While most of the published research on Gadolinium has been related to NSF (Nephrogenic Systemic Fibrosis) and patients with severe renal disease, more recent studies by Errante (2014), Kanda (2013) and Xia (2010) have presented evidence of Gadolinium retention in patients without severe kidney problems.

Some authors and members of the radiology community seem to be surprised by finding evidence of Gadolinium in abnormal brain tissue in patients with normal renal function, but based on what has been published about Gadolinium-Based Contrast Agents, it seems that this might be expected to occur.  Each of the manufacturers’ package inserts notes that GBCAs deposit in abnormal tissue, and none of the literature that I have read indicates that renal function plays any part in Gadolinium enhancement of abnormal tissue.    

Any patient with a brain tumor or a brain lesion, such as those seen in MS patients, would likely have evidence of the Gadolinium-Based Contrast Agent in their abnormal tissue.  GBCA product labeling indicates that Gadolinium-Based Contrast Agents “do not cross an intact blood-brain barrier”; however, “disruption of the blood-brain barrier” or “abnormal vascularity” allows accumulation in lesions such as neoplasms (tumors), abscesses, and subacute infarcts.  (See Background on Gadolinium for details.)

Gadolinium retention had been confirmed in two patients with Erdheim-Chester Disease even before the first patients with NFD/NSF appeared in 1997 (See Background on NSF).  If that was not expected to occur, then an opportunity to do something about the problem was sadly missed.

A 1989 case report of Erdheim-Chester Disease by Tien et al reported persistent enhancement of intracerebral lesions 8 days after injection with Gd-DTPA.  Chemical analysis of the biopsy specimen revealed a high concentration of Gadolinium.

A 1995 case report by Martinez noted persistent Gadolinium retention in an extra-axial brain stem lesion of a patient with Erdheim-Chester Disease.  Gadolinium retention was confirmed by comparing precontrast and postcontrast images from two MRIs performed 23 days apart.

The findings of these two case reports as well as those of the other studies mentioned would seem to be expected based on GBCA product labeling.  However, just because it is expected to occur does not mean that it should happen.  Allowing a toxic metal like Gadolinium to remain in a patient’s brain could have serious long-term consequences.

Works cited are listed below.

Sharon W

Errante, Y., Cirimele, V., Mallio, C. A., Di Lazzaro, V., Zobel, B. B., & Quattrocchi, C. C. (2014). Progressive Increase of T1 Signal Intensity of the Dentate Nucleus on Unenhanced Magnetic Resonance Images Is Associated With Cumulative Doses of Intravenously Administered Gadodiamide in Patients With Normal Renal Function, Suggesting Dechelation. Investigative Radiology, 49(10), 685–690.  Retrieved from http://journals.lww.com/investigativeradiology/Abstract/2014/10000/Progressive_Increase_of_T1_Signal_Intensity_of_the.8.aspx

Kanda, T., Ishii, K., Kawaguchi, H., Kitajima, K., & Takenaka, D. (2013). High Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-weighted MR Images: Relationship with Increasing Cumulative Dose of a Gadolinium-based Contrast Material. Radiology, 131669.  Retrieved from http://pubs.rsna.org/doi/abs/10.1148/radiol.13131669

Xia, D., Davis, R. L., Crawford, J. A., & Abraham, J. L. (2010). Gadolinium released from MR contrast agents is deposited in brain tumors: in situ demonstration using scanning electron microscopy with energy dispersive X-ray spectroscopy. Acta Radiologica , 51 (10 ), 1126–1136.  Retrieved from http://acr.sagepub.com/content/51/10/1126.abstract

Tien, R. D., Brasch, R. C., Jackson, D. E., & Dillon, W. P. (1989). Cerebral Erdheim-Chester disease: persistent enhancement with Gd-DTPA on MR images. Radiology, 172(3), 791–2.  Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2772189

Martinez, R. (1995). Erdheim-Chester disease: MR of intraaxial and extraaxial brain stem lesions. American Journal of Neuroradiology, 16(9), 1787–1790. Retrieved from http://www.ajnr.org/content/16/9/1787.full.pdf+html