Multiple Administrations of Gadobutrol in the Pediatric Brain: No Change in T1 Signal at MRI

Bhargava, Ravi; Persad, A; Bhargava, Nikhilesh K.; Hawkes, Michael

doi:10.1148/radiol.2018172988

Cited by 12 publications

(10 citation statements)

References 34 publications

(80 reference statements)

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“…Bhargava et al reported that there was no increased SI in the GP or DN with the use of at least five doses of gadobutrol, a macrocyclic GBCA. In a comparison study, Renz et al found no T 1 W SI increase with a macrocyclic agent gadobutrol, whereas they also reported SI elevation in the DN with a linear agent, gadopentetate dimeglumine.…”

Section: Discussionmentioning

confidence: 99%

Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case–Control Study

Topcuoğlu

Topçuoğlu

Semiz-Oysu

et al. 2019

Magnetic Resonance Imaging

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Background: Accumulation of macrocyclic gadolinium agents in children's brains remain to be determined. Purpose: To demonstrate whether there is an intracranial macrocyclic gadolinium deposition after multiple contrastenhanced MRI with gadoterate meglumine in a pediatric population. Study Type: Retrospective case-control. Population: In all, 45 children (age range: 5-17 years; mean, 13.7 AE 3.4 years) for the study group and 45 healthy children (age range: 5-17 years; mean, 13.7 AE 3.4 years) for the control group. Field Strength/Sequence: T 1 -and T 2 -weighted axial images on a 1.5T scanner. Assessment: Children with at least three enhanced brain MRIs and an age-and sex-matched control group with an unenhanced brain MRIs were compared in terms of T 1 signal intensity (SI). All patients in the study group received gadoterate meglumine intravenously (0.1 mmol/kg). SI measurements were made by drawing six regions of interest (ROIs): dentate nuclei (DN), pons, globus pallidi (GP), frontal white matter (FWM), thalamus (T), clivus, and cerebrospinal fluid (CSF) for both groups on unenhanced T 1 -weighted images. Statistical Tests: Student's t-test was used for comparison of SI. The Pearson correlation was calculated for the correlation between the SI and the number of gadolinium administrations. Results: A significant difference was detected between two groups for DN/CSF, pons/CSF, GP/CSF, thalamus/CSF, and FWM/CSF (P < 0.001, P < 0.001, P = 0.002, P = 0.002, P = 0.024, respectively). There was no significant difference between the two groups for clivus/CSF (P = 0.15). A good correlation between the number of gadoterate meglumine administrations and the SI for DN/CSF, pons/CSF, GP/CSF, and T/CSF (r = 0.80, r = 0.73, r = 0.91, and r = 0.90, respectively) was found. Data Conclusion: A significant T 1 SI increase reflecting gadolinium retention in the brain was detected for children with at least three gadoterate meglumine administrations in this series. The number of administrations correlated well with the increased SI. Level of Evidence: 3 Technical Efficacy Stage: 5

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Section: Discussionmentioning

confidence: 99%

Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case–Control Study

Topcuoğlu

Topçuoğlu

Semiz-Oysu

et al. 2019

Magnetic Resonance Imaging

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“…Prior MRI studies of macrocyclic GBCAs included large cohorts of adult and pediatric participants who were exposed to multiple doses of MRI contrast agents (12)(13)(14)(15). However, prior studies were primarily retrospective reviews of participants who had undergone clinically indicated MRI.…”

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confidence: 99%

MRI Brain Signal Intensity and Relaxation Times in Individuals with Prior Exposure to Gadobutrol

et al. 2019

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To perform follow-up brain MRI in volunteer participants who had previously received multiple doses of gadobutrol and to assess for changes in signal intensities and relaxation times. Materials and Methods: This prospective study included 160 participants who received gadobutrol only between 2007 and 2017. The participants were separated into two groups, including participants with at least five contrast agent-enhanced examinations and normal kidney function (group 1) or at least one examination and impaired renal function (group 2). Control groups with normal and impaired renal function (groups 3 and 4) without history of contrast agent exposure were included for comparison. Unenhanced brain MRI was performed in 220 participants (76, 84, 25, and 35 participants in groups 1-4, respectively) with T1weighted spin-echo and T1 and T2 mapping to determine visual signal intensity changes, signal intensity ratios (globus pallidus-tothalamus and dentate nucleus-to-pons ratios), and T1 and T2 relaxation times. Results: In groups 1 and 2, neither visual signal alterations nor differences in signal intensity ratio or T2 mapping were found. T1 mapping showed no changes for dentate nucleus, pons, and thalamus. However, shorter T1 relaxation times in the globus pallidus were found in group 1 compared with group 3 (difference of 226.2 msec; P = .002), which correlated with the number of previous gadobutrol doses in this group (P = .001). Conclusion: In study participants who had previously received gadobutrol, brain MRI showed no differences relative to healthy control participants without gadobutrol exposure. However, quantitative T1 measurements might indicate gadolinium retention in the globus pallidus.

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“…Bhargava et al . found no SI-ratio increase in the globus pallidus referenced to the corpus callosum in children with brain tumors after having received either five or more gadobutrol adminstrations (46 patients) or more than 14 administrations (6 patients) 19 . Despite that no significant increase was found in the first group, the results are comparable to our group II (bilaterally no SI-ratio increase with mean gadobutrol administrations of 7.51; pt.…”

Section: Discussionmentioning

confidence: 93%

T1-weighted Grey Matter Signal Intensity Alterations After Multiple Administrations of Gadobutrol in Patients with Multiple Sclerosis, Referenced to White Matter

Kelemen

Alaoui

Sieroń

et al. 2018

Sci Rep

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The aim of the study was to investigate the signal-intensity-(SI)-ratio changes in the basal ganglia, the pulvinar thalami (PN), and the dentate nucleus (DN) using frontal white matter (FWM) as reference area, in patients with multiple sclerosis after frequent administrations of gadobutrol. A control group (group I) was compared to three stratified patient groups (group II: mean applications of gadobutrol 3.7; group III: 7.5 applications; group IV: 13.8 applications). SI-ratios of the pallidum, putamen, caudate nucleus, and pulvinar thalami were calculated with: 1. FWM, and 2. PN. DN-to-pons and DN-to-FWM ratios were also calculated. The most significant SI-ratio-changes were found by comparing group I and IV for both reference values. However, by using FWM as reference an SI-ratio increase was observed, while an SI-ratio decrease was seen if referenced to the PN. DN-to-FWM showed an SI-ratio increase, too. The PN revealed a significant SI-ratio increase itself, correlating with the number of gadolinium applications, when referenced to FWM. Therefore, SI-ratio calculations using the thalamus as reference might be flawed. In addition, a minor gadolinium accumulation is possible, if FWM was used as reference area. Further studies are necessary to verify our results.

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Multiple Administrations of Gadobutrol in the Pediatric Brain: No Change in T1 Signal at MRI

Cited by 12 publications

References 34 publications

Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case–Control Study

Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case–Control Study

MRI Brain Signal Intensity and Relaxation Times in Individuals with Prior Exposure to Gadobutrol

T1-weighted Grey Matter Signal Intensity Alterations After Multiple Administrations of Gadobutrol in Patients with Multiple Sclerosis, Referenced to White Matter

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