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Contrast-Enhanced CT and MR Scanning of the Brain

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Medical Imaging Contrast Agents: A Clinical Manual

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Abstract

Since the number of medical imaging has increased in recent years, the use of contrast agents (CAs) has increased accordingly. CAs were used for cross-sectional studies in the 1970s for computed tomography (CT) and in the 1980s for magnetic resonance imaging (MRI).

CAs were used since the early days of CT for brain imaging. Iodine-based CAs can be grouped by osmolarity, ionicity, and the number of benzene rings (Beckett et al., Radiographics 35(6):1738–50, 2015). Initially, both urographic and angiographic iodine-based CAs were used for contrast-enhanced (CE) CT, whereas these agents were now replaced by low and iso-osmolar CAs which have fewer side effects and higher safety margins.

Gadolinium (Gd)-based agents, after validated for intravascular use in the late 1980s, are extremely well-tolerated and there has been a significant increase in the use of CAs since then. In 1988, the first CA specifically designed for MRI, gadopentetate dimeglumine, became available for clinical use (Lohrke et al., Adv Ther 33(1):1–28, 2016). In the early stages of development of Gd-based CAs, it was emphasized that many tumors (Schoerner et al., Neurosurg Rev 7(4):303–12, 1984) and inflammatory-infectious pathologies may exhibit CE due to impaired BBB in brain (Runge et al., AJNR Am J Neuroradiol 6(2):139–47, 1985). Imaging of primary and secondary central nervous system (CNS) tumors is now a major clinical application of CE-MRI. In the 1980s, when MS lesions started to be examined by MRI and were shown to be superior to CT in detecting lesions (Kirshner et al., Arch Neurol 42(9):859–63, 1985; Young et al. Lancet 2(8255):1063–66, 1981), CE-MRI has become the gold standard in the diagnosis of MS. Today, after nearly 30 years of CE-MRI imaging, the influence of this modality has widened beyond initial expectations and become an essential tool for diagnosis. Advances in CAs and the technical capabilities of MRI have increased the precision and usefulness of CE-MRI for many different indications.

The aim of this chapter is to give some information about CE mechanisms and patterns in brain, to ensure an overview of the CA-related density and signal changes of brain pathologies.

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Abbreviations

BBB:

Blood–brain barrier

CA:

Contrast agent

CE:

Contrast enhancement

CNS:

Central nervous system

CSF:

Cerebrospinal fluid

CT:

Computed tomography

GBM:

Glioblastoma multiforme

Gd:

Gadolinium

MR:

Magnetic resonance

MS:

Multiple sclerosis

NSF:

Nephrogenic systemic fibrosis

WHO:

World Health Organization

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Authors and Affiliations

  1. Fatih Sultan Mehmet Training and Research Hospital, Istanbul, Turkey

    Yilmaz Onal

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  1. Yilmaz Onal
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Editors and Affiliations

  1. Department of Radiology, Istanbul University School of Medicine, Istanbul, Turkey

    Sukru Mehmet Erturk

  2. Departments of Radiology and Pathology, Stony Brook University, Stony Brook, NY, USA

    Pablo R. Ros

  3. Departments of Diagnostic Radiology and Nuclear Medicine, Gunma University, Graduate School of Medicine, Maebashi, Gunma, Japan

    Tomoaki Ichikawa

  4. Department of Radiology, Eskişehir Osmangazi University, Eskisehir, Turkey

    Suzan Saylisoy

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Onal, Y. (2021). Contrast-Enhanced CT and MR Scanning of the Brain. In: Erturk, S.M., Ros, P.R., Ichikawa, T., Saylisoy, S. (eds) Medical Imaging Contrast Agents: A Clinical Manual. Springer, Cham. https://doi.org/10.1007/978-3-030-79256-5_16

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