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Debate on the Safety of MRI: With Contrast or Without?

If you have never heard of this before, you may think that the problem is made up. Trust me, I had the same feeling at first. After all, we all know that Magnetic Resonance Imaging (MRI) is a relatively safe procedure that does not involve radiation. And yet, everything seems fine when it comes to examining things on an MRI.

Let me make it clear: the problem is not with the MRI itself but with the contrast agent that is often used during this procedure. Like in many other cases, the elimination of this contrast agent from the body does not always go smoothly. And how well the body can eliminate it is highly individual.

The contrast agent used in MRI is a heavy metal. Those who know what chelation is and in which cases it is performed will immediately understand the potential problems we are talking about.

What is MRI used for?

MRI is used to obtain detailed and comprehensive images of internal body structures. It is used in medical diagnostics for the following purposes:

  • Detection and evaluation of pathological changes: MRI allows visualization of various body structures, including the brain, spinal cord, joints, organs of the thoracic and abdominal cavities, heart, and other organs. This helps detect and evaluate various diseases, tumors, infections, inflammations, injuries, and other pathologies.
  • Diagnosis and disease monitoring: MRI can be used to confirm or exclude diagnoses, assess the extent of disease development, monitor treatment effectiveness, and track its progress. It can aid in the diagnosis of conditions such as cancer, stroke, multiple sclerosis, head and spinal cord injuries, cardiovascular diseases, arthritis, and many others.
  • Treatment planning and surgical interventions: MRI can provide additional information about the structure and location of tumours or other changes, aiding in the planning of surgical interventions.
  • Research purposes: MRI is also widely used in scientific research to study the functional activity of the brain, the structural anatomy of organs, and various physiological processes in the body.

Please note that this is a general overview of the uses of MRI and not an exhaustive list. The specific reasons for conducting an MRI scan can vary depending on the individual patient and their medical condition.

When is contrast necessary?

Contrast material is not always used. For example, it is not needed to check for internal bleeding because blood itself is a contrast agent. However, contrast material is often necessary for:

  • Enhancing the visualization of specific structures.
  • Detecting pathological changes.
  • Refining diagnosis and treatment planning.
  • Evaluating the response to treatment.

What is gadolinium?

Gadolinium is a substance used as a contrast agent for MRI. Gadolinium has the property of altering the magnetic properties of the surrounding tissues, which improves the visualization of specific structures and processes in the body on MRI images.

It has always been known that gadolinium has side effects, but it used to be considered rare. After an MRI procedure, the kidneys should eliminate gadolinium from the body relatively quickly. However, in some cases, MRI can cause a serious complication known as nephrogenic systemic fibrosis, especially in patients with impaired kidney function.

In recent years, information has emerged that these are not the only possible problems associated with the use of contrast agents.

Chuck Norris files a lawsuit against contrast agents manufacturers

In 2017, Chuck Norris’ wife underwent three MRIs within a week, after which she experienced serious health problems. As a result, Chuck Norris filed a lawsuit against the manufacturers of contrast agents based on gadolinium. He claimed that his wife had suffered significant harm specifically due to the use of MRI with contrast agents. The lawsuit stated that her treatment cost him 2 million US dollars, and he demanded compensation of 10 million dollars.

The lawsuit listed the symptoms his wife experienced after undergoing MRI: intense pain throughout the body, severe tremors, numbness, tingling, weakness, cognitive impairments, kidney damage, and difficulty breathing.

Since Chuck Norris is a highly renowned individual with many fans, the news spread quickly. It became evident that the symptoms observed in his wife aligned with those shared by people on social media after undergoing an MRI procedure.

Controversies regarding the toxicity of gadolinium contrast in MRI

Doubts about the rapid elimination of gadolinium contrast material from the body when the kidneys are functioning normally have been growing in recent years. It started with a study in 2014 that showed gadolinium could deposit in the brain but was limited to pathological brain tissues. Then, information began to emerge that gadolinium could also remain in other tissues such as the skin, bones, and muscle tissues.

Nowadays, there are more frequent complaints from patients who started experiencing problems specifically after an MRI procedure. I can even speculate why this is happening more frequently now: because in the past, people simply didn’t consider that their symptoms could be related to MRI. However, once the information started to spread, many began to question whether their symptoms could be linked to the MRI they underwent before encountering these problems.

A survey conducted in 2022 on awareness of gadolinium toxicity among non-radiologists in Saudi Arabia showed that 74.6% of the participants had poor awareness, 20.9% had moderate awareness, and only 4.6% understood the side effects.

Symptoms of chronic gadolinium intoxication

In approximate order of frequency, as stated in our review of chronic effects of retained gadolinium in contrast-enhanced MRI:

  • Pain – dull, burning, tingling, and/or stabbing pain (paresthesia); deep bone pain. Typically in the limbs or joints, and sometimes in the site of the MRI procedure, such as the head.
  • Skin changes – for example, tightened skin, lesions, hyperpigmentation. Most commonly in the limbs.
  • Muscle issues – twitching – small, localized, rapid contractions, and weakness.
  • Eye problems – deteriorating vision, dry eyes, redness.
  • Cognitive symptoms.
  • Ear, nose, and throat – ringing in the ears, swallowing and voice problems.
  • Low body temperature.
  • Hair loss.
  • Skin itching.
  • Balance problems.
  • Limb swelling.

There is one symptom experienced by many, which is a sensation of being electrified, vibrating, or twitching, usually just under the skin. Sometimes it is localized, while other times it has a more generalized feeling. People may even feel like something is crawling under their skin. As you can imagine, such a symptom can lead to the patient being misdiagnosed with mental issues.

Is there an alternative to gadolinium?

On one hand, there are alternatives, but they are not extensively studied, so gadolinium is still widely used. On the other hand, if these alternatives are not sufficiently researched, it would not be surprising if these substances turn out to be less benign than they appear now once they become widely used.

What do regulatory bodies and specialists think about the toxicity of gadolinium?

After the scandal involving Chuck Norris’s wife, the FDA required manufacturers to add warning information about possible side effects to the packaging of contrast agents. However, in July 2017, the European Medicines Agency (EMA) issued a final conclusion recommending the restriction of the use of certain gadolinium-based contrast agents (GBCAs) and the suspension of registration certificates for others due to concerns about gadolinium deposition.

Radiologists are also concerned about this situation. They agree that gadolinium can be found years after an MRI, and not only in pathological tissues. However, there is currently insufficient information about the level of danger posed by this agent for patients with normal kidney function.

Furthermore, specialists are seriously concerned that the raised concerns may lead many people to consider avoiding the procedure when it is actually essential.

What can be done about gadolinium intoxication?

Now I will discuss what we have long known about toxins. If gadolinium is just another heavy metal that needs to be added to the list of metals we already eliminate from the body, then the situation becomes clearer.

The elimination of toxins by the body depends on kidney and liver function, as well as the overall toxin burden. If the body’s detoxification capacity is already overwhelmed, gadolinium, like other toxic substances, will simply increase the level of toxicity. The more toxic the body becomes, the less toxins it can eliminate. This is where chelation comes to our aid.

The results of gadolinium toxicity studies will heavily depend on the participants involved. Should those who already know they have an intoxication problem wait for these results? Probably not. Should you refuse an MRI procedure because it may increase the level of toxicity? If you have a neoplasm that needs to be investigated, the risk of missing a problem is far more dangerous than the risk of intoxication. Moreover, toxins can be eliminated afterwards.

Simply put, MRI should not be performed when it can be avoided. Remember, the effects of intoxication are cumulative. Take note: Chuck Norris’s wife experienced problems after undergoing three MRIs in one week! I had never heard of MRI being performed so frequently before this case.

Is there a natural way to detoxify from gadolinium?

Gadolinium is eliminated from the body very slowly unless it is excreted immediately after the procedure. One of the therapies that can help accelerate its excretion is chelation. We now know that the chelator EDTA binds gadolinium better than other chelators. However, since chelation removes not only toxins but also essential minerals from the body, the procedure should be performed in combination with other therapies.

Our goal is always to eliminate a critical mass of toxins from the body, after which it can eliminate the remaining toxins on its own. In other words, restoring the body’s natural detoxification function.

To determine the level of gadolinium intoxication, testing for its presence can be conducted. This service, as well as the chelation procedure itself, is available at our clinic.