Pediatric Radiology

, Volume 48, Issue 6, pp 858–864 | Cite as

Do we need gadolinium-based contrast medium for brain magnetic resonance imaging in children?

  • Dennis Dünger
  • Matthias Krause
  • Daniel Gräfe
  • Andreas Merkenschlager
  • Christian Roth
  • Ina SorgeEmail author
Original Article



Brain imaging is the most common examination in pediatric magnetic resonance imaging (MRI), often combined with the use of a gadolinium-based contrast medium. The application of gadolinium-based contrast medium poses some risk. There is limited evidence of the benefits of contrast medium in pediatric brain imaging.


To assess the diagnostic gain of contrast-enhanced sequences in brain MRI when the unenhanced sequences are normal.

Materials and methods

We retrospectively assessed 6,683 brain MR examinations using contrast medium in children younger than 16 years in the pediatric radiology department of the University Hospital Leipzig to determine whether contrast-enhanced sequences delivered additional, clinically relevant information to pre-contrast sequences. All examinations were executed using a 1.5-T or a 3-T system.


In 8 of 3,003 (95% confidence interval 0.12–0.52%) unenhanced normal brain examinations, a relevant additional finding was detected when contrast medium was administered. Contrast enhancement led to a change in diagnosis in only one of these cases.


Children with a normal pre-contrast brain MRI rarely benefit from contrast medium application. Comparing these results to the risks and disadvantages of a routine gadolinium application, there is substantiated numerical evidence for avoiding routine administration of gadolinium in a pre-contrast normal MRI examination.


Brain Children Contrast medium Diagnostic value Gadolinium Magnetic resonance imaging 


Compliance with ethical standards

Conflicts of interest



  1. 1.
    Kanal E (2016) Gadolinium based contrast agents (GBCA): safety overview after 3 decades of clinical experience. Magn Reson Imaging 34:1341–1345CrossRefPubMedGoogle Scholar
  2. 2.
    Collidge TA, Thomson PC, Mark PB et al (2007) Gadolinium-enhanced MR imaging and nephrogenic systemic fibrosis: retrospective study of a renal replacement therapy cohort. Radiology 245:168–175CrossRefPubMedGoogle Scholar
  3. 3.
    Todd DJ, Kay J (2016) Gadolinium-induced fibrosis. Annu Rev Med 67:273–291CrossRefPubMedGoogle Scholar
  4. 4.
    Todd DJ, Kagan A, Chibnik LB et al (2007) Cutaneous changes of nephrogenic systemic fibrosis: predictor of early mortality and association with gadolinium exposure. Arthritis Rheum 56:3433–3441CrossRefPubMedGoogle Scholar
  5. 5.
    Grobner T (2006) Gadolinium -- a specific trigger for the development of nephrogenic fibrosing dermopathy and nephrogenic systemic fibrosis? Nephrol Dial Transplant 21:1104–1108CrossRefPubMedGoogle Scholar
  6. 6.
    Marckmann P, Skov L, Rossen K et al (2006) Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging. J Am Soc Nephrol 17:2359–2362CrossRefPubMedGoogle Scholar
  7. 7.
    Quattrocchi CC, Mallio CA, Errante Y et al (2015) Gadodiamide and dentate nucleus T1 hyperintensity in patients with meningioma evaluated by multiple follow-up contrast-enhanced magnetic resonance examinations with no systemic interval therapy. Investig Radiol 50:470–472CrossRefGoogle Scholar
  8. 8.
    Radbruch A, Weberling LD, Kieslich PJ et al (2015) Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology 275:783–791CrossRefPubMedGoogle Scholar
  9. 9.
    Kanda T, Osawa M, Oba H et al (2015) High signal intensity in dentate nucleus on unenhanced T1-weighted MR images: association with linear versus macrocyclic gadolinium chelate administration. Radiology 275:803–809CrossRefPubMedGoogle Scholar
  10. 10.
    Murata N, Gonzalez-Cuyar LF, Murata K et al (2016) 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. Investig Radiol 51:447–453CrossRefGoogle Scholar
  11. 11.
    White GW, Gibby WA, Tweedle MF (2006) Comparison of Gd(DTPA-BMA) (Omniscan) versus Gd(HP-DO3A) (ProHance) relative to gadolinium retention in human bone tissue by inductively coupled plasma mass spectroscopy. Investig Radiol 41:272–278CrossRefGoogle Scholar
  12. 12.
    Weberling LD, Kieslich PJ, Kickingereder P et al (2015) Increased signal intensity in the dentate nucleus on unenhanced T1-weighted images after gadobenate dimeglumine administration. Investig Radiol 50:743–748CrossRefGoogle Scholar
  13. 13.
    Zhang Y, Cao Y, Shih GL et al (2017) Extent of signal hyperintensity on unenhanced T1-weighted brain MR images after more than 35 administrations of linear gadolinium-based contrast agents. Radiology 282:516–525CrossRefPubMedGoogle Scholar
  14. 14.
    Miller JH, Hu HH, Pokorney A et al (2015) MRI brain signal intensity changes of a child during the course of 35 gadolinium contrast examinations. Pediatrics 136:e1637–e1640Google Scholar
  15. 15.
    Roberts DR, Holden KR (2016) Progressive increase of T1 signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in the pediatric brain exposed to multiple doses of gadolinium contrast. Brain Dev 38:331–336Google Scholar
  16. 16.
    McDonald RJ, McDonald JS, Kallmes DF et al (2015) Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology 275:772–782CrossRefPubMedGoogle Scholar
  17. 17.
    Flood TF, Stence NV, Maloney JA et al (2017) Pediatric brain: repeated exposure to linear gadolinium-based contrast material is associated with increased signal intensity at unenhanced T1-weighted MR imaging. Radiology 282:222–228CrossRefPubMedGoogle Scholar
  18. 18.
    Roberts DR, Chatterjee AR, Yazdani M et al (2016) Pediatric patients demonstrate progressive T1-weighted hyperintensity in the dentate nucleus following multiple doses of gadolinium-based contrast agent. AJNR Am J Neuroradiol 37:2340–2347CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Hu HH, Pokorney A, Towbin RB, Miller JH (2016) 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 46:1590–1598Google Scholar
  20. 20.
    Elster AD, Rieser GD (1989) Gd-DTPA-enhanced cranial MR imaging in children: initial clinical experience and recommendations for its use. AJR Am J Roentgenol 153:1265–1268CrossRefPubMedGoogle Scholar
  21. 21.
    Baierl P, Muhlsteffen A, Haustein J et al (1990) Comparison of plain and Gd-DTPA-enhanced MR-imaging in children. Pediatr Radiol 20:515–519CrossRefPubMedGoogle Scholar
  22. 22.
    Eldevik OP, Brunberg JA (1994) Gadopentetate dimeglumine-enhanced MR of the brain: clinical utility and safety in patients younger than two years of age. AJNR Am J Neuroradiol 15:1001–1008PubMedGoogle Scholar
  23. 23.
    Petrou M, Foerster B, Maly PV et al (2007) Added utility of gadolinium in the magnetic resonance imaging (MRI) workup of seizures in children younger than 2 years. J Child Neurol 22:200–203CrossRefPubMedGoogle Scholar
  24. 24.
    Foerster BR, Ksar J, Petrou M et al (2006) Value of gadolinium in brain MRI examinations for developmental delay. Pediatr Neurol 35:126–130CrossRefPubMedGoogle Scholar
  25. 25.
    Gutierrez JE, Rosenberg M, Seemann J et al (2015) Safety and efficacy of gadobutrol for contrast-enhanced magnetic resonance imaging of the central nervous system: results from a multicenter, double-blind, randomized, comparator study. Magn Reson Insights 8:1–10PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany 2017

Authors and Affiliations

  1. 1.Department of Paediatric RadiologyUniversity LeipzigLeipzigGermany
  2. 2.Department of Neurosurgery/Paediatric NeurosurgeryUniversity LeipzigLeipzigGermany
  3. 3.Department of Woman and Child Health, Hospital for Children & Adolescents, University LeipzigLeipzigGermany

Personalised recommendations