In Reply We thank Roberts et al for their letter highlighting their case report of intracranial gadolinium deposition in a pediatric patient. Their case report provides additional evidence for gadolinium accumulation in pediatric neural tissues following intravenous gadolinium-based contrast agent (GBCA) administration for contrast-enhanced magnetic resonance imaging examinations. Such findings corroborate with the observed deposition detected in prior studies of adult patients.1- 4 The small number of patients in their study and ours5 illustrates the difficulty in finding human tissue samples for gadolinium quantification. We agree with Roberts et al that additional studies are crucial for better understanding both the mechanism and clinical sequelae of gadolinium deposition. However, it is also crucial to point out that GBCAs have revolutionized magnetic resonance imaging examination and diagnostic medicine, often permitting identification of disease that would otherwise go undetected using other imaging modalities. Future risk-benefit assessments of GBCA must balance the currently unproven harm of low levels of central nervous system gadolinium accumulation with the fact that GBCA-enhanced magnetic resonance imaging examinations have helped millions of patients worldwide by providing faster and more accurate diagnostic information.
Jennifer S. McDonald, Robert J. McDonald, Laurence J. Eckel. Gadolinium Deposition in the Pediatric Brain—Reply. JAMA Pediatr. Published online October 09, 2017. doi:10.1001/jamapediatrics.2017.3556