A literature search was done for this Personal View, consisting of PubMed, Google Scholar, and ISI Web of Science searches for the terms “gadolinium deposition”, “brain gadolinium”, “gd deposition”, and “deposition MRI” between September, 2015, and March, 2017. Because of the large number of published reports on this topic, those deemed most relevant for the aims of this Personal View were selected. Excluded from our selection were research articles that provided only anecdotal evidence. Papers
Personal ViewGadolinium deposition in the brain: summary of evidence and recommendations
Introduction
Gadolinium-based contrast agents (GBCAs) are widely used in research and clinical settings, for diagnosis and monitoring of many diseases. The signal intensity of an MR image is affected by T1 and T2 relaxation times, which are characteristic physical properties of each tissue related to its behaviour in a magnetic field. GBCAs shorten the T1 relaxation time of water protons near the agent, and this phenomenon produces images in which tissues with a high concentration of contrast agent are brighter than those with lower concentrations.
Over 30 million doses of GBCA are administered worldwide annually, and over 300 million doses have been administered since their introduction in 1987.1 The risks associated with the use of GBCAs include allergic and adverse reactions (which are infrequent, but can be serious),2, 3 and nephrogenic systemic fibrosis in patients with renal failure. Nephrogenic systemic fibrosis is a rare scleroderma-like illness that occurs in patients with severe renal disease and after exposure to certain GBCAs. Its incidence has been effectively eliminated by restricting the administration of the GBCAs most closely associated with nephrogenic systemic fibrosis in high-risk populations, and by lowering of GBCA dosage.
Multiple studies have shown evidence of residual brightness of tissue in the deep nuclei of the brain, particularly the globus pallidus and the dentate nucleus, in people who have received a GBCA; additional evidence shows that these regional signal changes are directly associated with the deposition of the contrast agent. These findings raise concerns about the context in which gadolinium deposits in the brain, and pose the question as to whether this deposition might cause any harm.
On behalf of the International Society for Magnetic Resonance in Medicine (ISMRM), we summarise the evidence on gadolinium deposition in the brain, contextualise this evidence according to knowledge obtained from cases of nephrogenic systemic fibrosis, and provide recommendations for future use of GBCAs in research and clinical practice.
Section snippets
Gadolinium deposition in the brain
The presence of high MRI signal intensity on unenhanced T1-weighted images of the dentate nucleus and the globus pallidus of patients who had undergone multiple GBCA-enhanced MRI examinations was first described in 2014.4 Increased relative signal intensity correlated with the number of contrast-agent administrations. A comparison of signal intensities in a subgroup of patients who had undergone at least six contrast-enhanced MRI examinations, with either gadopentetate dimeglumine or
Is there any evidence of harm?
The clinical and biological significance of retained gadolinium in the brain, if any, remains unknown. No harm from gadolinium exposure has been seen in animal models and no behavioural changes were reported in animals undergoing repeated examinations with gadolinium agents over a very short time period.21 Burke and colleagues35 have reported a list of non-specific symptoms from a survey of patients who believed that they suffered from gadolinium toxicity, though no evidence is available from
Conclusions and future directions
Convincing evidence is available for the deposition of gadolinium in the deep nuclei of the brain, particularly after repeated exposure to GBCAs. Although differences in gadolinium deposition are apparent among the agents and between agents' class, some data are contradictory. Additionally, no data are available regarding gadolinium deposition for some contrast agents. The detection of gadolinium deposition in the brain is concerning; however, there are no reliable data regarding its clinical
Search strategy and selection criteria
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