GBCAs should be used when necessary, but minimize repeating scans on the same patient

Imaging providers should still administer gadolinium-based contrast agents (GBCAs) when necessary, according to a recent commentary published in the Journal of the American College of Radiology. However, the authors added, assessing the “necessity, benefits and risks” of each examination and minimizing repeated scans on the same patient is recommended.

The commentary, written by a team of researchers from the Russell H. Morgan Department of Radiology and Radiological Science at the Johns Hopkins University School of Medicine in Baltimore, included a brief history of GBCAs as well as a summary of the recent debate surrounding gadolinium retention in the bodies of patients.  

“GBCAs have long been considered to have excellent safety and benefit-to-risk profiles,” wrote author Mahadevappa Mahesh, MS, PhD, and colleagues. “However, recent reports have highlighted the issue that not all GBCA is excreted after administration, leading to accumulation in various body tissues.”

The authors explained that concerns over gadolinium retention have grown in recent years, with various regulatory agencies exploring the issue in 2017. The FDA, for example, announced a new warning and other guidelines related to GBCA use in December 2017. “Gadolinium retention has not been directly linked to adverse health effects in patients with normal kidney function, and we have concluded that the benefit of all approved GBCAs continues to outweigh any potential risks,” the FDA said at the time in a statement.

Mahesh et al. concluded their commentary with a similar sentiment, adding that the “necessity, benefits and risks” should still be considered for each examination.

“The benefit-to-risk ratio for GBCAs remains extremely high, as they provide essential diagnostic information in a large number of clinical indications,” the authors wrote. “Taking a page from medical imaging studies using radiation, in which each study is weighted according to radiation exposure, MR studies that require GBCAs should be carefully triaged to minimize any associated risks, especially for patients who will likely require multiple MR scans during their lifetimes, pregnant women, children, and patients with known sensitivity to contrast agents. It is advantageous to minimize repeated GBCA imaging studies when possible, especially for studies that are closely spaced in time.”