Roberts D R, Chatterjee A R, Yazdani M, Marebwa B, Brown T, Collins H, Bolles G, Jenrette J M, Nietert P J, Zhu X
From the Departments of Radiology and Radiological Sciences (D.R.R., A.R.C., M.Y., B.M., T.B., H.C., G.B.)
Neurosciences and Neuroscience Research (D.R.R.).
AJNR Am J Neuroradiol. 2016 Dec;37(12):2340-2347. doi: 10.3174/ajnr.A4891. Epub 2016 Jul 28.
While there have been recent reports of brain retention of gadolinium following gadolinium-based contrast agent administration in adults, a retrospective series of pediatric patients has not previously been reported, to our knowledge. We investigated the relationship between the number of prior gadolinium-based contrast agent doses and increasing T1 signal in the dentate nucleus on unenhanced T1-weighted MR imaging. We hypothesized that despite differences in pediatric physiology and the smaller gadolinium-based contrast agent doses that pediatric patients are typically administered based on weighted-adjusted dosing, the pediatric brain would also demonstrate dose-dependent increasing T1 signal in the dentate nucleus.
We included children with multiple gadolinium-based contrast agent administrations at our institution. A blinded reader placed ROIs within the dentate nucleus and adjacent cerebellar white matter. To eliminate reader bias, we also performed automated ROI delineation of the dentate nucleus, cerebellar white matter, and pons. Dentate-to-cerebellar white matter and dentate-to pons ratios were compared with the number of gadolinium-based contrast agent administrations.
During 20 years at our institution, 280 patients received at least 5 gadolinium-based contrast agent doses, with 1 patient receiving 38 doses. Sixteen patients met the inclusion/exclusion criteria for ROI analysis. Blinded reader dentate-to-cerebellar white matter ratios were significantly associated with gadolinium-based contrast agent doses (r = 0.77, P = .001). The dentate-to-pons ratio and dentate-to-cerebellar white matter ratios based on automated ROI placement were also significantly correlated with gadolinium-based contrast agent doses (t = 4.98, P < .0001 and t = 2.73, P < .02, respectively).
In pediatric patients, the number of prior gadolinium-based contrast agent doses is significantly correlated with progressive T1-weighted dentate hyperintensity. Definitive confirmation of gadolinium deposition requires tissue analysis. Any potential clinical sequelae of gadolinium retention in the developing brain are unknown. Given this uncertainty, we suggest taking a cautious stance, including the use, in pediatric patients, of higher stability, macrocyclic agents, which in both human and animal studies have been shown to be associated with lower levels of gadolinium deposition, and detailed documentation of dosing. Most important, a patient should not be deprived of a well-indicated contrasted MR examination.
尽管近期有报道称成人使用钆基造影剂后钆会在脑内潴留，但据我们所知，此前尚未有关于儿科患者的回顾性系列报道。我们研究了既往钆基造影剂给药剂量与未增强T1加权磁共振成像（MRI）上齿状核T1信号增强之间的关系。我们假设，尽管儿科生理存在差异，且儿科患者通常根据体重调整剂量给予较小剂量的钆基造影剂，但儿科脑内齿状核的T1信号也会呈现剂量依赖性增强。
我们纳入了在本机构接受多次钆基造影剂给药的儿童。一名不知情的阅片者在齿状核及相邻小脑白质内放置感兴趣区（ROI）。为消除阅片者偏倚，我们还对齿状核、小脑白质和脑桥进行了自动ROI勾画。将齿状核与小脑白质的比值以及齿状核与脑桥的比值与钆基造影剂给药次数进行比较。
在本机构的20年期间，280例患者接受了至少5剂钆基造影剂，其中1例患者接受了38剂。16例患者符合ROI分析的纳入/排除标准。不知情阅片者测得的齿状核与小脑白质比值与钆基造影剂剂量显著相关（r = 0.77，P = .001）。基于自动ROI放置测得的齿状核与脑桥比值以及齿状核与小脑白质比值也与钆基造影剂剂量显著相关（分别为t = 4.98，P < .0001和t = 2.73，P < .02）。
在儿科患者中，既往钆基造影剂给药剂量与T1加权像上齿状核渐进性高信号显著相关。钆沉积的确切确认需要组织分析。钆在发育中脑内潴留的任何潜在临床后果尚不清楚。鉴于这种不确定性，我们建议采取谨慎态度，包括在儿科患者中使用稳定性更高的大环类制剂，在人体和动物研究中均已表明其与较低水平的钆沉积相关，并详细记录给药情况。最重要的是，不应剥夺患者进行有明确指征的增强MRI检查的机会。
