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Gadolinium-DTPA-enhanced magnetic resonance imaging in childhood brain tumors

Department of Pediatrics, University of Pennsylvania (Drs. Cohen and Packer)
Department of Neurology, University of Pennsylvania (Drs. Cohen and Packer)
Department of Radiology, University of Pennsylvania (Drs. Bury, Bilaniuk, and Zimmerman)
Department of Neurosurgery, University of Pennsylvania (Dr. Sutton)
Divisions of Pediatric Neurology, Children's Hospital of Philadelphia (Drs. Cohen and Packer)
Pediatric Neurosurgery, Children's Hospital of Philadelphia (Dr. Sutton)
Division of Neuroradiology, the Hospital of the University of Pennsylvania, Philadelphia, PA (Drs. Bury, Bilaniuk, and Zimmerman)

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.

Address correspondence and reprint requests to Dr. Packer, Division of Pediatric Neurology, Children's Hospital of Philadelphia, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104.

Supported in part by the Preuss Foundation and Berlex Laboratories, Wayne, NJ.

Received November 29, 1988. Accepted for publication in final form March 15, 1989.

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