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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…)
NSF Diagnosis made by means of Elemental Bioimaging and Speciation Analysis
A novel approach to diagnosing Nephrogenic Systemic Fibrosis, better known as NSF, was recently published by Birka et al in Analytical Chemistry. Birka and his colleagues used the combination of inductively coupled plasma mass spectrometry (ICP-MS), laser ablation (LA) ICP-MS for elemental bioimaging, and hydrophilic interaction liquid chromatography (HILIC) ICP-MS for speciation analysis, which allowed them to diagnose a case of NSF. While the article, Diagnosis of Nephrogenic Systemic Fibrosis by means of Elemental Bioimaging and Speciation Analysis, is very scientific in its details, there are facts to be learned by patients as well.
Skin biopsy specimens of NSF patients that were investigated by various techniques, found the presence of gadolinium deposits were mainly in the deeper regions of the subcutis (fat and connective tissue). A correlation of gadolinium with calcium, sodium, and phosphorous was observed in all cases.
The case report in this study involved a young woman who exhibited characteristic symptoms of NSF that began in 2011. Her clinical history included renal failure and kidney transplants from living donors in 2004 and 2006; the authors noted that she still has dialysis-dependent kidney insufficiency. The patient had an MRI in 2002 with Magnevist (Gd-DTPA) and in 2005 with ProHance (Gd-HP-DO3A). (more…)
Study finds association between high signal intensity in the brain and linear gadolinium-based contrast agents
In January of 2015, another study by Kanda et al was published online ahead of print in Radiology. The study, High Signal Intensity in Dentate Nucleus on Unenhanced T1-weighted MR Images: Association with Linear versus Macrocyclic Gadolinium Chelate Administration, evaluated MR images of 127 patients who had undergone contrast-enhanced brain MRIs at their institution in Japan. The images of nine patients (7.1%) showed hyperintensity in the Dentate Nucleus (DN) on unenhanced T1-weighted MR images – none of the patients had severe renal disease. Of those nine patients, 7 received only linear GBCA and 2 received both a linear and macrocyclic GBCA. The contrast agents were Magnevist and ProHance. After thorough analysis, the authors concluded that hyperintensity in the DN on unenhanced-T1 weighted MR images was associated with previous administration of the linear GBCA, but not with the macrocyclic GBCA. (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 