Journal
JOURNAL OF NEUROIMAGING
Volume 25, Issue 1, Pages 136-139Publisher
WILEY-BLACKWELL
DOI: 10.1111/jon.12067
Keywords
Intrathecal gadolinium; susceptibility weighted imaging; subarachnoid hemorrhage; gadolinium encephalopathy
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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.
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