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Dentate Nucleus Signal Intensity Changes in Children with Adrenoleukodystrophy in Comparison to Primary Brain Tumor
1Department of Radiology, University of Minnesota Health, Minneapolis, MN.
Insights
Brain irradiation and cerebral adrenoleukodystrophy (cALD) in children can increase T1-weighted imaging signal intensity in the dentate nucleus. Macrocyclic gadolinium-based contrast agents (mcGBCA) did not show this effect in brain tumor patients without radiation.
Area of Science:
- Radiology
- Pediatric Neurology
- Neuro-oncology
Background:
- Cerebral adrenoleukodystrophy (cALD) and brain irradiation are known to affect brain tissue.
- The impact of these conditions and macrocyclic gadolinium-based contrast agents (mcGBCA) on dentate nucleus (DN) signal intensity (SI) in pediatric T1-weighted imaging (T1WI) requires clarification.
Purpose of the Study:
- To investigate the effect of cALD and brain irradiation on DN SI in pediatric patients receiving mcGBCA gadobutrol.
- To compare DN SI in pediatric brain tumor patients with and without radiation therapy, and in cALD patients, against matched controls.
Main Methods:
- Retrospective analysis of 97 pediatric patients undergoing mcGBCA-enhanced MRI (2010-2020).
- Groups included: brain tumors without radiation, brain tumors with radiation, cALD, and matched controls.
- Dentate nucleus-to-middle cerebellar peduncle (DN-to-MCP) SI ratios on T1WI were calculated and compared using paired t-tests.
Main Results:
- Significantly higher DN-to-MCP SI ratios were observed in pediatric patients with brain tumors and radiation (mcGBCA group-2) and in cALD patients (mcGBCA group-3) compared to controls.
- No significant difference in DN SI ratio was found between pediatric brain tumor patients without radiation (mcGBCA group-1) and their controls.
- No correlation was found between SI ratios and cumulative mcGBCA dose, number of administrations, age, or time since MRI.
Conclusions:
- Hyperintense T1WI signal in the dentate nucleus is associated with brain irradiation in pediatric brain tumor patients and with cALD.
- mcGBCA gadobutrol administration alone in pediatric brain tumor patients without radiation did not significantly alter DN SI.
Background And Purpose:
To determine whether cerebral adrenoleukodystrophy (cALD) or brain irradiation in patients with primary brain tumor affects T1-weighted imaging (T1WI) signal intensity (SI) of the dentate nucleus (DN) in a pediatric cohort who had received consecutive macrocyclic gadolinium-based contrast agent (mcGBCA) gadobutrol.
Methods:
This study included 97 pediatric patients who underwent mcGBCA-enhanced MRI from 2010 to 2020 (29 children with primary brain tumors without brain radiation therapy [mcGBCA group-1], 33 children with primary brain tumors and radiation treatment [mcGBCA group-2], 35 children with cALD [mcGBCA group-3], and 97 sex-/age-matched control subjects [subgroups matched to each of the three subject groups] without GBCA administration). The DN-to-middle cerebellar peduncle (MCP) SI ratios on T1WI were then determined. A paired t-test was performed to compare SI ratios between children exposed to mcGBCA in each group and control subjects. The relationships between SI ratios and confounding variables were analyzed utilizing the Pearson correlation analysis.
Results:
The DN-to-MCP SI ratio was significantly higher of mcGBCA group-2 (1.046±.071) or mcGBCA group-3 (.972±.038) than in the control group-2 (.983±.041, P<.001) and control group-3 (.937±.051, P = .002), respectively, but no significant difference of the SI ratio was noted between mcGBCA group-1 (.984±.032) and control-group-1 (.982±.035, P = .860). No significant correlation was noted between SI ratio values and the cumulative dose or number of mcGBCA administrations, age, or the elapsed time between the MRI examinations (all P>.05).
Conclusions:
Hyperintense T1WI signal in the DN may be seen in children with brain tumors undergoing brain irradiation, as well as in children with cALD.
