Department of Radiology, Division of Neuroradiology, University of Minnesota, B-226 Mayo Memorial Bldg, MMC 292, 420 Delaware St SE, Minneapolis, MN 55455.
AJR Am J Roentgenol. 2021 Sep;217(3):753-760. doi: 10.2214/AJR.20.24536. Epub 2020 Oct 28.
An association is recognized between linear gadolinium-based contrast agents (GBCAs) and intracranial gadolinium retention in children. The relation between macrocyclic GBCAs and gadolinium retention remains incompletely understood. The purpose of this study was to assess whether 10 or more administrations of the macrocyclic GBCA gadobutrol are associated with increased signal intensity (SI) in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MRI of children and to explore clinical variables potentially associated with T1 hyperintensity. The case group consisted of 25 children (13 boys, 12 girls; mean age, 7 ± 4 years; range, 2-18 years) who underwent at least 10 (mean, 15 ± 6; range, 10-34) contrast-enhanced MRI examinations exclusively with gadobutrol. The control group consisted of 25 age- and sex-matched patients undergoing MRI who had never been exposed to gadolinium. Two observers in consensus using a 3-point scale assessed visual T1 hyperintensity in the DN and GP. One observer placed ROIs on T1-weighted images to mark the DN, GP, middle cerebellar peduncle (MCP), and pulvinar of the thalamus bilaterally to compute mean DN-to-MCP and GP-to-thalamus SI ratios. SI ratios were compared between the macrocyclic GBCA and control groups. In the macrocyclic GBCA group, Pearson correlation analysis was conducted between SI ratios and clinical variables. ROI measurements were repeated by the original reader and an independent reader, and interobserver and intraobserver agreement were computed by means of Lin concordance correlation coefficient (ρ). No patient had visual T1 hyperintensity in the DN or GP. No significant difference between the macrocyclic GBCA and control groups was observed for DN-to-MCP SI ratio (0.95 ± 0.05 vs 0.95 ± 0.03; = .67) or GP-to-thalamus SI ratio (1.05 ± 0.06 vs 1.04 ± 0.06; = .65). In the macrocyclic GBCA group, no significant correlation was observed between DN-to-MCP SI ratio or GP-to-thalamus SI ratio and age ( = 0.355, = .08; = 0.167, = .42), number of contrast-enhanced MRI examinations ( = 0.247, = .23; = 0.203, = .33), mean time between examinations ( = 0.193, = .36; = 0.047, = .82), or cumulative macrocyclic GBCA dose ( = 0.434, = .07; = 0.270, = .19). Interobserver and intraobserver agreement was substantial for DN-to-MCP SI and GP-to-TH SI ratios (ρ = 0.931-0.974). Ten or more serial gadobutrol administrations were not associated with T1 hyperintensity in the DN or GP of children. Selection of gadobutrol as an MRI contrast agent may reduce risk of gadolinium retention in children. The findings may help guide practices for GBCA administration to children.
在儿童中，线性钆基造影剂（GBCA）与颅内钆蓄积之间存在关联。大环 GBCA 与钆蓄积之间的关系仍不完全清楚。本研究的目的是评估是否有 10 次或更多次大环 GBCA 钆布醇给药与儿童未增强 T1 加权 MRI 上齿状核（DN）和苍白球（GP）的信号强度（SI）增加有关，并探讨与 T1 高信号可能相关的临床变量。病例组由 25 名儿童（13 名男孩，12 名女孩；平均年龄 7 ± 4 岁；范围 2-18 岁）组成，他们至少接受了 10 次（平均 15 ± 6；范围 10-34 次）仅用钆布醇增强的 MRI 检查。对照组由 25 名年龄和性别匹配的患者组成，他们从未接触过钆。两名观察者一致使用 3 分制评估 DN 和 GP 的视觉 T1 高信号。一名观察者在 T1 加权图像上放置 ROI，标记双侧齿状核、苍白球、小脑上脚（MCP）和丘脑枕，以计算 DN 与 MCP 和 GP 与丘脑的平均 SI 比。比较大环 GBCA 组和对照组之间的 SI 比。在大环 GBCA 组中，进行了 SI 比与临床变量之间的 Pearson 相关性分析。原始读者和独立读者重复了 ROI 测量，通过 Lin 一致性相关系数（ρ）计算了观察者间和观察者内的一致性。在 DN 或 GP 中，没有患者出现视觉 T1 高信号。大环 GBCA 组和对照组之间的 DN 与 MCP SI 比（0.95 ± 0.05 与 0.95 ± 0.03； =.67）或 GP 与丘脑 SI 比（1.05 ± 0.06 与 1.04 ± 0.06； =.65）无显著差异。在大环 GBCA 组中，DN 与 MCP SI 比或 GP 与丘脑 SI 比与年龄（ = 0.355， =.08； = 0.167， =.42）、增强 MRI 检查次数（ = 0.247， =.23； = 0.203， =.33）、两次检查之间的平均时间（ = 0.193， =.36； = 0.047， =.82）或累积大环 GBCA 剂量（ = 0.434， =.07； = 0.270， =.19）无显著相关性。DN 与 MCP SI 和 GP 与 TH SI 比的观察者间和观察者内一致性均较高（ρ=0.931-0.974）。10 次或更多次连续给予钆布醇与儿童 DN 或 GP 的 T1 高信号无关。选择钆布醇作为 MRI 造影剂可能会降低儿童钆蓄积的风险。这些发现可能有助于指导儿童 GBCA 给药的实践。
