An advanced MRI mapping technique has confirmed gadolinium accumulation in the brain according to a new study which was published on Tuesday.
Radiologists in South Korean analyzed 90 brain tumor patients who had received MRI scans using a gadolinium-based contrast agent (GBCA). The researchers found that the globus pallidus’ magnetic susceptibility increased by 1.4 parts per billion per GBCA administration. This means that the number of GBCA injections is associated with the magnetic susceptibility of the globus pallidus, and that more gadolinium steadily accumulates in the brain with each injection.
The advanced MRI mapping technique is known as quantitative susceptibility mapping (QSM). Standard T1-weighted MRI mapping did not detect the gadolinium accumulation in the brain.
“This spectacular improvement in the ability to noninvasively detect trace amounts of gadolinium in the brain by using QSM verifies that macrocyclic GBCA accumulates in the brain,” the researchers wrote.
The researchers said the results are a “wake-up call” about the limitations of T1-weighted MRI mapping and an “opportunity” for improved detection of gadolinium retention using QSM.
The researchers believe that performing QSM during routine MRIs can reduce the dosage of GBCA needed for the MRIs, clarify clinical ramifications and illuminate deposition pathways.
The results are relevant to the liability of GBCA manufacturers and radiologists regarding gadolinium deposition disease. The FDA warned in 2015 that gadolinium could accumulate in the brain.
Gadolinium deposition disease may cause GBCA patients to develop a suite of symptoms caused by an immune system response. The symptoms can include skin discoloration, skin thickening, mental confusion, a burning feeling in tissues and pain in the bones.
Gadolinium is a rare earth metal. It is silver-white in appearance. It is used in MRI contrast agents because it absorbs neutrons.
The United Kingdom pulled two GBCAs off the market. These GBCAs were discontinued in 2017 and their licenses were revoked in 2018. The GBCAs were removed from the market due to safety concerns.
A recent study found that a new type of contrast agent could revolutionize MRIs by allowing them to use much smaller magnets. The new type of contrast agent is based on superparamagnetic iron oxide nanoparticles (SPIONs), which are already FDA approved for treatment of anemia. These new agents are 3,000 times more magnetic than GBCAs.
This new technology could not only make MRI units affordable for small rural clinics but it might also put to rest fears about gadolinium deposition disease by replacing GBCAs altogether.