Signal changes in enhanced T1-weighted images related to gadolinium retention: A three-time-point imaging study - 19/07/20

Doi : 10.1016/j.neurad.2020.06.002

François Lersy ^a,⁎, ^{^{1
These authors have contributed equally to this work and are considered as co-first authors.},}^{^{2
These authors have contributed equally to this work and are considered as co-last authors.}} , Anne-Lise Diepenbroek ^b,^{^{1
These authors have contributed equally to this work and are considered as co-first authors.}} , Julien Lamy ^c , Thibault Willaume ^a , Guillaume Bierry ^a , François Cotton ^d , Stéphane Kremer ^a,^{^{2
These authors have contributed equally to this work and are considered as co-last authors.}}
^a Service de Radiologie, Hôpitaux Universitaires de Strasbourg, Hôpital de Hautepierre, 1 Avenue Molière, 67200 Strasbourg Cedex, France
^b Faculté de médecine de Strasbourg, Université de Strasbourg, 67000 Strasbourg, France
^c ICube, Université de Strasbourg-CNRS, ICube - Institut de physique biologique, 4, rue Kirschleger, 67000 Strasbourg, France
^d Service de Radiologie, Centre Hospitalier Lyon Sud, Hospices Civils de Lyon, 69310 Pierre Bénite, France

^⁎Corresponding author.

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Graphical abstract

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Highlights

•	No gadolinium accumulation after use of a macrocyclic agent (gadoterate meglumine)
•	Tendency to gadolinium accumulation after use of a linear agent (gadobenate dimeglumine)
•	Gadolinium elimination over time with the use of both macrocyclic, and linear agents.

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Abstract

Background and Purpose

Concern has grown about the finding of gadolinium deposits in the brain after administering gadolinium-based contrast agents (GBCAs). The mechanism is unclear, and related questions remain unanswered, including the stability over time. Therefore, we conducted a three-time-point study to explore T1-weighted (W) signal changes in the dentate nucleus (DN) and globus pallidus (GP), after the first, fifth, and tenth injections of either a macrocyclic agent (gadoterate meglumine) or a linear agent (gadobenate dimeglumine).

Materials and methods

For this retrospective, multicenter, longitudinal study, two groups of 18 (gadoterate meglumine) and 19 (gadobenate dimeglumine) patients were identified. The evolution of the signal over time was analyzed using DN/pons (DN/P) and GP/thalamus (GP/T) ratios.

Results

DN/P and GP/T ratios tended to increase after the fifth administration of gadobenate dimeglumine, following by a downward trend. A trend in a decrease in DN/P and GP/T ratios were found after the fifth and tenth administrations of gadoterate meglumine.

Conclusion

After exposure to gadobenate dimeglumine, the signal intensity (SI) tended to increase after the fifth injection owing to gadolinium accumulation, however, a SI increase was not found after the tenth administration supporting the hypothesis of a slow elimination of the previously retained gadolinium (wash-out effect) from the brain or of a change in form (by dechelation), causing the signal to fade. No increasing SI was found in the DN and GP after exclusive exposure to gadoterate meglumine, thus confirming its stability. We found, instead, a trend for a significative gadolinium elimination over time.

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Keywords : MRI, Gadolinium, Retention, Linear, Macrocyclic

Abbreviations : 2D, 3D, ANTs, CI, DN, eGFR, GBCAs, GP, MRI, P, ROIs, SI, T, W