Need to Know: Do I Need Contrast Dye for an MRI?

Need to Know: Do I Need Contrast Dye for an MRI?

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Editor’s note: “Need to Know” is a series inspired by common forum questions and comments from readers. Have a comment or question about MS? Visit our forumThis week’s question is inspired by the forum topic “Gadolinium – The contrast agent used in MRI scans,” from April 10, 2018.

MRI: A brief history

Magnetic resonance imaging (MRI) uses magnets to measure molecular activity in the soft tissues of the body, including the brain. Because it’s a noninvasive way to “take a picture” of your insides, it’s become the go-to diagnostic and assessment tool for identifying and measuring MS disease activity.

The first MRI test on a human being took place in 1977 for cancer research. Four years later, the technology was used to scan the brain of a person with MS, generating the first images of lesion activity. In 1988, the first contrast dye, a gadolinium-based contrast agent (GBCA) known as gadopentetate dimeglumine, was used to enhance MRI scans for better interpretation.

Since then, MRIs with and without contrast have been a mainstay of disease management for decades.

What is gadolinium dye?

Gadolinium is a rare earth mineral (Gd, No. 64 on the Periodic Table of Elements). It is bonded, then converted to a dye medium. In this state, it’s injected into a vein during MRI scanning to provide imaging contrast. This contrast allows a specialist to best interpret MS disease activity.

The dye, in early research, was thought to be eliminated as a waste product by the kidneys. However, more recent research suggests that about 1 percent of an injected dose of gadolinium dye may be retained in the tissues and bones.

The problem with gadolinium dye

Dye retention

Controversy over GBCAs has centered on these deposits. Science does not have a clear understanding of the risks these deposits may pose in the long term.

A rare condition known as nephrogenic systemic fibrosis, which occurs in patients with preexisting kidney failure, is the only known adverse health effect related to gadolinium retention.

However, reports of adverse events “involving multiple organ systems in patients with normal kidney function” have also been reported, though no link to gadolinium retention has been established.

The U.S. Food and Drug Administration issued new warnings in January 2018 regarding the use of GBCAs in tandem with MRI after reviewing safety concerns.

Adverse reactions

There is no easy way to predict who will have a negative reaction to gadolinium dye, but unfortunately, some people do not tolerate it well.

Most commonly, side effects include brief dizziness, nausea, and headache. However, about 1 in 1,000 patients may experience an itchy injection site rash.

The most severe reaction — anaphylaxis (difficulty breathing and swelling of the throat and lips) — occurs at a rate of about 1 in 10,000.

Research update: Gadolinium dye

Research published in the journal Radiology last March, titled “Accuracy of Unenhanced MRI in the Detection of New Brain Lesions in Multiple Sclerosis,” suggests that the use of contrast dye to enhance MRI scan images may no longer be necessary.

The retrospective study evaluated over 500 follow-up MRI images from 359 MS patients using a variety of methods for comparison. Based on the study’s findings, the study’s co-authors wrote: “In none of the 507 images did the contrast-enhanced sequences reveal interval progression that was missed in the readouts of the nonenhanced sequences. …”

Researchers concluded that scans that employ a 3T MRI* (a higher powered scanner used in research), when used in combination with new artificial intelligence techniques, are “ready to supersede routine use of contrast material in most instances of follow-up investigations of patients with MS, reducing both imaging time and cost without missing new or enlarged lesions.”

The Radiological Society of North America announced the findings in a press release.

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*Patient and clinical access to a 3T MRI scanner can vary widely.

Do you have a story about contrast dye you want to share? What questions do you still have about GBCAs? Post your replies in the comments below or at the original “Gadolinium – The contrast agent used in MRI scans” forum entry.

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Note: Multiple Sclerosis News Today is strictly a news and information website about the disease. It does not provide medical advice, diagnosis, or treatment. This content is not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read on this website. The opinions expressed in this column are not those of Multiple Sclerosis News Today or its parent company, BioNews Services, and are intended to spark discussion about issues pertaining to multiple sclerosis.

18 comments

  1. Bill. says:

    My doctors keep all the MRIs to track disease progression. They have AI to monitor brian atrophy. Unless new symptoms or annual MRI show something new they do not use contrast. So for me have not used in 7 years since the first attack. N

  2. Judy Crutchfield says:

    Are MRI’s needed after you have been diagnosed? My doctor does not do them because he says right now there is no cure so what good would it do. Should I find a new doctor?

    • Karen says:

      Judy – An MRI can tell part of the story of your disease course, and help inform treatment options. please reaserch HSCT. It has an 80% success rate of stopping disease progression.

    • Tamara Sellman says:

      If you’re stable, then you can go a while without having them. I’m on the 2-year schedule now (I graduated! LOL) and will only have one if I have new symptoms or extreme versions of my old symptoms that last more than a couple of days. But for a doctor to say “there is no cure so what good would it do” seems very concerning to me. If you have mild MS and slow progression, then maybe… but for people with more active disease, MRIs are the only way to track it, and you don’t always know you have active disease. My two cents, anyway. If you feel like your MD is dismissive, maybe you should consider looking for a new neuro?
      Tamara

  3. Janice B. says:

    Thank you for this article. I have had RRMS for 37 years. I have yearly check ups with my Neurologist and have refused yearly MRIs with and without GBCAs since 2010 as my symptoms have remained stable. In 2015 I was diagnosed with Smoldering Myeloma which remains stable based on regular check ups with my Oncology Hematologist. There is research published online suggesting a potential link between having an MRI with GBCA and the acceleration of Smoldering Myeloma to Stage One Myeloma. My Neurologist stated that having an MRI without contrast would reveal any new lesions but would not show changes or activity in existing lesions (if there are any). I’m unsure about having an MRI with contrast in the future should the need arise as I wouldn’t want to cause my Smoldering Myeloma advance to Stage One Myeloma . Any input or personal experience someone might share is most appreciated!

    • Tamara Sellman says:

      Hi Janice
      you’re welcome 🙂
      I cannot add much to your inquiries about Smoldering Myeloma (except that I wonder why they have to give it such a scary name??) It seems to me that more information is better information, at least for me, so it comes down to risk-benefit analysis… is the MRI with contrast worth the information it delivers within the context of your myeloma concerns? Only you can decide that, but maybe there are others in this community who could share their experiences. I hope you can keep that SM under wraps and wish you well moving forward!
      Tamara

  4. Alan S says:

    I’ve been declining contrast for years against doctor’s orders. Since contrast only allows the doctor you see if there is any current inflammation, I never understood the point if I wasn’t having an exacerbation. If there were any new lesions, whether 2 weeks or 2 months old, they would still show on a normal MRI. And if I were in an exacerbation, I’d know it anyway.

  5. Joanne Perkins says:

    I will not ever have a MRI using gadolinium contrast again. I had a concomitant symptom of a swollen left kidney and urinary difficulty after receiving it. This symptom has not subsided since 2016.

    • Tamara Sellman says:

      I’m sorry to hear this, Joanne. I do wonder how many people have experienced unnecessary damage to organs because of this dye. I hope you find relief!
      Tamara

  6. Jan Charles says:

    I was participating in an MS study about 20 years ago. Each month I would be infused with Omniscan with no problems. For my last scan, within seconds of the dye being infused, I knew something was wrong. I felt a fire going through my vein and into my chest. I had trouble breathing within 30 seconds. IV Benadryl turned me around before my throat closed up. What had happened was that they had used a different agent, Magnavist. From that time forward I have been able to obtain Omniscan for subsequent scans. I wonder why only one agent is easily available now.

    • Tamara Sellman says:

      Thank you for sharing this insight, Jan, and what an ordeal you must have had! Who knows why these agents are picked, one over the other, in the first place? I’m glad you were able to get through the allergic reaction with the Magnavist, that must have been awful.
      Tamara

    • Tamara Sellman says:

      That sounds right to me, Tracy. I think a lot of doctors are going this route, or not using it at all, but it’s good for us patients to know we have the option to say no.
      Tamara

  7. Jana says:

    I was diagnosed with RRMS 2007 and have been receiving Gandolinium for my MRI’s. I had a very severe case that nearly killed me. During the 2 months of severe deterioration, I was scanned, what seemed like, twice a week. At the beginning, the contrast didn’t affect me at all. Once I was discharged, I got scanned every six months until I started feeling a little funny right after receiving the Gandolinium. I shrugged it off. A year later, I had another MRI with prednisone and Benadryl to help with the allergic symptoms. I felt worse. I again didn’t think much of it because it lasted about 5 minutes. I spoke with my neurologist regarding my symptoms after receiving the contrast and how the symptoms had progressively gotten slightly worse. She again wanted another MRI a year later and I simply didn’t comply because I had been recovering and doing better. I repeated the MRI with contrast two years later. This time it really scared me and I did not accept having another MRI with contrast again. My neurologist now says that it isn’t necessary because I’ve been doing well. I wonder if I had never said anything, I could have been adding more unnecessary possibly harmful minerals to my body. I still hope that it doesn’t affect me in the future.

    The symptoms I felt with the contrast were dizziness and I felt the contrast go up from my stomach to my throat. It felt as if my airway was blocked. It was pretty scary. I told my neurologist that I must be allergic to contrast. I also felt as if no one believed me. I’m glad people are becoming aware of this!

    • Tamara Sellman says:

      Thank you for sharing this experience with us, Jana. When people read this, they’ll be more knowledgeable of the risks and perhaps more empowered to speak out against these risk factors. It’s hard to advocate for oneself but totally worth it, as your example shows.
      Tamara

  8. Emm says:

    I’m scheduled for an MRI w/wo contrast in a few weeks. My neurologist says I have CIS, so naturally a round of tests have been ordered.

    If anyone can help: Does the first MRI absolutely need imaging with contrast? I suppose if it’s the only way to get a definitive answer, I’ll consent, but otherwise I’d really like to forego this. I don’t have kidney failure, but my kidneys aren’t in the best of shape as I’ve had multiple kidney infections over the years.

    Also, what a great website! I’ve been browsing around the last couple days since I’m new to the CIS/MS “club” and am trying to learn as much as possible.

    • Tamara Sellman says:

      Thanks for writing, Emm. It’s a tricky question, one that might be best answered by your neurologist. Contrast might be used initially to get an accurate baseline image of your lesions to reference against in the future. If you’re concerned about kidney damage, share that with your doctor. It may depend on the quality and type of imaging equipment they have available to them. Good luck!
      Tamara

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