Lower Gadopiclenol Dosage Found Safe and Effective for Pediatric Imaging

New research supports the use of a lower-dose MRI contrast agent, gadopiclenol, in pediatric imaging, offering diagnostic quality comparable to standard agents while reducing gadolinium exposure by half.

The study, published in the American Journal of Roentgenology, compared gadopiclenol at 0.05 mmol/kg with gadoterate meglumine, a commonly used agent in pediatric MRI administered at 0.1 mmol/kg. Findings showed that gadopiclenol delivered equivalent diagnostic imaging quality despite using half the gadolinium dose, suggesting a safer alternative for children.

“The macrocyclic agent gadopiclenol, FDA-approved in 2022, has relatively high T1 relaxivity, allowing substantial dose reductions,” noted Camilo Jaimes, MD, of the Pediatric Imaging Research Center at Massachusetts General Hospital. “Use of gadopiclenol could facilitate reductions in cumulative gadolinium exposure in children requiring serial MRI examinations.”

Though approved for adults and children aged 2 and older, real-world pediatric data on gadopiclenol has been limited. This prompted researchers to study its effectiveness in clinical settings following FDA approval.

The team analyzed imaging data from 38 pediatric patients who had received MRIs using both contrast agents within a six-month period. All scans used the same MRI protocol and field strength. Two blinded neuroradiologists evaluated image quality, measuring both contrast ratio and contrast-to-noise ratio in enhancing anatomical structures, including the choroid plexus, pituitary gland, dural venous sinuses, and turbinate mucosa.

For gadopiclenol, the readers observed higher contrast ratios in the choroid plexus on 3D T1-weighted fast-spin echo sequences and better visualization of the turbinate on 3D T1-weighted gradient-recalled echo sequences. Contrast-to-noise ratio comparisons between the two agents showed no statistically significant differences across all measured areas.

Both neuroradiologists preferred gadopiclenol for 3D T1-weighted fast-spin echo sequences of the choroid plexus and pituitary gland. One reader also favored the lower-dose agent for imaging the turbinate. However, gadoterate meglumine remained the preferred choice for most FLAIR sequences.

Given the comparable imaging performance and significantly reduced gadolinium dose, the authors concluded that gadopiclenol is a promising option for pediatric MRI, with potential to lower long-term gadolinium exposure in children undergoing repeated imaging.