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Gadolinium Deposition Disease (GDD) in Patients with Normal Renal Function
We have some important news to share with patients with normal or near normal renal function who have developed unexplained symptoms since their exposure to gadolinium-based contrast agents (GBCAs). The disease we have been dealing with now has a name: Gadolinium Deposition Disease or GDD.
UNC Radiologist, Richard Semelka, MD, has given us permission to publish his “Initial Draft” of the Disease Description for Gadolinium Deposition Disease on our website; to our knowledge, this is the first time it has been published. Dr. Semelka said that this statement is a work in progress, and he intends to revise and expand it as he learns more about patterns of the disease. If important changes are needed, a revised Disease Description will be published.
While his research is ongoing, Dr. Semelka felt that it was important to release the Disease Description now, so that GDD is recognized as an entity by an expert, which he believes should be very important for sufferers. Dr. Semelka wants to get the initial description of the disease out into the community to start to provide relief and benefit to patients affected by retained gadolinium.
Gadolinium Deposition Disease. Disease Description.
Author: Richard C Semelka, MD. November/2015Gadolinium Deposition Disease (GDD) is a disease process observed in subjects with normal or near normal renal function who develop persistent symptoms that arise within hours to 2 months following the administration of gadolinium based contrast agents (GBCAs). In these cases, no pre-existent disease, or subsequently developed disease of an alternate known disease process, is present to account for the symptomatology.
Patient symptoms are similar but not identical to those observed in the condition Nephrogenic Systemic Fibrosis (NSF). Typical clinical features include persistent headache and bone and joint pain. More distinctive features are comparable to those observed in NSF, but to a lesser extent; patients often experience subcutaneous soft tissue thickening that clinically appears somewhat spongey, without the hardness and redness observed in NSF. Tendons and ligaments in a comparable distribution may also appear thickened and painful. Patients may complain of a tightness of the hands and feet that resemble the feeling of being fitted with extremely tight gloves or socks. Patients may experience excruciating pain typically in a distal distribution of the arms and legs but may also be torso or generalized in location. This pain is often described as ‘cutting’ or ‘burning’.
Supporting laboratory evidence.
In the early months following development of the disease patients should exhibit elevated blood, urine or other tissue gadolinium levels. The exact levels necessary are not yet determined. Bone gadolinium deposition is likely present for many years following disease development. In the early months after disease development, it may be of value to show elevated gadolinium deposition in some fluid or tissue to establish the diagnosis.###
As affected patients ourselves, we want to thank Dr. Semelka for publicly recognizing that patients with normal renal function are retaining gadolinium from administered GBCAs, and that they are being adversely affected by its toxic effects.
Sharon Williams and Hubbs Grimm
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You can learn more about Dr. Semelka at: https://www.med.unc.edu/radiology/Dept-info/faculty-staff/faculty-pages/richard-semelka-m-d
Dr. Semelka co-authored a recently published study by Ramalho et al, High Signal Intensity in Globus Pallidus and Dentate Nucleus on Unenhanced T1-weighted MR Images: Evaluation of Two Linear Gadolinium-based Contrast Agents.
Gadolinium in the brain, is it harmful? Yes!
Editorial – Last December, I posted a Viewpoint titled “Gadolinium Retention – Is it all in my head?” When I wrote that, I believed I had retained gadolinium in my brain, thyroid gland, and various other parts of my body. I believed it, but I did not know it for sure. It is one thing to think it, but it causes totally different feelings when you have confirmation that you have retained a toxic metal in your body.
On April 8, 2015, I posted about the gadolinium found in my thyroid tissue that was removed 51 months after my 5th dose of a linear gadolinium-based contrast agent. In July, I learned that an analysis of my 2012 non-contrast brain MRI found evidence of gadolinium deposition in the globus pallidus; that MRI was performed exactly two years after my last dose of contrast. Because of recently published studies, I was not surprised that they detected residual gadolinium in my brain. At the time of my MRIs, except for hypertension and a past history of migraine headaches, I had no history of anything known to alter the blood-brain barrier. Then and now, I continue to have “normal” renal function with an eGFR >60, but yet, I have evidence of long-term retention of gadolinium in my body. If I only had gadolinium in my tissues and no symptoms, I might not worry about it as much, but that is not the case. (more…)
MultiHance found to leave residual gadolinium in the brain
A new study by Weberling et al, Increased Signal Intensity in the Dentate Nucleus on Unenhanced T1-Weighted Images after Gadobenate Dimeglumine Administration, found increased signal intensity (SI) in the dentate nucleus (DN) after serial injections of the linear gadolinium-based contrast agent (GBCA) gadobenate dimeglumine (MultiHance, Bracco Diagnostics Inc.). The study included 50 patients that had a minimum of 5 consecutive brain MRI scans with MultiHance. All MRIs were performed between March 1, 2014 and December 31, 2014 in the German Cancer Research Center, Heidelberg, Germany. 45 of the patients had an estimated glomerular filtration rate (eGFR) greater than 60, and 5 had an eGFR between 45 and 60.
Like the 2015 study by Radbruch et al, the exclusion criteria included: history of brain hemorrhage, stroke, or brain ischemia; edema, tumor, or other lesions located in the cerebellum or pons; history of intracranial infection, such as meningitis or encephalitis; missing or unsatisfactory unenhanced T1-weighted MRI scans; and missing documentation of the contrast agent administered.
The study found an increased SI in the DN-to-CSF (cerebrospinal fluid) and DN-to-pons ratios on unenhanced T1-weighted images in patients that had at least 5 MRIs with the gadolinium-based contrast agent MultiHance. The authors said, “Because the previous work by McDonald et al showed that SI correlates with gadolinium retention in the respective area, the SI increase found herein likely reflects the specific potential of gadobenate dimeglumine to release gadolinium”. (more…)
Radiologists are in best position to watch patients’ backs
An August 1, 2015 article by Richard Dargan, Radiology Society of North America (RSNA), reviewed recent studies that reported finding evidence of gadolinium retention in the brains of patients with normal renal function. The article, “Radiology Should Take Lead in MRI Contrast Media Use, Research”, also included comments from Emanuel Kanal, M.D., regarding the role radiologists should play in MRI contrast agent research and usage. Dr. Kanal, a Professor of Radiology at the University of Pittsburgh Medical Center (UPMC), chairman of the American College of Radiology MR Safety Committee from 2002-2012, and chairman of the new American Board of Magnetic Resonance Safety (ABMRS), made his comments in an interview with RSNA News.
Recent research has shown that gadolinium-based-contrast agents (GBCAs) are leaving residual gadolinium in the brains of patients, including patients with normal renal function. Two regions in particular have been affected: the dentate nucleus and the globus pallidus. A 2013 study by Kanda et al, first reported finding high signal intensity in those two brain regions on unenhanced T1-weighted magnetic resonance (MR) images that appeared to be related to the increasing cumulative dose of a gadolinium-based contrast agent. Since then, additional studies have been published which confirmed the increased signal intensity is the result of gadolinium accumulation within the brain. (more…)
Gadolinium Toxicity 