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Dentate nucleus T1 hyperintensity: is it always gadolinium all that glitters?

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Abstract

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.

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Author notes

  1. Luca Pasquini and Maria Camilla Rossi Espagnet have contributed equally to this work.

Authors and Affiliations

  1. Neuroradiology Unit, Imaging Department, Bambino Gesù Children’s Hospital, Rome, Italy

    Luca Pasquini, Maria Camilla Rossi Espagnet & Daniela Longo

  2. NESMOS Department, Radiology Unit, Sant’Andrea Hospital, La Sapienza University of Rome, Rome, Italy

    Luca Pasquini & Maria Camilla Rossi Espagnet

  3. Enterprise Risk Management, Medical Physics Department, IRCCS, Bambino Gesù Children’s Hospital, Rome, Italy

    Antonio Napolitano

  4. Department of Hematology and Oncology, Bambino Gesù Children’s Hospital, Rome, Italy

    Alice Bertaina

  5. Neuroradiology Unit, M. Bufalini Hospital, Cesena, Italy

    Emiliano Visconti

  6. Imaging Department, Bambino Gesù Children’s Hospital, Rome, Italy

    Paolo Tomà

Authors
  1. Luca Pasquini
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  2. Maria Camilla Rossi Espagnet
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  3. Antonio Napolitano
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  4. Daniela Longo
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  5. Alice Bertaina
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  6. Emiliano Visconti
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  7. Paolo Tomà
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Corresponding author

Correspondence to Luca Pasquini.

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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.

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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.

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Informed consent was obtained from all individual participants (or next of kin) included in the study.

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Pasquini, L., Rossi Espagnet, M.C., Napolitano, A. et al. Dentate nucleus T1 hyperintensity: is it always gadolinium all that glitters?. Radiol med 123, 469–473 (2018). https://doi.org/10.1007/s11547-017-0846-3

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  • DOI: https://doi.org/10.1007/s11547-017-0846-3

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