About My Health Careers Internship MedBlogs Contact us

Gadolinium Deposition Identified in Early Multiple Sclerosis

by Colleen Fleiss on July 14, 2019 at 1:22 PM
Font : A-A+

Gadolinium Deposition Identified in Early Multiple Sclerosis

Male patients with multiple sclerosis had higher deposition in the brain from gadolinium-based contrast agent (GBCA) than female patients, revealed a comprehensive, longitudinal study. At the same time, the study found that there were some indications of greater disease severity in patients who had undergone more magnetic resonance imaging (MRI) studies using these agents.

The findings, published in the online issue of Neurology®, the medical journal of the American Academy of Neurology, are the result of work conducted by researchers at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo. It is the latest research to address the ongoing controversy in the MS community about use of gadolinium-based contrast agents, known as GBCAs.


Free gadolinium is highly toxic, and for clinical use, it has to be complexed with chelating molecules. There are different types of GBCAs, linear and macrocyclic are the two most frequently used, and structural differences in the molecules can impact their stability. Recently, a general consensus has emerged that linear, but to a lesser extent macrocyclic GBCAs, are associated with the development of gadolinium deposition in the brain.

GBCAs are powerful contrast agents that are injected in many MS patients undergoing MRI on a routine basis, in order to better detect acute inflammation and other signs of disease progression in the brain. Four of those agents have been banned in Europe and in 2017 the U.S. Food and Drug Administration recommended that GBCAs only be used in certain cases when deemed absolutely necessary.

"Our data could become an important reference contributing to regulatory decisions about the use of GBCA in MS," said Robert Zivadinov, MD, PhD, senior author, a professor of neurology in the Jacobs School and director of UB's Buffalo Neuroimaging Analysis Center (BNAC.) He also directs the Center for Biomedical Imaging at UB's Clinical and Translational Science Institute.

Many studies have found depositions of these contrast agents in the brains of patients who have undergone multiple repetitive scans. But no previous, large, case-control, longitudinal study followed MS patients since their first clinical sign of the disease.

Followed since diagnosis

In contrast, the UB study followed 203 MS patients from the time they were diagnosed with MS, and all were followed in UB's Buffalo Neuroimaging Analysis Center (BNAC) at some point between 2003 and 2016. They all received identical doses of GBCA exclusively on the same MRI at Buffalo General Medical Center.

"This study is one of the first to investigate the longitudinal association between well-established clinical and MRI outcomes of disease severity and gadolinium deposition," Zivadinov said. "The findings from this study should be incorporated into a risk-versus-benefit analysis when determining the need for GBCA administration in individual MS patients."

Of special concern, the UB authors noted, are areas of high intensity within some brain regions that have been identified in patients receiving GBCAs.

"But is it the gadodiamide creating the hyperintensity or is it the disease progression?" The UB study's main finding was that there was no clear association between GBCA deposition in the brain and development of disease progression.

"The study didn't find any correlation between deposition in the brain and clinical or MRI outcomes, such as accumulation of lesions, brain atrophy or disease severity, at least in the first five years of the disease," Zivadinov explained. "Over the 4.5 years of follow-up, we didn't find that GBCA deposition contributed to patients being more disabled." This study also was the first to study GBCA in MS patients in comparison to such a large group of healthy controls, 262.

Potentially more susceptible

Because of blood-brain barrier disruption that can be characteristic of MS, and because these agents are administered more frequently to MS patients, Zivadinov noted that they may be more susceptible to accumulating gadolinium in their brains.

The results showed similar GBCA deposition in MS patients who had between five and eight doses of gadodiamide, while patients with fewer than five doses behaved similarly to healthy controls. At the same time, 8.9% of MS patients who received fewer than 5 doses did have hyperintensity in the part of the brain, called the dentate nucleus, involved in voluntary motor function and cognition, which is often affected by MS; none of the healthy controls did.

And while there was no discernible clinical impact, the researchers did find that patients who received more than eight GBCA doses had more brain lesions and more advanced atrophy of grey matter, compared to patients who had fewer than 8 doses.

"Therefore, we cannot completely rule out that gadolinium deposition may have an impact on disease progression or clinical outcome," said Zivadinov.

More deposition in males

One unusual finding of the study was that it found more gadolinium deposition in male patients than in female patients, a finding that Zivadinov said is of interest but should be interpreted with caution. He said that one possible explanation is that males receive a higher dose because they tend to weigh more and dosage is based on weight.

Source: Eurekalert

News A-Z
News Category
What's New on Medindia
Ten Fruits for Diabetics
Natural Supplements Help Reverse Hair Loss during Menopause
Ways to Manage Stress during COVID-19 Pandemic
View all

Medindia Newsletters Subscribe to our Free Newsletters!
Terms & Conditions and Privacy Policy.

More News on:
Chemotherapy Chemotherapy Drugs Infectious Mononucleosis Multiple Sclerosis Treatment and Modify Optic Neuritis Autoimmune Disorders Health Risks of Eating Pork 

Recommended Reading
Multiple Sclerosis
Multiple sclerosis can be a severely disabling autoimmune disease that affects the myelin or ......
Multiple Sclerosis Treatment and Modify
Multiple sclerosis is treated with drugs that modify the course of the disease, suppress immunity .....
Quiz on Multiple Sclerosis
Multiple sclerosis is an autoimmune disease that affects nerves and can leave the affected patient ....
World Multiple Sclerosis Day: Increasing MS ‘Visibility’ for Everyone
World Multiple Sclerosis Day is observed on 30th May every year and aims to raise awareness on ......
Autoimmune Disorders
Autoimmune disorders occur when the immune system fails to recognize the body as ‘self’ and attacks ...
‘Chemo’ means medicine or ‘drug’; ‘therapy’ means ‘treatment’. Chemotherapy refers to the use of cy...
Chemotherapy Drugs
Chemotherapy drugs perform like ‘magic bullets’ to destroy cancer cells in the body....
Health Risks of Eating Pork
Pork is one of the most popular and widely consumed of all red meats, but how healthy is it? Find ou...
Infectious Mononucleosis
Called also the kissing diesase, Mononucleosis is an infectious disease due to infection with the Ep...
Optic Neuritis
Optic neuritis is acute inflammation of the optic nerve. Optic nerve connects the eye to the brain a...

Disclaimer - All information and content on this site are for information and educational purposes only. The information should not be used for either diagnosis or treatment or both for any health related problem or disease. Always seek the advice of a qualified physician for medical diagnosis and treatment. Full Disclaimer

© All Rights Reserved 1997 - 2021

This site uses cookies to deliver our services. By using our site, you acknowledge that you have read and understand our Cookie Policy, Privacy Policy, and our Terms of Use