Is MRI imaging in pediatric age totally safe? A critical reprisal

Abstract

Current radiological literature is strongly focussed on radiation imaging risks. Indeed, given there is a small but actual augment in cancer risk from exposure to ionizing radiation in children, it is important to understand what the risk of alternative techniques could be. We retrospectively review literature data concerning possible MR imaging risks, focussing on the biological effects of MR, sedation and gadolinium compound risks when dealing with infant patients. The main concerns can be summarized in: (1) Biological effects of non-ionizing electromagnetic fields (EMF) employed-whose mechanisms of interaction with human tissues are polarization, induced current, and thermal heating, respectively. (2) Risks associated with noises produced during MRI examinations. (3) Hazards from ferromagnetic external and/or implanted devices-whose risk of being unintentionally brought inside MR room is higher in children than in adults. (4) Risks associated with sedation or general anaesthesia, essential problem in performing MR in very young patients, due to the exam long-lasting. (5) Risks related to gadolinium-based contrast agents, especially considering the newly reported brain deposition.

Surveillance imaging in pediatric ependymoma

“…While MRI has the advantages of being the better imaging modality for brain tumors and involves no ionizing radiation exposure, recent studies have shown that gadolinium contrast deposits in various parts of brain. The significance of this has not been determined, but it has the potential to result in long‐term neurotoxicity 15,16 …”

Questioning the Value of Brain Magnetic Resonance Imaging in the Evaluation of Children with Isolated Growth Hormone Deficiency

“…With the relatively high incidence of the diagnosis of IGHD, the cost would represent a substantial health expenditure when multiplied across centers and across healthcare systems. Additional concerns regarding preforming nonessential MRI studies are related to the use of gadolinium contrast in pituitary-dedicated protocols and the need for sedation in younger children [17].…”

“…An MRI scan is costly and requires general anesthesia in young children. In addition, the use of gadolinium-based contrast in pituitary-dedicated protocols also raises some concern [17], although a recent study showed that gadolinium-based contrast may be avoided [18] and thus spare the potential adverse effects of gadolinium. Data on the contribution of brain MRI in the evaluation of children with IGHD are sparse and inconclusive.…”

Detection of recurrent brain tumors in children: No significant difference in sensitivity between unenhanced and contrast-enhanced MRI

“…17 Moreover, there are two other consequences of injecting GBCA: the need for a venous access, which is sometimes difficult in pediatric practice, and the need for longer examination time, with the difficulty of immobilization and sometimes the necessity for sedation. 18 The aim of the study was to evaluate the brain tumor recurrence detection sensitivity of unenhanced brain MRI (U-MRI) by different observers.…”

“…Moreover, there are two other consequences of injecting GBCA: the need for a venous access, which is sometimes difficult in pediatric practice, and the need for longer examination time, with the difficulty of immobilization and sometimes the necessity for sedation. 18…”