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  • Lack of T1 hyperintensity in the dentate nucleus after 15 administrations of a macrocyclic contrast agent in multiple sclerosis

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Lack of T1 hyperintensity in the dentate nucleus after 15 administrations of a macrocyclic contrast agent in multiple sclerosis
  1. Philipp Eisele1,
  2. Kristina Szabo1,
  3. Angelika Alonso1,
  4. Melissa Ong2,
  5. Michael Platten1,
  6. Stefan O Schoenberg2,
  7. Achim Gass1
  1. 1 Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
  2. 2 Institute of Clinical Radiology and Nuclear Medicine, Universitätsmedizin Mannheim, University of Heidelberg, Mannheim, Germany
  1. Correspondence to Professor Achim Gass, Department of Neurology, Universitätsmedizin Mannheim, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany; achim.gass{at}medma.uni-heidelberg.de

https://doi.org/10.1136/jnnp-2017-316102

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    Introduction

    In multiple sclerosis (MS), MRI has emerged as the most useful paraclinical biomarker. ‘No evidence of disease activity’ is a desired outcome in therapeutic clinical trials and therapy monitoring in individual patients, which includes the absence of new or enhancing lesions on MRI. Therefore, frequent follow-up contrast-enhanced MRI examinations play an important role in disease monitoring.

    In 2013, Kanda et al 1 described an increased signal intensity (SI) of the dentate nucleus (DN) on unenhanced T1-weighted MRI after multiple applications of gadolinium-based contrast agents (GBCAs) suggesting a deposition of gadolinium. Since then, numerous studies evaluated the effects of gadolinium deposition in the brain after serial application of GBCAs, and recent studies provide evidence that T1 hyperintensity of the DN is associated with the prior administrations of linear GBCAs, but not with macrocyclic GBCAs.2 3 However, the experience of an abnormal SI in the DN after more than 15 administrations of GBCAs is limited up to now.2 Since MS typically affects young adults, patients with MS commonly undergo a high number of MRI examinations through their lifetime. The aim of this study was to investigate the effect of 15 or more serial injections of the macrocyclic GBCA gadoterate meglumine on the SI of the DN on unenhanced T1-weighted images in patients with MS.

    Methods

    We retrospectively identified patients with relapsing-remitting MS who are at least 18 years of age and who underwent a minimum of 15 gadolinium-enhanced examinations in our institution that were all exclusively performed with the …

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    Footnotes

    • Contributors PE: conceptualisation of the study, acquisition, analysis and interpretation of the data, statistical analysis, drafting and revising the manuscript, submitted the manuscript. KS: acquisition and interpretation of the data, revising the manuscript. AA: acquisition and interpretation of the data, revising the manuscript. MO: interpretation of the data, revising the manuscript. MP: interpretation of the data, revising the manuscript. SOS: interpretation of the data, revising the manuscript. AG: conceptualisation of the study, acquisition, analysis and interpretation of the data, drafting and revising the manuscript, corresponding author, responsible for the overall content as guarantor.

    • Competing interests All authors declare no conflict of interests relevant to the manuscript. PE has received travel expenses from Bayer Health Care. KS has received research support from the German Research Foundation (DFG). AA is on the editorial board for Advances in Neuroscience and Cerebrovascular Diseases. MO reports no disclosures. MP has a consultant relationship with Novartis, Merck and Genentech/Roche, has received non-personal, institutional honoraria from Medac, Merck, Novartis, Teva and Genentech/Roche, and has research agreements with Bayer Health Care. SOS reports that the Institute of Clinical Radiology and Nuclear Medicine has research agreements with Siemens Healthineers GmbH. AG has received honoraria for lecturing, travel expenses for attending meetings, and financial support for research from Bayer Schering, Biogen Idec, Merck Serono, Novartis and Teva Neurosciences.

    • Ethics approval Local ethics committee.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data sharing statement None declared.