Tolerance of GBCAs in children

In this video, Dr. Bhargava discusses the use of gadolinium based contrast agents (GBCAs) in children. This includes a summary of the types of non-allergic and allergic-like reactions that can occur, a review of nephrogenic systemic fibrosis (NSF), and the topic of gadolinium presence in the brain.

NSF is a rare disease that is linked to the use of GBCAs. Most cases of NSF have occurred in patients with severe renal impairment. The prevailing theory regarding the association between the use of GBCAs and the development of NSF is that the stability of the GBCA is related to the risk of triggering the disease. Linear agents are more prone to dissociation of gadolinium ion than the macrocyclic agents, and the impact of this can be observed in preclinical studies that have investigated the concentration of gadolinium deposited in the skin of rats injected with different GBCAs.

The presence of gadolinium in the brain became a hot topic after reports started emerging in the literature in 2014 demonstrating an association between increasing signal intensity in certain brain structures and the cumulative dose of GBCA that a patient had received in their lifetime. In this video, Dr. Bhargava discusses his own research that showed no signal intensity change in the pediatric brain after multiple exposures to the macrocyclic agent, gadobutrol.

In the upcoming fourth and final part of this video series, Dr. Bhargava finishes with patient management strategies.