Is Gd-DTPA required for routine cranial MR imaging?

Gadopentetate dimeglumine (gadolinium diethylenetriaminepentaacetic acid [DTPA]) was administered prospectively to 500 consecutive children and adults referred for routine cranial magnetic resonance (MR) imaging over a 4-month period. Pre- and postcontrast images were blindly and independently interpreted by two experienced neuroradiologists. Specific criteria were provided to the readers to define objectively when contrast material enhancement (or lack thereof) would be considered "radiologically helpful." Contrast-enhancing lesions were observed in 99 cases (20%). In only 15 cases (3%) did Gd-DTPA permit detection of lesions not also apparent on the precontrast studies. Contrast enhancement was considered radiologically helpful in 74 of the 99 cases. Lack of enhancement was considered helpful in 112 of the 500 cases (22%). Factors that may indicate increased usefulness of Gd-DTPA include increased patient age, definite lesion seen at computed tomography or precontrast MR imaging, prior craniotomy for tumor, and clinically documented systemic or central nervous system disease. Gd-DTPA should probably be used routinely for cranial MR imaging in most patients, except, perhaps, children and young adults with normal precontrast images.