From the Department of Radiology, Lausanne University Hospital, Lausanne, Switzerland.
Invest Radiol. 2019 Sep;54(9):537-548. doi: 10.1097/RLI.0000000000000564.
Current findings on gadolinium deposition in the pediatric brain due to repeated exposure to macrocyclic contrast agents are inconclusive and possibly confounded by brain maturation processes. We evaluated the longitudinal effects of repeated gadoterate meglumine exposure (Dotarem; Guerbet, Villepinte, France) on the T1- and T2-weighted signal intensity (SI) in pediatric patients, and assessed the magnitude of age-related increase in T1-weighted (and decrease in T2-weighted) SI in a control cohort without prior gadolinium exposure.
In this retrospective, double-cohort study, magnetic resonance imaging (MRI) data of 24 patients (0.7-16.4 years, M = 5.74, SD = 4.15) who received at least 10 doses of exclusively gadoterate meglumine were included in the longitudinal study. The MRI data of 190 controls (age range, 1-20 years; 10 patients/bin; bin width, 1 year) without any prior gadolinium-based contrast exposure were included in the control, cross-sectional study to assess the age-dependent SI changes in the regions of interest (ROIs). We measured SI (native), T1-weighted gradient echo, and T2-weighted fast spin-echo of 12 deep brain nuclei. The ROIs were measured at each of the first 11 MRI examinations of the contrast-exposed patients and in the control subject's MRI. Regions of interest's SIs, normalized by the pons, were analyzed with mixed effects models, accounting for the potential confounding factors, such as radiotherapy and chemotherapy.
The number of gadoterate meglumine administrations had no effect on the SI increase in any of the ROIs (all P > 0.05), but age significantly correlated with increased SI in T1-weighted globus pallidus (GP; P < 0.01) and caudate (P < 0.05), and with decreased SI in T2-weighted GP (P < 0.001) and dentate nucleus (P < 0.005) in the contrast-exposed group. The cross-sectional analyses of the control cohort showed a significant age-dependent T1-weighted SI increase in multiple ROIs, including the GP and caudate, and decrease in the T2-weighted GP and dentate nucleus (P < 0.05).
Repeated exposure to gadoterate meglumine was not associated with brain hyperintensity in the pediatric patients, whereas age importantly contributed to the SI changes in several deep brain nuclei.
由于反复接触大环造影剂，目前关于儿童大脑中钆沉积的研究结果尚无定论，并且可能受到大脑成熟过程的影响。我们评估了重复使用钆特酸葡甲胺（Dotarem；Guerbet，Villepinte，法国）对儿科患者 T1 和 T2 加权信号强度（SI）的纵向影响，并评估了无先前钆暴露的对照组中年龄相关的 T1 加权（和 T2 加权）SI 增加幅度。
在这项回顾性、双队列研究中，纳入了至少接受 10 次单纯钆特酸葡甲胺治疗的 24 名患者（0.7-16.4 岁，M=5.74，SD=4.15）的磁共振成像（MRI）数据。该研究还纳入了 190 名无任何先前基于钆对比剂暴露的对照组患者（年龄范围为 1-20 岁；10 名患者/组；组宽度为 1 年）的 MRI 数据，以评估无对比剂暴露的对照组中感兴趣区（ROI）的年龄依赖性 SI 变化。我们测量了 12 个深部脑核的 SI（原始）、T1 加权梯度回波和 T2 加权快速自旋回波。在接受造影剂的患者的前 11 次 MRI 检查中的每个检查以及对照组患者的 MRI 中测量 ROI 的 SI。通过混合效应模型分析 ROI 的 SI，以校正潜在的混杂因素，如放疗和化疗。
钆特酸葡甲胺的给药次数对任何 ROI 的 SI 增加均无影响（均 P>0.05），但年龄与 T1 加权苍白球（GP）和尾状核（caudate）的 SI 增加显著相关（P<0.01 和 P<0.05），与 T2 加权 GP 和齿状核（dentate nucleus）的 SI 降低显著相关（P<0.001 和 P<0.005）。对照组的横断面分析显示，多个 ROI 的 T1 加权 SI 显著增加，包括 GP 和尾状核，T2 加权 GP 和齿状核的 SI 显著降低（P<0.05）。
重复接触钆特酸葡甲胺与儿科患者的脑高信号无关，而年龄对几个深部脑核的 SI 变化有重要贡献。
