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MRI with Contrast?
Hi David- I have a query regarding my mom and MRI with contrast wanted to run by you. She is all in all doing well. She is now in what they call partial remission. Her IGG has come down to
- 1301 Reference Range: 600-1540 mg/dL,
- when first diagnosed it was 4789,
- her M Spike is now: 0.6 when first diagnosed it was: 4.5
- and her Kappas Reference Range: 3.3-19.4 mg/L are down to: 60
- when first diagnosed they were: 1043.6
She feels mild pain in her back that oscillates all over her back, so not in one specific place, and in her left shoulder where we know she has a lesion as it came up on a past MRI. The pain comes and goes, but she says it isn’t very strong.
In 2023, right after she was first diagnosed in November 2022, she would get MRI’s every 3 months with contrast as we thought this was the only way to take a look at her lesions, and she was having all sorts of pain etc.
Back then we didn’t know about the potential side effects of gadolinium. We’re unsure if she should get MRI’s without contrast and wait until next year and then get them done with contrast. The reason she would potentially want to get them done now is to monitor these pains she has and to keep an eye on any potential new lesions and to keep an eye on old ones. Also, at the end of the year she has met the deductible with her insurance so we won’t have to pay out of pocket for her to get these now so we figured it would be good for her to get them.
I am questioning if it is ever beneficial to get an MRI with contrast, with the gadolinium? And I believe last time we spoke you said that gadolinium actually enhances/ can make myeloma worse?
Have you heard of Clariscan, as an alternative to gadolinium?
Finally, we have heard that taking a dosage of zinc can help combat the side effects of gadolinium, but I am unsure if this is proven. Have you heard of this? Thank you so much as always David,
What are some typical contrast agents used with MRI imaging?
1. Gadolinium-Based Contrast Agents (GBCAs)
- Gadolinium chelates: The most widely used class of MRI contrast agents. Gadolinium is a paramagnetic metal ion that enhances signal intensity on T1-weighted images.
- Examples: Gadopentetate dimeglumine (Magnevist), Gadobutrol (Gadavist), and Gadoterate meglumine (Dotarem).
- Used for imaging:
- Blood vessels (e.g., MR angiography)
- Brain and spinal cord (to detect tumors, infections, or inflammation)
- Abdominal organs (e.g., liver or kidney lesions)
2. Iron-Based Agents
- Superparamagnetic iron oxide (SPIO) and ultrasmall superparamagnetic iron oxide (USPIO) particles:
- Used for imaging liver, spleen, or lymph nodes.
- SPIO agents reduce signal intensity on T2-weighted images, making certain tissues stand out.
- Example: Ferumoxytol (used off-label in some cases for MR angiography).
3. Manganese-Based Agents
- Example: Mangafodipir trisodium (Teslascan) — rarely used today.
- Initially developed for imaging the liver and pancreas.
4. Hyperpolarized Agents
- Not standard in clinical practice but used in research.
- Enhance signal intensity by increasing the magnetic alignment of nuclei.
5. Perfluorocarbon-Based Agents
- Used experimentally to visualize oxygenation levels in tissues.
6. Non-Contrast Techniques
- Though not a chemical contrast agent, specialized sequences like Time-of-Flight (TOF) and Phase Contrast can enhance imaging without external agents.
Hi Julia-
Great to see your mom posting on Beating Myeloma. I replied to this same issue there and I will link the same two studies that I did on Beating Myeloma for your mom.
My interpretation of gadolinium in light of your question is that there may be alternatives to gad. so there is no reason that I can think of to take gad. potentially spurring MM.
As a MM survivor myself who has undergone a number of MRI’s over the years I wish I knew then what I know now.
I have never heard of Clariscan. Nor have I ever read a study citing zinc to eliminate gad.
Good to read that you mom is doing well. Take care. David Emerson
Gadolinium Containing Contrast Agent Promotes Multiple Myeloma Cell Growth: Implication for Clinical Use of MRI in Myeloma.
“Bone marrow infiltration by myeloma cells and osteolytic bone lesions are the major features of Multiple Myeloma. Magnetic Resonance Imaging (MRI) has been used in MM not only to image bone marrow (BM) and to identify lytic bone disease but to also evaluate therapeutic response and prognosis.
Gadolinium (Gd)-based contrast agents are frequently used to enhance MRI resolution. We evaluated effect of the most common Gd-containing agent, Omniscan, on myeloma cells.
We observed that Omniscan induced both time and dose dependent MM cell growth in vitro (8-20 fold increase relative to control). Importantly, the presence of BMSC enhanced the effect of Omniscan on growth of both MM cell lines and primary MM cells.
However, Omniscan was not able to overcome cytotoxic effects of conventional and novel agents in MM. This growth promoting effects were not observed on normal BM stromal cells. Evaluating the molecular mechanism of action of Omniscan on MM cells, we observed time dependent ERK1/2 phosphorylation as well as reversal of growth promoting effects of Omniscan by specific inhibition of ERK signaling; however, Omniscan had no effect on STAT3 and AKT signaling pathways…”
New contrast agent could make MRIs safer
“Researchers at Massachusetts General Hospital (MGH) have taken a key step forward in developing a new, possibly safer contrast agent for use in magnetic resonance imaging (MRI) exams. Contrast enhanced MRI is a widely used diagnostic tool with over 30 million procedures performed annually. Currently, gadolinium-based contrast agents (GBCAs) are used for this purpose, but recently concerns have been raised about the long-term safety of the gadolinium metal ion…”
MRI with contrast MRI with contrast