"Gadolinium Deposition Disease"?Does retention of gadolinium in the body cause symptoms?
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Abundant evidence clearly demonstrates that a small fraction of administered gadolinium contrast is retained in bone, skin, liver, brain, and other organs. The central question, still unanswered, is whether this gadolinium retention produces clinically meaningful effects in some patients.
Attention to this issue was first drawn by Semelka et al (2016) who recruited 42 patients from two online gadolinium toxicity support groups via questionnaire. These patients, all with normal renal function, claimed to have chronic, non-allergic reactions to gadolinium contrast administration, including headache, clouded mentation, peripheral neuropathies, bone and muscle pain, and skin thickening. The name “gadolinium deposition disease” was suggested for this syndrome. Personal injury attorneys got on board, highlighted by a lawsuit (later withdrawn) brought by celebrity Chuck Norris who sued Bracco for “poisoning” his wife with gadolinium.
Is gadolinium deposition disease real? Possibly, although as discussed in several references below, there is no conclusive scientific evidence that it exists. A better term for research purposes, suggested by the American College of Radiology Committee on Drugs and Contrast Agents, is SAGE (Symptoms Associated with Gadolinium Exposure). To me it seems reasonable that some of these patients could be experiencing mild symptoms in the spectrum of nephrogenic systemic fibrosis (NSF). Some of the self-reported symptomatic patients do have higher levels of urinary excretion of gadolinium than controls. Additionally there are cases of gadolinium-induced skin thickening and skin plaques in patients without full-blown NSF.
So, in my opinion, keeping an open mind is a good strategy until further conclusive research is available.
Attention to this issue was first drawn by Semelka et al (2016) who recruited 42 patients from two online gadolinium toxicity support groups via questionnaire. These patients, all with normal renal function, claimed to have chronic, non-allergic reactions to gadolinium contrast administration, including headache, clouded mentation, peripheral neuropathies, bone and muscle pain, and skin thickening. The name “gadolinium deposition disease” was suggested for this syndrome. Personal injury attorneys got on board, highlighted by a lawsuit (later withdrawn) brought by celebrity Chuck Norris who sued Bracco for “poisoning” his wife with gadolinium.
Is gadolinium deposition disease real? Possibly, although as discussed in several references below, there is no conclusive scientific evidence that it exists. A better term for research purposes, suggested by the American College of Radiology Committee on Drugs and Contrast Agents, is SAGE (Symptoms Associated with Gadolinium Exposure). To me it seems reasonable that some of these patients could be experiencing mild symptoms in the spectrum of nephrogenic systemic fibrosis (NSF). Some of the self-reported symptomatic patients do have higher levels of urinary excretion of gadolinium than controls. Additionally there are cases of gadolinium-induced skin thickening and skin plaques in patients without full-blown NSF.
So, in my opinion, keeping an open mind is a good strategy until further conclusive research is available.
References
ACR Committee on Drugs and Contrast Agents. ACR Manual on Contrast Agents, 2023. American College of Radiology, 2022.
Layne KA, Wood DM, Dargan PI. Gadolinium-based contrast agents – what is the evidence for ‘gadolinium deposition disease’ and the use of chelation therapy? Clinical Toxicology 2020; 58:151-160. [DOI LINK]
Lord ML, McNeill FE, Gräfe JL, et al. Self-identified gadolinium toxicity: comparison of gadolinium n bone and urine to healthy gadolinium-based contrast agent exposed volunteers. Physiol Meas 2018; 39:115008.
Lyapustina T, Goldfine C, Rhyee S, et al. Evaluating the patient with reported gadolinium-associated illness. J Med Toxicol 2019; 15:36-44.
McDonald RJ, Weinreb JC, Davenport MS. Symptoms Associated with Gadolinium Exposure (SAGE): A suggested term. Radiology 2022; 302:270-273. [DOI LINK]
Semelka RC, Ramalho J, Vakharia A, et al. Gadolinium deposition disease: initial description of a disease that has been around for a while. Magn Reson Imaging 2016;34:1383–1390.
Welk B, McArthur E, Morrow SA, et al. Association between gadolinium contrast exposure and the risk of Parkinsonism (letter). JAMA 2016; 316:96-98. (No increased risk)
Young LK, Matthew SZ, Houston JG. Absence of potential gadolinium toxicity symptoms following 22,897 gadoteric acid (Dotarem®) examinations, including 3,209 performed on renally insufficient individuals. Eur Radiol 2019; 29:1922-30.
ACR Committee on Drugs and Contrast Agents. ACR Manual on Contrast Agents, 2023. American College of Radiology, 2022.
Layne KA, Wood DM, Dargan PI. Gadolinium-based contrast agents – what is the evidence for ‘gadolinium deposition disease’ and the use of chelation therapy? Clinical Toxicology 2020; 58:151-160. [DOI LINK]
Lord ML, McNeill FE, Gräfe JL, et al. Self-identified gadolinium toxicity: comparison of gadolinium n bone and urine to healthy gadolinium-based contrast agent exposed volunteers. Physiol Meas 2018; 39:115008.
Lyapustina T, Goldfine C, Rhyee S, et al. Evaluating the patient with reported gadolinium-associated illness. J Med Toxicol 2019; 15:36-44.
McDonald RJ, Weinreb JC, Davenport MS. Symptoms Associated with Gadolinium Exposure (SAGE): A suggested term. Radiology 2022; 302:270-273. [DOI LINK]
Semelka RC, Ramalho J, Vakharia A, et al. Gadolinium deposition disease: initial description of a disease that has been around for a while. Magn Reson Imaging 2016;34:1383–1390.
Welk B, McArthur E, Morrow SA, et al. Association between gadolinium contrast exposure and the risk of Parkinsonism (letter). JAMA 2016; 316:96-98. (No increased risk)
Young LK, Matthew SZ, Houston JG. Absence of potential gadolinium toxicity symptoms following 22,897 gadoteric acid (Dotarem®) examinations, including 3,209 performed on renally insufficient individuals. Eur Radiol 2019; 29:1922-30.