Purpose To determine if hepatic
gadolinium deposition occurs in pediatric patients with
iron overload but normal renal and hepatic function who undergo
gadolinium-based
contrast agent (GBCA)-enhanced magnetic resonance (MR) imaging. Materials and Methods Design and execution of this study was approved by the Ethical Committee of Institute for Research in Maternal and Child Health Burlo Garofolo of Trieste (reference no. 1105/2015). Because of the retrospective nature of the study, the requirement to obtain informed consent was waived. Twenty-one recipients of allogeneic hematopoietic stem cell transplants who underwent GBCA-enhanced MR imaging for suspected
infection or relapse followed by liver biopsy comprised the study group. The number of GBCA-enhanced MR examinations and cumulative
gadolinium dose for each patient was analyzed by comparing liver histologic analysis and
iron and
gadolinium liver concentration (GLC). Eight patients had
siderosis and underwent
chelation therapy. The study group was compared with four control patients who were never exposed to GBCA. Statistical analysis was performed with Spearman rank coefficient for correlation. Results All 21 patients had positive correlations between GLC and total GBCA dose (r = 0.4486; P < .05) and between GLC and liver
iron concentration (r = 0.56; P < .05). Patients who underwent
deferoxamine therapy had a significant reduction of GLC (from 0.64 μg/g ± 0.29 to 0.20 μg/g ± 0.17 [standard deviation]; P < .05). Conclusion In the presence of
siderosis, a transmetallation mechanism may be set off between ferric ion and
gadoterate meglumine.
Deferoxamine appears capable of binding to
gadolinium ion. Further studies of the safety of GBCAs in severe
siderosis are needed. Chelation should be considered in patients with
iron overload and a history of GBCA exposure. © RSNA, 2016.