Gadolinium Toxicity

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Study suggests Gadolinium Deposition in Dentate Nucleus with MultiHance – Patients had normal renal function

Another 2015 study in Radiology reports findings consistent with gadolinium deposition within the brains of patients with normal renal function (eGFR >60).  The 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”, compared gadodiamide (Omniscan) and gadobenate dimeglumine (MultiHance).  The findings related to multiple administrations of gadodiamide are “in agreement with other investigators, who documented signal intensity changes associated with this contrast agent despite the presence of normal renal function”.  The authors also reported that, “A significant trend toward relative change in signal intensity was seen in the dentate nucleus (DN), but not in the globus pallidus (GP) after serial applications of gadobenate dimeglumine, suggesting that some gadolinium deposition also may occur with this agent”.

For the first time in the literature, the study established gadolinium accumulation related to the use of gadobenate dimeglumine, which is better known as MultiHance.  Of note is the fact that there are no unconfounded cases of NSF associated with the linear ionic gadolinium-based contrast agent (GBCA), MultiHance.  However, in this study, the patients in each group had received only one brand of GBCA.  Group 1 was comprised of 23 patients that had received between 3 and 11 doses of Omniscan, and Group 2 included 46 patients that had received between 3 and 11 doses of MultiHance.  All patients had normal liver and renal function.  (more…)

June 2015 Podcast of Group Discussion on gadolinium-based contrast media

If you would like to see and hear some of the experts discuss the issues surrounding gadolinium retention from gadolinium-based contrast agents, you should check out the June 2015 Radiology Podcast moderated by Herbert Y. Kressel, MD, Editor of Radiology.  It can be found here – http://pubs.rsna.org/page/radiology/podcasts.  You can also view it here – https://www.youtube.com/watch?v=gmgv6EvGw0o

Guests are:
Alexander Radbruch, MD, JD, Department of Neuroradiology, University of Heidelberg Medical Center, Heidelberg, Germany
Robert J. McDonald, MD, PhD, Department of Radiology, College of Medicine, Mayo Clinic, Rochester, Mn
Emanuel Kanal, MD, Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, Pa
Michael F. Tweedle, PhD, Department of Radiology and James Comprehensive Cancer Center, Ohio State University, Columbus, Ohio

Contributor:
Tomonori Kanda, MD, PhD, Department of Radiology, Teikyo University School of Medicine, Tokyo, Japan  (more…)

Gadolinium retention in brain tissue of patients with normal renal function

On April 6, 2015, a study by Radbruch et al was published online ahead of print in Radiology.  Like other recent studies, it reports on evidence of gadolinium retention in brain tissues of patients who had multiple MRIs with a gadolinium-based contrast agent or GBCA.  The study, Gadolinium Retention in the Dentate Nucleus and Globus Pallidus Is Dependent on the Class of Contrast Agent, found that increased signal intensity (SI) in the dentate nucleus (DN) and globus pallidus (GP) on unenhanced T1-weighted MR images is caused by serial administration of the linear GBCA gadopentetate dimeglumine (Magnevist), but not by the macrocyclic GBCA gadoterate meglumine (Dotarem).

The retrospective study was comprised of two groups of 50 patients who had undergone at least 6 consecutive MRIs with only the linear agent Magnevist or only the macrocyclic agent Dotarem.  All patients had an estimated glomerular filtration rate (eGFR) greater than 60 – which is a level of renal function not considered to be at risk of retaining gadolinium from the administered gadolinium-based contrast agent.  Of the 100 patients included in the study, 21 had an eGFR 60-90, and 79 patients had an eGFR greater than 90.  (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…)

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