Abstract
Purpose To test for measurable visual enhancement of the dentate nucleus (DN) on unenhanced T1-weighted magnetic resonance (MR) images in a cohort of patients with a primary brain tumor who had not received linear gadolinium-based contrast agents (GBCAs) but had received many injections of macrocyclic GBCAs. Materials and Methods Seventeen patients with high-grade gliomas who had received 10-44 administrations of the macrocyclic GBCA gadobutrol (0.1 mmol/kg of body weight) were retrospectively included in this regional ethics committee-approved study. Two neuroradiologists inspected T1-weighted MR images with optimized window settings to visualize small differences in contrast at the baseline and at the last examination for the presence of visual DN signal enhancement. Signal intensity (SI) in the DN was normalized to the SI of the pons, and a one-sample t test was used to test for differences between baseline normalized SI (nSI) in the DN (nSIDN) and the average change in nSIDN of all postbaseline MR imaging sessions (ΔnSIDNavg) or the change in nSIDN from baseline to the last MR imaging session (ΔnSIDN). Linear and quadratic correlation analyses were used to examine the association between the number of macrocyclic GBCA administrations and ΔnSIDN or ΔnSIDNavg. Results The mean ± standard deviation number of macrocyclic GBCA administrations was 22.2 ± 10.6 administered throughout 706 days ± 454. Visually appreciable signal enhancement was observed in two patients who had received 37 and 44 macrocyclic GBCA injections. Mean ΔnSIDN was greater than zero (0.03 ± 0.05; P = .016), and there was a significant linear association between the number of macrocyclic GBCA injections and ΔnSIDN (r = 0.69, P = .002) and ΔnSIDNavg (r = 0.77, P < .001). Conclusion A small but statistically significant dose-dependent T1-weighted signal enhancement was observed in the DN after multiple macrocyclic GBCA injections. Visually appreciable enhancement in the DN was observed on contrast-optimized images in two patients who had received 37 and 44 standard doses of macrocyclic GBCAs. © RSNA, 2017 Online supplemental material is available for this article.
Highlights
ObjectivesThe purpose of our study was to test for measurable and visual enhancement of the dentate nucleus (DN) on unenhanced T1-weighted magnetic resonance (MR) images in a cohort of patients with primary brain tumors and no history of administration of linear gadolinium-based contrast agents (GBCAs) but who had received a high number of macrocyclic GBCA injections
Signal intensity (SI) in the dentate nucleus (DN) was normalized to the SI of the pons, and a one-sample t test was used to test for differences between baseline normalized SI in the DN and the average change in nSIDN of all postbaseline magnetic resonance (MR) imaging sessions (DnSIDNavg) or the change in nSIDN from baseline to the last MR imaging session (DnSIDN)
The mean number of single doses 6 standard deviation (0.1 mmol of gadolinium per kilogram of body weight) of all macrocyclic gadolinium-based contrast agents (GBCAs) administered was 22.2 6 10.6, and they were administered throughout 706 days 6 454
Summary
The purpose of our study was to test for measurable and visual enhancement of the DN on unenhanced T1-weighted MR images in a cohort of patients with primary brain tumors and no history of administration of linear GBCAs but who had received a high number of macrocyclic GBCA injections
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