Susceptibility-Weighted Imaging of the Pediatric Brain after Repeat Doses of Gadolinium-Based Contrast Agent

Background and Purpose: Gadolinium complexes have paramagnetic properties; thus, we aimed to determine the susceptibility changes in the globus pallidus and dentate nucleus following administration of linear or macrocyclic gadolinium-based contrast agents in children. Materials and Methods: Thirty-three patients with linear gadolinium-based contrast agent gadopentetate dimeglumine administration, 33 age- and sex-matched patients with macrocyclic gadolinium-based contrast agent gadobutrol administration, and 33 age- and sex-matched control subjects without gadolinium exposure were enrolled in this retrospective study. The signal intensity on SWI and T1WI was determined in the dentate nucleus, middle cerebellar peduncle, globus pallidus, and pulvinar of the thalamus in an ROI-based analysis to calculate dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios. A repeated measures ANOVA was performed to compare SWI _minimum, SWI _mean, and T1WI signal intensity ratios between gadolinium-based contrast agent groups and control subjects. Pearson correlation analysis was performed to determine any correlation between signal intensity ratios and variables. Results: Dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios for both SWI _meanand SWI _minimumwere lower for the linear gadolinium-based contrast agent group compared with macrocyclic gadolinium-based contrast agent and control groups (P,.05). No significant difference of the SWI _meanand SWI _minimumratios were noted between the macrocyclic gadolinium-based contrast agent group and the control group (P..05). Both dentate nucleus-to-middle cerebellar peduncle and globus pallidus-to-thalamus ratios on T1WI in the linear gadolinium-based contrast agent group were higher than in the control group and the macrocyclic gadolinium-based contrast agent group (P,.05). A negative correlation was identified between SWI _meanand SWI _minimumratios and the number of linear gadolinium-based contrast agent administrations (dentate nucleus-to-middle cerebellar peduncle ratio: SWI _mean, r = -0.43, P=.005; SWI _minimum, r = -0.38, P = .011; globus pallidus-to-thalamus ratio: SWI _mean, r = -0.39, P=.009; SWI _minimum, r = -0.33, P = .017). Conclusions: SWI analysis of the pediatric brain demonstrated a statistically significant decrease in SWI _minimumand SWI _meanvalues for the dentate nucleus and globus pallidus after administration of linear gadolinium-based contrast agents but not macrocyclic gadolinium-based contrast agents.