Brain tissue gadolinium retention in pediatric patients after contrast-enhanced magnetic resonance exams: pathological confirmation

@article{Stanescu2020BrainTG,
  title={Brain tissue gadolinium retention in pediatric patients after contrast-enhanced magnetic resonance exams: pathological confirmation},
  author={A. Luana Stanescu and Dennis W. W. Shaw and Nozomu Murata and Kiyoko Murata and Joe C Rutledge and Ezekiel Maloney and Kenneth R. Maravilla},
  journal={Pediatric Radiology},
  year={2020},
  volume={50},
  pages={388-396}
}
Background Retained gadolinium from gadolinium-based contrast agents (GBCAs) used in MR exams has been inferred based on signal changes on serial brain MRI and subsequently demonstrated pathologically in adults. Retention has been similarly inferred in children but pathological demonstration in pediatric patients is limited. The long-term effects of retained gadolinium are unknown but are potentially of greater concern in children given their increased vulnerability from continuing development… 

Gadolinium retention — 5 years later…

It has been 5 years since the parenchymal retention of gadolinium used for contrast-enhanced MRI was first suggested to occur in the central nervous system and in this period of uncertainty, the most practical approach is to treat GBCAs like ionizing radiation.

Gadolinium retention: should pediatric radiologists be concerned, and how to frame conversations with families

With the belief that GBCAs should not be withheld for appropriate indications in the absence of evidence of its potential risks, a framework for determining when GBCA use is appropriate and suggestions for discussing its risks and benefits with children and their families are offered.

Non-inferiority of a non-gadolinium-enhanced magnetic resonance imaging follow-up protocol for isolated optic pathway gliomas

Investigation of whether GBCM is necessary for OPG MR imaging response assessment using a blinded, non-inferiority, multi-reader study found an overall 1.2% difference for intra-reader agreement using a non-GBCM-enhanced protocol and background variability.

Gadolinium Brain Deposition in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in oncologic pediatric patients

This study showed an increased SI in GP after several intravenous administrations of macrocyclic GBCAs but no increased SI was identified in the DN.

Safety and diagnostic efficacy of gadoteridol for magnetic resonance imaging of the brain and spine in children 2 years of age and younger

Gadoteridol at 0.1 mmol/kg body weight is safe, well tolerated and effective for contrast-enhanced MRI of the CNS in children ≤2 years of age.

Toxicity associated with gadolinium-based contrast-enhanced examinations

The analysis emphasizes that the vast majority of the clinical studies conducted up to date on gadolinium-based contrast agents were designed to assess acute toxicity and diagnostic efficacy of the agents, not to identify long-term health effects.

Safety issues related to intravenous contrast agent use in magnetic resonance imaging

The purpose of this review is to discuss the safety of GBCAs used in MRI in adult and pediatric populations, with particular attention on acute adverse reactions, nephrogenic systemic fibrosis and gadolinium deposition.

Benefits of diffusion-weighted imaging in pediatric acute osteoarticular infections

An unenhanced protocol with DWI may be an alternative to a contrast-based protocol, even in the presence of an abscess, however, gadolinium remains necessary to assess for chondroepiphyseal involvement of the femoral head.

Magnetic resonance imaging diagnosis of subependymal giant cell astrocytomas in follow-up of children with tuberous sclerosis complex: should we always use contrast enhancement?

The performances of non-enhanced and enhanced MRI sequences are comparable for detecting SEGAs, questioning the need for systematic GBCA injections for TSC patients.

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