Effects of serial macrocyclic-based contrast materials gadoterate meglumine and gadobutrol administrations on gadolinium-related dentate nuclei signal increases in unenhanced T1-weighted brain: a retrospective study in 158 multiple sclerosis (MS) patients
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To perform T1 signal intensity (SI) measurements in the dentate nuclei of adult patients with confirmed multiple sclerosis (MS) after serial administrations of the macrocyclic gadolinium-based contrast agents (GBCAs), gadoterate meglumine and gadobutrol.
Materials and methods
This retrospective study was approved by the institutional review board and informed consent was waived. A review of our PACS database for the period from March 1, 2007 to July 31, 2016 revealed 158 confirmed MS patients who received exclusively either gadoterate meglumine (n = 81) or gadobutrol (n = 77) for diagnosis and follow-up. SI measurements on unenhanced T1-weighted images were performed on all scans of all patients and at regions of interest (ROIs) positioned on the dentate nucleus (DN) and pons. The dentate nucleus-to-pons (DNP) T1-SI ratio was subsequently calculated. Unpaired T test and regression analysis were used to evaluate statistical differences.
An increase in DNP was noted between the first and last MR examinations for both gadoterate meglumine (0.0032 ± 0.0216) and gadobutrol (0.0019 ± 0.0346). Although the differences were not statistically significant based across the entire patient population, visible T1 hyperintensity in the DN was noted in approximately one-third of all patients in each group that received at least five administrations of either GBCA.
SI increases on unenhanced T1-weighted images possibly indicative of gadolinium retention occur after serial administrations of the macrocyclic GBCAs, gadoterate meglumine and gadobutrol.
KeywordsGadolinium MRI Multiple sclerosis Gadolinium-related dentate nuclei signal
Author contribution statement
Dr. Splendiani is the principal investigator. Other authors have equally contributed in drafting/revising the manuscript for content, including medical writing for content, study concept or design, and analysis or interpretation of data.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
Ethical standards and patient consent
We declare that all human and studies have been approved by the local ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. We declare that all patients gave informed consent prior to inclusion in this study.
- 2.Errante Y, Cirimele V, Mallio CA, Di Lazzaro V, Zobel BB, Quattrocchi CC (2014) Progressive increase of T1 signal intensity of the dentate nucleus on unenhanced magnetic resonance images is associated with cumulative doses of intravenously administered gadodiamide in patients with normal renal function, suggesting dechelation. Invest Radiol 49:685–690CrossRefPubMedGoogle Scholar
- 12.Ramalho J, Semelka RC, AlObaidy M, Ramalho M, Nunes RH, Castillo M (2016) Signal intensity change on unenhanced T1-weighted images in dentate nucleus following gadobenate dimeglumine in patients with and without previous multiple administrations of gadodiamide. Eur Radiol 26:4080–4088CrossRefPubMedGoogle Scholar
- 17.Stojanov DA, Aracki-Trenkic A, Vojinovic S, Benedeto-Stojanov D, Ljubisavljevic S (2016) Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1 W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol. Eur Radiol 26:807–815CrossRefPubMedGoogle Scholar
- 18.Rossi Espagnet MC, Bernardi B, Pasquini L, Figà-Talamanca L, Tomà P, Napolitano A (2017) Signal intensity at unenhanced T1-weighted magnetic resonance in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in children. Pediatr Radiol. 2017 May 19. [Epub ahead of print]. Erratum in: Pediatr RadiolGoogle Scholar
- 19.Maeda H, Sato M, Yoshikawa A, Kimura M, Sonomura T, Terada M, Kishi K (1997) Brain MR imaging in patients with hepatic cirrhosis: relationship between high intensity signal in basal ganglia on T1-weighted images and elemental concentrations in brain. Neuroradiology 39:546–550CrossRefPubMedGoogle Scholar
- 28.Rossi Espagnet M, Tomà P, Napolitano A (2017) Reply to Lancelot et al.: ‘lack of evidence of a relationship between magnetic resonance signal intensity changes in the globus pallidus and dentate nucleus, and repeated administrations of gadoterate meglumine in children. Pediatr Radiol. doi: 10.1007/s00247-017-3948-0 Google Scholar
- 33.Eisele P, Szabo K, Alonso A et al (2017) Lack of T1 hyperintensity in the dentate nucleus after 15 administrations of a macrocyclic contrast agent in multiple sclerosis. J Neurol Neurosurg Psychiatry. [Epub ahead of print]Google Scholar
- 36.Splendiani A, Felli V, Di Sibio A, Gennarelli A, Patriarca L, Stratta P, Di Cesare E, Rossi A, Massimo G (2016) Magnetic resonance imaging and magnetic resonance spectroscopy in a young male patient with anti-N-methyl-D-aspartate receptor encephalitis and uncommon cerebellar involvement: a case report with review of the literature. Neuroradiol J 29:30–35CrossRefPubMedGoogle Scholar
- 37.Marsecano C, Perri M, Michelini G, Varrassi M, Splendiani A, Di Cesare E, Masciocchi C, Gallucci M (2015) Vascular malformation mimicking multiple sclerosis active plaque: usefulness of susceptibility weighted imaging (SWI) to perform correct diagnosis. Neuroradiol J 28:488–492CrossRefPubMedPubMedCentralGoogle Scholar
- 39.Felli V, Di Sibio A, Anselmi M, Gennarelli A, Sucapane P, Splendiani A, Catalucci A, Marini C, Gallucci M (2014) Progressive multifocal leukoencephalopathy following treatment with rituximab in an HIV-negative patient with non-hodgkin lymphoma: a case report and literature review. Neuroradiol J 27:657–664CrossRefPubMedPubMedCentralGoogle Scholar
- 42.Levey AS, Stevens LA, Schmid CH, Zhang YL, Castro AF 3rd, Feldman HI, Kusek JW, Eggers P, Van Lente F, Greene T, Coresh J, CKD-EPI (Chronic Kidney Disease Epidemiology Collaboration) (2009) A new equation to estimate glomerular filtration rate. Ann Intern Med 150(9):604–612CrossRefPubMedPubMedCentralGoogle Scholar
- 48.Lauenstein T, Ramirez-Garrido F, Kim YH et al (2015) Nephrogenic systemic fibrosis risk after liver magnetic resonance imaging with gadoxetate disodium in patients with moderate to severe renal impairment: results of a prospective, open-label, multicenter study. Invest Radiol 50:416–422CrossRefPubMedPubMedCentralGoogle Scholar
- 49.Martin DR, Kalb B, Mittal A, Salman K, Vedantham S, Mittal PK (2017) No incidence of nephrogenic systemic fibrosis after gadobenate dimeglumine administration in patients undergoing dialysis or those with severe chronic kidney disease. Radiology 21:170102 (Epub ahead of print) Google Scholar