Gadopiclenol Enables Safer Pediatric Brain MRI with Half the Gadolinium Dose: Study Suggests

Gadopiclenol, a macrocyclic contrast agent approved by the U.S. FDA in 2022, is known for its high T1 relaxivity, enabling significant dose reduction compared to other GBCAs. This study compared the performance of gadopiclenol at 0.05 mmol/kg with gadoterate meglumine at the standard 0.1 mmol/kg in the same pediatric patients to assess contrast enhancement quality.

The retrospective study included 38 children (mean age 11.1 years) who underwent both types of contrast-enhanced brain MRI within a six-month span, using identical imaging protocols and field strength. Researchers analyzed three key postcontrast MRI sequences: 3D T1-weighted fast-spin echo (FSE), 3D T1-weighted gradient-recalled echo (GRE), and 2D fluid-attenuated inversion-recovery (FLAIR).

Contrast ratio (CR) and contrast-to-noise ratio (CNR) were measured in physiologically enhancing brain structures, such as the choroid plexus, pituitary gland, dural venous sinuses, and turbinate mucosa. Two neuroradiologists independently evaluated the quality of contrast enhancement using a side-by-side blinded Likert scale assessment.

The study revealed the following findings:

• Gadopiclenol demonstrated significantly higher contrast ratios than gadoterate for imaging the choroid plexus on 3D T1W FSE.
• It also showed superior contrast for the turbinate mucosa on 3D T1W GRE.
• Gadoterate was favored over gadopiclenol for visualizing the turbinate mucosa on FLAIR sequences.
• Contrast-to-noise ratios between gadopiclenol and gadoterate did not show significant differences across the evaluated brain structures.
• Both radiologists consistently preferred gadopiclenol for visualizing the choroid plexus and pituitary gland on 3D T1W FSE.
• Reader preferences varied slightly depending on the brain structure and MRI sequence used.
• Most other structural comparisons showed no significant difference between the two contrast agents.

The authors noted that reducing cumulative gadolinium exposure is particularly important in children, who have a longer expected lifespan and may be more vulnerable to the long-term effects of gadolinium retention. Given its lower required dose and comparable—if not superior—performance in certain sequences, gadopiclenol offers a promising alternative for pediatric neuroimaging.

The authors concluded, "The study provides evidence that gadopiclenol is a viable option for pediatric brain MRI at half the traditional GBCA dose, potentially improving safety for young patients who undergo serial imaging."

Reference:

Valencia S, Cortes-Albornoz MC, Ferracioli SF, Griffin H, Husseini JS, Machado-Rivas F, Victoria T, Gee MS, Jaimes C. Gadopiclenol Versus Gadoterate Meglumine for Pediatric Brain MRI: An Intraindividual Comparison of Contrast Enhancement. AJR Am J Roentgenol. 2025 Jun 25. doi: 10.2214/AJR.25.33201. Epub ahead of print. PMID: 40557986.