Gadolinium contrast and mpMRI scans


In his latest epistle to the medical community on the MedPage Today web site, prostate cancer patient Howard Wolinsky writes about the need (or lack of need) for the use of gadolinium-containing contrast agents associated with the conduct of multiparametric MRI (mpMRI) scans.

To read Howard’s complete article, please see “Gadzooks! And egads! Another dilemma in prostate cancer“.

What’s the bottom line? Unsurprisingly,

  • Sometimes use of a gadolinium-based contrast agent is necessary and a good idea.
  • Sometimes it is completely unnecessary.
  • Persuading one’s physicians of the latter can be a problem.

Faced with the last-mentioned issue, the question one might want to ask the doctors is this one:

  • “Are you aware that the radiology specialists at Memorial Sloan-Kettering Cancer Center stopped using gadolinium contrast agents in 2015 for the vast majority of MRIs associated with prostate cancer detection and diagnosis?”

4 Responses

  1. As a patient whose RP and subsequent RT to the prostate bed failed to get all my prostate cancer, the need for better imaging is why I went to the Netherlands in January 2018 for gallium-68 PSMA PET/CT combined with nanoparticle MRI. The findings led me to extended pelvic lymph node surgery in Belgium. Today, at 17 months post ePLND, continuing undetectable at a PSA level of < 0.01. All that American cancer centers offered me was chemo/ADT, and no capable imaging. When will the USA catch up with Europe in the diagnosis of prostate cancer?

  2. Michael,

    Thanks for sharing the link in your epistle — is that UK British for blog? I disagree with you on the “unsurprising” aspects. I find that most men on AS who I speak with are unaware of the gadolinium issue. The radiologists know. One told me last week it’s “poison.” But the urologists may be unformed. I base that on my unscientific poll of men on AS who tell me that they get pushback when they ask their docs about avoiding gadolinium. There is another complicating issue: skill levels of reading MRIs vary among radiologists.

  3. Dear Howard:

    I think you are misinterpreting my use of the term “unsurprisingly”, which refers exclusively to the scientific “unsurprisingness” of the fact that sometimes having a gadolinium scan is important and valuable and often it isn’t. I was not commenting on what patients or physicians did and didn’t know.

  4. The concern regarding gadolinium is not something new, yet it continues.

    This paper — “Questions and Answers” — is quite explanatory regarding this product, and it appears in reading that the major concern is using the contrast agent when patients are known to have “acute or chronic severe renal insufficiency, renal dysfunction of any severity due to the hepato-renal syndrome or in the perioperative liver transplantation period. In these patients, GBCA should be avoided unless the diagnostic information is essential and not available with non-contrast enhanced MRI”

    2017: Latest I am aware of regarding FDA concerns and a very comprehensive explanation which was updated in 2018.

    2018: Many gadolinium contrast agents are now available. What are the differences among them? See here. (Omniscan appears the Ga contrast agent most widely used in the U.S.)

    Regards,

    Charles (Chuck) Maack

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