title: The presence of the gadolinium-based contrast agent depositions in the brain and symptoms of gadolinium neurotoxicity - A systematic review.
abstract: OBJECTIVE
  Gadolinium based contrast agents (GBCAs) are widely used in magnetic resonance imaging, but recently, high signal intensity in the cerebellum structures was reported after repeated administrations of contrast- enhanced magnetic resonance images. The aim of this systematic review was to investigate the association between increased signal intensity in the dentate nucleus and globus pallidus in the brain and repeated administrations of GBCAs. Additionally, we focused on possible short- and long-term consequences of gadolinium use in those patients.
  
  
  METHODS
  Systematic review of retrospective investigations in PubMed and Medline was performed in July 2016. Primary outcomes included the presence of increased signal intensity within the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in patients following administrations of GBCAs. Two independent reviewers were responsible for search and data extraction.
  
  
  RESULTS
  25 publications satisfied inclusion criteria (19 magnetic resonance images analyses, 3 case reports; 3 autopsy studies). Magnetic resonance images of 1247 patients with increased signal intensity on unenhanced T1-weighted MR images were analyzed as well as tissue specimens from 27 patients. Signal intensity correlated positively with the exposure to GBCAs and was greater after serial administrations of linear nonionic than cyclic contrast agents. Gadolinium was detected in all tissue examinations.
  
  
  CONCLUSIONS
  High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted magnetic resonance images were associated with previous administration of GBCAs. Signal intensity correlated negatively with stability of contrast agents. Clinical significance of gadolinium deposition in the brain remains unclear. There is a strong need for further research to identify type of gadolinium deposited in the brain as well as to gather knowledge about long-term consequences.
authors.affiliation: Department of General and Pediatric Radiology, Wroclaw Medical University, Wrocław, Poland.
authors.forename: Cyprian
authors.initials: C
authors.lastname: Olchowy
authors.affiliation: Radiology Students' Scientific Club, Wrocław Medical University, Wroclaw, Poland Department of General and Pediatric Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Kamil
authors.initials: K
authors.lastname: Cebulski
authors.affiliation: Department of General and Pediatric Radiology, Wroclaw Medical University, Wrocław, Poland.
authors.forename: Mateusz
authors.initials: M
authors.lastname: Łasecki
authors.affiliation: Division of Hematology, Cancer Prevention and Propaedeutics of Rare Diseases, Faculty of Medicine, University of Rzeszow, Rzeszów, Poland.
authors.forename: Radosław
authors.initials: R
authors.lastname: Chaber
authors.affiliation: Radiology Students' Scientific Club, Wrocław Medical University, Wroclaw, Poland Department of General and Pediatric Radiology, Wroclaw Medical University, Wroclaw, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Olchowy
authors.affiliation: Department of Pediatric Hematology, Oncology and BMT, Wroclaw Medical University, Wrocław, Poland.
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Kałwak
authors.affiliation: Department of General and Pediatric Radiology, Wroclaw Medical University, Wrocław, Poland.
authors.forename: Urszula
authors.initials: U
authors.lastname: Zaleska-Dorobisz
mesh_terms: D001921:Brain / Q000000981:diagnostic imaging / Q000187:drug effects* / Q000473:pathology; D003287:Contrast Media / Q000009:adverse effects* / Q000633:toxicity; D005682:Gadolinium / Q000009:adverse effects* / Q000633:toxicity; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000009:adverse effects; D009498:Neurotoxins / Q000009:adverse effects* / Q000633:toxicity
chemical_list: D003287:Contrast Media; D009498:Neurotoxins; D005682:Gadolinium