Contrast Media pp 245-253 | Cite as

Contrast Media Use in Pediatrics: Safety Issues

  • Michael RiccabonaEmail author
Part of the Medical Radiology book series (MEDRAD)


Contrast media appear to be just as safe in children as they are in adults. The risk factors are the same and the same precautions should be taken. The main differences relate to differences in technique necessitated by differences in size, differences in relative body compartment size, growth, immature renal function, etc., as well as to limited published evidence on their use and safety. Not all agents are approved for use in children, but most of the nonapproved agents can be used off-label with the informed consent of the parents.


Nephrogenic Systemic Fibrosis High Iodine Concentration Iodine Load Neonatal Kidney Ultrasound Contrast Medium 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


  1. ACR Manual on Contrast Media, version 8 (2012a) Contrast media in children, p 47–52 and p 79
  2. ACR Manual on Contrast Media, version 8 (2012b) Table 4: management of acute reactions in children
  3. American College of Radiology—ACR (2012) 2012/Manual on Contrast Media v8—Contrast media in children.
  4. Ascenti G, Zimbaro G, Mazziotti S et al (2004) Harmonic US imaging of vesicoureteric reflux in children: usefulness of a second generation contrast agent. Pediatr Radiol 34:481–487PubMedCrossRefGoogle Scholar
  5. Baker JF, Kratz LC, Stevens GR, Wible JH (2004) Pharmacokinetics and safety of the MRI contrast agent Gadoversetamide injection in healthy pediatric subjects. Invest Radiol 39(6):334–339PubMedCrossRefGoogle Scholar
  6. Basu S, Kumar A, Das BK (2009) Accidental aspiration of barium sulphate in an infant. Pediatr Radiol 39:762PubMedCrossRefGoogle Scholar
  7. Berrocal T, Gaya F, Arjonilla A et al (2001) Vesicoureteral reflux: diagnosis and grading with echo-enhanced cystosonography versus voiding cystourethrography. Radiology 221:359–365PubMedCrossRefGoogle Scholar
  8. Berrocal T, Gaya F, Arjonilla A (2005) Vesicoureteral reflux: can the urethra be adequately assessed by using contrast-enhanced voiding US of the bladder? Radiology 234:235–241PubMedCrossRefGoogle Scholar
  9. Brasch RC (2008) Contrast media toxicity in children. Pediatr Radiol 38(Suppl 2):S281–S284PubMedCrossRefGoogle Scholar
  10. Calliada F, Campani R, Bottinelli O et al (1998) Ultrasound contrast agents: basic principles. Eur J Radiol 27(Suppl 2):S157–S160PubMedCrossRefGoogle Scholar
  11. Claudon M, Cosgrove D, Albrecht T et al (2008) Guidelines and good clinical practice recommendations for contrast enhanced ultrasound (CEUS)—update 2008. Ultraschall Med 29:28–44PubMedCrossRefGoogle Scholar
  12. Correas JM, Bridal L, Lesavre A et al (2001) Ultrasound contrast agents: properties, principles of action, tolerance, and artifacts. Eur Radiol 11:1316–1328PubMedCrossRefGoogle Scholar
  13. Darge K, Troeger J (2002) Vesicoureteral reflux grading in contrast-enhanced voiding urosonography. Eur J Radiol 43:122–128PubMedCrossRefGoogle Scholar
  14. Darge K (2008) Voiding urosonography with ultrasound contrast agents for the diagnosis of vesicoureteric reflux in children. I—Procedure, and II—Comparison with radiological examinations. Pediatr Radiol 38: 40–53, 54–63Google Scholar
  15. Darge K (2010) Voiding urosonography with US contrast agent for the diagnosis of vesicoureteric reflux in children: an update. Pediatr Radiol 40:956–962PubMedCrossRefGoogle Scholar
  16. Darge K (2011) CEUS task force of the society for pediatric radiology. Contrast-enhanced US (CEUS) in children: ready for prime time in the United States. Pediatr Radiol 41:1486–1488PubMedCrossRefGoogle Scholar
  17. Darge K, Papadopoulou F, Ntoulia A et al (2013) Safety of contrast-enhanced ultrasound in children for non-cardiac applications: a review by the Society for Pediatric Radiology (SPR) and the International Contrast Ultrasound Society (ICUS). Pediatr Radiol 43:1063–1073Google Scholar
  18. Dawson P, Becker A, Holton JM (1983) The effect of contrast media on the growth of bacteria. Brit J Radiol 56:809–815PubMedCrossRefGoogle Scholar
  19. Dharnidharka VR, Wesson SK, Fennell RS (2007) Gadolinium and nephrogenic fibrosing dermopathy in pediatric patients. Pediatr Nephrol 22:1395PubMedCrossRefGoogle Scholar
  20. Duran C, Valera A, Alguersuari A et al (2009) Voiding urosonography: the study of the urethra is no longer a limitation of the technique. Pediatr Radiol 39:124–131PubMedCrossRefGoogle Scholar
  21. Eklöf O, Hald J, Thomasson B (1983) Barium peritonitis. Experience of five pediatric cases. Pediatr Radiol 13:5–9PubMedCrossRefGoogle Scholar
  22. Eldevik PO, Brunberg JA (1994) Gadopentetate Dimeglumine—enhanced MRI of the brain: clinical ultility and safety in patients younger than two years of age. Am J Neuroradiol 15:1001–1008PubMedGoogle Scholar
  23. Esposito F, Di Serafino M, Sgambati P et al (2012) Ultrasound contrast media in paediatric patients: is it an off-label use? Regulatory requirements and radiologist’s liability. Radiol Med 117:148–159PubMedCrossRefGoogle Scholar
  24. Filler G, Yasin A, Medeiros M (2013) Methods of assessing renal function. Pediatr Nephrol. PMID: 23417278Google Scholar
  25. Forsting M, Palkowitch P (2010) Prevalence of acute adverse reactions to gadobutrol—a highly concentrated macrocyclic gadolinium chelate: review of 14,299 patients from observational trials. Eur J Radiol 74:186–190CrossRefGoogle Scholar
  26. Foss C, Smith JK, Ortiz L et al (2009) Gadolinium-associated nephrogenic systemic fibrosis in a 9-year-old boy. Pediatr Dermatol 26:579–582PubMedCrossRefGoogle Scholar
  27. Frush DP (2008) Pediatric abdominal CT angiography. Pediatr Radiol 38(Suppl 2):S259–S266PubMedCrossRefGoogle Scholar
  28. Hahn G, Sorge I, Gruhn B, Glutig K et al (2009) Pharmacokinetics and safety of gadobutrol-enhanced magnetic resonance imaging in pediatric patients. Invest Radiol 44(12):776–783PubMedCrossRefGoogle Scholar
  29. Hammer GP, Seidenbusch MC, Regulla DF et al (2011) Childhood cancer risk from conventional radiographic examinations for selected referral criteria: results from a large cohort study. AJR Am J Roentgenol 197:217–223PubMedCrossRefGoogle Scholar
  30. Heran MK, Marshalleck F, Temple M et al (2010) Society of interventional radiology standards of practice committee; society of pediatric radiology interventional radiology committee. Joint quality improvement guidelines for pediatric arterial access and arteriography: from the societies of interventional radiology and pediatric radiology. Pediatr Radiol 40:237–250PubMedCrossRefGoogle Scholar
  31. Hernanz-Schulman M, Foster C, Maxa R et al (2000) Experimental study of mortality and morbidity of contrast media and standardized fecal dose in the peritoneal cavity. Pediatr Radiol 30:369–378PubMedCrossRefGoogle Scholar
  32. Hiorns MP (2011) Gastrointestinal tract imaging in children: current techniques. Pediatr Radiol 41:42–54PubMedCrossRefGoogle Scholar
  33. Hocine N, Berry JP, Jafoura H et al (1995) Subcellular localization of gadolinium injected as soluble salt in rats: a microanalytical study. Cell Mol Biol (Noisy-le-grand) 41:271–278Google Scholar
  34. Idée JM, Port M, Raynal I et al (2006) Clinical and biological consequences of transmetallation induced by contrast agents for magnetic resonance imaging: a review. Fundam Clin Pharmacol 20:563–576PubMedCrossRefGoogle Scholar
  35. Jain SM, Wesson S, Hassanein A et al (2004) Nephrogenic fibrosing dermopathy in pediatric patients. Pediatr Nephrol 19:467–470PubMedCrossRefGoogle Scholar
  36. Kao SC, Franken EA Jr (1995) Nonoperative treatment of simple meconium ileus: a survey of the Society for Pediatric Radiology. Pediatr Radiol 25:97–100PubMedCrossRefGoogle Scholar
  37. Karcaaltincaba M, Oguz B, Haliloglu M (2009) Current status of contrast-induced nephropathy and nephrogenic systemic fibrosis in children. Pediatr Radiol 39(Suppl 3):S382–S384CrossRefGoogle Scholar
  38. Kenda RB, Novljan G, Kenig A et al (2000) Echo-enhanced ultrasound voiding cystography in children: a new approach. Pediatr Nephrol 14:297–300PubMedCrossRefGoogle Scholar
  39. Krille L, Zeeb H, Jahnen A et al (2012) Computed tomographies and cancer risk in children: a literature overview of CT practices, risk estimations and an epidemiologic cohort study proposal. Radiat Environ Biophys 51:103–111PubMedCrossRefGoogle Scholar
  40. Kurian J, Epelman M, Darge K et al (2013) The role of CT angiography in the evaluation of pediatric renovascular hypertension. Pediatr Radiol 43:490–501PubMedCrossRefGoogle Scholar
  41. Langlois V (2008) Laboratory evaluation at different ages. In: Geary DF, Schaefer F (eds) Comprehensive pediatric nephrology. Mosby, Elsevier, Philadelphia. pp 39–54Google Scholar
  42. Leonidas JC, Burry VF, Fellows RA, Beatty EC (1976) Possible adverse effect of methylglucamine diatrizoate compounds on the bowel of newborn infants with meconium ileus. Radiology 121:693–696PubMedGoogle Scholar
  43. Mannelli L, Maki JH, Osman SF et al (2012) Noncontrast functional MRI of the kidneys. Curr Urol Rep 13:99–107PubMedCrossRefGoogle Scholar
  44. McAlister WH, Siegel MJ (1984) Fatal aspirations in infancy during gastrointestinal series. Pediatr Radiol 14:81–83PubMedCrossRefGoogle Scholar
  45. McCarville MB (2011) Contrast-enhanced sonography in pediatrics. Pediatr Radiol 41(Suppl 1):S238–S242PubMedCrossRefGoogle Scholar
  46. Mendichovszky IA, Marks SD, Simcock CM, Olsen OE (2008) Gadolinium and nephrogenic systemic fibrosis: time to tighten practice. Pediatr Radiol 38:489–496PubMedCentralPubMedCrossRefGoogle Scholar
  47. Mikkonen R, Kontkanen T, Kivisaari L (1995) Late and acute adverse reactions to Iohexol in a pediatric population. Pediatr Radiol 35:350–352CrossRefGoogle Scholar
  48. Morcos SK. (2007) Nephrogenic systemic fibrosis following the administration of extracellular gadolinium based contrast agents: is the stability of the contrast agent molecule an important factor in the pathogenesis of this condition? Br J Radiol 80:73–76 (Erratum in: Br J Radiol 2007; 80:586)Google Scholar
  49. Morel DR, Schwieger I, Hohn L et al (2000) Human pharmacokinetics and safety evaluation of SonoVue, a new contrast agent for ultrasound imaging. Invest Radiol 35:80–85PubMedCrossRefGoogle Scholar
  50. Nolsoe C, Piscaglia F, Dietrich CF et al (2011) Primum non nocere? Why can’t we use second generation ultrasound contrast agents for the examination of children? Ultraschall Med 32:83–86Google Scholar
  51. Ntoulia K, Darge K, Riccabona M (2013) Contrast-enhanced US of the childs’ urinary tract revisited. Pediatr Radiol (in press)Google Scholar
  52. Papadopoulou F, Evangelou E, Riccabona M et al (2012) Contrast-enhanced voiding urosonography for diagnosis of vesico-ureteric reflux in comparison to conventional methods: a meta-analysis. ECR Book of abstracts, Insights Imaging 3(Suppl 1, SS 1712):B-0860Google Scholar
  53. Pärtan G (2013) Radiography and Fluoroscopy. In: Riccabona M (ed) Pediatric imaging essentials: X-ray, ultrasound, CT and MRI in neonates and children. Thieme Stuttgart (in press)Google Scholar
  54. Pearce MS, Salotti JA, Little MP et al (2012) Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet 380:499–505PubMedCentralPubMedCrossRefGoogle Scholar
  55. Penfield JG, Reilly RF (2008) Nephrogenic systemic fibrosis risk: is there a difference between gadolinium-based contrast agents? Semin Dial 21:129–134PubMedCrossRefGoogle Scholar
  56. Persson P (2011) Personal communication. ESUR meeting, DubrovnikGoogle Scholar
  57. Piscaglia F, Bolondi L (2006) The safety of Sonovue in abdominal applications: retrospective analysis of 23188 investigations. Ultrasound Med Biol 32:1369–1375PubMedCrossRefGoogle Scholar
  58. Piscaglia F, Nolsøe C, Dietrich CF et al (2012) The EFSUMB Guidelines and Recommendations on the Clinical Practice of Contrast Enhanced Ultrasound (CEUS): update 2011 on non-hepatic applications. Ultraschall Med 33:33–59PubMedCrossRefGoogle Scholar
  59. Piskunowicz M, Kosiak W, Irga N (2011) Primum non nocere? Why can’t we use second generation ultrasound contrast agents for the examination of children? Ultraschall Med 32:83–86PubMedGoogle Scholar
  60. Piskunowicz M, Kosiak W, Batko T (2012) Intravenous application of second-generation ultrasound contrast agents in children: a review of the literature. Ultraschall Med 33:135–140PubMedCrossRefGoogle Scholar
  61. Riccabona M, Olsen OE, Claudon M et al (2008a) Gadolinium and nephrogenic systemic fibrosis. In: Fotter R (ed) Pediatric uroradiology. Springer, Berlin-Heidelberg, pp 317–513Google Scholar
  62. Riccabona M, Avni FE, Blickman JG et al (2008b) Imaging recommendations in pediatric uroradiology: minutes of the ESPR working group session on urinary tract infection, fetal hydronephrosis, urinary tract ultrasonography and voiding cystourethrography, Barcelona, Spain, June 2007. Pediatr Radiol 38:138–145PubMedCrossRefGoogle Scholar
  63. Riccabona M, Avni FE, Blickman JG et al (2009) (Members of the ESUR pediatric recommendation working group and ESPR pediatric uroradiology working group). Imaging recommendations in paediatric uroradiology, part II: urolithiasis and haematuria in children, paediatric obstructive uropathy, and postnatal work-up of fetally diagnosed high grade hydronephrosis. Minutes of a mini-symposium at the ESPR annual meeting, Edinburgh June. Pediatr Radiol 39:891–898PubMedCrossRefGoogle Scholar
  64. Riccabona M, Avni FE, Dacher JN et al (2010) ESPR uroradiology task force and ESUR pediatric working group: imaging and procedural recommendations in pediatric uroradiology, part III. Minutes of the ESPR uroradiology task force minisymposium on intravenous urography, uro-CT and MR-urography in childhood. Pediatr Radiol 40:1315–1320PubMedCrossRefGoogle Scholar
  65. Riccabona M (2012) Application of a second-generation US contrast agent in infants and children—a European questionnaire-based survey. Pediatr Radiol 42:1471–1480PubMedCrossRefGoogle Scholar
  66. Ring E, Riccabona M, Fotter R (2008) Normal values, laboratory values. In: Fotter R (ed) Pediatric uroradiology. Springer, Heidelberg, pp 508–510Google Scholar
  67. Schreiber-Dietrich D, Dietrich CF (2012) Contrast enhanced ultrasound (CEUS) and off-label use (in children). Ultraschall Med 33:295–296PubMedCrossRefGoogle Scholar
  68. Schwartz GJ, Haycock GB, Spitzer A (1976) Plasma creatinine and urea concentration in children. Normal values for age and sex. J Pediatr 88:830–928CrossRefGoogle Scholar
  69. Schwartz GJ, Work DF (2008) Measurement and estimation of GFR in children and adolescents. Clin J Am Soc Nephrol 4:1832–1843CrossRefGoogle Scholar
  70. Schwartz GJ, Munoz A, Schneider MF et al (2009) New equations to estimate GFR in children with CKD. J Am Soc Nephrol 20:629–637PubMedCrossRefGoogle Scholar
  71. Sorantin E, Zsivcsec B, Zebedin D, Fotter R (2002) Optimierung von i.v. Kontrastmittelapplikatonen für pädiatrische spiral-CT Untersuchungen (Optimisation of i.v. contrast application for pediatric spiral-CT). Radiologe 45:683–684Google Scholar
  72. Sorantin ES, Weissensteiner S, Hasenburger G, Riccabona M (2013a) CT in children—dose protection and general considerations when planning a CT in a child. Eur J Radiol 82:1043–1049Google Scholar
  73. Sorantin E (2013b) Special aspects of computed tomography in children. In: Riccabona M (ed) Pediatric imaging essentials: X-ray, Ultrasound, CT and MRI in neonates and children. Thieme—Stuttgart (in press)Google Scholar
  74. Speck U (1999) Kontrastmittel Übersicht, Anwendung und pharmazeutische Aspekte. Springer, Berlin, pp 16–17Google Scholar
  75. Taylor GA (2000) Potential pediatric applications for US contrast agents: lessons from the laboratory. Pediatr Radiol 30:101–109PubMedCrossRefGoogle Scholar
  76. ter Haar G (2009) Safety and bio-effects of ultrasound contrast agents. Med Biol Eng Comput 47:893–900PubMedCrossRefGoogle Scholar
  77. Thomsen HS, Morcos SK, Almen T et al (2013) Nephrogenic systemic fibrosis and gadolinium-based contrast media: updated ESUR Contrast Media Safety Committee guidelines. Eur Radiol 23:307–318PubMedCrossRefGoogle Scholar
  78. Torzilli G (2005) Adverse effects associated with SonoVue use. Expert Opin Drug Saf 4:399–401PubMedCrossRefGoogle Scholar
  79. Valentini AL, De Gaetano AM, Destito C et al (2002) The accuracy of voiding urosonography in detecting vesico-ureteral reflux: a summary of existing data. Eur J Pediatr 161:380–384PubMedCrossRefGoogle Scholar
  80. Williams SM, Harned RK (1991) Recognition and prevention of barium enema complications. Curr Probl Diagn Radiol 20:123–151PubMedCrossRefGoogle Scholar
  81. Zerin JM (1992) Contrast studies of the gastrointestinal tract in the neonate. Semin Pediatr Surg 1:284–295PubMedGoogle Scholar
  82. Zimbaro G, Ascenti G, Visalli C et al (2007) Contrast-enhanced ultrasonography (voiding urosonography) of vesicoureteral reflux: state of the art. Radiol Med 112:1211–1224PubMedCrossRefGoogle Scholar
  83. Zoo M, Hoermann M, Balassy C et al (2011) Renal safety in pediatric imaging: randomized, double-blind phase IV clinical trial of iobitridol 300 versus iodixanol 270 in multidetector CT. Pediatr Radiol 41:1393–1400CrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  1. 1.Department of Radiology, Division of Pediatric RadiologyUniversity Hospital GrazGrazAustria

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