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Park, Heo, Jeong, Baek, Choo, and Jung: Retention of Gadolinium in Cerebrospinal Fluid and Decreased Renal Function: A Case Report
Case Report

J Korean Soc Radiol 2017;77(5):348-351.

Published online: 19 January 2017

DOI: https://doi.org/10.3348/jksr.2017.77.5.348

Retention of Gadolinium in Cerebrospinal Fluid and Decreased Renal Function: A Case Report

Kyeong Sik Park, Young Jin Heo, MD*, , Hae Woong Jeong, MD, Jin Wook Baek, MD, Hye Jung Choo, MD, Cheon Sik Jung

Department of Radiology, Busan Paik Hospital, Inje University, Busan, Korea

*Corresponding author: Young Jin Heo, MD Department of Radiology, Busan Paik Hospital, Inje University, 75 Bokji-ro, Busanjin-gu, Busan 47392, Korea. Tel. 82-51-890-6549 Fax. 82-51-896-1085 E-mail: youngjin726@hanmail.net

Received 31 May 201721 June 2017       Accepted 15 July 2017

Copyright © 2017 The Korean Society of Radiology

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A gadolinium-based contrast is the preferred agent when differentiating acute neu-rological diseases. Since the renal route is the main pathway for excretion of gadolini-um chelates, prolonged extracellular distribution of gadolinium has previously been reported in dialysis-dependent patients. Hence, gadolinium-based contrast agents are used cautiously in patients with known renal disease. Retention of gadolinium manifests as increased fluid-attenuated inversion recovery (FLAIR) signal intensity in the subarachnoid space, leading to diagnostic errors. Here, we describe a patient who presented to our emergency room with an acute cerebral infarction. Enhanced brain magnetic resonance imaging performed 2 days later revealed high signal inten-sity in the cerebrospinal fluid spaces on follow-up FLAIR images.

Keywords: Gadolinium, Subarachnoid Space, Cerebrospinal Fluid, Renal Insufficiency

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Fig. 1.
An 81-year-old woman with acute cerebral infarction. A. A diffusion-weighted image shows lesions with diffusion restriction in the left basal ganglia. B. Perfusion–weighted magnetic resonance imaging shows increased time to peak in left middle cerebral artery territory, suggesting acute infarction with perfusion-diffusion mismatch. C. Fluid-attenuated inversion recovery image shows multifocal hyperintense lesions in the left basal ganglia and insular cortex, but normal signal intensity in the cerebrospinal fluid spaces. D, E. Two-day follow-up axial fluid-attenuated inversion recovery images (D, E) show high signal intensity in the bilateral eye globes, subarach-noid spaces, and ventricular system.
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