MRI and side effects of Gadolinium

[stagnes]

7 years ago I was operated on for a brain tumour. Subsequently I have had an MRI scan every six months. I always had Gadolinium with the scan. I used to feel dreadful for days after the scan (seriously depressed, incredibly tired, very marked increase in the number of mild seizures I get, muscles aching and urine a seriously dark colour for days). I fully appreciate some of these systems could just be the result of tension/trauma due to worry about the MRI results. However, a couple of years ago I began to wonder if it was anything to do with the Gadolinium and I had a scan without it. I felt completely different - not so tired, seizures at normal level etc. I recently met with a new consultant who ask me to have an MRI with Gadolinium. I did and felt terrible again (having been told yet again that there are virtually no side effects with Gadolinium). Has anyone else had similar side effects with Gadolinium or is it just me?

[jerkylady]

Since you asked this question in 2008, the FDA conducted an investigation in 2017, which was several months before I had my 4th MRI. This one caused me to develop permanent Tinnitus. I searched my medical records and discovered they had ignored my insurance approval for 0.5 mL per minute of Gadobutrol, and increased it to ^60 mL per minute which means I got 600 times more. My hand was red and felt like it was burning. The neurologist put in my records that I had agreed to have an annual brain MRI, but that was never discussed with me. I showed this information to my primary doctor and told him I won’t allow any more Gadolinium. I’m sorry you had a bad reaction.

[Sara_MHModerator]

Hello jerkylady.  Yes, this is an old post but we are sorry to hear of your situation.  Your after effect of this medical error is permanent tinnitus? There does seem to be some toxicity questions regarding Gadolinium and it's most unfortunate that you've received this higher dose level.  Thank you for sharing your story.  And in the end, unfortunately, we have to be our own advocate with doctors.  You sound like you have a strong voice for yourself for which we are glad.

[CHIN_C]

The safety profile and dosing information for gadobutrol (Gadavist) is published on the manufacturer's web site:
https://www.radiologysolutions.bayer.com/products/contrast-agents/gadavist-injection

[jerkylady]

Sara, thanks for your concern. I think we’re trained from childhood to trust doctors with our life. The Imaging technician even asked me if I would like to have something  to help me hold still. “Yes, I would.” They attached a stretchy material  over my legs and chest and cinched them tight. I asked him “Are you sure this isn’t a straitjacket?” He said, “Shh, we don’t ever use that word.” I was okay with their restraint, because of my frequent jerks.

[CHIN_C]

Sounds like you have been through a lot, but I just wanted to clarify a couple of things. First, the insurance company is not involved in selecting the brand or dose of intravenous contrast. They just give pre-authorization for the type of study; for example, MRI brain w/ contrast or MRI brain w/ and w/o contrast. The brand of contrast used varies between hospitals and imaging centers. In fact, sometimes even the same facility may switch between different contrast agents, depending on availability and pricing. Second, the amount of contrast is dosed by weight. For example, the recommended dose of gadobutrol (Gadavist) is 0.1 mL/kg body weight (0.1 mmol/kg). The radiology report might specify 0.1 mmol/kg in the technique, but more commonly it will just state the volume of contrast given. For example, if a patient weighed 50 kg, the radiology would say something like 5 mL of intravenous gadobutrol (Gadavist) was administered without complication. It is not common to state the rate of contrast given such as 0.5 mL or 60 mL per minute of Gadobutrol. Because gadobutrol is a more concentrated form of gadolinium, the amount given tends to range between 0.25 mL for little babies to 14 mL for an obese patient, with the typical amount ranging from 5-10 mL for the average adult, in contrast to other brands of gadolinium such as gadobenate dimeglumine (MultiHance) with the typical amount ranging from 10-20 mL. If you told me the technologist used MultiHance dosing for Gadavist and accidentally gave 2x the dose, I might believe that, but it is highly unlikely and probably not even possible to give someone 600x the dose. I am not even sure they make the vials that big. Another more likely scenario is that there is a typographical error in the report, as many of these reports are generated with voice dictation; for example, the decimal point may have been misplaced or an extra 0 may have been added to the end.

[jerkylady]

I never knew that  Gadobutrol is a more concentrated form of Gadolinium contrast. I went to one of the best Medical Clinics in the US, and was even given the choice of which area of the country I wanted to visit. I chose Phoenix AZ since my appointment was during the middle of Winter. The first appointment day began  with a blood draw to determine my Creatinine level, which was normal. The Lab results includes the estimated GFR of ^ 60 mL/min recommended for me but didn’t mention the type of GFR. Another consideration was mentioned  in my MRI results. “The imaging was performed using the protocol for evaluation of the Pituitary gland by obtaining high resolution sequences through the sella.” We all have a small pouch filled with tiny cysts in the middle of the Pituitary gland, and they  found an immeasurable white Rathke’s cleft cyst to be the primary finding.  But a 6 mm non-enhancing  rounded hypothalamic structure that doesn’t appear to contact the optic chiasm, or the right optic nerve doesn’t show any  neural displacement or deformity, is being considered as “an incidental finding.” I realize my uncontrollable movement disorder is unsightly and it also ruined the function of my right hand, fingers and thumb. The Movement Disorders specialist only suggestion was to go see a Rheumatologist, who confirmed I don’t have Rheumatoid arthritis. She did ask me whether I was having any double vision or black spots in my peripheral vision. “No, I don’t.”  After 11 trying years, I’m tired of going to Movement Disorders specialists who say that my entire brain is functioning normally, but somehow I convinced my muscles not to move correctly, because “Gabapentin doesn’t cause this!” I will not recant what this drug did to me after only taking two consecutive doses!

[CHIN_C]

Regarding the concentration, Bayer's web site for gadobutrol (Gadavist) states: "Double the Concentration, Half the Volume."

[CHIN_C]

I will help to clear up some of the confusion. On your initial post, you stated 60 mL/min/1.73m^2 as if it were the rate of gadolinium was being injected into your body. However, this is not the case, as you sort of alluded to in your more recent post. Prior to receiving contrast, patients are often screened to determine kidney function. If the eGFR is greater than 60 mL/min/1.73m^2, then this is good. If the eGFR is between 30-59 mL/min/1.73m^2, then this is sort of borderline, technically defined as chronic kidney disease stage 3. If the eGFR is less than 30 mL/min/1.73m^2, then this is poor, technically defined as chronic kidney disease stage 4 or 5; if this is the case, then contrast is not given (to avoid risk of nephrogenic systemic fibrosis). In your case, the greater than 60 mL/min/1.73m^2 on your report does not mean you were getting overdosed; it just means your kidney function was good enough to clear you to receive intravenous contrast at the normal dose. Hope that alleviates your concerns.