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

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.

This is a preview of subscription content, log in to check access.

Fig. 1

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

References

  1. 1.

    Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D (2014) High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology 270:834–841

    Article  Google Scholar 

  2. 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 49:685–690

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Kanda T, Osawa M, Oba H et al (2015) High signal intensity in dentate nucleus on unenhanced T1-weighted MR images: association with linear versus macrocyclic gadolinium chelate administration. Radiology 275:803–809

    Article  Google Scholar 

  4. 4.

    Quattrocchi CC, Mallio CA, Errante Y et al (2015) Gadodiamide and dentate nucleus T1 Hyperintensity in patients with meningioma evaluated by multiple follow-up contrast-enhanced magnetic resonance examinations with no systemic interval therapy. Invest Radiol 50:470–472

    Article  PubMed  Google Scholar 

  5. 5.

    Radbruch A, Weberling LD, Kieslich PJ et al (2015) Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology 275:783–791

    Article  Google Scholar 

  6. 6.

    Miller JH, Hu HH, Pokorney A, Cornejo P, Towbin R (2015) MRI brain signal intensity changes of a child during the course of 35 gadolinium contrast examinations. Pediatrics 136:e1637–e1640

    Article  Google Scholar 

  7. 7.

    Ramalho J, Castillo M, AlObaidy M et al (2015) High signal intensity in globus pallidus and dentate nucleus on unenhanced T1-weighted MR images: evaluation of two linear gadolinium-based contrast agents. Radiology 276:836–844

    Article  Google Scholar 

  8. 8.

    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 T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol. Eur Radiol 26:807–815

    Article  Google Scholar 

  9. 9.

    Adin ME, Kleinberg L, Vaidya D, Zan E, Mirbagheri S, Yousem DM (2015) Hyperintense dentate nuclei on T1-weighted MRI: relation to repeat gadolinium administration. AJNR Am J Neuroradiol 36:1859–1865

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. 10.

    McDonald RJ, McDonald JS, Kallmes DF et al (2015) Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 275:772–782

    Article  Google Scholar 

  11. 11.

    Weberling LD, Kieslich PJ, Kickingereder P et al (2015) Increased signal intensity in the dentate nucleus on unenhanced T1-weighted images after gadobenate dimeglumine administration. Invest Radiol 50:743–748

    Article  CAS  PubMed  Google Scholar 

  12. 12.

    Radbruch A, Weberling LD, Kieslich PJ et al (2015) High-signal intensity in the dentate nucleus and Globus pallidus on unenhanced T1-weighted images: evaluation of the macrocyclic gadolinium-based contrast agent gadobutrol. Invest Radiol 50:805–810

    Article  CAS  PubMed  Google Scholar 

  13. 13.

    Cao Y, Huang DQ, Shih G, Prince MR (2016) Signal change in the dentate nucleus on T1-weighted MR images after multiple administrations of gadopentetate dimeglumine versus gadobutrol. AJR Am J Roentgenol 206:414–419

    Article  Google Scholar 

  14. 14.

    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 26:4080–4088

    Article  Google Scholar 

  15. 15.

    Ramalho J, Ramalho M, AlObaidy M, Nunes RH, Castillo M, Semelka RC (2016) T1 signal-intensity increase in the dentate nucleus after multiple exposures to gadodiamide: intraindividual comparison between 2 commonly used sequences. AJNR Am J Neuroradiol 37(8):1427–1431

    Article  CAS  PubMed  Google Scholar 

  16. 16.

    Tedeschi E, Palma G, Canna A et al (2016) In vivo dentate nucleus MRI relaxometry correlates with previous administration of gadolinium-based contrast agents. Eur Radiol 26(12):4577–4584

    Article  Google Scholar 

  17. 17.

    Roberts DR, Chatterjee AR, Yazdani M et al (2016) Pediatric patients demonstrate progressive T1-weighted hyperintensity in the dentate nucleus following multiple doses of gadolinium-based contrast agent. AJNR Am J Neuroradiol 37(12):2340–2347

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. 18.

    Tanaka M, Nakahara K, Kinoshita M (2016) Increased signal intensity in the dentate nucleus of patients with multiple sclerosis in comparison with neuromyelitis optica spectrum disorder after multiple doses of gadolinium contrast. Eur Neurol 75:195–198

    Article  CAS  PubMed  Google Scholar 

  19. 19.

    Cao Y, Zhang Y, Shih G et al (2016) Effect of renal function on gadolinium-related signal increases on unenhanced T1-weighted brain magnetic resonance imaging. Invest Radiol 51:677–682

    Article  CAS  PubMed  Google Scholar 

  20. 20.

    Hu HH, Pokorney A, Towbin RB, Miller JH (2016) Increased signal intensities in the dentate nucleus and globus pallidus on unenhanced T1-weighted images: evidence in children undergoing multiple gadolinium MRI exams. Pediatr Radiol 46:1590–1598

    Article  Google Scholar 

  21. 21.

    Roberts DR, Holden KR (2016) Progressive increase of T1 signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in the pediatric brain exposed to multiple doses of gadolinium contrast. Brain Dev 38:331–336

    Article  Google Scholar 

  22. 22.

    Khant ZA, Hirai T, Kadota Y et al (2017) T1 shortening in the cerebral cortex after multiple administrations of gadolinium-based contrast agents. Magn Reson Med Sci 16:84–86

    Article  CAS  PubMed  Google Scholar 

  23. 23.

    Eisele P, Alonso A, Szabo K et al (2016) Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis: an observational study. Medicine (Baltimore) 95:e4624

    Article  CAS  Google Scholar 

  24. 24.

    Radbruch A, Weberling LD, Kieslich PJ et al (2016) Intraindividual analysis of signal intensity changes in the dentate nucleus after consecutive serial applications of linear and macrocyclic gadolinium-based contrast agents. Invest Radiol 51:683–690

    Article  CAS  PubMed  Google Scholar 

  25. 25.

    Zhang Y, Cao Y, Shih GL, Hecht EM, Prince MR (2017) Extent of signal hyperintensity on unenhanced T1-weighted brain MR images after more than 35 administrations of linear gadolinium-based contrast agents. Radiology 282:516–525

    Article  Google Scholar 

  26. 26.

    Eisele P, Szabo K, Alonso A et al (2018) Lack of T1 hyperintensity in the dentate nucleus after 15 administrations of a macrocyclic contrast agent in multiple sclerosis. J Neurol Neurosurg Psychiatry 89:324–326

    Article  PubMed  Google Scholar 

  27. 27.

    Schlemm L, Chien C, Bellmann-Strobl J et al (2017) Gadopentetate but not gadobutrol accumulates in the dentate nucleus of multiple sclerosis patients. Mult Scler 23:963–972

    Article  CAS  PubMed  Google Scholar 

  28. 28.

    Radbruch A, Haase R, Kieslich PJ et al (2017) No signal intensity increase in the dentate nucleus on unenhanced T1-weighted MR images after more than 20 serial injections of macrocyclic gadolinium-based contrast agents. Radiology 282:699–707

    Article  Google Scholar 

  29. 29.

    Kuno H, Jara H, Buch K, Qureshi MM, Chapman MN, Sakai O (2017) Global and regional brain assessment with quantitative MR imaging in patients with prior exposure to linear gadolinium-based contrast agents. Radiology 283:195–204

    Article  PubMed  Google Scholar 

  30. 30.

    Bae S, Lee HJ, Han K et al (2017) Gadolinium deposition in the brain: association with various GBCAs using a generalized additive model. Eur Radiol 27:3353–3361

    Article  Google Scholar 

  31. 31.

    Radbruch A, Haase R, Kickingereder P et al (2017) Pediatric brain: no increased signal intensity in the dentate nucleus on unenhanced T1-weighted MR images after consecutive exposure to a macrocyclic gadolinium-based contrast agent. Radiology 283(3):828–836

    Article  Google Scholar 

  32. 32.

    Flood TF, Stence NV, Maloney JA, Mirsky DM (2017) Pediatric brain: repeated exposure to linear gadolinium-based contrast material is associated with increased signal intensity at unenhanced T1-weighted MR imaging. Radiology 282:222–228

    Article  Google Scholar 

  33. 33.

    Langner S, Kromrey ML, Kuehn JP, Grothe M, Domin M (2017) Repeated intravenous administration of gadobutrol does not lead to increased signal intensity on unenhanced T1-weighted images-a voxel-based whole brain analysis. Eur Radiol 27:3687–3693

    Article  Google Scholar 

  34. 34.

    Kahn J, Posch H, Steffen IG et al (2017) Is there long-term signal intensity increase in the central nervous system on T1-weighted images after MR imaging with the hepatospecific contrast agent gadoxetic acid? A cross-sectional study in 91 patients. Radiology 282:708–716

    Article  Google Scholar 

  35. 35.

    Ichikawa S, Motosugi U, Omiya Y, Onishi H (2017) Contrast agent-induced high signal intensity in dentate nucleus on unenhanced T1-weighted images: comparison of gadodiamide and gadoxetic acid. Invest Radiol 52:389–395

    Article  CAS  PubMed  Google Scholar 

  36. 36.

    Conte G, Preda L, Cocorocchio E et al (2017) Signal intensity change on unenhanced T1-weighted images in dentate nucleus and globus pallidus after multiple administrations of gadoxetate disodium: an intraindividual comparative study. Eur Radiol 27:4372–4378

    Article  Google Scholar 

  37. 37.

    Tedeschi E, Cocozza S, Borrelli P, Ugga L, Morra VB, Palma G (2018) Longitudinal assessment of dentate nuclei relaxometry during massive gadobutrol exposure. Magn Reson Med Sci 17:100–104

    Article  CAS  PubMed  Google Scholar 

  38. 38.

    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 47:1345–1352

    Article  Google Scholar 

  39. 39.

    Forslin Y, Shams S, Hashim F et al (2017) Retention of gadolinium-based contrast agents in multiple sclerosis: retrospective analysis of an 18-year longitudinal study. AJNR Am J Neuroradiol 38:1311–1316

    Article  CAS  Google Scholar 

  40. 40.

    Roberts DR, Welsh CA, LeBel DP 2nd, Davis WC (2017) Distribution map of gadolinium deposition within the cerebellum following GBCA administration. Neurology 88:1206–1208

    Article  CAS  PubMed  Google Scholar 

  41. 41.

    Schneider GK, Stroeder J, Roditi G et al (2017) T1 signal measurements in pediatric brain: findings after multiple exposures to gadobenate dimeglumine for imaging of nonneurologic disease. AJNR Am J Neuroradiol 38:1799–1806

    Article  CAS  Google Scholar 

  42. 42.

    Eisele P, Konstandin S, Szabo K et al (2017) Sodium MRI of T1 high signal intensity in the dentate nucleus due to gadolinium deposition in multiple sclerosis. J Neuroimaging 27:372–375

    Article  PubMed  Google Scholar 

  43. 43.

    Tibussek D, Rademacher C, Caspers J et al (2017) Gadolinium brain deposition after macrocyclic gadolinium administration: a pediatric case-control study. Radiology 285:223–230

    Article  Google Scholar 

  44. 44.

    Splendiani A, Perri M, Marsecano C et al (2018) 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. Radiol Med 123:125–134

    Article  Google Scholar 

  45. 45.

    Lee JY, Park JE, Kim HS et al (2017) Up to 52 administrations of macrocyclic ionic MR contrast agent are not associated with intracranial gadolinium deposition: multifactorial analysis in 385 patients. PLoS One 12:e0183916

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  46. 46.

    Bjørnerud A, Vatnehol SAS, Larsson C, Due-Tønnessen P, Hol PK, Groote IR (2017) Signal enhancement of the dentate nucleus at unenhanced MR imaging after very high cumulative doses of the macrocyclic gadolinium-based contrast agent gadobutrol: an observational study. Radiology 285:434–444

    Article  Google Scholar 

  47. 47.

    Yoo RE, Sohn CH, Kang KM et al (2018) Evaluation of gadolinium retention after serial administrations of a macrocyclic gadolinium-based contrast agent (gadobutrol): a single-institution experience with 189 patients. Invest Radiol 53:20–25

    Article  CAS  PubMed  Google Scholar 

  48. 48.

    Müller A, Jurcoane A, Mädler B, Ditter P, Schild H, Hattingen E (2017) Brain relaxometry after macrocyclic Gd-based contrast agent. Clin Neuroradiol 27:459–468

    Article  PubMed  Google Scholar 

  49. 49.

    Kromrey ML, Liedtke KR, Ittermann T et al (2017) Intravenous injection of gadobutrol in an epidemiological study group did not lead to a difference in relative signal intensities of certain brain structures after 5 years. Eur Radiol 27:772–777

    Article  Google Scholar 

  50. 50.

    Young JR, Orosz I, Franke MA et al (2018) Gadolinium deposition in the paediatric brain: T1-weighted hyperintensity within the dentate nucleus following repeated gadolinium-based contrast agent administration. Clin Radiol 73:290–295

    Article  CAS  Google Scholar 

  51. 51.

    Renz DM, Kümpel S, Böttcher J et al (2018) Comparison of unenhanced T1-weighted signal intensities within the dentate nucleus and the globus pallidus after serial applications of gadopentetate dimeglumine versus gadobutrol in a pediatric population. Invest Radiol 53:119–127

    Article  CAS  PubMed  Google Scholar 

  52. 52.

    Tamrazi B, Nguyen B, Liu CJ et al (2018) Changes in signal intensity of the dentate nucleus and globus pallidus in pediatric patients: impact of brain irradiation and presence of primary brain tumors independent of linear gadolinium-based contrast agent administration. Radiology 287:452–460

    Article  PubMed  Google Scholar 

  53. 53.

    Ryu YJ, Choi YH, Cheon JE et al (2018) Pediatric brain: gadolinium deposition in dentate nucleus and globus pallidus on unenhanced T1-weighted images is dependent on the type of contrast agent. Invest Radiol 53:246–255

    Article  CAS  PubMed  Google Scholar 

  54. 54.

    Vergauwen E, Vanbinst AM, Brussaard C et al (2018) Central nervous system gadolinium accumulation in patients undergoing periodical contrast MRI screening for hereditary tumor syndromes. Hered Cancer Clin Pract 16:2

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  55. 55.

    Moser FG, Watterson CT, Weiss S et al (2018) High signal intensity in the dentate nucleus and globus pallidus on unenhanced t1-weighted mr images: comparison between gadobutrol and linear gadolinium-based contrast agents. AJNR Am J Neuroradiol. https://doi.org/10.3174/ajnr.A5538

  56. 56.

    Kasper E, Schemuth HP, Horry S, Kinner S (2018) Changes in signal intensity in the dentate nucleus at unenhanced T1-weighted magnetic resonance imaging depending on class of previously used gadolinium-based contrast agent. Pediatr Radiol 48:686–693

    Article  Google Scholar 

  57. 57.

    Kinner S, Schubert TB, Bruce RJ et al (2018) Deep brain nuclei T1 shortening after gadobenate dimeglumine in children: influence of radiation and chemotherapy. AJNR Am J Neuroradiol 39:24–30

    Article  CAS  Google Scholar 

  58. 58.

    Quattrocchi CC, Errante Y, Mallio CA et al (2018) Effect of age on high T1 signal intensity of the dentate nucleus and globus pallidus in a large population exposed to gadodiamide. Invest Radiol 53:214–222

    Article  CAS  PubMed  Google Scholar 

  59. 59.

    Bolles GM, Yazdani M, Stalcup ST et al (2018) Development of high signal intensity within the globus pallidus and dentate nucleus following multiple administrations of gadobenate dimeglumine. AJNR Am J Neuroradiol. https://doi.org/10.3174/ajnr.A5510

  60. 60.

    Pei L, Xu J, Zhang M (2017) Correlation between high signal intensity in cerebrum nucleus on unenhanced T1-weighted MR images and number of previous gadolinium-based contrast agent administration. Zhejiang Da Xue Xue Bao Yi Xue Ban 46:487–491

    PubMed  Google Scholar 

  61. 61.

    Behzadi AH, Farooq Z, Zhao Y, Shih G, Prince MR (2018) Dentate nucleus signal intensity decrease on T1-weighted MR images after switching from gadopentetate dimeglumine to gadobutrol. Radiology 287:816–823

    Article  PubMed  Google Scholar 

  62. 62.

    Young JR, Qiao J, Orosz I et al (2018) 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. https://doi.org/10.1007/s00330-018-5464-5

  63. 63.

    Rahatli FK, Donmez FY, Kibaroglu S et al (2018) Does renal function affect gadolinium deposition in the brain? Eur J Radiol 104:33–37

    Article  PubMed  Google Scholar 

  64. 64.

    Quattrocchi CC, van der Molen AJ (2017) Gadolinium retention in the body and brain: is it time for an international joint research effort? Radiology 282:12–16

    Article  PubMed  Google Scholar 

  65. 65.

    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

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  66. 66.

    Dekkers IA, Roos R, van der Molen AJ (2018) Gadolinium retention after administration of contrast agents based on linear chelators and the recommendations of the European Medicines Agency. Eur Radiol 28:1579–1584

    Article  PubMed  Google Scholar 

  67. 67.

    Gianolio E, Bardini P, Arena F et al (2017) Gadolinium retention in the rat brain: assessment of the amounts of insoluble gadolinium-containing species and intact gadolinium complexes after repeated administration of gadolinium-based contrast agents. Radiology 285:839–849

    Article  Google Scholar 

  68. 68.

    Robert P, Fingerhut S, Factor C et al (2018) One-year retention of gadolinium in the brain: comparison of gadodiamide and gadoterate meglumine in a rodent model. Radiology 288(2):424–433

    Article  Google Scholar 

  69. 69.

    Radbruch A, Roberts DR, Clement O, Rovira A, Quattrocchi CC (2017) Chelated or dechelated gadolinium deposition. Lancet Neurol 16:955

    Article  PubMed  Google Scholar 

  70. 70.

    Radbruch A (2018) Gadolinium deposition in the brain: we need to differentiate between chelated and dechelated gadolinium. Radiology 88(2):434–435

    Article  Google Scholar 

  71. 71.

    Lohrke J, Frisk AL, Frenzel T et al (2017) Histology and gadolinium distribution in the rodent brain after the administration of cumulative high doses of linear and macrocyclic gadolinium-based contrast agents. Invest Radiol 52(6):324–333

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  72. 72.

    Gibby WA, Gibby KA, Gibby WA (2004) Comparison of Gd DTPA-BMA (Omniscan) versus Gd HP-DO3A (ProHance) retention in human bone tissue by inductively coupled plasma atomic emission spectroscopy. Invest Radiol 39:138–142

    Article  PubMed  Google Scholar 

  73. 73.

    Tweedle MF, Wedeking P, Kumar K (1995) Biodistribution of radiolabeled, formulated gadopentetate, gadoteridol, gadoterate, and gadodiamide in mice and rats. Invest Radiol 30:372–380

    Article  CAS  PubMed  Google Scholar 

  74. 74.

    Pietsch H, Lengsfeld P, Jost G, Frenzel T, Hütter J, Sieber MA (2009) Long-term retention of gadolinium in the skin of rodents following the administration of gadolinium-based contrast agents. Eur Radiol 19:1417–1424

    Article  PubMed  Google Scholar 

  75. 75.

    Robert P, Frenzel T, Factor C et al (2018) Methodological aspects for preclinical evaluation of gadolinium presence in brain tissue: critical appraisal and suggestions for harmonization-a joint initiative. Invest Radiol 53:499–517

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Funding

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

Author information

Affiliations

Authors

Consortia

Corresponding author

Correspondence to Carlo C. Quattrocchi.

Ethics declarations

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

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Quattrocchi, C.C., Ramalho, J., van der Molen, A.J. et al. 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. Eur Radiol 29, 3959–3967 (2019). https://doi.org/10.1007/s00330-018-5803-6

Download citation

Keywords

  • Contrast media
  • Gadolinium
  • Magnetic resonance imaging
  • Dentate nucleus