Comparison of Unenhanced T1-Weighted Signal Intensities Within the Dentate Nucleus and the Globus Pallidus After Serial Applications of Gadopentetate Dimeglumine Versus Gadobutrol in a Pediatric Population

Abstract

The T1-weighted SI increase within the DN and GP after serial administrations of the linear contrast medium gadopentetate dimeglumine, but not after serial applications of the macrocyclic agent gadobutrol, found in a pediatric population, is consistent with results published for adult patients. The clinical impact of the intracranial T1-hyperintensities is currently unclear. However, in accordance with the recent decision of the Pharmacovigilance and Risk Assessment Committee of the European Medicines Agency, intravenous macrocyclic agents should be preferred and MR contrast media should be used with caution and awareness of the pediatric brain development in children and adolescents.

Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case–Control Study

“…Our study also revealed a good correlation between the number gadoterate meglumine administrations and the T 1 W SI increase for the DN, pons, GP, and T as well. Many studies used pons or thalamus as a reference anatomical location for standardization and dentate nucleus‐to‐pons or thalamus, GP‐to‐pons or thalamus ratios were assessed and compared . However, in the current study the T 1 W SI of both the pons and thalamus were also found to be increased compared with those of the control group.…”

“…Bhargava et al reported that there was no increased SI in the GP or DN with the use of at least five doses of gadobutrol, a macrocyclic GBCA. In a comparison study, Renz et al found no T 1 W SI increase with a macrocyclic agent gadobutrol, whereas they also reported SI elevation in the DN with a linear agent, gadopentetate dimeglumine. Their study included pediatric patients with at least three injections of GBCAs.…”

The Effects of Gadolinium-Based Contrast Agents on the Cerebellum: from Basic Research to Neurological Practice and from Pregnancy to Adulthood

“…A previous single case report in a pediatric patient who received 4 administrations of a linear GBCA (gadopentetate and possibly gadodiamide) described similar observations [22]. Gadolinium deposition seems to be class-dependent, as no brain MRI modification is visible in subjects who received several doses of macrocyclic agents [18,[23][24][25]. Nevertheless, after an average of 10 macrocyclic GBCA administrations, a SI increase has been quantitatively measured in the dentate nucleus and globus pallidus of 50 children [26].…”

“…1 [15][16][17][18][19], showed a significant decrease in the time spent on the rotarod on day 3 in both GBCA-treated groups (gadoterate meglumine-treated group, p < 0.001 and gadodiamide-treated group, p < 0.001, by ANOVA followed by Bonferroni test) compared with that in the control group. ***p < 0.001…”

“…After (a) repeated reports of signal intensity (SI) increase in the dentate nuclei and basal ganglia on brain T1-weighted images of pediatric patients who underwent several contrastenhanced MRI scans with administration of linear products [16][17][18][19] and (b) a study with no SI after gadobenate administration [20], an autoptic study of three children has confirmed the deposition of gadolinium in the dentate nucleus, globus pallidus, and at a smaller concentration in the thalamus and pons, after more than 3 administrations of gadodiamide, a linear GBCA [21]. Pathological changes were also observed in the dentate nuclei (gliosis, axonal spheroids).…”