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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…)
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…)
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…)
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. (more…)