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European Radiology

, Volume 29, Issue 8, pp 3959–3967 | Cite as

Standardized assessment of the signal intensity increase on unenhanced T1-weighted images in the brain: the European Gadolinium Retention Evaluation Consortium (GREC) Task Force position statement

  • Carlo C. QuattrocchiEmail author
  • Joana Ramalho
  • Aart J. van der Molen
  • Àlex Rovira
  • Alexander Radbruch
  • on behalf of the GREC, European Gadolinium Retention Evaluation Consortium and the ESNR, European Society of Neuroradiology
Contrast Media

Abstract

After the initial report in 2014 on T1-weighted (T1w) hyperintensity of deep brain nuclei following serial injections of linear gadolinium-based contrast agents (GBCAs), a multitude of studies on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain have been published. The vast majority of these studies found a signal intensity (SI) increase for linear GBCAs in the brain—first and foremost in the dentate nucleus—while no SI increase was found for macrocyclic GBCAs. However, the scientific debate about this finding is kept alive by the fact that SI differences do not unequivocally represent the amount of gadolinium retained. Since the study design of the SI measurement in various brain structures is relatively simple, MRI studies investigating gadolinium-dependent T1w hyperintensity are currently conducted at multiple institutions worldwide. However, methodological mistakes may result in flawed conclusions. In this position statement, we assess the methodological basis of the published retrospective studies and define quality standards for future studies to give guidance to the scientific community and to help identify studies with potentially flawed methodology and misleading results.

Key Points

• A multitude of studies has been published on the potential of the marketed GBCAs to cause T1w hyperintensity in the brain.

The gadolinium-dependent T1w hyperintensity in the brain depends on patient’s history, types of GBCAs used (i.e., linear vs. macrocyclic GBCAs) and MR imaging setup and protocols.

Quality standards for the design of future studies are needed to standardize methodology and avoid potentially misleading results from retrospective studies.

Keywords

Contrast media Gadolinium Magnetic resonance imaging Dentate nucleus 

Abbreviations

ACR

American College of Radiology

DN

Dentate nucleus

EMA

European Medicine Agency

ESUR

European Society of Urogenital Radiology

FDA

Food and Drug Administration

GBCA

Gadolinium-based contrast agent

GP

Globus pallidus

GREC

Gadolinium Retention Evaluation Consortium

NSF

Nephrogenic systemic fibrosis

SI

Signal intensity

T1w

T1-weighted

Notes

Funding

The GREC Task Force is an independent, voluntary body. No funding supported this work.

Compliance with ethical standards

Guarantor

The scientific guarantor of this publication is Carlo C. Quattrocchi, Departmental Faculty of Medicine and Surgery, Head of the Unit of Diagnostic Imaging and Interventional Radiology, Università Campus Bio-Medico di Roma, Rome, Italy.

Conflict of interest

The authors of this manuscript declare relationships with the following companies:

C.C. Quattrocchi has received speaker honoraria from Bayer Healthcare; has organized the 1st and 2nd European GREC meetings in 2016 and 2017 sponsored by Bayer, Bracco, GE, and Guerbet.

J. Ramalho has organized the 2nd European GREC meeting sponsored by Bayer, Bracco, GE and Guerbet.

A. J. van der Molen has received chairman honoraria from Guerbet; has organized the 1st and 2nd European GREC meetings in 2016 and 2017 sponsored by Bayer, Bracco, GE, and Guerbet.

À. Rovira serves on scientific advisory boards for Novartis, Sanofi-Genzyme, Icometrix, SyntheticMR, and OLEA Medical, and has received speaker honoraria from Bayer Healthcare, Sanofi-Genzyme, Bracco, Merck-Serono, Teva Pharmaceutical Industries Ltd., Novartis, Roche, and Biogen Idec.

A. Radbruch: Bayer (invited talks, study funding, consultancy, advisory boards), Bracco (advisory board), Guerbet (invited talks, study funding, consultancy), GE (advisory board).

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was not required for this study because no original data were produced.

Ethical approval

Institutional Review Board approval was not required because the paper is a recommendation statement and experiments were not performed.

Methodology

International consensus statement on methodological recommendations on clinical studies

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Copyright information

© European Society of Radiology 2018

Authors and Affiliations

  • Carlo C. Quattrocchi
    • 1
    Email author
  • Joana Ramalho
    • 2
  • Aart J. van der Molen
    • 3
  • Àlex Rovira
    • 4
  • Alexander Radbruch
    • 5
  • on behalf of the GREC, European Gadolinium Retention Evaluation Consortium and the ESNR, European Society of Neuroradiology
  1. 1.Unit of Diagnostic Imaging and Interventional Radiology, Departmental Faculty of Medicine and SurgeryUniversità Campus Bio-Medico di RomaRomeItaly
  2. 2.Department of NeuroradiologyCentro Hospitalar de Lisboa CentralLisbonPortugal
  3. 3.Department of RadiologyC2-S, Leiden University Medical CenterLeidenThe Netherlands
  4. 4.Section of Neuroradiology Vall d’Hebron University HospitalBarcelonaSpain
  5. 5.Department of Radiology, German Cancer Research Center (DKFZ)HeidelbergGermany

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