THE USE AND SAFETY OF CONTRAST AGENTS IN MODERN IMAGING IN PEDIATRICS
Abstract
Contrast agents (CAs) have become essential tools in medical imaging, enhancing the clarity of anatomical details and the accuracy of result interpretation in X-ray, computed tomography (CT), magnetic resonance imaging (MRI), and ultrasound (US). Despite extensive guidelines for their use in adults, pediatric protocols remain underdeveloped. This creates a gap in clinical practice, given children’s distinct anatomical and physiological features, including metabolic rate, radiation sensitivity, and dosing nuances. This review analyzes approaches to using contrast agents across three key modalities — CT, MRI, and US — in patients ranging from infancy to adolescence. For CT, the focus is on reducing doses of iodine-based agents to minimize risks of nephrotoxicity and allergic reactions. In MRI, gadolinium-based agents are discussed, including their safety in the context of an immature blood-brain barrier and limitations in renal insufficiency. For ultrasound, microbubble agents are examined, which improve vascular and parenchymal organ visualization but require caution in younger children. Special emphasis is placed on protocol adaptations: adjusting contrast volume based on body weight, selecting less invasive techniques, and prioritizing patient psychological comfort. The need for unified pediatric guidelines, grounded in multidisciplinary consensus, is highlighted to optimize diagnostic value while minimizing potential complications.
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