Gadolinium Toxicity

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Study reports Increasing Signal Intensity within the Brains of Patients with Multiple Sclerosis after multiple injections of the macrocyclic GBCA Gadovist – All Patients had Normal Renal Function

On June 25, 2015, European Radiology published a new study online ahead of print that reports increasing signal intensity on brain MR images after repeated administrations of the macrocyclic agent, gadobutrol (Gadovist, Bayer Healthcare, Berlin, Germany). The study by Stojanov et al is titled, Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol. This is the first study to report a correlation between the cumulative dose of a macrocyclic, gadolinium-based contrast agent (GBCA), and gadolinium deposition within the dentate nucleus (DN) and globus pallidus (GP) in patients with relapsing-remitting multiple sclerosis (RRMS).  All patients had normal renal function at the beginning and end of the study.

Liver function was also normal at the beginning of the study; however, the authors noted that at the end of the study there was a significant increase (p=0.004) in GGT, gamma-glutamyl transpeptidase.  The other liver function parameters remained normal.

Since all patients had normal renal function at the beginning and end of the study, there was no correlation between renal function and signal intensity within either dentate nucleus or globus pallidus.  The authors noted that, “This suggests that gadolinium deposition within the brain may occur even in patients with normal renal function”. (more…)

Study reports brain abnormalities on MRI in patients with normal kidney function

In the October 2014 issue of Investigative Radiology, Errante et al report study findings that confirm the association between the increase in the unenhanced T1-weighted signal intensity of the dentate nucleus and the number of gadolinium-enhanced MRI scans.  (The dentate nucleus is located within the deep white matter of the brain.)

The study included 38 patients with Multiple Sclerosis (MS) and 37 patients with brain metastases (BMs) who had undergone at least 2 consecutive enhanced MRIs.  After calculating the dentate nuclei-to-pons (DNP) signal intensity ratio, these values were compared between patients with less than 6 and those with 6 or more contrast-enhanced MRI.  A progressive increase in the T1 signal intensity of the DNP ratio was observed in both the MS group and the BM group.  All patients had normal kidney function. (more…)

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