ORIGINAL RESEARCH Does Gadoterate Meglumine Cause Gadolinium Retention in the Brain of Children? A Case–Control Study Elif Dilara Topcuoglu, MD, 1 * Osman Melih Topcuoglu, MD, 2 Aslihan Semiz Oysu, MD, 1 and Yasar Bukte, MD 1 Background: Accumulation of macrocyclic gadolinium agents in children’s brains remain to be determined. Purpose: To demonstrate whether there is an intracranial macrocyclic gadolinium deposition after multiple contrast- enhanced MRI with gadoterate meglumine in a pediatric population. Study Type: Retrospective case–control. Population: In all, 45 children (age range: 5–17 years; mean, 13.7  3.4 years) for the study group and 45 healthy children (age range: 5–17 years; mean, 13.7  3.4 years) for the control group. Field Strength/Sequence: T 1 - and T 2 -weighted axial images on a 1.5T scanner. Assessment: Children with at least three enhanced brain MRIs and an age- and sex-matched control group with an unenhanced brain MRIs were compared in terms of T 1 signal intensity (SI). All patients in the study group received gadoterate meglumine intravenously (0.1 mmol/kg). SI measurements were made by drawing six regions of interest (ROIs): dentate nuclei (DN), pons, globus pallidi (GP), frontal white matter (FWM), thalamus (T), clivus, and cerebrospinal fluid (CSF) for both groups on unenhanced T 1 -weighted images. Statistical Tests: Student’s t-test was used for comparison of SI. The Pearson correlation was calculated for the correlation between the SI and the number of gadolinium administrations. Results: A significant difference was detected between two groups for DN/CSF, pons/CSF, GP/CSF, thalamus/CSF, and FWM/CSF (P < 0.001, P < 0.001, P = 0.002, P = 0.002, P = 0.024, respectively). There was no significant difference between the two groups for clivus/CSF (P = 0.15). A good correlation between the number of gadoterate meglumine administrations and the SI for DN/CSF, pons/CSF, GP/CSF, and T/CSF (r = 0.80, r = 0.73, r = 0.91, and r = 0.90, respec- tively) was found. Data Conclusion: A significant T 1 SI increase reflecting gadolinium retention in the brain was detected for children with at least three gadoterate meglumine administrations in this series. The number of administrations correlated well with the increased SI. Level of Evidence: 3 Technical Efficacy Stage: 5 J. MAGN. RESON. IMAGING 2019. G ADOLINIUM-BASED CONTRAST AGENTS (GBCAs) are valuable tools for magnetic resonance imaging (MRI). They have been accepted as safe for many years. How- ever, after it was demonstrated by Kanda et al 1 that GBCAs could accumulate in the brain and cause signal intensity (SI) increase on T 1 -weighted (T 1 W) images following repeated administrations. The two main categories of GBCAs are available in the market as linear and macrocyclic molecules. Studies in adults demonstrated that macrocyclic GBCAs, in contrast to linear GBCAs, did not accumulate in the brain 2–7 except in two reports. 8,9 Linear GBCAs were studied more than macrocyclic GBCAs in the pediatric age group and have been shown to be associated with gadolinium retention in the brain. 10–15 However, Schneider et al 16 reported no increased T 1 SI in the pediatric brain with the use of a diminished dose (half- dose) linear GBCAs and a few reports demonstrate an SI View this article online at wileyonlinelibrary.com. DOI: 10.1002/jmri.26954 Received Jul 12, 2019, Accepted for publication Sep 16, 2019. *Address reprint requests to: E.D.T., Radiology Department, University of Health Sciences Umraniye Training and Research Hospital, Adem Yavuz Street. No: 1 Umraniye 34764, Istanbul-Turkey. E-mail: elifdilaratopcuoglu@gmail.com From the 1 University of Health Sciences Umraniye Training and Research Hospital, Department of Radiology, Istanbul, Turkey; and 2 Yeditepe University Hospital, Department of Radiology, Istanbul, Turkey © 2019 International Society for Magnetic Resonance in Medicine 1