Lack of increased signal intensity in the dentate nucleus after repeated administration of a macrocyclic contrast agent in multiple sclerosis: An observational study

Medicine (Baltimore). 2016 Sep;95(39):e4624. doi: 10.1097/MD.0000000000004624.

Abstract

Recently, several studies reported increased signal intensity (SI) in the dentate nucleus (DN) after repeated application of gadolinium-based contrast agents (GBCAs), suggesting a deposition of gadolinium in this location. Patients with relapsing-remitting multiple sclerosis (RRMS) frequently show increased permeability of the blood-brain barrier as part of the inflammatory process in the brain parenchyma, which theoretically might increase the risk of gadolinium deposition. In this retrospective study, we investigated a possible increasing SI in the DN after repeated administrations of the macrocyclic contrast agent gadoterate meglumine.Forty-one RRMS patients (33 women, mean age 38 years) with at least 6 prior gadolinium-enhanced examinations (single dose gadoterate meglumine) were identified. A total of 279 unenhanced T1-weighted examinations were analyzed.SI ratio differences did not differ between the first and last MRI examination, neither for the DN-to-pons ratio (P = 0.594) nor for the DN-to-cerebellum ratio (P = 0.847). There was no correlation between the mean DN-to-pons, or between the mean DN-to-cerebellum SI ratio and the number of MRI examinations (P = 0.848 and 0.891), disease duration (P = 0.676 and 0.985), and expanded disability status scale (EDSS) (P = 0.639 and 0.945).We found no signal increases in the DN after a minimum of 6 injections of the macrocyclic GBCA gadoterate meglumine in RRMS patients. This warrants further investigations in regard to the true pathophysiologic basis of intracerebral gadolinium deposition.

Publication types

  • Observational Study

MeSH terms

  • Adolescent
  • Adult
  • Blood-Brain Barrier / metabolism
  • Cerebellar Nuclei / metabolism*
  • Contrast Media / pharmacokinetics*
  • Female
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Meglumine / pharmacokinetics*
  • Middle Aged
  • Multiple Sclerosis, Relapsing-Remitting / diagnostic imaging*
  • Multiple Sclerosis, Relapsing-Remitting / metabolism*
  • Organometallic Compounds / pharmacokinetics*
  • Retrospective Studies
  • Young Adult

Substances

  • Contrast Media
  • Organometallic Compounds
  • Meglumine
  • gadoterate meglumine