Gadolinium Toxicity

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Another study finds gadolinium accumulates in brain tissues of patients with normal renal function

On May 5, 2015, another gadolinium-related study by Kanda et al was published online ahead of print in Radiology.  The study, Gadolinium-based Contrast Agent Accumulates in the Brain Even in Subjects without Severe Renal Dysfunction: Evaluation of Autopsy Brain Specimens with Inductively Coupled Plasma Mass Spectroscopy, evaluated brain tissues obtained at autopsy in five randomly selected subjects that had received a gadolinium-based contrast agent (GBCA) at least twice, and five subjects that had no history of GBCA administration.  The GBCAs involved were the linear agents Magnevist and Omniscan, and the macrocyclic agent ProHance.  Gadolinium was detected in all specimens in the GBCA group, and was found at significantly higher concentrations in the dentate nucleus (DN) and globus pallidus (GP) than the other regions tested.  The estimated glomerular filtration rates (eGFRs) of the five subjects in the GBCA group were 47.5, 49.5, 60, 65.5, and 83.4.  Kanda and his colleagues concluded that even in subjects without severe renal disease, GBCA administration causes gadolinium accumulation in the brain, especially in the dentate nucleus and globus pallidus. (more…)

Gadolinium retention in brain tissue of patients with normal renal function

On April 6, 2015, a study by Radbruch et al was published online ahead of print in Radiology.  Like other recent studies, it reports on evidence of gadolinium retention in brain tissues of patients who had multiple MRIs with a gadolinium-based contrast agent or GBCA.  The study, Gadolinium Retention in the Dentate Nucleus and Globus Pallidus Is Dependent on the Class of Contrast Agent, found that increased signal intensity (SI) in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MR images is caused by serial administration of the linear GBCA gadopentetate dimeglumine (Magnevist), but not by the macrocyclic GBCA gadoterate meglumine (Dotarem).

The retrospective study was comprised of two groups of 50 patients who had undergone at least 6 consecutive MRIs with only the linear agent Magnevist or only the macrocyclic agent Dotarem.  All patients had an estimated glomerular filtration rate (eGFR) greater than 60 – which is a level of renal function not considered to be at risk of retaining gadolinium from the administered gadolinium-based contrast agent.  Of the 100 patients included in the study, 21 had an eGFR 60-90, and 79 patients had an eGFR greater than 90.  (more…)

Patients with meningioma have increased T1 hyperintensity after multiple contrast-enhanced MRI

On March 11, 2015, a retrospective study on 46 patients with a meningioma who had routinely undergone follow-up enhanced-MRI scans with gadodiamide was published online in Investigative Radiology.  The authors report a significant increase in T1 hyperintensity of the dentate nuclei of the cerebellum on unenhanced scans was observed between the first and last MRI in the group of patients with a history of at least 6 enhanced MRI.  All patients had normal renal function before intravenous administration of gadodiamide (Omniscan).

Two recent studies (Kanda and Errante), with different cohorts of patients, have shown the association between high T1 signal intensity of the dentate nucleus and history of a high number of contrast-enhanced MRI in patients with cancer and brain metastases, and in patients with Multiple Sclerosis (MS). (more…)

Mayo study reports Gadolinium remains in the brain after contrast-enhanced MRI

An important new study was published online March 5, 2015 in Radiology.  Dr. Robert McDonald and his colleagues at Mayo Clinic in Rochester, Minnesota, found high levels of gadolinium in four regions of the brain of 13 deceased patients who had 4 or more contrast-enhanced MRIs with Omniscan.  None of the patients had severe renal disease.  Except for one patient with an eGFR of 54, the other 12 had an eGFR between 74 and 122.  The authors concluded that “intravenous GBCA exposure is associated with neuronal tissue deposition in the setting of relatively normal renal function”.

The study, Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging, sought to confirm the findings of Errante et al (2014) and Kanda et al (2103) which reported progressive increases in T1-weighted signal intensity in parts of the brain after repeated administration of a Gadolinium-based Contrast Agent (GBCA). (more…)

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