Gadolinium Intermediate Elimination and Persistent Symptoms After Magnetic Resonance Imaging Contrast Agent Exposure

Area of Science:

• Nephrology
• Radiology
• Toxicology

Background:

• Gadolinium is a widely used heavy metal contrast agent for MRI in the Military Health System and Veterans Health Administration (VHA).
• While essential for diagnostic imaging, gadolinium contrast agents carry potential toxic risks.
• VHA facilities have seen a significant increase in contrast-enhanced MRI procedures utilizing gadolinium.

Purpose of the Study:

• To investigate the potential for subclinical gadolinium exposure and its associated symptoms.
• To evaluate the persistence of symptoms despite undetectable gadolinium levels post-MRI.

Main Methods:

• A case presentation of a 65-year-old Air Force veteran undergoing a contrast-enhanced MRI.
• Monitoring of serum and urine gadolinium levels before, during, and after the MRI procedure.
• Assessment of patient-reported symptoms and correlation with gadolinium levels and elimination rates.

Main Results:

• The patient experienced acute symptoms during the MRI, including claustrophobia, sweating, shortness of breath, and a metallic taste.
• Post-MRI, serum gadolinium was 0.1 ng/mL and 24-hour urine gadolinium was 0.3 mcg, suggesting exposure to 0.5% to 8.0% of a standard dose.
• Despite undetectable gadolinium levels at 107 days post-MRI, the metallic taste symptom persisted.

Conclusions:

• Detectable gadolinium in serum and urine can indicate subclinical exposure, even below standard prescription doses.
• Clinicians should consider gadolinium as a potential cause of diverse symptoms, even when gadolinium levels are no longer detectable.
• Persistent symptoms post-gadolinium exposure warrant clinical consideration, regardless of current biomarker levels.