For several years, an ongoing discussion by radiologists has been the question of the safety of gadolinium-based contrast agents (GBCAs) used in magnetic resonance imaging (MRI). This conversation was heightened by reports that the contrast agent is deposited and retained in patients' brains.

A review of this issue by the U.S. Food and Drug Administration (FDA) did not identify adverse health effects from gadolinium retained in the brain after the use of GBCAs for MRI. The FDA found no evidence to date that gadolinium retention in the brain is harmful, and at this time the FDA has not imposed restrictions on the use of GBCAs as an MRI contrast. Nevertheless, both the FDA and the profession continue to assess the safety and utilization of GBCAs.

In 2018, the FDA updated its information to the industry to advise: “All MRI centers should provide a Medication Guide the first time an outpatient receives a GBCA injection or when the information is substantially changed. In general, hospital inpatients are not required to receive a Medication Guide unless the patient or caregiver requests it. A health care professional who determines that it is not in a patient’s best interest to receive a Medication Guide because of significant concerns about its effects may direct that it not be provided to that patient; however, the Medication Guide should be provided to any patient who requests the information.”

In an abstract of an article scheduled to be published in the November 2021 issue of Clinical Radiology, researchers from the Department of Radiology of Memorial Sloan Kettering Cancer Center briefly described their review of the question as to whether the use of gadolinium-based contrast agents is necessary for MRI follow-up studies for children with abdominal neuroblastoma.

They have conducted a retrospective review of 110 pediatric patients who underwent abdominal MRI with gadolinium contrast. The reviewer determined the presence or absence of a tumor, both before and after administration of IV contrast material, and documented a level of confidence when a finding was encountered. Change in reviewer confidence after the use of contrast was measured, and a fraction of missed lesions on pre-contrast was calculated. 

The team from Memorial Sloan Kettering Cancer Center conclude that, in selected pediatric patients with neuroblastoma who are undergoing MRI to determine the recurrences of tumors, it may be reasonable to forgo the use of the contrast agents.

No doubt, gadolinium-based contrast agents will continue in use to answer clinical questions the MRI is supposed to provide. At the same time, however, it is also likely that new protocols will evolve in the profession to help reduce or eliminate the need for MRI contrast, particularly in cases involving children.