Progressive increase of T1 signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images in the pediatric brain exposed to multiple doses of gadolinium contrast

Recently, there have been reports of gadolinium accumulation in the brain and bone of adult patients with normal renal function who have undergone multiple gadolinium contrast administrations. This case report gives the first description of a pediatric patient who, following multiple contrasted MRI exams, demonstrated abnormal signal on unenhanced T1-weighted imaging involving the dentate nucleus and globus pallidus, a finding which has previously been shown to represent gadolinium deposition in adults. The patient presented here had no history of intracranial pathology which would alter the blood brain barrier or abnormal renal function. The clinical significance of gadolinium accumulation in the human body is currently unknown but is of concern, particularly in pediatric patients who have a lifetime to manifest any potential adverse consequences. Therefore, research is needed to address the clinical significance, if any, of gadolinium deposition in the developing pediatric brain. Given these current uncertainties, clinicians should continue to use prudence in selecting pediatric patients to undergo contrasted MRI and in selecting the appropriate contrast agents to use.