Reply to Letter to the Editor re: Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance images in patients with relapsing-remitting multiple sclerosis: Correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol

Excerpt

We appreciate the interest and constructive comments expressed by Balzer et al. in their Letter to the Editor regarding our study “Increasing signal intensity within the dentate nucleus and globus pallidus on unenhanced T1W magnetic resonance (MR) images in patients with relapsing-remitting multiple sclerosis (RRMS): Correlation with cumulative dose of a macrocyclic gadolinium-based contrast agent, gadobutrol” [1], as well as the opportunity to respond to their concerns. As they correctly point out, our study was the first to provide evidence of a correlation between the use of a macrocyclic gadolinium-based contrast agent (GBCAs), gadobutrol and increased T1W magnetic resonance signal intensity (SI) in these regions in RRMS patients. While the experiments we described did not yield definitive evidence that use of macrocyclic GBCAs alone is responsible for the observed increases in SI, our study and others that have been published subsequently highlight the importance of further exploration of this phenomenon. …