1
|
Weinstein RM, Gowda PC, Yuan F, Khalil A, Motaghi M, Garg T, Gong AJ, Lin DD, Weiss CR. Risk factors and clinical features associated with basal ganglia manganese deposition in patients with hereditary hemorrhagic telangiectasia. Clin Imaging 2023; 101:183-189. [PMID: 37390610 DOI: 10.1016/j.clinimag.2023.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 06/06/2023] [Accepted: 06/16/2023] [Indexed: 07/02/2023]
Abstract
BACKGROUND T1-hyperintensity of the basal ganglia (BG) due to manganese deposition is a known radiologic finding in patients with hereditary hemorrhagic telangiectasia (HHT), but risk factors and associated clinical manifestations are unclear. This study conducted a quantitative analysis of the association of T1-hyperintensity in HHT patients with specific risk factors, signs, and symptoms. METHODS Patients seen at our center between 2005 and 2020 with a definitive diagnosis of HHT who had an available non-contrast T1-weighted brain MRI were included. Hyperintensity was evaluated using oval regions of interest measurements. The BG: thalamus intensity ratio was used to quantitatively evaluate T1-hyperintensity. Patient laboratory values and clinical findings were collected from electronic medical records. Hyperintensity was analyzed for its association with laboratory values, and clinical findings. Variables were analyzed through regression analysis. RESULTS A total of 239 patients were included in this study. On 1.5 T scanners, values that were significant on multivariable regression analysis were age (p < .001), hepatic AVMs (p < .001), iron deficiency anemia (p = .0021), and cirrhosis (p = .016). On 3 T scanners, values that were significant on multivariable analysis were hepatic AVMs (p = .0024) and cirrhosis (p = .0056). On 3 T scanners, hyperintensity was significantly associated with tremor (OR = 1.17, p = .033), restless leg syndrome (OR = 1.22, p = .0086), and memory problems (OR = 1.17, p = .046). CONCLUSIONS BG hyperintensity due to manganese deposition is significantly associated with hepatic risk factors on 1.5 T and 3 T scanners and iron deficiency anemia on 1.5 T scanners. On 3 T scanners, T1-hyperintensity is associated with neuropsychiatric signs and symptoms, such as tremor, restless leg syndrome, and memory problems.
Collapse
Affiliation(s)
- Robert M Weinstein
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Prateek C Gowda
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Frank Yuan
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America
| | - Adham Khalil
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America
| | - Mina Motaghi
- Georgia Southern University, Jiann-Ping Hsu College of Public Health, Department of Biostatistics, Epidemiology and Environmental Health Sciences, United States of America
| | - Tushar Garg
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America
| | - Anna J Gong
- The Johns Hopkins University School of Medicine, Baltimore, MD, United States of America
| | - Doris D Lin
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Neuroradiology, United States of America
| | - Clifford R Weiss
- The Johns Hopkins University School of Medicine, Russell H. Morgan Department of Radiology and Radiologic Science, Division of Interventional Radiology, United States of America.
| |
Collapse
|
2
|
Kromrey ML, Oswald S, Becher D, Bartel J, Schulze J, Paland H, Ittermann T, Hadlich S, Kühn JP, Mouchantat S. Intracerebral gadolinium deposition following blood-brain barrier disturbance in two different mouse models. Sci Rep 2023; 13:10164. [PMID: 37349374 PMCID: PMC10287697 DOI: 10.1038/s41598-023-36991-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 06/14/2023] [Indexed: 06/24/2023] Open
Abstract
To evaluate the influence of the blood-brain barrier on neuronal gadolinium deposition in a mouse model after multiple intravenous applications of the linear contrast agent gadodiamide. The prospective study held 54 mice divided into three groups: healthy mice (A), mice with iatrogenic induced disturbance of the blood-brain barrier by glioblastoma (B) or cerebral infarction (C). In each group 9 animals received 10 iv-injections of gadodiamide (1.2 mmol/kg) every 48 h followed by plain T1-weighted brain MRI. A final MRI was performed 5 days after the last contrast injection. Remaining mice underwent MRI in the same time intervals without contrast application (control group). Signal intensities of thalamus, pallidum, pons, dentate nucleus, and globus pallidus-to-thalamus and dentate nucleus-to-pons ratios, were determined. Gadodiamide complex and total gadolinium amount were quantified after the last MR examination via LC-MS/MS and ICP-MS. Dentate nucleus-to-pons and globus pallidus-to-thalamus SI ratios showed no significant increase over time within all mice groups receiving gadodiamide, as well as compared to the control groups at last MR examination. Comparing healthy mice with group B and C after repetitive contrast administration, a significant SI increase could only be detected for glioblastoma mice in globus pallidus-to-thalamus ratio (p = 0.033), infarction mice showed no significant SI alteration. Tissue analysis revealed significantly higher gadolinium levels in glioblastoma group compared to healthy (p = 0.013) and infarction mice (p = 0.029). Multiple application of the linear contrast agent gadodiamide leads to cerebral gadolinium deposition without imaging correlate in MRI.
Collapse
Affiliation(s)
- M L Kromrey
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany.
| | - S Oswald
- Institute of Pharmacology and Toxicology, Rostock University Medical Center, Rostock, Germany
| | - D Becher
- Department of Microbial Proteomics, Institute of Microbiology, University of Greifswald, Greifswald, Germany
| | - J Bartel
- Department of Microbial Proteomics, Institute of Microbiology, University of Greifswald, Greifswald, Germany
| | - J Schulze
- Department of Neurology, University Medicine Greifswald, Greifswald, Germany
| | - H Paland
- Department of Pharmacology/C_DAT, University Medicine Greifswald, Greifswald, Germany
- Department of Neurosurgery, University Medicine Greifswald, Greifswald, Germany
| | - T Ittermann
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - S Hadlich
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| | - J P Kühn
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
- Institute and Policlinic of Diagnostic and Interventional Radiology, University Hospital Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany
| | - S Mouchantat
- Department of Diagnostic Radiology and Neuroradiology, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475, Greifswald, Germany
| |
Collapse
|
3
|
Olszewska DA, Rawal S, Fearon C, Alcaide‐Leon P, Stell R, Paramanandan V, Lynch T, Jawad T, Vittal P, Barton B, Miyajima H, Kono S, Kandadai RM, Borgohain R, Lang AE. Neuroimaging Pearls from the MDS Congress Video Challenge. Part 1: Genetic Disorders. Mov Disord Clin Pract 2022; 9:297-310. [PMID: 35402643 PMCID: PMC8974871 DOI: 10.1002/mdc3.13412] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2021] [Revised: 12/29/2021] [Accepted: 12/30/2021] [Indexed: 02/05/2023] Open
Abstract
We selected several "imaging pearls" presented during the Movement Disorder Society (MDS) Video Challenge for this review. While the event, as implicated by its name, was video-centered, we would like to emphasize the important role of imaging in making the correct diagnosis. We divided this anthology into two parts: genetic and acquired disorders. Genetic cases described herein were organized by the inheritance pattern and the focus was put on the imaging findings and differential diagnoses. Despite the overlapping phenotypes, certain described disorders have pathognomonic MRI brain findings that would provide either the "spot" diagnosis or result in further investigations leading to the diagnosis. Despite this, the diagnosis is often challenging with a broad differential diagnosis, and hallmark findings may be present for only a limited time.
Collapse
Affiliation(s)
- Diana A. Olszewska
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Sapna Rawal
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Conor Fearon
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| | - Paula Alcaide‐Leon
- Division of Neuroradiology, Joint Department of Medical Imaging, Toronto Western HospitalUniversity Health NetworkTorontoOntarioCanada
| | - Rick Stell
- Movement Disorders Unit, Perron Institute of Neurological Translational ScienceSir Charles Gairdner HospitalPerthWestern AustraliaAustralia
| | | | - Tim Lynch
- Centre for Brain HealthDublin Neurological Institute at the Mater Misericordiae University HospitalDublinIreland
- School of Medicine and Medical ScienceUniversity College DublinDublinIreland
| | - Tania Jawad
- Department of NeurologyThe Royal Free HospitalLondonUnited Kingdom
| | - Padmaja Vittal
- Northwestern Medicine Central Dupage HospitalNeurodegenerative Diseases CenterWinfieldIllinoisUSA
| | - Brandon Barton
- Rush University Medical CenterChicagoIllinoisUSA
- Parkinson's Disease Research, Education, and Clinical Care ConsortiumJesse Brown VA Medical CenterChicagoIllinoisUSA
| | - Hiroaki Miyajima
- First Department of MedicineHamamatsu University School of MedicineHamamatsuJapan
| | | | | | - Rupam Borgohain
- Department of NeurologyNizam's Institute of Medical SciencesHyderabadIndia
| | - Anthony E. Lang
- Edmond J. Safra Program in Parkinson's Disease, Morton and Gloria Shulman Movement Disorders Clinic, Toronto Western Hospital—UHN, Division of NeurologyUniversity of TorontoTorontoOntarioCanada
| |
Collapse
|
4
|
Al-Muhanna A. Gadolinium retention after contrast-enhanced magnetic resonance imaging: A narratative review. SAUDI JOURNAL OF MEDICINE AND MEDICAL SCIENCES 2022; 10:12-18. [PMID: 35283709 PMCID: PMC8869263 DOI: 10.4103/sjmms.sjmms_198_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Revised: 09/01/2021] [Accepted: 12/28/2021] [Indexed: 11/04/2022] Open
Abstract
Over the past five years, several studies have reported deposition and retention of gadolinium in the brain after administration of gadolinium-based contrast agents (GBCAs) during radiological procedures. Patients with renal insufficiency cannot filter gadolinium efficiently; however, gadolinium is also retained in the brain of some adults and pediatrics with no renal impairment. In the literature, data is mostly available from retrospective magnetic resonance imaging (MRI) studies, where gadolinium deposition may be indirectly measured by evaluating changes in T1 signal intensity in the brain tissues, particularly in the deep gray matter such as the dentate nucleus and/or globus pallidus. Many pathological studies have reported a direct correlation between T1 signal changes and gadolinium deposition in human and animal autopsy specimens, which raised concerns on the use of GBCAs, particularly with linear chelators. The association between gadolinium accumulation and occurrence of physical and neurological side effects or neurotoxic damage has not yet been conclusively demonstrated. Studies have also observed that gadolinium is deposited in the extracranial tissues, such as the liver, skin, and bone, of patients with normal kidney function. This narrative review describes the effects of different types of GBCAs in relation to gadolinium deposition, evaluates current evidence on gadolinium deposition in various tissues of the human body, and summarizes the current recommendations regarding the use of GBCAs.
Collapse
|
5
|
Choi JW, Moon WJ. Gadolinium Deposition in the Brain: Current Updates. Korean J Radiol 2018; 20:134-147. [PMID: 30627029 PMCID: PMC6315073 DOI: 10.3348/kjr.2018.0356] [Citation(s) in RCA: 105] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 09/21/2018] [Indexed: 12/21/2022] Open
Abstract
Gadolinium-based contrast agents (GBCAs) are commonly used for enhancement in MR imaging and have long been considered safe when administered at recommended doses. However, since the report that nephrogenic systemic fibrosis is linked to the use of GBCAs in subjects with severe renal diseases, accumulating evidence has suggested that GBCAs are not cleared entirely from our bodies; some GBCAs are deposited in our tissues, including the brain. GBCA deposition in the brain is mostly linked to the specific chelate structure of the GBCA: linear GBCAs were responsible for brain deposition in almost all reported studies. This review aimed to summarize the current knowledge about GBCA brain deposition and discuss its clinical implications.
Collapse
Affiliation(s)
- Jin Woo Choi
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| | - Won-Jin Moon
- Department of Radiology, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul, Korea
| |
Collapse
|
6
|
Signal Changes in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Magnetic Resonance Images After Intrathecal Administration of Macrocyclic Gadolinium Contrast Agent. Invest Radiol 2018; 53:535-540. [DOI: 10.1097/rli.0000000000000472] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
7
|
[Weakness of the left hand and pallor in a 21-year-old woman]. Rev Med Interne 2017; 39:134-137. [PMID: 28780283 DOI: 10.1016/j.revmed.2017.06.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 06/26/2017] [Indexed: 11/21/2022]
|
8
|
Parvinian A, Iyer VN, Pannu BS, Apala DR, Wood CP, Brinjikji W. Basal Ganglia T1 Hyperintensity in Hereditary Hemorrhagic Telangiectasia. AJNR Am J Neuroradiol 2017; 38:1929-1933. [PMID: 28775059 DOI: 10.3174/ajnr.a5322] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/28/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND AND PURPOSE The implications of basal ganglia T1 hyperintensity remain unclear in patients with hereditary hemorrhagic telangiectasia. This study was performed to assess the prevalence of this imaging finding in a large cohort of patients with hereditary hemorrhagic telangiectasia and to identify any association between this phenomenon and other disease manifestations. MATERIALS AND METHODS In this retrospective study, we identified all patients at our institution diagnosed with definite hereditary hemorrhagic telangiectasia from 2001 to 2017. Patients who did not undergo brain MR imaging were excluded. Patient demographics, laboratory results, and hereditary hemorrhagic telangiectasia disease characteristics were noted. Basal ganglia hyperintensity was evaluated both qualitatively and quantitatively relative to the signal intensity in the ipsilateral thalami. Statistical analysis was performed with commercially available software. RESULTS A total of 312 patients (41% men, 59% women; mean age, 51 ± 18 years) with definite hereditary hemorrhagic telangiectasia were identified. Basal ganglia T1 hyperintensity was present in 23.4% of patients and demonstrated a statistically significant association with older age (P < .001), increased hepatic AVMs (P < .001), high cardiac output state (P < .001), hepatic failure (P = .01), elevated peak serum alkaline phosphatase level (P = .03), and increased total bilirubin count (P = .03). There was no significant association with sex, hereditary hemorrhagic telangiectasia genetic mutation status, parkinsonism, or serum transaminase levels. CONCLUSIONS Basal ganglia T1 hyperintensity occurs in >23% of patients with hereditary hemorrhagic telangiectasia and is associated with hepatic vascular malformations, hepatic dysfunction, and elevated cardiac output. The presence of this finding on screening MR imaging in patients with hereditary hemorrhagic telangiectasia should prompt further evaluation for visceral lesions causing arteriovenous shunting.
Collapse
Affiliation(s)
- A Parvinian
- From the Departments of Radiology (A.P., B.S.P., D.R.A., C.P.W., W.B.)
| | - V N Iyer
- Pulmonary and Critical Care Medicine (V.N.I.), Mayo Clinic, Rochester, Minnesota
| | - B S Pannu
- From the Departments of Radiology (A.P., B.S.P., D.R.A., C.P.W., W.B.)
| | - D R Apala
- From the Departments of Radiology (A.P., B.S.P., D.R.A., C.P.W., W.B.)
| | - C P Wood
- From the Departments of Radiology (A.P., B.S.P., D.R.A., C.P.W., W.B.)
| | - W Brinjikji
- From the Departments of Radiology (A.P., B.S.P., D.R.A., C.P.W., W.B.)
| |
Collapse
|
9
|
Kanda T, Nakai Y, Oba H, Toyoda K, Kitajima K, Furui S. Gadolinium deposition in the brain. Magn Reson Imaging 2016; 34:1346-1350. [DOI: 10.1016/j.mri.2016.08.024] [Citation(s) in RCA: 104] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Revised: 08/25/2016] [Accepted: 08/29/2016] [Indexed: 12/30/2022]
|
10
|
Effect of Renal Function on Gadolinium-Related Signal Increases on Unenhanced T1-Weighted Brain Magnetic Resonance Imaging. Invest Radiol 2016; 51:677-682. [PMID: 27272543 DOI: 10.1097/rli.0000000000000294] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
|
11
|
Intravenous injection of gadobutrol in an epidemiological study group did not lead to a difference in relative signal intensities of certain brain structures after 5 years. Eur Radiol 2016; 27:772-777. [PMID: 27221561 DOI: 10.1007/s00330-016-4418-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 05/10/2016] [Accepted: 05/13/2016] [Indexed: 12/17/2022]
Abstract
PURPOSE To investigate if application of macrocyclic gadolinium-based contrast agents in volunteers is associated with neuronal deposition detected by magnetic resonance imaging in a 5-year longitudinal survey. MATERIALS AND METHODS Three hundred eighty-seven volunteers who participated in a population-based study were enrolled. Subjects underwent plain T1-weighted brain MRI at baseline and 5 years later with identical sequence parameters. At baseline, 271 participants additionally received intravenous injection of the macrocyclic contrast agent gadobutrol (0.15 mmol/kg). A control group including 116 subjects received no contrast agent. Relative signal intensities of thalamus, pallidum, pons and dentate nucleus were compared at baseline and follow-up. RESULTS No difference in relative signal intensities was observed between contrast group (thalamus, p = 0.865; pallidum, p = 0.263; pons, p = 0.533; dentate nucleus, p = 0.396) and control group (thalamus, p = 0.683; pallidum; p = 0.970; pons, p = 0.773; dentate nucleus, p = 0.232) at both times. Comparison between both groups revealed no significant differences in relative signal intensities (thalamus, p = 0.413; pallidum, p = 0.653; pons, p = 0.460; dentate nucleus, p = 0.751). The study showed no significant change in globus pallidus-to-thalamus or dentate nucleus-to-pons ratios. CONCLUSIONS Five years after administration of a 1.5-fold dose gadobutrol to normal subjects, signal intensity of thalamus, pallidum, pons and dentate nucleus did not differ from participants who had not received gadobutrol. KEY POINTS • Gadobutrol does not lead to neuronal signal alterations after 5 years. • Neuronal deposition of macrocyclic contrast agent could not be confirmed. • Macrocyclic contrast agents in a proven dosage are safe.
Collapse
|
12
|
Thomsen HS. T1 hyperintensity in the brain after multiple intravenous injections of gadolinium-based contrast agents. Acta Radiol 2016; 57:389-91. [PMID: 26792824 DOI: 10.1177/0284185115626479] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Henrik S Thomsen
- Department of Diagnostic Radiology 54E2, Copenhagen University Hospital Herlev-Gentofte, Herlev, Denmark
| |
Collapse
|
13
|
Contribution of metals to brain MR signal intensity: review articles. Jpn J Radiol 2016; 34:258-66. [PMID: 26932404 DOI: 10.1007/s11604-016-0532-8] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/18/2016] [Indexed: 12/14/2022]
Abstract
Various metals are essential nutrients in humans, and metal shortages lead to a variety of deficiency diseases. Metal concentration abnormalities may cause metal deposition in the brain, and magnetic resonance imaging (MRI) is the most potent and sensitive technique now available for detecting metal deposition given the difficulties associated with performing brain tissue biopsy. However, the brain contains many kinds of metals that affect the signal intensity of MRI, which has led to numerous misunderstandings in the history of metal analysis. We reviewed the history of brain metal analysis with histologic findings. Typically, manganese overload causes high signal intensity on T1-weighted images (T1WI) in the globus pallidus, iron overload causes low signal intensity in the globus pallidus on T2-weighted images, and gadolinium deposition causes high signal intensity in the dentate nucleus, globus pallidus, and pulvinar of thalamus on T1WI. However, because nonparamagnetic materials and other coexisting metals also affect the signal intensity of brain MRI, the quantitative analysis of metal concentrations is difficult. Thus, when analyzing metal deposition using MRI, caution should be exercised when interpreting the validity and reliability of the obtained data.
Collapse
|
14
|
Stojanov D, Aracki-Trenkic A, Benedeto-Stojanov D. Gadolinium deposition within the dentate nucleus and globus pallidus after repeated administrations of gadolinium-based contrast agents-current status. Neuroradiology 2016; 58:433-41. [PMID: 26873830 DOI: 10.1007/s00234-016-1658-1] [Citation(s) in RCA: 91] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Accepted: 02/02/2016] [Indexed: 12/14/2022]
Abstract
INTRODUCTION Gadolinium-based contrast agents (GBCAs) have been used clinically since 1988 for contrast-enhanced magnetic resonance imaging (CE-MRI). Generally, GBCAs are considered to have an excellent safety profile. However, GBCA administration has been associated with increased occurrence of nephrogenic systemic fibrosis (NSF) in patients with severely compromised renal function, and several studies have shown evidence of gadolinium deposition in specific brain structures, the globus pallidus and dentate nucleus, in patients with normal renal function. METHODS Gadolinium deposition in the brain following repeated CE-MRI scans has been demonstrated in patients using T1-weighted unenhanced MRI and inductively coupled plasma mass spectroscopy. Additionally, rodent studies with controlled GBCA administration also resulted in neural gadolinium deposits. RESULTS Repeated GBCA use is associated with gadolinium deposition in the brain. This is especially true with the use of less-stable, linear GBCAs. In spite of increasing evidence of gadolinium deposits in the brains of patients after multiple GBCA administrations, the clinical significance of these deposits continues to be unclear. CONCLUSION Here, we discuss the current state of scientific evidence surrounding gadolinium deposition in the brain following GBCA use, and the potential clinical significance of gadolinium deposition. There is considerable need for further research, both to understand the mechanism by which gadolinium deposition in the brain occurs and how it affects the patients in which it occurs.
Collapse
Affiliation(s)
- Dragan Stojanov
- Faculty of Medicine, University of Nis, Bul. Dr. Zorana Djindjica 81, Nis, 18000, Serbia.
- Center for Radiology, Clinical Center Nis, Nis, Serbia.
| | | | | |
Collapse
|
15
|
Stojanov DA, Aracki-Trenkic A, Vojinovic S, Benedeto-Stojanov D, Ljubisavljevic S. Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol. Eur Radiol 2015; 26:807-15. [PMID: 26105022 DOI: 10.1007/s00330-015-3879-9] [Citation(s) in RCA: 164] [Impact Index Per Article: 18.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 05/23/2015] [Accepted: 06/03/2015] [Indexed: 02/07/2023]
Affiliation(s)
- Dragan A Stojanov
- Faculty of Medicine, University of Nis, Nis, Serbia, Bul. Dr. Z. Djindjica 82.
- Center for Radiology, Clinical Center Nis, Nis, Serbia, Bul. Dr. Z. Djindjica 48.
| | | | - Slobodan Vojinovic
- Faculty of Medicine, University of Nis, Nis, Serbia, Bul. Dr. Z. Djindjica 82.
- Clinic for Neurology, Clinical Center Nis, Nis, Serbia, Bul. Dr. Z. Djindjica 48.
| | | | - Srdjan Ljubisavljevic
- Faculty of Medicine, University of Nis, Nis, Serbia, Bul. Dr. Z. Djindjica 82.
- Clinic for Neurology, Clinical Center Nis, Nis, Serbia, Bul. Dr. Z. Djindjica 48.
| |
Collapse
|
16
|
Zhu Z, Han X, Qian F, Shi W, Tang W, Dong Q. "Multiple system degeneration" in hereditary hemorrhagic telangiectasia: the hepatic connection. J Neurol Sci 2014; 346:339-40. [PMID: 25179876 DOI: 10.1016/j.jns.2014.08.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 06/18/2014] [Accepted: 08/11/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Zhu Zhu
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Xiang Han
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China
| | - Feng Qian
- Department of Health Policy, Management, and Behavior, School of Public Health, University at Albany - State University of New York, United States
| | - Wei Shi
- Department of General Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Weijun Tang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology, Huashan Hospital, State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
| |
Collapse
|
17
|
Li SJ, Jiang L, Fu X, Huang S, Huang YN, Li XR, Chen JW, Li Y, Luo HL, Wang F, Ou SY, Jiang YM. Pallidal index as biomarker of manganese brain accumulation and associated with manganese levels in blood: a meta-analysis. PLoS One 2014; 9:e93900. [PMID: 24718592 PMCID: PMC3981755 DOI: 10.1371/journal.pone.0093900] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Accepted: 03/09/2014] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE The current study was designed to evaluate the sensitivity, feasibility, and effectiveness of the pallidal index (PI) serving as a biomarker of brain manganese (Mn) accumulation, which would be used as an early diagnosis criteria for Mn neurotoxicity. METHODS The weighted mean difference (WMD) of the PI between control and Mn-exposed groups was estimated by using a random-effects or fixed-effects meta-analysis with 95% confidence interval (CI) performed by STATA software version 12.1. Moreover, the R package "metacor" was used to estimate correlation coefficients between PI and blood Mn (MnB). RESULTS A total of eight studies with 281 occupationally Mn-exposed workers met the inclusion criteria. Results were pooled and performed with the Meta-analysis. Our data indicated that the PI of the exposed group was significantly higher than that of the control (WMD: 7.76; 95% CI: 4.86, 10.65; I2 = 85.7%, p<0.0001). A random effects model was used to perform meta-analysis. These findings were remarkably robust in the sensitivity analysis, and publication bias was shown in the included studies. Seven out of the eight studies reported the Pearson correlation (r) values. Significantly positive correlation between PI and MnB was observed (r = 0.42; 95% CI, 0.31, 0.52). CONCLUSIONS PI can be considered as a sensitive, feasible, effective and semi-quantitative index in evaluating brain Mn accumulation. MnB can also augment the evaluation of brain Mn accumulation levels in the near future. However, the results should be interpreted with caution.
Collapse
Affiliation(s)
- Shao-Jun Li
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Li Jiang
- Department of Radiotherapy, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Xue Fu
- School of Health Sciences, Purdue University, West Lafayette, Indiana, United States of America
| | - Shuang Huang
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yan-Ni Huang
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Xiang-Rong Li
- Department of Radiology, the First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi, China
| | - Jing-Wen Chen
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yong Li
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Hai-Lan Luo
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Fang Wang
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Shi-Yan Ou
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
| | - Yue-Ming Jiang
- Department of Toxicology, School of Public Health, Guangxi Medical University, Nanning, Guangxi, China
- * E-mail:
| |
Collapse
|
18
|
Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. 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. Radiology 2013; 270:834-41. [PMID: 24475844 DOI: 10.1148/radiol.13131669] [Citation(s) in RCA: 965] [Impact Index Per Article: 87.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
PURPOSE To explore any correlation between the number of previous gadolinium-based contrast material administrations and high signal intensity (SI) in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance (MR) images. MATERIALS AND METHODS The institutional review board approved this study, waiving the requirement to obtain written informed consent. A group of 381 consecutive patients who had undergone brain MR imaging was identified for cross-sectional analysis. For longitudinal analysis, 19 patients who had undergone at least six contrast-enhanced examinations were compared with 16 patients who had undergone at least six unenhanced examinations. The mean SIs of the dentate nucleus, pons, globus pallidus, and thalamus were measured on unenhanced T1-weighted images. The dentate nucleus-to-pons SI ratio was calculated by dividing the SI in the dentate nucleus by that in the pons, and the globus pallidus-to-thalamus SI ratio was calculated by dividing the SI in the globus pallidus by that in the thalamus. Stepwise regression analysis was undertaken in the consecutive patient group to detect any relationship between the dentate nucleus-to-pons or globus pallidus-to-thalamus SI ratio and previous gadolinium-based contrast material administration or other factors. A random coefficient model was used to evaluate for longitudinal analysis. RESULTS The dentate nucleus-to-pons SI ratio showed a significant correlation with the number of previous gadolinium-based contrast material administrations (P < .001; regression coefficient, 0.010; 95% confidence interval [CI]: 0.009, 0.011; standardized regression coefficient, 0.695). The globus pallidus-to-thalamus SI ratio showed a significant correlation with the number of previous gadolinium-based contrast material administrations (P < .001; regression coefficient, 0.004; 95% CI: 0.002, 0.006; standardized regression coefficient, 0.288), radiation therapy (P = .009; regression coefficient, -0.014; 95% CI: -0.025, -0.004; standardized regression coefficient, -0.151), and liver function (P = .031; regression coefficient, 0.023; 95% CI: 0.002, 0.044; standardized regression coefficient, 0.107). The dentate nucleus-to-pons and globus pallidus-to-thalamus SI ratios in patients who had undergone contrast-enhanced examinations were significantly greater than those of patients who had undergone unenhanced examinations (P < .001 for both). CONCLUSION 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.
Collapse
Affiliation(s)
- Tomonori Kanda
- From the Department of Diagnostic Radiology, Hyogo Cancer Center, Akashi, Hyogo, Japan (T.K., H.K., D.T.); Department of Radiology, Kinki University Faculty of Medicine, Osakasayama, Osaka, Japan (K.I.); and Department of Radiology, Kobe University Graduate School of Medicine, Kobe, Hyogo, Japan (K.K.)
| | | | | | | | | |
Collapse
|