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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…)
While doing research in early 2012, I came across a 2007 article written by J.F.M. Wetzels of The Netherlands that really caused me to pause and think about the problems associated with Gadolinium-Based Contrast Agents. The title was “Thorotrast toxicity: the safety of Gadolinium compounds”. Thorotrast was a radiocontrast agent used from 1930 to 1960. It wasn’t until the late 1940’s that the first “Thorotrast-related malignancies” were described in the literature and the problem came to light.
Thorotrast particles had been deposited in cells in the liver, spleen, bone marrow, and lymph nodes where they stayed and continually exposed the surrounding tissue to radiation. The problems created by Thorotrast had such a long-latency period that malignancies might not show up for 45 years or more later.
Wetzels described what was happening with Gadolinium and NSF through 2006. He said that because Gadolinium is a toxic, heavy metal, “Gadolinium-Based Contrast Agents are all chelates, which must ensure that no free Gadolinium is present in the circulation”. Wetzels closed by saying, “we must keep in mind that toxic effects may occur less frequently, later, and only after repeated exposure in patients with less severe renal dysfunction”. When I read that, I thought of what might be happening to patients with normal renal function. (more…)
In the October 2014 issue of Investigative Radiology, Errante et al report study findings that confirm the association between the increase in the unenhanced T1-weighted signal intensity of the dentate nucleus and the number of gadolinium-enhanced MRI scans. (The dentate nucleus is located within the deep white matter of the brain.)
The study included 38 patients with Multiple Sclerosis (MS) and 37 patients with brain metastases (BMs) who had undergone at least 2 consecutive enhanced MRIs. After calculating the dentate nuclei-to-pons (DNP) signal intensity ratio, these values were compared between patients with less than 6 and those with 6 or more contrast-enhanced MRI. A progressive increase in the T1 signal intensity of the DNP ratio was observed in both the MS group and the BM group. All patients had normal kidney function. (more…)