Gadolinium-haltige Kontrastmittel nach anaphylaktoiden Reaktionen, nephrogener systemischer Fibrose und Hirnretention – was haben wir gelernt?

Zusammenfassung

Hintergrund Radiologen verabreichen Gadolinium-haltige Kontrastmittel (GBCA) in der Magnetresonanztomografie seit mehreren Jahrzehnten, sodass umfangreiche Erfahrung mit diesen Präparaten bezüglich anaphylaktoider Reaktionen, nephrogener systemischer Fibrose (NSF) und Retentionen von Gadolinium im Gehirn besteht.

Methode Diese Übersichtsarbeit basiert auf einer selektiven Literaturrecherche und gibt den aktuellen Forschungsstand bezüglich akuter unerwünschter Wirkungen, NSF und Hirnretentionen von Gadolinium nach Verabreichung von GBCA wieder.

Ergebnisse Aufgrund der häufigen Verwendung von GBCA liegen Daten über unerwünschte Wirkungen dieser Verbindungen in großen Kollektiven vor. Anaphylaktoide Reaktionen traten dabei selten auf, wobei schwere akute Reaktionen sehr selten zu beachten waren. Zu den systemischen Veränderungen der NSF kommt es ebenfalls sehr selten, wobei Maßnahmen zur Vermeidung der NSF in einer signifikant reduzierten Inzidenz der NSF resultierten. Aufgrund der Gadolinium-Retention im Körper nach Verabreichung von linearen MR-Kontrastmitteln werden derzeit mit wenigen Ausnahmen nur noch makrozyklische Präparate eingesetzt. Eindeutige klinische Korrelate von Gadolinium-Retentionen im Gehirn konnten bislang nicht identifiziert werden. Obwohl der klinische Mehrwert von GBCA unbestritten ist, sollten individuelle Risiken in Verbindung mit der Injektion von GBCA ermittelt und der Einsatz nativer MR-Techniken erwogen werden. Alternative Kontrastmittel, wie beispielsweise Eisenoxid-Nanopartikel, sind nicht klinisch zugelassen, befinden sich aber aktuell in klinischer Prüfung.

Schlussfolgerung Gadolinium-haltige Kontrastmittel weisen ein sehr gutes Risikoprofil auf mit einer geringen Rate unerwünschter Wirkungen. Lineare GBCA führen zu Gadolinium-Retentionen im Gehirn, klinische Korrelate sind jedoch nicht gesichert. Durch die Verwendung von makrozyklischen Kontrastmitteln lässt sich die Gadolinium-Retention im Gehirn minimieren.

Kernaussagen: 

• Akute unerwünschte Wirkungen sind vorwiegend mild/moderat, selten treten schwere Reaktionen auf.

• Internationale Richtlinien führten zu einer signifikanten Reduktion der nephrogenen systemischen Fibrose.

• Durch Einsatz makrozyklischer Kontrastmittel lassen sich Gadolinium-Retentionen im Gehirn minimieren.

Zitierweise

• Bäuerle T, Saake M, Uder M. Gadolinium-based contrast agents: What we learned from acute adverse events, nephrogenic systemic fibrosis and brain retention. Fortschr Röntgenstr 2021; 193: 1010 – 1018

Key words

gadolinium-based contrast agents - acute adverse events - nephrogenic systemic fibrosis - gadolinium retention

Publication History

Received: 22 July 2020

Accepted: 24 November 2020

Article published online:
21 December 2020

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