Gadolinium deposition within the paediatric brain: no increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of a minimum of four doses of the macrocyclic agent gadobutrol

Abstract

Objectives

To determine whether repeated administration of the macrocyclic gadolinium-based contrast agent (GBCA) gadobutrol in children is associated with T1-weighted hyperintensity within the dentate nucleus, an imaging surrogate for gadolinium deposition.

Methods

With institutional review board approval, we identified a cohort of eight patients aged 18 years or younger who underwent at least four gadobutrol-enhanced magnetic resonance imaging (MRI) examinations of the brain from 2013 to 2017. For comparison, we identified a cohort of 19 patients who underwent at least four gadopentetate dimeglumine-enhanced MRI examinations. For each examination, both dentate nuclei were contoured on unenhanced images; the mean dentate-to-pons signal intensity (DN-P SI) ratio was calculated. DN-P SI ratios from the first and last MRI exams were compared using Wilcoxon signed ranks tests and linear regression analyses.

Results

In the gadobutrol cohort, there was no significant change in the mean DN-P SI ratio from the first to the last scan (1.02 vs 1.02, p = 1.00). In the gadopentetate dimeglumine cohort, there was a significant increase in the mean DN-P SI ratio from the first to the last scan (1.05 vs 1.13, p = 0.003). After controlling for potentially confounding variables, the change in DN-P SI ratio from the first to the last scan was significantly lower for patients in the gadobutrol group than in the gadopentetate dimeglumine group (β = -0.08, p = 0.04).

Conclusions

Repeated administration of the macrocyclic GBCA gadobutrol in children was not associated with T1-weighted dentate hyperintensity, while the repeated administration of the linear GBCA gadopentetate dimeglumine was associated with T1-weighted dentate hyperintensity, presumably due to gadolinium deposition.

Key Points

• Gadolinium-based contrast agents are routinely used in magnetic resonance imaging.

• Repeated administration of the macrocyclic agent gadobutrol in children was not associated with T1-weighted dentate hyperintensity.

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Abbreviations

DN-P SI:

Dentate-to-pons signal intensity

GBCA:

Gadolinium-based contrast agent

MP-RAGE:

Magnetisation preparation rapid acquisition gradient-echo

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Funding

The authors state that this work has not received any funding.

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Authors

Corresponding author

Correspondence to Jonathan R. Young.

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Guarantor

The scientific guarantor of this publication is Whitney B. Pope, MD, PhD.

Conflict of interest

Whitney B. Pope, MD, PhD, is a consultant for Guerbet and Bracco.

Statistics and biometry

One of the authors, Hyun J. Kim, PhD, has significant statistical expertise.

Informed consent

Written informed consent was waived by the institutional review board.

Ethical approval

Institutional review board approval was obtained.

Methodology

• retrospective

• performed at one institution

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Young, J.R., Qiao, J., Orosz, I. et al. Gadolinium deposition within the paediatric brain: no increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of a minimum of four doses of the macrocyclic agent gadobutrol. Eur Radiol 28, 4882–4889 (2018). https://doi.org/10.1007/s00330-018-5464-5

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Keywords

  • Gadolinium
  • Contrast media
  • Magnetic resonance imaging
  • Cerebellar nuclei
  • Paediatrics