Here is My Question:
Is there an alternative MRI contrast to Gadolinium? I understand it leaves metal deposits in the body's organs and tissues including the brain.
Gadolinium is a paramagnetic ion used as a contrast agent in MR imaging. Gadolinium is toxic, so it must be administered as a chelated molecule. There are many gadolinium contrast products on the market in the united states and Europe. They differ primarily in the type of chelates used and the stability of the chelated molecule. Macrocyclic chelates are the most stable and least toxic of the products on the market, particularly in individuals with kidney disease. Recent guidelines recommend using these macrocyclic chelated gadolinium contrast agents in people with kidney disease. They also recommend using the lowest dose required, since higher doses are associated with greater toxicity.
Currently, the least toxic gadolinium contrast agents (all macrocyclic chelates of gadolinium) are Prohance (gadoteridol), Dotarem (Gadoteric acid) and Gadavist (Gadobutrol).
This being said, we still do not know if certain gadolinium contrast agents accumulate more or less in our body tissues- including the brain- more than other agents. We also do not know the consequences of this gadolinium accumulation.
Therefore, it is generally recommended that doctors use gadolinium contrast agents only when needed and in the lowest dose required. Newer automated image analysis techniques are decreasing the requirement for gadolinium contrast in monitoring scans done in people with MS.
It is also recommended that if MRI contrast is needed in a patient with kidney disease, the macrocyclic chelated agents mentioned above should be used in the lowest dose required.
There are several non gadolinium based contrast agents in development but none have been approved as of this writing.
Revere (Rip) Kinkel MD
Professor of Clinical Neurosciences
Director of the Multiple Sclerosis Program
Clinical Neurosciences Director
University of California San Diego
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