To the Editor We read with interest the Research Letter of McDonald et al1 describing the deposition of gadolinium within the brains of 3 pediatric patients following the administration of the gadolinium-based contrast agent gadodiamide. The gadolinium levels detected within the brain tissue of these decedents ranged from 0.1 to 3.0 µg/g.
We have previously published a case report2 of a pediatric patient, aged 17 years at time of death, who had undergone 4 gadolinium-enhanced magnetic resonance imaging scans. Tissue analysis by inductively coupled plasma mass spectrometry demonstrated 1.01 µg/g of gadolinium within the dentate nucleus and laser ablation inductively coupled plasma mass spectrometry demonstrated the distribution of gadolinium throughout the cerebellum. While the highest levels of gadolinium were noted in the dentate nucleus, gadolinium deposition was found throughout the cerebellar cortex, particularly within the depths of the cerebellar folia, which may indicate a vascular route of gadolinium deposition. Analysis of a brain tissue sample from another pediatric patient who had not been exposed to gadolinium contrast demonstrated no evidence of gadolinium deposition within the cerebellar tissue (less than the limits of detection of our technique). Our results, along with those of McDonald et al,1 highlight the need for further research into any potential adverse effects of gadolinium accumulation, particularly in pediatric patients requiring exposure to multiple contrasted MR examinations.
Roberts DR, Welsh CA, Davis WC. Gadolinium Deposition in the Pediatric Brain. JAMA Pediatr. 2017;171(12):1229. doi:10.1001/jamapediatrics.2017.3553
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