Gadolinium poisoning: The murky side to MRIs

Actor and martial artist Chuck Norris and his wife Gena have had a rough five years. After receiving three MRIs to test for rheumatoid arthritis in 2012, Gena’s health took a turn for the worst.

Gena began experiencing neurological symptoms, like weakness, burning, shaking and confusion, which left her unable to function or care for herself. Those three MRIs, which she had received over the course of just eight days, had given Gena gadolinium deposition disease (a.k.a. gadolinium poisoning).

Gadolinium is a heavy metal that’s sometimes used in MRI scans to make the results easier to read. If you’ve ever had an “enhanced” MRI, then you’ve probably been injected with gadolinium.

Gena is far from the only person to witness her health go downhill because of gadolinium. Online forums and support groups dedicated to the disease are rife with people reporting neurological symptoms like Gena’s, as well as skin, bone and joint issues.

The problem is, there’s not a lot of research available about gadolinium toxicity, which means there’s still a lot of conjecture about how big of a threat it is. But we know that there is a threat.

The risks of gadolinium

In September, the FDA’s Medical Imaging Drugs Advisory Committee (MIDAC) called for warning labels on the gadolinium-based contrast agents (GBCAs) used in MRIs. Several studies show that gadolinium sticks around in certain organs after you’re exposed, like your skin, bones and brain. A study from 2016 showed that roughly 2.4 percent of people who get MRIs experience side effects from gadolinium, like pain, nausea, headaches, hives, tingling and dizziness.

Other studies have confirmed that GBCAs are especially dangerous to one group — people with kidney problems. Since their kidneys aren’t working properly, they aren’t able to flush GBCAs out of their system. As a result, people with kidney problems can develop a painful and sometimes deadly disease called nephrogenic systemic fibrosis (NSF), which causes thickened, darkened skin.

Researchers have known about the connection between kidney problems, gadolinium-based contrast agents and nephrogenic systemic fibrosis since at least 2006. But they were more shocked and concerned to learn 10 years later in 2016 that people with healthy, functioning kidneys still retain about 25 percent of the gadolinium they’re exposed to.

Another recent study that included 4,300 older adults found that GBCAs don’t seem to increase the risk of dementia. That’s good news, but all in all, there’s not enough scientific evidence to clear or condemn gadolinium. So even scientists agree the best approach to gadolinium is a cautious one.

“A lack of evidence is not evidence of safety,” said Sonia Hernandez-Diaz, M.D., a member of the FDA’s Medical Imaging Drugs Advisory Committee, Harvard TH Chan School of Public Health, Boston.

What to do about MRIs?

All of these questions about the safety of gadolinium put you in a bad spot if you need an MRI. Is it still safe to get one?

Since gadolinium is only used in about 30 percent of MRI scans, the first step is to figure out if yours requires it.  If you do need an enhanced MRI, you have to consider the risks versus benefits of getting one, just like you would with any other medical intervention. In some cases, enhanced MRIs can detect such life-threatening health conditions as cancer and blood clots. But whenever an MRI can be done without gadolinium and still be effective, that’s clearly the better option.

There are also safer alternatives to gadolinium-based contrast agents. Manganese-based MRI contrast agents. are the most promising, because they have a lower likelihood of toxicity. There are also iodine-based MRI dyes. You can ask for alternative imaging tests too, when that’s an option, like sonograms and low-radiation X-rays.

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