Dejan Samardzic1, Krishnamoorthy Thamburaj. 1. Department of Radiology, Penn State Milton S Hershey Medical Center, Penn State College of Medicine, Hershey, PA, 17033.
Abstract
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.
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 gadoliniumencephalopathy 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.
Authors: J Kikuta; K Kamagata; K Takabayashi; T Taoka; H Yokota; C Andica; A Wada; Y Someya; Y Tamura; R Kawamori; H Watada; S Naganawa; S Aoki Journal: AJNR Am J Neuroradiol Date: 2021-11-18 Impact factor: 3.825