Gadolinium deposition in the brain of patients with relapsing-remitting multiple sclerosis after 10 years of follow-up

Dejan Kostić; Miroslav  Mišović; Filip  Vučković; Djuro  Crevar; Igor  Sekulić; Biljana  Geogievski-Brkić; Smiljana  Kostić; Evica  Dinčić

doi:10.2298/VSP220314018K

Dejan Kostić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Miroslav Mišović Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Filip Vučković University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Djuro Crevar University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Igor Sekulić Military Medical Academy, Institute of Radiology, Belgrade, Serbia
Biljana Geogievski-Brkić Special Hospital for Cerebrovascular Diseases “Sveti Sava”, Department of Radiology Diagnostics, Belgrade, Serbia
Smiljana Kostić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia
Evica Dinčić University of Defence, Faculty of Medicine of the Military Medical Academy, Belgrade, Serbia

DOI: https://doi.org/10.2298/VSP220314018K

Keywords: gadolinium dtpa, long term adverse effects, magnetic resonance imaging, multiple sclerosis, relapsing-remitting

Abstract

Background/Aim. Since 2014 and the publication of the results of the first study on the accumulation of gadolini-um contrast, we have witnessed a growing body of evi-dence on the deposition and retention of gadolinium in the brain after the use of gadolinium-based contrast agents (GBCAs). However, there is still no strong clinical evi-dence of the adverse effects of GBCAs on the brain pa-renchyma. The aim of the study was to determine the ex-istence of gadolinium deposits in the brain of patients with relapsing-remitting multiple sclerosis after a ten-year fol-low-up period. During this period, the patients have regu-larly, each year, undergone magnetic resonance imaging (MRI) with the administration of gadolinium contrast (gadopentetate dimeglumine – Magnevist®) in order to fol-low the course of the disease. Methods. A cohort of 20 patients was formed for the purpose of this study. The ra-tio of the values of the signal intensity (SI) of different re-gions of the brain-to-cerebrospinal fluid (CSF) was com-pared for each patient on the initial MRI examination and the MRI examination ten years later. Results. Frontal cor-tex-to-CSF (p < 0.01), occipital cortex-to-CSF (p < 0.01), the white matter of the corona radiata-to-CSF (p < 0.01), pa-rietal cortex-to-CSF (p < 0.05), thalamus-to-CSF (p = 0.051), putamen-to-CSF (p = 0.06), and anterior and posterior limb of the capsula interna-to-CSF (p = 0.062) SI ratios increased after multiple gadopentetate administra-tions. An increase in the absolute values of the T1-weighted (T1W) signal in three-quarters of patients was registered in the frontal and occipital cortex and cerebellar hemispheres. A slightly smaller increase in SI, but still greater than 55–65%, was registered in structures of the parietal cortex, putamen, cornu anterior and posterior of the capsula interna, corpus callosum (CC) splenium, pons, thala-mus, nucleus caudatus, substantia nigra, CC genu, and temporal cortex. Conclusion. In the cohort of 20 patients, there was a statistically significant increase in SI in the pre-contrast T1W sequence in the following structures: frontal, parietal, and occipital cortex, as well as supratento-rial white matter. This result speaks in favor of the exist-ence of chronic accumulation of gadolinium contrast agent gadopentetate dimeglumine in brain structures.

Author Biography

Dejan Kostić, Military Medical Academy, Institute of Radiology, Belgrade, Serbia

docent

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