Is administration of gadolinium-based contrast media to pregnant women and small children justified?

Journal of Magnetic Resonance Imaging

Volumn 34, Issue 4, 2011, Pages 750-757

  Sundgren, Pia C ^a,b   Leander, Peter ^a  

^a LUND UNIVERSITY HOSPITAL   (Sweden)

^b UNIVERSITY OF MICHIGAN HEALTH SYSTEM   (United States)

Author keywords

children; gadolinium; MR; pregnant women

Indexed keywords

CONTRAST MEDIUM; GADOBENATE DIMEGLUMINE; GADODIAMIDE; GADOLINIUM; GADOLINIUM PENTETATE; GADOVERSETAMIDE;

ABDOMINAL RADIOGRAPHY; ABSENCE OF SIDE EFFECTS; BREAST FEEDING; CARDIOVASCULAR SYSTEM EXAMINATION; CHILD; COMPUTER ASSISTED TOMOGRAPHY; CONTRAST ENHANCEMENT; DRUG EXCRETION; DRUG MEGADOSE; DRUG TISSUE LEVEL; FEMALE; FETOTOXICITY; FIRST TRIMESTER PREGNANCY; GLOMERULUS FILTRATION RATE; GROUPS BY AGE; HIGH RISK POPULATION; HUMAN; LACTATION; MEDICAL PRACTICE; MUSCULOSKELETAL SYSTEM EXAMINATION; NEPHROGENIC SYSTEMIC FIBROSIS; NEUROIMAGING; NONHUMAN; NUCLEAR MAGNETIC RESONANCE IMAGING; PLACENTA CIRCULATION; PLACENTAL TRANSFER; PRACTICE GUIDELINE; PREGNANT WOMAN; PRENATAL DRUG EXPOSURE; PRIORITY JOURNAL; RADIODIAGNOSIS; RECOMMENDED DRUG DOSE; REVIEW; RISK FACTOR; THORAX RADIOGRAPHY;

ADULT; AGE FACTORS; ANIMALS; CHILD, PRESCHOOL; CONTRAST MEDIA; FEMALE; GADOLINIUM; GESTATIONAL AGE; HUMANS; INFANT; INFANT, NEWBORN; LACTATION; MAGNETIC RESONANCE IMAGING; MATERNAL-FETAL EXCHANGE; PRACTICE GUIDELINES AS TOPIC; PREGNANCY; PREGNANCY COMPLICATIONS; PREGNANCY, ANIMAL; RABBITS; RADIOGRAPHIC IMAGE ENHANCEMENT; REPRODUCIBILITY OF RESULTS; RISK ASSESSMENT; SAFETY MANAGEMENT; SWEDEN;

EID: 80053024740     PISSN: 10531807     EISSN: 15222586     Source Type: Journal    
DOI: 10.1002/jmri.22413     Document Type: Review

References (70)

1. Kanal E, Barkovich AJ, Bell C, et al. ACR guidance document for safe MR practices: 2007. AJR Am J Roentgenol 2007; 188: 1447-1474. (Pubitemid 46866845)
2. Shellock FG, Crues JV., MR procedures: biologic effects, safety, and patient care. Radiology 2004; 232: 635-652. (Pubitemid 39100245)
3. Wagner LK, Lester RG, Saldana LR, Exposure of the pregnant patient to diagnostic radiations: a guide to medical management, 2nd ed. Madison, WI: Medical Physics, 1997.
4. Sundgren PC,. Is there a need for use of contrast in the pregnant mother and in small children. In: Proc 17th Annual Meeting ISMRM, Honolulu; 2009.
5. Shellock FG, Kanal E., Safety of magnetic resonance imaging contrast agents. J Magn Reson Imaging 1999; 10: 477-484. (Pubitemid 29463135)
6. Shellock FG, Kanal E, Bioeffects and safety of MR procedures. In:, Edelman R, Heselink J, Zlatkin M, editors. Clinical magnetic resonance imaging. Philadelphia: Saunders; 1996: 429.
7. American College of Radiology. Manual on contrast media, 5th ed. Reston, VA: American College of Radiology; 2004: 44-45.
8. Jung SE, Byun JY, Lee JM, et al. MR imaging of maternal diseases in pregnancy. AJR Am J Roentgenol 2001; 177: 1293-1300.
9. Novak Z, Thurmond AS, Ross PL, Jones MK, Thornburg KL, Katzberg RW., Gadolinium-DTPA transplacental transfer and distribution in fetal tissue in rabbits. Invest Radiol 1993; 28: 828-830. (Pubitemid 24079734)
10. Okazaki O, Murayama N, Masubuchi N, Nomura H, Hakasui H., Placental transfer and milk secretion of gadodiamide injection in rats. Arzneimittelfors Drug Res 1996; 46: 83-86. (Pubitemid 26051484)
11. Taillieu F, Salomon LJ, Siauve N, et al. Placenta perfusion and permeability: simultaneous assessment with dual-echo contrast enhanced MR imaging in mice. Radiology 2006; 241: 737-745. (Pubitemid 46190539)
12. Marcos HB, Semelka RC, Worawattanakul S., Normal placenta: gadolinium-enhanced dynamic MR imaging. Radiology 1997; 205: 493-496. (Pubitemid 27467331)
13. Petrou M, Foerster B, Maly PV, Eldevik PO, Leber S, Sundgren PC., Added utility of gadolinium in the MRI work-up of seizures in children under the age of two. J Child Neurol 2007; 22: 200-203. (Pubitemid 46860419)
14. Foerster BR, Ksar J, Petrou M, et al. Value of gadolinium administration in brain MRI examinations for developmental delay in children less than two years of age. Pediatr Neurol 2006; 35: 126-130. (Pubitemid 44093989)
15. Jennings J, Petrou M, Sundgren PC, et al. The value of contrast administration in MRI of the spine in children under two years of age. In: Proc ECR 200, p 296, P4491.
16. Magnevist (brand of gadopentetate dimeglumine) injection [package insert]. Montville, NJ: Berlex; 2005.
17. Omniscan (gadodiamide) injection [package insert]. Waukesha, WI: General Electric Healthcare; 2002.
18. OptiMARK (gadoversetamide) injection [package insert]. St. Louis, MO: Mallinckrodt; 2003.
19. ProHance (gadoteridol) injection [package insert]. Princeton, NJ: Bracco Diagnostics; 2002.
20. MultiHance (gadobenate dimeglumine) injection [package insert]. Princeton, NJ: Bracco Diagnostics; 2005.
21. Panigel M, Wolf G, Zeleznick A., Magnetic resonance imaging of the placenta in rhesus monkeys, Macaca mulatta. J Med Primatol 1988; 17: 3-18. (Pubitemid 18071467)
22. Wible JH Jr, Galen KP, Wojdyla JK., Cardiovascular effects caused by rapid administration of gadoversetamide injection in anesthetized dogs. Invest Radiol 2001; 36: 292-298. (Pubitemid 32436610)
23. Rofsky NM, Pizzarello DJ, Weinreb JC, Ambrosino MM, Rosenberg C., Effect on fetal mouse development of exposure to MR imaging and gadopentetate dimeglumine. J Magn Reson Imaging 1994; 4: 805-807.
24. Soltys RA., Summary of preclinical safety evaluation of gadoteridol injection. Invest Radiol 1992; 27 (Suppl 1): S7-11.
25. Morisetti A, Bussi S, Tirone P, de Haen C,. Toxicological safety evaluation of gadobenate dimeglumine 0.5 M solution for injection (MultiHance), a new magnetic resonance imaging contrast medium. J Comput Assist Tomogr 1999; 23 (Suppl 1): S207-217. (Pubitemid 30027609)
26. Rofsky NM, Pizzarello DJ, Duhaney MO, Falick AK, Prendengast N, Weinreb JC., Effect on magnetic resonance exposure combined with gadopentetate dimeglumine on chromosomes in animal specimens. Acad Radiol 1995; 2: 492-496.
27. Tanaka Yo, Sohda S, Shigemitsu S, Niitsu M, Itai Y., High temporal resolution dynamic MRI in a high risk group for placenta accreta. Magn Reson Imaging 2001; 19: 635-642. (Pubitemid 32751595)
28. Palacios Jaraquemada JM, Bruno C., Gadolinium-enhanced MR imaging in the differential diagnosis of placenta accreta and placenta percreta [letter]. Radiology 2000; 216: 610-611. (Pubitemid 30599891)
29. Shoenut JP, Semelka RC, Silverman R, Yaffe CS, Micflikier AB., MRI in the diagnosis of Crohn's disease in two pregnant women. J Clin Gastroenterol 1993; 17: 244-247. (Pubitemid 23304506)
30. Barkhof F, Heijboer RJ, Algra PR,. Inadvertent i.v. administration of gadopentetate dimeglumine during early pregnancy. AJR Am J Roentgenol 1992; 158: 1171.
31. De Santis M, Straface G, Cavaliere AF, Carducci B, Caruso A., Gadolinium preconceptional exposure: pregnancy and neonatal outcome. Acta Obstet Gynecol Scand 2007; 86: 99-101. (Pubitemid 46009534)
32. Leyendecker JR, Gorengaut V, Brown JJ., MR imaging of maternal diseases of the abdomen and pelvis during pregnancy and the immediate postpartum period. RadioGraphics 2004; 24: 1301-1316. (Pubitemid 39329376)
33. Birchard KR, Broan MA, Hyslop WB, Firat Z, Semelka RC., MRI of acute abdominal and pelvic pain in pregnant patients. AJR Am J Roentgenol. 2005; 184: 452-458. (Pubitemid 46657250)
34. Spencer JA, Tomlinson AJ, Weston MJ, Lloyd SN,. Early report: comparison of breath-hold MR excretory urography, Doppler ultrasound and isotope renography in evaluation of symptomatic hydronephrosis in pregnancy. Clin Radiol 2000; 55: 446-453. (Pubitemid 32054551)
35. Pedrosa I, Zeikus EA, Levine D, Rofsky NM., MR imaging of acute right lower quadrant pain in pregnant and nonpregnant patients. RadioGraphics 2007; 27: 721-753.
36. Oto A, Ernst RD, Ghulmiyyah LM, et al. MR imaging in the triage of pregnant patients with acute abdominal and pelvic pain. Abdom Imaging 2009; 34: 243-250.
37. Pedrosa I, Levine D, Eyvazzadeh AD, Siewert B, Ngo L, Rofsky NM., MR imaging evaluation of acute appendicitis in pregnancy. Radiology 2006; 238: 891-899. (Pubitemid 43289919)
38. Jaffe, TA, Miller CM, Merkle EM,. Practice patterns in imaging of the pregnant patient with abdominal pain: a survey of academic centers. AJR Am J Roentgenol 2007; 189: 1128-1134. (Pubitemid 350033005)
39. ESUR guidelines on contrast media. European Society of Urogenital Radiology, version 7.0. Available at
40. Webb JA, Thomsen HS, Morcos SK,; Members of Contrast Media Safety Committee of European Society of Urogenital Radiology (ESUR). The use of iodinated and gadolinium contrast media during pregnancy and lactation. Eur Radiol 2005; 15: 1234-1240.
41. Marti-Bonmati L, Vega T, Benito C, et al. Safety and efficacy of Omniscan (gadodimide injection) at 0.1 mmol/kg for MRI in infants younger than 6 months of age: phase III open multicenter study. Invest Radiol 2000; 35: 141-147. (Pubitemid 30078275)
42. Tsai-Goodman B, Geva T, Odegard KC, Sena LM, Powell AJ., Clinical role, accuracy, and technical aspects of cardiovascular magnetic resonance imaging in infants. Am J Cardiol 2004; 94: 69-74. (Pubitemid 38813457)
43. Kirchin MA, Pirovano G, Venetianer C, Spinazzi A., Safety assessment of gadobenate dimeglumine (MultiHance): extended clinical experience from phase I studies to post-marketing surveillance. J Magn Reson Imaging 2001; 14: 281-294. (Pubitemid 32801062)
44. Shellock FG, Parker JR, Venetianer C, Pirovano G, Spinazzi A., Safety of dimeglumine (MultiHance). Summary of findings from clinical studies and postmarketing surveillance. Invest Radiol 2006; 41: 500-509.
45. Kubik-Huch RA, Gottstein-Aalame NM, Frenzel T, et al. Gadopentetate dimeglumine extraction into human breast milk during lactation. Radiology 2000; 216: 555-558. (Pubitemid 30599881)
46. Schmiedl U, Maravilla KR, Gerlach R, Dowling CA,. Excretion of gadopentetate dimeglumine in human breast milk. AJR Am J Roentgenol. 1990; 154: 1305-1306. (Pubitemid 20179484)
47. Rofsky NM, Weinreb JC, Litt AW., Quantitative analysis of gadopentetate dimeglumine excreted in breast milk. J Magn Reson Imaging 1993; 3: 131-132.
48. Chen MM, Coakley FV, Kaimal A, Laros RK Jr. , Guidelines for computer tomography and magnetic resonance imaging use druing pregnancy and lactation. Obstet Gynecol 2008; 112: 333-340.
49. Hylton NM., Suspension of breast-feeding following gadopentetate dimeglumine administration [editorial)] Radiology 2000; 216: 325-326.
50. Colosimo C, Demaerel P, Tortori-Donati P, et al. Comparison of gadobenate dimeglumine (Gd-BOPTA) with gadopentetate dimeglumine (Gd-DTPA) for enhanced MR imaging of brain and spine tumours in children. Pediatr Radiol 2005; 35: 501-510. (Pubitemid 41166688)
51. Hahn G, Sorge I, Gruhn B, et al. Pharmacokinetics and safety of gadobutrol-enhanced magnetic resonance imaging in pediatric patients. Invest Radiol 2009; 44: 776-783.
52. Dillman JR, Ellis JH, Cohan RH, Strouse PJ, Jan SC,. Frequency and severity of acute allergic-like reactions to gadolinium-containing i.v. contrast media in children. AJR Am J Roentgenol 2007; 189: 1535-1538.
53. Bellin MF, Van Der Molen AJ., Extracellular gadolinium-based contrast media: an overview. Eur J Radiol 2008; 66: 160-167.
54. Eldevik OP, Brunberg JA,. Gadopentetate dimeglumine-enhanced MR of the brain: clinical utility and safety in patients younger than two years of age. AJNR Am J Neuroradiol 1994; 15: 1001-1008. (Pubitemid 24184357)
55. Malviya S, Voepel-Lewis T, Eldevik P, et al. Sedation and general anaesthesia in children undergoing MRI and CT: adverse effects and outcomes. Br J Anaesth 2000; 84: 743-748. (Pubitemid 30312044)
56. Mayr M, Burkhalter F, Bongartz G., Nephrogenic systemic fibrosis: clinical spectrum of disease. J Magn Reson Imaging 2009; 30: 1289-1297.
57. Bhave G, Lewis JB, Chang SS., Association of gadolinium based magnetic resonance imaging contrast agents and nephrogenic systemic fibrosis. J Urol 2008; 180: 830-835; discussion 835.
58. Shabana WM, Cohan RH, Ellis JH, et al. Nephrogenic systemic fibrosis: a report of 29 cases. AJR Am J Roentgenol 2008; 190: 736-741. (Pubitemid 351304519)
59. Wiginton CD, Kelly B, Oto A, et al. Gadolinium-based contrast exposure, nephrogenic systemic fibrosis, and gadolinium detection in tissue. AJR Am J Roentgenol 2008; 190: 1060-1068. (Pubitemid 351571526)
60. Chrysochou C, Buckley DL, Dark P, Cowie A, Kalra PA., Gadolinium-enhanced magnetic resonance imaging for renovascular disease and nephrogenic systemic fibrosis: critical review of the literature and UK experience. J Magn Reson Imaging 2009; 29: 887-894.
61. Perez-Rodriguez J, Lai S, Ehst BD, Fine DM, Bluemke DA,. Nephrogenic systemic fibrosis: incidence, associations, and effect of risk factor assessment-report of 33 cases. Radiology 2009; 250: 371-377.
62. Shellock FG, Spinazzi A., MRI Safety update 2008: Part 1, MRI contrast agents and nephrogenic systemic fibrosis. AJR Am J Roentgenol 2008; 191: 1129-1139.
63. 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.
64. Thomsen HS, Marckmann P., Extracellular Gd-CA: differences in prevalence of NSF. Eur J Radiol 2008; 66: 180-183.
65. Halvorsen RA,. Which study when? Iodinated contrast enhanced CT versus gadolinium-enhanced MR imaging. Radiology 2008; 249: 9-15.
66. Weinreb JC,. Which study when? Is gadolinium-enhanced MR imaging safer than iodine-enhanced CT? Radiology 2008; 249: 3-8.
67. Foss C, Smith JK, Ortiz L, Hanevold C, Davis L., Gadolinium-associated nephrogenic systemic fibrosis in a 9-year-old boy. Pediatr Dermatol 2009; 26: 579-582.
68. Jain SM, Wesson S, Hassanein A, et al. Nephrogenic fibrosing dermopathy in pediatric patients. Pediatr Nephrol 2004; 19: 467-470. (Pubitemid 38477417)
69. Dharnidharka VR, Wesson SK, Fennell RS,. Gadolinium and nephrogenic fibrosing dermopathy in pediatric patients. Pediatr Nephrol 2007; 22: 1395. (Pubitemid 47054936)
70. Penfield JG., Nephrogenic systemic fibrosis and the use of gadolinium-based contrast agents. Pediatr Nephrol 2008; 23: 2121-2129.