BACKGROUND Retained gadolinium from gadolinium-based contrast agents (GBCAs) used in MR exams has been inferred based on signal changes on serial brain MRI and subsequently demonstrated pathologically in adults. Retention has been similarly inferred in children but pathological demonstration in pediatric patients is limited. The long-term effects of retained gadolinium are unknown but are potentially of greater concern in children given their increased vulnerability from continuing development and their expected longer period of exposure. Several factors can influence gadolinium retention. In adults as well as in children, greater accumulation has been demonstrated based on MR signal changes with linear compared with macrocyclic gadolinium chelates, attributed to lower chelate affinity with linear agents. Effects of age at exposure on retention are unknown, while differences in GBCA washout rates are still under investigation and might affect gadolinium retention relative to time of GBCA administration. OBJECTIVE The purpose of this study was to confirm whether gadolinium brain deposits are present in pediatric patients who received GBCAs and to quantify the amounts present. MATERIALS AND METHODS Brain autopsy specimens from 10 pediatric patients between 1 year and 13 years of age who underwent at least one contrast-enhanced MR exam were analyzed for elemental gadolinium using inductively coupled plasma mass spectrometry. Brain samples included white matter, basal ganglia (putamen, globus pallidus), thalamus, dentate nucleus and tumor tissue as available. Type and dose of contrast agent, number and timing of contrast-enhanced MR exams and renal function (estimated glomerular filtration rate [eGFR]) were documented for each child. RESULTS Patient exposures ranged from 1 dose to 20 doses of GBCAs including both macrocyclic and linear ionic agents. Gadolinium was found to be present in brain tissue in all children and was generally highest in the globus pallidus. Those who received only macrocyclic agents showed lower levels of gadolinium retention. CONCLUSION This study demonstrates pathological confirmation of gadolinium retention in brain tissue of a series of pediatric patients exposed to GBCAs including not only linear ionic agents but also macrocyclic agents with both nonionic and ionic compounds. The distribution and deposition levels in this small pediatric population are comparable with the findings in adults. While the clinical significance of these deposits remains unknown, at this point it would be prudent to exert caution and avoid unnecessary use of GBCAs in pediatric patients.

中文翻译：

---

对比增强磁共振检查后，小儿患者脑组织g保留：病理学证实。

背景技术已经基于连续脑MRI上的信号变化推断出了MR检查中使用的contrast基造影剂（GBCA）中的残留g，随后在成人中进行了病理证实。对儿童的保留也有类似的推断，但小儿患者的病理学表现有限。g的长期作用尚不清楚，但由于持续发展中的脆弱性增加以及预期的暴露时间更长，潜在地引起了儿童更大的关注。几个因素会影响g的保留。在成年人和儿童中，与大环with螯合物相比，基于MR信号线性变化已显示出更大的积累，这归因于与线性试剂的螯合亲和力较低。暴露时的年龄对保留的影响尚不清楚，尽管GBCA清除率的差异仍在研究中，并且可能会影响GBCA施用时间后的retention保留。目的本研究的目的是确认接受GBCA的小儿患者是否存在g脑沉积物并量化其存在量。材料与方法使用电感耦合等离子体质谱法分析了至少10例接受了MR对比增强检查的10例小儿患者的脑组织解剖标本中的元素g。脑样本包括白质，基底神经节（丘脑，苍白球），丘脑，齿状核和肿瘤组织。造影剂的种类和剂量 记录了每个孩子的造影剂增强MR检查的次数和时间以及肾功能（估计的肾小球滤过率[eGFR]）。结果患者暴露范围从1剂到20剂GBCA，包括大环和线性离子药物。发现all在所有儿童的脑组织中均存在，通常在苍白球中最高。那些只接受大环药物的患者showed保留率较低。结论本研究证明了一系列接触GBCA的儿科患者脑组织中retention保留的病理学证实，这些患者不仅包括线性离子药物，还包括具有非离子和离子化合物的大环药物。在这个小儿科人群中的分布和沉积水平与成年人的发现相当。