Taloženje gadolinijuma u mozgu bolesnika sa relapsno-remitentnom multiplom sklerozom nakon 10 godina praćenja
Sažetak
Uvod/Cilj. Od 2014. godine kao i od objavljivanja rezultata prve studije o akumulaciji kontrastnih sredstava na bazi gadolinijuma (gadolinium-based contrast agents – GBCAs), svedoci smo sve većeg broja dokaza o taloženju i zadržavanju gadolinijuma u mozgu nakon primene ovih sredstava. Međutim, još uvek nema jakih kliničkih dokaza o štetnim efektima GBCAs na moždani parenhim. Cilj rada bio je da se utvrdi postojanje naslaga gadolinijuma u mozgu kod bolesnika sa relapsno-remitentnom multiplom sklerozom nakon desetogodišnjeg perioda praćenja. Tokom ovog perioda, bolesnici su redovno, svake godine, bili podvrgnuti pregledu magnetnom rezonancom (MR) koji je uključivao davanje linearnog kontrastnog sredstva (gadopentetat dimeglumin – Magnevist®) kako bi se pratio tok bolesti. Metode. Za potrebe ove studije formirana je kohorta od 20 bolesnika. Za svakog bolesnika je upoređivan odnos vrednosti intenziteta signala (IS) u različitim regionima mozga i IS cerebrospinalnog likvora (CSL) na inicijalnom pregledu primenom MR i na pregledu deset godina kasnije primenom iste metode. Rezultati. Odnosi IS frontalnog korteksa i CSL-a (p < 0,01), okcipitalnog korteksa i CSL-a (p < 0,01), bele mase corona radiata i CSL-a (p < 0,01), parijetalnog korteksa i CSL-a (p < 0,05), talamusa i CSL-a (p = 0,051), putamena i CSL-a (p = 0,06) i cornu anterior i posterior capsula interna i CSL-a (p = 0,062) povećali su se nakon višestruke primene gadopentetata. Porast apsolutnih vrednosti T1-weighted (T1W) signala kod tri četvrtine bolesnika registrovan je u frontalnom i okcipitalnom korteksu i hemisferi malog mozga. Nešto manje povećanje IS, ali ipak veće od 55–65%, registrovano je u strukturama kao što su: parijetalni korteks, putamen, cornu anterior i posterior capsula interna, corpus callosum (CC) splenium, pons, talamus, nucleus caudatus, substantia nigra, CC genu i temporalni korteks. Zaključak. U kohorti od 20 bolesnika pokazano je statistički značajno povećanje IS u prekontrastnoj T1W sekvenci u sledećim strukturama: frontalnom, parijetalnom i okcipitalnom korteksu, kao i beloj masi corona radiata. Rezultati govore u prilog tome da postoji hronično deponovanje gadolinijumskog kontrastnog sredstva, gadopentetat dimeglumina, u moždanim strukturama.
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