High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material.

PURPOSE To explore any correlation between the number of previous gadolinium-based contrast material administrations and high signal intensity (SI) in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance (MR) images. MATERIALS AND METHODS The institutional review board approved this study, waiving the requirement to obtain written informed consent. A group of 381 consecutive patients who had undergone brain MR imaging was identified for cross-sectional analysis. For longitudinal analysis, 19 patients who had undergone at least six contrast-enhanced examinations were compared with 16 patients who had undergone at least six unenhanced examinations. The mean SIs of the dentate nucleus, pons, globus pallidus, and thalamus were measured on unenhanced T1-weighted images. The dentate nucleus-to-pons SI ratio was calculated by dividing the SI in the dentate nucleus by that in the pons, and the globus pallidus-to-thalamus SI ratio was calculated by dividing the SI in the globus pallidus by that in the thalamus. Stepwise regression analysis was undertaken in the consecutive patient group to detect any relationship between the dentate nucleus-to-pons or globus pallidus-to-thalamus SI ratio and previous gadolinium-based contrast material administration or other factors. A random coefficient model was used to evaluate for longitudinal analysis. RESULTS The dentate nucleus-to-pons SI ratio showed a significant correlation with the number of previous gadolinium-based contrast material administrations (P < .001; regression coefficient, 0.010; 95% confidence interval [CI]: 0.009, 0.011; standardized regression coefficient, 0.695). The globus pallidus-to-thalamus SI ratio showed a significant correlation with the number of previous gadolinium-based contrast material administrations (P < .001; regression coefficient, 0.004; 95% CI: 0.002, 0.006; standardized regression coefficient, 0.288), radiation therapy (P = .009; regression coefficient, -0.014; 95% CI: -0.025, -0.004; standardized regression coefficient, -0.151), and liver function (P = .031; regression coefficient, 0.023; 95% CI: 0.002, 0.044; standardized regression coefficient, 0.107). The dentate nucleus-to-pons and globus pallidus-to-thalamus SI ratios in patients who had undergone contrast-enhanced examinations were significantly greater than those of patients who had undergone unenhanced examinations (P < .001 for both). CONCLUSION High SI in the dentate nucleus and globus pallidus on unenhanced T1-weighted images may be a consequence of the number of previous gadolinium-based contrast material administrations.

[1]  Yong Chul Shin,et al.  High signal intensity on magnetic resonance imaging as a predictor of neurobehavioral performance of workers exposed to manganese. , 2007, Neurotoxicology.

[2]  M. Tweedle,et al.  Comparison of Gd(DTPA-BMA) (Omniscan) Versus Gd(HP-DO3A) (ProHance) Relative to Gadolinium Retention in Human Bone Tissue by Inductively Coupled Plasma Mass Spectroscopy , 2006, Investigative radiology.

[3]  P. Lai,et al.  Hyperintense basal ganglia on T1-weighted MR imaging. , 1999, AJR. American journal of roentgenology.

[4]  V. Runge,et al.  MRI contrast agents: Basic chemistry and safety , 2012, Journal of magnetic resonance imaging : JMRI.

[5]  T. Taoka,et al.  Hyperintense dentate nucleus on unenhanced T1-weighted MR images is associated with a history of brain irradiation. , 2011, Radiology.

[6]  R. Henkelman,et al.  High signal intensity in MR images of calcified brain tissue. , 1991, Radiology.

[7]  À. Rovira,et al.  MR Imaging Findings in Hepatic Encephalopathy , 2008, American Journal of Neuroradiology.

[8]  P. Prassopoulos,et al.  Basal ganglia hyperintensity on T1‐weighted MRI in rendu–osler–weber disease , 2012, Journal of magnetic resonance imaging : JMRI.

[9]  A. Maia,et al.  A Preliminary Study Revealing a New Association in Patients Undergoing Maintenance Hemodialysis: Manganism Symptoms and T1 Hyperintense Changes in the Basal Ganglia , 2007, American Journal of Neuroradiology.

[10]  V. Runge,et al.  Safety of approved MR contrast media for intravenous injection , 2000, Journal of magnetic resonance imaging : JMRI.

[11]  J. Cheon,et al.  MR imaging of the brain in Wilson disease of childhood: findings before and after treatment with clinical correlation. , 2006, AJNR. American journal of neuroradiology.

[12]  R. Guillevin,et al.  MRI features of neurodegenerative Langerhans cell histiocytosis , 2006, European Radiology.

[13]  M. Tweedle,et al.  Physicochemical properties of gadoteridol and other magnetic resonance contrast agents. , 1992, Investigative radiology.

[14]  Luca Roccatagliata,et al.  Multiple sclerosis: hyperintense dentate nucleus on unenhanced T1-weighted MR images is associated with the secondary progressive subtype. , 2009, Radiology.

[15]  J. Wardlaw,et al.  Identification of mineral deposits in the brain on radiological images: a systematic review , 2012, European Radiology.

[16]  W. Matthai,et al.  Comparative Safety of High‐Osmolality and Low‐Osmolality Radiographic Contrast Agents: Peport of a Multidisciplinary Working Group , 1992, Investigative radiology.

[17]  S. Mirowitz,et al.  Hyperintense basal ganglia on T1-weighted MR images in patients receiving parenteral nutrition. , 1991, Radiology.

[18]  D. V. van Thiel,et al.  Chronic acquired hepatic failure: MR imaging of the brain at 1.5 T. , 1991, AJNR. American journal of neuroradiology.