Franklin G. Moser
Prior to the discovery of nephrogenic systemic fibrosis (NSF), the radiology community felt that gadolinium-based contrast agents were exceedingly safe and could be injected with impunity. NSF made it clear that we had to rethink the use of gadolinium-based contrast agents. With the initial publication of reports of gadolinium deposition in the brain and other organs, we again feared that we faced a crisis that would force us to change how we practiced radiology.
When the literature began to suggest that the cerebral deposition of gadolinium was different between cyclic agents and linear agents, I felt we were in a unique position to examine that difference. For totally unrelated reasons, our medical center made a change from a linear agent to a cyclic agent on a specific, identifiable date, which allowed us to define 2 groups of subjects. We have a large cohort of patients with brain tumors who are scanned and receive gadolinium-based contrast agents at regular intervals, and this population was the group we studied for this publication. The project clearly demonstrated a difference in gadolinium deposition between the 2 groups.
This research has given us a high level of confidence when recommending contrast scans to patients worried by the specter of “gadolinium deposition disease,” and we can assure them that we use the contrast agent with the lowest level of deposition. The problem, of course, is that we have no proof at this point that gadolinium deposition creates clinically important conditions, despite the fact that certain television commercials would have one believe that “gadolinium deposition disease” is a true clinical condition.
This leads into our next project: we are exploring using inorganic agents to scrub gadolinium from biologic systems. There are naturally occurring minerals that attract metallic ions, and we are hoping to find compounds with a specificity for gadolinium that are biologically safe. This research is only in the very early stages but has shown some promise. Additionally, we are developing a retrospective study of patients who received multiple injections of gadolinium-based contrast agents for noncerebral reasons longer than 10 years ago. We plan to study these patients with PET scans, MRI scans,