Abstract
BACKGROUND AND PURPOSE: Dose-dependent association between hyperintensity in deep brain structures on unenhanced T1WIs and gadolinium-based contrast agent administrations has been demonstrated with subsequent histopathological confirmation of gadolinium deposition. Our aim was to determine whether greater exposure to linear gadolinium-based contrast agent administration is associated with higher signal intensity in deep brain structures on unenhanced T1-weighted MR imaging. Secondary objective was to compare signal intensity differences between ionic and nonionic linear gadolinium-based contrast agents.
MATERIALS AND METHODS: Subjects with secondary-progressive MS originally enrolled in a multicenter clinical trial were studied retrospectively. Eighty subjects (high-exposure cohort) received 9 linear gadolinium-based contrast agent administrations (30 nonionic/50 ionic) between week −4 and year 1 and a tenth administration by year 2. One hundred fifteen subjects (low-exposure cohort) received 2 administrations (40 nonionic/75 ionic) between week −4 and year 1 and a third administration by year 2. Signal intensities were measured on unenhanced T1WIs by placing sample-points on the dentate nucleus, globus pallidus, caudate, thalamus, pons, and white matter, and they were normalized using the following ratios: dentate/pons, globus pallidus/white matter, caudate/white matter, and thalamus/white matter.
RESULTS: Between week −4 and year 1, subjects in the high-exposure cohort showed increased signal intensity ratios in all regions (P < .01), while the low-exposure cohort showed only an increase in the dentate nucleus (P = .003). Between years 1 and 2, when both cohorts received only 1 additional gadolinium-based contrast agent, no significant changes were observed. In the high-exposure cohort, significantly higher changes in signal intensity ratios were observed in subjects receiving linear nonionic than in those receiving linear ionic gadolinium-based contrast agents.
CONCLUSIONS: Hyperintensity in deep brain structures from gadolinium deposition is related to the number of doses and the type of linear gadolinium-based contrast agent (nonionic greater than ionic) administration.
ABBREVIATIONS:
- CD
- caudate
- DN
- dentate nucleus
- GBCA
- gadolinium-based contrast agent
- GP
- globus pallidus
- SI
- signal intensity
- TH
- thalamus
Footnotes
Disclosures: Roger Tam—RELATED: Other: Jefferson Mooney, Comments: Mr Mooney donated $10,000 to support trainees in multiple sclerosis research at the University of British Columbia. This donation had no other restrictions on its use, and we used it to support Megan He, an undergraduate intern who worked on the technical aspects of the project*; UNRELATED: Grants/Grants Pending: Natural Sciences and Engineering Research Council of Canada, Comments: grant support from Natural Sciences and Engineering Research Council*; Other: Roche, Genzyme, Comments: Our group participates in sponsored clinical studies and clinical trials, which are unrelated to the submitted work.* Anthony Traboulsee—UNRELATED: Other: Consortium of Multiple Sclerosis Centers, Comments: honoraria to develop and disseminate MRI guidelines for diagnosing and monitoring patients with MS, including the role of gadolinium. Shannon Kolind—UNRELATED: Consultancy: Acorda Therapeutics; Grants/Grants Pending: Sanofi, Roche. Mark S. Freedman—UNRELATED: Consultancy: Actelion Pharmaceutical, Bayer Healthcare, Biogen, Chugai Pharmaceutical, Clene, EMD Serono Canada, Genzyme, Merck Serono, MedDay, Novartis, Roche, Sanofi, Teva Pharmaceutical Industries, Comments: consultant, ad board, steering committee; Grants/Grants Pending: Genzyme, Comments: Investigator Sponsored Studies (ISS)*; Payment for Lectures Including Service on Speakers Bureaus: Genzyme, Sanofi, Merck, Actelion, Biogen, EMD, Teva Pharmaceutical Industries; Payment for Development of Educational Presentations: Roche. David K.B. Li—UNRELATED: Consultancy: Vertex Pharmaceuticals, Opexa Therapeutics, Adelphi Group, Comments: I have been a consultant for Vertex Pharmaceuticals and served on the Data and Safety Advisory Board for Opexa Therapeutics and the Scientific Advisory Board for the Adelphi Group; Grants/Grants Pending: Genzyme, Hoffmann-la Roche, Merck Serono. Perceptive/Novartis, Sanofi-Aventis, Comments: I am the Emeritus Director of the University of British Columbia MS/MRI Research Group, which has received contracts to provide the central MRI analysis for MS clinical trials*; Payment for Lectures Including Service on Speakers Bureaus: Academy of Health Care Learning, Biogen Idec, Consortium of Multiple Sclerosis Centers, Novartis, Sanofi Genzyme, and Teva Pharmaceutical Industries; Payment for Development of Educational Presentations: Academy of Health Care Learning, Comments: Webinar. *Money paid to the institution in Canadian dollars.
Paper previously presented at: Annual Meeting of the American Society of Neuroradiology and the Foundation of the ASNR Symposium, June 2–7, 2018; Vancouver, British Columbia, Canada.
- © 2018 by American Journal of Neuroradiology
