Download Gadolinium Deposition in the Dentate Nucleus: An

Thao T. Tran, BSc, ARMRIT
Director of Clinical Services/Senior MR Tech
Advanced Imaging & Spectroscopy Center
Huntington Medical Research Institutes
10 Pico Street, Pasadena, CA 91105
Orest B. Boyko MD PhD
University of Southern California
Keck School of Medicine
1500 San Pablo Avenue
Los Angeles CA 90033
Disclosure
O
Boyko- Speakers Bureau Bracco
Diagnostics, Guerbet LLC
 T Tran- No Disclosures
PURPOSE
 Our initial study utilizes magnetic
resonance spectroscopy to evaluate
possible changes of MRS biomarkers
Choline, Myo-inositol, and N-acetyl
aspartate changes in the dentate nuclei
region of patients who have had
multiple Gd contrast injections and
demonstrated T1 hyperintensity in the
Dentate Nuclei.
MATERIALS AND METHODS
Two subjects (1 brain tumor and 1 multiple
sclerosis) with histories of multiple
gadolinium-based contrast injections and
four patients with no history of gadoliniumbased contrast injections underwent
magnetic resonance (MR) examinations on a
General Electric 1.5T clinical scanner in the
region of the dentate nucleus using single
voxel point resolved spectroscopy (PRESS) TE
35 msec TR 1500 msec (Fig. 1).
RESULTS
 Fig 1
RESULTS
The two subjects with history of multiple gadolinium-based
contrast administrations demonstrate (Fig. 2A,B) :
1. Increase in mI/Cr compared to normal controls (p < 0.05)
2.Cho/Cr also was elevated but minimally.
Bright Dentate Nucleus Subjects Red Square and Green Tirangle
Normal control atients no Bright Dentate Nucleus Blue Diamond
NeuroMetabolites of MRS and
Their Histologic Correlates
MRS NeuroMetabolites- A Primer
A. 2.0 ppm - N acetyl aspartate 2.0 ppm (NAA):
Is an aminoacid derivative synthesized in neurons and transported along
axons. It is therefore a "marker" of viable neurons, axons, and
dendrites
B. 2.1 and 2.4 ppm -
Glutamate—Glutamine—Gammaamino butyrate (Glx): A mixture of closely related amino acids,
amines and derivatives involved in excitatory neurotransmission
Glx is a vital marker(s) in MRS of stroke, lymphoma, hypoxia, and
many metabolic brain disorders. glutamine is mainly synthesized
in the glia from synaptic glutamate and has been used as an index
of glutamatergic neurotransmission. GABA is the principal
inhibitory neurotransmitter in the CNS
C. 3.0 ppm - Creatine (Cr): It is the central energy marker of
both neurons and astrocytes and remains relatively constant
MRS NeuroMetabolites- A Primer
A. 3.2 ppm - Choline (Cho): Choline includes several
soluble components of brain myelin and fluid-cell
membranes. Because by far the majority of cholinecontaining brain constituents are not normally soluble,
pathological alterations in membrane turnover (tumor,
leukodystrophy, multiple sclerosis) result in a massive
increase in MRS-visible Cho.
B. 3.6 ppm - Myo-inositol (mI): A little known polyol
(sugar-like molecules) and as an astrocyte marker and
osmolyte, mI contributes specificity in dementia
diagnoses1, inflammation, low grade gliomas and an
almost absolute specificity to hepatic encephalopathy and
hyponatremic brain syndromes. Myoinositol is a
precursor in the phosphatidylinositol second messenger
system, and is also a glial marker.
CONCLUSIONS
 Currently, there are no noninvasive methods to
evaluate metabolic changes in the brains of patient
who exhibit T1 hyperintense signal in the dentate
nucleus after multiple gadolinium injections.
Magnetic resonance spectroscopy has been shown to
be a reliable and reproducible method of assessing
chemical changes in the brain and potentially can be
established as a monitoring tool for metabolic changes
in patients receiving medical necessary multiple
gadolinium injections.
REFERENCES
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Nucleus and Globus Pallidus on Unenhanced T1-weighted MR Images:
Relationship with Increasing Cumulative Dose of a Gadolinium-based Contrast
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<link.springer.com/article/10.1007/s10534-106-9931-7>