Effect of Renal Function on Gadolinium-Related Signal Increases on Unenhanced T1-Weighted Brain Magnetic Resonance Imaging.
The purpose of this study was to determine if renal function affects signal changes in the deep brain nuclei on unenhanced T1-weighted images after administration of linear gadolinium-based contrast agents (GBCAs).



An electronic medical records search of 2 large medical centers identified 25 patients who received linear GBCA while on hemodialysis and had unenhanced T1-weighted images of the brain before and after. The dentate-to-cerebellar peduncle (DCP) ratio, globus pallidus-to-mid thalamus (GPT) ratio, and choroid plexus-to-nearby white matter ratio were measured and compared with 25 age/sex/GBCA exposure-matched control patients with normal or near-normal renal function (estimated glomerular filtration rate >60 mL/min per 1.73 m). Two additional control groups included 13 patients on hemodialysis without GBCA exposure and 13 age/sex-matched patients with estimated glomerular filtration rate greater than 60 mL/min per 1.73 m.



Hemodialysis patients (n = 25) with an average of 1.8 linear GBCA administrations had a 4.9% mean increase (1.00 ± 0.04 vs 1.05 ± 0.05; P < 0.001) in DCP, which was greater than the 1.6% change (0.99 ± 0.04 vs 1.00 ± 0.05; P = 0.08) observed in matched controls (P = 0.01). There was no significant signal change in the DCP ratio in the 13 hemodialysis patients (0.99 ± 0.04 vs 0.99 ± 0.04; P = 0.78) and 13 age/sex-matched patients (0.99 ± 0.02 vs 0.99 ± 0.03; P = 0.78) who did not receive GBCA. The hemodialysis patients had a baseline GPT that was higher than nondialysis patients (P < 0.001). However, the GPT change after GBCA administration was not significantly different from controls. Increased signal in the choroid plexus on unenhanced T1-weighted images after GBCA administration was noted in hemodialysis patients (0.72 ± 0.20 vs 0.86 ± 0.23; P = 0.006); however, a multivariate analysis showed this to be primarily related to hemodialysis (P = 0.003) with only a trend toward relating to GBCA exposure (P = 0.07).



Hemodialysis patients receiving linear GBCA have greater dentate nucleus signal increases on unenhanced T1-weighted images, suggesting that renal function may affect the rate of gadolinium accumulation in the brain after linear GBCA-enhanced magnetic resonance imaging.
From the *Department of Radiology, Weill Medical College of Cornell University, New York, NY; †Department of Radiology, Qilu Hospital, Shandong University, Jinan, China; ‡Department of Nephrology, Weill Medical College of Cornell University; and §Department of Radiology, Columbia College of Physicians and Surgeons, New York, NY.
Yan
Y
Cao
Yang
Y
Zhang
George
G
Shih
Yan
Y
Zhang
Andrew
A
Bohmart
Elizabeth M
EM
Hecht
Martin R
MR
Prince
D000368:Aged; D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects*; D003287:Contrast Media / Q000494:pharmacology*; D016208:Databases, Factual; D005260:Female; D005682:Gadolinium / Q000494:pharmacology*; D019786:Gadolinium DTPA / Q000494:pharmacology; D006801:Humans; D007668:Kidney / Q000503:physiopathology*; D007676:Kidney Failure, Chronic / Q000503:physiopathology / Q000628:therapy; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008536:Meglumine / Q000031:analogs & derivatives / Q000494:pharmacology; D008875:Middle Aged; D009942:Organometallic Compounds / Q000494:pharmacology; D006435:Renal Dialysis; D012189:Retrospective Studies; D012815:Signal Processing, Computer-Assisted
D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; C064925:gadodiamide; D005682:Gadolinium; D019786:Gadolinium DTPA