From the Department of Radiology (H.K., M.L., R.T., S.K., D.K.B.L.)
University of British Columbia MS/MRI Research Group (M.H., R.T., A.R., A.T., S.K., D.K.B.L.).
AJNR Am J Neuroradiol. 2018 Sep;39(9):1597-1603. doi: 10.3174/ajnr.A5751. Epub 2018 Aug 23.
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.
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.
Between week -4 and year 1, subjects in the high-exposure cohort showed increased signal intensity ratios in all regions ( < .01), while the low-exposure cohort showed only an increase in the dentate nucleus ( = .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.
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.
在增强 T1WI 上，深部脑结构的高信号与钆基造影剂的剂量依赖性相关，随后通过组织病理学证实了钆沉积。我们的目的是确定在增强 T1WI 上，深部脑结构的信号强度是否与线性钆基造影剂的更大暴露量有关。次要目标是比较离子型和非离子型线性钆基造影剂之间的信号强度差异。
回顾性研究了最初参加多中心临床试验的继发进展型 MS 患者。80 例（高暴露组）在第-4 周到第 1 年接受了 9 次线性钆基造影剂（30 次非离子型/50 次离子型）治疗，第 2 年进行了第 10 次治疗。115 例（低暴露组）在第-4 周到第 1 年接受了 2 次治疗（40 次非离子型/75 次离子型），第 2 年进行了第 3 次治疗。通过在齿状核、苍白球、尾状核、丘脑、脑桥和白质上放置样本点，在增强 T1WI 上测量信号强度，并使用以下比值进行归一化：齿状核/脑桥、苍白球/白质、尾状核/白质和丘脑/白质。
在第-4 周到第 1 年期间，高暴露组的所有区域的信号强度比值均增加（<0.01），而低暴露组仅齿状核增加（=0.003）。在第 1 年到第 2 年期间，当两组均仅接受 1 次额外的钆基造影剂治疗时，未观察到明显变化。在高暴露组中，接受线性非离子型造影剂治疗的患者的信号强度比值变化明显高于接受线性离子型造影剂治疗的患者。
来自钆沉积的深部脑结构高信号与剂量数和线性钆基造影剂的类型（非离子型大于离子型）有关。
