Gadolinium is a rare earth metal that’s used daily in contrast solutions for magnetic resonance imaging (MRI) scans.
Gadolinium-based contrast agents (GBCAs) are generally considered safe and effective. But like all drugs, side effects of gadolinium are possible.
Doctors and radiologists use gadolinium for MRI with contrast to provide them with sharper, more accurate images. This helps in diagnosing and monitoring treatment progress of serious health conditions, such as cancer.
What Is Gadolinium?
Gadolinium is a chemical element. Jean Charles de Marignac discovered it in 1880. It is silvery-white in color and is able to be shaped or molded without breaking or cracking.
Gadolinium is found in nature in an oxidized form. This means it is combined with oxygen – or that it contains at least one oxygen atom.
Is Gadolinium Toxic?
Gadolinium by itself is considered toxic to humans. But gadolinium becomes less toxic when combined with other metals occurring in the body such as zinc, calcium and iron.
This bonding allows the gadolinium to be carried out through the kidneys – in the same way the body would disperse of the other metals – before it can cause harm to the body’s tissues.
What Is Gadolinium Used For?
Gadolinium is used in contrast media, agents or “dyes” for MRI scans.
MRI scans assist with disease detection, diagnosis and treatment monitoring, especially in the non-bony or soft tissue areas of the body such as the brain.
Gadolinium-based contrast agents are sometimes used to provide clearer or brighter images thereby leading to better diagnosis.
How Does Gadolinium Work?
Gadolinium provides a greater contrast between normal and abnormal tissues. It works by changing the magnetic environment during an MRI scan.
Gadolinium is colorless or clear, but when exposed to MRI scanning, it becomes very bright. It accumulates in abnormal tissues, highlighting deposits of fluid indicating irregularities – such as inflammation or blood clots – as well as unwanted growths (i.e. tumors).
How Is Gadolinium Administered?
Gadolinium-based contrast agents are administered directly into your vein using a small needle or tube inserted through the skin. This is known as intravenous injection.
How Long Does Gadolinium Stay in the Body?
Gadolinium can stay in the body for months or years after it’s injected, according to the medication guide. Gadolinium stays longest in the bone.
The highest concentrations have been seen in the bone, followed by other organs, including the brain, skin, kidney, liver and spleen.
Gadolinium retention is greater with Omniscan (gadodiamide) and Optimark (gadoversetamide) than with Eovist (gadoxetate disodium), Magnevist (gadopentetate dimeglumine) and MultiHance (gadobenate dimeglumine).
The amount of gadolinium that stays in the body is lowest with Dotarem (gadoterate meglumine), Gadavist (gadobutrol) and ProHance (gadoteridol).
In 2018, the U.S. Food and Drug Administration required the makers of GBCAs to include updated drug labels warning about gadolinium retention. It can lead to gadolinium toxicity or a condition called gadolinium deposition disease (GDD).
The recommended dose of gadolinium-based contrast agents by injection for MRI scans ranges from 0.1 to 0.2 mL per kilogram of body weight.
Flow rates may vary based on the brand of GBCA being used and the area of the body being examined by MRI. The flow rate determines the amount of medication delivered in a specified period of time.
The rate of GBCA administration for most brands generally falls between 1 mL to 2 mL per second.
Magnevist’s drug labeling recommends not exceeding a flow rate of 10 mL per 15 seconds. This brand of GBCA also advises that dosing for patients exceeding 286 pounds has not been systematically studied.
It is advised that 5 mL normal saline flush be given directly after the injection to ensure complete administration of the GBCA.
All brands’ drug labels state that imaging should be completed within one hour of administering the injection of GBCA.
Gadolinium Side Effects
Side effects of gadolinium can be minor, such as headache, nausea and dizziness. But side effects such as gadolinium toxicity or gadolinium deposition disease (GDD) can be serious or potentially life-threatening.
All brands of GBCAs carry a black box warning — the FDA’s strongest warning — for an increased risk for nephrogenic systemic fibrosis (NSF) in certain patients. Patients with kidney problems are at a greater risk for developing NSF. The rare disease can affect internal organs and cause disabling joint problems.
Patients injured after using GBCAs have filed gadolinium lawsuits.
Who Should Not Use Gadolinium?
Patients should let their doctor know if they have kidney problems before using gadolinium-based contrast agents.
Drug labels of most brands of GBCAs advise against the use of the contrast media in patients with chronic, severe kidney disease or acute kidney injury.
Some brands’ labeling, though – including drug labels for Gadavist, Eovist, ProHance and MultiHance – do not list kidney impairment under contraindications.
Patients with known allergies or hypersensitivities to GBCAs should not be given these drugs.
GBCA MRIs should only be used during pregnancy if the imaging is “essential… and cannot be delayed,” according to GBCA drug labels. This is because there’s a potential for serious and even life-threatening risks to the fetus.
Types of Gadolinium-Based Contrast Agents (GBCAs)
There are eight FDA-approved brands of gadolinium-based contrast agents (GBCAs). Companies that manufacture GBCAs include Bayer, GE Healthcare, Guerbet and Bracco Diagnostic Inc.
The American College of Radiology (ACR) divides the different brands of GBCAs into three groups based on their associated risk of nephrogenic systemic fibrosis (NSF).
Omniscan, Magnevist and OptiMARK, for example, make up Group I. They have the greatest number of NSF cases, according to the American College of Radiology.
- Group I Agents – having the greatest number of NSF cases
- Group II Agents – associated with few, if any, confirmed cases of NSF
- Group III Agents – data is limited about NSF risk
|Brand||Manufacturer||Risk of NSF|
|Omniscan (gadodiamide)||GE Healthcare||Group I|
|Magnevist (gadopentetate dimeglumine)||Bayer||Group I|
|OptiMARK (gadoversetamide)||Guerbet||Group I|
|MutliHance (gadobenate dimeglumine)||Bracco Diagnostic Inc.||Group II|
|ProHance (gadoteridol)||Bracco Diagnostic Inc.||Group II|
|Gadavist (gadobutrol)||Bayer||Group II|
|Dotarem (gadoterate acid)||Guerbet||Group II|
|Eovist (gadoxetic acid)||Bayer||Group III|
Please seek the advice of a medical professional before making health care decisions.