Gadolinium Dyeing Out?

August 13, 2019, 1:45PM. By Jane Mundy

A new study has found more brain lesions in multiple sclerosis patients who had undergone multiple magnetic resonance imaging (MRI) using gadolinium contrast dye, and a new imaging technique may be able to help identify patients with coronary artery disea

Buffalo, NYMany reports of adverse side events associated with gadolinium contrast dye, along with recent data showing that gadolinium deposits in the brain and other organs have spurred researchers to find imaging approaches that don’t need gadolinium-based contrast agents (GBCAs).

The Multiple Sclerosis and Gadolinium Study

There has been ongoing controversy in the MS community regarding the use of GBCAs, particularly now: A new study has found that multiple sclerosis patients may be susceptible to accumulating gadolinium in their brains. (GBCAs are routinely injected into many Multiple Sclerosis patients to help detect acute inflammation and other signs of disease progression in the brain.) The Journal Neurology (July 5, 2019) published the study conducted by researchers at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. And this is the first large, case-controlled study to follow MS patients since their first clinical sign of the disease.

The researchers found that patients who received more than eight GBCA doses had more brain lesions and more advanced atrophy of grey matter, compared to patients who had less than eight doses. One of the researchers said they “cannot completely rule out that gadolinium deposition may have an impact on disease progression or clinical outcome.” As well, almost nine percent of MS patients who received fewer than five doses had hyper-intensity in a part of the brain that is involved in voluntary motor function and cognition, which is often affected by MS. Further, more gadolinium deposition was found in male patients than in female patients, but researchers explained that that males receive a higher dose because they tend to weigh more and dosage is based on weight.

Varieties of Gadolinium-based Contrast Agents

Free gadolinium is highly toxic and it must be “complexed with chelating molecules” for clinical use. There are different types of GBCAs; the two most frequently used are linear and macrocyclic. Linear GBCA appears to be more associated with the development of gadolinium deposition in the brain and the linear variety accumulates in the brain early in the course of MS, but has no apparent clinical or radiologic impact, the study suggests.

The FDA in 2017 advised that GBCAs only be used in certain cases when deemed absolutely necessary, and four kinds of contrast agents have been banned in Europe. Meanwhile, research published in the Journal of the American College of Cardiology: Cardiovascular Imaging (July 2019) may be good news for patients with coronary artery disease (CAD) who may otherwise undergo multiple MRIs with gadolinium. A new imaging technique may be able to help identify patients with CAD without the use of drugs or any contrast agents.

Radiology Business (August 2019) reports that a new technique has been developed that tracks changes in a patient’s heart as they exercise. Healthy patients underwent a series of imaging exams before lying on their backs and pedaling an exercise bicycle at the opening of an MRI scanner. The 30-second scans allowed researchers to look for changes in blood flow in the myocardium. The process was repeated with known or suspected CAD patients. Researchers then compared images from both groups and found they “revealed that magnetic properties of myocardium change differently in areas impacted by coronary atherosclerosis than in normal areas.”

Lastly, Science Daily reports that Belgian scientists recently developed a contrast agent suited for two imaging techniques at once. The technique is called photoacoustic imaging and uses only one contrast agent for two imaging techniques, thereby lessening on the patient's body.

Perhaps Gadolinium’s shelf life is set to expire?-