Gadolinium, Dermal, Tissue
Evaluation of dermal tissue for gadolinium
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 (MRI) and computer tomography (CT) 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 increased gadolinium excretion half-life.
Patient with reduced renal function exposed to gadolinium chelates used as MRI or CT contrast media may be affected by nephrogenic systemic fibrosis (NSF). 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.
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 (>0.5 mcg/g) observed in affected dermal tissue specimens collected more than 48 hours after administration of gadolinium-containing contrast media indicates gadolinium deposition. These patients may have increased risk of nephrogenic systemic fibrosis (NSF).
In individuals with NSF, affected tissues are likely to contain gadolinium at concentrations in the range of 4 to 186 mcg/g. Unaffected tissues from gadolinium-exposed subjects exhibit gadolinium concentration of 0.6 to 28 mcg/g.
A reportable gadolinium concentration in tissue suggests recent administration of gadolinium-containing contrast media. Patients with increased gadolinium in affected dermal tissue have an increased risk to develop NSF.
Cautions Discusses conditions that may cause diagnostic confusion, including improper specimen collection and handling, inappropriate test selection, and interfering substances
This test is useful for evaluation of dermal tissue. No other tissue types have been validated. The reference range applies only to dermal tissue.
Tissue gadolinium concentration will be elevated if the specimen is collected <48 hours of administration of gadolinium-containing contrast media. This elevation is due to residual gadolinium present from contrast media infusion. Elevated gadolinium in a specimen collected <48 hours after contrast media infusion does not indicate risk of nephrogenic systemic fibrosis.
Dermal tissue gadolinium concentrations observed in Mayo Clinic patients with nephrogenic systemic fibrosis (NSF) were in the range of 6 to 186 mcg/g. Non-Mayo Clinic studies observed gadolinium concentrations in NSF patient biopsies from involved sites ranging from 4.8 to 106.2 mcg/g.
Clinical Reference Provides recommendations for further in-depth reading of a clinical nature
1. Otherson JB, Maize JC, Woolson RF, Budisavljevic MN: Nephrogenic systemic fibrosis after exposure to gadolinium in patients with renal failure. Nephrol Dial Transplant 2007;10:1093-1100
2. Perazella MA: Nephrogenic systemic fibrosis, kidney disease, and gadolinium: is there a link? Clin J AM Soc Nephrol 2007;2:200-202
3. Saitoh T, Hayasaka K, Tanaka Y, et al: Dialyzability of gadodiamide in hemodialysis patients. Radiat Med 2006;24:445-451
4. High WA, Ayers RA, Cowper SE: Gadolinium is quantifiable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007;56:710-712
5. High WA, Ayers RA, Chandler J, et al: Gadolinium is detectable within the tissue of patients with nephrogenic systemic fibrosis. J Am Acad Dermatol 2007;56:21-26
6. 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
7. Girardi M, Kay J, Elston DM, et al: Nephrogenic systemic fibrosis: Clinicopathological definition and workup recommendations. J Am Acad Dermatol 2011;65:1095-1106