Unenhanced vs. Gadolinium-Assisted MRI/MRA
MRI (magnetic resonance imaging) and MRA (magnetic resonance angiography) are diagnostic procedures that provide images of internal organs, tissues and blood vessels. Doctors use these images to diagnose multiple sclerosis, stroke, tumors and other abnormal tissue growths throughout the body. While unenhanced MRI/MRA can provide a relatively detailed image of tissue structures, a gadolinium-assisted scan can create a more complete image. This happens because gadolinium functions like a dye, illuminating the abnormal cell structures so doctors can identify and assess them more easily.
Gadolinium Side Effects
Gadolinium-based contrast agents have been used in the United States since 1988. Currently, five gadolinium substances (Magnevist, MultiHance, Omniscan, OptiMark and ProHance) have received approval by the U.S. Food and Drug Administration (FDA). While gadolinium-based contrast agents are considered relatively safe, in some cases patients have developed allergic reactions to gadolinium, with symptoms such as itchy eyes, hives and facial swelling. Additional gadolinium side effects include infection of the injection site, headache, lightheadedness and low blood pressure. These side effects are considered “normal” and can be usually managed with medications.
In rare cases, however, patients who undergo gadolinium-assisted MRI/MRA scans develop a serious, potentially fatal condition called nephrogenic systemic fibrosis / nephrogenic fibrosing dermopathy. This disease is typically referred to as NSF / NFD, and its main symptoms are hardening of the skin and internal body tissue. As a result, patients might lose the ability to walk and fully use their arms, and might also develop pain in their bones. If the NSF / NFD progresses to the point where it causes hardening of tissue in vital internal organs, important body functions such as breathing and waste processing might become compromised. If the disease progresses further, it can cause complete failing of fundamental body systems, resulting in a victim’s death.
Gadolinium Risk Groups
While NSF / NFD is an exceptionally debilitating disease, it afflicts a relatively small number of patients who undergo gadolinium-assisted MRI/MRA scans. According to current data, the vast majority of NSF / NFD cases have occurred in patients with serious kidney problems, such as acute or chronic renal insufficiency. The kidneys of these patients are unable to properly filter gadolinium out of the body, which is the likely cause of NSF / NFD.
In addition to people suffering from kidney problems, patients with the following conditions also have a higher risk of developing NSF / NFD after gadolinium exposure:
- Liver transplant
- Major tissue injury (such as from surgery)
- Thrombosis
- Ischemic limb
Safe MRI/MRA Practices
In order to reduce the chance of developing NSF / NFD and other complications after an MRI/MRA scan, the patient should tell the doctor about any allergies and health conditions he or she has. If the doctor has prescribed gadolinium-assisted MRI/MRA, the patient’s kidney function should be evaluated prior to this procedure. In general, patients with compromised kidney health should avoid gadolinium-assisted scans unless the rewards clearly outweigh the risks. To provide the necessary diagnostic answers, patients with kidney problems can undergo other procedures, such as unenhanced MRI/MRA, computer tomography, ultrasonography and/or conventional radiography.
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