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Updated: Aug 16, 2025
Magnetic Resonance Imaging of Multiple Sclerosis at 7.0 Tesla
Published on: February 19, 2021
Does Gadolinium Deposition Lead to Metabolite Alteration in the Dentate Nucleus? An MRS Study in Patients with MS
M Mohammadzadeh1, S Kolahi1, M-M Mehrabi Nejad1
1From the Departments of Radiology (M.M., S.K., M.-M.M.N., K.F., H.N., M.S., H.S., H.H.).
Background And Purpose:
Repeat contrast-enhanced MR imaging exposes patients with relapsing-remitting MS to frequent administration of gadolinium-based contrast agents. We aimed to investigate the potential metabolite and neurochemical alterations of visible gadolinium deposition on unenhanced T1WI in the dentate nucleus using MRS.
Materials And Methods:
This prospective study was conducted in a referral university hospital from January 2020 to July 2021. The inclusion criteria for case and control groups were as follows: 1) case: patients with relapsing-remitting MS, visible gadolinium deposition in the dentate nucleus (ribbon sign), >5 contrast-enhanced MR images obtained; 2) control 1: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, >5 contrast-enhanced MR images obtained; 3) control 2: patients with relapsing-remitting MS without visible gadolinium deposition in the dentate nucleus, <5 contrast-enhanced-MR images obtained; and 4) control 3: adult healthy individuals, with no contrast-enhanced MR imaging. Dentate nucleus and pontine single-voxel 12 × 12 × 12 MRS were analyzed using short TEs.
Results:
Forty participants (10 per group; 27 [67.5%] female; mean age, 35.6 [SD, 9.6] years) were enrolled. We did not detect any significant alteration in the levels of NAA and choline between the studied groups. The mean concentrations of mIns were 2.7 (SD, 0.73) (case), 1.5 (SD, 0.8) (control 1), 2.4 (SD, 1.2) (control 2), and 1.7 (SD, 1.2) (control 3) (P = .04). The mean concentration of Cr and mIns (P = .04) and the relative metabolic concentration (dentate nucleus/pons) of lipid 1.3/Cr (P = .04) were significantly higher in the case-group than in healthy individuals (controls 1-3). Further analyses compared the case group with cumulative control 1 and 2 groups and showed a significant increase in lactate (P = .02), lactate/Cr (P = .04), and Cr (dentate nucleus/pons) (P = .03) in the case group.
Conclusions:
Although elevated concentrations of Cr, lactate, mIns, and lipid in the dentate nucleus of the case group indicate a metabolic disturbance, NAA and choline levels were normal, implying no definite neuronal damage.
Insights
Gadolinium deposition in the dentate nucleus of relapsing-remitting MS patients is associated with altered brain metabolites, including increased myo-inositol, creatine, and lactate. These changes suggest metabolic disturbances without definite neuronal damage.
Area of Science:
- Neuroimaging
- Neurochemistry
- Multiple Sclerosis
Background:
- Repeated contrast-enhanced MRI in relapsing-remitting MS (RRMS) leads to gadolinium accumulation.
- Gadolinium deposition in the dentate nucleus is visible on unenhanced T1-weighted imaging.
Purpose of the Study:
- To investigate metabolite and neurochemical alterations in the dentate nucleus associated with visible gadolinium deposition in RRMS patients.
- To assess potential neuronal damage indicated by specific metabolite levels.
Main Methods:
- Prospective study comparing RRMS patients with and without gadolinium deposition to healthy controls.
- Single-voxel magnetic resonance spectroscopy (MRS) of the dentate nucleus and pons using short echo times (TE).
- Analysis of metabolites including N-acetylaspartate (NAA), choline, myo-inositol (mIns), creatine (Cr), and lactate.
Main Results:
- No significant differences in NAA and choline levels were found between groups.
- Elevated concentrations of mIns, Cr, and lipids were observed in the gadolinium deposition group compared to controls.
- Increased lactate and lactate/Cr ratios were detected in the gadolinium deposition group.
Conclusions:
- Elevated Cr, lactate, mIns, and lipid concentrations in the dentate nucleus suggest metabolic disturbances in RRMS patients with gadolinium deposition.
- Normal NAA and choline levels indicate no definitive neuronal damage despite gadolinium accumulation.
- MRS can detect neurochemical changes associated with gadolinium deposition in the dentate nucleus.
