İNSANDA GADOLİNYUM BİRİKİMİ: RADYOLOJİ UZMANLARI VE KLİNİK UYGULAMALAR ÜZERİNDEKİ ETKİSİ

Amaç: Bu çalışmada, 1) Son yıllarda ortaya konulan, insan beyninde gadolinyum birikimi verileri hakkında radyologların farkındalığı, klinik uygulamaları ve tercihleri üzerindeki etkisi ve 2) Gadolinyum kullanımı ve riski hakkındaki yaklaşımları etkileyen faktörlerin değerlendirilmesi amaçlandı. Ayrıca bu çalışmada, Türkiye’deki radyoloji pratiği hakkında önemli bilgiler sunuldu. Yöntem: İhtisas veya yan dal eğitiminin tamamlanmasından en az bir yıl geçmiş olan radyologlara yönelik 21 soruluk anket hazırlandı. Türk Radyoloji Derneği üyelerine e-posta ile gönderilen anket linki dört hafta boyunca aktifti. Bulgular: Üç yüz otuz beş kişi anketi tamamladı. Katılımcıların %89’u beyinde gadolinyum birikimi hakkındaki gelişmelerden haberdardı. Katılımcıların %45’i gadolinyum birikimi verilerinin ortaya çıkmasından bu yana uyguladıkları gadolinyum miktarını ve/veya gadolinyum gerektiren görüntülemelerin sıklığını azalttığını söyledi. Gadolinyum ajanlarının moleküler sınıflandırmasının farkında olan radyologların %88’i makrosiklik bir ajan kullandığını belirtti. Yüzde 39’u (n=130) önceki üç yıl içinde (2015-2018) lineer bir ajandan makrosiklik bir ajana geçtigini bildirdi. Radyologların gadolinyum birikimine yönelik yaklaşımı, radyoloji deneyimi, üst ihtisas eğitimi, kurumu ve bir radyoloji konferansına katılım sıklığı gibi kişiye özel faktörlerle önemli ölçüde ilişkiliydi. Katılımcıların günlük klinik pratikte gadolinyum birikimine bağlı gelişen hiperintens dentat nukleus gözlemleme sıklığı düşüktü. Sonuç: Gadolinyum birikimi çalışmaları, radyologların MR görüntüleme pratiğini ve yaklaşımını, çoğunlukla makrosiklik gadolinyum ajanlarina geçiş ve gadolinyum kullanımını azaltmak suretiyle etkilemiştir. Bu değişiklikler, radyologların bireysel koşullarına göre değişiklik göstermektedir.

Anahtar Kelimeler:

Gadolinyum, manyetik rezonans görüntüleme, anketler, radyoloji uzmanları, serebellar çekirdekler

GADOLINIUM RETENTION IN HUMANS: SURVEY OF RADIOLOGISTS AND IMPACT ON DAILY PRACTICE

Objective: We sought to assess the 1) awareness and impact of emerging gadolinium retention data on preferences of radiologists in their practice, and 2) factors that influence the attitudes about gadolinium use and risk. This study also documents various specifics of radiology practice in Turkey. Methods: A twenty-one question survey was directed to radiologists who were at least one year from completion of residency and/or fellowship training. A survey link was emailed to the members of the Turkish Society of Radiology and was active for four weeks. The results were statistically analyzed. Results: Three hundred and thirty-five radiologists completed the survey. At the time of this survey, 89% of respondents were aware of gadolinium retention in the brain. Forty-five percent of respondents said they decreased the amount of gadolinium administered and/or frequency of gadolinium-enhanced scans since the emergence of the gadolinium retention data. Eightyeight percent of radiologists, who were aware of the molecular classification of different gadolinium agents, used a macrocyclic agent. Thirty-nine percent (n=130) had switched to a macrocyclic agent from a linear agent within the previous three years. Radiologists’ attitudes toward gadolinium retention were significantly associated with their background factors such as experience in radiology, subspecialty training, and daily work definition, amongst others. Observence of hyperintense dentate nuclei due to gadolinium retention was uncommon in daily practice. Conclusions: Gadolinium retention publications have affected the practice of contrast enhanced Magnetic resonance imaging (MRI) scans, mostly in the form of switching to a macrocyclic gadolinium agent and decreasing utilization of gadolinium in general for some indications. These changes varied among radiologists by background factors.

Keywords:

Gadolinium, magnetic resonance imaging, surveys and questionnaires, radiologists, cerebellar nuclei,

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