Abstract：
In the arterial phase of gadoxetate disodium administration for dynamic MRI, transient severe motion (TSM) sometimes occurs, making image evaluation difficult. This study was to identify risk factors for TSM in a clinical study, and confirm them and investigate the cause in an animal study.
A retrospective, single-center, observational study included patients who underwent dynamic MRI using gadoxetate disodium for the first time from April 2016 to September 2019 and free-breathing MRI was performed. Differences in clinical characteristics and laboratory tests between the presence and absence of TSM were examined. Animal experiments were conducted in 50 rats; gadoxetate disodium was injected into three sites (distal inferior vena cava (IVC), ascending aorta, and descending aorta) to identify the organ which triggers respiratory irregularities. Phosphate-buffered saline and gadopentetate dimeglumine were also injected into the distal IVC. In addition, to evaluate the effect of albumin, gadoxetate disodium was diluted with phosphate-buffered saline or 5% human serum albumin and injected into the ascending aorta. The time course of the respiratory rate was monitored and evaluated.
20 of 51 (39.2%) patients showed TSM. On multivariable analysis, a low albumin level was an independent risk factor (P = .035). Gadoxetate disodium administration caused significant tachypnea compared to gadopentetate dimeglumine or PBS (an elevation of 16.6 vs 3.0 or 4.3 breaths/min; both P < .001) in rats. The starting time of tachypnea was earlier with injection into the ascending aorta than into the descending aorta (10.3 vs 17.9 sec; P < .001) and the distal IVC (vs 15.6 sec; P < .001). With dilution with albumin instead of phosphate-buffered saline, tachypnea was delayed and suppressed (9.9 vs 13.0 sec; P < .001, 24.1 vs 17.0 breaths/min; P = .031).
A low albumin level is a risk factor for TSM, which could be caused by the effect of gadoxetate disodium on the head and neck region.
A retrospective, single-center, observational study included patients who underwent dynamic MRI using gadoxetate disodium for the first time from April 2016 to September 2019 and free-breathing MRI was performed. Differences in clinical characteristics and laboratory tests between the presence and absence of TSM were examined. Animal experiments were conducted in 50 rats; gadoxetate disodium was injected into three sites (distal inferior vena cava (IVC), ascending aorta, and descending aorta) to identify the organ which triggers respiratory irregularities. Phosphate-buffered saline and gadopentetate dimeglumine were also injected into the distal IVC. In addition, to evaluate the effect of albumin, gadoxetate disodium was diluted with phosphate-buffered saline or 5% human serum albumin and injected into the ascending aorta. The time course of the respiratory rate was monitored and evaluated.
20 of 51 (39.2%) patients showed TSM. On multivariable analysis, a low albumin level was an independent risk factor (P = .035). Gadoxetate disodium administration caused significant tachypnea compared to gadopentetate dimeglumine or PBS (an elevation of 16.6 vs 3.0 or 4.3 breaths/min; both P < .001) in rats. The starting time of tachypnea was earlier with injection into the ascending aorta than into the descending aorta (10.3 vs 17.9 sec; P < .001) and the distal IVC (vs 15.6 sec; P < .001). With dilution with albumin instead of phosphate-buffered saline, tachypnea was delayed and suppressed (9.9 vs 13.0 sec; P < .001, 24.1 vs 17.0 breaths/min; P = .031).
A low albumin level is a risk factor for TSM, which could be caused by the effect of gadoxetate disodium on the head and neck region.
摘要：
在动态MRI的gadoxetate二钠给药的动脉期，瞬时剧烈运动（TSM）有时会发生，使形象评价变得困难。这项研究是为了在临床研究中确定TSM的危险因素，并确认它们并在动物研究中调查原因。
回顾,单中心,观察性研究纳入2016年4月至2019年9月首次使用gadoxetate二钠进行动态MRI检查并进行自由呼吸MRI检查的患者.检查了存在和不存在TSM之间的临床特征和实验室测试的差异。在50只大鼠中进行了动物实验；将gadoxetate二钠注入三个部位（下腔静脉远端（IVC），升主动脉,和降主动脉）以确定触发呼吸不规则的器官。磷酸盐缓冲盐水和gadopentate二甲胺也被注射到远端IVC中。此外,为了评估白蛋白的效果，gadoxetate二钠用磷酸盐缓冲盐水或5％人血清白蛋白稀释，并注入升主动脉。监测和评估呼吸频率的时间过程。
51例患者中有20例（39.2%）出现TSM。在多变量分析中，低白蛋白水平是独立危险因素(P=0.035)。与gadopentatedimeglumine或PBS相比，Gadoxetate二钠的给药在大鼠中引起明显的呼吸急促（16.6比3.0或4.3呼吸/分钟；两者均P<.001）。升主动脉注射时呼吸急促的开始时间早于降主动脉（10.3vs17.9秒；P<.001）和远端IVC（vs15.6秒；P<.001）。用白蛋白代替磷酸盐缓冲盐水稀释，呼吸急促被延迟和抑制(9.9vs13.0秒;P<.001,24.1vs17.0次呼吸/分钟;P=.031)。
低白蛋白水平是TSM的危险因素，这可能是由gadoxetate二钠对头颈部区域的影响引起的。
回顾,单中心,观察性研究纳入2016年4月至2019年9月首次使用gadoxetate二钠进行动态MRI检查并进行自由呼吸MRI检查的患者.检查了存在和不存在TSM之间的临床特征和实验室测试的差异。在50只大鼠中进行了动物实验；将gadoxetate二钠注入三个部位（下腔静脉远端（IVC），升主动脉,和降主动脉）以确定触发呼吸不规则的器官。磷酸盐缓冲盐水和gadopentate二甲胺也被注射到远端IVC中。此外,为了评估白蛋白的效果，gadoxetate二钠用磷酸盐缓冲盐水或5％人血清白蛋白稀释，并注入升主动脉。监测和评估呼吸频率的时间过程。
51例患者中有20例（39.2%）出现TSM。在多变量分析中，低白蛋白水平是独立危险因素(P=0.035)。与gadopentatedimeglumine或PBS相比，Gadoxetate二钠的给药在大鼠中引起明显的呼吸急促（16.6比3.0或4.3呼吸/分钟；两者均P<.001）。升主动脉注射时呼吸急促的开始时间早于降主动脉（10.3vs17.9秒；P<.001）和远端IVC（vs15.6秒；P<.001）。用白蛋白代替磷酸盐缓冲盐水稀释，呼吸急促被延迟和抑制(9.9vs13.0秒;P<.001,24.1vs17.0次呼吸/分钟;P=.031)。
低白蛋白水平是TSM的危险因素，这可能是由gadoxetate二钠对头颈部区域的影响引起的。
