Now a new study, published online on March 12, 2019, in the journal Radiology (and appearing in print in the April issue), suggests that MRIs performed without the use of the contrast agent are just as effective at monitoring MS progression as those in which gadolinium is used. So-called noncontrast scans take less time to perform, cost less, and reduce the possible effects of long-term exposure to the heavy metal–based material. Recent research, published in May 2017 in the journal Advances in Chronic Kidney Disease, suggested that gadolinium remains in the body for some time following administration and may lead to health complications. People with relapsing forms of MS are generally advised to have a brain MRI every six months to two years, according to an expert task force sponsored by the Consortium of MS Centers.
Questions About the Safety of Gadolinium Spur Study
“There is already an active debate about whether contrast agent is truly necessary in routine follow-up imaging for MS patients,” notes study coauthor Benedikt Wiestler, MD, of the Technische Universität München Neuroimaging Center in Munich, Germany, citing the revised guidelines from the Consortium of MS Centers published in 2018. “In our large MS clinic, we already in 2017 decided to omit contrast agent in these scans, and the results of our analysis strongly reassured us in doing so. We expect our findings to encourage other centers to review the routine use of contrast agent also,” says Dr. Wiestler. Although the U.S. Food and Drug Administration (FDA) announced in December 2017 that its investigations to date haven’t identified specific harmful effects associated with gadolinium, its assessments remain ongoing. In 2015, in response to an FDA announcement that it intended to evaluate potential risks associated with gadolinium, the National MS Society advised people with MS and their care partners to talk to health care providers if they have questions about its use with MRIs.
New MRI Technology Makes Better Noncontrast MRIs Possible
Of course, recent advances in noncontrast MRI technology, including 3T systems, have made gadolinium-free scans a more viable option in general. To assess their utility in people with MS, Wiestler and colleagues assessed new or enlarged lesions in 359 people with MS using both contrast and noncontrast MRI. In 507 follow-up scans, 264 showed some progression of MS, and there were a total of 1,992 new or enlarged lesions. Notably, though, these findings didn’t differ significantly between the contrast-enhanced and nonenhanced MRI images. In all, noncontrast MRI missed only 4 of the 1,992 lesions and identified all cases of MS progression, according to Wiestler. “Our results are based on the use of 3D sequences from a 3T MRI machine in conjunction with longitudinal subtraction maps,” he explains. “When these requirements are met, omitting contrast agent does not decrease sensitivity for detecting new lesions.” RELATED: A View Into the MS Brain: What New Imaging Techniques Reveal
Technology for Good Noncontrast Imaging Is Commercially Available
The technology he cites was initially developed and tested at the Technische Universität München Neuroimaging Center, and it combines 3-D MRI and techniques that effectively cancel out unchanged areas in follow-up images to significantly improve visualization of new or enlarged white matter lesions. Wiestler says several MRI manufacturers have already made the technology commercially available — meaning: Its use has already started and is growing. “Patients should discuss this possibility with their physician. It is, however, important to keep in mind that there are situations when administering contrast agent is necessary, for example at initial diagnosis.” Still, it’s possible that people with MS may no longer have to worry about gadolinium exposure during routine follow-up care, whether it’s harmful or not, in the near future. And that’s one less worry they’ll have as their condition progresses.
