Use of gadolinium-based contrast agents in pediatric radiology departments: A 2016 survey

Gadoterate meglumine is increasingly being used by radiology departments seeking stable MRI contrast agents in pediatric hospitals, according to a survey conducted to assess the current state of gadolinium-based contrast agent (GBCA) use. Results of the survey, published in Pediatric Radiology, also suggest that radiologists as well as referring physicians need to become better educated on the subject.

A multi-disciplinary team of researchers from the Northwestern University Feinberg School of Medicine in Chicago and the University of Arizona School of Medicine in Phoenix sought to determine what types of GBCAs are used in pediatric radiology departments, the number of radiology departments in the United States and Canada  that have changed or plan to change their contrast agents and the reasons for the change, and the level of knowledge and concern among radiologists and referring physicians.

They developed and validated a survey sent at the beginning of 2016 to all 70 members of the Society of Chairs of Radiology in Children’s Hospitals (SCORCH), all members of the Society for Pediatric Radiology (SPR) and to over 3,700 physicians whose specialties order the largest number of pediatric MRI exams. These referring physicians included members of the Pediatric Endocrine Society (PES), pediatric neuro-oncology specialists, and pediatric infectious disease physicians.

Six-hundred-ninety responses were received, representing 13% of the total. Interestingly, the highest percentage of respondents in their respective categories were infectious disease physicians (43%) and the chairs of pediatric radiology departments (37%).

Nearly 60% of the pediatric radiology department chairpersons reported that their hospital had switched from their GBCA, primarily to gadoterate meglumine, a more stable macrocyclic MR contrast agent.  An additional 23% were considering switching to a macrocyclic GBCAs in 2017, with the majority considering gadoterate meglumine. Reasons to switch included concern about brain gadolinium deposition, improving the safety profile, improved stability, NSF concerns and cost.

Participants were asked if they were familiar with recent research and the July 2015 U.S. Food and Drug Administration statement advising that “health care professionals should consider limiting GBCA use to clinical circumstances in which the additional information provided by the contrast is necessary.”¹ They also were asked to rate their level of concern regarding brain gadolinium deposition.

As expected, the overwhelming majority (86.7) radiologists responding reported familiarity with the FDA statement, but more than 10% were not. Nearly 75% of referring physicians were not familiar with the FDA statement.

Most respondents stated they were mildly or moderately concerned about brain gadolinium deposition. Fewer than 12% in all categories were very concerned. 98% of referring physicians and 72% of radiologists stated that they were unsure whether macrocyclic ionic agents were safer than macrocyclic non-ionic agents.

Lead author Leena B. Mithal, MD, noted that over one-fourth of the radiology department chairs reported that referring physicians had expressed concern over brain gadolinium deposition to them or their radiology colleagues and to a much lesser extent, parents of patients had inquired about this issue.

Were radiologists ready to discuss this? Some 43% of radiologist respondents reported either not feeling comfortable or knowledgeable enough to discuss this subject with fellow physicians or with patients’ caregivers. In fact, the majority (80%) of referring physicians suggested that a public website explaining the subject in lay terminology would be beneficial.

REFERENCES

1. U.S. Food and Drug Administration (2015) FDA drug safety communication: FDA evaluating the risk of brain deposits with repeated use of gadolinium-based contrast agents for magnetic resonance imaging (MRI).
2. Mithal LB, Patel PS, Mithal D, et al. Use of gadolinium-based magnetic resonance imaging contrast agents and awareness of brain gadolinium deposition among pediatric providers in North America. Pediat Radiol. Published online March 10, 2017.