Elsevier

Magnetic Resonance Imaging

Volume 34, Issue 8, October 2016, Pages 1078-1080
Magnetic Resonance Imaging

Original contribution
Self-reported gadolinium toxicity: A survey of patients with chronic symptoms

https://doi.org/10.1016/j.mri.2016.05.005Get rights and content

Abstract

Purpose

This study aims to describe the self-reporting symptoms experienced by individuals with self-reported normal renal function after gadolinium based contrast agent (GBCA) administration.

Materials and methods

This HIPAA-compliant, IRB-approved study consisted of an anonymous online survey of patients who believe that they suffer from gadolinium toxicity. 50 respondents completed the nine-question survey.

Results

Fifty (100%) of the subjects ascribed their complaints to gadolinium exposure. Thirty-three (66%) described the onset immediately following GBCA administration and 16 (32%) within 6 weeks. The most common symptoms included bone/joint pain and head/neck symptoms including headache, vision change, and hearing change (77.6% each). Other symptoms occurred with lesser incidence.

Conclusions

This survey represents an initial description of patients with normal renal function who self-described toxicity related to GBCA administration. Bone and joint complaints and skin changes are two of the most common complaints.

Introduction

Historically, gadolinium based contrast agents (GBCAs) have been considered extremely safe for detecting and characterizing lesions using magnetic resonance imaging (MRI) [1], [2]. In 2006, however, alarming reports of nephrogenic systemic fibrosis (NSF) associated with GBCA administration began to surface. NSF is characterized by progressive skin and organ fibrosis and is associated with significant morbidity and mortality [3], [4], [5]. Research demonstrated that the combined effect of unstable forms of GBCAs and poor renal function predisposed patients to NSF. This resulted in radiologists and clinicians restricting the use of gadolinium in patients with poor renal function, and using GBCAs in which the chelation of gadolinium was more stable (e.g., macrocyclic and linear ionic chelators). In patients with normal renal function, GBCAs continued to be considered extremely safe [6].

In 2014, research demonstrated that a subset of patients with normal renal function have retained gadolinium in the brain, specifically within the basal ganglia and dentate nucleus [7], [8], [9], [10]. The underlying cause of gadolinium retention remains unclear. In addition to reports of gadolinium deposition, there are several patient advocacy groups who believe that they suffer from “gadolinium toxicity”, chronic symptoms secondary to gadolinium exposure and retention. Therefore, the intent of this manuscript is to collate and describe the self-reported onset and type of symptoms of these individuals.

Section snippets

Materials and methods

This anonymous survey was approved by the institutional review board. All recipients of the survey were informed of the purpose of the study. An electronic link to the survey was posted to a private blog (MRI-Gadolinium-Toxicity support group) that discusses gadolinium toxicity, and a public Gadolinium Toxicity Facebook page.

The survey was posted using an online survey program (SurveyMonkey.com, Palo Alto, CA). The survey consisted of 9 open and closed questions and was open for responses for a

Results

All 50 respondents (100%) received intravenous gadolinium contrast with an average of 4.2 doses (range 1–23). All 50 respondents (100%) attribute their current symptoms to gadolinium exposure.

Results from the gadolinium exposure and symptomatology are presented in Table 1, Table 2.

Only six patients (12%) had a personal or family history of renal disease.

Discussion

While there is increasing evidence in the literature that gadolinium retention occurs in patients with normal renal function, it remains unknown as to whether patients with normal renal function may also experience persistent symptomology related to GBCA administration [10]. This anonymous survey intended to inquire whether gadolinium toxicity may occur in this subset of patients and what symptoms patients may experience. In this self-report survey 66% of respondents complained that the onset

References (13)

  • T Frenzel et al.

    Stability of gadolinium-based magnetic resonance imaging contrast agents in human serum at 37 degrees C

    Investig Radiol

    (2008)
  • M Tweedle et al.

    Biodistribution of radiolabeled, formulated gadopentetate, gadoteridol, gadoterate, and gadodiamide in mice and rats

    Investig Radiol

    (1995)
  • P Marckmann et al.

    Nephrogenic systemic fibrosis: suspected causative role of gadodiamide used for contrast-enhanced magnetic resonance imaging

    J Am Soc Nephrol

    (2006)
  • N Rofsky et al.

    Nephrogenic systemic fibrosis: a chemical perspective

    Radiology

    (2008)
  • P Kuo et al.

    Gadolinium-based MR contrast agents and nephrogenic systemic fibrosis

    Radiology

    (2007)
  • R Wertman et al.

    Risk of nephrogenic systemic fibrosis: evaluation of gadolinium chelate contrast agents at four American universities

    Radiology

    (2008)
There are more references available in the full text version of this article.

Cited by (87)

  • MXenes and their composites for medical and biomedical applications

    2021, MXenes and their Composites: Synthesis, Properties and Potential Applications
  • Pituitary magnetic resonance imaging use in the posttreatment follow-up of secreting pituitary adenomas

    2021, Pituitary Tumors: A Comprehensive and Interdisciplinary Approach
  • MR Imaging Safety Considerations of Gadolinium-Based Contrast Agents: Gadolinium Retention and Nephrogenic Systemic Fibrosis

    2020, Magnetic Resonance Imaging Clinics of North America
    Citation Excerpt :

    Apart from NSF, data linking GBCA exposure with chronic toxicologic findings among humans with normal renal function are scant and are limited to case reports or studies involving multiple or supratherapeutic GBCA doses.3 More recently, patient-reported data have emerged from approximately 130 patients that may suggest neurologic, musculoskeletal, and connective tissue–related symptoms from GBCA exposure.67–69 These clinical manifestations, termed Gd deposition disease (GDD), have been reported to occur within minutes of GBCA administration.

View all citing articles on Scopus
View full text