Dennis Dünger1, Matthias Krause2, Daniel Gräfe1, Andreas Merkenschlager3, Christian Roth1, Ina Sorge4. 1. Department of Paediatric Radiology, University Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany. 2. Department of Neurosurgery/Paediatric Neurosurgery, University Leipzig, Leipzig, Germany. 3. Department of Woman and Child Health, Hospital for Children & Adolescents, University Leipzig, Leipzig, Germany. 4. Department of Paediatric Radiology, University Leipzig, Liebigstrasse 20a, 04103, Leipzig, Germany. Ina.Sorge@medizin.uni-leipzig.de.
Abstract
BACKGROUND: 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. OBJECTIVE: 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. RESULTS: 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. CONCLUSION: 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.
BACKGROUND: 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. OBJECTIVE: 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. RESULTS: 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. CONCLUSION: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.
Authors: Alexander Radbruch; Lukas D Weberling; Pascal J Kieslich; Oliver Eidel; Sina Burth; Philipp Kickingereder; Sabine Heiland; Wolfgang Wick; Heinz-Peter Schlemmer; Martin Bendszus Journal: Radiology Date: 2015-04-06 Impact factor: 11.105
Authors: Nozomu Murata; Luis F Gonzalez-Cuyar; Kiyoko Murata; Corinne Fligner; Russell Dills; Daniel Hippe; Kenneth R Maravilla Journal: Invest Radiol Date: 2016-07 Impact factor: 6.016
Authors: D R Roberts; A R Chatterjee; M Yazdani; B Marebwa; T Brown; H Collins; G Bolles; J M Jenrette; P J Nietert; X Zhu Journal: AJNR Am J Neuroradiol Date: 2016-07-28 Impact factor: 3.825
Authors: Tara Anne Collidge; Peter Campbell Thomson; Patrick Barry Mark; James Phillip Traynor; Alan George Jardine; Scott Thomas William Morris; Keith Simpson; Giles Hannibal Roditi Journal: Radiology Date: 2007-08-17 Impact factor: 11.105
Authors: Myria Petrou; Bradley Foerster; Pavel V Maly; Odd P Eldevik; Steven Leber; Pia C Sundgren Journal: J Child Neurol Date: 2007-02 Impact factor: 1.987