Gadolinium retention – what we know and what we don’t know
Presented by Dr Herb Kressel
Based on a NIH, ACR and RSNA sponsored workshop held in Washington in February 2018, Professor Dr Herb Kressel will review what is known regarding chemical properties, stability, bio-distribution, and toxicology of GBCA (gadolinium based contrast agents); and the current state of our understanding of gadolinium retention in brain, bone skin, liver and other organs. Most importantly Dr Kressel will highlight key questions that need to be answered to determine the clinical significance, if any, of gadolinium retention in patients receiving these agents.
| 5:00pm | Networking drinks |
| 6:00pm | Lecture starts |
| 7:00pm | Lecture ends |
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About the Speaker
Dr Herb Kressel is Radiologist-In-Chief of the Department of Radiology at the Beth Israel Hospital in Boston, and Miriam H. Stoneman Professor of Radiology at the Harvard Medical School. For 10 years, Dr Kressel was Editor Designate for Radiology. He has served as past president of Society of Magnetic Resonance in Medicine, and on the Editorial Board of many professional journals. Dr Kressel’s major interests are magnetic resonance imaging of the abdomen and pelvis with particular interests in prostate, liver and pancreas.
Abstract
Since initial regulatory approvals in 1988, over 450 million doses of GBCA (gadolinium based contrast agents) have been administered worldwide. The historic safety profile of GBCA use has been highly favorable, with very low rates of immediate adverse side effects compared to other pharmaceuticals including iodinated contrast agents.
However, GBCA use in patients with severely compromised renal function has been associated with development of the rare condition of nephrogenic systemic fibrosis (NSF) in which fibrotic changes may be seen in many tissues, predominately skin, and muscle contractures may occur. Fortunately, rapid changes in clinical practice in the use of GBCA have essentially eradicated this clinical entity.
At the time of initial regulatory approval, it was widely thought that the Gd (gadolinium) ion remained in the chelated state following intravenous administration of GBCA, and was rapidly excreted via the urinary system. However, more recently, scientific evidence has been mounting that traces of Gd remain in the bone, brain and other organs in patients with normal renal function (10-21). The extent of tissue retention tends to show an association with cumulative dose, and appears to be highest with linear GBCA.
The causal relationship between GBCA exposure, retention, and symptoms remains unclear due to inconsistencies in the timing of symptom onset relative to GBCA administration, dose thresholds, and heterogeneity in presumed associated symptoms, and the low evidence level of many of the reports (26) on this issue to date.
