Publikationsrepositorium - Helmholtz-Zentrum Dresden-Rossendorf

Gadolinium-based contrast agents (GBCA) form the cornerstone of current primary brain tumor MRI protocols at all stages of the patient journey. Though an imperfect of tumor grade, GBCA is repeatedly used for diagnosis and monitoring.
In practice, however, radiologists will encounter situations where GBCA injection is unwanted or of doubtful benefit. Reducing GBCA administration could improve the patient burden of (repeated) imaging, especially in vulnerable patient groups such as children, minimize risks of putative side effects, as well as benefit costs, logistics, and the environmental footprint.
This review presents standard imaging strategies to reduce GBCA exposure for pediatric and adult patients with primary brain tumors, including the effect of prolonging follow-up intervals and omitting contrast-enhanced sequences. The potential of novel pulse sequences, such as arterial spin labeling, and upcoming artificial intelligence methods, e.g., to generate synthetic post-contrast images, promise to replace GBCA-dependent approaches. To attain a concise summary of the knowledge in the field, gliomas and meningiomas as typical representatives of primary brain tumors are the review’s focus. Special attention is paid to study quality and real-life applicability.