Gadolinium DTPA (
Gd-DTPA) is a paramagnetic blood-brain barrier
contrast agent for MRI that has been used primarily in adults. During May through October 1987, 17 children between the ages of 3 and 18 years with
brain tumors underwent MRI examinations, before and after
Gd-DTPA (11
gliomas, 4
medulloblastomas, 1
craniopharyngioma, and 1 child with
neurofibromatosis and no pathologic diagnosis). We compared T1 and T2
Gd-DTPA-enhanced MRI with concurrent unenhanced MRI and enhanced CT, and then correlated this with the clinical and pathologic findings.
Gd-DTPA enhanced
tumors in all 7 patients with newly diagnosed
tumors and enhanced
tumors in 7 of 10 patients without clinical evidence of progressive disease at the time of the study. In the 7 new patients,
Gd-DTPA defined
tumor margins in all, and demonstrated internal
tumor architecture (vessels,
necrosis, and
cysts) in 5. Areas believed to represent surgical
scars showed varying degrees of enhancement. Leptomeningeal
tumor spread, including spinal, not seen on pre-
Gd-DTPA MRI or on contrast CT, was evident in 2 patients.
Gd-DTPA enhancement obscured
hemorrhage within the
tumor (
methemoglobin) in 2 patients. There were no significant side effects. These results suggest that
Gd-DTPA-enhanced MRI (1) is safe in children, (2) demonstrates the extent and character of
tumors better than unenhanced MRI and enhanced CT, and (3) may allow for noninvasive imaging of leptomeningeal disease, including the spine, not previously demonstrated by any other noninvasive neuroimaging technique.