Gadolinium-based contrast agents in children

Rozenfeld, Michael N.; Podberesky, Daniel J.

doi:10.1007/s00247-018-4165-1

Cited by 47 publications

(29 citation statements)

References 73 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We were also unable to obtain MRI data on perfusion in live human individuals, as there are risks associated with contrast administration in children, the most well-described being nephrotoxicity. 30 - 32 Another study limitation was that we did not map out the individual vascular pattern in each specimen, but rather analyzed overall perfusion within the designated ROI groups. Further research using higher resolution MRI or micro-computed tomography could help define the precise vascular pattern supplying the immature patella, making comparisons with adult patellar vascularity even stronger.…”

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of the vascularity of the skeletally immature patella: A cadaveric study using MRI

Gadinsky

Lin

Klinger

et al. 2021

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

Purpose While predominant blood supply to the adult patella enters inferomedially, little is known about skeletally immature patellar perfusion. Improved knowledge of immature patella vascularity can further understanding of osteochondritis dissecans, dorsal defects of the patella and bipartite patella, and help ensure safe surgical approaches. We hypothesized that the immature patella would exhibit more uniform blood flow. The study purpose was to quantify immature patella regional perfusion in comparison with adults. Methods Ten cadaveric knees were utilized (five immature, five mature). The superficial femoral artery was cannulated proximally. Signal enhancement increases were compared from pre- to post-contrast MRI to assess relative arterial contributions to patella regions (quadrants, anterior/posterior, superior/inferior, medial/lateral, and outer/inner). Results Quantitative-MRI analysis revealed similar distribution of enhancement between the immature and mature patella. The inferior pole exhibited significantly higher arterial contribution versus superior pole in both immature and mature groups (p = 0.009; both groups), while the inferomedial quadrant had the highest arterial contribution of all quadrants in both groups. The superolateral quadrant demonstrated the lowest arterial contribution in the immature group and second lowest in the adult group. The patella outer periphery had significantly greater arterial contribution than the inner central region in both immature (p = 0.009) and mature (p = 0.009) groups. Conclusion Distribution of arterial contributions between the immature and mature patella was similar. Our results highlight the importance of inferior and inferomedial blood supply in both immature and mature patellas. These findings have implications for paediatric and adult patients; surgical damage to inferior patellar vessels should be avoided to prevent associated complications.

show abstract

Section: Discussionmentioning

confidence: 99%

Quantitative assessment of the vascularity of the skeletally immature patella: A cadaveric study using MRI

Gadinsky

Lin

Klinger

et al. 2021

Journal of Children's Orthopaedics

View full text Add to dashboard Cite

show abstract

“…An advantage of DWI is that it does not require intravenous contrast, suggesting that surveillance MRE to detect subclinical disease recurrence may be performed without gadolinium. While the known potential adverse effects of gadolinium agent exposure and gadolinium tissue deposition are the topic of active investigation, the use of these agents in pediatric patients who will potentially undergo repeated MRI exams over their lifetimes should be carefully considered . It is worth mentioning that three out of the four individual imaging features shown to be significant predictors of clinical recurrence in our study can be assessed without intravenous gadolinium.…”

Section: Discussionmentioning

confidence: 99%

Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn's Disease

Chu

Moran

et al. 2019

Magnetic Resonance Imaging

View full text Add to dashboard Cite

Background MR enterography (MRE) is the primary modality for evaluating small bowel disease in pediatric Crohn's patients. Standard clinical practice includes imaging patients at diagnosis and during symptomatic recurrence. The role for MRE in surveillance of asymptomatic Crohn's patients has not yet been established. Purpose To determine whether MRE imaging features are associated with clinical recurrence. Study Type Retrospective. Populations Pediatric Crohn's patients who underwent MRE while asymptomatic, defined by pediatric gastroenterologists using a physician global assessment; 35 MREs were identified. Field Strength/Sequence 1.5T including T2‐weighted single‐shot fast spin echo, balanced steady‐state free precession, diffusion‐weighted, and contrast‐enhanced multiphase T1‐weighted gradient recalled echo sequences. Assessment MREs were reviewed by three radiologists independently for mural thickening, T2‐weighted hyperintensity, diffusion restriction, hyperenhancement, vasa recta engorgement, and overall assessment of disease activity. Two pediatric gastroenterologists reviewed patient medical records for 6 months following MRE to evaluate for recurrence, defined as Crohn's‐related treatment escalation, surgery, or hospitalization. Statistical Tests Fisher's exact test, Wald chi‐square test, and model selection by Akaike information criterion minimization were used to assess statistical significance of MRE imaging features. Results Of 35 MREs identified, seven cases demonstrated clinical recurrence at 6 months (20%); 28 cases remained in remission (80%). Imaging features of active disease were present in 86% of patients with recurrence compared to 29% of patients in remission (P = 0.01). Wall thickening, T2‐weighted hyperintensity, hyperenhancement, and diffusion restriction were significantly associated with recurrence. Multivariate regression analysis determined diffusion restriction to be the best predictor of recurrence within 6 months (P = 0.001, area under the curve 0.786). Data Conclusion MRE performed on young asymptomatic Crohn's patients can identify patients who have a high probability of developing clinical recurrence in a 6‐month period, indicating a potential role for surveillance imaging to assess for subclinical active disease. Level of Evidence: 3 Technical Efficacy Stage 5 J. Magn. Reson. Imaging 2019;50:1955–1963.

show abstract

“…However, both procedures require the use of an extracellular contrast agent with low risk of complications such as extravasation, allergic reaction, or even extremely rare, nephrogenic systemic fibrosis [10]. Furthermore, the uncertainty regarding long-term effects of possible gadolinium retention in the brain after repetitive contrast-enhanced magnetic resonance imaging led to revised recommendations [11][12][13]. Also, mistiming of the contrast bolus can result in poor image quality.…”

Section: Introductionmentioning

confidence: 99%

Free-breathing non-contrast flow-independent cardiovascular magnetic resonance angiography using cardiac gated, magnetization-prepared 3D Dixon method: assessment of thoracic vasculature in congenital heart disease

Isaak

Luetkens

Faron

et al. 2021

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

Background To evaluate a non-contrast respiratory- and electrocardiogram-gated 3D cardiovascular magnetic resonance angiography (CMRA) based on magnetization-prepared Dixon method (relaxation-enhanced angiography without contrast and triggering, REACT) for the assessment of the thoracic vasculature in congenital heart disease (CHD) patients. Methods 70 patients with CHD (mean 28 years, range: 10–65 years) were retrospectively identified in this single-center study. REACT-CMRA was applied with respiratory- and cardiac-gating. Image quality (IQ) of REACT-CMRA was compared to standard non-gated multi-phase first-pass-CMRA and respiratory- and electrocardiogram-gated steady-state-CMRA. IQ of different vessels of interest (ascending aorta, left pulmonary artery, left superior pulmonary vein, right coronary ostium, coronary sinus) was independently assessed by two readers on a five-point Likert scale. Measurements of vessel diameters were performed in predefined anatomic landmarks (ascending aorta, left pulmonary artery, left superior pulmonary vein). Both readers assessed artifacts and vascular abnormalities. Friedman test, chi-squared test, and Bland-Altman method were used for statistical analysis. Results Overall IQ score of REACT-CMRA was higher compared to first-pass-CMRA (3.5 ± 0.4 vs. 2.7 ± 0.4, P < 0.001) and did not differ from steady-state-CMRA (3.5 ± 0.4 vs. 3.5 ± 0.6, P = 0.99). Non-diagnostic IQ of the defined vessels of interest was observed less frequently on REACT-CMRA (1.7 %) compared to steady-state- (4.3 %, P = 0.046) or first-pass-CMRA (20.9 %, P < 0.001). Close agreements in vessel diameter measurements were observed between REACT-CMRA and steady-state-CMRA (e.g. ascending aorta, bias: 0.38 ± 1.0 mm, 95 % limits of agreement (LOA): − 1.62–2.38 mm). REACT-CMRA showed high intra- (bias: 0.04 ± 1.0 mm, 95 % LOA: − 1.9–2.0 mm) and interobserver (bias: 0.20 ± 1.1 mm, 95 % LOA: − 2.0–2.4 mm) agreements regarding vessel diameter measurements. Fat-water separation artifacts were observed in 11/70 (16 %) patients on REACT-CMRA but did not limit diagnostic utility. Six vascular abnormalities were detected on REACT-CMRA that were not seen on standard contrast-enhanced CMRA. Conclusions Non-contrast-enhanced cardiac-gated REACT-CMRA offers a high diagnostic quality for assessment of the thoracic vasculature in CHD patients.

show abstract

Gadolinium-based contrast agents in children

Cited by 47 publications

References 73 publications

Quantitative assessment of the vascularity of the skeletally immature patella: A cadaveric study using MRI

Quantitative assessment of the vascularity of the skeletally immature patella: A cadaveric study using MRI

Performance of Surveillance MR Enterography (MRE) in Asymptomatic Children and Adolescents With Crohn's Disease

Free-breathing non-contrast flow-independent cardiovascular magnetic resonance angiography using cardiac gated, magnetization-prepared 3D Dixon method: assessment of thoracic vasculature in congenital heart disease

Contact Info

Product

Resources

About