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National breast screening guidelines for high-risk women recommend breast MRI with contrast. The contrast agent—called gadolinium—helps radiologists to more easily spot abnormalities such as breast cancer. However, some concern has been expressed about the safety of gadolinium; specifically, that gadolinium remains in patients’ bodies, including the brain, for months to years. However there are different types of gadolinium-based contrast agents (GBCA). GBCA are classified based on their chemical structures (linear vs macrocyclic). Macrocyclic types (including the following brand names: Dotarem, Gadavast/Gadovist, ProHance) are less likely to remain in the brain than linear products.
To date, the only known adverse health effect related to gadolinium retention is nephrogenic systemic fibrosis (NSF), a rare condition that occurs in a small subgroup of patients with pre-existing kidney failure. While the US Food and Drug Administration (FDA) has received some reports of adverse events in patients with normal kidney function, it has not been proven that the gadolinium caused these adverse events. The FDA has concluded that the benefit of all approved GBCAs continues to outweigh any potential risks. Experts on our Advisory Board agree. They feel that the benefits from enhanced contrast breast MRIs for high-risk women outweigh the potential risks associated with contrast exposure. They continue to recommend annual breast MRI with contrast for women at high risk for breast cancer who have not undergone mastectomy.
The FDA recently updated the label for gadolinium-based contrast agents (GBCA), to include a warning and other safety measures before these agents are given to patients. Individuals who are scheduled for an MRI with contrast should carefully read the new warning to understand the risks associated with GBCAs, and tell their health care professional about their medical conditions, including:
The long-term effects of gadolinium-based contrast agents remain an area of research. The FDA also requires manufacturers of GBCAs to conduct additional studies to further assess the safety of these contrast agents.