From the University of Connecticut, School of Medicine, Farmington, CT.
Warren Alpert Medical School of Brown University, Providence, RI.
Invest Radiol. 2020 Oct;55(10):629-635. doi: 10.1097/RLI.0000000000000663.
Gadolinium deposition is widely believed to occur, but questions regarding accumulation pattern and permanence remain. We conducted a retrospective study of intracranial signal changes on monthly triple-dose contrast-enhanced magnetic resonance imaging (MRI) examinations from the previously published Betaseron vs. Copaxone in Multiple Sclerosis With Triple-Dose Gadolinium and 3-Tesla MRI Endpoints Trial (N = 67) to characterize the dynamics of gadolinium deposition in several deep brain nuclei and track persistence versus washout of gadolinium deposition on long-term follow-up (LTFU) examinations (N = 28) obtained approximately 10 years after enrollment in the Betaseron vs. Copaxone in Multiple Sclerosis With Triple-Dose Gadolinium and 3-Tesla MRI Endpoints Trial.
Using T2 and proton density images and using image analysis software (ITK-SNAP), manual regions of interest were created ascribing boundaries of the caudate nucleus, dentate nucleus, globus pallidus, pulvinar, putamen, white matter, and air. Intensity analysis was conducted on T1-weighted fat-saturated (fat-sat) images using the FSL package. A linear rigid-body transform was calculated from the fat-sat image at each target time point to the region of interest segmentation reference time point fat-sat image. Serial MRI signal was analyzed using linear mixed regression modeling with random intercept. Annual MRI signal changes including LTFU scans were assessed with t test.
During monthly scanning, all gray matter structures demonstrated a significant (P < 0.0001) increase in contrast-to-noise ratio. Yearly changes in deposition showed distinctive patterns for the specific nucleus: globus pallidus showed complete retention, pulvinar showed partial washout, while dentate, caudate, and putamen returned to baseline (ie, complete washout).
Monthly increased contrast-to-noise ratio in gray matter nuclei is consistent with gadolinium deposition over time. The study also suggests that some deep gray matter nuclei permanently retain gadolinium, whereas others demonstrate washout of soluble gadolinium.
人们普遍认为钆沉积会发生，但关于其积累模式和持久性的问题仍存在争议。我们对先前发表的 Betaseron vs. Copaxone 在多发性硬化症三重剂量钆和 3T MRI 终点试验中的颅内信号变化进行了回顾性研究（N = 67），以描述几个深部脑核中的钆沉积动态，并在长期随访（LTFU）检查中追踪钆沉积的持久性与洗脱（N = 28），这些检查大约在 Betaseron vs. Copaxone 在多发性硬化症三重剂量钆和 3T MRI 终点试验入组后 10 年获得。
使用 T2 和质子密度图像，并使用图像分析软件（ITK-SNAP），手动创建感兴趣区域，将尾状核、齿状核、苍白球、丘脑、壳核、白质和空气的边界指定为感兴趣区域。在 T1 加权脂肪饱和（fat-sat）图像上使用 FSL 包进行强度分析。从每个目标时间点的 fat-sat 图像到感兴趣区域分割参考时间点的 fat-sat 图像计算线性刚体变换。使用线性混合回归模型进行序列 MRI 信号分析，带有随机截距。使用 t 检验评估包括 LTFU 扫描在内的年度 MRI 信号变化。
在每月扫描期间，所有灰质结构的对比噪声比均显著增加（P < 0.0001）。沉积的年变化显示出特定核的独特模式：苍白球显示完全保留，丘脑显示部分洗脱，而齿状核、尾状核和壳核则恢复到基线（即完全洗脱）。
灰质核中每月增加的对比噪声比与随时间推移的钆沉积一致。该研究还表明，一些深部灰质核永久性保留钆，而其他核则显示可溶性钆的洗脱。
