Recent studies have demonstrated persistent gadolinium deposits in the brains of patients who underwent brain MRIs with gadolinium. The potential long-term risks of these deposits are not clear. The European Medicines Agency recommends restricted use of some gadolinium-based contrast agents (GBCAs) to prevent future risks associated with gadolinium deposits in the brain. FDA’s Medical Imaging Drugs Advisory Committee recommends labels on GBCAs to warn of potential gadolinium retention. We hypothesize that contrast brain MRIs may be over-utilized in infants, and the addition of contrast is often not helpful in clinical decision making.

In 28 of 100 cases analyzed, the addition of gadolinium was considered beneficial.  Of those, contrast was most helpful in suspected infectious etiologies (13/16, 81% benefit). The yield in other diagnostic categories include suspected: seizure (6/25, 24%), intracranial mass (3/12, 25%), vascular lesions (1/5, 20%), abnormal head growth (2/14, 14%), visual problems (2/15, 13%), developmental delay (0/4, 0%), neurocutaneous disorders (0/4, 0%) and miscellaneous (hearing loss, facial droop, vocal cord paralysis and scalp lesion)(1/5, 20%).

Long-term effects of gadolinium deposition in the brain are unknown. Providers should use caution when considering the addition of gadolinium to brain MRIs based on presenting symptoms that may have a low diagnostic yield.  Larger studies are needed to confirm these findings.