Video: Why Gadolinium with MP-MRI, Dan Margolis, MD Answers | Excerpt from the 2019 PCRI Conference

2019 PCRI Conference | Transcription

Dr. Margolis Yes? 

Audience Member: Good morning doctor. Can you explain why there's still an insistence on using gadolinium contrast for MRIs when it's, right now, there's a lot of damaging information coming out about it, and even Sloan-Kettering has stopped using gadolinium. I just had an MRI with them about a month ago. Yeah, just your thoughts on that?

Dr. Margolis: So gadolinium is the dye that we use for MRI. We know that it is retained in a part of the brain called the basal ganglia. So we can see on patients that have had an MRI scan with contrast and then have another scan without a contrast that it's still in the basal ganglia. We've looked at millions of patients in followup by looking at medical records and there's no indication that there's any neurological effects. So there may be risks, but as far as we can tell, there are none from this component. But there are other risks: Allergy, patients in renal failure. There's a severe condition called nephrogenic systemic fibrosis and this can be devastating when we were using older agents. 

So our current recommendations are that we use something called a macrocyclic, or a compound where the molecule is entirely bound. The gadolinium molecule is entirely bound by its chelator, the chemical that surrounds it, and that makes it extremely safe. And with these newer agents we've seen none of the effects of nephrogenic systemic fibrosis. So there may be risks, but with the agents that we use now, other than allergy (which is not really something that we can predict, but is something we can prevent with pre-medication) we don't think that there is a significant risk. There may be a risk, but there is also a risk to not using the contrast, and as I've shown you, it's crucial for figuring out how large the tumor is. What I didn't show you are those scans where diffusion-weighted imaging fails, and it does that in about 5% of cases, and we can't predict that. We can to some extent. So patients with hip-replacements, there's a good chance diffusion will fail and that's the most important sequence. And if we know that it's going to fail, we need to have dynamic contrast, otherwise, we can't make a diagnosis. 

So Sloan-Kettering, my neighbor across the street, they don't use contrast—for follow up. Because they already have a baseline. And if they're not using it to evaluate for recurrent disease, if they're simply following patients that are on active-surveillance they're looking for a change from that initial scan. And, in general, that's probably a good technique. The radiologists that invented prostate MRI, Hedvig Hricak, is their chair. So I figure if anybody is going to know how to do a prostate MRI, she's the one.