Gadolinium Contrast Agent

[rodneyd]

Hi all,

I just read an interesting article about the residual effect of the Gadolinium Contrast Agent used for MRI contrast.  In the past, there have been concerns about the affect Gadolinium has on the kidneys and it is now standard practice for doctors to ask whether you have any kidney problems or disease before they prescribe the use of the Gadolinium during the MRI.
 
The kidneys are supposed to eventually filter out the Gad solution so it can be excreted. 

Apparently, there are 9 such Gadolinium Contrast Agents and two of them have been shown to leave some Gadolinium in the brain and other tissues for a significant period of time.

I am on W& W and am due for my annual MRI next month and I will be sure to ask who the manufacturer of the Agent is before I have the MRI.  There have been no studies done on the effects of the Gadolinium in brain tissue, but there are at least seven other Agents that can be used that don't seem to leave residual Gadolinium so why take a chance on one that is known to leave residual Gadolinium in the brain? 

I am purposefully not naming the companies or the name of the Contrast Agent, but wanted to alert the AN community that you might want to do some research and ask about this issue when you are ready for your MRI.

One more thing to worry about.   

[ANGuy]

Link to the article?

[CHD63]

Hi rodneyd .....

I did a superficial search on this issue and found some related information about it.  From what I can gather, while yes, they have found on autopsies that the brains of patients who had multiple MRIs with Gadolinium have more of these deposits in their brains ..... so far there is no data to support harm to patients.

I, for one, have to believe: #1 the benefits outweigh the risks for me personally and #2 surely, if given a choice of companies, the radiology department would use the safer one on me with the MRIs of my head and neck.

That being said, I am a victim of massive radium treatments to my head as a kid, before they knew the dangers ..... so anything is possible 20, 30, 40 years down the road.  I just refuse to include this in my worry list.   

Thanks for the heads up on this though.

Clarice

[rodneyd]

Hi all,

My purpose for posting the article about the Gadolinium Contrast Agent was not to alarm or scare anyone away from it's use.  Like any other medical procedure or medication there are side effects that medical personnel take great care in mentioning (in some cases, ad nauseum until it sounds like you could have all sorts of ill effects when in most likelihood, the actual threat is probably minimal).

And the clarity of the MRI image may be ultra important (for example, when it is used to prepare the computer program for the Gamma Knife or Cyber Knife procedures, which require as much detail as possible) and the question as to whether a Gad Agent should be used or not is a moot point.

Clearly though, the agent can have serious medical effects when administered to a patient with renal problems or failures, and the FDA has required a warning label regarding the use in this situation since around 2006. And that is why we are now asked if we are suffering from any forms of renal failure before an MRI with the Gad Agent is administered. 

So what about the use of the agent in periodic MRI's for those of us on the W & W or other longer term monitoring programs?  Should we be using the Gad agent or just a normal MRI? 

My own personal opinion is that it is a good question to ask your medical professionals.  I think, at the very least, we should ask who the maker of the Gad agent is, and ask if there are any other products that do not appear to leave a Gad residue in the brain or other neuron cells.

ANA guy has asked for a link to the article I read on the computer.    Unfortunately, it was one of those articles that just "pop up" on the main web page (I believe I was using Yahoo at the time) but that "disappears" after a few hours or so.  I wish I had been smart enough to notice the publication or to add the article to my favorites, but alas, I didn't do it and now everything is based on my memory of the article.

However, there are many other articles about the use and side effects of the use of Gad Agents and here is a link to just one of them.  I think you will have to copy and paste it into your browser to read it but that is a fairly simple procedure.

http://www.healthimaging.com/topics/molecular-imaging/neuroimaging/contrast-concerns-gadolinium-deposits-remain-brain-after-contrast-enhanced-mri

As CHD63 has posted, the benefits of the Gad Agent may far outweigh any residual side effects from it's use.  As in all things medical, it is your body and your decision about what to do about your treatment. 

And, as she correctly pointed out, there have been no studies as to the actual effect of the Gad product even if it is residual in the certain brain regions. 

I just think it a good question to ask the medical team that is treating you.  Then make your own decision based on what they tell you.


Rod

 

[ANGuy]

Rod,

Thanks for posting the article.  Even though it's not the original one you read, it was enough for me to get the general idea.  I wonder if contrast is necessary for someone like me at this point for my WW monitoring.  I don't know enough about imaging and how much the gadolinium helps define mine. 

I plan on asking about it before my August MRI.

[rodneyd]

Hi AN Guy

I am definitely going to ask before my W & W MRI in July so we will see what they say at the Swedish Hospital in Seattle. 

I am sure there are good reasons for using the Gad Agent, but it is a heavy metal and even though it is chelated (surrounded by other chemicals to make it less reactive) and heavy metals in the brain tissue have been known to cause lots of problems.

The Gad Agent had been used for awhile before they discovered that weak or damaged kidneys could not effectively deal with it, so the FDA had to put a notice on the packaging.  I just wonder if there are other subtle symptoms that haven't been identified yet and that may cause problems down the line as the MRI's add up. 

I had three MRI's in the space of 9 months and they all used the Gad Agent and now I am waiting for one year between MRI's.

I will keep everyone posted on what I find out.

Rod

[Alix May]

Here's the original study for those interested:
http://www.ncbi.nlm.nih.gov/pubmed/25742194
http://pubs.rsna.org/doi/10.1148/radiol.15150025?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

And a study on whether it's necessary:

Brain tumors: MR imaging with gadolinium-DTPA. 
R Felix, W Schörner, M Laniado, H P Niendorf, C Claussen, W Fiegler, and U Speck
DOI: http://dx.doi.org/10.1148/radiology.156.3.4040643

Abstract
 
Magnetic resonance (MR) imaging was performed on 40 patients with intracranial tumors, before and after intravenous administration of gadolinium-DTPA (Gd-DTPA). Precontrast studies included a comprehensive protocol of spin-echo sequences. Tumors were visualized on precontrast images either directly or indirectly by anatomic distortion caused by the mass. However, differentiation of the tumor from adjacent tissues was possible in only 17 of 40 cases. Delineation of the tumor was best on precontrast, T2-weighted images. After administration of Gd-DTPA (0.1 mmol/kg), increased signal intensity from the tumor was observed in all patients. The localized increase in signal intensity in the tumor considerably improved the tumor delineation in 36 of 40 patients. Whereas most of the meningiomas, neuromas, and adenomas could be delineated prior to administration of contrast material if appropriate pulse sequences were applied, glioblastomas and intracranial metastases required Gd-DTPA administration for diagnostically sufficient tumor display.

[ANGuy]

Here's the original study for those interested:
http://www.ncbi.nlm.nih.gov/pubmed/25742194
http://pubs.rsna.org/doi/10.1148/radiol.15150025?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub%3dpubmed

And a study on whether it's necessary:

Brain tumors: MR imaging with gadolinium-DTPA. 
R Felix, W Schörner, M Laniado, H P Niendorf, C Claussen, W Fiegler, and U Speck
DOI: http://dx.doi.org/10.1148/radiology.156.3.4040643

Abstract
 
Magnetic resonance (MR) imaging was performed on 40 patients with intracranial tumors, before and after intravenous administration of gadolinium-DTPA (Gd-DTPA). Precontrast studies included a comprehensive protocol of spin-echo sequences. Tumors were visualized on precontrast images either directly or indirectly by anatomic distortion caused by the mass. However, differentiation of the tumor from adjacent tissues was possible in only 17 of 40 cases. Delineation of the tumor was best on precontrast, T2-weighted images. After administration of Gd-DTPA (0.1 mmol/kg), increased signal intensity from the tumor was observed in all patients. The localized increase in signal intensity in the tumor considerably improved the tumor delineation in 36 of 40 patients. Whereas most of the meningiomas, neuromas, and adenomas could be delineated prior to administration of contrast material if appropriate pulse sequences were applied, glioblastomas and intracranial metastases required Gd-DTPA administration for diagnostically sufficient tumor display.

Thanks for that since I think it addresses the most logical question, "How necessary is the contrast?"

From the abstract, it seems the tumors would show up without it.  But it didn't address detail, like has my 1cm tumor grown a couple of mm or not.

[rodneyd]

Update:

Just got off the phone with my radiologist (maybe not the right title) at Swedish Medical Center in Seattle and was informed that the Gad Agent wasn't necessary for my one year follow-up MRI in late July and they will modify the MRI order to reflect that change.

I would insist on the Gad Agent if I was preparing for the Cyberknife treatments as I believe the Agent would provide the most precise location and size, but I am just as happy that I won't have to have it for this test.

I am gratified that the people at Swedish seemed to be aware of the issue and were more than happy to change the test without any argument from me.

It pays to be aware of changes in the field that could potentially affect our brains and to ask questions if you are concerned about the treatment options.

Rod

[keithmac]

On questioning why no Gadolinium was to be used on my last scan in early May, the radiologist double-checked my records and found a note to say it wasn't needed.  At the follow up consultation I asked again and the consultant told me it was because the tumor could be seen well enough without. 

That was fine by me!  I had just assumed that after the first time it would be ordered routinely for all subsequent scans.

[ANGuy]

My first two had it.  My next one is in about a month.  I messaged my Dr's office asking why my next one should have contrast.  I'll post his response in a few days when he gets back to me.

[MG]

rodneyd,
Thank you for bringing this topic up. I had no idea this contrast may cause problems until my son who teaches Radiography, mentioned that I needed to flush my body out with lots of water before and after my MRI. I have had three with contrast. I wish I knew why I had to have all three with contrast because I have been on W&W for 3 years now. I will surely ask the doctor in Gaineville next week why the ENT doctor gave me a script for an Mri with contrast.    More to worry about I guess.

MG

[rodneyd]

Hi all,

My guess is that doctors want to see everything they can, and they order it out of habit.  But certainly, if they are preparing to do Gamma Knife or Cyberknife, it should be used for accuracy.

Unless they keep current with the latest concerns, they may not even know this is something to worry about.

I am giving them the benefit here, a cynic might say that it could be that the hospital makes more money by using the solution than is does by not using it.

In any event, I think it is something to discuss with your doctors and see what they say.

Rod

[jsanders1379]

I've been following this thread and so asked my doctor about it at my annual checkup. He said he strongly recommended the contrast for the first 3-4 yrs. MRIs post GK. He said that not using the contrast would reduce the measurement accuracy by a magnitude of 10. He also said that even though Gad deposits can be detected in the brain, no studies showing associated damage had been reported. So, I'm not saying I necessarily agree, just reporting what one dr. said.

[ANGuy]

I've been following this thread and so asked my doctor about it at my annual checkup. He said he strongly recommended the contrast for the first 3-4 yrs. MRIs post GK. He said that not using the contrast would reduce the measurement accuracy by a magnitude of 10. He also said that even though Gad deposits can be detected in the brain, no studies showing associated damage had been reported. So, I'm not saying I necessarily agree, just reporting what one dr. said.

My Dr just responded with basically the same info.  He said that the borders of the tumor won't be clear enough to discern size and that it is pretty much a waste of time not to use the contrast.  Contrast it is for me.