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DOI:10.2214/AJR.06.5040
AJR 2006; 187:W446
© American Roentgen Ray Society

Contrast Agent for Intrathecal Gadolinium Administration

Sait Albayram, Aysegul Gunduz and Harun Özer

Istanbul University Cerrahpasa Medical Faculty Istanbul, Turkey



 
WEB—This is a Web exclusive article.

We read with interest the article, "Intrathecal Gadolinium-Enhanced MR Myelography Showing Multiple Dural Leakages in a Patient with Marfan Syndrome," by Kraemer et al. [1], in the July 2005 issue of AJR.

To our knowledge, this article is the first report of intrathecal gadolinium-enhanced MR cisternography performed to show dural tears in a spontaneous intracranial hypotension case. We think that intrathecal gadolinium-enhanced MR myelography will be the diagnostic technique of choice in the future for spontaneous intracranial hypotension. However, we would like to criticize the use of gadobenate dimeglumine (Multihance, Bracco Diagnostics) by the authors for intrathecal gadolinium-enhanced MR cisternography.

Studies of safety and tolerance of intrathecal gadolinium administration in both animal and human models were performed by Jinkins et al. [2] using gadopentetate dimeglumine (Magnevist, Schering). Also, in subsequent reports of Tali et al. [3], Reiche et al. [4], and Aydin et al. [5] gadopentetate dimeglumine was used as the gadolinium-containing contrast medium. These studies have led to the integration of data over the use of gadopentetate dimeglumine. However, Kraemer et al. [1] used gadobenate dimeglumine for their case, although the use of that contrast agent has been reported only in a single clinical case and a single animal model in the literature [6].

Although this technique made a major contribution to the diagnosis of CSF leakage in the patient in the case of Kraemer et al. [1], we do not agree with the use of gadobenate dimeglumine instead of gadopentetate dimeglumine, which is well studied for intrathecal administration.


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  1. Kraemer N, Berlis A, Schumacher M. Intrathecal gadolinium-enhanced MR myelography showing multiple dural leakages in a patient with Marfan syndrome. AJR 2005;185 : 92-94[Free Full Text]
  2. Jinkins JR, Rudwan M, Krumina G, Tali ET. Intrathecal gadolinium-enhanced MR cisternography in the evaluation of clinically suspected cerebrospinal fluid rhinorrhea in humans: early experience. Radiology 2002;222 : 555-559[Abstract/Free Full Text]
  3. Tali ET, Ercan N, Krumina G, et al. Intrathecal gadolinium (gadopentetate dimeglumine) enhanced magnetic resonance myelography and cisternography: results of a multicenter study. Invest Radiol 2002; 37:152 -159[CrossRef][Medline]
  4. Reiche W, Komenda Y, Schick B, Grunwald I, Steudel WI, Reith W. MR cisternography after intrathecal Gd-DTPA application. Eur Radiol 2002; 12:2943 -2949[Medline]
  5. Aydin K, Guven K, Sencer S, Jinkins JR, Minareci O. MRI cisternography with gadolinium-containing contrast medium: its role, advantages and limitations in the investigation of rhinorrhoea. Neuroradiology 2004;46 : 75-80[CrossRef][Medline]
  6. Kramer N, Berlis A, Klisch J, Kubalek R, Miosczka H, Schumacher M. Intrathecal gadolinium-enhanced MR-cisternography: depiction of the subarachnoidal space and evaluation of gadobenate-dimeglumine-(Gd-BOPTA, "Multihance") toxicity in an animal model and a clinical case. Acad Radiol 2002;9 [suppl 2]:S447 -S451

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This Article
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