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Master Thesis

Facteurs associés au passage de chélates de gadolinium dans le corps vitré chez des patients avec et sans accident vasculaire cérébral ischémique

Abstract : Background. Gadolinium leakage in ocular structures (GLOS) was recently observed in control fluid-attenuated inversion recovery (FLAIR) images performed the day after an initial gadolinium injection in stroke patients. The specificity of GLOS to stroke and its mechanisms remain unclear. Purpose. We investigated the factors associated with GLOS in a cohort of patients presenting with acute neurological deficits. Materiel and Methods. This retrospective study included consecutive patients admitted to our stroke unit for acute neurological deficit between July 2017 and August 2018 who underwent a baseline brain MRI with injection of gadolinium and a second scan within the following 72h. The patients were separated into a stroke- and stroke-mimic-group based on diffusion-weighted images. GLOS was defined as a bright signal within the vitreous in follow-up FLAIR compared to baseline FLAIR (pre-gadolinium). Clinical data were collected together with imaging features from the baseline scans that included the volume of the infarct and of hypoperfusion, as well as white matter hyperintensities, the number of lacunes and of microbleeds, which were combined to yield a small vessel disease (SVD) score. Univariable and multivariable regression models were used to test the association between GLOS and collected data. Results. Among the 467 included patients, GLOS was observed in 32.2% (136/422) of the patients in the stroke-group and 28.9% (13/45) in the stroke-mimic-group. In the 2 populations, GLOS was associated with older age, increased prevalence of risk factors, and imaging features of cerebral SVD, as well as with renal function and gadolinium dose. Multivariable analyses showed that age (p<0.001), diabetes (p=0.018), severe renal failure (p=0.007), and dose of gadolinium (p=0.001) were independent contributors to GLOS. Conclusion. GLOS, which occurs more commonly at higher concentrations of gadolinium, is nonspecific to stroke and may represent increased permeability of the blood–retinal barrier associated with age- and vascular risk-factor-related SVD.
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Submitted on : Thursday, October 22, 2020 - 10:47:06 AM
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Chloé Galmiche. Facteurs associés au passage de chélates de gadolinium dans le corps vitré chez des patients avec et sans accident vasculaire cérébral ischémique. Sciences du Vivant [q-bio]. 2020. ⟨dumas-02974861⟩

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