From the Department of Radiology (G.B., B.B., S.M., S.C., A.L., M.L.)
Stevens Neuroimaging and Informatics Institute (G.B., B.B., A.W.T., M.L.).
AJNR Am J Neuroradiol. 2019 Aug;40(8):1274-1281. doi: 10.3174/ajnr.A6148. Epub 2019 Jul 25.
The clinical implications of gadolinium deposition in the CNS are not fully understood, and it is still not known whether gadolinium tends to be retained more in the brain compared with the spinal cord. In this study, we assessed the effects of linear gadolinium-based contrast agents on the T1 signal intensity of 3 cerebral areas (dentate nucleus, globus pallidus, and the less studied substantia nigra) and the cervical spinal cord in a population of patients with MS.
A single-center population of 100 patients with MS was analyzed. Patients underwent 2-16 contrast-enhanced MRIs. Fifty patients received ≤5 linear gadolinium injections, and 50 patients had ≥6 injections: Fifty-two patients had both Gd-DTPA and gadobenate dimeglumine injections, and 48 patients received only gadobenate dimeglumine. A quantitative analysis of signal intensity changes was independently performed by 2 readers on the first and last MR imaging scan. The globus pallidus-to-thalamus, substantia nigra-to-midbrain, dentate nucleus-to-middle cerebellar peduncle, and the cervical spinal cord-to-pons signal intensity ratios were calculated.
An increase of globus pallidus-to-thalamus (mean, +0.0251 ± 0.0432; < .001), dentate nucleus-to-middle cerebellar peduncle (mean, +0.0266 ± 0.0841; = .002), and substantia nigra-to-midbrain (mean, +0.0262 ± 0.0673; < .001) signal intensity ratios after multiple administrations of linear gadolinium-based contrast agents was observed. These changes were significantly higher in patients who received ≥6 injections ( < .001) and positively correlated with the number of injections and the accumulated dose of contrast. No significant changes were detected in the spinal cord (mean, +0.0008 ± 0.0089; = .400).
Patients with MS receiving ≥6 linear gadolinium-based contrast agent injections showed a significant increase in the signal intensity of the globus pallidus, dentate nucleus, and substantia nigra; no detectable changes were observed in the cervical spinal cord.
目前尚未完全了解 CNS 中钆沉积的临床意义，也不知道与脊髓相比，钆是否更容易在大脑中蓄积。本研究旨在评估线性钆基造影剂对多发性硬化症（MS）患者脑内 3 个区域（齿状核、苍白球和研究较少的黑质）和颈髓 T1 信号强度的影响。
分析了 100 例单中心 MS 患者，所有患者均接受了 2 至 16 次增强 MRI 检查。50 例患者接受了 ≤5 次线性钆造影剂注射，50 例患者接受了 ≥6 次注射：52 例患者同时接受了 Gd-DTPA 和钆贝葡胺注射，48 例患者仅接受了钆贝葡胺注射。由 2 名读者独立对首次和末次 MRI 扫描进行信号强度变化的定量分析。计算苍白球-丘脑、黑质-中脑、齿状核-小脑上脚和颈髓-脑桥信号强度比值。
接受多次线性钆基造影剂注射后，观察到苍白球-丘脑（平均增加 0.0251 ± 0.0432；<0.001）、齿状核-小脑上脚（平均增加 0.0266 ± 0.0841；=0.002）和黑质-中脑（平均增加 0.0262 ± 0.0673；<0.001）信号强度比值升高。在接受 ≥6 次注射的患者中，这些变化更显著（<0.001），且与注射次数和造影剂累积剂量呈正相关。而在脊髓中未发现明显变化（平均增加 0.0008 ± 0.0089；=0.400）。
接受 ≥6 次线性钆基造影剂注射的 MS 患者，其苍白球、齿状核和黑质的信号强度显著增加，而颈髓无明显变化。
