An aid in documenting past exposure to gadolinium-containing chelates
Clinical Information Discusses physiology, pathophysiology, and general clinical aspects, as they relate to a laboratory test
Gadolinium is a member of the lanthanide series of the periodic table of elements and is considered a nonessential element. Due to its paramagnetic properties, chelated gadolinium is commonly employed as contrast media for magnetic resonance imaging and computer tomography scanning.
Gadolinium is eliminated primarily by the renal filtration. In healthy subjects with normal renal function, the plasma half-life of gadolinium is approximately 90 minutes. Patients with reduced renal function exhibit an increased gadolinium excretion half-life.
Gadolinium has been associated with the nephrogenic systemic fibrosis in patients with impaired renal function. In this syndrome, prolonged retention of gadolinium is thought to allow the gadolinium cation to dissociate from its synthetic organic chelator and deposit predominantly in the skin, although other organs may be affected as well. These patients are often severely debilitated by progressive skin thickening and tightening. Fibrosis of skeletal muscle, lungs, liver, testes, and myocardium have also been observed, often with fatal results. Because the ionic radius of gadolinium (3+) is similar to that of calcium (2+), it may also deposit in bone.
Three hemodialysis treatments are required to substantially remove gadolinium from patients with impaired renal function; peritoneal dialysis is not effective.
Reference Values Describes reference intervals and additional information for interpretation of test results. May include intervals based on age and sex when appropriate. Intervals are Mayo-derived, unless otherwise designated. If an interpretive report is provided, the reference value field will state this.
Elevated gadolinium (>3 ng/mL) observed in serum specimens draw >96 hours after administration of gadolinium-containing contrast media is not typical of most patients with normal renal function, indicating impaired elimination of gadolinium or exposure to anthropogenic sources. Patients with reduced renal function who have been exposed to gadolinium may have an increased risk to develop nephrogenic systemic fibrosis.
A normal value is <0.5 ng/mL; the lower limit of the assay's reportable range is 0.1 ng/mL.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
Serum gadolinium concentration may be elevated if the specimen is drawn <96 hours of administration of gadolinium-containing contrast media. This elevation is due to residual gadolinium present from contrast media infusion. Elevated serum gadolinium in a specimen drawn <96 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.
An evaluation of serum gadolinium concentration in healthy human subjects with no exposure to gadolinium chelates within 96 hours of serum collection generated a reference range of <0.1 to 0.5 ng/mL (median value 0.2 ng/mL) with no evidence of age or gender trend. A small number of patients studied at Mayo Clinic have demonstrated measureable (0.6-2.1 ng/mL) gadolinium in serum collected 30 days after gadolinium infusion, so some delay in total elimination is possible. Serum gadolinium concentrations observed in Mayo Clinic patients with nephrogenic systemic fibrosis were in the range of 2 to 5 ng/mL. 95% of unexposed patients have values <0.1 ng/mL more than 96 hours after infusion. The lower limit of detection is 0.1 ng/mL.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Othersen JB, Maize JC, Woolson RF, Budisavljevic MN: Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;22:3179-3185
2. Perazella MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J Am Soc Nephrol 2007;2:200-202
3. Leung N, Pittelkow M, Lee CU, et al: Chelation of gadolinium with deferoxamine in a patient with nephrogenic systemic fibrosis. NDT Plus 2009;2:309-311
4. Christensen KN, Lee CU, Hanley MM, et al: Quantification of gadolinium in fresh skin and serum samples from patients with nephrogenic systemic fibrosis. J Am Acad Dermat 2011;64(1):91-96
5. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol 2011;65:1095-1106
6. Telgmann L, Sperling M, Karst U: Determination of gadolinium-based MRI contrast agents in biological and environmental samples: A review. Analytica Chimica Acta 2013;764:1-16