Gadolinium deposition in the brain of patients with relapsing-remitting multiple sclerosis after 10 years of follow-up

Abstract

Background/Aim. Since 2014 and the publication of the results of the first study on the accumulation of gadolinium contrast, we have witnessed a growing body of evidence on the deposition and retention of gadolinium in the brain after the use of gadolinium-based contrast agents (GBCAs). However, there is still no strong clinical evidence of the adverse effects of GBCAs on the brain parenchyma. The aim of the study was to determine the existence of gadolinium deposits in the brain of patients with relapsing-remitting multiple sclerosis after a ten-year follow-up period. During this period, the patients have regularly, each year, undergone magnetic resonance imaging (MRI) with the administration of gadolinium contrast (gadopentetate dimeglumine – Magnevist®) in order to follow the course of the disease. Methods. A cohort of 20 patients was formed for the purpose of this study. The ratio of the values of the signal intensity (SI) of different regions of the brain-to-cerebrospinal fluid (CSF) was com-pared for each patient on the initial MRI examination and the MRI examination ten years later. Results. Frontal cortex-to-CSF (p < 0.01), occipital cortex-to-CSF (p < 0.01), the white matter of the corona radiata-to-CSF (p < 0.01), parietal cortex-to-CSF (p < 0.05), thalamus-to-CSF (p = 0.051), putamen-to-CSF (p = 0.06), and anterior and posterior limb of the capsula interna-to-CSF (p = 0.062) SI ratios increased after multiple gadopentetate administrations. An increase in the absolute values of the T1- weighted (T1W) signal in three-quarters of patients was registered in the frontal and occipital cortex and cerebellar hemispheres. A slightly smaller increase in SI, but still greater than 55–65%, was registered in structures of the parietal cortex, putamen, cornu anterior and posterior of the capsula interna, corpus callosum (CC) splenium, pons, thalamus, nucleus caudatus, substantia nigra, CC genu, and temporal cortex. Conclusion. In the cohort of 20 patients, there was a statistically significant increase in SI in the pre-contrast T1W sequence in the following structures: frontal, parietal, and occipital cortex, as well as supratentorial white matter. This result speaks in favor of the existence of chronic accumulation of gadolinium contrast agent gadopentetate dimeglumine in brain structures.

Keywords

• gadolinium dtpa
• long term adverse effects
• magnetic resonance imaging
• multiple sclerosis, relapsing-remitting