The use of gadolinium-based contrast agents (GBCAs) in MRI brain studies was long thought to be safe for patients without severe renal insufficiency, but in 2014, researchers started finding evidence that GBCAs can leave traces of gadolinium (GD) behind in the brain. Interest in the subject has increased, but specialists do not fully agree about whether GBCA use should be left alone, limited or stopped altogether.
As the overall impact of GD deposition is still not known, some specialists are taking a “wait and see” approach while others have already made changes based on existing data, according to a study published in Current Problems in Diagnostic Radiology. The authors surveyed radiologists throughout the world in late 2015, receiving data from a total of 94 respondents. Eighteen percent of the responses came from the United States.
Overall, 58 percent of radiologists “do not or would not” include findings related to GD deposition in their radiology reports. Meanwhile, 28 percent of respondents have changed their practice on the basis of current data regarding GBCAs.
“Whether or not GD deposition in the brain of patients receiving GBCAs will negatively impact the health and well-being of those patients is as yet unknown,” wrote lead author Vikas Agarwal, MD, department of radiology at the University of Pittsburgh Medical Center, and colleagues. “It is now known that deposition occurs even in the setting of normal renal function and therefore, in contrast to nephrogenic systemic fibrosis, any potential detriments may not be limited to a small subset of patients with severely impaired renal dysfunction. As such, cautious approach seems prudent at this juncture.”
Twenty-nine percent of radiologists said they do not/would not report gadolinium deposition because of the risk of unnecessary patient anxiety. Another popular reason was that no action was needed “based on our current understanding.”
“Time will tell whether or not GD deposition represents a real risk to our patients,” the authors concluded. “Until we know whether intracranial GD reposition has negative health consequences, radiologists must be cognizant of the way in which we report the imaging manifestations of GD deposition in the brain and consider the potential impact of what we report on our patients, referring physicians, and ourselves.”