Gadolinium Toxicity

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Patients with meningioma have increased T1 hyperintensity after multiple contrast-enhanced MRI

On March 11, 2015, a retrospective study on 46 patients with a meningioma who had routinely undergone follow-up enhanced-MRI scans with gadodiamide was published online in Investigative Radiology.  The authors report a significant increase in T1 hyperintensity of the dentate nuclei of the cerebellum on unenhanced scans was observed between the first and last MRI in the group of patients with a history of at least 6 enhanced MRI.  All patients had normal renal function before intravenous administration of gadodiamide (Omniscan).

Two recent studies (Kanda and Errante), with different cohorts of patients, have shown the association between high T1 signal intensity of the dentate nucleus and history of a high number of contrast-enhanced MRI in patients with cancer and brain metastases, and in patients with Multiple Sclerosis (MS). (more…)

Mayo study reports Gadolinium remains in the brain after contrast-enhanced MRI

An important new study was published online March 5, 2015 in Radiology.  Dr. Robert McDonald and his colleagues at Mayo Clinic in Rochester, Minnesota, found high levels of gadolinium in four regions of the brain of 13 deceased patients who had 4 or more contrast-enhanced MRIs with Omniscan.  None of the patients had severe renal disease.  Except for one patient with an eGFR of 54, the other 12 had an eGFR between 74 and 122.  The authors concluded that “intravenous GBCA exposure is associated with neuronal tissue deposition in the setting of relatively normal renal function”.

The study, Intracranial Gadolinium Deposition after Contrast-enhanced MR Imaging, sought to confirm the findings of Errante et al (2014) and Kanda et al (2103) which reported progressive increases in T1-weighted signal intensity in parts of the brain after repeated administration of a Gadolinium-based Contrast Agent (GBCA). (more…)

Confirmation of Gadolinium Retention from as far back as 1989

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…)

Difference between Linear and Macrocyclic GBCAs

GBCAs can be divided into two categories based on their molecular structure.  Linear and Macrocyclic GBCAs have different properties that may contribute to their propensity to dechelate at some time after administration. This very short video explains the difference between linear and macrocyclic GBCAs and it hits on transmetallation too. (more…)