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Brain MRI and clinical exam findings in women with multiple gadolinium-based contrast agent (GBCA) exposures due to screening breast MRIs

  • Kelly S. Myers
    Correspondence
    Corresponding author.
    Affiliations
    Johns Hopkins School of Medicine, Department of Radiology, 601 N Caroline St, Baltimore, MD 21287, USA
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  • David M. Yousem
    Affiliations
    Johns Hopkins School of Medicine, Department of Radiology, 601 N Caroline St, Baltimore, MD 21287, USA
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  • Kelly A. Mills
    Affiliations
    Johns Hopkins School of Medicine, Department of Neurology, 1800 Orleans St, Sheikh Zayed Tower, Baltimore, MD 21287, USA
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  • Author Footnotes
    1 Present address: Suez Canal University, Ismailia, Egypt, and Ibn Sina Hospital, Medical Imaging Department, Kuwait.
    Khaled Gad
    Footnotes
    1 Present address: Suez Canal University, Ismailia, Egypt, and Ibn Sina Hospital, Medical Imaging Department, Kuwait.
    Affiliations
    Johns Hopkins School of Medicine, Department of Radiology, 601 N Caroline St, Baltimore, MD 21287, USA
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  • Author Footnotes
    2 Present address: Bay Imaging Consultants, 2125 Oak Grove Rd #200, Walnut Creek CA 94598.
    Sanaz Ghaderi Niri
    Footnotes
    2 Present address: Bay Imaging Consultants, 2125 Oak Grove Rd #200, Walnut Creek CA 94598.
    Affiliations
    Johns Hopkins School of Medicine, Department of Radiology, 601 N Caroline St, Baltimore, MD 21287, USA
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  • Nicholas Bienko
    Affiliations
    Johns Hopkins Bayview Medical Center, Department of Psychiatry, 5300 Alpha Commons Dr, 4th floor, Baltimore, MD 21224, USA
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  • Cynthia A. Munro
    Affiliations
    Johns Hopkins Bayview Medical Center, Department of Psychiatry, 5300 Alpha Commons Dr, 4th floor, Baltimore, MD 21224, USA
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  • Author Footnotes
    1 Present address: Suez Canal University, Ismailia, Egypt, and Ibn Sina Hospital, Medical Imaging Department, Kuwait.
    2 Present address: Bay Imaging Consultants, 2125 Oak Grove Rd #200, Walnut Creek CA 94598.
Published:September 29, 2022DOI:https://doi.org/10.1016/j.clinimag.2022.09.009

      Highlights

      • GBCA exposures and brain MRI signal changes showed no association in 9 healthy women with multiple GBCA exposures
      • In this study, there was no association between GBCA exposures and neurologic or neuropsychologic exam
      • Although this is reassuring for women undergoing annual breast cancer screening with MRI, larger studies are needed

      Abstract

      Objectives

      Multiple exposures to gadolinium-based contrast agents (GBCAs) is known to be associated with gadolinium deposition in the brain in certain patients. Such deposition has been correlated with specific brain MRI findings, although most available data is in patients with underlying neurologic disorders. We aim to prospectively evaluate brain MRI signal changes as well as neurologic and neuropsychologic testing results in women undergoing screening breast MRI.

      Methods

      In this IRB-approved, HIPAA-compliant prospective study, 9 women with 5 or more exposures to linear and/or macrocyclic GBCA due to screening breast MRI underwent noncontrast brain MRI, neurologic exam and neuropsychologic testing. Women with underlying neurologic, psychologic, hepatic or renal disorders were excluded.

      Results

      The mean total number of GBCA exposures was 8 (standard deviation 2.7), with 63/72 (87%) of the exposures being linear agents. There was no association between brain MRI signal changes and abnormalities on neurologic or neuropsychologic examination. There was no association between total number of GBCA exposures and abnormalities on neurologic or neuropsychologic examination.

      Conclusion

      In this prospective exploratory study of 9 women with 5 or more GBCA exposures due to screening breast MRI, there was no association between brain MRI signal changes and clinical abnormalities on neurologic or neuropsychologic examination. While larger studies are needed in this patient population, the lack of clinical impact of multiple GBCA exposures in this study is reassuring.

      Keywords

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