Ten years of gadolinium retention and deposition: ESMRMB-GREC looks backward and forward

Abstract

In 2014, for the first time, visible hyperintensities on unenhanced T1-weighted images in the nucleus dentatus and globus pallidus of the brain were associated with previous Gadolinium-based contrast agent (GBCA) injections and gadolinium deposition in patients with normal renal function. This led to a frenzy of retrospective studies with varying methodologies that the European Society of Magnetic Resonance in Medicine and Biology Gadolinium Research and Educational Committee (ESMRMB-GREC) summarised in 2019. Now, after 10 years, the members of the ESMRMB-GREC look backward and forward and review the current state of knowledge of gadolinium retention and deposition. CLINICAL RELEVANCE STATEMENT: Gadolinium deposition is associated with the use of linear GBCA but no clinical symptoms have been associated with gadolinium deposition. KEY POINTS : • Traces of Gadolinium-based contrast agent-derived gadolinium can be retained in multiple organs for a prolonged time. • Gadolinium deposition is associated with the use of linear Gadolinium-based contrast agents. • No clinical symptoms have been associated with gadolinium deposition.

Keywords: Body; Brain; Contrast media; Gadolinium; Magnetic resonance imaging.

Fig. 1

Axial (A, C) and sagittal (B, D) T1-weighted images. Forty-seven-year-old male with multiple sclerosis previously exposed to 14 intra-venous injections of gadodiamide. Globus pallidus and dentate nucleus hyperintensity on unenhanced T1-weighted images due to gadolinium deposition (arrows in A–D). Faint T1 hyperintensity of the pulvinar thalami is also seen (arrowheads in A)

Fig. 2

Slightly greater T1 signal intensity of the anterior pituitary gland in sagittal T1W image acquired at post-injection time delay of 1 day and only 1 previous GBCA exposure (arrow in A) with respect to a similar image acquired at post-injection time delay of 180 days and four previous GBCA injections (arrow in B). The lower panel shows the decreasing trend of normalised ratios from minimum to maximum post-injection time delay of each individual patient. Reproduced from reference 24 under the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Fig. 3

Example images of the right kidney from a healthy volunteer obtained at the first scan session. a T₁ source image at multiple inversion times (in msec) after motion correction and the masks of the cortical and medullary segmentation. b Calculated corresponding T₁ map. The color bar indicates T₁ relaxation time in msec. The cortex and medulla can easily be discriminated thanks to the higher T₁ in the medulla compared to the cortex. Reproduced from reference 69 under the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)

Fig. 4

a Boxplots summarising the T₁ values in the gadolinium (n = 16) and control group (n = 5) at baseline and follow-up. b Boxplots of the ΔT₁ for cortex and medulla and both for the gadolinium and control group. ΔT₁in the gadolinium group differed significantly from ΔT₁ in the control group, both in the cortex (p < 0.001) and medulla (p = 0.001). Reproduced from reference 69 under the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/)