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

Abstract

High SI in the dentate nucleus and globus pallidus on unenhanced T1-weighted images may be a consequence of the number of previous gadolinium-based contrast material administrations.

Gadolinium toxicity and treatment

“…Gadolinium presence was originally observed in bone [5,6,30] and more recently in the brain [7][8][9][31][32][33][34][35][36][37][38][39] in patients with normal renal function.…”

“…It may be that difficulty with processing and/or metabolizing metals, or over-reaction to them, may be primarily a European-origin Caucasian person's disease. As further indirect proof of GDD being a predominantly white person's genetic disease, the initial and subsequent publication of gadolinium retained in the dentate nucleus and globus pallidus was made by Kanda et al [31] on a Japanese population, hence simple storage is likely a universal phenomenon of gadolinium exposure, and especially of linear agents [33,34,[36][37][38][39]. Yet there are no major series of NSF coming from Japan, South Korea or China [51,52].…”

Technical aspects of MRI signal change quantification after gadolinium-based contrast agents' administration

“…Different ratios have been used for quantitative measurements including DN-to-pons, DN-to-middle cerebellar peduncle, DN-to-cerebellar white matter, DN-to-CSF, DN-to-corpus callosum genu (CC), GP-to-Th, GP-to-CSF, GP-to-CC, Th-to-CC, and Caudate nucleus-to-CC [1][2][3][4][5][6][7][8][9][17][18][19][20]. In a study with healthy volunteers, T1 SI of DN, pons, GP, white matter, and gray matter were all evaluated and normalized with CSF [21].…”

“…Some authors suggested that 6 or more contrast enhanced MRI were needed to evaluate T1 signal changes over time [1,2], while others evaluate the effect of only one high dose GBCA [21]. Provided that the number of doses were all accounted for, including brain and other contrast enhanced MRI, the critical factor is that only one GBCA should be evaluated for each patient to determine the potential for deposition of each agent.…”

“…In the past 2 years several magnetic imaging (MRI) studies reported high T1 signal intensity in the dentate nucleus (DN) and/or globus pallidi (GP) in patients with normal renal function after multiple administrations of gadolinium-based contrast agents (GBCAs) suggesting gadolinium deposition [1][2][3][4][5][6][7][8][9]. The agent most commonly implicated was gadodiamide (Omniscan ® ) a non-ionic linear agent, classified according to its stability as a weak agent [10], followed by gadopentetate dimeglumine (Magnevist ® ) and gadobenate dimeglumine (MultiHance ® ), both ionic linear agents, classified as agents with intermediate stability [10].…”