On May 5, 2015, Health Imaging published “Q&A: Gadolinium update with leading MRI safety expert Emanuel Kanal, MD”. That same day, an editorial authored by Emanuel Kanal, MD, Director of MR Services at the University of Pittsburgh Medical Center, and Michael F. Tweedle, PhD, Professor and Stefanie Spielman Chair in Cancer Imaging at The Ohio State University Medical School, was published online in Radiology. Their editorial, “Residual or Retained Gadolinium: Practical Implications for Radiologists and Our Patients”, addresses the issue of gadolinium retention in patients with normal renal function. The Q&A is a follow-up to that editorial.
For those who may not be familiar with Dr. ‘Manny’ Kanal, he is a nationally recognized radiologist and a leader in the area of MRI safety. He is the Chair of the founding Board of Directors of the American Board of Magnetic Resonance Safety (ABMRS). Dr. Kanal spoke with Health Imaging for an exclusive interview regarding the new evidence of gadolinium retention and its potential impact on diagnostic imaging and patient safety.
I will not go into all the details of the Q&A here, but there are several interesting comments that Dr. Kanal made that I want to mention.
Regarding the effects of retained gadolinium, Dr. Kanal questioned a comment in an article on Mayo Clinic News Network that was made by one of the authors of the recently published Mayo Clinic study. He said something to the effect of ‘Well, no one has ever shown that this is harmful.’ Dr. Kanal, acknowledged that is true, but, he said, “At the same time, no one has ever studied it to date, so how could they show whether it’s harmful or not?”
When asked how many of the patients who received one or more of the estimated 10 million contrast injections in the U.S. each year could have retained gadolinium in their bodies, Dr. Kanal said, “There is the potential for some level of gadolinium retention for essentially 100 percent of those patients who receive contrast for an MR examination”.
Dr. Kanal questioned making decisions to use certain GBCAs based on cost alone. He also said that the “risk-benefit assessment” is the responsibility of the diagnostic radiologist and not the referring physician.
The last question asked what Dr. Kanal would advise medical professionals ordering and administering MRIs with contrast, based on what we know right now about GBCAs. His response follows.
Dr. Kanal said, “Reassess for every single patient that has an order for an MR examination with contrast. Every one of them needs to be prospectively reviewed by a radiologist. The decisions have to be made about, number one, is it an appropriate indication for contrast? If it is, which agents should you be using, and how much of that agent should you be using? That needs to be considered in 100 percent of cases in which patients are receiving contrast. The data at this point do not permit us to ignore that consideration. We cannot leave the decision as to whether or not it is appropriate to administer contrast to a given patient only to the referring physician when the diagnostic radiologist is the one far better suited to assess the true risks and benefits of such an administration. Further, we cannot leave the decision as to which agents to be used to several people sitting in a room with pocket protectors. To relegate that to a financial decision only based on best price alone is something that at this stage I believe cannot be any longer condoned.”
As I have said before, I believe patients have an important advocate in Dr. Kanal. While he still sees great diagnostic value in using gadolinium-based contrast agents, Dr. Kanal realizes that not all GBCAs perform exactly as they were intended. Besides determining what to do about future GBCA administrations, someone needs to determine what to do about those patients that have retained gadolinium from their prior doses of a gadolinium-based contrast agent. Hopefully Dr. Kanal can help patients with that issue as well.
HealthImaging. (2015). Q&A: Gadolinium update with leading MRI safety expert Emanuel Kanal, MD. Retrieved June 7, 2015, from http://www.healthimaging.com/print/topics/practice-management/q-gadolinium-update-leading-mri-safety-expert-emanuel-kanal-md
Kanal, E., & Tweedle, M. F. (2015). Residual or Retained Gadolinium: Practical Implications for Radiologists and Our Patients. Radiology, 150805. http://doi.org/10.1148/radiol.2015150805. Published online May 5, 2015.
ABMRS | American Board of Magnetic Resonance Safety. (n.d.). Retrieved June 7, 2015, from http://www.abmrs.org/
McDonald, R. J., McDonald, J. S., Kallmes, D. F., Jentoft, M. E., Murray, D. L., Thielen, K. R., … Eckel, L. J. (2015). Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging. Radiology, 150025. http://doi.org/10.1148/radiol.15150025. Published online March 5, 2015.
Eisenman, R. (2015). Mayo Clinic Finds Direct Evidence of Gadolinium Deposition i […] | Mayo Clinic News Network. Retrieved June 7, 2015, from http://newsnetwork.mayoclinic.org/discussion/mayo-clinic-finds-direct-evidence-of-gadolinium-deposition-in-brain-tissues-following-contrast-enhan/?linkId=12954551