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Absence of T1 Hyperintensity in the Brain of High-risk Patients After Multiple Administrations of High-dose Gadobutrol for Cardiac Magnetic Resonance

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Abstract

Purpose

A prospective study was conducted to evaluate signal changes in the dentate nucleus, globus pallidus, pons, and thalamus (normalized to the deep cerebellum white matter) in T1-weighted magnetic resonance (MR) images after serial injections of gadobutrol in patients with thalassemia without neurological lesions.

Methods

In this study three groups were scanned at both 1.5 T and 3 T: 15 thalassemia patients transfused and chelated with ≥4 gadobutrol administrations at a high dose (0.2 mmol/kg per scan) for late gadolinium enhancement (LGE) cardiovascular MR, 8 thalassemia patients and 13 healthy subjects who had never received gadolinium-based contrast agents (GBCA).

Results

Signal intensity (SI) ratios at 1.5 T in all regions were comparable among the three groups and were not correlated with the number of gadobutrol administrations.

In healthy subjects SI ratios were significantly different among the 4 regions, being higher in the pallidus.

The SI ratios at 1.5 T were significantly higher and not correlated with SI ratios at 3 T or with iron overload in the same regions assessed by the T2* technique.

Conclusion

This article describes the lack of increased SI in T1-weighted MR images after repeated administration of gadobutrol for cardiovascular MR studies in a high-risk population (high dose per scan, iron overload that can facilitate the transmetalation of gadolinium) scanned at 3 T and 1.5 T.

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Acknowledgements

We would like to thank all the radiologists and thalassemologists of the MIOT and eMIOT projects. A thanks goes to all the radiology technicians and nurses in our Lab for their cooperation, helpfulness and patience. We finally thank all patients and healthy subjects who underwent MRI for their double cooperation and Claudia Santarlasci for skillful secretarial work.

Funding

The MIOT and EMIOT projects receive no-profit support from industrial sponsorships (Chiesi Farmaceutici S.p.A., ApoPharma Inc., and Bayer).

Author information

Authors and Affiliations

  1. MRI Unit, Fondazione G. Monasterio CNR-Regione Toscana, Area della Ricerca S. Cataldo, 1 Moruzzi Street, 56124, Pisa, Italy

    Antonella Meloni, Domenico Montanaro, Daniele De Marchi, Petra Keilberg, Laura Pistoia, Vincenzo Positano, Sara De Cori & Alessia Pepe

  2. Istituto di Radiologia, Policlinico Università di Bari, 11 Giulio Cesare Square, 70124, Bari, Italy

    Mariachiara Resta

  3. Unità Operativa Semplice Dipartimentale Malattie Rare del Globulo Rosso, Azienda Ospedaliera di Rilievo Nazionale “A. Cardarelli”, 9 Cardarelli Street, 80131, Napoli, Italy

    Anna Spasiano

  4. Centro Talassemie ed Emoglobinopatie, Ospedale “Meyer”, 13 Luca Giordano Street, 50132, Firenze, Italy

    Tommaso Casini

  5. Unità Operativa Immunoematologia e Medicina Trasfusionale, Ospedale “San Donato”, 20 Pietro Nenni Street, 52100, Arezzo, Italy

    Caterina Cinzia De Bari

Authors
  1. Antonella Meloni
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  2. Domenico Montanaro
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  3. Daniele De Marchi
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  4. Mariachiara Resta
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  5. Petra Keilberg
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  6. Laura Pistoia
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  7. Vincenzo Positano
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  8. Anna Spasiano
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  9. Tommaso Casini
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  10. Caterina Cinzia De Bari
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  11. Sara De Cori
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  12. Alessia Pepe
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Contributions

Conduction of the study, statistical analysis, data interpretation, and manuscript drafting: Antonella Meloni; method development, image analysis, data interpretation, and manuscript revision: Domenico Montanaro; MRI scanning and manuscript revision: Daniele De Marchi and Petra Keilberg; method development, data interpretation, and manuscript revision: Mariachiara Resta and Sara De Cori; clinical data collection, volunteer recruitment, and manuscript revision: Laura Pistoia; software development and manuscript revision: Vincenzo positano; patient recruitment and manuscript revision: Anna Spasiano, Tommaso Casini, and Caterina Cinzia De Bari; study conception, design and coordination, data interpretation, and manuscript drafting: Alessia Pepe. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Alessia Pepe.

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Conflict of interest

A. Meloni,D. Montanaro, D. De Marchi, M. Resta, P. Keilberg, L. Pistoia, V. Positano,A. Spasiano, T. Casini, C.C. De Bari, S. De Cori and A. Pepe declare that they have no competing interests.

Ethical standards

This prospective study was approved by the local ethics committee and was conducted in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. All persons gave informed consent prior to inclusion in the study.

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Meloni, A., Montanaro, D., De Marchi, D. et al. Absence of T1 Hyperintensity in the Brain of High-risk Patients After Multiple Administrations of High-dose Gadobutrol for Cardiac Magnetic Resonance. Clin Neuroradiol 31, 347–355 (2021). https://doi.org/10.1007/s00062-020-00897-z

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