In early November, Chuck Norris filed a lawsuit against medical device manufacturers involving gadolinium based contrast media, a chemical used in MRI imaging scans. The lawsuit stated that the gadolinium that doctors injected into his wife Gena to improve the clarity of her MRIs have left her “weak and tired and with debilitating bouts of pain and a burning sensation”.
Since the U.S. Food and Drug Administration (FDA) approved the use of gadolinium based contrast agents (GBCA) for magnetic resonance imaging (MRI) use in 1998 to improve visibility of internal structures, gadolinium has been used in more than 300 million patients for diagnosis and treatment guidance. The overall risks of GBCA have been found to be small over multiple scientific studies with most reactions being only mild. The adverse event rate for MRI contrast agents administered at clinical doses ranges up to 2.4% with severe life-threatening reactions only occurring in up to 0.01% of patients.
However, in 2000, nephrogenic systemic fibrosis was first described, a disease that causes fibrosis of the skin, muscles, and organs and can even lead to death. In 2006, several groups noticed a strong association with nephrogenic systemic fibrosis when GBCA is given to patients with end-stage chronic kidney disease and now MRI contrast agents are avoided in patients with advanced renal disease.
More recently, gadolinium deposits have been found within the brain tissue of patients who received multiple doses of MRI contrast media over their lifetimes. No adverse health effects have yet been discovered by the FDA or the European Union Agency.
As a radiologist, the specialty that interprets these MRI images, I have diagnosed infections, cancers, strokes, bleeding, and many other things with the use of contrast enhanced MRI when all other imaging was normal. We once had a patient that had a CT scan of the head without contrast come through the emergency room department that did not show any abnormalities. So, an MRI was ordered with contrast. The MRI showed a tiny abnormal area at the top of the brain that was “enhancing”, or lighting up with the contrast agent. This could have been many things including infection, an entity called a vascular malformation, or a tumor. A follow up MRI scan two months later showed that the lesion ended up tripling in size which was very suspicious. After biopsy, the diagnosis came back as a glioblastoma multiforme, a devastating brain cancer. If it wasn’t for the MRI contrast agent that highlighted the tumor, this likely would not have been discovered.
As a physician, it is very much appreciated that Gena and Chuck Norris do not blame the doctors that cared for her. The truth is physicians use their numerous years of training and best judgement to do what they can for their patients. Every single medical procedure and treatment performed has the potential to cause unfavorable effects. In addition, most patients that come to the hospital or need procedures and imaging may already have an illness and may not return to 100% health ever again. Healthcare providers have to use a “risk-benefit” ratio to decide what possible dangers must be taken to help the patient. For example, if a patient has symptoms and laboratory abnormalities from bile duct stones, a special procedure - an endoscopic retrograde cholangiopancreatography (ERCP), is needed to remove the stones. Unfortunately, the ERCP comes at the risk of pancreatitis, infection of the pancreas that can be very destructive to the body. Even something appearing so simple as a blood draw for diagnostic tests can also lead to adverse reactions such as a terrible infection. The physicians taking care of Mrs. Norris, in order to help her, used their best clinical decision for her health.
MRI with contrast has proven to be useful with often life-saving advantages. But patients should always keep in mind that with every single medical procedure, there are risks and these must always be weighed with the possible benefits of receiving the procedure. And although it has been proven that very few patients have reactions to gadolinium media, it is still devastating to be one of those few patients.
So, if you happen to be a patient that has had an MRI with contrast or is scheduled for one: do not hesitate to ever ask your doctor questions. Together, you and your health care team should always work together to decide the best course of action for your wellness.
Originally from Orange County, California, Karen Tran-Harding is a radiology resident physician that found love, education, life lessons, and two corgis in the heart of the bluegrass. She has interest in medical media and education. She is a regular contributor to StantonMD and Everyday Medicine.