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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…)
NSF Diagnosis made by means of Elemental Bioimaging and Speciation Analysis
A novel approach to diagnosing Nephrogenic Systemic Fibrosis, better known as NSF, was recently published by Birka et al in Analytical Chemistry. Birka and his colleagues used the combination of inductively coupled plasma mass spectrometry (ICP-MS), laser ablation (LA) ICP-MS for elemental bioimaging, and hydrophilic interaction liquid chromatography (HILIC) ICP-MS for speciation analysis, which allowed them to diagnose a case of NSF. While the article, Diagnosis of Nephrogenic Systemic Fibrosis by means of Elemental Bioimaging and Speciation Analysis, is very scientific in its details, there are facts to be learned by patients as well.
Skin biopsy specimens of NSF patients that were investigated by various techniques, found the presence of gadolinium deposits were mainly in the deeper regions of the subcutis (fat and connective tissue). A correlation of gadolinium with calcium, sodium, and phosphorous was observed in all cases.
The case report in this study involved a young woman who exhibited characteristic symptoms of NSF that began in 2011. Her clinical history included renal failure and kidney transplants from living donors in 2004 and 2006; the authors noted that she still has dialysis-dependent kidney insufficiency. The patient had an MRI in 2002 with Magnevist (Gd-DTPA) and in 2005 with ProHance (Gd-HP-DO3A). (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…)
Gadolinium Toxicity 