Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Apr;43(4):2631-2639.
doi: 10.1007/s10072-021-05702-4. Epub 2021 Nov 4.

Dentate-nucleus gadolinium deposition on magnetic resonance imaging: ultrasonographic and clinical correlates in multiple sclerosis patients

Isabelle Kühn #  1   2 , Henning Maschke #  3   4 , Annette Großmann  3 , Karlheinz Hauenstein  3 , Marc-André Weber  3 , Uwe K Zettl  1 , Alexander Storch  1   5 , Uwe Walter  6   7
Affiliations

Dentate-nucleus gadolinium deposition on magnetic resonance imaging: ultrasonographic and clinical correlates in multiple sclerosis patients

Isabelle Kühn et al. Neurol Sci. 2022 Apr.

Abstract

Objective: The objective of this study is to find out whether gadolinium accumulation in the dentate nucleus (DN) after repeated gadolinium-based contrast agent (GBCA) administration in multiple sclerosis (MS) patients is related to tissue alteration detectable on transcranial ultrasound.

Methods: In this case-control study, 34 patients (17 with, and 17 age-, sex-, MS severity-, and duration-matched participants without visually rated DN T1-hyperintensity) who had received 2-28 (mean, 11 ± 7) consecutive 1.5-Tesla MRI examinations with application of linear GBCA were included. Real-time MRI-ultrasound fusion imaging was applied, exactly superimposing the DN identified on MRI to calculate its corresponding echo-intensity on digitized ultrasound image analysis. In addition, cerebellar ataxia and cognitive performance were assessed. Correlation analyses were adjusted for age, MS duration, MS severity, and time between MRI scans.

Results: DN-to-pons T1-signal intensity-ratios (DPSIR) were larger in patients with visually rated DN T1-hyperintensity compared to those without (1.16 ± 0.10 vs 1.09 ± 0.06; p = 0.01). In the combined group, DPSIR correlated with the cumulative linear-GBCA dose (r = 0.49, p = 0.003), as did the DPSIR change on last versus first MRI (r = 0.59, p = 0.003). Neither DPSIR nor globus pallidus internus-to-thalamus T1-signal intensity-ratios were related to echo-intensity of corresponding ROI's. DPSIR correlated with the dysarthria (r = 0.57, p = 0.001), but no other, subscore of the International Cooperative Ataxia Rating Scale, and no other clinical score.

Conclusions: DN gadolinium accumulation is not associated with trace metal accumulation, calcification, or other tissue alteration detectable on ultrasound. A possible mild effect of DN gadolinium accumulation on cerebellar speech function in MS patients, suggested by present data, needs to be validated in larger study samples.

Keywords: Dentate nucleus; Gadolinium; MRI contrast media; Multiple sclerosis; Transcranial ultrasonography.

PubMed Disclaimer

Conflict of interest statement

IK, HN, AG, KH and MAW report no conflicting interests. UKZ has received research support and speaker honoraria or travel funds from Alexion, Almirall, Bayer HealthCare, Biogen, Merck Serono, Novartis, Roche, Sanofi, and TEVA Pharma. AS reports unrestricted research grants from the Deutsche Forschungsgemeinschaft (DFG), Germany; Helmholtz Association, Germany; and GKC and TEVA Pharma outside the submitted work. He has received personal fees from UCB Pharma, Lobsor Pharma, AbbVie Pharma, Desitin Arzneimittel, GKC, Bial Pharma, Bayer Healthcare, and Grünenthal and royalties from Kohlhammer Verlag, and Elsevier Press, outside the submitted work. He serves as editorial board member for Stem Cells, Stem Cells International, and the Journal of Biological Chemistry. UW has received speaker honoraria and travel funds from Ipsen Pharma, Merz Pharma, Allergan, Bristol-Myers Squibb, Daiichi Sankyo, Bayer Vital, Boehringer Ingelheim, and Pfizer and a research grant from Merz Pharma. He has received royalties from Thieme and Elsevier Press. He serves as editor of the European Journal of Ultrasound.

Figures

Fig. 1
Fig. 1
Diagrams showing the relationship between cumulative life-time dose of intravenously administered linear GBCA and dentate-nucleus T1-intensity measures (bilateral mean DPSIR). The r and p values shown are controlled for potential confounders (age, MS duration, EDSS, latency between first and last MRI). a Relationship between cumulative dose of linear GBCA and change of DPSIR in patients with assessable data of first MRI (n = 23). b Relationship between cumulative dose of linear GBCA and DPSIR on last MRI in all patients (n = 34)
Fig. 2
Fig. 2
Diagrams showing the relationship between T1-intensity and echo-intensity on digitized analysis of exact real-time MRI-ultrasound fusion images. Note that no correlation between T1-intensity and echo-intensity measures was found. a Relationship between dentate-nucleus T1-intensity (bilateral mean DPSIR on last MRI) and echo-intensity. b Relationship between globus pallidus internus (GPi) T1-intensity (bilateral mean GTSIR on last MRI) and echo-intensity
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Filippi M, Preziosa P, Banwell BL, et al. Assessment of lesions on magnetic resonance imaging in multiple sclerosis: practical guidelines. Brain. 2019;142:1858–1875. doi: 10.1093/brain/awz144. - DOI - PMC - PubMed
    1. Brisset JC, Kremer S, Hannoun S, et al. New OFSEP recommendations for MRI assessment of multiple sclerosis patients: special consideration for gadolinium deposition and frequent acquisitions. J Neuroradiol. 2020;47:250–258. doi: 10.1016/j.neurad.2020.01.083. - DOI - PubMed
    1. Wattjes MP, Ciccarelli O, Reich DS, et al. 2021 MAGNIMS-CMSC-NAIMS consensus recommendations on the use of MRI in patients with multiple sclerosis. Lancet Neurol. 2021;20:653–670. doi: 10.1016/S1474-4422(21)00095-8. - DOI - PubMed
    1. Kanda T, Ishii K, Kawaguchi H, Kitajima K, Takenaka D. 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. Radiology. 2014;270:834–841. doi: 10.1148/radiol.13131669. - DOI - PubMed
    1. Errante Y, Cirimele V, Mallio CA, Di Lazzaro V, Zobel BB, Quattrocchi CC. Progressive increase of T1 signal intensity of the dentate nucleus on unenhanced magnetic resonance images is associated with cumulative doses of intravenously administered gadodiamide in patients with normal renal function, suggesting dechelation. Invest Radiol. 2014;49:685–690. doi: 10.1097/RLI.0000000000000072. - DOI - PubMed