Is MRI Contrast Agent Worth Risk

alywest

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Good luck, @x-ray peat I hope you find a competent provider. And thanks for starting this thread. I actually never had any clue this was an issue in the past. I think it speaks to not only MRIs but in general the way we need to be so vigilant about what we allow medical professionals to do to us, even if they have the best of intentions. I'm sure 90% of people who get the contrast report no issues, and even if someone has issues after the fact it's probably not reported to the professionals who performed the service of MRI. They are obviously just trying to do their jobs, but it's another symptom of the way health is treated in our society--they want to look at one aspect of the picture but not the whole.

@Ras thank you for your honesty. It's refreshing to be given the straight up truth by a medical professional instead of only hearing the bits and pieces that they usually want us to hear because they either a) think we're too stupid to understand, or b) don't want us to know that there are risks and think if we don't know them we'll hopefully just go along, get the service needed, and get all better. It's similar to the way I have to sneak a syringe full of antibiotics into my kid's mouth when he's sick. He doesn't want to take it so I have to squeeze it into his mouth when he's not paying attention and hope he swallows. I feel so guilty doing it but then I feel justified because it's the "best thing for him." Or is it? Am I totally positive that antibiotics are good for him? I go along with it out of fear, as most patients and their parents do.

I also have a mouthful of mercury because the dentist "knows best" and I have to wonder if that is the root of a lot of my health issues (along with the crap they put in the food supply.) Just shut up and swallow.
 

Ras

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Good luck, @x-ray peat I hope you find a competent provider. And thanks for starting this thread. I actually never had any clue this was an issue in the past. I think it speaks to not only MRIs but in general the way we need to be so vigilant about what we allow medical professionals to do to us, even if they have the best of intentions. I'm sure 90% of people who get the contrast report no issues, and even if someone has issues after the fact it's probably not reported to the professionals who performed the service of MRI. They are obviously just trying to do their jobs, but it's another symptom of the way health is treated in our society--they want to look at one aspect of the picture but not the whole.

@Ras thank you for your honesty. It's refreshing to be given the straight up truth by a medical professional instead of only hearing the bits and pieces that they usually want us to hear because they either a) think we're too stupid to understand, or b) don't want us to know that there are risks and think if we don't know them we'll hopefully just go along, get the service needed, and get all better. It's similar to the way I have to sneak a syringe full of antibiotics into my kid's mouth when he's sick. He doesn't want to take it so I have to squeeze it into his mouth when he's not paying attention and hope he swallows. I feel so guilty doing it but then I feel justified because it's the "best thing for him." Or is it? Am I totally positive that antibiotics are good for him? I go along with it out of fear, as most patients and their parents do.

I also have a mouthful of mercury because the dentist "knows best" and I have to wonder if that is the root of a lot of my health issues (along with the crap they put in the food supply.) Just shut up and swallow.
You're welcome.
 
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MRI tech here.

I don't know what machine they used to acquire those images, but as someone that does MRIs of the abdomen every weekday, I think the quality of those images is very poor, insomuch that I suspect our Rads would refuse to read them.

I use a 3T Philips, and our non-cons look excellent. We acquire a variety of sequences with various weightings that give the Rads a lot to read, even without Gad. We use Gadavist almost exclusively, which, being macro-cyclic, is reputed to be safer if retained; we use Multihance in renal-compromised patients, as it will provide the same T1-relaxation at half the dose of gadolinium. Howbeit, gadolinium-based contrast of any brand has been found to be retained (Magnevist being especially bad), and they all will cause Nephrogenic Systemic Fibrosis and God knows what else when the gadolinium dissociates, so that's why I refuse to have an MRI with contrast of any kind for any reason, especially not for a renal cyst - even an amateur tech can identify a renal cyst and any associated pathology without contrast.

Hello,
Radiologist here. The reason for the gadolinium in your case is to determine if your kidney lesion is vascular (enhancing). It sounds like it is not a simple cyst, because simple cysts are hyperintense on T2. It could be a complex cyst (no vascular component, not enhancing), meaning that there is more than just water inside (blood, protein), or it could be a tumor (solid tissue with vascularity). An MRI picture with gadolinium can be digitally "subtracted" from the picture without gadolinium, in order to tell if the whole lesion or any part of the lesion is vascular. If there is no enhancing component, you can rest assured that it is not cancer.

That said, you are correct that there is concern over residual gadolinium in the body. The gadolinium contrast agents that leave the least amount of gadolinium behind are Dotarem, Gadavist, and Prohance, and I would certainly tell you to request one of those. Since the lesion is so small, you could track its size with non-gadolinium MRIs to see if it grows over time. How long has it been since the lesion was initially found? Another alternative is ultrasound, but that depends on where the lesion is (how deep from the skin) in terms of how well it can be characterized (complex cyst vs tumor) that way. Ultrasound can also be used to track the size of the lesion over time, instead of the more expensive MRI. CT can also tell if it is vascular or not, but that involves iodinated contrast and radiation.

Finally, there is one kind of kidney tumor that has fat in it and that is usually a benign tumor. If they detect fat in the tumor by MRI (gadolinium is not needed for this), they do not need to give you gadolinium. You could ask the techs to have the radiologist check the images for fat in the tumor after the first part of the study, to see if you need the gadolinium or not. Good luck to you and let us know how it goes.

Precious information! Thanks!
 

DrJ

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What machine produces the best images is a matter of subjective opinion.

I really enjoyed reading your comments. It's funny you say this b/c I worked in a lab whose main function was to do extremely rigorous assessment of image quality. Specifically meaning that there would be a task (like detect a lesion, or estimate a tumor volume, or estimate heart ejection fraction), and then a machine would be used to perform the scans required for the task, and then the image data would be given to observers - sometimes humans, sometimes computer programs, sometimes both. It would then be determined what the true-positive and false-positive fraction of detection was (in the case of finding a tumor or lesion) or what the mean-squared error in the estimate was (if doing e.g. volume estimation). This would allow you to plot a curve saying how often the task was performed accurately. Both machine/scanner and observer (radiologist/computer) are part of the process. Machine/observer combos that had the highest true positive fraction and lowest false positive fraction would be "best".

In the grand scheme of things, the studies were relatively cheap to run as they were mostly conducted by cheap but ostensibly skilled grad student labor. It might cost less than $100k to run a full-blown study that would determine which machine was best for what type of task. Of course, there are many many imaging tasks, but if you knew for $100k what machine was best for what type of study, you could probably save several orders of magnitude more in medical costs by achieving correct diagnosis on that one task. Rinse, repeat for other tasks. $100k is a drop in the bucket to medical costs. Won't even buy you a tenth of a premium CT scanner. Probably not even a radiography system.

The manufacturers hated, Hated, HATED these studies because they could essentially disqualify their systems outright, so they made sure that they were never used for policy, although the NIH still funds such studies and has a whole department devoted to that discipline. They are toothless. It's messed up. In CT, which is my field, there is a huge conference every year called RSNA which I sometimes attend, and the big CT/MRI manufacturers create fancy temporary booths that cost around a million dollars, and just smoooze up the radiologists to get them to buy their systems. Take them out to nice dinners, send their wives/husbands on nice day junkets. The systems are marketed on bells and whistles - fancy lights, nice computer interfaces, cute girls talking to you, etc. - not on image quality. It's basically a corrupt system, but my experience is that a lot of things operate this way. Depressing.
 

DrJ

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Oh, to just add to the irony of the "image quality" situation, for several years I worked at a company that made CT scanners for airport security. The CT scanners are used at almost all decently sized airports to screen for bombs of any luggage you check to the airplane baggage hold. In this case, it was quite rigorous. The TSA would actively test the systems by placing real explosives in luggage and testing the true-positive and false-positive rates of finding the explosives, and they would fail systems - meaning they could not be purchased for airport security. A similar testing regime is quite possible for medical scanners, but is not done. The expense involved in this (testing of the security CT scanners) was quite huge. For every system model we sold, we had to give one to the TSA, which they kept at their facility and tested periodically. They would also continually raise the pass/fail rate to achieve continuous improvement in efficacy, so fielded systems could eventually be disqualified if they didn't "keep up" with the standards. The cost was enormous: over a million dollars per scanner housed at the TSA lab, plus staffing costs, plus our costs to maintain the systems at the TSA site and have scientists and engineers on site for new testing regimes. Millions and millions of dollars per year. But of course everyone considers it worth it for keeping airplanes safe, and millions is not a lot in this scenario. It seems quite reasonable to do it for medical scanners, but they only do (in my opinion) basic tests for radiation dose and simple signal/noise ratio tests and uniformity tests. They also have crazy paperwork and regulatory requirements, but that doesn't always have much to do with image quality.
 

Ras

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It seems quite reasonable to do it for medical scanners, but they only do (in my opinion) basic tests for radiation dose and simple signal/noise ratio tests and uniformity tests. They also have crazy paperwork and regulatory requirements, but that doesn't always have much to do with image quality.
I enjoyed reading your comments here and above.

I work in CT also, and my experiences have taught me that "the time" comes around when your facility must bring in their chosen physicist to perform a few hours of tests to ensure that the machine passes ACR guidelines, which are essentially meant to ensure an acceptable signal-to-noise ratio while keeping dose as low as reasonably achievable. And, no sooner does he return the ACR's PASS designation and sticker for the scanner than does the lead technologist begin altering sequence parameters to suit the few pissy Radiologists that are disgruntled your facility's lowest bidder was Toshiba/Canon (Iterative reconstruction) instead of the Siemens (Filtered Beck-Projection reconstruction) whose images he was used to reading. And, as you suggested in your other comment, the scanner was sold on a bunch of Photoshopped promises and steak dinners to bloated, balding men in suits and $300 loafers.
 
OP
x-ray peat

x-ray peat

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Just wanted to update the thread. I finally had my ultra sound to see what was going on in my kidney and thank God it was only a benign cyst. I am very thankful to those contributing to the thread, who convinced me to avoid the contrast agent. I cant really explain why they wanted to do an MRI to begin with and not a cheap and simple ultra sound but there is a lot about modern medicine that I don't pretend to understand.
 

alywest

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Just wanted to update the thread. I finally had my ultra sound to see what was going on in my kidney and thank God it was only a benign cyst. I am very thankful to those contributing to the thread, who convinced me to avoid the contrast agent. I cant really explain why they wanted to do an MRI to begin with and not a cheap and simple ultra sound but there is a lot about modern medicine that I don't pretend to understand.

Yay! That's great news! Must be a relief.
 
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Just wanted to update the thread. I finally had my ultra sound to see what was going on in my kidney and thank God it was only a benign cyst. I am very thankful to those contributing to the thread, who convinced me to avoid the contrast agent. I cant really explain why they wanted to do an MRI to begin with and not a cheap and simple ultra sound but there is a lot about modern medicine that I don't pretend to understand.
Wait, so ultrasound CAN distinguish benign?
 
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x-ray peat

x-ray peat

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Yay! That's great news! Must be a relief.
I know, thanks :)
Wait, so ultrasound CAN distinguish benign?
Maybe not all of them but in my case it was very clear it was benign. It was basically a solid black spot that indicates only water and no other cellular material.

I think they were trying to make some extra cash by using the MRI first and skipping the cheap ultrasound. Potentially poisoning the patient with contrast, which would then need to be treated later is known as cross-selling.
 
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I know, thanks :)

Maybe not all of them but in my case it was very clear it was benign. It was basically a solid black spot that indicates only water and no other cellular material.

I think they were trying to make some extra cash by using the MRI first and skipping the cheap ultrasound. Potentially poisoning the patient with contrast, which would then need to be treated later is known as cross-selling.
Ah thank goodness!
 

freyasam

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@Ras @Fiver

I have an MRI with contrast scheduled for this Saturday. It's abdominal / pelvic, to check for neuroendocrine tumors in the GI tract, adrenals, liver, and probably other organs. I have symptoms and elevated markers for carcinoid tumors and pheochromocytoma. So pretty serious life-threatening things.

I've called all the doctors and the radiology lab involved. Everyone insists that contrast is necessary to find these tumors, and they refuse to do it without contrast. My request for an ultrasound was denied; they say the images wouldn't be good enough to find these types of tumors.

So -- risk gadolinium poisoning or neuroendrocrine cancer? I'm beside myself with worry over what to do about this. Any thoughts, please?
 

Ras

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In the case of some pathologies, contrast is "necessary." It is necessary in the sense that the radiologists don't want to decipher the signs of carcinoma from the associated expressions of its presence (i.e., it's harder for them to read without it). And, myself not being a radiologist, I admit that it's possible there are cases that truly do require contrast, or the scan is worthless (so I've been told).

When we scan areas that are affected by peristalsis, we have nurses administer glucagon. However, I find that it makes very little improvement. I fail to see how your facility's radiologists will see anything meaningful in your GI tract on an MRI. The pancreas and adrenals are included in every liver scan I do, however, I am forced to change the slice thickness for many patients in order to keep the breath-hold times reasonable; this is bad for the adrenals, because they tend to be very small, and the pancreas, which is already difficult to image. The last place in which I worked did mostly free-breathing sequences, which take considerably longer if the machine sucks, or you suck at breathing consistently, and I think the image quality is worse than breath-hold sequences. And depending upon their lie in your abdomen, the kidneys might be incompletely captured without increasing slice thickness or lengthening the scan time. If the scanner will be a 1.5T, the image quality will suck no matter what.

Based upon what you wrote, other imaging could be more diagnostic, like a PET scan, or at least a CT with contrast (howbeit that's nephrotoxic and contraindicated in patients with pheochromocytoma). I hate ionizing radiation (then why did I choose this field?) and the administration of pharmaceuticals, but it sounds like you're intent on treating this. If your scans are positive and you're going ahead with treatment, you'll likely be coerced into chemotherapy of some kind, so what does it matter if you get gadolinium? If I discovered I had a mortal disease (besides life), I'd rejoice and prepare to be with Christ, which is far better.
 

JustAGuy

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I ended up with permanent sensitivity in one spot in my arm after being injected with mri contrast. The operator missed the artery and my arm ballooneed up where the needle was injected, it was like a golfball sitting in my arm. When she noticed she pulled it out, started panically squeezing all the liquid out of my arm, so there is that risk aswell.
 

JustAGuy

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@Ras @Fiver

I have an MRI with contrast scheduled for this Saturday. It's abdominal / pelvic, to check for neuroendocrine tumors in the GI tract, adrenals, liver, and probably other organs. I have symptoms and elevated markers for carcinoid tumors and pheochromocytoma. So pretty serious life-threatening things.

I've called all the doctors and the radiology lab involved. Everyone insists that contrast is necessary to find these tumors, and they refuse to do it without contrast. My request for an ultrasound was denied; they say the images wouldn't be good enough to find these types of tumors.

So -- risk gadolinium poisoning or neuroendrocrine cancer? I'm beside myself with worry over what to do about this. Any thoughts, please?
Wondering if you ate certain forbidden foods before the blood/urine test? I actually had a similar result which ended up being a false positive. I suspect it was due to eating a banana before the lab test which skews the results.
 

freyasam

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In the case of some pathologies, contrast is "necessary." It is necessary in the sense that the radiologists don't want to decipher the signs of carcinoma from the associated expressions of its presence (i.e., it's harder for them to read without it). And, myself not being a radiologist, I admit that it's possible there are cases that truly do require contrast, or the scan is worthless (so I've been told).

When we scan areas that are affected by peristalsis, we have nurses administer glucagon. However, I find that it makes very little improvement. I fail to see how your facility's radiologists will see anything meaningful in your GI tract on an MRI. The pancreas and adrenals are included in every liver scan I do, however, I am forced to change the slice thickness for many patients in order to keep the breath-hold times reasonable; this is bad for the adrenals, because they tend to be very small, and the pancreas, which is already difficult to image. The last place in which I worked did mostly free-breathing sequences, which take considerably longer if the machine sucks, or you suck at breathing consistently, and I think the image quality is worse than breath-hold sequences. And depending upon their lie in your abdomen, the kidneys might be incompletely captured without increasing slice thickness or lengthening the scan time. If the scanner will be a 1.5T, the image quality will suck no matter what.

Based upon what you wrote, other imaging could be more diagnostic, like a PET scan, or at least a CT with contrast (howbeit that's nephrotoxic and contraindicated in patients with pheochromocytoma). I hate ionizing radiation (then why did I choose this field?) and the administration of pharmaceuticals, but it sounds like you're intent on treating this. If your scans are positive and you're going ahead with treatment, you'll likely be coerced into chemotherapy of some kind, so what does it matter if you get gadolinium? If I discovered I had a mortal disease (besides life), I'd rejoice and prepare to be with Christ, which is far better.

Yes, they wanted to do a CT scan with iodine. However I've had such a severe reaction to oral iodine that still affects me 5 years later, that I refused the CT scan with iodine contrast, so they went with an MRI.

You're saying that they won't find anything in the GI tract and that it might be hard to get good images in pancreas and adrenals either?

I am going through an endo/colonoscopy so maybe they'd find something that way too.

I've followed Peat's stuff for 5 years, consulted with him and Peat-inspired practitioners, and my body just doesn't seem to respond to it. I'm not saying I'd necessarily go through with surgery (the recommended treatment for carcinoid or pheo) but cyproheptadine, etc just isn't enough for me. I'm 38 and not at the place where I'd rejoice at the prospect of dying.
 

Ras

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You're saying that they won't find anything in the GI tract and that it might be hard to get good images in pancreas and adrenals either?
Unless you have significant (in size, severity, and/or distribution) pathology in your GI tract and glucagon halts your peristalsis very well, I fail to see how it and your other organs will be successfully imaged with MRI. We rarely do enterography, and the rectum must be imaged in a unique way.

I image common livers using 7 mm slices with a 1 mm gap in the coronal and axial planes (enhanced sequences 5 mm at -2.5 mm). The pancreas and adrenals I scan using 4 mm slices with a 0.5 mm gap (enhanced: 4 mm at -2 mm). Enterography sequences use parameters similar to the liver.
 

puella

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Really sad story & video showing a small glimpse of what MRI contrast can do:
Sandra Wagner Titus

I received 4 injections of the supposed "safer" macrocyclic MRI contrasts (aka GBCA). Had the scans due to a large brain tumor & my quality of life is so bad, even 9 months after last injection (2 years post op), I think it would have been better to let the tumor take its course.

It feels like being trapped in a Black Mirror episode where someone created a drug that gets the body to torture itself in 25 different ways, in no predictable combinations, in ever changing severity, without any viable antidote. On good days it feels like my life is on a short leash. On bad days it' feels like an execution gone wrong resulting in a long, drawn out, painful death. This stuff is so weird & wicked that, in a very untypical fashion, I do not feel it's safe to tinker & experiment with self treatment.

This effects everyone too since free gadolinium is rarely found bouncing about in nature. The literal down stream effects are often overlooked: aquatic life, drinking water, donated organs from people having retained gadolinium...which they are learning is almost everyone who has received a GBCA. It breaks my heart to pieces to think of an animal, child, or someone clinging to hope waiting on an organ being exposed to this nightmare.
People with kidney problems can get a "disease" that only happens if they have received been exposed to gadolinium. There have been kidney patients who have received only ONE injection & developed Nephrogenic Systemic Fibrosis (which is the most fatal manifestation of gadolinium toxicity) 6-10 years after injection.

Dr. Brent Wagner ( @wagner_nephro) is the best & least corrupted source I have found on this topic to date. See his presentation to the FDA
gadoliniumtoxicity.com is great source as well. Pretty amazing that they are doing patient led studies over there.

One of the other leading voices on this topic, who is supposedly trying to help people damaged by GBCAs, turns out to be on the take. After a very jarring interaction with him I looked him up on openpayments. ...In hindsight, it seems clear to me that his job is fire containment for the drug makers. Feigning to give & sell hope to a very desperate & stranded group of people in order to quiet down the uproar..at least that's what it looks like to me. Buyer beware.

I've been compiling a financial conflict of interest list if anyone is interested.
Short story: The gadolinium narrative is being dominated by the drug companies & PLEASE warn people it's not worth it
 

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