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Gadolinium-based contrast agents in pediatric MRI: renal safety, risk mitigation, and emerging alternatives

Matthew M Jones1, Amma A Boakye2, Nirali Dave3

  • 1Department of Radiology and Imaging Sciences, Indiana University, 705 Riley Hospital Drive, Room 1053, Indianapolis, IN, 46202, USA. matmjone@iu.edu.

Pediatric Radiology
|April 7, 2026
PubMed

Insights

This review details safe use of gadolinium-based contrast agents (GBCAs) in pediatric MRI, addressing renal function and gadolinium retention risks. It offers strategies for risk mitigation and discusses alternatives like ferumoxytol.

Area of Science:

  • Pediatric Radiology
  • Pharmacology
  • Nephrology

Background:

  • Gadolinium-based contrast agents (GBCAs) are essential for pediatric MRI.
  • Pediatric use necessitates caution due to immature renal function, gadolinium retention concerns, and risk of nephrogenic systemic sclerosis (NSF).

Purpose of the Study:

  • To review GBCA molecular structure, pediatric pharmacokinetics, and adverse effects.
  • To provide evidence-based strategies for safe GBCA administration in children.
  • To discuss alternative contrast agents and future research needs.

Main Methods:

  • Comprehensive literature review of GBCA safety and efficacy in pediatric populations.
  • Synthesis of current evidence and guideline recommendations.
  • Analysis of pediatric-specific pharmacokinetic data and adverse event profiles.

Main Results:

  • Identified key risk factors for adverse events in children, including renal impairment.
  • Outlined strategies for risk mitigation, such as agent selection based on eGFR and minimizing cumulative doses.
  • Highlighted the potential of alternative agents like ferumoxytol for specific pediatric cases.

Conclusions:

  • Judicious use of GBCAs in pediatric MRI requires careful patient selection and risk management.
  • Adherence to evidence-based guidelines can optimize safety and efficacy.
  • Further pediatric-specific research is crucial to refine contrast agent protocols.

Keywords:
ChildContrast mediaGadoliniumInfant, newbornKidneyMagnetic resonance imaging

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