Gadolinium not needed for monitoring pediatric thoracic lymphoma with MRI

Teenagers hit by thoracic lymphoma can be safely and effectively imaged for primary staging and follow-up care with MRI unenhanced by gadolinium-based contrast agents—or by any contrast at all.

The research behind the finding was conducted at University Hospital Frankfurt in Germany and published online Dec. 13 in European Radiology.

Christophe Arendt and colleagues reviewed the cases of 51 patients between 13 and 19 years old who had pathology-verified thoracic Hodgkin’s lymphoma (70.6 percent), non-Hodgkin’s lymphoma (25.5 percent) or lymphadenopathy (3.9 percent). All patients were imaged with at least one chest MRI using unenhanced and contrast-enhanced sequences.

Two radiologists evaluated the images and recorded various characteristics, including lesion location, diameter, number, shape, necrosis and spread into surrounding tissue structures. They also categorized lesions as either suspicious (larger than 1 centimeter, round, necrotic and spreading) or non-suspicious.

The researchers found high agreement between unenhanced and contrast-enhanced sequences for both suspicious and non-suspicious lymph nodes.

They did find a small but noteworthy falloff when it came to sizing unenhanced lesions located in the mediastinum, the part of the chest situated between the sternum, spinal column and lungs. This area contained most of the lesions categorized as suspicious, 86.4 percent.

Where contrast was used, the results had no difference between five different agents.

“Increasing awareness of potential side effects from gadolinium-based contrast agents has underlined the need for contrast-free MRI,” Arendt et al. wrote, pointing to the proliferation of recent literature flagging the risk of gadolinium deposits in the brain.

As a result of the attention, they noted, interest in testing alternative unenhanced imaging techniques is keen.

“MRI of young patients with thoracic lymphoma can safely be done without the use of contrast agent,” the authors concluded.