Dentate nucleus T1 hyperintensity: is it always gadolinium all that glitters?
- 277 Downloads
In the last few years, several scientific papers and reports have demonstrated magnetic resonance (MR) signal intensity (SI) changes on pre-contrast T1-weighted images following multiple gadolinium-based contrast agents (GBCA) administrations, particularly following the exposure to linear GBCAs. Pathological animal and human post-mortem studies have confirmed the relationship between this radiological finding and the presence of gadolinium accumulation in vulnerable brain regions in patients with normal renal function. In this short communication, we report the case of a 15-year-old patient affected by b-cell acute lymphoblastic leukemia (bALL) who developed a hyperintense signal in the dentate nuclei following multiple administrations of a macrocyclic GBCA. The purpose of this report is to discuss possible differential diagnoses of this radiological finding with special focus on the differentiation between iron or manganese accumulation, post-irradiation changes and GBCA-related Gd deposition, highlighting the importance of the acquisition of accurate clinical data to improve our scientific knowledge.
KeywordsGBCA Gadolinium Dentate Nucleus MRI Macrocyclic
Compliance with ethical standards
Conflict of interest
Author L.P declares that he has no conflict of interest. Author M.C.R.E. declares that she has no conflict of interest. Author A.N. declares that he has no conflict of interest. Author D.L. declares that she has no conflict of interest. Author A.B. declares that she has no conflict of interest. Author E.V. declares that he has no conflict of interest. Author P.T. declares that he has no conflict of interest.
This article does not contain any studies with animals performed by any of the authors. Due to the typology of the report, the ethical approval was considered unnecessary.
Informed consent was obtained from all individual participants (or next of kin) included in the study.
- 7.Frenzel T, Apte C, Jost G, Schöckel L, Lohrke J, Pietsch H (2017) Quantification and assessment of the chemical form of residual gadolinium in the brain after repeated administration of gadolinium-based contrast agents: comparative study in rats. Invest Radiol 52:396–404. https://doi.org/10.1097/rli.0000000000000352. [Epub ahead of print]
- 9.McDonald RJ, McDonald JS, Kallmes DF et al (2017) Gadolinium deposition in human brain tissues after contrast-enhanced MR imaging in adult patients without intracranial abnormalities. Radiology 27:161595. https://doi.org/10.1148/radiol.2017161595. [Epub ahead of print]
- 10.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. https://doi.org/10.1007/s00247-017-3874-38 CrossRefPubMedGoogle Scholar
- 22.European Medicines Agency-Human medicines-Gadolinium-containing contrast agents. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/gadolinium_contrast_agents_31/Recommendation_provided_by_Pharmacovigilance_Risk_Assessment_Committee/WC500223161.pdf. Accessed 29 March 2017
- 23.American College of Radiology (ACR) response to European PRAC recommendation. Available at: https://www.acr.org/About-Us/Media-Center/Press-Releases/2017-Press-Releases/20170404-ACR-Response-to-the-European-PRAC-Recommendations. Accessed 29 March 2017
- 24.U.S. Food & Drug Administration (FDA) statement on brain Gd retention. Available at: https://www.fda.gov/Drugs/DrugSafety/ucm559007.htm. Accessed 29 March 2017
- 25.European Medicines Agency-Human medicines-PRAC confirms restrictions on the use of linear gadolinium agents. http://www.ema.europa.eu/docs/en_GB/document_library/Referrals_document/gadolinium_contrast_agents_31/Recommendation_provided_by_Pharmacovigilance_Risk_Assessment_Committee/WC500230928.pd