Gadolinium contrast necessary in ‘countless’ MRIs, safety research encouraged

Matthew Davenport

On Nov. 1, Chuck Norris, Hollywood actor and martial artist, took on a new type of battle: fighting against medical device manufacturers in a lawsuit alleging that his wife contracted gadolinium poisoning from a contrast agent used for an MRI scan.

The FDA approved gadolinium-based contrast agents in 1988 and since then they have been used in more than 300 million patients worldwide to guide diagnosis and treatment, according to a position statement by the American College of Radiology (ACR) published in May 2016.

In the statement, ACR affirmed that gadolinium-based contrast agents “provide crucial, life-saving medical information.”

Norris’ lawsuit calls attention to potential safety concerns that patients may have regarding use of gadolinium during routine MRIs.

Healio Internal Medicine spoke with Matthew Davenport, MD, chair of the ACR Contrast Committee to help physicians address concerns patients may have about the safety of routine MRI screening. – by Alaina Tedesco

Question: Why is the gadolinium-based contrast necessary for diagnoses?

Answer: Gadolinium changes the local magnetic environment. It makes pathologic conditions stand out compared with normal background tissue as well as compared with abnormal tissue without contrast enhancement.

Q: What types of diagnoses would be missed without the contrast?

A: There are countless examples. A few include cancer and blood clots. Contrast material is not only important for diagnosis and exclusion of many critical diagnoses, but it also is necessary for monitoring treatment response and defining disease extent in many conditions.

Q: Are the concerns of patients like Norris’ warranted?

A: We cannot comment on the specifics of their case. Gadolinium-containing compounds have been administered to hundreds of millions of patients and, compared with other drugs, have a very robust safety profile in most clinical settings. However, the ACR, Radiological Society of North America (RSNA), and other radiology organizations are taking the issue of gadolinium deposition seriously.

We continue to encourage research to better understand its clinical significance. In the meantime, the risk-benefit equation in most situations favors continued use of gadolinium-containing contrast media for indicated examinations according to ACR guidelines.

Q: Anything else you would like to mention about patient safety concerns regarding gadolinium and MRIs?

A: As with other medical concerns, patients should speak with their doctor about their individual care decisions. Both the choice to receive contrast material and the choice to refuse contrast material when it otherwise would be indicated can have potential health consequences.

Patients who are considering an imaging exam that may involve contrast material may visit the Contrast Materials section of RadiologyInfo.org. This is a public information website co-operated by the American College of Radiology and Radiological Society of North America. It provides information that may answer a great many questions about medical imaging exams, related procedures, and radiation therapy techniques. This information can empower patients to ask questions of their health care providers.

Disclosure: Davenport reports no relevant financial disclosures.

Matthew Davenport

On Nov. 1, Chuck Norris, Hollywood actor and martial artist, took on a new type of battle: fighting against medical device manufacturers in a lawsuit alleging that his wife contracted gadolinium poisoning from a contrast agent used for an MRI scan.

The FDA approved gadolinium-based contrast agents in 1988 and since then they have been used in more than 300 million patients worldwide to guide diagnosis and treatment, according to a position statement by the American College of Radiology (ACR) published in May 2016.

In the statement, ACR affirmed that gadolinium-based contrast agents “provide crucial, life-saving medical information.”

Norris’ lawsuit calls attention to potential safety concerns that patients may have regarding use of gadolinium during routine MRIs.

Healio Internal Medicine spoke with Matthew Davenport, MD, chair of the ACR Contrast Committee to help physicians address concerns patients may have about the safety of routine MRI screening. – by Alaina Tedesco

Question: Why is the gadolinium-based contrast necessary for diagnoses?

Answer: Gadolinium changes the local magnetic environment. It makes pathologic conditions stand out compared with normal background tissue as well as compared with abnormal tissue without contrast enhancement.

Q: What types of diagnoses would be missed without the contrast?

A: There are countless examples. A few include cancer and blood clots. Contrast material is not only important for diagnosis and exclusion of many critical diagnoses, but it also is necessary for monitoring treatment response and defining disease extent in many conditions.

Q: Are the concerns of patients like Norris’ warranted?

A: We cannot comment on the specifics of their case. Gadolinium-containing compounds have been administered to hundreds of millions of patients and, compared with other drugs, have a very robust safety profile in most clinical settings. However, the ACR, Radiological Society of North America (RSNA), and other radiology organizations are taking the issue of gadolinium deposition seriously.

We continue to encourage research to better understand its clinical significance. In the meantime, the risk-benefit equation in most situations favors continued use of gadolinium-containing contrast media for indicated examinations according to ACR guidelines.

Q: Anything else you would like to mention about patient safety concerns regarding gadolinium and MRIs?

A: As with other medical concerns, patients should speak with their doctor about their individual care decisions. Both the choice to receive contrast material and the choice to refuse contrast material when it otherwise would be indicated can have potential health consequences.

Patients who are considering an imaging exam that may involve contrast material may visit the Contrast Materials section of RadiologyInfo.org. This is a public information website co-operated by the American College of Radiology and Radiological Society of North America. It provides information that may answer a great many questions about medical imaging exams, related procedures, and radiation therapy techniques. This information can empower patients to ask questions of their health care providers.

Disclosure: Davenport reports no relevant financial disclosures.