Gadolinium deposition in the paediatric brain: T1-weighted hyperintensity within the dentate nucleus following repeated gadolinium-based contrast agent administration
Introduction
It has recently been demonstrated that gadolinium-based contrast agent (GBCA) administration for clinical magnetic resonance imaging (MRI) can result in gadolinium deposition or retention in multiple organs, including the brain.1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11 Gadolinium deposition in the brain is associated with increased intrinsic signal intensity on T1-weighted images, which is most detectable in the globus pallidus and the cerebellar dentate nucleus. To date, most studies of brain gadolinium retention have been performed in adults with few studies of the paediatric brain. Although the clinical significance, if any, of brain gadolinium deposition or retention is uncertain, the paediatric brain could be more susceptible to the deleterious effects of gadolinium deposition because the paediatric brain is in general more vulnerable to a variety of toxins.12, 13 Additionally, the lifetime dose and duration of exposure to GBCA may be greater in children than adults. Initial studies documenting intracranial gadolinium deposition in adults focused on linear contrast agents, such as gadopentetate dimeglumine and gadodiamide.2, 4 Subsequent studies in adults have suggested that macrocyclic gadolinium-based contrast agents, such as gadoteridol and gadoterate meglumine, may be less likely to deposit within the brain in comparison to gadopentetate dimeglumine3, 6; however, Stojanov et al. found that the macrocyclic agent gadobutrol was associated with increasing T1-weighted hyperintensity within the dentate nucleus and globus pallidus.9 Thus, the nature of deposition of macrocyclic versus linear agents is currently unclear. Three recently published studies examining gadolinium deposition within the paediatric brain have focused exclusively on the linear agent gadopentetate dimeglumine.14, 15, 16
Gadolinium-enhanced MRI is an essential component of neuroimaging and clinical care in paediatric and adult patient populations. Thus, the aim of the present study was to investigate whether, as with adults, the paediatric brain shows imaging evidence of gadolinium retention following repeated exposure to a variety of GBCA.
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Patients
With institutional review board approval for this HIPAA (Health Insurance Portability and Accountability Act)-compliant study and a waiver of informed consent, the institution's PACS (picture archiving and communication system) was queried to identify all patients under the age of 18 years who underwent a contrast-enhanced MRI of the brain performed at between the years of 2005 and 2015. From this query, a total of 247 patients were identified. Patients with fewer than four MRI examinations,
Patients
The present cohort was comprised of 25 male (61%) and 16 female (39%) paediatric patients under the age of 18 years (Table 1). On average (±standard deviation), each patient received 9.27±4.26 MRI examinations. Thirty-five of the patients (85%) had brain tumours. Eighteen of the patients (44%) had a history of chemotherapy, and six patients (15%) had a history of irradiation.
T1-hyperintensity within the dentate nuclei following repeated GBCA administration
For the 41 patients in the cohort, there was a significant increase in the DN-P SI ratio from the first MRI to the last
Discussion
The aim of the present study was to determine if T1-weighted signal intensity within the dentate nucleus increases in the paediatric brain following repeated GBCA administration, a phenomenon that has been well-documented in adults. For the cohort of 41 patients who received serial MRI examinations with GBCAs, the mean DN-P SI ratio significantly increased from the first MRI examination to the last MRI examination. A linear mixed effects model demonstrated that even after controlling for
References (17)
- et al.
Progressive increase of T1 signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MRI images in the paediatric brain exposed to multiple doses of gadolinium contrast
Brain Dev
(2016) Imaging brain development: the adolescent brain
Neuroimage
(2012)- et al.
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
(2014) - et al.
High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MRI images: relationship with increasing cumulative dose of a gadolinium-based contrast material
Radiology
(2014) - et al.
High signal intensity in dentate nucleus on unenhanced T1-weighted MRI images: association with linear versus macrocyclic gadolinium chelate administration
Radiology
(2015) - et al.
Intracranial gadolinium deposition after contrast-enhanced MRI imaging
Radiology
(2015) - et al.
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
(2015) - et al.
Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent
Radiology
(2015)
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These authors contributed equally to this study.