title: Use of gadolinium-based magnetic resonance imaging contrast agents and awareness of brain gadolinium deposition among pediatric providers in North America.
abstract: BACKGROUND
  Numerous recent articles have reported brain gadolinium deposition when using linear but not macrocyclic gadolinium-based contrast agents (GBCAs).
  
  
  OBJECTIVE
  To determine the current landscape of gadolinium use among pediatric institutions and the knowledge base of radiologists and referring providers with regard to GBCAs and brain gadolinium deposition.
  
  
  METHODS
  We e-mailed voluntary closed surveys to 5,390 physicians in various pediatric professional societies between January 2016 and March 2016. We used chi-square and Fisher exact tests to compare response distributions among specialties.
  
  
  RESULTS
  We found that 80% of surveyed pediatric hospitals use macrocyclic contrast agents. In the last year, 58% switched their agent, most commonly to gadoterate meglumine, with the most common reason being brain gadolinium deposition. Furthermore, surveys indicated that 23% of hospitals are considering switching, and, of these, 83% would switch to gadoterate meglumine; the most common reasons were brain gadolinium deposition and safety. Radiologists were more aware of brain gadolinium deposition than non-radiologist physicians (87% vs. 26%; P<0.0001). Radiologists and referring providers expressed similar levels of concern (95% and 89%). Twelve percent of radiologists and 2% of referring providers reported patients asking about brain gadolinium deposition. Radiologists were significantly more comfortable addressing patient inquiries than referring pediatric physicians (48% vs. 6%; P<0.0001). The number of MRIs requested by referring pediatric physicians correlated with their knowledge of brain gadolinium deposition, contrast agent used by their hospital, and comfort discussing brain gadolinium deposition with patients (P<0.0001).
  
  
  CONCLUSIONS
  Since the discovery of brain gadolinium deposition, many pediatric hospitals have switched to or plan to switch to a more stable macrocyclic MR contrast agent, most commonly gadoterate meglumine. Despite this, there is need for substantial further education of radiologists and referring pediatric providers regarding GBCAs and brain gadolinium deposition.
authors.affiliation: Department of Pediatrics, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Leena B
authors.initials: LB
authors.lastname: Mithal
authors.affiliation: Department of Pediatrics, University of Arizona College of Medicine, Phoenix, AZ, USA.
authors.forename: Payal S
authors.initials: PS
authors.lastname: Patel
authors.affiliation: Department of Pediatric Neurology, Northwestern University, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, USA.
authors.forename: Divakar
authors.initials: D
authors.lastname: Mithal
authors.affiliation: Biostatistics, Feinberg School of Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University, Chicago, IL, USA.
authors.forename: Hannah L
authors.initials: HL
authors.lastname: Palac
authors.affiliation: Department of Radiology, University of Arizona College of Medicine, 2323 W. Rose Garden Lane, Phoenix, AZ, 85027, USA. mikerozenfeld@email.arizona.edu.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Rozenfeld
mesh_terms: D001921:Brain / Q000378:metabolism*; D002648:Child; D003287:Contrast Media / Q000493:pharmacokinetics*; D005682:Gadolinium / Q000493:pharmacokinetics*; D006801:Humans; D008279:Magnetic Resonance Imaging; D009656:North America; D011446:Prospective Studies; D012955:Societies, Medical; D011795:Surveys and Questionnaires
chemical_list: D003287:Contrast Media; D005682:Gadolinium
keywords: Brain gadolinium deposition; Children; Contrast agent; Gadolinium; Magnetic resonance imaging