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

Published Online:https://doi.org/10.1148/radiol.13131669

Increased signal intensity in the dentate nucleus and, to a lesser extent, globus pallidus on unenhanced T1-weighted MR images showed a positive correlation with previous exposure to gadolinium-based contrast material.

Purpose

To explore any correlation between the number of previous gadolinium-based contrast material administrations and high signal intensity (SI) in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance (MR) images.

Materials and Methods

The institutional review board approved this study, waiving the requirement to obtain written informed consent. A group of 381 consecutive patients who had undergone brain MR imaging was identified for cross-sectional analysis. For longitudinal analysis, 19 patients who had undergone at least six contrast-enhanced examinations were compared with 16 patients who had undergone at least six unenhanced examinations. The mean SIs of the dentate nucleus, pons, globus pallidus, and thalamus were measured on unenhanced T1-weighted images. The dentate nucleus–to-pons SI ratio was calculated by dividing the SI in the dentate nucleus by that in the pons, and the globus pallidus–to-thalamus SI ratio was calculated by dividing the SI in the globus pallidus by that in the thalamus. Stepwise regression analysis was undertaken in the consecutive patient group to detect any relationship between the dentate nucleus–to-pons or globus pallidus–to-thalamus SI ratio and previous gadolinium-based contrast material administration or other factors. A random coefficient model was used to evaluate for longitudinal analysis.

Results

The dentate nucleus–to-pons SI ratio showed a significant correlation with the number of previous gadolinium-based contrast material administrations (P < .001; regression coefficient, 0.010; 95% confidence interval [CI]: 0.009, 0.011; standardized regression coefficient, 0.695). The globus pallidus–to-thalamus SI ratio showed a significant correlation with the number of previous gadolinium-based contrast material administrations (P < .001; regression coefficient, 0.004; 95% CI: 0.002, 0.006; standardized regression coefficient, 0.288), radiation therapy (P = .009; regression coefficient,−0.014; 95% CI: −0.025, −0.004; standardized regression coefficient, −0.151), and liver function (P = .031; regression coefficient, 0.023; 95% CI: 0.002, 0.044; standardized regression coefficient, 0.107). The dentate nucleus–to-pons and globus pallidus–to-thalamus SI ratios in patients who had undergone contrast-enhanced examinations were significantly greater than those of patients who had undergone unenhanced examinations (P < .001 for both).

Conclusion

High SI in the dentate nucleus and globus pallidus on unenhanced T1-weighted images may be a consequence of the number of previous gadolinium-based contrast material administrations.

© RSNA, 2013

References

  • 1. Kasahara S, Miki Y, Kanagaki M, et al. Hyperintense dentate nucleus on unenhanced T1-weighted MR images is associated with a history of brain irradiation. Radiology 2011;258(1):222–228.
  • 2. Roccatagliata L, Vuolo L, Bonzano L, Pichiecchio A, Mancardi GL. Multiple sclerosis: hyperintense dentate nucleus on unenhanced T1-weighted MR images is associated with the secondary progressive subtype. Radiology 2009;251(2):503–510.
  • 3. Lai PH, Chen C, Liang HL, Pan HB. Hyperintense basal ganglia on T1-weighted MR imaging. AJR Am J Roentgenol 1999;172(4):1109–1115.
  • 4. Rovira A, Alonso J, Córdoba J. MR imaging findings in hepatic encephalopathy. AJNR Am J Neuroradiol 2008;29(9):1612–1621.
  • 5. Brunberg JA, Kanal E, Hirsch W, Van Thiel DH. Chronic acquired hepatic failure: MR imaging of the brain at 1.5 T. AJNR Am J Neuroradiol 1991;12(5):909–914.
  • 6. Kim TJ, Kim IO, Kim WS, et al. MR imaging of the brain in Wilson disease of childhood: findings before and after treatment with clinical correlation. AJNR Am J Neuroradiol 2006;27(6):1373–1378.
  • 7. Oikonomou A, Chatzistefanou A, Zezos P, Mintzopoulou P, Vadikolias K, Prassopoulos P. Basal ganglia hyperintensity on T1-weighted MRI in Rendu-Osler-Weber disease. J Magn Reson Imaging 2012;35(2):426–430.
  • 8. Valdés Hernández Mdel C, Maconick LC, Tan EM, Wardlaw JM. Identification of mineral deposits in the brain on radiological images: a systematic review. Eur Radiol 2012;22(11):2371–2381.
  • 9. Shin YC, Kim E, Cheong HK, et al. High signal intensity on magnetic resonance imaging as a predictor of neurobehavioral performance of workers exposed to manganese. Neurotoxicology 2007;28(2):257–262.
  • 10. Henkelman RM, Watts JF, Kucharczyk W. High signal intensity in MR images of calcified brain tissue. Radiology 1991;179(1):199–206.
  • 11. da Silva CJ, da Rocha AJ, Jeronymo S, et al. A preliminary study revealing a new association in patients undergoing maintenance hemodialysis: manganism symptoms and T1 hyperintense changes in the basal ganglia. AJNR Am J Neuroradiol 2007;28(8):1474–1479.
  • 12. Mirowitz SA, Westrich TJ, Hirsch JD. Hyperintense basal ganglia on T1-weighted MR images in patients receiving parenteral nutrition. Radiology 1991;181(1):117–120.
  • 13. Martin-Duverneuil N, Idbaih A, Hoang-Xuan K, et al. MRI features of neurodegenerative Langerhans cell histiocytosis. Eur Radiol 2006;16(9):2074–2082.
  • 14. Hao D, Ai T, Goerner F, Hu X, Runge VM, Tweedle M. MRI contrast agents: basic chemistry and safety. J Magn Reson Imaging 2012;36(5):1060–1071.
  • 15. Runge VM. Safety of approved MR contrast media for intravenous injection. J Magn Reson Imaging 2000;12(2):205–213.
  • 16. White GW, Gibby WA, Tweedle MF. Comparison of Gd(DTPA-BMA) (Omniscan) versus Gd(HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Invest Radiol 2006;41(3):272–278.
  • 17. Tweedle MF. Physicochemical properties of gadoteridol and other magnetic resonance contrast agents. Invest Radiol 1992;27(Suppl 1):S2–S6.

Article History

Received July 18, 2013; revision requested September 9; revision received October 9; accepted October 14; final version accepted November 13.
Published online: Dec 07 2013
Published in print: Mar 2014