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Gadolinium Brain Deposition after Macrocyclic Gadolinium Administration: A Pediatric Case-Control Study
Daniel Tibussek1, Christin Rademacher1, Julian Caspers1
1From the Department of General Pediatrics, Neonatology and Pediatric Cardiology, University Children's Hospital, Heinrich-Heine University, Düsseldorf, Germany (D.T.); and Department of Diagnostic and Interventional Radiology, University Düsseldorf, Medical Faculty, Moorenstrasse 5, 40225 Düsseldorf, Germany (C.R., J.C., B.T., J.S., G.A., D.K.).
Repeated use of macrocyclic gadolinium-based contrast agents (GBCAs) in children did not show increased signal intensity on T1 sequences, indicating no measurable brain gadolinium deposition. Further studies are needed to confirm these findings.
Area of Science:
- Radiology
- Neuroimaging
- Pediatric Oncology
Background:
- Gadolinium deposition in the brain has been a concern with repeated use of gadolinium-based contrast agents (GBCAs).
- Macrocyclic GBCAs, such as gadoteridol and gadoterate meglumine, are commonly used in pediatric patients.
- The potential for gadolinium accumulation and its impact on T1 signal intensity requires investigation.
Purpose of the Study:
- To evaluate if repeated administration of macrocyclic GBCAs (gadoteridol, gadoterate meglumine) leads to increased signal intensity (SI) in T1 sequences.
- To assess T1 SI as a potential indicator of gadolinium deposition in the pediatric brain.
- To investigate the relationship between the number of GBCA administrations and gadolinium deposition.
Main Methods:
- Retrospective case-control study of pediatric patients with brain tumors receiving nine or more contrast-enhanced MR imaging studies.
- Inclusion of a control group with nonpathologic MR neuroimaging findings and no GBCA administration, matched for age and sex.
- Measurement of SI on unenhanced T1-weighted MR images in specific brain regions (dentate nucleus, pons, substantia nigra, pulvinar thalami, globus pallidus) and calculation of SI ratios.
Main Results:
- No significant differences in mean SI were found in any region of interest between case and control patients.
- No significant group differences were observed when comparing DN-to-pons and GP-to-pulvinar SI ratios.
- No correlation was found between the number of GBCA administrations or total GBCA dose and signal change in any ROI.
Conclusions:
- Multiple intravenous administrations of macrocyclic GBCAs in children were not associated with a measurable increase in T1 signal intensity.
- T1 SI did not appear to be a reliable indicator of brain gadolinium deposition detectable by MR imaging in this cohort.
- Additional imaging and pathologic studies are recommended to further confirm these findings.
