Gd in infants/children
Can gadolinium be given safely to infants and children?
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All available evidence suggests that gadolinium-based contrast agents are well tolerated in infants and children and may provide useful radiologic information in selected cases. The risk of an adverse drug reaction is apparently no higher or lower in the pediatric population than in adults.
In the last several years considerable attention has been directed toward the potential cellular toxicity of gadolinium and its role in the development of nephrogenic systemic fibrosis (NSF). In a recent review 23 children were identified in the United States between 1997 and 2012 with proof of this disease. All had significant renal impairment or were on dialysis. Nearly all were teenagers or adolescents; the four youngest were between 6 and 9 years old. Seventeen (74%) patients had documented exposure to gadolinium contrast, predominantly gadodiamide. Of note, no gadolinium exposure could be demonstrated in 6 of the patients.
Appropriate use of Gd in newbornwith congenital brain tumor.
Because of potential cellular toxicity and unknown effects, I personally recommend the use of gadolinium contrast only sparingly in infants and young children and restrict its use to cases when a reasonable diagnostic benefit seems likely. Most frequently this includes those with suspected tumor or infection.
Because some amount of free gadolinium is likely leaked into tissues by all contrast agents, it seems reasonable to recommend Dotarem® in infants and children because it possesses the strongest gadolinium binding of all commercially available agents.
Since the biological half-life of these agents may be prolonged in premature infants due to their naturally lower glomerular filtration rates (GFRs), a theoretical risk of increased exposure to free gadolinium may be present in this subgroup. Precautions and prohibitions regarding the use of gadolinium in children with renal impairment should follow those guidelines used in the adult population.
Because some amount of free gadolinium is likely leaked into tissues by all contrast agents, it seems reasonable to recommend Dotarem® in infants and children because it possesses the strongest gadolinium binding of all commercially available agents.
Since the biological half-life of these agents may be prolonged in premature infants due to their naturally lower glomerular filtration rates (GFRs), a theoretical risk of increased exposure to free gadolinium may be present in this subgroup. Precautions and prohibitions regarding the use of gadolinium in children with renal impairment should follow those guidelines used in the adult population.
References
ACR Committee on Drugs and Contrast Agents. ACR Manual on Contrast Agents, 2023. American College of Radiology, 2022.
Elster AD. Cranial MR imaging with Gd-DTPA in neonates and young infants: preliminary experience. Radiology 1990; 176:225-230.
Elster AD, Rieser GD. Gd-DTPA-enhanced cranial MR imaging in children: initial clinical experience and recommendation for its use. AJNR Am J Neuroradiol 1989; 10:1027-1030.
Foss C, Smith JK, Ortiz L, et al. Gadolinium-associated nephrogenic systemic fibrosis in a 9-year old boy. Ped Derm 2009;26:579-582.
Karcaaltincaba M, Oguz B, Haliloglu M. Current status of contrast-induced nephropathy and nephrogenic systemic fibrosis in children. Pediatr Radiol 2009; 39 (Suppl 3):S382-S384.
Nardone B, Saddleton E, Laumann AE, et al. Pediatric nephrogenic systemic fibrosis is rarely reported: a RADAR report. Ped Radiol 2014; 44:173-8.
ACR Committee on Drugs and Contrast Agents. ACR Manual on Contrast Agents, 2023. American College of Radiology, 2022.
Elster AD. Cranial MR imaging with Gd-DTPA in neonates and young infants: preliminary experience. Radiology 1990; 176:225-230.
Elster AD, Rieser GD. Gd-DTPA-enhanced cranial MR imaging in children: initial clinical experience and recommendation for its use. AJNR Am J Neuroradiol 1989; 10:1027-1030.
Foss C, Smith JK, Ortiz L, et al. Gadolinium-associated nephrogenic systemic fibrosis in a 9-year old boy. Ped Derm 2009;26:579-582.
Karcaaltincaba M, Oguz B, Haliloglu M. Current status of contrast-induced nephropathy and nephrogenic systemic fibrosis in children. Pediatr Radiol 2009; 39 (Suppl 3):S382-S384.
Nardone B, Saddleton E, Laumann AE, et al. Pediatric nephrogenic systemic fibrosis is rarely reported: a RADAR report. Ped Radiol 2014; 44:173-8.
Related Questions
Why are most MR contrast agents based on the element gadolinium?
Should the dose of gadolinium be reduced in infants and children?
Why are most MR contrast agents based on the element gadolinium?
Should the dose of gadolinium be reduced in infants and children?