Gadolinium Contrast Agent Concerns for Multiple Sclerosis
Researchers in Europe and the United States continue to make important advances in understanding gadolinium based contrast agent (GBCA) concerns for multiple sclerosis patients. Because MS patients regularly monitor their respective medical conditions through an MRI, it is important to know about GBCAs.
Gadolinium is a rare earth element that has special magnetic properties. Those properties make it particularly effective as a contrast agent for MRI. In its pure form, it is highly toxic.
In order to use gadolinium as a contrast agent, it is surrounded (chelated) by substances to make it inert while in the body. Generally, the chelates are more water-soluble, so most of the gadolinium leaves the body through the kidneys within a few days. As a result for many years since gadolinium was first used in MRIs in 1988, doctors considered it safe. What that generally meant is doctors saw it as safer than other contrast materials. However, in light of new research, gadolinium-based contrasts come with what is known as a black box warning, the FDA’s sternest warning about safety.
Before an MRI is performed, patients receive an informed consent forms to read and sign. Most informed consent forms don’t even mention the risks of gadolinium. When they do, because form documents are often slow in being updated, the forms do not mention the latest information. Even more, the forms usually do not provide information about a particular GBCA. Click here to see two Gadolinium Based Contrast Agents Sample Medical Releases.
GBCAs came into common use in the late 1980s. For many years, the general belief was that about 90% of the gadolinuim associated with a GBCA clears the system within a few days. Then concerns began to emerge about greater amounts of gadolinium retained by people with impaired kidney function. In response, the FDA required use of a specific warning about use by patients with acute kidney disorders in 2006. The FDA upgraded and expanded the warnings in 2010 and again in 2013. More recently, researchers in Denmark and at the Mayo Clinic discovered people withoug kidney issues retain greater amounts of gadolinium than previously known. That information reveals gadolinium can stay for many years in the body and has been found in bone and brain tissues in greater amounts that previously known.
With that as background, the concerns start to arise when the gadolinium breaks apart from the chelate or does not clear the body well. As long as the chelate remains bound, it has not been considered a significant risk. When the chelate breaks, an occurrence called transmetalation, the materials used for the chelate can also bind to other metallic elements, like iron, zinc and others, leaving free gadolinium in the system in its free, poisonous form. It can also occur when patients receive frequent contrast-based MRIs , as is more common for MS patients than the general population. Add in the fact that the chemical and ionic structure of the three most common GBCAs are the most likely to break apart, and grave concerns arise.
When free gadolinium releases into the body, a condition known as Nephrogenic System Fibrosis (NSF) can result. First discovered in 1997, this disease is a progressive and potentially fatal condition associated with the hardening and thickening of the skin and potentially organs, severely restricting movement. Early on, NSF can feel like an MS hug. Other symptoms include:
- Burning or itching, reddened or darkened patches; and/or skin swelling, hardening and/or tightening of skin,
- Yellow raised spots on the whites of the eyes, and/or
- Joint stiffness; limited range of motion in the arms, hands, legs, or feet; pain deep in the hip bone or ribs; and/or muscle weakness
Eventually, it leads to suffocation, hardening of the heart muscle, liver failure, and/or multiple system failures. Physicians and radiologists are not generally familiar with NSF or free gadolinium. Gadolinium can be removed from the body through chelation therapy, however, you and your doctors must catch it early. Unfortunately, most people begin noticing the symptoms months after an MRI when it is too late. Physicians consider NSF incurable.
There are concerns that MS patients are at greater risk than others for gadolinium exposure because of the frequency of their MRIs. It’s not yet clear how many MRIs or how close in time MRIs are done increases the risks. In the US, the FDA recommends caution regarding how close one MRI with gadolinium contrast are performed. The European Medical Agency prohibits MRIs with GBCAs from being performed within seven days of one another. Denmark’s medical authority has now outlawed MRIs with GBCAs in favor of newer equipment that is becoming available. The FDA suggests patients with kidney issues should have a kidney function test performed. The EMEA now requires it for all patients.
Because of the risks involved with GBCAs, especially for Multiple Sclerosis patients, Soter Healthcare recommends using a gadolinium contrast only in very limited circumstances, having a kidney function test prior to the MRI, and having a urine test done to check gadolinium levels after an MRI with GBCA. Fortunately, technology in the latest generation of MRI machines reduces the need for use of GBCAs as often. We also recommend looking back at your medical records to check out the GBCA used in your prior MRIs. You can find the information on your MRI report. If you need assistance in locating it, we can help.
For more information, speak to your physicians and radiologists. Ask whether your MRI requires a gadolinium contrast agent. If the answer is yes, ask what gadolinium contrast agent will be used and ask the doctor and radiologist for specific information about the specific risks associated with that agent. It may a long conversation, but it will definitely be worth the time.
The information contained here is for informational purposes only. It is not a substitute for consulting with your physicians about your specific condition and care.