Reply to the Letter to the Editor: “Gadolinium in brain – more indicator than main tissue at risk?”
by Jonathan R. Young, Whitney B. Pope (firstname.lastname@example.org)
Gadolinium deposition within the paediatric brain: no increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of a minimum of four doses of the macrocyclic agent gadobutrol
Dear Professor Menu,
We thank Schellenberger et al. for their interest to our article regarding the lack of increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of multiple doses of the macrocyclic agent gadobutrol in pediatric patients . The clinical significance of gadolinium deposition within the brain remains unclear. However, because the pediatric brain is generally more susceptible to the deleterious effects of a variety of toxins [2, 3] and may therefore be more susceptible to effects of gadolinium deposition, it remains important to minimize the risk of gadolinium deposition in pediatric patients. Our studies examining the association of intrinsic T1-weighted signal intensity within the dentate nucleus with both gadobutrol  and gadoteridol  administration, as well the work of other groups [5-10], suggest that macrocyclic gadolinium-based contrast agents may be less likely to deposit within the pediatric brain and should therefore be used instead of linear gadolinium-based contrast agents.
We look forward to future studies examining the clinical significance of gadolinium deposition both within and outside the brain.
 Young JR, Qiao J, Orosz I et al (2018) Gadolinium deposition within the paediatric brain: no increased intrinsic T1-weighted signal intensity within the dentate nucleus following the administration of a minimum of four doses of the macrocyclic agent gadobutrol. Eur Radiol 28:4882-4889
 Blakemore SJ (2012) Imaging brain development: the adolescent brain. Neuroimage 61:397-406
 Stein J, Schettler T, Wallinga D, Valenti M (2002) In harm's way: toxic threats to child development. J Dev Behav Pediatr 23:S13-22
 Young JR, Pope WB, Bobinski M (2018) Gadolinium Deposition within the Pediatric Brain: No Increased Intrinsic T1-Weighted Signal Intensity within the Dentate Nucleus following the Administration of a Minimum of 4 Doses of the Macrocyclic Agent Gadoteridol. AJNR Am J Neuroradiol 39:1604-1608
 Kanda T, Osawa M, Oba H et al (2015) High Signal Intensity in Dentate Nucleus on Unenhanced T1-weighted MR Images: Association with Linear versus Macrocyclic Gadolinium Chelate Administration. Radiology 275:803-809
 Radbruch A, Weberling LD, Kieslich PJ et al (2015) Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology 275:783-791
 Radbruch A, Haase R, Kickingereder P et al (2017) Pediatric Brain: No Increased Signal Intensity in the Dentate Nucleus on Unenhanced T1-weighted MR Images after Consecutive Exposure to a Macrocyclic Gadolinium-based Contrast Agent. Radiology 283:828-836
 Ryu YJ, Choi YH, Cheon JE et al (2018) Pediatric Brain: Gadolinium Deposition in Dentate Nucleus and Globus Pallidus on Unenhanced T1-Weighted Images Is Dependent on the Type of Contrast Agent. Invest Radiol 53:246-255
 Tibussek D, Rademacher C, Caspers J et al (2017) Gadolinium Brain Deposition after Macrocyclic Gadolinium Administration: A Pediatric Case-Control Study. Radiology 285:223-230
 Renz DM, Kümpel S, Böttcher J et al (2018) Comparison of Unenhanced T1-Weighted Signal Intensities Within the Dentate Nucleus and the Globus Pallidus After Serial Applications of Gadopentetate Dimeglumine Versus Gadobutrol in a Pediatric Population. Invest Radiol 53:119-127