背景和目的自1988年以来,基于钆的造影剂(GBCA)已在临床上使用。儿童对它们的耐受性非常好,并导致剂量依赖性组织沉积,即使是肾功能正常的患者。在肾功能正常的患者中,没有发现钆沉积的不良反应。鉴于钆沉积的不确定影响,我们试图分析儿童非增强原发性脑肿瘤影像学随访中钆的使用情况.材料和方法本回顾性研究,机构审查委员会批准的、符合健康保险可携带性和责任法案的研究评估了在脑肿瘤常规评估中接受GBCA的儿科患者.这一特殊子集包括30例患者(<18岁),这些患者最初患有原发性颅内肿瘤,在我们机构接受了治疗和随访。患者数据包括性别,从诊断到最近的影像学随访的年龄,对比增强磁共振成像(MRI)随访检查的数量,活检或切除的组织病理学。结果本组有多种预期的肿瘤,包括低级星形细胞瘤,胚胎发育不良神经上皮肿瘤,少突神经胶质瘤,还有畸胎瘤.我们的患者中有一半患有组织病理学未知的肿瘤,未进行活检或切除。诊断时的中位年龄为8.9岁,每位患者四次随访MRI的中位数,和中位随访时间为四年。30例患者中只有1例增强了对随访MRI的关注,该MRI在两年内保持稳定且无症状,并且不需要手术干预。结论在儿童中合理使用GBCA,尤其是当预期多年来的无数考试时,建议给出有关软组织沉积的数据。初步结果表明,从最初未增强的脑肿瘤的常规随访中省略GBCA可能是可行的。
Background and purpose Gadolinium-based contrast agents (GBCAs) have been administered clinically since 1988. They are remarkably well tolerated by children and result in dose-dependent tissue deposition, even in patients with normal renal function. No adverse effects of gadolinium deposition in patients with normal renal function have been established. Given the uncertain effects of gadolinium deposition, we sought to analyze gadolinium use in the imaging follow-up of nonenhancing primary brain neoplasms in children. Materials and methods This retrospective, institutional review board-approved and Health Insurance Portability and Accountability Act-compliant study evaluated pediatric patients who received GBCA in the routine evaluation of brain neoplasms. This special subset included 30 patients (<18 years old) with initially nonenhancing primary intracranial neoplasms who received treatment and follow-up at our institution. Patient data included sex, age from diagnosis to most recent imaging follow-up, number of contrast-enhanced magnetic resonance imaging (MRI) follow-up exams, and histopathology from a biopsy or resection. Results The group had an expected variety of tumors, including low-grade astrocytomas, dysembryoplastic neuroepithelial tumors, oligodendrogliomas, and teratomas. Half of our patients had tumors of unknown histopathology that were not biopsied or resected. The median age at diagnosis was 8.9 years, the median of four follow-up MRIs per patient, and the median follow-up time of four years. Only one of the 30 patients developed an enhancing focus on follow-up MRI that remained stable and asymptomatic over two years and did not require surgical intervention. Conclusion Judicious use of GBCA in children, especially when numerous exams over many years are anticipated, is advised given the data regarding soft-tissue deposition. Preliminary results suggest that it may be feasible to omit GBCA from routine follow-ups of initially nonenhancing brain neoplasms.