The utility of gadoteric acid in contrast-enhanced MRI: A review

Abstract

Gadoteric acid (Dotarem®) is a macrocyclic, paramagnetic, gadolinium-based contrast agent. It is used in the magnetic resonance imaging (MRI) of the brain, spine, and associated tissues. Particularly, it is able to detect and visualize areas with disruption of the blood-brain barrier and/or abnormal vascularity. Gadoteric acid has been also approved for MR angiography of supraaortic vessels, cardiac MR (to detect myocardial infarctions), as well as whole-body MRI including abdominal, renal, pelvic, breast, and osteoarticular diseases. Cyclic chelates are more stable compared to linear chelates, and ionic chelates are more stable compared to nonionic chelates. Linear chelates have a greater likelihood of releasing free Gd3+ compared to cyclic chelates. Non-ionic chelates are more likely, compared to ionic chelates, to release Gd3+from their chelates. Gadoteric acid is a cyclic ionic chelate and has the greatest kinetic stability among gadolinium-based contrast agents. In patients with chronic reduced kidney function, the use of gadolinium-based contrast agents leads to acute kidney injury and dialysis. The risk of acute kidney injury may increase with increasing dose of the contrast agents. Therefore, it is recommended to administer the lowest dose necessary for adequate imaging. The dose reduction allows protection the patients form potential risk of nephrogenic systemic fibrosis, a systemic reaction that is probably due to unbound Gd3+ ions deposited in body tissues. The dose of gadoteric acid should not exceed 0.1 mmol/kg body weight. More than one dose should not be used during a scan. Because of the lack of information on repeated administration, Dotarem®injections should not be repeated unless the interval between injections is at least 7 days. After administration, hemodialysis may not be useful to remove Dotarem® from the body. Dotarem®may allow the administration of a significantly lower dosage (a single dose of 0.1 mmol/kg) compared to 0.5 mmol/mL non-protein-binding gadolinium compounds and achieving equivalent efficacy in the MRI diagnostic detection rate.