The increasing levels of gadolinium found in lakes, bays, rivers, and water supplies around the world correlate with the increased administration of gadolinium-based contrast agents (GBCAs) for MRIs. The gadolinium (Gd) from those GBCAs that gets into our water is called anthropogenic gadolinium since it comes from human activity. Some studies refer to it as a Gd anomaly and note that it is difficult to remove by the usual sewage treatment technology. This is not a new problem, but it is one that requires further investigation to confirm that gadolinium is not absorbed by the GI tract since it could be ingested via drinking water. It seems that might be of even greater concern for infants, children, and pregnant women. Besides being in our drinking water, a 2019 study by Schmidt et al. found anthropogenic gadolinium, in similar concentrations, in tap-water and in a related water-based popular fountain soft drink from two fast food restaurants in six major German cities. That study provided the first evidence that anthropogenic gadolinium in contrast agents enters the human food chain.

A recent study by Inoue et al. reported a significant increase in the Gd anomaly in the rivers in Tokyo, compared to data obtained 22 years ago, depending on the location of the wastewater treatment plants. The amount of Gd had increased by as much as 6.6 times since the assessment 22 years ago. That coincides with the significant increase in the number of MRI scanners in Japan and scans performed with a GBCA. The study notes that common wastewater treatment plants cannot remove gadolinium, so it is released back into the environment. That fact is well-documented in the literature.

A 2020 study by Brünjes and Hofmann found that “contrary to previous assumptions that GBCAs are stable throughout the water cycle, they can degrade.” The authors noted that there is specific concern that “UV end-of-pipe treatment” may enhance the risks posed by GBCAs in drinking water. They noted that increasing GBCA concentrations could become a concern in settings where drinking water is produced from raw water resources with a high proportion of recycled wastewater. They said that during drinking water production, improved water purification would require using expensive reverse osmosis as it is the only efficient way to fully remove GBCAs.  The authors suggested a novel way to reduce the input of gadolinium into the aquatic environment and its potential health risk, and it is to have patients collect urine in leakproof collection bags that include super absorbent polymers for at least 24 hours following administration of GBCAs. Urine would need to be collected not only in hospitals, but also in patients’ homes. It appears that a pilot study by Niederste-Hollenberg et al. was done in Germany in 2018 that had a high level of acceptance by patients.

Is collecting urine after contrast-enhanced MRIs enough to solve the potential problems that might be caused by anthropogenic gadolinium in our drinking water? (more…)