Development and Use of Elucirem (gadopiclenol) injection, a Macrocyclic, High-Relaxibity GBCA for CE-MRI
Lawrence Tanenbaum, MD, FACR; Laurie A. Loevner, MD; Donna Roberts, MD; Jeffrey Weinreb, MD; Ahmed Abdelal, PharmD
Estimated time for completion: 1.0 hour • Date of Release: February 24, 2023 • Expiration Date: March 31, 2026
After decades of administrations, substantial evidence has accumulated for the efficacy and safety of gadolinium-based contrast agents (GBCAs) in magnetic resonance imaging (MRI). However, their excellent performance has led to increased use and dosing for many neuro and cardiovascular applications in adults and children.
As a result, concern has been growing in the radiology community, particularly with respect to use of the less stable agents, which are generally linear and, therefore, bind less tightly to the gadolinium (Gd) ion. While recognizing the value of these agents, the US Food and Drug Administration (FDA) and the American College of Radiology (ACR) now recommend limiting patient Gd exposure where possible. One technique for reducing Gd exposure is to use a high-relaxivity
One technique for reducing Gd exposure is to use a high-relaxivity GBCA that can be used at a lower dose than a conventional GBCA without impact on image quality. Until recently, however, the GBCA with the highest relaxivity was a linear agent. Consequently, it has been widely recognized for some time that it would be preferable if a GBCA was both macrocyclic in structure and high relaxivity, and that such an agent could be used to reduce Gd exposure by decreasing the amount of Gd injected.
A new GBCA that is both macrocyclic and high relaxivity has been developed and received FDA marketing approval in September 2022. A group of radiologists with extensive experience in contrast-enhanced (CE)-MRI convened to discuss this new GBCA, Elucirem™ (gadopiclenol) injection, and this monograph presents a summary of this expert panel forum.
Learning Objectives
At the conclusion of this activity, participants should be able to:
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Describe the distinguishing properties of the available gadolinium-based contrast agents (GBCAs) currently used for magnetic resonance imaging (MRI);
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Review how the structure of the gadolinium (Gd)-chelate complex determines the stability of a GBCA, and how stability relates to both Gd retention and nephrogenic systemic fibrosis (NSF);
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Explain what a “high-relaxivity” GBCA is and summarize results of crossover studies comparing standard- and high-relaxivity GBCAs for MRI;
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State the key considerations when selecting a GBCA for neuro MRI, pediatric MRI, body MRI, and breast MRI.
Accreditation
This course is approved by the The Association for Medical Imaging Management (AHRA) for 1.0 "Category A" ARRT continuing education credit.
Commercial Support
This program has been supported by Guerbet LLC.
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