Purpose or Case Report: Gadolinium-based contrast agents (GBCAs) are widely used in clinical practice. However, there are growing concerns regarding the safety of GBCAs with recent findings of gadolinium deposition in patients with normal renal function. This educational exhibit reviews the use of gadolinium in children, including the safety profile, existing controversies, and potential solutions.
Methods & Materials: Critical analysis of the literature was performed and combined with the experience of the authors at our institution to provide a comprehensive review of gadolinium use in children.
Results: GBCAs offer substantial benefit to the patient for MR lesion detection, lesion characterization, and angiography. As free gadolinium is toxic to the human body, gadolinium is made safe by chelating it to a macromolecule. The structure of the macromolecule influences stability and thus safety. Toxicity can manifest in immediate adverse events, nephrogenic systemic fibrosis (NSF), or gadolinium deposition. The rate of immediate adverse events is 0.07 to 2.4%, with allergic reactions occurring in 0.004 to 0.7% and life threatening anaphylactoid or nonallergic anaphylactic reactions occurring in 0.001 to 0.01%. NSF is a severe multisystem disorder postulated to be the result of free gadolinium binding with anions in the blood that deposit in the skin and viscera, which then incite fibrosis. Between January 1997 and October 2012, only 23 cases of pediatric NSF have been reported, and none under the age of 6. Most patients with NSF had severe renal dysfunction. In recent years, there has been increased concern over the findings of gadolinium deposition in patients with normal renal function, specifically in brain tissue. The clinical significance of gadolinium tissue deposition remains unknown. Because of the potential toxicity of such gadolinium deposition, many studies in recent years have looked at ways to achieve diagnostic effectiveness without GBCA administration. Some of the studies relevant to use in children will be reviewed.
Conclusions: Use of GBCAs in children continues to be of substantial clinical benefit to patients. But safe responsible use requires a risk-benefit assessment for each individual patient by the radiologist. Future research is needed to find ways to achieve diagnostic effectiveness without administration of GBCAs.