Gd-DTPA was administered prospectively to 65 consecutive children (ages 1 day to 18 years, mean 9.6 years) to document its utility and safety for routine cranial MR imaging. Precontrast T1- and T2-weighted scans and postcontrast T1-weighted scans were obtained. No complications or significant adverse reactions were encountered. Contrast enhancement was seen in 14 lesions from seven patients, but each of these patients had some abnormality also present on precontrast images. Contrast enhancement was thought to be extremely helpful in characterizing four primary tumors and moderately helpful in characterizing four other lesions. Absence of contrast enhancement was helpful in clarifying the nature of abnormalities seen in an additional four patients. Gd-DTPA may be used safely in children, but this study does not support its routine administration. The highest incremental diagnostic yield from its use will likely be among patients with suspected neoplasms or inflammatory diseases and among those requiring further characterization of lesions seen on precontrast scans.