Gadolinium in pediatric cardiovascular magnetic resonance: what we know and how we practice

The association of gadolinium-based contrast agents (GBCAs) with nephrogenic systemicfibrosis (NSF) has led to a heightened awareness towards patients'renal function. Whereasdetailed guidelines exist for the use of GBCAs in adult patients, best practice is less welldefined in children, especially in the very young.

We aimed at identifying current practicewith regards to the use of GBCAs in children who undergo Cardiovascular MagneticResonance.

Methods: We conducted a worldwide survey among cardiac imagers with pediatric expertise. Thequestionnaire contained 21 questions covering the imagers'work environments, GBCAsused, monitoring of renal function, and a special emphasis was placed on the practice inneonates.

Results: The survey yielded 70 replies.

The single most commonly used GBCA was gadopentetatedimeglumine 34/70 (49%). Among the respondents, the choice of GBCA was moreimportantly based on availability 26/70 (37%) and approval by a pharmaceutical licensingbody that most closely reflects the indication 16/70 (23%) than image quality 7/70 (10%) andside effect profile 8/70 (11%).

55/70 (79%) of respondents performed scans in neonates <1week of age and 52/55 (95%) of them use GBCA in neonates. 65/70 (93%) respondents atleast assess some of their patients'renal functions.

Formula-based estimate of glomerularfiltration rate is the most popular assessment method 35/65 (54%). In patients with aglomerular filtration rate <30 ml/kg/1.73 m2 62/70 (89%) of respondents do not administergadolinium at all.

The single most common side effect of gadolinium was noted to benausea/emesis 34/57 (60%) followed by discomfort at injection site 17/57 (30%).

Conclusions: Cardiac imagers are aware of the immature renal function and physiological differences oftheir pediatric patients that place them at risk for NSF. Epidemiological data is needed forpediatric cardiovascular licensure of gadolinium compounds and for the creation of practiceguidelines which will replace current-day practice based on individual clinical judgment.

Author: Howard MengLars Grosse-Wortmann
Credits/Source: Journal of Cardiovascular Magnetic Resonance 2012, 14:56

Published on: 2012-08-07

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