Accumulation of gadolinium in human cerebrospinal fluid after gadobutrol-enhanced MR imaging: A prospective observational cohort study

Avinash K. Nehra, Robert McDonald, Amy M. Bluhm, Tina M. Gunderson, David L. Murray, Paul J. Jannetto, David F Kallmes, Laurence J. Eckel, Jennifer S McDonald

Research output: Contribution to journalArticle

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Abstract

Purpose: To determine whether gadolinium accumulates within cerebrospinal fluid (CSF) in patients recently exposed to the macrocyclic agent gadobutrol and identify factors that may affect this accumulation. Materials and Methods: In this prospective observational cohort study, gadolinium was quantified by using inductively coupled plasma mass spectrometry of CSF samples from patients who underwent gadobutrol-enhanced magnetic resonance (MR) imaging followed by lumbar puncture within 30 days (gadobutrol group) or patients who underwent lumbar puncture without history of gadolinium-enhanced MR imaging (control group). CSF total protein level of 35 mg/dL or lower was used as a surrogate marker of an intact blood-brain barrier (BBB). Associations between gadolinium CSF concentration and patient characteristics were examined by using log (e)–linear regression models. Results: A total of 82 patients (68 in gadobutrol group, 14 in control group; 42 male and 40 female patients; median age, 47 years [interquartile range, 25–65 years]) were included in this study. Gadolinium was detected in the CSF of all 68 patients in the gadobutrol group (100% [95% confidence interval: 94.7, 100]; range, 0.2–1494 ng/mL). CSF total protein level higher than 35 mg/dL and patient age of at least 18 years were associated with higher gadolinium concentrations (estimate: 1.1, with standard error [SE] of 0.26 [P , .001] and 0.91, with SE of 0.37 [P = .02], respectively). Conclusion: Intravenous administration of the macrocyclic agent gadobutrol results in gadolinium accumulation within the CSF, even in the setting of normal renal function and no BBB dysfunction.

Original languageEnglish (US)
Pages (from-to)416-423
Number of pages8
JournalRadiology
Volume288
Issue number2
DOIs
StatePublished - Aug 1 2018

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Gadolinium
Observational Studies
Cerebrospinal Fluid
Cohort Studies
Magnetic Resonance Imaging
Cerebrospinal Fluid Proteins
Spinal Puncture
Blood-Brain Barrier
Linear Models
Control Groups
gadobutrol
Intravenous Administration
Mass Spectrometry
Biomarkers
Confidence Intervals
Kidney

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Accumulation of gadolinium in human cerebrospinal fluid after gadobutrol-enhanced MR imaging : A prospective observational cohort study. / Nehra, Avinash K.; McDonald, Robert; Bluhm, Amy M.; Gunderson, Tina M.; Murray, David L.; Jannetto, Paul J.; Kallmes, David F; Eckel, Laurence J.; McDonald, Jennifer S.

In: Radiology, Vol. 288, No. 2, 01.08.2018, p. 416-423.

Research output: Contribution to journalArticle

Nehra, Avinash K. ; McDonald, Robert ; Bluhm, Amy M. ; Gunderson, Tina M. ; Murray, David L. ; Jannetto, Paul J. ; Kallmes, David F ; Eckel, Laurence J. ; McDonald, Jennifer S. / Accumulation of gadolinium in human cerebrospinal fluid after gadobutrol-enhanced MR imaging : A prospective observational cohort study. In: Radiology. 2018 ; Vol. 288, No. 2. pp. 416-423.
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abstract = "Purpose: To determine whether gadolinium accumulates within cerebrospinal fluid (CSF) in patients recently exposed to the macrocyclic agent gadobutrol and identify factors that may affect this accumulation. Materials and Methods: In this prospective observational cohort study, gadolinium was quantified by using inductively coupled plasma mass spectrometry of CSF samples from patients who underwent gadobutrol-enhanced magnetic resonance (MR) imaging followed by lumbar puncture within 30 days (gadobutrol group) or patients who underwent lumbar puncture without history of gadolinium-enhanced MR imaging (control group). CSF total protein level of 35 mg/dL or lower was used as a surrogate marker of an intact blood-brain barrier (BBB). Associations between gadolinium CSF concentration and patient characteristics were examined by using log (e)–linear regression models. Results: A total of 82 patients (68 in gadobutrol group, 14 in control group; 42 male and 40 female patients; median age, 47 years [interquartile range, 25–65 years]) were included in this study. Gadolinium was detected in the CSF of all 68 patients in the gadobutrol group (100{\%} [95{\%} confidence interval: 94.7, 100]; range, 0.2–1494 ng/mL). CSF total protein level higher than 35 mg/dL and patient age of at least 18 years were associated with higher gadolinium concentrations (estimate: 1.1, with standard error [SE] of 0.26 [P , .001] and 0.91, with SE of 0.37 [P = .02], respectively). Conclusion: Intravenous administration of the macrocyclic agent gadobutrol results in gadolinium accumulation within the CSF, even in the setting of normal renal function and no BBB dysfunction.",
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T1 - Accumulation of gadolinium in human cerebrospinal fluid after gadobutrol-enhanced MR imaging

T2 - A prospective observational cohort study

AU - Nehra, Avinash K.

AU - McDonald, Robert

AU - Bluhm, Amy M.

AU - Gunderson, Tina M.

AU - Murray, David L.

AU - Jannetto, Paul J.

AU - Kallmes, David F

AU - Eckel, Laurence J.

AU - McDonald, Jennifer S

PY - 2018/8/1

Y1 - 2018/8/1

N2 - Purpose: To determine whether gadolinium accumulates within cerebrospinal fluid (CSF) in patients recently exposed to the macrocyclic agent gadobutrol and identify factors that may affect this accumulation. Materials and Methods: In this prospective observational cohort study, gadolinium was quantified by using inductively coupled plasma mass spectrometry of CSF samples from patients who underwent gadobutrol-enhanced magnetic resonance (MR) imaging followed by lumbar puncture within 30 days (gadobutrol group) or patients who underwent lumbar puncture without history of gadolinium-enhanced MR imaging (control group). CSF total protein level of 35 mg/dL or lower was used as a surrogate marker of an intact blood-brain barrier (BBB). Associations between gadolinium CSF concentration and patient characteristics were examined by using log (e)–linear regression models. Results: A total of 82 patients (68 in gadobutrol group, 14 in control group; 42 male and 40 female patients; median age, 47 years [interquartile range, 25–65 years]) were included in this study. Gadolinium was detected in the CSF of all 68 patients in the gadobutrol group (100% [95% confidence interval: 94.7, 100]; range, 0.2–1494 ng/mL). CSF total protein level higher than 35 mg/dL and patient age of at least 18 years were associated with higher gadolinium concentrations (estimate: 1.1, with standard error [SE] of 0.26 [P , .001] and 0.91, with SE of 0.37 [P = .02], respectively). Conclusion: Intravenous administration of the macrocyclic agent gadobutrol results in gadolinium accumulation within the CSF, even in the setting of normal renal function and no BBB dysfunction.

AB - Purpose: To determine whether gadolinium accumulates within cerebrospinal fluid (CSF) in patients recently exposed to the macrocyclic agent gadobutrol and identify factors that may affect this accumulation. Materials and Methods: In this prospective observational cohort study, gadolinium was quantified by using inductively coupled plasma mass spectrometry of CSF samples from patients who underwent gadobutrol-enhanced magnetic resonance (MR) imaging followed by lumbar puncture within 30 days (gadobutrol group) or patients who underwent lumbar puncture without history of gadolinium-enhanced MR imaging (control group). CSF total protein level of 35 mg/dL or lower was used as a surrogate marker of an intact blood-brain barrier (BBB). Associations between gadolinium CSF concentration and patient characteristics were examined by using log (e)–linear regression models. Results: A total of 82 patients (68 in gadobutrol group, 14 in control group; 42 male and 40 female patients; median age, 47 years [interquartile range, 25–65 years]) were included in this study. Gadolinium was detected in the CSF of all 68 patients in the gadobutrol group (100% [95% confidence interval: 94.7, 100]; range, 0.2–1494 ng/mL). CSF total protein level higher than 35 mg/dL and patient age of at least 18 years were associated with higher gadolinium concentrations (estimate: 1.1, with standard error [SE] of 0.26 [P , .001] and 0.91, with SE of 0.37 [P = .02], respectively). Conclusion: Intravenous administration of the macrocyclic agent gadobutrol results in gadolinium accumulation within the CSF, even in the setting of normal renal function and no BBB dysfunction.

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