Magnetic resonance characteristics and susceptibility weighted imaging of the brain in gadolinium encephalopathy

J Neuroimaging. 2015 Jan-Feb;25(1):136-9. doi: 10.1111/jon.12067. Epub 2013 Nov 19.


Background and purpose: To report the brain imaging features on magnetic resonance imaging (MRI) in inadvertent intrathecal gadolinium administration.

Methods: A 67-year-old female with gadolinium encephalopathy from inadvertent high dose intrathecal gadolinium administration during an epidural steroid injection was studied with multisequence 3T MRI.

Results: T1-weighted imaging shows pseudo-T2 appearance with diffusion of gadolinium into the brain parenchyma, olivary bodies, and membranous labyrinth. Nulling of cerebrospinal fluid (CSF) signal is absent on fluid attenuation recovery (FLAIR). Susceptibility-weighted imaging (SWI) demonstrates features similar to subarachnoid hemorrhage. CT may demonstrate a pseudo-cerebral edema pattern given the high attenuation characteristics of gadolinium.

Conclusion: Intrathecal gadolinium demonstrates characteristic imaging features on MRI of the brain and may mimic subarachnoid hemorrhage on susceptibility-weighted imaging. Identifying high dose gadolinium within the CSF spaces on MRI is essential to avoid diagnostic and therapeutic errors.

Keywords: Intrathecal gadolinium; gadolinium encephalopathy; subarachnoid hemorrhage; susceptibility weighted imaging.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Brain / drug effects*
  • Brain / pathology*
  • Brain Diseases / chemically induced*
  • Brain Diseases / pathology*
  • Contrast Media / adverse effects
  • Diagnosis, Differential
  • Female
  • Gadolinium DTPA / adverse effects*
  • Humans
  • Magnetic Resonance Imaging / adverse effects
  • Magnetic Resonance Imaging / methods*


  • Contrast Media
  • gadodiamide
  • Gadolinium DTPA