Gadolinium contrast agents are now being used worldwide. Technological advancements in the healthcare sector have gone through endless iterations to finally provide us with the simplest and most advanced medical equipment to make the entire process less painful (literally). One such significant upgrade in the field comes from Magnetic Resonance Imaging (MRI) and MRI dye.
MRI belongs to the category of Medical Imaging technology. It specifically deals with producing clear and detailed images of the internal organs. The MRI scanner does this with the help of strong radio waves and a magnetic field.
MRI scanners are used actively for a vast array of medical applications. However, due to the application of a strong magnetic field, there is always some magnitude of health risk or side effects of using such types of medical equipment.
What is Gadolinium contrast and how is it used as an MRI dye?
MRI dye or Gadolinium contrast medium is a special chemical substance that is used in addition to the normal MRI scanning procedure. It helps in obtaining a better image of the internal organs. It flows into the vascular system after intravenous injection. This serves to highlight any organs that have vascular flow. Gadolinium is the primary metal ion that is used for making such contrast or dye. It is primarily due to their unique magnetic field interaction, providing clearer and more detailed pictures.
The Gadolinium contrast dye is generally injected into the patient’s body during a certain part of the MRI procedure within the 10-20 milliliters volume limit. The dye takes 10-30 seconds to spread uniformly within the targeted area. It ensures the MRI scanner produces a crisp and clear image of your internal organs.
Gadolinium contrast side effects – what are they?
- mild allergic reactions like itchy skin or skin redness
- moderate allergic reactions like difficulty breathing
- tissue thickening, leading to things like Nephrogenic Systemic Fibrosis
One of the most heated debates over the years in the Medical Imaging field is directly related to the side effects of MRI dye. The earliest signs of relevant side effects of using MRI dye can be traced back to 2014 when several medical studies showed that a small proportion of the contrast dye was retained or present in the brain even after the completion of the MRI scanning procedure. This further led to the development and identification of several Gadolinium contrast side effects that were previously not known.
Some of Gadolinium’s most common and relevant MRI contrast side effects include nausea, dizziness, and headache. Some patients even report slight arm pain after injection and a cold sensation on the MRI dye’s specific area.
The MRI contrast side effects may not take place on a major health-concerning scale, but there are some other side effects of the application of MRI dye that you should be concerned about, especially after the MRI.
Allergy to Gadolinium contrast
Even though the chances of Gadolinium allergy are very small (1 in 1000), there are some reports that patients develop a mild allergic reaction after the MRI scan. They usually cease within an hour. In some rare cases, this leads to more serious allergic reactions, such as anaphylaxis. However, they are easily treatable using the standard allergy drug treatment.
Nephrogenic Systemic Fibrosis
Nephrogenic Systemic Fibrosis (NSF) is a common MRI contrast side effect of implementing MRI dye that can cause kidney damage or muscle-related abnormalities. The NSF causes deliberate tightening and thickening of the epidermis or skin. Such contraction is known as fibrous tissue. It also leads to the tightening, swelling, and hardening several body parts. These body parts mostly include the heart, lungs, stiff joints, and muscles.
This is the primary reason for some patients experiencing muscle pain after an MRI scan.
Vomiting after MRI is also one of the minor yet irrefutable side effects. Several studies associated with gadopentetate dimeglumine (Gadolinium) show that the significant chances of such occurrence are about 4%.
Can you get Sick from Gadolinium Contrast?
- Yes, there are mild to severe potential allergic reactions.
Even though Gadolinium dye has shown signs of numerous side effects, most are transient, meaning they usually cease after a certain period. The evidence suggests that people can get very sick due to thin MRI contrast injections. However, some minor aspects can cause potential sickness, and previous instances where people have even filed a lawsuit against the procedure.
Gadolinium Deposition
Gadolinium deposition is the general term used for describing potential health problems that patients develop after an MRI contrast procedure. The severity of Gadolinium deposition disease can vary from a minor health complication such as mild headache after MRI with contrast to chronic pain disease such as kidney damage. However, there has not been any conclusive evidence to support such major sickness post-MRI contrast exam.
90% of the total volume of Gadolinium injected into a patient’s body with Normal Kidney function is excreted out along with urine within 24 hours. However, recent medical research has shown that some minute percentage (usually 1%) of the total contrast volume is retained by the body, especially in the skin, bones, and brain.
There aren’t any convincing studies or research to prove the adverse health effects of such Gadolinium deposition retention. Dr. Emanuel Kanal from the University of Pittsburg Medical Centre suggests that retention does not pose a major threat as long as Gadolinium molecules remain intact with suitable chelating agents.
The “infamous” lawsuit
Certain moderate and transient pain after MRI contrast injection is not uncommon. However, in November 2017, the famous Hollywood actor Chuck Norris filed a $10 million lawsuit against the MRI contrast vendor after his wife reportedly suffered from various health complications after the procedure.
The MRI contrast dye lawsuit alleged that Gena Norris showed several symptoms of Gadolinium Deposition disease such as violent shaking, burning sensation throughout the body, and cognitive deficits among many others. However, this has not been the sole case presented to legal courts. Mr. Jeffrey Steiner, a patient from California, also filed an MRI contrast dye lawsuit claiming he was poisoned as a result of several Gadolinium-injected procedures. Mr. Steiner alleged he suffered from bone, skin, and organ fibrosis.
Can MRI Dye Make You Itch?
- yes, one person in 1000 can develop urticaria (itchy skin)
MRI dye comes with some expected side effects you may develop post-procedure. Although the magnitude of those health risks is not severe, they still exist in mild headaches, dizziness, vomiting, etc.
However, some patients (1 in 1000) develop hypersensitivity after the procedure. This mostly occurs in patients with asthma, allergies, or any reaction to chemicals before the dye application. Such conditions can cause mild pruritus or itching sensation after the MRI contrast scan. Hence, MRI warnings for people with such reactions are mandatory before the injection of the MRI dye.
This mild itching sensation usually lasts only for a short period and medications like Benedryl can be used to resolve. However, there are other gadobutrol side effects that can take place as a result of the reaction to MRI dye. Some of the severe side effects can include weakness, fatigue or extremely tired after MRI with contrast, laryngospasm, arrhythmias, and tachycardia. However, the chances of such reactions are usually very low (1 in 5000 cases).
If you have ever had an allergic reaction to any chemical, you should inform your healthcare specialist so they can chart it in your record. Prior allergies do not predict future allergies but can help in alerting healthcare employees to their existence.
How Long Does it Take For Gadolinium to Get Out of your system?
- most MRI dye is excreted in your urine within 24 hours
One of the major concerns of applying Gadolinium contrast dye prior to performing the MRI scan is determining how long the Gadolinium toxicity stays in your body. There hasn’t been any conclusive evidence to link the duration of Gadolinium contrast in your system to various health complications directly. However, quicker elimination of such Gadolinium toxicity from your system is always better to avoid any long-term side effects (however minor they may be).
For people with normal kidney function and no prior reaction to Gadolinium contrast, the MRI dye usually gets out of your system ranging from a day to a one-week duration. Approximately 80% of the Gadolinium toxic is removed within 24 hours by your kidney. By the end of 1 week, your urine and feces remove almost 98-99.5% of the total Gadolinium toxic from your system.
Gadolinium and Alcohol
Consumption of Alcohol 24 hours prior to or post MRI contrast dye procedure is usually NOT recommended. There hasn’t been any major medical study conducted on alcohol reaction with Gadolinium contrast dye post-MRI scan acting as a catalyst in causing health complications. No biologic abnormality has been linked to alcohol consumption in relationship to Gadolinium contrast us.
Gadolinium breast–feeding
In case you’re breastfeeding, studies have shown that it is safe to breastfeed after 24 hours of active expression of breast milk from each breast. This will provide a reasonable amount of safety margin to return to breastfeeding. However, a small amount of Gadolinium (less than 0.04%) has been known to enter your breast milk.
Can Gadolinium be removed from the body?
- natural expulsion occurs in one week, leaving less than one percent remaining
- chelation therapy is one method of speeding up the process
Usually, the majority of the Gadolinium dye injected into your body is removed naturally from the urine and kidneys. Almost 98% of Gadolinium is excreted post-MRI scan within a period of 24 hours. Studies show less than one percent remains at the end of one week.
Gadolinium half-life refers to the life span of Gadolinium contrast chelates in your system or the time they spend in your body before their eventual excretion. The half-life span of Gadolinium contrast dye is approximately 1.5 hours.
DTPA chelation therapy
DTPA chelation is one agent approved by the FDA in the United States for treating the potential side effects of Gadolinium Deposition Disease (GDD). Chelation is a chemical process that involves binding metal ions and forming chelates. The body then excretes these. In the case of Gadolinium specifically, DTPA Chelation removes the Gadolinium toxins from the body post-MRI contrast scan.
Contrast Dye Urine Color
There is a large misconception that contrast dye changes the color of your urine. However, as evident by many professional explanations, the color of your urine does NOT change. The contrast dyes used before your MRI scan are clear, going in and coming out. MRI dye is a colorless liquid.
Conclusion
The medical community acknowledges that there are side effects of injecting Gadolinium contrast to obtain superior picture quality. However, the lack of decisive evidence or major health problems due to Gadolinium contrast dye makes the practice “acceptable.” As far as the medical community is concerned, the positive results of the procedure outweigh the magnitude of potential side effects. However, that does not necessarily mean there are none. Active research and studies are still dedicated to drawing a clear line between the pros and cons of using MRI dye.
As a patient, you should be careful about your health status before agreeing to undertake the contrast dye scan and also look for any significant signs of side-effects post the procedure. As always, consult your medical professional before receiving any injection as to the potential risks associated with that drug.
Note: Ron Jones, the author of this article, is not a medical physician and is not offering medical advice. He is licensed in the use of radiography and computed tomography and has been practicing in the field of radiography since 2005.
Resources:
Blasco-Perrin, H., Glaser, B., Pienkowski, M., Peron, J. M., & Payen, J. L. (2013). Gadolinium induced recurrent acute pancreatitis. Pancreatology, 13(1), 88-89.
Caravan, P., Ellison, J. J., McMurry, T. J., & Lauffer, R. B. (1999). Gadolinium (III) chelates as MRI contrast agents: structure, dynamics, and applications. Chemical reviews, 99(9), 2293-2352.
Kubik-Huch, R. A., Gottstein-Aalame, N. M., Frenzel, T., Seifert, B., Puchert, E., Wittek, S., & Debatin, J. F. (2000). Gadopentetate dimeglumine excretion into human breast milk during lactation. Radiology, 216(2), 555-558.
Li, A., Wong, C. S., Wong, M. K., Lee, C. M., & Au Yeung, M. C. (2006). Acute adverse reactions to magnetic resonance contrast media–gadolinium chelates. The British journal of radiology, 79(941), 368-371.
McDonald, R. J., McDonald, J. S., Kallmes, D. F., Jentoft, M. E., Murray, D. L., Thielen, K. R., … & Eckel, L. J. (2015). Intracranial gadolinium deposition after contrast-enhanced MR imaging. Radiology, 275(3), 772-782.
Rofsky, N. M., Weinreb, J. C., & Litt, A. W. (1993). Quantitative analysis of gadopentetate dimeglumine excreted in breast milk. Journal of Magnetic Resonance Imaging, 3(1), 131-132.