Distribution of Gadolinium-based Contrast Agent after Leaking into the Cerebrospinal Fluid: Comparison between the Cerebral Cisterns and the Lateral Ventricles

PURPOSE: Leakage of a small amount of intravenously administered gadolinium-based contrast agents (GBCAs) into the cerebrospinal fluid (CSF) space has been reported, even in healthy subjects without blood–brain barrier disruption. Several candidates including the choroid plexus and cortical veins have been proposed as the source of the leakage. The purpose of this study was to evaluate the distribution of intravenously administered GBCA leakage into the CSF by comparing the contrast enhancement of the cerebral cisterns to the lateral ventricles (LVs). METHODS: In 26 patients with a suspicion of endolymphatic hydrops (21–80 years old), a three-dimensional real inversion recovery (3D-real IR) image was obtained at pre-, and at 5 min, and 4 h post-intravenous administration of a single dose of GBCA (IV-SD-GBCA). In the 3D-real IR image, the signal intensities (SIs) in the anterior horn of the LV (LV(ante)), the trigone of the LV (LV(tri)), the Sylvian fissure (SyF), the ambient cistern (Amb), the prepontine cistern (PPC), the cerebellopontine angle cistern (CPA), and the vitreous (Vit) were measured. The differences in the SI at pre-, and at 5 min and 4 h post-IV-SD-GBCA were evaluated for each region. The change in the SI pre- to post-IV-SD-GBCA (SI(change)) were calculated for each region. The differences in the SI(change) in each region were evaluated at 5 min and 4 h post-IV-SD-GBCA. A Steel-Dwass’s test was applied to correct for multiple comparisons. RESULTS: The SIs of all regions at 4 h post-IV-SD-GBCA were significantly higher compared with pre-IV-SD-GBCA (P < 0.05). The SI(change) in the SyF, Amb, PPC, and the CPA were significantly higher compared with those of the LV(ante), LV(tri), and the Vit at 4 h post-IV-SD-GBCA (P < 0.05). CONCLUSION: The contrast enhancement in the cerebral cisterns was greater than that in the LVs.