2006年,肾源性系统性纤维化(nephrogenic systemic fibrosis,NSF)首次引起影像领域对于GBCA的广泛关注。NSF是一种罕见但是严重的系统性疾病,可造成肾损伤患者全身的纤维化改变。为了保证患者的安全,2007年后,药监部门加强了对于GBCA的管理,明显减少了NSF的发生率。近年来,脑部特别是苍白球和齿状核的钆沉积事件使得GBCA的安全性再次得到前所未有的关注,各个国家、地区对于GBCA的不同监管措施使得广大影像医生以及临床医生在对比剂的使用和选择时担忧、疑虑。因此,笔者回顾国内外关于GBCA安全性的有关文章,总结GBCA的安全性及潜在风险及钆沉积的发生背景、历史、可能机制、临床意义等,为GBCA的应用和正确认识提供一定参考。Magnetic resonance imaging(MRI)has become a crucial radiologic method for clinical diagnosis,and enhanced MRI can improve image quality of tissue,organ and vessel.Since U.S.FDA approved the first Gadolinium-based contrast agent(GBCA)in 1988,it has been used more than 30 years,and over 300 million patients worldwide were benefited by its diagnosis and treatment guidance.GBCA was considered as a comparative safer contrast media for its overall low incidence rate of adverse drug reaction.With deep understanding and widespread application of GBCA,clinicians pay more attention to its safety.In 2006,nephrogenic systemic fibrosis(NSF)which drew a lot radiologists’attention.NSF is a rare but serious systemic disease characterized by fibrosis throughout the body in renally impaired individuals.Consider the patients’benefit,the management of GBCA was strengthened to ensure the NSF incidence ratio decreased.Recently,another issue,Gd retention in the brain,especially in dental nucleus and globus pallidus arouse widespread attention again.Drug authorities executed different regulatory measures in different countries and regions make radiologists overstressed in GBCA application and selection.Therefore,the paper will review the literatures on the application of GBCA,summarizing the background,possible mechanism and clinical significance,providing a powerful theory foundation for GBCA selection and correct understanding in clinic.

关 键 词：钆对比剂 磁共振成像 肾源性系统性纤维化 急性不良反应 钆沉积 

分 类 号：R445.2[医药卫生—影像医学与核医学]