FORCE has a strong commitment to promoting research to benefit our community. We advocate for more research funding, educate people about available studies, and report findings back to our community.
By Lisa Rezende, PhD
Breast MRI is an important surveillance tool for finding cancer in high-risk women. This article, prepared in conjunction with our advisory board members, addresses concerns submitted by FORCE members about the use of gadolinium, an MRI contrast agent. These concerns are based on studies that question the safety of gandolinium under certain circumstances.
Gadolinium-containing contrast agent is commonly administered during breast MRI to improve imaging. Because gadolinium is a metal, it is given in a form that is rapidly removed from the body, limiting side effects and making it safe for most patients.1 A 2014 study of 10,595 patients who received a gadolinium-based contrast agent found it to be very safe. None of the patients had severe reactions –43 had mild reactions, and 5 had moderate reactions, including swelling and mild blood pressure changes.2 Precautions are often taken when using gadolinium-containing contrast agents in patients with a history of allergic reactions to imaging agents, women who are pregnant or nursing, and patients with kidney disease, who are risk for a rare kidney disorder known as nephrogenic systemic fibrosis if exposed to gadolinium.
The long-term effects of gadolinium-based contrast agents remain an area of research. A recent small study of 35 patients with existing brain disease showed changes in brain MRI after six or more brain MRI scans with gadolinium3. Dr. Tomonori Kanda, the paper’s lead author, states in the accompanying press release that the study does not prove that gadolinium caused the changes, nor is it clear that these findings affect patient health. Another small study looking at 31 patients undergoing hip replacement surgery found that those who previously had MRI with gadolinium-based contrast agents had a higher concentration of gadolinium in their bones than those who did not4.
Experts on our advisory board feel that these and prior research studies do not raise concern that mutation carriers are more sensitive to the effects of gadolinium, and that the benefits from enhanced contrast on breast MRIs outweigh the theoretical risks. They continue to recommend annual breast MRI with contrast for women at high-risk for breast cancer who have not undergone mastectomy.
1 Hao D, Tweedle M, Hu X, et al. "MRI Contrast Agents: Basic Chemistry and Safety," Journal of Magnetic Resonance Imaging, Volume 36, Number 5, p. 1060-71, November 2012.
2 Okigawa T, Utsunomiya D, Yamashita Y, et al., "Incidence and Severity of Acute Adverse Reactions to Four Different Gadolinium-based MR Contrast Agents," Magnetic Resonance in Medical Science, Volume 13, Number 1, p. 1-6, January 21, 2014.
3 Kanda T, Takenaka D, et al., "High Signal Intensity in the Dentate Nucleus and Globus Pallidus on Unenhanced T1-weighted MR Images: Relationship with Increasing Cumulative Dose of a Gadolinium-based Contrast Material," Radiology, Volume 270, Number 3, p. 834-41, March 2014.
4 Darrah TH, Hannigan RE, et al., "Incorporation of Excess Gadolinium into Human Bone from Medical Contrast Agents," Metallomics, Issue 6, p. 445-528, November 1, 2009.