In an attempt to assess current practices regarding the use of GBCAs, we anonymously surveyed members of the British Society of Skeletal Radiologists (BSSR), European Society of Musculoskeletal Radiology (ESSR), and the Musculoskeletal Society of India (MSS). It is because of this GBCAs were expected to have high contrast efficiency and safety in addition to their rapid excretion, high stability, low osmolality, and low viscosity. The chelating ligand compounds are designed to minimize dissociation of gadolinium. These are classified as linear or macrocyclic. Pharmacologically GBCAs are classified according to the molecular structure of the chelating ligand to which they are bound. Its structure makes it unstable in vivo and therefore it is bound to a ligand and administered in chelated forms. They are biologically inert and generally eliminated by the kidneys. GBCAs are distributed within the blood and extravascular–extracellular space. Administration of Gdįalters the rotation frequency of water molecules, shortening both T1 and T2 relaxation times of tissues in which it accumulates, thus allowing differentiation through increasing signal intensity on T1 sequences and decreasing signal on T2 sequences. ), in its raw form is a paramagnetic ion composed of seven unpaired electrons The role of GBCAs in spinal disease will not be covered in this article. GBCAs can provide accurate representation of the degree of osseous and nonosseous involvement in complicated extremity infections.Īdditionally, GBCAs can aid in the diagnosis of infections in septic arthritis, acute- subacute- and chronic osteomyelitis. It is also useful to gauge the extent of the infections and make abscess/collections more conspicuous. They help radiologists plan soft tissue biopsies by identifying viable enhancing malignant tissue from cystic/necrotic tissue.Ĭontrast can enable the detection of the early stages of soft tissue infection and differentiate phlegmon from normal surrounding tissues. In MSK MRI GBCAs are often used in the assessment of soft tissue sarcomas (STS) prior to histological diagnosis and in follow-up imaging to assess for local recurrence. GBCAs are used in an attempt to improve diagnostic confidence to influence patient care and management. The use of GBCAs has grown substantially they are used in approximately one-in-three of all MRI studies worldwide.
Thus, to reduce their toxicity and improve stability, they are bound to a ligand and administered in chelated forms. In its free form, unpaired gadolinium electrons are highly toxic. The 1980s brought about new advances in MSK MRI with the development of gadolinium-based contrast agents (GBCAs). MRI is also useful in the evaluation of trauma, It is key for diagnosing, staging, preoperative work-up, and follow-up of patients with benign and malignant soft tissue neoplasms.įurthermore, it provides detailed tissue characterization and aids in the staging of bone lesions. The modality of choice for tumors and tumor-like conditions is often MRI, owing to its excellent soft tissue contrast, its sensitivity to bone marrow and soft tissue edema, and its multiplanar imaging. This is due to its high-resolution providing unparalleled soft tissue contrast and allowing the visualization of both anatomical structures and pathological processes. It is the primary imaging modality for the detailed evaluation of a broad spectrum of musculoskeletal (MSK) disease processes. Magnetic resonance imaging (MRI) is a sensitive noninvasive modality with several advantages in comparison to other imaging techniques.