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Diffusion Tensor Imaging of the Dentate Nucleus After Repeated Administration of Gadobutrol in Children
1Division of Neuroradiology, Department of Radiology, University of Minnesota, B-226 Mayo Memorial Building, MMC 292, 420 Delaware Street S.E, Minneapolis, MN, 55455, USA. oztur027@umn.edu.
Insights
Gadobutrol administration in children was linked to changes in brain tissue integrity, specifically lower fractional anisotropy (FA) and higher mean diffusivity (MD) in the dentate nucleus (DN). These diffusion tensor imaging (DTI) findings suggest potential alterations in cerebellar tissue following exposure to macrocyclic gadolinium-based contrast agents (mcGBCAs).
Area of Science:
- Neuroradiology
- Pediatric Imaging
- Diffusion Tensor Imaging
Background:
- Gadolinium-based contrast agents (GBCAs) are widely used in MRI.
- Concerns exist regarding potential long-term effects of GBCAs, particularly in pediatric populations.
- Macrocyclic GBCAs (mcGBCAs) like gadobutrol are considered safer but require continued safety evaluation.
Purpose of the Study:
- To investigate signal changes in the dentate nucleus (DN) using diffusion tensor imaging (DTI) after gadobutrol administration in pediatric patients.
- To compare DTI metrics (FA, MD) and T1WI SI ratios in the DN between children exposed to gadobutrol and a control group.
- To explore correlations between DTI changes, GBCA exposure, and confounding parameters.
Main Methods:
- A cohort of 50 pediatric patients exposed to gadobutrol and 50 age/sex-matched controls were included.
- Diffusion tensor imaging (DTI) was performed to determine mean diffusivity (MD) and fractional anisotropy (FA) values in the dentate nucleus (DN).
- Paired t-tests and Pearson correlation analyses were used to compare DTI metrics and assess relationships with GBCA administration and other factors.
Main Results:
- Children exposed to gadobutrol showed significantly lower FA values (0.254 ± 0.05) compared to controls (0.299 ± 0.03) (p < 0.001).
- Significantly higher MD values (0.173 × 10⁻³ mm²/s) were observed in the gadobutrol group compared to controls (0.152 × 10⁻³ mm²/s) (p < 0.001).
- A significant correlation was found between FA/MD values and the number of gadobutrol administrations (FA: r = -0.355, p = 0.011; MD: r = 0.334, p = 0.018).
Conclusions:
- Gadobutrol administration in children is associated with altered dentate nucleus (DN) integrity, indicated by reduced FA and increased MD.
- These DTI findings suggest potential changes in cerebellar tissue microstructure following exposure to macrocyclic GBCAs.
- Further research is warranted to understand the long-term clinical significance of these observed DTI changes in pediatric patients.
Abstract:
This study aimed to investigate possible signal changes in the dentate nucleus (DN) on diffusion tensor imaging (DTI) after administration of gadobutrol in a pediatric cohort. Total of 50 pediatric patients (mean age: 6.2 ± 4.3 years) with normal renal function exposed exclusively to the macrocyclic GBCA (mcGBCA) gadobutrol and 50 age- and sex-matched control patients with nonpathological neuroimaging findings (and no GBCA administration). Mean diffusivity (MD) and fractional anisotropy (FA) values were determined in the DN. A paired t test was performed to compare FA, MD values, and DN-to-middle cerebral peduncle (MCP) T1WI SI ratios between children exposed to gadobutrol and controls. Pearson correlation analysis was conducted to determine any correlation between FA and MD values as well as T1WI SI ratios and confounding parameters. The mean FA values of DN was significantly lower in children with mcGBCA than in the control group (p < 0.001; non-GBCA group, 0.299 ± 0.03; mcGBCA group, 0.254 ± 0.05), but no significant difference of the T1WI SI ratio was noted between the mcGBCA group (0.946 ± 0.06) and the control group (0.963 ± 0.05; p = 0.336). There was also a significant MD value difference between mcGBCA group and control group (p < 0.001; non-GBCA group, 0.152 ± 0.02 × 10-3 mm2/s; mcGBCA group, 0.173 ± 0.03 × 10-3 mm2/s). A significant correlation was identified between FA/MD values and the number of mcGBCA administration (FA; correlation coefficient = - 0.355, p = 0.011 and MD; correlation coefficient = 0.334, p = 0.018). The administration of the gadobutrol was associated with higher MD and lower FA values in DN suggesting a difference in cerebellar tissue integrity between children exposed to mcGBCAs and control group.
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