Linear gadolinium-based contrast agent (gadodiamide and gadopentetate dimeglumine)-induced high signal intensity on unenhanced T 1 -weighted images in pediatric patients

J Magn Reson Imaging. 2019 Apr;49(4):1046-1052. doi: 10.1002/jmri.26311. Epub 2018 Oct 11.


Background: Recent studies of adults have found an association between hyperintensity of the dentate nucleus (DN) and globus pallidus (GP) on T1 -weighted images (T1 WI) and a history of linear gadolinium-based contrast agent (GBCA) administration. Several reports have also focused on this phenomenon in pediatric patients; however, data in the current literature remains limited.

Purpose/hypothesis: To evaluate the associations between DN and GP T1 -signal increase and previous administration of linear GBCAs in pediatric patients.

Study type: Single-center, retrospective, cross-sectional study.

Population: We included pediatric patients with histories of ≥5 linear GBCA (gadodiamide and gadopentetate dimeglumine) administrations (the "≥5 Linear GBCA administrations" group), 1-4 administrations (the "1-4 Linear GBCA administrations" group), and no history of GBCA administration (the "No GBCA administration" group). Each group included 42 patients. Therefore, 126 patients (male:female, 72:54; median age, 16 [range, 4-18] years) were included in this study.

Field strength/sequence: 1.5T/ Spin-echo unenhanced T1 -weighted imaging.

Assessment: Unenhanced T1 -weighted images were quantitatively analyzed by two radiologists. The DN-to-pons and GP-to-thalamus signal intensity ratios (DN-to-pons and GP-to-thalamus ratios, respectively) were compared.

Statistical tests: Wilcoxon test with the Bonferroni correction and intraclass correlation coefficients.

Results: The DN-to-pons ratio increased as the number of GBCA administrations increased (P < 0.0063). The GP-to-thalamus ratio of the "≥5 Linear GBCA administrations" group was significantly higher than those of the other two groups (P < 0.0001). The GP-to-thalamus ratio of the "1-4 Linear GBCA administrations" group did not differ significantly from that of the "No GBCA administration" group (P = 1.000). The DN-to-pons and GP-to-thalamus ratios' interobserver intraclass correlation coefficients were excellent (0.8236) and good (0.6738), respectively.

Data conclusion: High signal intensities in the DN and GP on T1 WI were associated with previous linear GBCA administration in pediatric patients.

Level of evidence: 3 Technical Efficacy: Stage 2 J. Magn. Reson. Imaging 2019;49:1046-1052.

MeSH terms

  • Adolescent
  • Cerebellar Nuclei / diagnostic imaging
  • Child
  • Child, Preschool
  • Contrast Media / chemistry*
  • Cross-Sectional Studies
  • Female
  • Gadolinium / chemistry*
  • Gadolinium DTPA / chemistry*
  • Globus Pallidus / diagnostic imaging
  • Humans
  • Image Processing, Computer-Assisted*
  • Magnetic Resonance Imaging*
  • Male
  • Observer Variation
  • Pediatrics
  • Retrospective Studies


  • Contrast Media
  • gadodiamide
  • Gadolinium
  • Gadolinium DTPA