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

Abstract

Purpose To determine whether repeated exposure of the pediatric brain to a linear gadolinium-based contrast agent (GBCA) is associated with an increase in signal intensity (SI) relative to that in GBCA-naive control subjects at unenhanced T1-weighted magnetic resonance (MR) imaging. Materials and Methods This single-center, retrospective study was approved by the institutional review board and compliant with HIPAA. The authors evaluated 46 pediatric patients who had undergone at least three GBCA-enhanced MR examinations (30 patients for two-group analysis and 16 for pre- and post-GBCA exposure comparisons) and 57 age-matched GBCA-naive control subjects. The SI in the globus pallidus, thalamus, dentate nucleus, and pons was measured at unenhanced T1-weighted MR imaging. Globus pallidus-thalamus and dentate nucleus-pons SI ratios were calculated and compared between groups and relative to total cumulative gadolinium dose, age, sex, and number of and mean time between GBCA-enhanced examinations. Analysis included the Wilcoxon signed rank test, Wilcoxon rank sum test, and Spearman correlation coefficient. Results Patients who underwent multiple GBCA-enhanced examinations had increased SI ratios within the dentate nucleus (mean SI ratio ± standard error of the mean for two-group comparison: 1.007 ± 0.0058 for GBCA-naive group and 1.046 ± 0.0060 for GBCA-exposed group [P < .001]; mean SI ratio for pre- and post-GBCA comparison: 0.995 ± 0.0062 for pre-GBCA group and 1.035 ± 0.0063 for post-GBCA group [P < .001]) but not the globus pallidus (mean SI ratio for two-group comparison: 1.131 ± 0.0070 for GBCA-naive group and 1.014 ± 0.0091 for GBCA-exposed group [P = .21]; mean SI ratio for pre- and post-GBCA comparison: 1.068 ± 0.0094 for pre-GBCA group and 1.093 ± 0.0134 for post-GBCA group [P = .12]). There was a significant correlation between dentate nucleus SI and total cumulative gadolinium dose (r = 0.4; 95% confidence interval [CI]: 0.03, 0.67; P = .03), but not between dentate nucleus SI and patient age (r = 0.23; 95% CI: -0.15, 0.56; P = .22), sex (mean SI ratio: 1.046 ± 0.0072 for boys and 1.045 ± 0.0110 for girls; P = .88), number of contrast-enhanced examinations (r = 0.13; 95% CI: -0.25, 0.48; P = .49), or time between contrast-enhanced examinations (r = -0.06; 95% CI: -0.42, 0.32; P = .75). Conclusion SI in the pediatric brain increases on unenhanced T1-weighted MR images with repeated exposure to a linear GBCA. RSNA, 2016.

The first joint ESGAR/ ESPR consensus statement on the technical performance of cross-sectional small bowel and colonic imaging

“…Examples include the role of DWI and motility imaging as part of MRI protocols, and more detailed guidance on i.v. gadolinium contrast administration given the generally young age of the imaged patient population, frequent repeat imaging and increasing evidence of possible neuronal retention of gadolinium for some contrast agent classes [95]. The clinical utility of micro-bubble contrast agents in small bowel US requires further clarity together with the impact of further advances in dose reduction techniques during CT examinations.…”

Pediatric Cancer Predisposition Imaging: Focus on Whole-Body MRI

“…The effects of the deposition are unknown. Newer contrast agents based on macrocyclic chelators are considered safer, owing to chemical structures that encase the gadolinium and provide a more stable chelate, thus reducing the free dissociation of gadolinium and limiting its potential for reacting with and depositing in adjacent tissues (13)(14)(15).…”

“…This includes discussion of WBMRI technical parameters for basic and more syndromespecific scan acquisitions, guidelines for image interpretation and reporting, and an overview of risks, in particular sedation issues in the very young and intravenous gadolinium-based contrast agent (GBCA) retention in pediatrics (13)(14)(15)(16).…”

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

“…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).…”