title: Gadolinium in pediatric cardiovascular magnetic resonance: what we know and how we practice.
abstract: BACKGROUND
  The association of gadolinium-based contrast agents (GBCAs) with nephrogenic systemic fibrosis (NSF) has led to a heightened awareness towards patients' renal function. Whereas detailed guidelines exist for the use of GBCAs in adult patients, best practice is less well defined in children, especially in the very young. We aimed at identifying current practice with regards to the use of GBCAs in children who undergo cardiovascular magnetic resonance.
  
  
  METHODS
  We conducted a worldwide survey among cardiac imagers with pediatric expertise. The questionnaire contained 21 questions covering the imagers' work environments, GBCAs used, monitoring of renal function, and a special emphasis was placed on the practice in neonates.
  
  
  RESULTS
  The survey yielded 70 replies. The single most commonly used GBCA was gadopentetate dimeglumine 34/70 (49%). Among the respondents, the choice of GBCA was more importantly based on availability 26/70 (37%) and approval by a pharmaceutical licensing body that most closely reflects the indication 16/70 (23%) than image quality 7/70 (10%) and side effect profile 8/70 (11%). 55/70 (79%) of respondents performed scans in neonates <1 week of age and 52/55 (95%) of them used GBCA in neonates. 65/70 (93%) respondents at least assess some of their patients' renal functions. Formula-based estimate of glomerular filtration rate is the most popular assessment method 35/65 (54%). In patients with a glomerular filtration rate < 30 ml/min/1.73 m(2) 62/70 (89%) of respondents do not administer gadolinium at all. The single most common side effect of gadolinium was noted to be nausea/emesis 34/57 (60%) followed by discomfort at injection site 17/57 (30%).
  
  
  CONCLUSIONS
  Cardiac imagers are aware of the immature renal function and physiological differences of their pediatric patients that place them at risk for NSF. Epidemiological data is needed for pediatric cardiovascular licensure of gadolinium compounds and for the creation of practice guidelines which will replace current-day practice based on individual clinical judgment.
authors.affiliation: The Labatt Family Heart Centre, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Meng
authors.forename: Lars
authors.initials: L
authors.lastname: Grosse-Wortmann
mesh_terms: D000293:Adolescent; D000367:Age Factors; D019985:Benchmarking; D002648:Child; D002675:Child, Preschool; D003287:Contrast Media / Q000009:adverse effects* / Q000592:standards; D005682:Gadolinium / Q000009:adverse effects* / Q000592:standards; D019786:Gadolinium DTPA / Q000009:adverse effects; D005919:Glomerular Filtration Rate / Q000187:drug effects; D019538:Health Care Surveys; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007668:Kidney / Q000187:drug effects* / Q000503:physiopathology; D008279:Magnetic Resonance Imaging / Q000592:standards / Q000639:trends*; D008536:Meglumine / Q000009:adverse effects / Q000031:analogs & derivatives; D054989:Nephrogenic Fibrosing Dermopathy / Q000139:chemically induced* / Q000503:physiopathology / Q000517:prevention & control; D009942:Organometallic Compounds / Q000009:adverse effects; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends*; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires
chemical_list: D003287:Contrast Media; D009942:Organometallic Compounds; C064572:gadobenic acid; D008536:Meglumine; D005682:Gadolinium; D019786:Gadolinium DTPA; C072417:gadoterate meglumine