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Signal Changes in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Magnetic Resonance Images After Intrathecal Administration of Macrocyclic Gadolinium Contrast Agent

Ozturk, Kerem, MD*; Nas, Omer Fatih, MD*; Soylu, Esra, MD; Hakyemez, Bahattin, MD*

doi: 10.1097/RLI.0000000000000472
Original Articles

Objectives The aim of this study was to evaluate signal changes in the dentate nucleus and globus pallidus (GP) on unenhanced T1-weighted magnetic resonance (MR) images (T1 WI) in a cohort of patients who have received intrathecal macrocyclic ionic gadolinium-based contrast agent (GBCA) gadoterate meglumine.

Materials and Methods A group of 20 patients (male/female ratio, 8:12; mean age, 39.5 ± 15.5 years) who had not received intravenous GBCA but had received an intrathecal macrocyclic ionic GBCA (plus baseline and an additional final magnetic resonance imaging [MRI] for reference) from 2012 to 2017 were retrospectively included in this institutional review board–approved study. Two radiologists inspected T1-weighted 2-dimensional spin echo (n = 7) and 3-dimensional isotropic turbo field echo (n = 13) images on a 3 T MRI system to conduct visual evaluation and quantitative analysis. Baseline and final examination signal intensity (SI) ratios were assessed across time by using the same pulse sequences. For visual analysis, SI changes on the GP, thalamus (Th), cerebellar peduncle (CP), and dentate nucleus (DN) were graded as a 3-point scale. For quantitative analysis, SI ratio differences between the baseline and final MR examinations were estimated for the DN-to-CP and GP-to-Th ratios. One-sample t tests were used to investigate whether they differed from 0. In addition, to investigate significant differences between the SI ratios for various pulse sequences, t tests were performed. The regression analysis was additionally used to find any correlation between SI ratio differences and various confounding variables including age, sex, or the mean interval between the baseline and final MR examinations.

Results The SI ratio differences did not deviate significantly from 0, neither for the DN/CP ratio (0.013 ± 0.0584, P = 0.287) nor the GP/Th ratio (−0.0113 ± 0.0546, P = 0.366). The DN-to-CP and GP-to-Th SI ratio differences did not significantly deviate from 0 in the patient groups in either of the imaging sequences (P > 0.05) as well. Age, sex, and the mean interval between examinations did not influence SI ratio differences between examinations (P > 0.05).

Conclusions Intrathecal macrocyclic GBCA administration was not associated with measurable T1 SI changes in the GP and DN as an indicator of brain gadolinium deposition detectable by MRI.

From the *Department of Radiology, Uludag University Faculty of Medicine; and

Radiology Clinic, Cekirge State Hospital, Bursa, Turkey.

Received for publication January 26, 2018; and accepted for publication, after revision, February 28, 2018.

Conflicts of interest and sources of funding: none declared.

All procedures performed were in accordance with the ethical standards of the institutional research committee and with the 1983 revised Helsinki declaration and its later amendments or comparable ethical standards. Approval for this study was obtained through the intuitional review board of the University of Uludag. Written informed consent was waived by the institutional review board. The committee granted further review board exemption. No patient data were included in this study.

Authors' contributions: KO and ES conceived the study. KO, ES, OFN, and BH acquired and managed the data. KO and ES analyzed and interpreted the data and performed statistical analysis. KO drafted the manuscript. BH and OFN contributed substantially to its revisions. All authors read and approved the final manuscript.

The datasets used or analyzed during the current study are available from the corresponding author upon reasonable request.

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Correspondence to: Bahattin Hakyemez, MD, Department of Radiology, Uludag University Faculty of Medicine, Gorukle Street, 16059, Bursa, Turkey. E-mail:

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