I wanted to create a page which helps patients wade through all the misinformation about Gadolinium based contrast for MRI imaging. There are only 2 safest contrasts for MRI marketed in the U.S. I have done MRI since 1984. I have experience with three of the five marketed MRI contrasts in the United States. The two contrasts I have never used for MR - I consider to be truly unsafe - DO NOT LET YOURSELF GET INJECTED WITH THEM. THIS IS MY OPINION BUT THE REDUCED STABILITY OF OPTIMARK AND OMNISCAN makes them very unsafe for human or animal MRI studies. If you use them there is a significantly higher risk of NSF - nephrogenic system sclerosis. Please ask questions. Check the web. Read about the horror stories of NSF because once you get this diagnosis you are in most cases stricken with a debilitating fatal illness. Recently in the past year a new agent called Eovist was announced. It has been used for about 2 years in Europe and Asia.
There are actually a few more contrast agents - which are specialized or not Gadolinium based but let's focus on these five major contrasts: Prohance (tm) - gadoteridol is a cyclical chelation molecule which is the most stable and considered to be the safest. Multihance is safest at 1.5T because it can used at 1/2 dose at 1.5T. By using less contrast - it is clearly safer. (At our facilities we use only 1/2 dose Prohance at 3T and 1/2 dose Multihance at 1.5T) Please ask your doctor or MRI technologist which contrast they use and what dose they are giving you. Never accept more than the standard dose.
Intermediate to less safe in safety profile is Magnevist (gadolinium DTPA) which was considered intermediate in safety. Recently in January 2009 Dr. Richard Semelka lumped Magnevist in with the less safe contrasts Omniscan and Optimark. He recommended the 1/2 dose strategy for contrast using Prohance and Multihance - about 5 months after I decided this was safest for my patients. Please ask what contrast your provider uses. If they use a less safe contrast insist that order Multihance or Prohance for your study. If they refuse you know they do not have your best interests at heart. Some facilities actually use more than the standard dose to produce an MR angiogram runoff or carotid study. Please try to avoid getting more than the standard dose. It is even less safe to use a bad contrast agent at high dose.
And least safe are Omniscan (gadodiamide) and Optimark (gadoverdiamide) which are the least stable and thought to be likely to release free Gd ions into your body in just a few minutes time. This is considered the most dangerous. I would not recommend using these two least safe contrast agents. You are taking a significant risk if you let the doctor or technologist inject this into your body. Please read about NSF. Although it is rare it is a severe debilitating disease which is totally preventable. If you have any compromise of your kidneys please tell your fdoctors about this. If your renal function is less than normal your ability to tolerate MR contrast and CT contrast is compromised. And the poor patients who have this are embroiled in lawsuits which to this day have not been settled. Many patients have died from NSF (nephrogenic systemic sclerosis) which causes intractable pain and flzen joins, skin tags, blindness and severe morbidity. While rare it is totally preventable if your facility had switched to Prohance at 1/2 dose or Multihance at 1/2 dose. NSF has never been described under these dosages.
Patients wrongly assume that your doctor would choose the safest contrast for your study. We at MRI Consultants are the only providers in Delaware to use this safest contrast method. It also happens to be the most expensive. We care about our patients and we feel that an informed public would agree with us. (It costs about 14 dollars more.) I find it sad that other providers will not choose the safest contrast for you. Safety should not be optional.
The newest contrast called Eovist is very expensive. But since it is a new generation contrast the amount of gadolinium is actually 1/4 the dose used in Magnevist. I would highely recommend that if you have chronic renal disease you should ask your nephrologist about Eovist for your MRI study. Insurance will cover the additional cost. However the patient would be responjsible for any deductible. The reason why this contrast is particularly safe for renal impaired patients is that it has a dual excretion pathway. It is eliminated from your body by the liver (50%) and by the kidneys 50%. So for the renal imparied patient I would consider this the best contrast even though it costs a little more. Cost should neverr be in considered when safety is being considered. Eovist is also very useful if your doctor thinks you have a liver tumor. If you have a gastroenteorlogist or oncologist who is well informed you can ask him why Eovist is 50% mroe sensitive for metastatic cancer. In this small group of patients - cancer patietns and patients with cirrhosis - Eovist might be the best contrast for you.
Please call us our offices or visit our websites to learn more about the innovative approach we have to MRI and MR imaging. We have the strongest MR magnet allowed in routine clinical practice - a 3T MRI system. It is the ONLY MRI since 2007 to 2009. This has many benefits but in particular for patients with renal failure I recommend that their MRI studies ONLY be performed at 3T and also with Prohance. This is because at 3T we can use 1/2 or 1/4 dose contrast and still get similar results to lower fields and full dose due to the increased contrast and lengthened T1 at 3T. Therefore any patient on dialysis should follow the University of Washington guidelines. GUIDELINES FOR THE USE OF GADOLINIUM IN PATIENTS WITH RENAL IMPAIRMENT. These guidelines should also be followed even if you have normal renal function to be the most cautious and prudent. Basically it says to use Prohance in these patients.
Prohance has never been associated with NSF by itself. It is the most stable and the safest contrast for MRI. If I was going to have an enhanced study - I would ask first that we are CERTAIN we need to use contrast. If we have to use MR contrast then we would like to use the safest possible - which is Prohance. In my facility I give contrast prn - (as needed) and if I feel that contrast is not necessary I say son in my reports and stand by it.
I refer you to the wikipedia page about this -