MRI With Contrast? Not So Fast.

Magnetic Resonance Imaging (MRI) is a wonderful tool for seeing what is going on inside the body.  Unlike CT scans, which use x-rays, MRI’s use magnetic fields and radio wave pulses to image the organs, joints, muscles, bones and soft tissues of the body.  About half of all MRI’s use a contrast material which contains gadolinium, a rare earth metal.  Many radiologists believe that MRI’s with gadolinium contrast allow them to see tumors, blood vessels and inflammation that would not be as clearly visible in the absence of contrast.

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Evidence has been mounting that some people have permanent problems as the result of the injection of this metal-based dye into their bodies.  Doctors recognize that the kidneys will be called upon to excrete the gadolinium and have cautioned against its use in patients with damaged or fragile kidneys.  In those patients it causes scarring of the kidneys and further reduces their function.  However, even some patients with perfectly healthy kidneys have reported suffering kidney damage due to the presence of the metal in their bodies.  Many of these people have been urging that patients be given specific warnings about these potential effects of gadolinium contrast and an opportunity to refuse them, if they are concerned about the extra risk.

Research on the subject has also identified a syndrome which is believed to result from the use of gadolinium.  The syndrome is called Gadolinium Deposition Disease (GDD).  It is believed to be an immune system response and can cause skin conditions, bone pain and brain or chemo “fog.”  Caucasian women of European descent are believed to be at highest risk for this response, which shows up within days of the administration of the contrast.

Earlier this month an FDA advisory committee voted almost unanimously to urge the agency to put additional warnings on the label cautioning that gadolinium may end up deposited in the brain and kidneys.  The committee also urged that more research be done into the problems presented by gadolinium contrasts.  Patient activists do not believe these recommendations go far enough as patients never see the label warnings, which are directed only to physicians.

As a careful patient, if you are going to have an MRI, have a conversation with the radiologist about whether contrast will be used and the risks and benefits of gadolinium contrast.  Don’t let the radiologist tell you that there is no risk, because there is.  That there is risk does not mean you should not get the contrast.  It only means that you should be able to have a frank talk with the radiologist about what benefits he or she expects from the use of contrast and whether the study can be as helpful or almost as helpful without the use of gadolinium contrast.

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