The European Society of Neuroradiology has published practice recommendations on reducing gadolinium-based contrast in paediatric neuroimaging, as part of the ESR Essentials series. The authors are explicit that this is a concise literature review combined with the expert opinion of neuroradiologists working in large centres, not a formal guideline.
The starting point is evidence that gadolinium is retained in brain tissue after repeated doses. The group identifies common indications where contrast is given more from habit than evidence, and asks that each use be judged on whether it will change management or outcome. Alternatives include advanced unenhanced sequences and closer discussion with referring clinicians.
The clinical significance of retained gadolinium remains uncertain, and contrast is still essential in many paediatric indications, such as tumour staging and some infections. The practical change is in the default: contrast should be a deliberate decision for each child, especially those facing repeated surveillance scans.
- Ask before each paediatric neuro-MRI whether contrast will change management.
- Consider unenhanced protocols for indications where contrast has been given by habit.
- Pay particular attention to children on long-term surveillance who will be scanned repeatedly.
- Agree indication-specific protocols with referring paediatric teams.
- Where contrast is needed, use it; the recommendations do not argue for withholding it.
Why it matters
Children on surveillance can accumulate many contrast doses, and some of those doses may not change care.
Don't overread it
Expert opinion — brain retention is documented, but clinical harm from it has not been shown.
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