钆造影剂（GBCA）对于诊断性MRI检查至关重要。GBCA仅在每个患者的基础上少量使用；然而，全球范围内获得对比增强MRI检查导致每年使用数千升GBCA。数据显示，这些GBCA存在于污水中，地表水,和世界上许多地区的饮用水。因此,由于GBCA在水生环境中无处不在，因此人们越来越关注GBCA的环境影响。为了解决GBCA在整个水系统中的问题，所有利益相关者之间的合作是必要的，包括GBCA的生产商，医疗专业人员，重要的是，饮用水的消费者，即病人。本文旨在使医疗保健专业人员意识到有机会带头就GBCA的使用做出明智的决定，并概述了不同的行动选择。在本文中,我们首先对GBCA的代谢和临床应用进行了综述，然后是GBCA的环境命运和观察，其次是减少GBCA使用的措施。GBCA对环境的影响可以通过(1)通过基于重量的对比体积减少来关注GBCA的应用的措施来减少,每mmolGd具有较高弛豫率的GBCA，对比增强序列，和后处理；(2)减少GBCA浪费的措施，包括使用散装包装和在应用点收集GBCA的残留物。关键相关性声明本综述旨在使医疗保健专业人员意识到GBCA对环境的影响，以及他们有机会率先就GBCA的使用和减轻其环境负担的不同选择做出明智的决定。关键点•在饮用水源中发现基于钆的造影剂并构成环境风险。•放射科医生有广泛的选择，以减少GBCA的使用，而不影响诊断质量。•通过在临床实践中采用此类措施，放射学可以变得更加可持续。
Gadolinium-based contrast agents (GBCA) are essential for diagnostic MRI examinations. GBCA are only used in small quantities on a per-patient basis; however, the acquisition of contrast-enhanced MRI examinations worldwide results in the use of many thousands of litres of GBCA per year. Data shows that these GBCA are present in sewage water, surface water, and drinking water in many regions of the world. Therefore, there is growing concern regarding the environmental impact of GBCA because of their ubiquitous presence in the aquatic environment. To address the problem of GBCA in the water system as a whole, collaboration is necessary between all stakeholders, including the producers of GBCA, medical professionals and importantly, the consumers of drinking water, i.e. the patients. This paper aims to make healthcare professionals aware of the opportunity to take the lead in making informed decisions about the use of GBCA and provides an overview of the different options for action.In this paper, we first provide a summary on the metabolism and clinical use of GBCA, then the environmental fate and observations of GBCA, followed by measures to reduce the use of GBCA. The environmental impact of GBCA can be reduced by (1) measures focusing on the application of GBCA by means of weight-based contrast volume reduction, GBCA with higher relaxivity per mmol of Gd, contrast-enhancing sequences, and post-processing; and (2) measures that reduce the waste of GBCA, including the use of bulk packaging and collecting residues of GBCA at the point of application.Critical relevance statement This
review aims to make healthcare professionals aware of the environmental impact of GBCA and the opportunity for them to take the lead in making informed decisions about GBCA use and the different options to reduce its environmental burden.Key points• Gadolinium-based contrast agents are found in sources of drinking water and constitute an environmental risk.• Radiologists have a wide spectrum of options to reduce GBCA use without compromising diagnostic quality.• Radiology can become more sustainable by adopting such measures in clinical practice.
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