Reply to the Letter to the Editor: “Gadolinium in brain – more indicator than main tissue at risk?”
by Jonathan R. Young, Whitney B. Pope (joyoung@coh.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 gadobutrolDear 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 [1]. 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 [1] and gadoteridol [4] 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.