Gadolinium Toxicity

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Gadolinium found in gliomas and adjacent normal brain tissue

February 24, 2019 – Researchers from Finland, led by Dr. Aida Kiviniemi, found that gadolinium deposits can be detected in both enhancing and non-enhancing gliomas, adjacent normal brain tissue, and necrosis.  The authors said that to their knowledge, “this is the first study to provide quantitative data of gadolinium retention in gliomas and neighboring normal brain with respect to tumor enhancement and type of GBCA used”.   “The levels of gadolinium in the tumor and normal brain correlated suggesting a possible transit of gadolinium to the surroundings of the brain lesion.  The most powerful predictor of gadolinium retention was the type of GBCA administered with significantly higher gadolinium accumulation detected with linear (gadodiamide and gadopentetate dimeglumine) relative to macrocyclic (gadoterate meglumine and gadobutrol) agents.”  The study, Gadolinium retention in gliomas and adjacent normal brain tissue: association with tumor contrast enhancement and linear/macrocyclic agents, was recently published online in Neuroradiology. (more…)

Pilot study reports elevated gadolinium levels 30 days after MRIs with contrast

A new study by Alwasiyah et al. concluded that the current reference range of 0.7 μg/24hr for 24-hour urinary gadolinium is not applicable to patients for at least 30 days following exposure to a gadolinium-based contrast agent (GBCA).  In the study, the authors “calculated an estimated average of 57 days for the urinary gadolinium to creatinine ratio to reach below the current reference range following GBCA exposure and possibly much longer (i.e., 80+ days)”.  The article, “Urinary Gadolinium Levels After Contrast-Enhanced MRI in Individuals with Normal Renal Function: a Pilot Study”, was published online December 12, 2018 in the Journal of Medical Toxicology.

This was a prospective, observational pilot study to determine urine gadolinium concentrations over a 30-day period after GBCA administration in patients with normal renal function.  The 13 subjects were between 18 and 65 years of age and were reported to have received a gadolinium-based contrast agent for the first time.  Prior to contrast administration, spot urine samples were obtained and tested for gadolinium and creatinine.  All testing was performed by Mayo Medical Laboratories in Rochester, MN.  Post-MRI 24-hour urine testing was performed on day 3, 10 and 30.  Eight subjects received gadobutrol (Gadavist®), four received gadopentetate dimeglumine (Magnevist®), and 1 received gadoxetate disodium (Eovist®) for their MRIs with contrast.  The authors reported that all 13 subjects had 24-hour gadolinium levels higher than 0.7 μg/24hr on day 3, day 10, and day 30 after contrast administration.  The authors estimated that “urinary gadolinium levels will often remain above the current reference range for >50 days”. (more…)

Clinical Criteria for Gadolinium Deposition Disease has been revised

On May 12, 2018, Dr. Richard Semelka revised the primary clinical diagnostic findings for Gadolinium Deposition Disease (GDD).  While the revision is being made sooner than anticipated, Dr. Semelka said it is based on well-informed recommendations from “patient experts” on the disease, and observations from 2 physician sufferers.  There are 5 symptoms that stand out to Dr. Semelka as critical diagnostic findings for GDD.  It is imperative that individuals have at least 1 of the symptoms, but he prefers to see 4/5 to make certain of the diagnosis.  Note that a 24-hour gadolinium urine test, performed 30 days or more after an MRI with a gadolinium-based contrast agent (GBCA), is still part of the diagnostic criteria for GDD.

The revised main clinical criteria for Gadolinium Deposition Disease, as described by Dr. Semelka are:

  1. Intense burning of the skin and skin substrate.Arising in early stage (early on after GBCA): This can be an all over feeling in the body, but often may be localized to the trunk region or distal extremities.
  2. Intense boring pain in bones or joints. Arising in early stage (early on after GBCA): This can be any bones or any joints. Often the joints may be peripheral but can also be large joints like the knee or hip. Any bones can have severe point pain, but rib pain is quite distinctive for the disease.
  3. Brain fog. Arising in early stage (early on after GBCA): Many terms have been used for this: mental confusion sounds more scientific, but brain fog gets the point across well and succinctly.
  4. Muscle vibrations (muscle fasciculations) and skin pins and needles/tingling (early on after GBCA). These symptoms may represent part of the same process that is causing brain fog. Muscle vibrations/twitching and pins and needles skin sensations generally reflect nerve disease (neuropathy).
  5. Distal arm and leg skin/skin substrate thickening, discoloration, and pain. Arising in the subacute stage (2 weeks +): This is very much like the principal features of NSF, but generally less severe. Instead of woodiness, doughiness; instead of redness, pinkness; instead of extreme joint contractures, stiffness of joints and decreased range of motion. This symptom complex should be expected.

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NIH study finds unexpected leakage of gadolinium into eyes of stroke patients

On February 7, 2018, researchers from the National Institutes of Health (NIH) reported on the unexpected finding of gadolinium leakage into ocular structures (GLOS) in acute stroke patients after administration of a gadolinium-based contrast agent (GBCA).  “Blood-ocular barrier disruption in acute stroke patients” by Hitomi et al. is published in the journal Neurology.  Blood-ocular barriers (BOBS) protect the compartments of the eye.

NIH researchers performed baseline MRI scans with a gadolinium-based contrast agent on 167 stroke patients upon admission to the hospital and compared them to scans performed 2 and/or 24 hours later with fluid-attenuated inversion recovery (FLAIR) imaging.  The study found that gadolinium leakage was evident on post-contrast FLAIR images in 127/167 (76%) patients.  At 2 hours after administration of the GBCA, GLOS was more common in the aqueous chamber alone.  At 24 hours, GLOS was present in 121/162 (75%) patients, always involving the vitreous chamber, but also affecting the aqueous chamber in 6% of cases.

The authors concluded that GLOS is common in patients with acute stroke, and delayed GLOS was a marker for chronic vascular disease. They noted that the mechanism for acute GLOS remains uncertain but may be a remote effect of acute cerebral injury on the blood-ocular barrier.

It remains unclear whether gadolinium can enter the eye in healthy people.

Gadolinium has been detected in eyes before (more…)

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