title: Magnetic resonance characteristics and susceptibility weighted imaging of the brain in gadolinium encephalopathy.
abstract: OBJECTIVE
  To report the brain imaging features on magnetic resonance imaging (MRI) in inadvertent intrathecal gadolinium administration.
  
  
  METHODS
  A 67-year-old female with gadolinium encephalopathy from inadvertent high dose intrathecal gadolinium administration during an epidural steroid injection was studied with multisequence 3T MRI.
  
  
  RESULTS
  T1-weighted imaging shows pseudo-T2 appearance with diffusion of gadolinium into the brain parenchyma, olivary bodies, and membranous labyrinth. Nulling of cerebrospinal fluid (CSF) signal is absent on fluid attenuation recovery (FLAIR). Susceptibility-weighted imaging (SWI) demonstrates features similar to subarachnoid hemorrhage. CT may demonstrate a pseudo-cerebral edema pattern given the high attenuation characteristics of gadolinium.
  
  
  CONCLUSIONS
  Intrathecal gadolinium demonstrates characteristic imaging features on MRI of the brain and may mimic subarachnoid hemorrhage on susceptibility-weighted imaging. Identifying high dose gadolinium within the CSF spaces on MRI is essential to avoid diagnostic and therapeutic errors.
authors.affiliation: Department of Radiology, Penn State Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA, 17033.
authors.forename: Dejan
authors.initials: D
authors.lastname: Samardzic
authors.forename: Krishnamoorthy
authors.initials: K
authors.lastname: Thamburaj
mesh_terms: D000368:Aged; D001921:Brain / Q000187:drug effects* / Q000473:pathology*; D001927:Brain Diseases / Q000139:chemically induced* / Q000473:pathology*; D003287:Contrast Media / Q000009:adverse effects; D003937:Diagnosis, Differential; D005260:Female; D019786:Gadolinium DTPA / Q000009:adverse effects*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects / Q000379:methods*
chemical_list: D003287:Contrast Media; C064925:gadodiamide; D019786:Gadolinium DTPA
keywords: Intrathecal gadolinium; gadolinium encephalopathy; subarachnoid hemorrhage; susceptibility weighted imaging