Gadolinium Enhancement of Cerebrospinal Fluid on Flair Sequence in A Patient With Chronic Renal Failure
Journal Title: Journal of Neurological Sciences-Turkish - Year 2006, Vol 23, Issue 3
Abstract
On Fluid-attenuated inversion recovery (FLAIR) sequence, the cerebrospinal fluid signal is nulled, allowing better analysis of adjacent tissue. In some pathologies such as subarachnoid haemorrhage, menengitis, and sagittal sinus thrombosis the FLAIR sequence has demonstrated CSF signal changes. But it should be remembered that persistence of gadolinium in CSF may cause diagnostic pitfall in patients with chronic reanl failure (CRF). A 73 year old female patient with CRF, who were receiving dialysis treatment underwent magnetic resonance imaging (MRI) for evaluation of an altered mental state. Initial axial FLAIR sequences, obtained before and after IV gadolinium administration, showed nonspecific T2-hyperintense white matter foci with a normal appearing subarachnoid space. A follow-up FLAIR scan without gadolinium, obtained 3 days later, showed diffuse CSF hyperintensity. The patient had not been on dialysis during the time between the first and follow-up imaging sessions: blood urea nitrogen and creatinine values were 56 mg/dl and 5.8 mg/dl, respectively. Findings from lumbar puncture did not reveal evidence of xanthochromia, haemorrhage, elevated protein, or infection. Follow-up MRI that was obtained 1.5 month later, revealed a normal subarachnoid space. Absent renal function allows the gadolinium to accumulate in CSF and equilibrate over a prolonged period with the extracellular fluid volume. It is unkown what contributions are made by blood-brain-barrier disturbances or other mechanisms of accumulation. This understanding may prevent diagnostic errors or unnecessary additional diagnostic examinations in these patients. In this article a dialysis-dependent CRF patient with persistence of gadolinium in the subaracnoid space on MRI is presented.
Authors and Affiliations
Aynur YILMAZ, Oktay AKALIN, Hüseyin ÇELİK, Ufuk CAN, Hatice LAKADAMYALI
Keywords
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