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Is history repeating itself? Are Gadolinium-Based Contrast Agents the next Thorotrast?
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…)
We have an important advocate in Dr. Manny Kanal.
After years of trying to get the FDA and medical community’s attention about the issue of Gadolinium retention in patients with normal kidney function, it looks like our efforts have begun to pay off.
I want to share some news about Dr. Emanuel (Manny) Kanal. If you aren’t familiar with his name, Dr. Kanal is a leading radiologist and someone the FDA looks to for advice on matters related to MRI Safety. Duke and I have been in communication with him since October of 2013.
As you might imagine, MRI Safety is an important issue that requires medical professionals to stay well-informed about safety issues directly related to MR devices as well as the Gadolinium-based Contrast Agents administered for contrast-enhanced MRI and MRA. Since June of this year, Dr. Kanal has been conducting MRI Safety Officer (MRSO) and MRI Medical Director (MRMD) Seminars.
During a seminar on September 9, 2014, Dr. Kanal provided a “Gadolinium Contrast Overview”. According to the MRI Patient Safety blog, besides describing the state of NSF, he described “new and growing concerns about non-NSF bio-retention”. (more…)
Mast Cells and Gadolinium Toxicity, is there a connection?
In the summer of 2012, I was asked if I had ever read anything about mast cells and Gadolinium or NSF. I vaguely remembered mast cells being mentioned in one study, but it obviously didn’t strike me as being important or I would have done some research on it then. But after digging around a bit, I came away thinking that there might be a connection between mast cells and the disease progression of NSF/GASF.
For those who don’t know, mast cells are found in tissues throughout the body, particularly in association with structures such as blood vessels, peripheral nerves, in mucosal membranes, skin and subcutaneous tissue. Mast cells are bone marrow-derived and particularly dependent upon stem cell factor for their survival. They express a variety of phenotypic features within tissues that are determined by their local environment. Mast cells appear to be highly engineered cells with multiple critical biological functions. (more…)
Study reports brain abnormalities on MRI in patients with normal kidney function
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…)
Gadolinium Toxicity 