Gadolinium is a rare earth metal that forms a silvery metal color, and is well known for its magnetic properties and use as a contrast agent in magnetic resonance imaging (MRI). Many people wonder whether gadolinium is safe. The answer is, generally, gadolinium is considered safe; however, in some people, especially those with kidney issues, gadolinium can cause serious and sometimes life-threatening problems1,2. This blog will cover research, side effects, and long-term risks of using gadolinium-based contrast agents (GBCAs), and give insights into safer alternatives like non-contrast MRIs, low-dose CT scans, and alternative contrast agents.
What Is Gadolinium Contrast and How Is It Used in MRI Scans?
GBCAs are types of contrast agents given intravenously, through a small needle into a vein in the arm, and are used for imaging procedures during MRI scans3. They are administered to provide sharper MRI images and have been used to aid imaging of tumors, blood vessels, and inflammation3. While GBCAs are still available for administration, the Food and Drug Administration (FDA) has now issued a warning on the use of GBCAs due to concerns over how long they stay in the body, especially in people with kidney problems4. GBCAs can be characterized as macrocyclic or linear, with macrocyclic GBCAs generally being more stable, and linear GBCAs having more of a risk of remaining in the body. Generic types of GBCAs include gadopentetate dimeglumine (linear) and gadoterate meglumine (cyclic)4.
Gadolinium Side Effects: What to Expect
Some short-term effects after having GBCAs include warmth, headache, nausea, vomiting, chills, flushing, metallic taste, and pain or discomfort at the injection site2,3. In some rare cases, some people may experience acute allergic reactions, which can include rash, hives, swelling, and difficulty breathing5. Some individuals may also experience bone and joint pain, joint stiffness, muscle spasms, fatigue, mental fog, skin thickening, and tightness in the hands and feet6.
Long-Term Risks and Emerging Research
Gadolinium retention (remaining in the body) in the brain and bones has been seen even in healthy people7. This risk is even greater in people with kidney problems. For this reason, individuals with severe, acute, or chronic kidney failure with a glomerular filtration rate of below 30 cannot be administered gadolinium8. This is because they have an increased risk of developing nephrogenic systemic fibrosis, a rare but severe disease caused by gadolinium being deposited in the skin9. Nephrogenic systemic fibrosis causes skin thickening and hardening (fibrosis), especially in the arms and legs. This can burn, itch, and cause pain9. Sometimes patients can also experience swelling, loss of flexibility, and joint stiffness, which limits movement. In some people, nephrogenic systemic fibrosis can cause serious problems and affect internal organs such as the heart, lungs, diaphragm, and liver9.
As of 2017, the Medical Imaging Drugs Advisory Committee (MIDAC) of the FDA recommended adding a warning to labels about gadolinium retention in various organs, including the brain. The FDA highlighted that several specific patient populations are at greater risk, including children, pregnant women, and patients requiring frequent lifetime doses of GBCA. There is a significant data gap on what gadolinium deposits in the brain mean for patients in the long term, so ongoing research is investigating this4.
How Long Does Gadolinium Stay in the Body?
In healthy individuals, the kidneys remove gadolinium in the urine in the first 24 hours, and it is nearly all cleared within 72 hours10,11. Although there have been reports of gadolinium lingering for longer in the bones, skin, and brain. Many factors contribute to how much gadolinium remains in the body, including the dosage, how often it is administered, and the individual's kidney function10,12.
Who Should Be Cautious with Gadolinium-Based Dyes?
There are a few patient populations that may be more at risk of adverse effects after GBCA administration; these individuals include13:
- Patients with kidney disease or renal impairment
- Pregnant individuals
- People with autoimmune conditions
- People with known allergies to contrast dyes
- Elderly or pediatric patients with frequent scans
Are There Alternatives to Gadolinium Contrast?
A safe alternative to gadolinium contrast includes non-contrast MRI scans, especially for individuals with increased risk of having adverse effects after receiving GBCAs, including those with kidney problems, pregnant individuals, and those with allergies to contrast dyes. When contrast is necessary, for example, for those having an MRI scan for brain lesions, there should be discussions with healthcare providers to assess alternative imaging options like iodinated contrast or low-dose radiation computed tomography (CT) scans. Iodine is highly effective for enhancing CT and X-ray scans and can be used for a wide range of body areas and procedures14. Here at Ezra, we offer non-invasive, fast, contrast-free MRI scans, which are safe and still highly effective. We also offer low-dose radiation CT scans, which use a similar technology to regular CT scans but emit much less ionizing radiation for screening of the lungs.
Ezra’s Approach: No Contrast Needed
Ezra’s AI-enhanced, full-body MRI scans are completely contrast-free. They use FDA-cleared technology and are conducted by top-tier radiologists. Our full-body MRI scans can screen for abnormalities in up to 13 organs and for over 500 conditions. If you are looking for a fast, safe, and contrast-free MRI scan, consider contacting us today. Our contrast-free MRI scans are ideal for anyone concerned about gadolinium or any other contrast agents.
Ezra offers fast, non-invasive, contrast-free full-body MRI scans that can detect abnormalities in up to 13 organs. Take control of your health with early detection—book your Ezra Scan today!
FAQ
Q: What is gadolinium contrast made of?
A: The rare earth metal gadolinium bound to a carrier, which prevents free gadolinium from being toxic whilst still allowing it to enhance MRI scans6.
Q: How safe is gadolinium contrast?
A: In most people, gadolinium contrast is safe. In rare cases, some people can have allergic reactions, and in very rare cases, people may get nephrogenic systemic fibrosis, but this is mainly seen in people with kidney problems5,9. Some small amounts of gadolium may stay in the body, but there is no evidence that this causes adverse effects in healthy people4.
Q: Why is gadolinium used as a contrast agent?
A: Due to its ability to sharpen MRI scan images, making abnormal tissues, blood vessels, inflammation, tumors, and blood clots more visible and easier to diagnose3.
Q: How to detox from gadolinium contrast?
A: Gadolinium leaves the body in the urine for most people10,11. There is no medical way to detox from it, but for some people with kidney damage, dialysis may be used to help remove it, this is very rare.
Q: Can gadolinium cause long-term damage?
A: In rare cases, mostly in people with kidney problems, there is a potential risk for long-term kidney injury, joint and skin problems, and nephrogenic systemic fibrosis9.
Q: What are the signs of gadolinium toxicity?
A: Skin thickening or changes, joint pain or stiffness, mental fog, persistent limb pain, skin discoloration or rashes. These signs are rare and are often more commonly reported in patients with kidney problems9.
Q: What does a gadolinium injection feel like?
A: It usually feels like any other intravenous injection, where most people do not feel very different afterwards, although some people may experience a cold sensation in the arm during the injection3.
