Advertisement
Topical Review| Volume 86, P27-32, September 2018

Safety of Gadolinium Administration in Children

      Abstract

      The introduction of paramagnetic contrast in the late 1980s constituted a paradigm shift boosting the efficacy of magnetic resonance imaging. Due to its high magnetic moment, gadolinium-based contrast agent made its way smoothly as the flagship paramagnetic contrast. With the widespread application, reports of untoward effects started to surface. Allergic reactions, nephrogenic systemic sclerosis, and deposition in brain tissue dented the safety profile of gadolinium-based contrast agent. Better understanding of these adverse effects prompted preventive measures. This article elucidates the gadolinium-based contrast agent toxicity in the pediatric population based on the current available evidence.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

      1. Runge VM, Stewart RG, Clanton JA, et al. Potential oral and intravenous paramagnetic NMR contrast agents. Oral Presentation At: Radiological Society Of North America Annual Meeting, 1982; Chicago, IL.

        • Runge VM
        Enhanced Magnetic Resonance Imaging.
        C.V. Mosby Company, St. Louis, MO1989
        • Pasquini L
        • Napolitano A
        • Visconti E
        • et al.
        Gadolinium-based contrast agent-related toxicities.
        CNS Drugs. 2018; 32: 229-240
        • Runge VM
        • Price AC
        • Wehr CJ
        • Atkinson JB
        • Tweedle MF
        Contrast-enhanced MRI. Evaluation of a canine model of osmotic blood-brain barrier disruption.
        Invest Radiol. 1985; 20: 830-844
        • Runge VM
        • Kirsch JE
        • Burke VJ
        • et al.
        High-dose gadoteridol in MR imaging of intracranial neoplasms.
        J Magn Reson Imaging. 1992; 2: 9-18
        • Runge VM
        • Wells JW
        • Williams NM
        • Lee C
        • Timoney JF
        • Young AB
        Detectability of early brain meningitis with magnetic resonance imaging.
        Invest Radiol. 1995; 30: 484-495
        • Behzadi AH
        • Zhao Y
        • Farooq Z
        • Prince MR
        Immediate Allergic reactions to gadolinium-based contrast agents: a systematic review and meta-analysis.
        Radiology. 2018; 286: 731
        • Fraum TJ
        • Ludwig DR
        • Bashir MR
        • Fowler KJ
        Gadolinium-based contrast agents: a comprehensive risk assessment.
        J Magn Reson Imaging. 2017; 46: 338-353
        • Trout AT
        • Dillman JR
        • Ellis JH
        • Cohan RH
        • Strouse PJ
        Patterns of intravenous contrast material use and corticosteroid premedication in children—a survey of Society of Chairs of Radiology in Children's Hospitals (SCORCH) member institutions.
        Pediatr Radiol. 2011; 41: 1272-1283
        • Soares BP
        • Lequin MH
        • Huisman TAGM
        Safety of contrast material use in children.
        Magn Reson Imaging Clin N Am. 2017; 25: 779-785
        • Glutig K1
        • Bhargava R2
        • Hahn G3
        • et al.
        Safety of gadobutrol in more than 1,000 pediatric patients: subanalysis of the GARDIAN study, a global multicenter prospective non-interventional study.
        Pediatr Radiol. 2016; 46: 1317-1323
        • Pullicino RadonM
        • Biswas S
        • Bhojak M
        • Das K2
        Review of the current evidence on gadolinium deposition in the brain.
        Clin Neuroradiol. 2018; https://doi.org/10.1007/s00062-018-0678-0
        • Idée JM1
        • Fretellier N
        • Robic C
        • Corot C
        The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: a critical update.
        Crit Rev Toxicol. 2014; 44: 895-913
        • Cohen MD
        Safe use of imaging contrast agents in children.
        J Am Coll Radiol. 2009; 6: 576-581
        • Dillman JR1
        • Ellis JH
        • Cohan RH
        • Strouse PJ
        • Jan SC
        Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children and adults.
        AJR Am J Roentgenol. 2007; 189: 1533-1538
        • Lasser EC.
        Chasing contrast molecules: a 45-year quixotic quest.
        Acad Radiol. 2004; 11: 1190-1196
        • Grobner T.
        Gadolinium: a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis?.
        Nephrol Dial Transplant. 2006; 21 (Erratum in: Nephrol Dial Transplant 21:1745): 1104-1108
        • Marckmann P
        • Skov L
        • Rossen K
        • Dupont A
        • Damholt MB
        • Heaf JG
        • Thomsen HS
        Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging.
        J Am Soc Nephrol. 2006; 17: 2359-2362
        • Idée JM1
        • Fretellier N
        • Robic C
        • Corot C
        The role of gadolinium chelates in the mechanism of nephrogenic systemic fibrosis: A critical update.
        Crit Rev Toxicol. 2014; 44: 895-913
        • Fraum TJ
        • Ludwig DR
        • Bashir MR
        • Fowler KJ
        Gadolinium-based contrast agents: a comprehensive risk assessment.
        J Magn Reson Imaging. 2017; 46: 338-353
        • Edward M
        • Quinn JA
        • Mukherjee S
        • et al.
        Gadodiamide contrast agent ‘ activates ’ fibroblasts:a possible cause of nephrogenic systemic fibrosis.
        J Pathol. 2008; 21 (Erratum in: J Pathol 214:593): 584-593
        • Edward M
        • Quinn JA
        • Burden AD
        • Newton BB
        • Jardine AG
        Effect of different classes of gadolinium-based contrast agents on control and nephrogenic systemic fibrosis-derived fibroblast proliferation.
        Radiology. 2010; 256: 735-743
        • Bhagavathula N
        • Dame MK
        • DaSilva M
        • et al.
        Fibroblast response to gadolinium: role for platelet-derived growth factor receptor.
        Invest Radiol. 2010; 45: 769-777
      2. Steger-Hartmann T, Raschke M, Riefke B, Pietsch H, Sieber MA, Walter J. The involvement of pro-inflammatory cytokines in nephrogenic systemic fibrosis- a Mechanistic hypothesis based on preclinical results from a rat model treated with gadodiamide. Exp Toxicol Pathol 61: 537–552.

        • Fretellier N
        • Idée JM
        • Guerret S
        • et al.
        Clinical, biological, and skin histopathologic eff ects of ionic macrocyclic and nonionic linear gadolinium chelates in a rat model of nephrogenic systemic fibrosis.
        Invest Radiol. 2011; 46: 85-93
        • Pietsch H
        • Raschke M
        • Ellinger-Ziegelbauer H
        • et al.
        The role of residual gadolinium in thei nduction of nephrogenic systemic fibrosis-like skin lesions in rats.
        Invest Radiol. 2011; 46: 48-56
        • Wermuth PJ
        • Jiménez SA
        Gadolinium compounds signaling through TLR4 and TLR7 in normal human macrophages: establishment of a proinfl ammatory phenotype and implications for the pathogenesis of nephrogenic systemic fibrosis.
        J Immunol. 2012; 189: 318-327
        • Wermuth PJ
        • Del Galdo F
        • Jim é nez SA
        Induction of the expression of profibrotic cytokines and growth factors in normal human peripheral blood monocytes by gadolinium contrast agent.
        Arthritis Rheum. 2009; 60: 1508-1518
        • Wermuth PJ
        • Jim é nez SA
        Induction of a type I interferon signature in normal human monocytes by gadolinium-based contrast agents: comparison of linear and macrocyclic agents.
        Clin Exp Immunol. 2014; 175: 113-125
        • Perone PA
        • Weber SL
        • DaSilva M
        • et al.
        Collagenolytic activity is suppressed in organ-cultured human skin exposed to a gadolinium-based MRI contrast agent.
        Invest Radiol. 2010; 45: 42-48
        • Jan F
        • Segal JM
        • Dyer J
        • LeBoit P
        • Siegfried E
        • Frieden IJ
        Nephrogenic fibrosing dermopathy: two pediatric cases.
        J Pediatr. 2003; 143: 678-681
        • Jain SM
        • Wesson S
        • Hassanein A
        • et al.
        Nephrogenic fibrosing dermopathy in pediatric patients.
        Pediatr Nephrol. 2004; 19: 467-470
        • Girardi M
        • Kay J
        • Elston DM
        • Leboit PE
        • Abu-Alfa A
        • Cowper SE
        Nephrogenic systemic fibrosis: clinicopathological definition and workup recommendations.
        J Am Acad Dermatol. 2011; 65 (e7): 1095-1106
        • Auron A
        • Shao L
        • Warady BA
        Nephrogenic fibrosing dermopathy in children.
        Pediatr Nephrol. 2006; 21: 1307-1311
        • Nardone B1
        • Saddleton E
        • Laumann AE
        • et al.
        Pediatric nephrogenic systemic fibrosis is rarely reported: a RADAR report.
        Pediatr Radiol. 2014; 44: 173-180
        • Ramalho J
        • Semelka RC
        • Ramalho M
        • Nunes RH
        • AlObaidy M
        • Castillo M
        Gadolinium- based contrast agent accumulation and toxicity: an update.
        AJNR Am J Neuroradiol. 2016; 37: 1192-1198
        • Pullicino R
        • Radon M
        • Biswas S
        • Bhojak M
        • Das K
        A review of the current evidence on gadolinium deposition in the brain.
        Clin Neuroradiol. 2018; https://doi.org/10.1007/s00062-018-0678-0
        • Flood TF
        • Stence NV
        • Maloney JA
        • Mirsky DM
        Pediatric brain: repeated exposure to linear gadolinium-based contrast material is associated with increased signal intensity at unenhanced T1-weighted MR imaging.
        Radiology. 2017; 282: 222-228
        • Hu HH
        • Pokorney A
        • Towbin RB
        • Miller JH
        Increased signal intensities in the dentate nucleus and globus pallidus on unenhanced T1-weighted images: evidence in children undergoing multiple gadolinium MRI exams.
        Pediatr Radiol. 2016; 46: 1590-1598
        • Roberts DR
        • Chatterjee AR
        • Yazdani M
        • et al.
        Pediatric patients demonstrate progressive T1-weighted hyperintensity in the dentate nucleus following multiple doses of gadolinium-based contrast agent.
        AJNR Am J Neuroradiol. 2016; 37: 2340-2347
        • Tibussek D
        • Rademacher C
        • Caspers J
        • et al.
        Gadolinium brain deposition after macrocyclic gadolinium administration: a pediatric case-control study.
        Radiology. 2017; 285: 223-230
        • Radbruch A
        • Haase R
        • Kickingereder P
        • et al.
        Pediatric brain: no increased signal intensity in the dentate nucleus on unenhanced T1-weighted MR images after consecutive exposure to a macrocyclic gadolinium-based contrast agent.
        Radiology. 2017; 283: 828-836
        • Renz DM
        • Kümpel S
        • Böttcher J
        • et al.
        Comparison of unenhanced T1-weighted signal intensities within the dentate nucleus and the globus pallidus after serial applications of gadopentetate dimeglumine versus gadobutrol in a pediatric population.
        Invest Radiol. 2018; 53: 119-127
        • Ryu YJ
        • Choi YH
        • Cheon JE
        • et al.
        Pediatric Brain: Gadolinium deposition in dentate nucleus and globus pallidus on unenhanced T1-weighted images is dependent on the type of contrast agent.
        Invest Radiol. 2018; 53: 246-255
        • Kasper E
        • Schemuth HP
        • Horry S
        • Kinner S
        Changes in signal intensity in the dentate nucleus at unenhanced T1-weighted magnetic resonance imaging depending on class of previously used gadolinium-based contrast agent.
        Pediatr Radiol. 2018; 48: 686-693
        • Young JR
        • Orosz I
        • Franke MA
        • et al.
        Gadolinium deposition in the paediatric brain: T1-weighted hyperintensity within the dentate nucleus following repeated gadolinium-based contrast agent administration.
        Clin Radiol. 2018; 73: 290-295
        • Schneider GK
        • Stroeder J
        • Roditi G
        • et al.
        T1 signal measurements in pediatric brain: findings after multiple exposures to gadobenate dimeglumine for imaging of nonneurologic disease.
        AJNR Am J Neuroradiol. 2017; 38: 1799-1806
        • Rossi Espagnet MC
        • Bernardi B
        • Pasquini L
        • Figà-Talamanca L
        • Tomà P
        • Napolitano A
        Signal intensity at unenhanced T1-weighted magnetic resonance in the globus pallidus and dentate nucleus after serial administrations of a macrocyclic gadolinium-based contrast agent in children.
        Pediatr Radiol. 2017; 47: 1345-1352
        • Xia D
        • Davis RL
        • Crawford JA
        • Abraham JL
        Gadolinium released from MR contrast agents is deposited in brain tumors: in situ demonstration using scanning electron microscopy with energy dispersive X-ray spectroscopy.
        Acta Radiol. 2010; 51: 1126-1136
        • Roberts DR
        • Welsh CA
        • LeBel DP
        • Davis WC
        Distribution map of gadolinium deposition within the cerebellum following GBCA administration.
        Neurology. 2017; 88: 1206-1208
        • Jost G
        • Frenzel T
        • Lohrke J
        • Lenhard DC
        • Naganawa S
        • Pietsch H
        Penetration and distribution of gadolinium-based contrast agents into the cerebrospinal fluid in healthy rats: a potential pathway of entry into the brain tissue.
        Eur Radiol. 2017; 27: 2877-2885
        • Wardlaw JM
        • Farrall A
        • Armitage PA
        • et al.
        Changes in background blood-brain barrier integrity between lacunar and cortical ischemic stroke subtypes.
        Stroke. 2008; 39: 1327-1332
        • Naganawa S
        • Kawai H
        • Taoka T
        • Sone M
        Improved HYDROPS: imaging of endolymphatic hydrops after intravenous administration of gadolinium.
        Magn Reson Med Sci. 2017; 16: 357-361
        • Iliff JJ
        • Wang M
        • Liao Y
        • et al.
        A paravascular pathway facilitates CSF flow through the brain parenchyma and the clearance of interstitial solutes, including amyloid β.
        Sci Transl Med. 2012; 4 (147ra111)
        • Iliff JJ
        • Lee H
        • Yu M
        • et al.
        Brain-wide pathway for waste clearance captured by contrast enhanced MRI.
        J Clin Invest. 2013; 123: 1299-1309
        • Rasschaert M
        • Emerit A
        • Fretellier N
        • et al.
        Gadolinium retention, brain T1 hyperintensity, and endogenous metals: a comparative study of macrocyclic versus linear gadolinium chelates in renally sensitized rats.
        Invest Radiol. 2018; https://doi.org/10.1097/RLI.0000000000000447
        • Zhang Y
        • Cao Y
        • Shih GL
        • Hecht EM
        • Prince MR
        Extent of signal hyperintensity on unenhanced T1-weighted brain MR images after more than 35 administrations of linear gadolinium-based contrast agents.
        Radiology. 2017; 282: 516-525
        • Radbruch A
        • Weberling LD
        • Kieslich PJ
        • et al.
        Intraindividual analysis of signal intensity changes in the dentate nucleus after consecutive serial applications of linear and macrocyclic gadolinium-based contrast agents.
        Invest Radiol. 2016; 51: 683-690
        • Murata N
        • Gonzalez-Cuyar LF
        • Murata K
        • et al.
        Macrocyclic and other non-group 1 Gadolinium contrast agents deposit low levels of gadolinium in brain and bone tissue:preliminary results from 9 patients with normal renal function.
        Invest Radiol. 2016; 51: 447-453
        • Murata N
        • Murata K
        • Gonzalez-Cuyar LF
        • Maravilla KR
        Gadolinium tissue deposition in brain and bone.
        Magn Reson Imaging. 2016; 34: 1359-1365
        • McDonald RJ
        • McDonald JS
        • Kallmes DF
        • et al.
        Gadolinium deposition in human brain tissues after contrast-enhanced MR imaging in adult patients without intracranial abnormalities.
        Radiology. 2017; 285: 546-554
      3. U.S. Food and Drug Administration. Center for Drug Evaluation and Research. FDA evaluating the risk of brain deposits with repeated use of gadolinium-based contrast agents for magnetic resonance imaging (MRI). 2015. http://www.fda.gov/Drugs/DrugSafety/ucm455386.htm#collapseOne. Accessed 21 April 2018.

        • Gulani V
        • Calamante F
        • Shellock FG
        • Kanal E
        • Reeder SB
        Gadolinium deposition in the brain: summary of evidence and recommendations.
        Lancet Neurol. 2017; 16: 564-570
        • European Medicines Agency
        EMA's final opinion confirms restrictions on use of linear gadolinium agents in body scans.
        (Accessed 17 April 2018)
        • Forgács A
        • Regueiro-Figueroa M
        • Barriada JL
        • et al.
        Mono-, bi-, and trinuclear bis-hydrated Mn(2+) complexes as potential MRI contrast agents.
        Inorg Chem. 2015; 54: 9576-9587
        • Boehm-Sturm P
        • Haeckel A
        • Hauptmann R
        • Mueller S
        • Kuhl CK
        • Schellenberger EA
        Low-molecular-weight iron chelates may be an alternative to gadolinium-based contrast agents for T1-weighted contrast-enhanced MR imaging.
        Radiology. 2018; 286: 537-546
        • Nguyen HV
        • Chen Q
        • Paletta JT
        • et al.
        Nitroxide based macromolecular contrast agents with unprecedented transverse relaxivity and stability for magnetic resonance imaging of tumors.
        Acs Cent Sci. 2017; 3: 800-811
        • Zheng Y
        • Wang X
        The applicability of amide proton transfer imaging in the nervous system: focus on hypoxic-ischemic encephalopathy in the neonate.
        Cell Mol Neurobiol. 2018; 38: 797-807
        • Togao O1
        • Yoshiura T
        • Keupp J
        • et al.
        Amide proton transfer imaging of adult diffuse gliomas: correlation with histopathological grades.
        Neuro Oncol. 2014; 16: 441-448
        • Goo HW
        • Ra YS
        Advanced MRI for pediatric brain tumors with emphasis on clinical benefits.
        Korean J Radiol. 2017; 18: 194-207