Doc having concerns about MRI's because of Gadolinium toxicities

Thanks for this info, MelissaDallas and Light1Candle.

In fact my BS was not even sure if insurance would cover MRIs for LCIS because the 20%+ lifetime risk due to genetic factors is reason for MRI, but 20% risk due to LCIS is not she said. However, she said coverage can be granted and is not a definite NO. In contrast a nurse practicioner told me she has always been able to get MRIs for patients with LCIS, but cautioned about the safety of them longterm.

An allergic reaction can happen with anything and differs from the concerns about gadolinium that have been raised over it's safety in general. If you are allergic to something,it's best to avoid it or work with you doctors to prevent or stop the reaction if necessary.

As far as general safety concerns about gadolinium...

There are two types of gadolinium contrast agents that I am aware of. The older linear ones such as omniscan, and the newer macrocyclic ones such as gadivist.

In these contrast agents, gadolinium, which is a rare metal, and like many metals, toxic in it's free form when it gets up in to your biological workings, is chelated. This means it's bound to other atoms so it can't do any damage. Think of it like a prisoner being detained by guards.

In linear contrast agents, the gadolinium is like a prisoner with a guard on each arm.

In macrocyclic contrast agents, the gadolinium is like a prisoner being detained by guards not only at the arms, but the front and back as well, so it's encaged.

The key to gadolinium contrast safety (for people who are not allergic to it), is to void it from the body before the gadolinium breaks free from it's bonds to the chelation agents.

The primary way to void gadolinium contrast agents is through the urine. A few years after gadolinium contrast agents hit the market, people with reduced renal function who had been given gadolinium contrast agents started turning up with wide spread fibrosis. This is now called nephrotic system fibrosis. One theory is that these individuals were unable to filter out and excrete the gadolinium contrast before it broke freem from the chelation agents, and that the gadolinium atoms lodged in the tissue, triggering fibrosis as the body tried to isolate the atoms.

The macrocyclic gadolinium contrast agents are more stable, allowing for longer excretion times, but over the years, concern has grown about the safety of gadolinium contrast agents in general in people with normal renal function, due to a growing number of individuals who believe they developed symptoms after multiple injections of gadolinium contrast and studies that have found that small amounts of gadolinium can remain in the body of individulas with normal renal function. There are currently efforts to develop an alternative to gadolinium contrast agents.

I've declined gadolinium contrast in the past but I have not declined it for any MRIs to image and stage my cancer because it's necessary to make some tumors visible and the risk the cancer posses to me is greater than the risk that the gadolinium contrast does, but I take a few precautions. I ask which contrast they use. For some parts of the body, linear contrast agents are necessary but if a linear agent isn't necessary than I insist on a macrocyclic contrast agent. My imaging facility uses Gadovist, which is thought to be a safer one.

After the imaging I drink a lot of fluids (to the extent that it is safe to do so) in a bid to increase my urine output.

And last, I try to space out the MRIs.

Would I have had the gadolinium if I were having an MRI of a mass that had not been confirmed to be malignant? Maybe. I really don't like having it but it would depend on the a number of factors I think. I would have to detemine how necessary the contrast was. When I had a brain MRI a few years ago pre cancer dx, I did not have the contrast because we weren't looking for cancer but the second brain MRI post dx was to look for metastasis and the contrast was necessary.

What I am wondering is whether my brain could be more vulnerable to gadolinium-induced cognitive problems since it has been deprived of estrogen and/or chemo-ed for seven years. I’m currently on the chemo Xeloda, which does cross the blood-brain barrier. I know I should weigh the gadolinium risk against the risk of not getting the info an MRI might provide. So it’s important to know if I am at greater-than-average risk. Two of my non-oncology docs want an MRI from me.