Title: National Institutes of Health Perspective on Reports of Gadolinium Deposition in the Brain
Abstract: Gadolinium-based contrast agents (GBCAs) are currently approved by the FDA for use in conjunction with MRI. GBCAs are indispensable adjuncts to MRI, with numerous studies showing their efficacy in improving the accuracy of MRI studies, and they have a positive cumulative safety record to date. For example, acute adverse reactions have been reported in only approximately 0.079% of all administrations, of which 91% were classified as mild reactions [ 1 Jung J.W. Kang H.R. Kim M.H. et al. Immediate hypersensitivity reaction to gadolinium-based MR contrast media. Radiology. 2012; 264: 414-422 Crossref PubMed Scopus (178) Google Scholar ]. Despite the positive safety profile immediately after the injection of GBCAs, there has been recent attention to reports of gadolinium deposition in the brains of patients who received multiple doses of GBCAs [ 2 Kanda T. Fukusato T. Matsuda M. et al. 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. Radiology. 2015; 276: 228-232 Crossref PubMed Scopus (642) Google Scholar , 3 Kanda T. Ishii K. Kawaguchi H. Kitajima K. Takenaka D. High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: relationship with increasing cumulative dose of a gadolinium-based contrast material. Radiology. 2014; 270: 834-841 Crossref PubMed Scopus (913) Google Scholar , 4 Kanda T. Osawa M. Oba H. et al. High signal intensity in dentate nucleus on unenhanced T1-weighted MR images: association with linear versus macrocyclic gadolinium chelate administration. Radiology. 2015; 275: 803-809 Crossref PubMed Scopus (382) Google Scholar , 5 McDonald R.J. McDonald J.S. Kallmes D.F. et al. Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology. 2015; 275: 772-782 Crossref PubMed Scopus (996) Google Scholar , 6 Radbruch A. Weberling L.D. Kieslich P.J. et al. Gadolinium retention in the dentate nucleus and globus pallidus is dependent on the class of contrast agent. Radiology. 2015; 275: 783-791 Crossref PubMed Scopus (461) Google Scholar ]. Although it is not yet known if there is a clinical implication of brain deposition of gadolinium, concerns for patient safety are of paramount importance, and thus internal review of institutional policies on GBCA use are warranted. The purposes of this perspective are to (1) summarize the literature regarding GBCA deposition in the brain and (2) determine any potential impact of that knowledge on how GBCA-enhanced MRI may be performed to minimize patient risk. MRI With Gadolinium-Based Contrast Agents: Practical Help to Ensure Patient SafetyJournal of the American College of RadiologyVol. 13Issue 8PreviewMalayeri et al [1] write, "At present, there is no evidence suggesting that gadolinium deposition in the brain alters neurologic function." Where is the evidence for this statement? Free gadolinium is highly toxic. Even though no clinical implications can be drawn from the reported hyperintensities in the dentate nucleus, globus pallidus, pons, and thalamus, the findings are worrisome. Primum non nocere. We must ensure that we do not confuse the lack of results with safety. The precautionary principle must be prevalent. Full-Text PDF