Feature | May 05, 2015

Gadolinium May Remain in Brain After Contrast MRI

Series of three studies finds residual contrast years later, but long-term effects still unknown

gadolinium, brain, contrast MRI, Radiology, Kanal, brain, brain MRI with contrast

May 5, 2015 — New research, published in the journal Radiology, suggests some types of a popular contrast agent used in magnetic resonance imaging (MRI) exams may remain in the brain for years, but that the long-term effects are unknown.

“We now have clear evidence that the administration of various gadolinium-based contrast agents results in notably varied levels of accumulation of residual gadolinium in the brain,” said Emanuel Kanal, M.D., director of magnetic resonance services and professor of radiology and neuroradiology at the University of Pittsburgh Medical Center. “What we still don’t know is the clinical significance, if any, of this observation.”

Watch the VIDEO "MRI Gadolinium Contrast Retention in the Brain," an interview with Emanuel Kanal, M.D. at RSNA 2016. 

Gadolinium-based contrast agents have been used for diagnosis and treatment guidance in more than 100 million patients worldwide over the past 25 years. These agents enhance the quality of MR images by altering the magnetic properties of nearby water molecules in the body. By improving the visibility of specific organs, blood vessels or tissues, contrast agents help physicians diagnose and treat a wide variety of medical conditions.

On its own, gadolinium can be toxic. Therefore, when used in contrast agents, gadolinium is bonded with a molecule called a chelating agent, which controls the distribution of gadolinium within the body.

“Integral to the safety of gadolinium contrast agents is the persistence of the gadolinium-chelate bond for as long as the agent remains within the patient,” said Kanal, who, along with Michael F. Tweedle, Ph.D., Stefanie Spielman Professor of Cancer Imaging at The Ohio State University, co-authored an editorial on the topic published in the June issue of the journal Radiology.

Gadolinium contrast agents are generally considered safe. Until 2006, it was believed that most, if not all, gadolinium left the body shortly after the exam. However, in the last 10 years, studies have reported that prolonged, elevated levels of gadolinium in the body may cause a condition called nephrogenic systemic fibrosis in patients with severe kidney disease.

Now, three studies published online in Radiology raise new questions about residual gadolinium concentrations in the brains of patients with no history of kidney disease.

Researchers from Teikyo University School of Medicine in Tokyo, Japan, found that even in patients without severe renal dysfunction, gadolinium-based contrast agent administration causes gadolinium accumulation in the brain. Brain tissues from five autopsied patients who had undergone multiple gadolinium-based contrast MRI exams and five patients with no gadolinium history were examined. None of the patients had been diagnosed with severely compromised renal function or acute renal failure. Gadolinium in significant amounts was detected in all specimens from the contrast group.

These findings lend support to the results of a Mayo Clinic study published in March, which showed residual gadolinium deposits in the postmortem brains of 13 patients who had undergone at least four gadolinium-based contrast MRI exams.

Neither of these studies was able to identify whether the residual gadolinium was in free or chelated form.

A third study, from the University of Heidelberg Medical Center in Heidelberg, Germany, suggests that the molecular structure of the contrast agent may play a role in gadolinium retention. There are two structurally distinct categories of gadolinium-based contrast agents: linear and macrocyclic. In the macrocyclic structure, the gadolinium is bound more tightly to the chelating agent and, therefore, less likely to release free gadolinium into the body.

For the Heidelberg study, the researchers retrospectively looked at two groups of 50 patients who had undergone at least six MRI exams with the exclusive use of a linear or macrocyclic gadolinium-based contrast agent. They found an increase in MRI signal intensity in specific brain regions in the linear group, but not in the macrocyclic group, suggesting gadolinium retention only in the group that had received the linear type of contrast agent. Both the Japanese study and the Mayo Clinic study focused solely on linear gadolinium agents.

Based on these findings, Kanal emphasizes that physicians should only order contrast MRI when truly indicated, and take into consideration the unknown risks of residual gadolinium when determining the type and amount of contrast agent to administer.

“Gadolinium-based contrast agents are extremely valuable to patients worldwide and have been so for decades,” he said. “We cannot unnecessarily deprive our patients of crucial, even life-saving medical data from gadolinium contrast-enhanced MRI. Nor can we ignore these new findings and continue prescribing them as we have until now, without change.”

Read the article “MRIs During Pregnancy Are Safe, But Gadolinium Scans May Increase Risk to Fetus.”
 

Related Gadolinium Safety Concern Articles

ACR Manual on Contrast Media Addresses FDA Gadolinium Safety Concerns

Study Finds No Association Between Gadolinium Contrast and Nervous System Disorder

Even High Doses of Gadolinium-Based Contrast Agents Doesn't Cause NSF

 

For more information: www.radiologyinfo.org

Related Content

Two brain metastases from primary lung cancer are contrast enhanced in the brain of a 61-year-old male. Speakers at AHRA 2019 will state that ProHance and other macrocyclic MR agents present a very low risk to patients. Images courtesy of Bracco

Two brain metastases from primary lung cancer are contrast enhanced in the brain of a 61-year-old male. Speakers at AHRA 2019 will state that ProHance and other macrocyclic MR agents present a very low risk to patients. Images courtesy of Bracco

Feature | Contrast Media | July 18, 2019 | By Greg Freiherr
Macrocyclic contrast agents have the best safety profile of all the magnetic resonance (MR) contrast media that are n
AAPM 2019 Features More Than 40 Presentations on ViewRay's MRIdian MRI-guided Radiotherapy
News | Image Guided Radiation Therapy (IGRT) | July 16, 2019
ViewRay Inc. announced that the company's MRIdian System is the focus of more than 40 abstracts selected by the...
FDA Approves Bayer's Gadavist Contrast for Cardiac MRI in Adult Coronary Artery Disease Patients
Technology | Contrast Media | July 15, 2019
The U.S. Food and Drug Administration (FDA) has approved Gadavist injection for use in cardiac magnetic resonance...
Insightec's Exablate Neuro Approved With GE Signa Premier MRI in U.S. and Europe
News | Focused Ultrasound Therapy | July 10, 2019
GE Healthcare and Insightec announced U.S. Food and Drug Administration (FDA) approval and CE mark for Insightec’s...
Delta T1 Maps Provide Quantitative, Automated Solution to Assess Brain Tumor Burden
News | Neuro Imaging | July 05, 2019
Imaging Biometrics LLC (IB) a subsidiary of IQ-AI Ltd., is highlighting a recently published study in the American...
Medic Vision Wins Japanese PMDA Clearance for iQMR Image Reconstruction Solution
News | Magnetic Resonance Imaging (MRI) | July 05, 2019
Medic Vision Imaging Solutions announced that its 3-D iterative image reconstruction technology for shortening magnetic...
LVivo EF Comparable to MRI, Contrast Echo in Assessing Ejection Fraction
News | Cardiovascular Ultrasound | June 19, 2019
DiA Imaging Analysis announced the presentation of two studies assessing the performance and accuracy of the company's...
International Working Group Releases New Multiple Myeloma Imaging Guidelines

X-ray images such as the one on the left fail to indicate many cases of advanced bone destruction caused by multiple myeloma, says the author of new guidelines on imaging for patients with myeloma and related disorders. Image courtesy of Roswell Park Comprehensive Cancer Center.

News | Computed Tomography (CT) | June 17, 2019
An International Myeloma Working Group (IMWG) has developed the first set of new recommendations in 10 years for...
SyMRI Software Receives FDA Clearance for Use With Siemens MRI Systems
Technology | Magnetic Resonance Imaging (MRI) | June 14, 2019
SyntheticMR announced U.S. Food and Drug Administration (FDA) clearance for clinical use of its SyMRI Image and SyMRI...
A high-fidelity 3-D tractography of the left ventricle heart muscle fibers of a mouse

Figure 1. A high-fidelity 3-D tractography of the left ventricle heart muscle fibers of a mouse from Amsterdam Ph.D. researcher Gustav Strijkers.

News | Magnetic Resonance Imaging (MRI) | June 07, 2019
The Amsterdam University Medical Center has won MR Solutions’ Image of the Year 2019 award for the best molecular...