From the Department of Radiology, New York University Langone Health, New York, New York.
From the Department of Radiology, New York University Langone Health, New York, New York
AJNR Am J Neuroradiol. 2021 May;42(5):824-830. doi: 10.3174/ajnr.A7031. Epub 2021 Feb 25.
Studies associate repeat gadolinium-based contrast agent administration with T1 shortening in the dentate nucleus and globus pallidus, indicating CNS gadolinium deposition, most strongly with linear agents but also reportedly with macrocyclics. Renal impairment effects on long-term CNS gadolinium deposition remain underexplored. We investigated the relationship between signal intensity changes and renal function in patients who received ≥10 administrations of the macrocyclic agent gadobutrol.
Patients who underwent ≥10 brain MR imaging examinations with administration of intravenous gadobutrol between February 1, 2014, and January 1, 2018, were included in this retrospective study. Dentate nucleus-to-pons and globus pallidus-to-thalamus signal intensity ratios were calculated, and correlations were calculated between the estimated glomerular filtration rate (minimum and mean) and the percentage change in signal intensity ratios from the first to last scan. Partial correlations were calculated to control for potential confounders.
One hundred thirty-one patients (73 women; mean age at last scan, 55.9 years) showed a mean percentage change of the dentate nucleus-to-pons of 0.31%, a mean percentage change of the globus pallidus-to-thalamus of 0.15%, a mean minimum estimated glomerular filtration rate of 69.65 (range, 10.16-132.26), and a mean average estimated glomerular filtration rate at 89.48 (range, 38.24-145.93). No significant association was found between the estimated glomerular filtration rate and percentage change of the dentate nucleus-to-pons (minimum estimated glomerular filtration rate, = -0.09, = .28; average estimated glomerular filtration rate, = -0.09, = .30,) or percentage change of the globus pallidus-to-thalamus ( = 0.07, = .43; = 0.07, = .40). When we controlled for age, sex, number of scans, and total dose, there were no significant associations between the estimated glomerular filtration rate and the percentage change of the dentate nucleus-to-pons ( = 0.16, = .07; = 0.15, = .08) or percentage change of the globus pallidus-to-thalamus ( = -0.14, = .12; = -0.15, = .09).
In patients receiving an average of 12 intravenous gadobutrol administrations, no correlation was found between renal function and signal intensity ratio changes, even in those with mild or moderate renal impairment.
研究表明，重复使用基于钆的造影剂会导致齿状核和苍白球的 T1 缩短，这表明中枢神经系统中存在钆沉积，这种现象在使用线性造影剂时最为明显，但也有报道称在使用大环造影剂时也会出现这种现象。肾功能损害对长期中枢神经系统钆沉积的影响仍未得到充分研究。我们调查了在接受≥ 10 次大环类造影剂钆布醇静脉注射的患者中，信号强度变化与肾功能之间的关系。
本回顾性研究纳入了 2014 年 2 月 1 日至 2018 年 1 月 1 日期间接受≥ 10 次脑 MRI 检查并接受静脉注射钆布醇的患者。计算齿状核-脑桥和苍白球-丘脑的信号强度比值，并计算肾小球滤过率（最小值和平均值）与从第一次扫描到最后一次扫描的信号强度比值变化之间的相关性。计算偏相关以控制潜在的混杂因素。
131 例患者（73 例女性；最后一次扫描时的平均年龄为 55.9 岁）显示齿状核-脑桥的平均百分比变化为 0.31%，苍白球-丘脑的平均百分比变化为 0.15%，平均最小估计肾小球滤过率为 69.65（范围为 10.16-132.26），平均平均估计肾小球滤过率为 89.48（范围为 38.24-145.93）。未发现肾小球滤过率与齿状核-脑桥的百分比变化（最小估计肾小球滤过率， = -0.09， =.28；平均估计肾小球滤过率， = -0.09， =.30）或苍白球-丘脑的百分比变化（ = 0.07， =.43； = 0.07， =.40）之间存在显著相关性。当我们控制年龄、性别、扫描次数和总剂量时，肾小球滤过率与齿状核-脑桥的百分比变化（ = 0.16， =.07； = 0.15， =.08）或苍白球-丘脑的百分比变化（ = -0.14， =.12； = -0.15， =.09）之间也没有显著相关性。
在接受平均 12 次静脉注射钆布醇的患者中，即使在肾功能轻度或中度受损的患者中，也未发现肾功能与信号强度比变化之间存在相关性。
