In vivo dentate nucleus MRI relaxometry correlates with previous administration of Gadolinium-based contrast agents

Tedeschi, Enrico; Palma, Giuseppe; Canna, Antonietta; Cocozza, Sirio; Russo, Carmela; Borrelli, Pasquale; Lanzillo, Roberta; Angelini, Valentina; Postiglione, Emanuela; Morra, Vincenzo Brescia; Salvatore, Marco; Brunetti, Arturo; Quarantelli, Mario

doi:10.1007/s00330-016-4245-2

Cited by 81 publications

(64 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This would be in line with a recent study evaluating effects in T1 and T2∗ relaxometry of the DN in 74 RRMS patients with respect to the number of previous applied GBCAs. [26] The authors found a correlation of increased R1 (=1/T1) values with repeated administration of GBCAs, mainly related to linear contrast agents, while T2∗ relaxometry was not affected, supporting the hypothesis that the observed T1-shortening is related to gadolinium administration and not to iron deposition. In MS, an increase of the permeability of the BBB represents a crucial step in the development of new acute contrast-enhancing lesions.…”

Section: Discussionmentioning

confidence: 71%

See 1 more Smart Citation

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Eisele¹,

Alonso²,

Szabo³

et al. 2016

Medicine

View full text Add to dashboard Cite

Recently, several studies reported increased signal intensity (SI) in the dentate nucleus (DN) after repeated application of gadolinium-based contrast agents (GBCAs), suggesting a deposition of gadolinium in this location. Patients with relapsing–remitting multiple sclerosis (RRMS) frequently show increased permeability of the blood–brain barrier as part of the inflammatory process in the brain parenchyma, which theoretically might increase the risk of gadolinium deposition. In this retrospective study, we investigated a possible increasing SI in the DN after repeated administrations of the macrocyclic contrast agent gadoterate meglumine.Forty-one RRMS patients (33 women, mean age 38 years) with at least 6 prior gadolinium-enhanced examinations (single dose gadoterate meglumine) were identified. A total of 279 unenhanced T1-weighted examinations were analyzed.SI ratio differences did not differ between the first and last MRI examination, neither for the DN-to-pons ratio (P = 0.594) nor for the DN-to-cerebellum ratio (P = 0.847). There was no correlation between the mean DN-to-pons, or between the mean DN-to-cerebellum SI ratio and the number of MRI examinations (P = 0.848 and 0.891), disease duration (P = 0.676 and 0.985), and expanded disability status scale (EDSS) (P = 0.639 and 0.945).We found no signal increases in the DN after a minimum of 6 injections of the macrocyclic GBCA gadoterate meglumine in RRMS patients. This warrants further investigations in regard to the true pathophysiologic basis of intracerebral gadolinium deposition.

show abstract

Section: Discussionmentioning

confidence: 71%

“…However, it still remains unclear in what form gadolinium deposition (free ionic form, chelated state) occurs, but the most prevalent hypothesis [11] is that the observed SI changes are a result of dechelation and release of the Gd 3+ ion from its ligand molecule. [26] …”

Section: Discussionmentioning

confidence: 99%

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Eisele¹,

Alonso²,

Szabo³

et al. 2016

Medicine

View full text Add to dashboard Cite

show abstract

“…In all scans, along with the routine clinical sequences, an unenhanced 3D double-echo FLASH sequence (TR = 28 ms; TE 1 = 7.63 ms; TE 2 = 22.14 ms; voxel size = 0.65 mm × 0.65 mm × 1.3 mm; 128 axial slices) was acquired with a flip angle of 20° to provide QSM and R2* maps, as already described in detail (15–17). …”

Section: Case Presentationmentioning

confidence: 99%

Brain Susceptibility Changes in a Patient with Natalizumab-Related Progressive Multifocal Leukoencephalopathy: A Longitudinal Quantitative Susceptibility Mapping and Relaxometry Study

et al. 2017

Self Cite

View full text Add to dashboard Cite

BackgroundBrain MRI plays an essential role in both diagnosis and follow-up of the JC virus infection of the brain. Recently, MR studies with susceptibility-weighted imaging (SWI) sequences have shown hypointensities in U-fibers adjacent to white matter (WM) lesions of progressive multifocal leukoencephalopathy (PML). This finding has been confirmed with the use of quantitative susceptibility mapping (QSM), allowing to hypothesize a paramagnetic effect in these regions. Here, we report the first longitudinal assessment of QSM and R2* maps in natalizumab-associated PML to evaluate serial changes in susceptibility contrast images and their role in PML diagnosis and follow-up.Case presentationWe report the case of a 42-year-old woman with multiple sclerosis (MS) who eventually developed, after the 28th natalizumab infusion, subacute cognitive decline and received a laboratory-confirmed diagnosis of PML, leading to immediate drug discontinuation. Three months later, she suffered a new clinical exacerbation, with a brain scan revealing significant inflammatory activity compatible with the radiological diagnosis of an Immune Reconstitution Inflammatory Syndrome (IRIS). She was then treated with corticosteroids until the clinico-radiological spectrum became stable, with the final outcome of a severe functional impairment. Quantitative maps obtained in the early symptomatic stage clearly showed increased QSM and R2* values in the juxtacortical WM adjacent to PML lesions, which persisted during the subsequent disease course.Discussion and conclusionHigh QSM and R2* values in U-fibers adjacent to WM lesions were early and seemingly time-independent radiological findings in the presented PML case. This, coupled to the known absence of significant paramagnetic effect of new active MS lesions, could support the use of quantitative MRI as an additional tool in the diagnosis and follow-up of natalizumab-related PML in MS.

show abstract

“…Tedechi et al [27] recently described a different MRI approach that could obviate this limitation. The authors evaluated changes on T1 and T2* relaxometry of DN with respect to the number of previous administrations of GBCAs in relapsing-remitting multiple sclerosis (RR-MS) patients.…”

Section: Quantitative Ratios Measurementsmentioning

confidence: 99%

“…They found that the number of previous GBCA administrations correlated with R1 relaxation rates of DN, while R2* values remain unaffected, suggesting that T1-shortening in these patients is related to the amount of gadolinium that had been administered. In fact, while standard qualitative or quantitative analysis have variations between subjects, time-points, and imaging centers; the measurement of relaxation rates can offer a more consistent and reliable tissue characterization, as they are intrinsically related to tissue microstructure and are not affected by variations in the signal intensity of images or by acquisition factors (e.g., variable RF homogeneity and coil sensitivity profile) [27][28][29]. MR relaxometry likely provides accurate and reproducible quantitative information of gadolinium accumulation in DN; however, it requires specific gradient echo sequences in development that are not at present available on standard MR systems, and hence are not performed as part of the brain MRI protocol.…”

Section: Quantitative Ratios Measurementsmentioning

confidence: 99%

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

Ramalho

AlObaidy

et al. 2016

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Over the last 2 years several studies have been published regarding gadolinium deposition in brain structures in patients with normal renal function after repeated administrations of gadolinium-based contrast agents (GBCAs). Most of the publications are magnetic resonance imaging (MRI) based retrospective studies, where gadolinium deposition may be indirectly measured by evaluating changes in T1 signal intensity (SI) in brain tissue, particularly in the dentate nucleus (DN) and/or globus pallidi (GP). The direct correlation between T1 signal changes and gadolinium deposition was validated by human pathology studies. However, the variability of the MR equipment and parameters used across different publications, along with the inherent limitations of MRI to assess gadolinium in human tissues should be acknowledged when interpreting those studies. Nevertheless, MRI studies remain essential regarding gadolinium bio-distribution knowledge. The aim of this paper is to overview current knowledge of technical aspects of T1 signal intensity evaluation by MRI and describe confounding factors, with the intention to achieve higher accuracy and maximize reproducibility.

show abstract

In vivo dentate nucleus MRI relaxometry correlates with previous administration of Gadolinium-based contrast agents

Cited by 81 publications

References 46 publications

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis

Brain Susceptibility Changes in a Patient with Natalizumab-Related Progressive Multifocal Leukoencephalopathy: A Longitudinal Quantitative Susceptibility Mapping and Relaxometry Study

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

Contact Info

Product

Resources

About