Gadolinium contrast media are chemical substances used in magnetic resonance imaging (MRI) scans. When injected into the body, gadolinium contrast medium enhances and improves the quality of the MRI images. It is used in about 1 in 3 of MRI scans

Three MRI contrast agents have been approved for clinical use in the United States as of 1994. Six more MRI contrast agents were approved by FDA for clinical use from 1995 through 2017.

Radiologists and patients began to question the safety of gadolinium a few years ago when a study came out in late 2014 showing the agent is deposited and retained in the brain.This, combined with a small percentage of patients who claim their health was harmed following gadolinium exams, has sparked a big debate in radiology over the safety of these agents.

There are numerous patient-created groups on social media that discuss MRI gadolinium toxicity issues, which have raise public awareness on the topic of possible connections with previously unknown gadolinium side effects.

The biggest public relations boost for these patients came in November 2017 when action movie actor Chuck Norris filed a lawsuit against a contrast vendor and the contrast distributor for allegedly poisoning his wife Gena. She had several contrast MRI exams and the suit alleges numerous adverse health effects began after these exams. Norris is seeking $10 million in damage.

The suit alleges she contracted what is being called “gadolinium deposition disease.” It is a term often used by patients who claim they now have chronic health problems from their contrast MRI exams. However, the term is not accepted by many in the medical community because of the lack of scientific evidence showing a direct connection with the contrast agents.

The lawsuit described Gena’s symptoms as burning pain throughout her body, violent shaking, numbness, tingling, weakness, cognitive deficits, kidney damage and trouble breathing. These symptoms are similar to others often reported in patient social media groups.

The FDA stated there is no clinical evidence that directly links gadolinium retention to adverse health effects in patients with normal kidney function, and the FDA has concluded that the benefit of all approved GBCAs continues to outweigh any potential risks.

However, in July 2017, the European Medicines Agency (EMA) issued a final opinion that recommended restricting the use of some linear gadolinium-based contrast agents (GBCAs) and suspending the marketing authorizations of others, citing concerns about gadolinium deposition.

Patients that say they were harmed by gadolinium agents often argue they were never given any sort of informed consent documents to sign warning them of gadolinium’s potential hazards. Experts speaking at Radiological Society of North America (RSNA) 2017 said this might be easier said than done.

Worker’s Compensation Claims Administrators need to be aware of these risks, which may cause a compensable consequence injury to an injured worker. Utilization Review vendors should carefully review a RFA for a contrast study, and consider safer alternatives when they are available.

Some MRI vendors have touted new technologies like black blood imaging, or new protocols that can reduce or eliminate the need for MRI contrast. However, some types of exams still require the use of gadolinium in order to answer the clinical questions the MRI is supposed to answer. There is ongoing research to find alternatives, but currently there is no good alternative for all the things that the gadolinium can help with.