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Residual or Retained Gadolinium in Patients with Normal Renal Function – What happens next?
On May 5, 2015, an editorial by Emanuel Kanal, MD, Director of Magnetic Resonance Services and Professor of Radiology and Neuroradiology at the University of Pittsburgh Medical Center, and Michael F. Tweedle, PhD, Professor and Stefanie Spielman Chair in Cancer Imaging at The Ohio State University Medical School, was published online ahead of print. The editorial, “Residual or Retained Gadolinium: Practical Implications for Radiologists and Our Patients”, is in the June 2015 issue of Radiology. It addresses the issue of gadolinium retention in patients with normal renal function, as evidenced by published findings by Kanda et al, Errante et al, Quattrocchi et al, McDonald et al, and Radbruch et al.
In December of 2013, a study by Kanda et al first brought attention to what appeared to be evidence of residual gadolinium within the brain tissues of patients without severe renal disease. The evidence of gadolinium in the brain started with reports of abnormal signals in the globus pallidus and the dentate nuclei on unenhanced T1-weighted MR images after repeated prior administration of certain gadolinium-based contrast agents or GBCAs. Other studies found measureable concentrations of gadolinium in normal brain tissues from patients with normal renal (kidney) function. In their editorial, Kanal and Tweedle said, “These provocative findings cause us to reconsider what we know and what we need to learn to better care for our patients”.
The authors said, “We now have clear evidence that the administration of various GBCAs results in notably varied levels of accumulation of residual gadolinium in the brain and bones of patients, even those with normal renal function. What we still do not know is the clinical significance, if any, of this observation.” (more…)
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…)
Reports of Gadolinium Retention in brain tissues of patients with normal renal function raise safety concerns
Several recent studies that involve Gadolinium-based Contrast Agents used for enhanced MRIs have gotten the attention of the radiology community. The findings of all the studies indicate that Gadolinium-based Contrast Agents, or GBCAs, might not work exactly as everyone thought they did. The recent Mayo Clinic study by McDonald et al appears to confirm that at least some gadolinium from the intravenously administered GBCA can remain in brain tissues of patients – including in patients with normal renal function. Based on reports of increasing T1 signal intensity on unenhanced magnetic resonance images (MRI) in patients who had multiple MRIs with a GBCA, it appears that once deposited, gadolinium accumulates in the brain tissue. (Recent studies cited at end.)
Prior to the publication of these studies, patients with normal renal function had been told that their unexplained, chronic symptoms could not be from retained gadolinium; however, the findings of the recent studies cast serious doubt on that. The findings seem to support what patients with normal renal function have been saying for years now – they are retaining gadolinium from the GBCA administered for their MRIs and they are experiencing troubling symptoms because of it.
Recently I had the opportunity to provide some information for a story about GBCA safety that John Hocter, managing editor of Health Imaging, was writing. The recent publication of his article brought the plight of patients with normal renal function to a broader and more public audience. Also contributing to the article was Tobias Gilk, a leading MRI Patient-Safety advocate and member of the newly formed American Board of MR Safety. (more…)
Gadolinium Toxicity 