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

Moser, Franklin G.; Watterson, Christopher; Weiss, Stanley H.; Austin, Matthew J.; Mirocha, James; Prasad, Ravi; Wang, Jinnan

doi:10.3174/ajnr.a5538

Cited by 28 publications

(19 citation statements)

References 25 publications

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“…The presence of ELH was observed on the 3D-FLAIR images as enlarged negative-signal spaces inside the labyrinth, according to a previously reported method [32,33]. The decision to apply a single-dose contrast agent was made because of the ongoing discussion about gadolinium deposition within the dentate nucleus and globus pallidus after repeated administration of gadolinium-based contrast agents [34][35][36][37]. It was not considered ethical to apply higher doses of contrast agent if not necessary.…”

Section: D1 and D3-sequence Protocol And Grading Of The Delayed Gadolmentioning

confidence: 99%

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

et al. 2020

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Background Objective and volumetric quantification is a necessary step in the assessment and comparison of endolymphatic hydrops (ELH) results. Here, we introduce a novel tool for automatic volumetric segmentation of the endolymphatic space (ELS) for ELH detection in delayed intravenous gadolinium-enhanced magnetic resonance imaging of inner ear (iMRI) data. Methods The core component is a novel algorithm based on Volumetric Local Thresholding (VOLT). The study included three different data sets: a real-world data set (D1) to develop the novel ELH detection algorithm and two validating data sets, one artificial (D2) and one entirely unseen prospective real-world data set (D3). D1 included 210 inner ears of 105 patients (50 male; mean age 50.4 ± 17.1 years), and D3 included 20 inner ears of 10 patients (5 male; mean age 46.8 ± 14.4 years) with episodic vertigo attacks of different etiology. D1 and D3 did not differ significantly concerning age, gender, the grade of ELH, or data quality. As an artificial data set, D2 provided a known ground truth and consisted of an 8-bit cuboid volume using the same voxel-size and grid as real-world data with different sized cylindrical and cuboid-shaped cutouts (signal) whose grayscale values matched the real-world data set D1 (mean 68.7 ± 7.8; range 48.9-92.8). The evaluation included segmentation accuracy using the Sørensen-Dice overlap coefficient and segmentation precision by comparing the volume of the ELS. Results VOLT resulted in a high level of performance and accuracy in comparison with the respective gold standard. In the case of the artificial data set, VOLT outperformed the gold standard in higher noise levels. Data processing steps are fully automated and run without further user input in less than 60 s. ELS volume measured by automatic segmentation correlated significantly with the clinical grading of the ELS (p < 0.01). Conclusion VOLT enables an open-source reproducible, reliable, and automatic volumetric quantification of the inner ears' fluid space using MR volumetric assessment of endolymphatic hydrops. This tool constitutes an important step towards comparable and systematic big data analyses of the ELS in patients with the frequent syndrome of episodic vertigo attacks. A generic version of our three-dimensional thresholding algorithm has been made available to the scientific community via GitHub as an ImageJ-plugin.

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Section: D1 and D3-sequence Protocol And Grading Of The Delayed Gadolmentioning

confidence: 99%

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

et al. 2020

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“…8 In 2018, Moser et al published a study of 119 patients with brain tumors who had been exposed to various forms of GBCAs and found that exposure to linear GBCAs led to increased signal on T1-weighted images, whereas similar changes were not observed with macrocyclic GBCAs. 13 Vergauwen et al conducted a retrospective study in a population of patients with either von Hippel-Lindau disease (n=28 subjects) or tuberous sclerosis complex (n=24 subjects) and discovered that both demonstrated increased signal on T1weighted images in the DN and GP, although the increase in the tuberous sclerosis complex group did not reach statistical significance. 11 Notably, detailed records of the identity of contrast agents used for this study were not available, but basing a conjecture on the agents used by the hospitals where the MRIs were performed, linear GBCAs (gadopentetate, gadodiamide, gadobenate) were likely predominately used, with the recent introduction of gadoterate in 2016 (2 years prior to publication).…”

Section: Studies Of Gadolinium Deposition In the Human Brainmentioning

confidence: 99%

“…[4][5][6][7][8][9][10][11][12]35,36,40,41 An example of the accumulation of gadolinium deposition is shown in Figure 2. Gadolinium deposition has been more prominently associated with linear than with macrocyclic GBCAs, 4,6,[8][9][10]13,36,40 possibly because of differences in kinetic and thermal stabilities. 31,32 Additionally, evidence suggests a dose-dependent effect of gadolinium deposition.…”

Section: Summary Of Evidence For Gadolinium Deposition In the Brainmentioning

confidence: 99%

“…31,32 Additionally, evidence suggests a dose-dependent effect of gadolinium deposition. 7,12,35 Although studies have revealed mixed evidence of gadolinium deposition with macrocyclic GBCAs on MRI, 2,4,6,9,10,13,36,40 spectroscopic evidence suggests that macrocyclic GBCAs can result in gadolinium deposition. 6,8 One hypothesis to explain these findings is that the rate of macrocyclic GBCA gadolinium deposition is too low for detection via MRI but detectable by ICP-MS.…”

Section: Summary Of Evidence For Gadolinium Deposition In the Brainmentioning

confidence: 99%

“…However, several recent papers (1995-2018) have indicated that gadolinium has the potential to deposit and persist within the body, particularly within the dentate nucleus (DN) and globus pallidus (GP) of the brain. [2][3][4][5][6][7][8][9][10][11][12][13] While the long-term clinical significance of gadolinium deposition remains unclear, this discovery has many in the medical community reconsidering the applications and necessity of GBCAs. In this article, we review the peer-reviewed data on GBCA safety and deposition.…”

Section: Introductionmentioning

confidence: 99%

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Gadolinium Deposition in Neurology Clinical Practice

Smith

Steven

Bagert

2019

TOJ

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Background: Magnetic resonance imaging (MRI) enhanced with gadolinium-based contrast agents (GBCAs) is an essential tool in the diagnosis and management of many neurologic diseases, including multiple sclerosis, brain tumors, and infections. The clinical utility of GBCAs is evidenced by their widespread use. GBCAs are produced in macrocyclic and linear forms. Since 2014, evidence has suggested that repeated administration of GBCAs can lead to gadolinium deposition in the brain. Methods: We review the literature on gadolinium deposition, including both animal and human studies, as well as the literature on GBCA-associated health outcomes. Additionally, we summarize and discuss the updated medical society recommendations and perspectives on GBCA use in clinical practice. Results: The first publication reporting gadolinium deposition in the human brain was published in 2014. Since that seminal report, multiple studies have demonstrated that exposure to linear GBCAs is associated with gadolinium deposition in the dentate nucleus and globus pallidus as seen on brain MRI. Macrocyclic GBCA exposure has not convincingly been associated with gadolinium deposition evident on brain MRI. Conclusion: Clear evidence demonstrates that GBCAs lead to gadolinium deposition in the brain in a dose-dependent manner; however, only linear GBCAs have been associated with gadolinium deposition visualized on MRI. To date, no evidence links gadolinium deposition with any adverse health outcome. Updated medical society guidelines emphasize the importance of an individualized risk-benefit analysis with each administration of GBCAs.

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Endolymphatic volume in patients with meniere's disease and healthy controls: Three‐dimensional analysis with magnetic resonance imaging

Ito

Inui

Miyasaka

et al. 2019

Laryngoscope Investig Oto

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ObjectiveRecently, 3‐Tesla magnetic resonance imaging (MRI) with intravenous gadolinium injection has been used to reveal endolymphatic hydrops (EH). In the present study, we aimed to evaluate EH in patients with Meniere's disease (MD) objectively and quantitatively, and compared the endolymphatic space (ELS) in individuals with MD and healthy controls, to gain understanding of the characteristics of MD.MethodsEighty‐two patients with unilateral MD (uMD), 16 patients with bilateral MD (bMD), and 47 healthy volunteers were enrolled. All participants underwent 3‐T MRI at 4 hours after intravenous gadolinium injection. The volumes of the total fluid space (TFS) and ELS were measured semiautomatically using our workstation, and the percentage of ELS to TFS (ELS percentage) was calculated.ResultsThe ELS percentage was 13.9 in the ears of controls, 18.2 in the contralateral ear of individuals with uMD, 26.1 in the affected ears of these individuals, and 23.0 in both ears of individuals with bMD. The ELS percentages in the affected ear of uMD and the ears of bMD individuals were significantly higher than that in the ears of control individuals (P < .01, one‐way analysis of variance (ANOVA), Tukey's test).ConclusionThe ELS is significantly larger in the affected ears of uMD and in both ears of bMD individuals. Accurate diagnosis of MD can be facilitated by using 3‐T MRI 4 hours after intravenous gadolinium injection and performing volumetric measurements of the ELS.Level of Evidence2b

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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

Abstract: Successive doses of gadobutrol do not result in T1 shortening compared with changes seen in linear gadolinium-based contrast agents.

Cited by 28 publications

References 25 publications

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI

Gadolinium Deposition in Neurology Clinical Practice

Endolymphatic volume in patients with meniere's disease and healthy controls: Three‐dimensional analysis with magnetic resonance imaging

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