Purpose or Case Report: Gadolinium based contrast agents have been used in pediatric neuroradiology for years and are thought to be safe when administered appropriately. However, it has been discovered that gadolinium used in routine clinical practice results in gadolinium deposition in the even in patients with normal renal function. No studies have addressed gadolinium deposition in the soft tissues of pediatric patients or its potential ill-effects. The potential for harm may exist. We reviewed our gadolinium use in the follow up of pediatric primary intracranial neoplasms.
Methods & Materials: After IRB approval, we retrospectively reviewed data from 96 patients with initial imaging between 2001 and 2015, who had been diagnosed with a primary intracranial neoplasm either by histopathology or widely accepted imaging appearance. We gathered patient demographics, tumor, and data related to contrast enhanced MRIs (CE-MRI). We noted whether or not the original tumor enhanced.
Results: Overall, 96 patients (46 girls, 50 boys) received 851 contrast enhanced MRIs. They ranged in age from 0.1 to 18.8 years at the time of the first CE-MRI. They received an average of 7.9 (range 0-31) follow-up CE-MRIs over an average of 3.3 years (range 0-14.1). Number of cases with age, exam, and follow-up data is presented in table 1. The trend was for enhancing lesions to receive for more exams for longer time, the difference was not statistically significant (table 2). A summary of solitary FLAIR hyperintense non-enhancing lesions is presented in table 3.
Conclusions: Children are undergoing a very large number of CE-MRIs for follow-up of primary intracranial neoplasms. The data did not take patient death into account, so we did not evaluate the significance of tumor grade or prognosis on follow up. Alternatively, lower grade neoplasms have an excellent prognosis and these children may have many years of imaging follow-up. Many patients likely “graduated” from our institution during the study time, which could lead to underrepresentation of their true follow up. Neoplasms which did not initially enhance continued to receive contrast for follow up exams. Whether or not this is necessary is yet to be determined, and is the focus of some of our on-going research. In light of new evidence of gadolinium deposition in the tissue, perhaps more care could be taken in protocolling exams for follow-up. Non-enhancing neoplasms and postoperative follow –up MRIs without recent change would be excellent opportunities to reduce contrast administration.