The Impact of Gadolinium Deposition on Radiology Practice: An International Survey of Radiologists

https://doi.org/10.1067/j.cpradiol.2018.02.003Get rights and content

Rationale and Objectives

Brain deposition of gadolinium following the administration of gadolinium-based contrast agents (GBCAs) was initially reported in 2014. Gadolinium deposition is now recognized as a dose-dependent consequence of exposure. The potential clinical implications are not yet understood. The purpose of this study was to determine radiologists’ reporting practices in response to gadolinium deposition.

Materials and Methods

An electronic survey querying radiologists’ practices regarding gadolinium deposition was distributed by Radiopaedia.org from November-December 2015.

Results

Our study sample included 94 total respondents (50% academic; 27% private practice; 23% hybrid) from 30 different countries (USA 18%). Fifty-seven (62%) radiologists had observed brain gadolinium deposition on MRI brain studies howerver more than half of these (30 of 57) reported detecting dentate T1 shortening only rarely (<1/month). Among respondents, 58% (52 of 89) do not or would not include the finding in the radiology report; only 12 (13%) report the finding in the impression of their reports. The most common reason for not reporting gadolinium deposition was the risk of provoking unnecessary patient anxiety (29%, 20 of 70). Recent data on gadolinium deposition has led to a reported practice change in 24 of 87 (28%) of respondents.

Conclusion

Recognition of, and attitudes toward, brain gadolinium deposition were inconsistent in this worldwide sample. Most surveyed radiologists do not routinely report dentate T1shortening as a marker of gadolinium deposition. Fear of provoking patient/clinician anxiety and an incomplete understanding of the implications of gadolinium deposition contribute to inconsistencies in reporting.

Section snippets

Purpose

Gadolinium-based contrast agents (GBCA)s are retained in the human brain as a dose-dependent consequence of exposure manifested by T1 shortening within several distinct brain regions including the cerebellar dentate nuclei.1., 2., 3. Less than a decade previously, the finding of hyperintense T1 signal within the dentate nuclei had been attributed to a variable etiologies including prior therapeutic brain irradiation4 and also as a marker of the secondary progressive subtype of multiple

Study Population and Survey

We conducted an online survey of radiologists using SurveyMonkey.com over 17 days spanning November-December 2015. A 10-question survey was distributed by study authors through Radiopaedia.org using social media including Facebook.com and Twitter.com. Queries included basic respondent characteristics such as practice type and location, frequency of detection of GD deposition, and reporting habits (Table). Poll results were conveyed using descriptive statistics.

Study Group

Our study included survey data from 94 respondent radiologists from 30 different countries (USA 18%) on 6 continents. Not all respondents answered every question resulting in a variable denominator. Close to half (47 of 93) of the survey respondents described their practice as academic, 27% (25 of 93) private practice, and 23% (21 of 93) reported a hybrid practice. Fourteen of the respondents were radiology residents or fellows. The majority of respondents reported their primary area of

Discussion

Recent evidence has established a causal link between T1 shortening in specific brain regions and cumulative exposure to certain GBCAs.1., 2., 7., 8. The response of the radiology community to this data in terms of reporting and effects on practice patterns has, to our knowledge, not yet been examined. The aim of our study was to describe the impact of data regarding GD deposition on radiologists from among a worldwide sample. We found high variability regarding radiologists′ recognition and

References (17)

  • T. Kanda et al.

    Gadolinium-based contrast agent accumulates in the brain even in subjects without severe renal dysfunction: Evaluation of autopsy brain specimens with inductively coupled plasma mass spectroscopy

    Radiology

    (2015)
  • R.J. McDonald et al.

    Intracranial gadolinium deposition after contrast-enhanced MR imaging

    Radiology

    (2015)
  • Y. Errante et al.

    Progressive increase of T1 signal intensity of the dentate nucleus on unenhanced magnetic resonance images is associated with cumulative doses of intravenously administered gadodiamide in patients with normal renal function, suggesting dechelation

    Invest Radiol

    (2014)
  • S. Kasahara et al.

    Hyperintense dentate nucleus on unenhanced T1-weighted MR images is associated with a history of brain irradiation 1

    Radiology

    (2011)
  • L. Roccatagliata et al.

    Multiple sclerosis: Hyperintense dentate nucleus on unenhanced T1-weighted MR images is associated with the secondary progressive subtype 1

    Radiology

    (2009)
  • T. Kanda et al.

    High signal intensity in the dentate nucleus and globus pallidus on unenhanced T1-weighted MR images: Relationship with increasing cumulative dose of a gadolinium-based contrast material

    Radiology

    (2014)
  • J. Ramalho et al.

    Gadolinium-based contrast agent accumulation and toxicity: An update

    Am J Neuroradiol

    (2015)
  • E. Kanal et al.

    Residual or retained gadolinium: Practical implications for radiologists and our patients

    Radiology

    (2015)
There are more references available in the full text version of this article.

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Components of the work were presented at the Annual Meeting of the American Society of Neuroradiology held in May 2016.

Potential Conflicts of Interest: E.K.: paid consultant for Bracco Diagnostics and Guerbet, F.G.: CEO and editor or Radiopaedia.org

1

Primary Institution: University of Arkansas for Medical Sciences, Little Rock, AR.

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