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On May 27, 2015, JAMA Dermatology published a Case Report by Larson et al that described a biopsy-confirmed case of “Nephrogenic Systemic Fibrosis Manifesting a Decade after Exposure to Gadolinium”. According to the report, a long-term hemodialysis patient was exposed to a gadolinium-based contrast agent several times between 1998 and 2004 during magnetic resonance angiography (MRA) of his abdominal vessels and arteriovenous fistula. Ten years later, in 2014, he developed new dermal papules and plaques. The diagnosis of NSF was made based on the findings of a biopsy of affected skin which showed thickening of collagen, CD34+ spindle cells, and increased mucin in the dermis. (Information about the agent(s) and dosages are not provided).
Prior to this case, the authors noted that the longest documented time after exposure to gadolinium to NSF manifestation was 3 ½ years.
This case shows that even in patients with severe renal disease retained gadolinium can take many years before causing “visible” evidence of a problem. The authors concluded that, “Although the use of gadolinium contrast agents in patients with kidney failure has markedly decreased, patients with exposure to gadolinium years to decades previously may manifest the disease”. (more…)
On June 22, 2015, an article in Investigative Radiology was published online ahead of print. The study by Robert et al, T1-Weighted Hypersignal in the Deep Cerebellar Nuclei After Repeated Administrations of Gadolinium-Based Contrast Agents in Healthy Rats – Difference Between Linear and Macrocyclic Agents”, describes for the first time “an animal model reproducing closely the recent clinical observations of cerebellum T1 signal hypersignal”. “It also introduces an animal model to investigate the mechanism of the brain retention observed after repeated administrations of some GBCA.”
After 20 intravenous injections of 0.6 mmol of gadolinium per kilogram (4 injections per week for 5 weeks) of gadodiamide (Omniscan) or gadoterate meglumine (Dotarem) to healthy rats, they found that repeated injections of gadodiamide are associated with “progressive and persistent T1 signal hyperintensity in the deep cerebellar nuclei (DCN), with Gd deposition in the cerebellum in contrast with the macrocyclic GBCA gadoterate meglumine for which no effect was observed”. Although repeated doses of gadoterate meglumine (Dotarem) did not cause signal increases, detectable concentrations of gadolinium were found in the cerebellum, cerebral cortex, and subcortical brain of the rats that were injected with it. (more…)
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…)
My first urine test for Gadolinium was not done until a full two years after my last dose of contrast. Part of the delay was because I did not know about the test until almost 18 months had gone by.
I wanted my first test to be performed by Mayo Clinic Labs; however, I had difficulty making that happen. The lab affiliated with the medical clinic where most of my doctors are located told me that they could not do any testing for heavy metals or send specimens out to another lab for the testing. But I finally found a way around that problem.
The lab at our local hospital regularly sends specimens to Mayo Clinic in Rochester, Minnesota. (more…)