Review of strategies to reduce the contamination of the water environment by gadolinium-based contrast agents.

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.

The role of gadolinium-based contrast agents in magnetic resonance imaging structured reporting and data systems (RADS).

Among the 28 reporting and data systems (RADS) available in the literature, we identified 15 RADS that can be used in Magnetic Resonance Imaging (MRI). Performing examinations without using gadolinium-based contrast agents (GBCA) has benefits, but GBCA administration is often required to achieve an early and accurate diagnosis. The aim of the present review is to summarize the current role of GBCA in MRI RADS. This overview suggests that GBCA are today required in most of the current RADS and are expected to be used in most MRIs performed in patients with cancer. Dynamic contrast enhancement is required for correct scores calculation in PI-RADS and VI-RADS, although scientific evidence may lead in the future to avoid the GBCA administration in these two RADS. In Bone-RADS, contrast enhancement can be required to classify an aggressive lesion. In RADS scoring on whole body-MRI datasets (MET-RADS-P, MY-RADS and ONCO-RADS), in NS-RADS and in Node-RADS, GBCA administration is optional thanks to the intrinsic high contrast resolution of MRI. Future studies are needed to evaluate the impact of the high T1 relaxivity GBCA on the assignment of RADS scores.

Skin Toxicity After Exposure to Gadolinium-Based Contrast Agents in Normal Renal Function, Using Clinical Approved Doses: Current Status of Preclinical and Clinical Studies.

OBJECTIVES: The aim of this study was to summarize the current preclinical and clinical evidence on the association between exposure to gadolinium (Gd) compounds and skin toxicity in a setting similar to clinical practice. MATERIALS AND METHODS: A search of MEDLINE and PubMed references from January 2000 to December 2022 was performed using keywords related to gadolinium deposition and its effects on the skin, such as "gadolinium," "gadolinium-based contrast agents," "skin," "deposition," and "toxicity." In addition, cross-referencing was added when appropriate. For preclinical in vitro studies, we included all the studies that analyzed the response of human dermal fibroblasts to exposure to various gadolinium compounds. For preclinical animal studies and clinical studies, we included only those that analyzed animals or patients with preserved renal function (estimated glomerular filtration rate >30 mL/min/1.73 m 2 ), using a dosage of gadolinium-based contrast agents (GBCAs) similar to that commonly applied (0.1 mmol/kg). RESULTS: Forty studies were selected. Preclinical findings suggest that Gd compounds can produce profibrotic responses in the skin in vitro, through the activation and proliferation of dermal fibroblasts and promoting their myofibroblast differentiation. Gadolinium influences the process of collagen production and the collagen content of skin, by increasing the levels of matrix metalloproteinase-1 and tissue inhibitor of metalloproteinase-1. Preclinical animal studies show that Gd can deposit in the skin with higher concentrations when linear GBCAs are applied. However, these deposits decrease over time and are not associated with obvious macroscopic or histological modifications. The clinical relevance of GBCAs in inducing small fiber neuropathy remains to be determined. Clinical studies show that Gd is detectable in the skin and hair of subjects with normal renal function in higher concentrations after intravenous administration of linear compared with macrocyclic GBCA. However, these deposits decrease over time and are not associated with cutaneous or histological modifications. Also, subclinical dermal involvement related to linear GBCA exposure may be detectable on brain MRI. There is no conclusive evidence to support a causal relationship between GBCA administration at the clinical dose and cutaneous manifestations in patients with normal renal function. CONCLUSIONS: Gadolinium can produce profibrotic responses in the skin, especially acting on fibroblasts, as shown by preclinical in vitro studies. Gadolinium deposits are detectable in the skin even in subjects with normal renal function with higher concentrations when linear GBCAs are used, as confirmed by both preclinical animal and human studies. There is no proof to date of a cause-effect relationship between GBCA administration at clinical doses and cutaneous consequences in patients with normal renal function. Multiple factors, yet to be determined, should be considered for sporadic patients with normal renal function who develop clinical skin manifestations temporally related to GBCA administration.

Tackling the increasing contamination of the water supply by iodinated contrast media.

Contrast media are essential for diagnostic and interventional procedures. Iodinated contrast media are the most commonly used agents, with CT requiring the largest overall quantities. Data show that these iodinated contrast media are found in sewage water, surface water and drinking water in many regions in the world. Because standard drinking water purification techniques only provide poor to moderate removal of iodinated contrast media, these substances pose a problem for drinking water preparation that has not yet been solved. There is a growing body of evidence supporting the negative environmental effects of iodinated contrast media via their breakdown products. The environmental impact of iodinated contrast media can be mitigated by measures focusing on the application of contrast media or the excretion of contrast media. Measures with respect to contrast application include reducing the utilization of contrast media, reducing the waste of contrast media and collecting residues of contrast media at the point of application. The amount of contrast media excreted into the sewage water can be decreased by introducing urine bags and/or special urine collection and waste-water processing techniques in the hospital. To tackle the problem of contrast media in the water system in its entirety, it is necessary for all parties involved to cooperate, from the producer of contrast medium to the consumer of drinking water. This paper aims to make health professionals aware of the opportunity to take the lead now in more conscious decisions regarding use of contrast media and gives an overview of the different perspectives for action.

Extraction tools for identification of chemical contaminants in estuarine and coastal waters to determine toxic pressure on primary producers.

The extent to which chemical stressors affect primary producers in estuarine and coastal waters is largely unknown. However, given the large number of legacy pollutants and chemicals of emerging concern present in the environment, this is an important and relevant issue that requires further study. The purpose of our study was to extract and identify compounds which are inhibitors of photosystem II activity in microalgae from estuarine and coastal waters. Field sampling was conducted in the Western Scheldt estuary (Hansweert, The Netherlands). We compared four different commonly used extraction methods: passive sampling with silicone rubber sheets, polar organic integrative samplers (POCIS) and spot water sampling using two different solid phase extraction (SPE) cartridges. Toxic effects of extracts prepared from spot water samples and passive samplers were determined in the Pulse Amplitude Modulation (PAM) fluorometry bioassay. With target chemical analysis using LC-MS and GC-MS, a set of PAHs, PCBs and pesticides was determined in field samples. These compound classes are listed as priority substances for the marine environment by the OSPAR convention. In addition, recovery experiments with both SPE cartridges were performed to evaluate the extraction suitability of these methods. Passive sampling using silicone rubber sheets and POCIS can be applied to determine compounds with different structures and polarities for further identification and determination of toxic pressure on primary producers. The added value of SPE lies in its suitability for quantitative analysis; calibration of passive samplers still needs further investigation for quantification of field concentrations of contaminants.

Identification strategy for unknown pollutants using high-resolution mass spectrometry: androgen-disrupting compounds identified through effect-directed analysis.

Effect-directed analysis has been applied to a river sediment sample of concern to identify the compounds responsible for the observed effects in an in vitro (anti-)androgenicity assay. For identification after non-target analysis performed on a high-resolution LTQ-Orbitrap, we developed a de novo identification strategy including physico-chemical parameters derived from the effect-directed analysis approach. With this identification strategy, we were able to handle the immense amount of data produced by non-target accurate mass analysis. The effect-directed analysis approach, together with the identification strategy, led to the successful identification of eight androgen-disrupting compounds belonging to very diverse compound classes: an oxygenated polyaromatic hydrocarbon, organophosphates, musks, and steroids. This is one of the first studies in the field of environmental analysis dealing with the difficult task of handling the large amount of data produced from non-target analysis. The combination of bioassay activity assessment, accurate mass measurement, and the identification and confirmation strategy is a promising approach for future identification of environmental key toxicants that are not included as priority pollutants in monitoring programs.

Comparing the sensitivity of algal, cyanobacterial and bacterial bioassays to different groups of antibiotics.

Antibiotics may affect both primary producers and decomposers, potentially disrupting ecosystem processes. Hence, it is essential to assess the impact of antibiotics on aquatic ecosystems. The aim of the present study was therefore to evaluate the potential of a recently developed test for detecting antibiotics in animal tissue, the Nouws Antibiotic Test (NAT), as a sensitive bioassay to assess the effects of antibiotics in water. To this purpose, we determined the toxicity of sulphamethoxazole, trimethoprim, flumequine, tylosin, streptomycin, and oxytetracycline, using the NAT adapted for water exposure. The sensitivity of the NAT was compared to that of bioassays with bacteria (Microtox), cyanobacteria and green algae. In the Microtox test with Vibrio fischeri as test organism, no effects were observed for any of the test compounds. For three of the six antibiotics tested, the cyanobacteria were more vulnerable than the green algae when using photosynthetic efficiency as an endpoint. The lowest EC50 values for four out of six tested antibiotics were obtained using the NAT bacterial bioassay. The bacterial plate system responded to antibiotics at concentrations in the microgL(-1) and lower mgL(-1) range and, moreover, each plate proved to be specifically sensitive to the antibiotics group it was designed for. It is concluded that the NAT bioassay adapted for water exposure is a sensitive test to determine the presence of antibiotics in water. The ability of this test to distinguish five major antibiotic groups is a very strong additional value.

PAH biotransformation in terrestrial invertebrates--a new phase II metabolite in isopods and springtails.

Soil-living invertebrates are exposed to high concentrations of contaminants accumulating in dead organic matter, such as polycyclic aromatic hydrocarbons (PAHs). The capacity for PAH biotransformation is not equally developed in all invertebrates. In this paper, we compare three species of invertebrates, Porcellio scaber (Isopoda), Eisenia andrei (Lumbricidae) and Folsomia candida (Collembola), for the metabolites formed upon exposure to pyrene. Metabolic products of pyrene biotransformation in extracts from whole animals or isopod hepatopancreas were compared to those found in fish bile (flounder and plaice). An optimized HPLC method was used with fluorescence detection; excitation/emission spectra were compared to reference samples of 1-hydroxypyrene and enzymatically synthesized conjugates. Enzymatic hydrolysis after fractionation was used to demonstrate that the conjugates originated from 1-hydroxypyrene. All three invertebrates were able to oxidize pyrene to 1-hydroxypyrene, however, isopods and collembolans stood out as more efficient metabolizers compared to earthworms. In contrast to fish, none of the invertebrates produced pyrene-1-glucuronide as a phase II conjugate. Both Collembola and Isopoda produced significant amounts of pyrene-1-glucoside, whereas isopods also produced pyrene-1-sulfate. A third, previously unknown, conjugate was found in both isopods and springtails, and was analysed further using electrospray and atmospheric pressure chemical ionisation mass spectrometry. Based on the obtained mass spectra, a new conjugate is proposed: pyrene-1-O-(6"-O-malonyl)glucoside. The use of glucose-malonate as a conjugant in animal phase II biotransformation has not been described before, but is understandable in the microenvironment of soil-living invertebrates. In the earthworm, three other pyrene metabolites were observed, none of which was shared with the arthropods, although two were conjugates of 1-hydroxypyrene. Our study illustrates the great variety of the still unexplored metabolic diversity of invertebrate xenobiotic metabolism.

Tenax extraction mimics benthic and terrestrial bioavailability of organic compounds.

Biota to sediment accumulation factors (BSAFs) are widely used to describe the potential accumulation of organic contaminants in organisms. From field studies it is known that these BSAFs can vary dramatically between sediments of different origin, which is possibly explained by the variation in bioavailability of organic contaminants in sediments. In the present study it is shown that the variability in BSAF values for different sediment samples obtained at two Dutch freshwater sites could largely be explained by the variation in Tenax-extractable concentrations in these sediments. Variations of a factor of about 50 could be explained. The ratio between concentrations in biota and Tenax-extractable concentrations in sediment varied slightly between sediments and contaminant class, but was close to the theoretically expected value of 2. This is a strong indication that Tenax-extractable concentrations of contaminants in sediments are an excellent indicator of available concentrations.

Pyrene biotransformation products as biomarkers of polycyclic aromatic hydrocarbon exposure in terrestrial Isopoda: concentration-response relationship, and field study in a contaminated forest.

In this study, biotransformation products of pyrene were measured in the hepatopancreas of terrestrial isopods as biomarkers of polycyclic aromatic hydrocarbon (PAH) exposure. These products--pyrene-1-glucoside, pyrene-1-sulfate, an unknown pyrene conjugate, and 1-hydroxypyrene--were quantitated using high-performance liquid chromatography (HPLC) with fluorescence detection. In a controlled exposure experiment, a linear relationship was established between pyrene exposure and pyrene metabolite concentrations in the hepatopancreas of Porcellio scaber Latr. To this end, isopods of the species P. scaber were exposed to a range of pyrene concentrations spiked to their food. A linear response was found for all pyrene conjugates in the range 0.67 to 67 microg/g of pyrene (dry wt). Hepatopancreatic pyrene metabolite concentrations were also measured in isopods (P. scaber and Oniscus asellus L.) from PAH-contaminated field sites. The sites and the inhabiting isopods were located in a gradient of atmospheric PAH deposition caused by a nearby blast furnace plant. The highest levels of conjugated 1-hydroxypyrene in the hepatopancreas were 3.8 pmol/g fresh weight (pyrene-1-glucoside) and 2.8 pmol/g fresh weight (pyrene-1-sulfate) (expressed on whole-body basis). The levels of the pyrene metabolites correlate with reported pyrene concentrations in spite of these sites. As pyrene is one of the most predominant PAHs, analysis of its metabolites provides a good tool for environmental risk assessment of ecosystems with regard to PAH exposure, bioavailability, and biotransformation.

Metabolism of 1-fluoropyrene and pyrene in marine flatfish and terrestrial isopods.

Monofluorinated polycyclic aromatic hydrocarbons (F-PAHs) are useful reference compounds for a broad spectrum of PAH studies. The pyrene metabolite 1-hydroxypyrene is often used as a biomarker of PAH exposure. Two species, isopod (Porcellio scaber) and flatfish (Platichthys flesus), that produce 1-hydroxypyrene as the major intermediary metabolite and have distinct phase-II conjugates, were selected to investigate the cytochrome P450 catalyzed metabolism of 1-fluoropyrene. The fluorine atom blocks one of the four most favored carbon atoms, yielding different metabolite patterns and the results obtained in the selected species were compared with metabolite profiles obtained for unsubstituted pyrene. Charge densities in 1-fluoropyrene measured with (13)C-NMR were used to predict possible positions of hydroxylation, which were confirmed by (19)F-NMR. Additionally, the retention behaviour of conjugated 1-fluoropyrene metabolite isomers in reversed-phase liquid chromatography on a polymeric alkyl-bonded phase was interpreted based on the slot model. Whereas three phase-I metabolites were found in isopod hepatopancreas, only two were observed in flatfish bile. Phase-II metabolism appeared unaffected by the fluorine substituent. It was concluded that the phase-I enzyme cytochrome P450 is non-regioselective in the isopod: the activation is mostly influenced by the electron density distribution. In contrast, the enzymatic oxidation in the flounder is more selective. These differences will affect to what extent pyrene metabolite measurements can be used to assess the impact of PAHs to different species.

Pyrene metabolites in the hepatopancreas and gut of the isopod porcellio scaber, a new biomarker for polycyclic aromatic hydrocarbon exposure in terrestrial ecosystems.

The object of this study was to investigate the formation of pyrene metabolites by the isopod Porcellio scaber as a possible tool in the environmental risk assessment of polycyclic aromatic hydrocarbon (PAH) exposure in terrestrial ecosystems. The formation of pyrene metabolites was studied after either pulse exposure to a single high dose, or prolonged exposure (14 d) to a lower dosage. Exposure studies were carried out with unlabeled or radiolabeled pyrene, ion pair chromatography was used for analysis, and reference conjugates were synthesized. We also measured pyrene metabolites in field-exposed animals, to explore their use as biomarkers of PAH exposure. Analysis of the hepatopancreas and gut of single isopods revealed the formation of five products, one of which was 1-hydroxypyrene. Four of the remaining products were identified as phase II metabolites of 1- hydroxypyrene, with UV absorption and fluorescence characteristics similar to that of pyrene. One metabolite was identified as pyrene-1-glucoside, which is in accordance with high rates of glucosidation, reported for these isopods. Another conjugate was identified as pyrene-1-sulfate. None of the metabolites coeluted with a pyrene-1-glucuronide reference obtained from fish bile. A fifth metabolite detected by on-line scintillation detection did not exhibit any absorption at 340 nm, possibly because one of the aromatic rings of pyrene had lost its aromatic character. Although pyrene is not known for its toxicity, it usually co-occurs with other PAHs that are transformed into toxic products. Investigating the metabolism of pyrene can provide information with regard to the biotransformation capacity of invertebrate species and uptake and elimination kinetics. Because pyrene is one of the most predominant PAHs in the environment, analysis of its metabolites provides an extra tool for the environmental risk assessment of ecosystems with regard to PAH exposure, bioavailability, and biotransformation.