Pediatric MR imagers switching to more stable gadolinium contrast agent

As word has gotten around that macrocyclic gadolinium-based contrast agents (GBCAs) are more stable than linear GBCAs, and thus less likely to deposit in the brain, use of the former type has increased. However, in pediatric settings, at least, much education still needs to be directed to rads and referrers, according to the authors of a study published online March 10 in Pediatric Radiology.

Leena Mithal, MD, of Northwestern University and colleagues e-mailed voluntary closed surveys to 5,390 physicians in various pediatric professional societies between January 2016 and March 2016.

Some 58 percent of pediatric hospital respondents said they had switched their MRI contrast agent from a linear GBCA to a macrocyclic. Another 23 percent said they were considering switching.

The most common reason both groups gave was concern over brain gadolinium deposition, the authors report.

In total, 80 percent indicated they use macrocyclic contrast agents.

The team further found that radiologists were more aware of brain gadolinium deposition than non-radiologist physicians (87 percent vs. 26 percent), while radiologists and referring providers expressed similar levels of concern (95 percent and 89 percent).

Other findings of note from the study:

• 12 percent of radiologists and 2 percent of referring providers reported patients asking about brain gadolinium deposition.
• Radiologists were significantly more comfortable addressing patient inquiries than referring pediatric physicians (48 percent vs. 6 percent).
• The number of MRIs requested by referring pediatric physicians correlated with their knowledge of brain gadolinium deposition, contrast agent used by their hospital and comfort discussing brain gadolinium deposition with patients.

“Since the discovery of brain gadolinium deposition, many pediatric hospitals have switched to or plan to switch to a more stable macrocyclic MR contrast agent, most commonly gadoterate meglumine [(trade name Dotarem)],” Mithal and co-authors write. “Despite this, there is need for substantial further education of radiologists and referring pediatric providers regarding GBCAs and brain gadolinium deposition.”