Towbin Alexander J, Zhang Bin, Dillman Jonathan R
Department of Radiology, Cincinnati Children's Hospital Medical Center, University of Cincinnati College of Medicine, 3333 Burnet Ave., MLC 5031, Cincinnati, OH, 45229, USA.
Division of Biostatistics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.
Pediatr Radiol. 2021 Dec;51(13):2568-2580. doi: 10.1007/s00247-021-05134-4. Epub 2021 Jul 20.
Repeated administrations of linear gadolinium-based contrast media (GBCM) are associated with T1-weighted (T1-W) signal intensity change in brain structures.
The purpose of this study was to compare different brain structures in children after unconfounded, repeated administrations of either a macrocyclic or linear GBCM.
We performed a retrospective cohort study, identifying subjects with ≥5 unconfounded administrations of gadoterate meglumine. We matched subjects with repeated administrations of gadopentetate dimeglumine to the gadoterate meglumine arm based on the number of unconfounded GBCM administrations. Two reviewers drew regions of interest on 27 structures in and around the brain. We recorded demographic, modality and study parameters and evaluated them to determine whether they were associated with T1-W signal intensity (SI) changes. Linear mixed effects models evaluated the relationships between the number of GBCM doses and T1-W SI ratio. Finally, we identified differences in the rate of T1-W SI ratio change among individuals using a linear mixed effects model with random slope.
We included a total of 52 patients (age range at first MRI: 6.0 months to 17.1 years), 26 in each arm. We detected a significant change in the T1-W SI ratio with repeated administrations of GBCM in one location in the gadoterate meglumine arm and in four locations in the gadopentetate dimeglumine arm. Patient gender and age were not associated with T1-W SI change. Modality vendor, imaging sequence and field strength were variably associated with a systematic difference in the ability to detect a T1-W SI change. Finally, linear mixed effects model with random slope showed that there were individual differences in the slope of SI change at various structures among individuals for both arms. This effect was present in more brain structures in the gadopentetate dimeglumine arm (14 vs. 8).
There is a significant change in the T1-W SI ratio over time in multiple brain structures after repeated gadopentetate dimeglumine administrations. This effect was only seen in one ratio after repeated administrations of gadoterate meglumine. There are individual differences in the rate of change of SI ratios over time after repeated administration of gadopentetate dimeglumine and gadoterate meglumine, suggesting that individual differences are present.
多次注射线性钆基造影剂（GBCM）与脑结构的T1加权（T1-W）信号强度变化有关。
本研究的目的是比较在无干扰的情况下多次注射大环或线性GBCM后儿童不同脑结构的情况。
我们进行了一项回顾性队列研究，确定了接受过≥5次无干扰钆喷酸葡胺注射的受试者。我们根据无干扰GBCM注射次数，将多次注射钆双胺的受试者与钆喷酸葡胺组进行匹配。两名研究者在脑内及脑周围的27个结构上绘制感兴趣区域。我们记录了人口统计学、检查方式和研究参数，并对其进行评估以确定它们是否与T1-W信号强度（SI）变化相关。线性混合效应模型评估了GBCM剂量数与T1-W SI比值之间的关系。最后，我们使用具有随机斜率的线性混合效应模型确定个体之间T1-W SI比值变化率的差异。
我们共纳入了52例患者（首次MRI检查时的年龄范围：6.0个月至17.1岁），每组26例。在钆喷酸葡胺组的一个部位以及钆双胺组的四个部位，多次注射GBCM后检测到T1-W SI比值有显著变化。患者的性别和年龄与T1-W SI变化无关。检查方式供应商、成像序列和场强与检测T1-W SI变化能力的系统差异存在不同程度的关联。最后，具有随机斜率的线性混合效应模型显示，两组个体在不同结构处SI变化斜率存在个体差异。这种效应在钆双胺组的更多脑结构中出现（14个对8个）。
多次注射钆双胺后，多个脑结构的T1-W SI比值随时间有显著变化。多次注射钆喷酸葡胺后仅在一个比值中观察到这种效应。多次注射钆双胺和钆喷酸葡胺后，SI比值随时间的变化率存在个体差异，表明存在个体差异。
