Background and Purpose While there have been recent reports of brain retention of gadolinium following gadolinium-based contrast agent (GBCA) administration in adults, a retrospective series of pediatric patients has not previously been reported. We investigated the relationship between the number of prior GBCA doses and increasing T1 signal in the dentate nucleus on unenhanced T1-weighted MR imaging. We hypothesized that, despite differences in pediatric physiology and the smaller GBCA doses pediatric patients are typically administered based on weighted-adjusted dosing, the pediatric brain would also demonstrate dose dependent increasing T1 signal in the dentate nucleus. Materials and methods We included children with multiple GBCA administrations at our institution. A blinded-reader placed regions of interest (ROIs) within the dentate nucleus and adjacent cerebellar white matter. To eliminate reader bias, automated ROI delineation of the dentate nucleus, cerebellar white matter, and pons was also performed. Dentate to cerebellar white matter (DN/C) and dentate to pons (DN/P) ratios were compared to the number of GBCA administrations. Results Over 20 years at our institution, 280 patients received at least 5 GBCA doses with one patient receiving 38 doses. Sixteen patients met inclusion/exclusion criteria for ROI analysis. Blinded-reader DN/C ratios were significantly associated with GBCA doses (rs=0.77, p=0.001). DN/P and DN/C ratios based on automated ROI placement were also significantly correlated with GBCA doses (t=4.98, p<0.0001 and t=2.73, p<0.02 respectively). Conclusion In pediatric patients, the number of prior GBCA doses is significantly correlated with progressive T1-weighted dentate hyperintensity. Definitive confirmation of gadolinium deposition requires tissue analysis. Any potential clinical sequelae of gadolinium retention in the developing brain are unknown. Given this uncertainty, we suggest taking a cautious stance including the use in pediatric patients of higher stability, macrocyclic agents, which in both human and animal studies have been shown to be associated with lower levels of gadolinium deposition, and detailed documentation of dosing. Most importantly, a patient should not be deprived of a well-indicated contrasted MR exam.

BACKGROUND AND PURPOSE:Previous studies have evaluated various gadolinium based contrast agents and their association with gadolinium retention, however, there is a discrepancy in the literature concerning the linear agent gadobenate dimeglumine. Our aim was to determine whether an association exists between the administration of gadobenate dimeglumine and the development of intrinsic T1-weighted signal in the dentate nucleus and globus pallidus.

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