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

  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},
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.



Gadolinium Brain Deposition after Macrocyclic Gadolinium Administration: A Pediatric Case-Control Study.

Multiple intravenous administrations of these macrocyclic GBCAs in children were not associated with a measurable increase in SI in T1 sequences as an indicator of brain gadolinium deposition detectable by using MR imaging.

Gadolinium Deposition in Human Brain Tissues after Contrast-enhanced MR Imaging in Adult Patients without Intracranial Abnormalities.

Gadolinium deposition in neural tissues after GBCA administration occurs in the absence of intracranial abnormalities that might affect the permeability of the blood-brain barrier, and these findings challenge current understanding of the biodistribution of these contrast agents and their safety.

Intracranial Gadolinium Deposition Following Gadodiamide-Enhanced Magnetic Resonance Imaging in Pediatric Patients: A Case-Control Study

The purpose of this study was to determine the extent of deposition in the GBCA-exposed population and whether prior observations were related to age-dependent breakdown of the blood-brain barrier through study of a cohort of pediatric patients who received gadodiamide-enhanced MRI examinations.

Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging.

Intravenous GBCA exposure is associated with neuronal tissue deposition in the setting of relatively normal renal function and the generalizability to other GBCAs is investigated.

Pediatric Brain: Repeated Exposure to Linear Gadolinium-based Contrast Material Is Associated with Increased Signal Intensity at Unenhanced T1-weighted MR Imaging.

SI in the pediatric brain increases on unenhanced T1-weighted MR images with repeated exposure to a linear GBCA with a significant correlation between dentate nucleus SI and total cumulative gadolinium dose.

Pediatric Brain: No Increased Signal Intensity in the Dentate Nucleus on Unenhanced T1-weighted MR Images after Consecutive Exposure to a Macrocyclic Gadolinium-based Contrast Agent.

No increase of the SI in the DN was found after a mean of 8.6 serial injections of the macrocyclic GBCA gadoterate meglumine in pediatric patients, confirming previous studies that did not find this effect afterserial injections of macrocyclIC GBCAs in adults.

Use of gadolinium-based magnetic resonance imaging contrast agents and awareness of brain gadolinium deposition among pediatric providers in North America

Since the discovery of brain gadolinium deposition, many pediatric hospitals have switched to or plan to switch to a more stable macrocyclic MR contrast agent, most commonly gadoterate meglumine.

Pediatric Patients Demonstrate Progressive T1-Weighted Hyperintensity in the Dentate Nucleus following Multiple Doses of Gadolinium-Based Contrast Agent

In pediatric patients, the number of prior gadolinium-based contrast agent doses is significantly correlated with progressive T1-weighted dentate hyperintensity, and taking a cautious stance is suggested, including the use of higher stability, macrocyclic agents, which in both human and animal studies have been shown to be associated with lower levels of gadolinia deposition.

MRI Brain Signal Intensity Changes of a Child During the Course of 35 Gadolinium Contrast Examinations

The pattern of regional brain hyperintensity observed in this pediatric patient is consistent with findings from adult studies, and progressive increases were the most evident in the dentate nuclei, the globus pallidus, and the thalamus.