Department of Neurology, Rostock University Medical Center, University of Rostock, Gehlsheimer Str. 20, 18147, Rostock, Germany.
Department of Dermatology and Venereology, University Hospital Hamburg-Eppendorf (UKE), Hamburg, Germany.
Neurol Sci. 2022 Apr;43(4):2631-2639. doi: 10.1007/s10072-021-05702-4. Epub 2021 Nov 4.
The objective of this study is to find out whether gadolinium accumulation in the dentate nucleus (DN) after repeated gadolinium-based contrast agent (GBCA) administration in multiple sclerosis (MS) patients is related to tissue alteration detectable on transcranial ultrasound.
In this case-control study, 34 patients (17 with, and 17 age-, sex-, MS severity-, and duration-matched participants without visually rated DN T1-hyperintensity) who had received 2-28 (mean, 11 ± 7) consecutive 1.5-Tesla MRI examinations with application of linear GBCA were included. Real-time MRI-ultrasound fusion imaging was applied, exactly superimposing the DN identified on MRI to calculate its corresponding echo-intensity on digitized ultrasound image analysis. In addition, cerebellar ataxia and cognitive performance were assessed. Correlation analyses were adjusted for age, MS duration, MS severity, and time between MRI scans.
DN-to-pons T1-signal intensity-ratios (DPSIR) were larger in patients with visually rated DN T1-hyperintensity compared to those without (1.16 ± 0.10 vs 1.09 ± 0.06; p = 0.01). In the combined group, DPSIR correlated with the cumulative linear-GBCA dose (r = 0.49, p = 0.003), as did the DPSIR change on last versus first MRI (r = 0.59, p = 0.003). Neither DPSIR nor globus pallidus internus-to-thalamus T1-signal intensity-ratios were related to echo-intensity of corresponding ROI's. DPSIR correlated with the dysarthria (r = 0.57, p = 0.001), but no other, subscore of the International Cooperative Ataxia Rating Scale, and no other clinical score.
DN gadolinium accumulation is not associated with trace metal accumulation, calcification, or other tissue alteration detectable on ultrasound. A possible mild effect of DN gadolinium accumulation on cerebellar speech function in MS patients, suggested by present data, needs to be validated in larger study samples.
本研究旨在探讨多发性硬化症（MS）患者多次接受基于钆的造影剂（GBCA）治疗后齿状核（DN）中钆的蓄积是否与经颅超声检测到的组织改变有关。
在这项病例对照研究中，纳入了 34 名患者（17 名有、17 名无视觉评定的 DN T1 高信号），这些患者在 1.5T MRI 检查中接受了 2-28 次（平均 11±7 次）线性 GBCA 连续应用，应用实时 MRI-超声融合成像，将 MRI 上识别的 DN 与数字超声图像分析上的相应回声强度精确叠加。此外，还评估了小脑共济失调和认知表现。相关性分析调整了年龄、MS 持续时间、MS 严重程度和 MRI 扫描之间的时间。
与无视觉评定的 DN T1 高信号的患者相比，有视觉评定的 DN T1 高信号的患者的齿状核-脑桥 T1 信号强度比（DPSIR）更大（1.16±0.10 比 1.09±0.06；p=0.01）。在联合组中，DPSIR 与累积线性 GBCA 剂量相关（r=0.49，p=0.003），DPSIR 在上一次与第一次 MRI 之间的变化也与累积线性 GBCA 剂量相关（r=0.59，p=0.003）。DPSIR 与苍白球内侧-丘脑 T1 信号强度比均与相应 ROI 的回声强度无关。DPSIR 与构音障碍相关（r=0.57，p=0.001），但与国际合作共济失调评分的其他亚量表或其他临床评分无关。
DN 中的钆蓄积与经超声检测到的痕量金属蓄积、钙化或其他组织改变无关。目前的数据提示，MS 患者 DN 中钆蓄积可能对小脑言语功能有轻微影响，这需要在更大的研究样本中进一步验证。
